Diseases » Conversion Disorder » Causes

Causes of Conversion Disorder

Conversion Disorder Causes: Book Excerpts

• Differential Diagnosis - Fatigue
• Differential Diagnosis - Fatigue
• Medical causes - Fatigue
• Medical causes - Gait, bizarre [Hysterical gait]
• Causes and incidence - Conversion disorder
• Causes - Chronic fatigue syndrome
• Causes and incidence - Somatization disorder
• Causes - Platelet function disorders
• Medical causes - Fatigue
• Medical causes - Gait, bizarre [Hysterical gait]
• Differential Overview - Fatigue
• Differential Overview - Multiple Somatic Complaints
• Causes - Somatization disorder
• Causes - Chronic fatigue and immune dysfunction syndrome
• Medical causes - Fatigue
• Principal Causes of Fatigue - Fatigue
• Medical causes - Fatigue
• Medical causes - Gait, bizarre [Hysterical gait]

Related information on causes of Conversion Disorder:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Conversion Disorder may be found in:

• Hidden causes of Conversion Disorder

Causes of Conversion Disorder: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Conversion Disorder.

Fatigue: Differential Diagnosis
(In a Page: Signs and Symptoms)

• Infectious
  –Acute viral or bacterial infection
  –Chronic infection (e.g., subacute bacterial endocarditis, osteomyelitis, tuberculosis, HIV, viral hepatitis, mononucleosis)

Hematologic
–Anemia
–Thrombotic thrombocytopenic purpura
–Polycythemia vera

Cardiac
–Congestive heart failure
–Congenital heart disease
–Valvular heart disease
–Coronary artery disease

Pulmonary
–COPD
–Obstructive sleep apnea
–Poorly controlled asthma

Endocrine
–Hypothyroidism/hyperthyroidism
–Diabetes, types I and II
–Pregnancy
–Perimenopause
–Addison's disease

Rheumatologic
–Rheumatoid arthritis
–Systemic lupus erythematosus
–Sjögren's syndrome
–Polymyalgia rheumatica

Gastrointestinal
–Inflammatory bowel disease
–Portal hypertension (e.g., cirrhosis)

Acute or chronic renal failure

Neurologic
–Parkinson's disease
–Multiple sclerosis

Psychiatric (e.g., depression, anxiety or panic disorder, anorexia nervosa or bulimia, somatization disorder)

Malignancy

Chronic fatigue syndrome

Fibromyalgia

Tension headache

Primary obesity

Medication side effects (e.g., β-blockers, phenytoin, digitalis, antidepressants, muscle relaxants, hypnotics)

Drug intoxication or withdrawal (e.g., alcohol, opioids, benzodiazepines, barbiturates, cocaine)

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Fatigue: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Inadequate rest
• Excessive exercise
• Insufficient caloric intake
• Depression
• Infectious mononucleosis: Common in adolescence, typically due to EBV or CMV
• Anemia
• Hepatitis
  –Viral (e.g., HAV, HBV, HCV)
  –Consider autoimmune in adolescent girls
• Drugs
  –Antihistamines, anticonvulsants, opiates
• Obesity
  –Rapid fatigue with exertion
  –Somnolence with elevated PaCO₂is termed Pickwickian syndrome
• Tonsillar-adenoidal hypertrophy
  –Impaired air exchange while sleeping
  –Associated with restless sleeping
• Chronic fatigue syndrome
  –Controversial diagnosis
  –Underlying depression is common
• Polycythemia in neonates can be associated with cyanosis and feeding problems
• Encephalitis/meningitis
• Tuberculosis
• Brucellosis: Weight loss, low-grade fever, back pain
• Hypothyroidism
• Adrenocortical insufficiency: Often with hyperpigmentation and weakness
• Hypoglycemia
• Inflammatory bowel disease
• Juvenile rheumatoid arthritis
• Systemic lupus erythematosus
• Intussusception
• Dermatomyositis: Often with muscle weakness and pain
• Congestive heart failure: With tachypnea and dyspnea on exertion
• Pericarditis: Fatigue and dyspnea may precede friction rub
• Renal tubular acidosis
• Uremia
• Myasthenia gravis
• Malignancy

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Fatigue: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Acquired immunodeficiency syndrome (AIDS)

In addition to fatigue, AIDS may cause a fever, night sweats, weight loss, diarrhea, and a cough, followed by several concurrent opportunistic infections.

