Abstract: Medically unexplained symptoms and neuropsychological assessment

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J Clin Exp Neuropsychol. 2004 May;26(3):369-92. Binder LM, Campbell KA. Oregon Health and Sciences University Portland OR USA.

Several illnesses expressed somatically that do not have clearly demonstrated pathophysiological origin and that are associated with neuropsychological complaints are reviewed. Among them are nonepileptic seizures, fibromyalgia, chronic fatigue syndrome, Persian Gulf War unexplained illnesses, toxic mold and sick building syndrome, and silicone breast implant disease.

Some of these illnesses may be associated with objective cognitive abnormalities, but it is not likely that these abnormalities are caused by traditionally defined neurological disease. Instead, the cognitive abnormalities may be caused by a complex interaction between biological and psychological factors. Nonepileptic seizures serve as an excellent model of medically unexplained symptoms. Although nonepileptic seizures clearly are associated with objective cognitive abnormalities, they are not of neurological origin.

There is evidence that severe stressors and PTSD are associated with immune system problems, neurochemical changes, and various diseases; these data blur the distinctions between psychological and organic etiologies. Diagnostic problems are intensified by the fact that many patients are poor historians. Patients are prone to omit history of severe stressors and psychiatric problems, and the inability to talk about stressors increases the likelihood of suffering from physiological forms of stress. PMID: 15512927 [PubMed – in process]

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One thought on “Abstract: Medically unexplained symptoms and neuropsychological assessment”

  1. SerenaEdwards says:

    This kind of hypothesis presented as good science is irresponsible at the least. What is the logic that takes us from objectively identified neurological dysfunction to PTSD as an explanation? PTSD, is not a medical disease, and so is far less medically explained than the neurological dysfunction it proposes to explain.

    I rate it a psychological shot in the dark, at best. For one thing, it does not (because it cannot) explain the many cases with no prior history of trauma. Instead, it attempts to retrofit an entire spectrum of physical illnesses into conveniently pre-existing neuro-psychological theories and tests. On the other side of the coin, medical research into these illnesses is progressing very rapidly, with each year bringing us new objective data and medical testing – and none of it is fundamentally associated with PTSD.

    Frankly, my take on this is that the idea is a general attempt to wrongly extend the practice of neuropsychology into the medical arena. This has a generally negative impact on patients, who are already so often abused at the hands of private disability insurers (who love neuropsych testing as a means of dropping claims on psychological exemptions), and the Social Security Administration, which already has a dreadful track record in serving the CFS populations. Most patients are not made aware that when subjected to the MMPI-2, they may also be subjected without warning to the highly prejudicial built-in “Fake Bad Scale”, which is designed from the bottom up to accuse CFS patients of somatization problems, rather than properly treating the physical illness they suffer.

    I feel this type of “research” does us all a terrible disservice, and those who promote it are nowhere to be found when the patient is suffering physically and cannot obtain proper medical care because benefits have been cut out from under them. PTSD was a handy theory during the decades when the government refused to admit the damage done by Agent Orange. I think the time has long passed to put this one back in the box.

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