Adrenocortical insufficiency

Mild fatigue, the hallmark of adrenocortical insufficiency, initially appears after exertion and stress, but later becomes more severe and persistent. Weakness and weight loss typically accompany GI disturbances, such as nausea, vomiting, anorexia, abdominal pain, and chronic diarrhea; hyperpigmentation; orthostatic hypotension; and a weak, irregular pulse.

Anemia

Fatigue following mild activity is commonly the first symptom of anemia. Associated findings vary, but generally include pallor, tachycardia, and dyspnea.

Anxiety

Chronic, unremitting anxiety invariably produces fatigue, typically characterized as nervous exhaustion. Other persistent findings include apprehension, indecisiveness, restlessness, insomnia, trembling, and increased muscle tension.

Cancer

Unexplained fatigue is commonly the earliest sign of cancer. Related findings reflect the type, location, and stage of the tumor and typically include pain, nausea, vomiting, anorexia, weight loss, abnormal bleeding, and a palpable mass.

Chronic fatigue syndrome

Chronic fatigue syndrome, whose cause is unknown, is characterized by incapacitating fatigue. Other findings are a sore throat, myalgia, and cognitive dysfunction. Diagnostic criteria have been determined, but research and data collection continues. These findings may alter the diagnostic criteria.

Chronic obstructive pulmonary disease (COPD)

The earliest and most persistent symptoms of COPD are progressive fatigue and dyspnea. The patient may also experience a chronic and usually productive cough, weight loss, barrel chest, cyanosis, slight dependent edema, and poor exercise tolerance.

Depression

Persistent fatigue unrelated to exertion nearly always accompanies chronic depression. Associated somatic complaints include a headache, anorexia (occasionally, increased appetite), constipation, and sexual dysfunction. The patient may also experience insomnia, slowed speech, agitation or bradykinesia, irritability, loss of concentration, feelings of worthlessness, and persistent thoughts of death.

Diabetes mellitus

Fatigue, the most common symptom in diabetes mellitus, may begin insidiously or abruptly. Related findings include weight loss, blurred vision, polyuria, polydipsia, and polyphagia.

Heart failure

Persistent fatigue and lethargy characterize heart failure. Left-sided heart failure produces exertional and paroxysmal nocturnal dyspnea, orthopnea, and tachycardia. Right-sided heart failure produces jugular vein distention and, possibly, a slight but persistent nonproductive cough. In both types, mental status changes accompany later signs and symptoms, including nausea, anorexia, weight gain and, possibly, oliguria. Cardiopulmonary findings include tachypnea, inspiratory crackles, palpitations and chest tightness, hypotension, a narrowed pulse pressure, a ventricular gallop, pallor, diaphoresis, clubbing, and dependent edema.

Hypercortisolism

Hypercortisolism typically causes fatigue, related in part to accompanying sleep disturbances. Unmistakable signs include truncal obesity with slender extremities, buffalo hump, moon face, purple striae, acne, and hirsutism; increased blood pressure and muscle weakness are other findings.

Hypothyroidism

Fatigue occurs early in hypothyroidism, along with forgetfulness, cold intolerance, weight gain, metrorrhagia, and constipation.

Infection.

With chronic infection, fatigue is commonly the most prominent symptom — and sometimes the only one. A low-grade fever and weight loss may accompany signs and symptoms that reflect the type and location of infection, such as burning upon urination or swollen, painful gums. Subacute bacterial endocarditis is an example of a chronic infection that causes fatigue and acute hemodynamic decompensation

With acute infection, brief fatigue typically accompanies a headache, anorexia, arthralgia, chills, a high fever, and such infection-specific signs as a cough, vomiting, or diarrhea.

Lyme disease

In addition to fatigue and malaise, signs and symptoms of Lyme disease include an intermittent headache, a fever, chills, an expanding red rash, and muscle and joint aches. In later stages, patients may suffer arthritis, fluctuating meningoencephalitis, and cardiac abnormalities, such as a brief, fluctuating atrioventricular heart block

Malnutrition

Easy fatigability is common in patients with protein-calorie malnutrition, along with lethargy and apathy. Patients may also exhibit weight loss, muscle wasting, sensations of coldness, pallor, edema, and dry, flaky skin

Myasthenia gravis

The cardinal symptoms of myasthenia gravis are easy fatigability and muscle weakness, which worsen as the day progresses. They also worsen with exertion and abate with rest. Related findings depend on the specific muscles affected

Renal failure

Acute renal failurecommonly causes sudden fatigue, drowsiness, and lethargy. Oliguria, an early sign, is followed by severe systemic effects: an ammonia breath odor, nausea, vomiting, diarrhea or constipation, and dry skin and mucous membranes. Neurologic findings include muscle twitching and changes in the patient’s personality and level of consciousness, possibly progressing to seizures and coma.

With chronic renal failure, insidious fatigue and lethargy occur with marked changes in all body systems, including GI disturbances, an ammonia breath odor, Kussmaul’s respirations, bleeding tendencies, poor skin turgor, severe pruritus, paresthesia, visual disturbances, confusion, seizures, and coma.

Systemic lupus erythematosus

Fatigue usually occurs along with generalized aching, malaise, a low-grade fever, a headache, and irritability. Primary signs and symptoms include joint pain and stiffness, a butterfly rash, and photosensitivity. Also common are Raynaud’s phenomenon, patchy alopecia, and mucous membrane ulcers.

Valvular heart disease.

All types of valvular heart disease commonly produce progressive fatigue and a cardiac murmur. Additional signs and symptoms vary, but generally include exertional dyspnea, a cough, and hemoptysis

Other causes

Carbon monoxide poisoning

Fatigue occurs along with a headache, dyspnea, and confusion and can eventually progress to unconsciousness and apnea.

Drugs

Fatigue may result from various drugs, notably antihypertensives and sedatives. In those receiving cardiac glycoside therapy, fatigue may indicate toxicity.

Surgery

Most types of surgery cause temporary fatigue, probably due to the combined effects of hunger, anesthesia, and sleep deprivation.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Gait, bizarre [Hysterical gait]: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Conversion disorder

Conversion disorder is a  rare somatoform disorder, in which a bizarre gait or paralysis may develop after severe stress and isn’t accompanied by other symptoms. The patient typically shows indifference toward his impairment.

Malingering

Malingering is a rare cause of bizarre gait, in which the patient may also complain of a headache and chest and back pain.

Somatization disorder

Bizarre gait is one of many possible somatic complaints. The patient may exhibit any combination of pseudoneurologic signs and symptoms — fainting, weakness, memory loss, dysphagia, visual problems (diplopia, vision loss, blurred vision), loss of voice, seizures, and bladder dysfunction. He may also report pain in the back, joints, and extremities (most commonly the legs) and complaints in almost any body system. For example, characteristic GI complaints include pain, bloating, nausea, and vomiting.

The patient’s reflexes and motor strength remain normal, but peculiar contractures and arm or leg rigidity may occur. His reputed sensory loss doesn’t conform to a known sensory dermatome. In some cases, he won’t stand or walk (astasia/abasia), remaining bedridden although still able to move his legs in bed.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Conversion disorder: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

The patient suddenly develops the conversion symptom soon after experiencing a traumatic conflict that he believes he can’t handle. Two theories may explain why this occurs. According to the first, the patient achieves a “primary gain” when the symptom keeps a psychological conflict out of conscious awareness. For example, a person may experience blindness after witnessing a violent crime.

The second theory suggests that the patient achieves “secondary gain” from the symptom by avoiding a traumatic activity. For example, a soldier may develop a “paralyzed” hand that prevents him from entering into combat.

Conversion disorder can occur in either sex at any age. An uncommon disorder, it usually begins in adolescence or early adulthood.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Chronic fatigue syndrome: Causes
(Professional Guide to Diseases (Eighth Edition))

The cause of chronic fatigue syndrome (CFS) is unknown, but researchers suspect that it may be found in human herpes virus-6 or in other herpesviruses, enteroviruses, or retroviruses. Recent studies have shown that inflammation of nervous system pathways, acting as an immune or autoimmune response, may play a role as well. CFS may also be associated with a reaction to viral illness that’s complicated by dysfunctional immune response and by other factors that may include gender, age, genetic disposition, prior illness, stress, and environment.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Somatization disorder: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Genetic and environmental factors contribute to the development of somatization disorder. It usually develops before age 30 and is more common in females than in males.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Platelet function disorders: Causes
(Professional Guide to Diseases (Eighth Edition))

Abnormal platelet function disorders may be inherited (autosomal recessive) or acquired. Inherited disorders cause bone marrow production of platelets that are ineffective in the clotting mechanism. Acquired disorders result from the effects of such drugs as aspirin or carbenicillin; from such systemic diseases as uremia; or from other hematologic disorders.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Fatigue: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Acquired immunodeficiency syndrome

Besides fatigue, this syndrome may cause fever, night sweats, weight loss, diarrhea, and a cough, followed by several concurrent opportunistic infections.

Adrenocortical insufficiency

Mild fatigue, the hallmark of this disorder, initially appears after exertion and stress but later becomes more severe and persistent. Weakness and weight loss typically accompany GI disturbances, such as nausea, vomiting, anorexia, abdominal pain, and chronic diarrhea; hyperpigmentation; orthostatic hypotension; and a weak, irregular pulse.

Anemia

Fatigue after mild activity is commonly the first symptom of anemia. Associated findings vary but generally include pallor, tachycardia, and dyspnea.

Anxiety

Chronic, unremitting anxiety invariably produces fatigue, often characterized as nervous exhaustion. Other persistent findings include apprehension, indecisiveness, restlessness, insomnia, trembling, and increased muscle tension.

Cancer

Unexplained fatigue is commonly the earliest sign of cancer. Related findings reflect the type, location, and stage of the tumor and typically include pain, nausea, vomiting, anorexia, weight loss, abnormal bleeding, and a palpable mass.

Chronic fatigue syndrome

This syndrome, whose cause is unknown, is characterized by incapacitating fatigue. Other findings are sore throat, myalgia, and cognitive dysfunction.

Chronic obstructive pulmonary disease

The earliest and most persistent symptoms of this disease are progressive fatigue and dyspnea. The patient may also experience a chronic and usually productive cough, weight loss, barrel chest, cyanosis, slight dependent edema, and poor exercise tolerance.

Cirrhosis

Severe fatigue typically occurs late in this disorder, accompanied by weight loss, bleeding tendencies, jaundice, hepatomegaly, ascites, dependent edema, severe pruritus, and decreased level of consciousness.

Cushing’s syndrome (hypercortisolism)

This disorder typically causes fatigue, related in part to accompanying sleep disturbances. Cardinal signs include truncal obesity with slender extremities, buffalo hump, moon face, purple striae, acne, and hirsutism; increased blood pressure and muscle weakness may also occur.

Depression

Persistent fatigue unrelated to exertion nearly always accompanies chronic depression. Associated somatic complaints include headache, anorexia (occasionally, increased appetite), constipation, and sexual dysfunction. The patient may also experience insomnia, slowed speech, agitation or bradykinesia, irritability, loss of concentration, feelings of worthlessness, and persistent thoughts of death.

Diabetes mellitus

Fatigue, the most common symptom of this disorder, may begin insidiously or abruptly. Related findings include weight loss, blurred vision, polyuria, polydipsia, and polyphagia.

Heart failure

Persistent fatigue and lethargy characterize this disorder. Left-sided heart failure produces exertional and paroxysmal nocturnal dyspnea, orthopnea, and tachycardia. Right-sided heart failure produces jugular vein distention and possibly a slight but persistent nonproductive cough. In both types, later signs and symptoms include mental status changes, nausea, anorexia, weight gain and, possibly, oliguria. Cardiopulmonary findings include tachypnea, inspiratory crackles, palpitations and chest tightness, hypotension, narrowed pulse pressure, ventricular gallop, pallor, diaphoresis, clubbing, and dependent edema.

Hypopituitarism

Fatigue, lethargy, and weakness usually develop slowly. Other insidious effects may include irritability, anorexia, amenorrhea or impotence, decreased libido, hypotension, dizziness, headache, visual disturbances, and cold intolerance.

Hypothyroidism

Fatigue occurs early in this disorder along with forgetfulness, cold intolerance, weight gain, metrorrhagia, and constipation.

Infection

Fatigue is commonly the most prominent symptom—and sometimes the only one—in a chronic infection. Low-grade fever and weight loss may accompany signs and symptoms that reflect the type and location of the infection, such as burning on urination or swollen, painful gums. Subacute bacterial endocarditis is an example of a chronic infection that causes fatigue and acute hemodynamic decompensation.

In an acute infection, brief fatigue typically accompanies headache, anorexia, arthralgia, chills, high fever, and such infection-specific signs as a cough, vomiting, or diarrhea.

Lyme disease

Besides fatigue and malaise, signs and symptoms of this tick-borne disease include intermittent headache, fever, chills, an expanding red rash, and muscle and joint aches. Later, patients may develop arthritis, fluctuating meningoencephalitis, and cardiac abnormalities, such as a brief, fluctuating atrioventricular heart block.

Malnutrition

Easy fatigability, lethargy, and apathy are common findings in patients with protein-calorie malnutrition. Patients may also exhibit weight loss, muscle wasting, sensations of coldness, pallor, edema, and dry, flaky skin.

Myasthenia gravis

The cardinal symptoms of this disorder are easy fatigability and muscle weakness, which worsen as the day progresses. They also worsen with exertion and abate with rest. Related findings depend on the specific muscles affected.

Myocardial infarction

Fatigue can be severe but is typically overshadowed by chest pain. Related findings include dyspnea, anxiety, pallor, cold sweats, increased or decreased blood pressure, and abnormal heart sounds.

Narcolepsy

One or more of the following characterizes this disorder: hypersomnia, hypnagogic hallucinations, cataplexy, sleep paralysis, and insomnia. Fatigue is a common symptom as well.

Renal failure

Acute renal failure commonly causes sudden fatigue, drowsiness, and lethargy. Oliguria, an early sign, is followed by severe systemic effects: ammonia breath odor, nausea, vomiting, diarrhea or constipation, and dry skin and mucous membranes. Neurologic findings include muscle twitching, personality changes, and altered level of consciousness, which may progress to seizures and coma.

Chronic renal failure produces insidious fatigue and lethargy along with marked changes in all body systems, including GI disturbances, ammonia breath odor, Kussmaul’s respirations, bleeding tendencies, poor skin turgor, severe pruritus, paresthesia, visual disturbances, confusion, seizures, and coma.

Restrictive lung disease

Chronic fatigue may accompany the characteristic signs and symptoms: dyspnea, cough, and rapid, shallow respirations. Cyanosis first appears with exertion; later, even at rest.

Rheumatoid arthritis

Fatigue, weakness, and anorexia precede localized articular findings: joint pain, tenderness, warmth, and swelling along with morning stiffness.

Systemic lupus erythematosus

Fatigue usually occurs along with generalized aching, malaise, low-grade fever, headache, and irritability. Primary signs and symptoms include joint pain and stiffness, butterfly rash, and photosensitivity. Also common are Raynaud’s phenomenon, patchy alopecia, and mucous membrane ulcers.

Thyrotoxicosis

In this disorder, fatigue may accompany characteristic signs and symptoms, including an enlarged thyroid, tachycardia and palpitations, tremors, weight loss despite increased appetite, diarrhea, dyspnea, nervousness, diaphoresis, heat intolerance, amenorrhea and, possibly, exophthalmos.

Valvular heart disease

All types of valvular heart disease commonly produce progressive fatigue and a cardiac murmur. Additional signs and symptoms vary but generally include exertional dyspnea, cough, and hemoptysis.

Other causes

Carbon monoxide poisoning

Fatigue occurs along with headache, dyspnea, and confusion; apnea and unconsciousness may occur eventually.

Drugs

Fatigue may result from various drugs, notably antihypertensives and sedatives. In those receiving cardiac glycoside therapy, fatigue may indicate toxicity.

Surgery

Most types of surgery cause temporary fatigue, probably from the combined effects of hunger, anesthesia, and sleep deprivation.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Gait, bizarre [Hysterical gait]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Conversion disorder

In this rare somatoform disorder, a bizarre gait or paralysis may develop after severe stress and is not accompanied by other symptoms. The patient typically shows indifference toward his impairment.

Malingering

In this rare cause of bizarre gait, the patient may also complain of headache and chest and back pain.

Somatization disorder

Bizarre gait is one of many possible somatic complaints. The patient may exhibit any combination of pseudoneurologic signs and symptoms—fainting, weakness, memory loss, dysphagia, visual problems (diplopia, vision loss, blurred vision), loss of voice, seizures, and bladder dysfunction. He may also report pain in the back, joints, and extremities (most commonly the legs) and complaints in almost any body system. For example, characteristic GI complaints include pain, bloating, nausea, and vomiting.

The patient’s reflexes and motor strength remain normal, but he may exhibit peculiar contractures and arm or leg rigidity. His reputed sensory loss doesn’t conform to any known sensory dermatome. He may claim that he can’t stand (astasia) or walk (abasia), remaining bedridden although still able to move his legs in bed.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Fatigue: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Infectious mononucleosis

❑ Depression

❑ Diabetes

❑ Hypothyroidism

❑ Drugs

❑ Chronic sleep deprivation

❑ Congestive heart failure

❑ Occult infection

❑ Iron deficiency anemia

❑ Obstructive sleep apnea

❑ Renal failure

❑ Chronic fatigue syndrome

❑ Cushing syndrome

❑ Occult cancer

❑ Addison disease

❑ Myasthenia gravis

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Multiple Somatic Complaints: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Anxiety

❑ Depression

❑ Hypothyroidism

❑ Premenstrual syndrome

❑ Hypochondriasis

❑ Somatization disorder

❑ Chronic fatigue syndrome

❑ Fibromyalgia

❑ Panic disorder

❑ Malingering

❑ Conversion reaction

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Somatization disorder: Causes
(Handbook of Diseases)

Both genetic and environmental factors contribute to the development of somatization disorder.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Chronic fatigue and immune dysfunction syndrome: Causes
(Handbook of Diseases)

Although the cause of CFIDS is unknown, researchers suspect that it may be found in human herpesvirus 6 or in other herpesviruses, enteroviruses, or retroviruses. Rising levels of antibodies to EBV, once thought to implicate EBV infection as the cause of CFIDS, are now considered a result of this disease.

CFIDS may be associated with a reaction to viral illness that’s complicated by dysfunctional immune response and by other factors that may include sex, age, genetic disposition, prior illness, stress, and environment.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Fatigue: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Acquired immunodeficiency syndrome

In addition to fatigue, acquired immunodeficiency syndrome (AIDS) may cause fever, night sweats, weight loss, diarrhea, and a cough, followed by several concurrent opportunistic infections. The patient may also show signs of malnutrition.

Adrenocortical insufficiency

Mild fatigue, the hallmark of adrenocortical insufficiency, initially appears after exertion and stress but later becomes more severe and persistent. Weakness and weight loss typically accompany GI disturbances, such as nausea, vomiting, anorexia, abdominal pain, and chronic diarrhea; hyperpigmentation; orthostatic hypotension; and a weak, irregular pulse.

Anemia

Fatigue following mild activity is commonly the first symptom of anemia. Associated findings vary but generally include listlessness, irritability, inability to concentrate, pallor, tachycardia, and dyspnea.

CULTURAL CUE:To detect anemia-related pallor in the dark-skinned patient, assess his oral mucosa.

Anxiety

Chronic, unremitting anxiety invariably produces fatigue, commonly characterized as nervous exhaustion. Other persistent findings include apprehension, indecisiveness, restlessness, insomnia, trembling, and increased muscle tension.

Cancer

Unexplained fatigue is commonly the earliest sign of cancer. Related findings reflect the type, location, and stage of the tumor and typically include pain, nausea, vomiting, anorexia, weight loss, abnormal bleeding, and a palpable mass.

Chronic fatigue syndrome

Chronic fatigue syndrome, the cause of which is unknown, is characterized by incapacitating fatigue. Other findings are sore throat, myalgia, low-grade fever, painful lymph nodes, sleep disturbances, and cognitive dysfunction.

Chronic obstructive pulmonary disease

The earliest and most persistent symptoms of chronic obstructive pulmonary disease (COPD) are progressive fatigue and dyspnea. The patient may also experience a chronic and usually productive cough, weight loss, barrel chest, cyanosis, slight dependent edema, and poor exercise tolerance.

Cirrhosis

Severe fatigue typically occurs late in cirrhosis, accompanied by weight loss, bleeding tendencies, jaundice, hepatomegaly, ascites, dependent edema, severe pruritus, and decreased level of consciousness (LOC).

Depression

Persistent fatigue unrelated to exertion nearly always accompanies chronic depression. Associated somatic complaints include headache, anorexia (occasionally, increased appetite), constipation, and sexual dysfunction. The patient may also experience insomnia, slowed speech, agitation or bradykinesia, irritability, loss of concentration, feelings of worthlessness, and persistent thoughts of death.

Diabetes mellitus

Fatigue, the most common symptom in diabetes mellitus, may begin insidiously or abruptly. Related findings include weight loss, blurred vision, polyuria, polydipsia, and polyphagia.

Heart failure

Persistent fatigue and lethargy characterize heart failure. Left-sided heart failure produces exertional and paroxysmal nocturnal dyspnea, orthopnea, and tachycardia. Right-sided heart failure produces jugular vein distention and possibly a slight but persistent nonproductive cough. In both types, mental status changes accompany later signs and symptoms, including nausea, anorexia, weight gain and, possibly, oliguria. Cardiopulmonary findings include tachypnea, inspiratory crackles, palpitations and chest tightness, hypotension, narrowed pulse pressure, ventricular gallop, pallor, diaphoresis, clubbing, and dependent edema.

Hypercortisolism

Hypercortisolism typically causes fatigue, related in part to accompanying sleep disturbances. Unmistakable signs include truncal obesity with slender extremities, buffalo hump, moon face, purple striae, acne, and hirsutism; increased blood pressure and muscle weakness are other findings.

Hypopituitarism

With hypopituitarism, fatigue, lethargy, and weakness usually develop slowly. Other insidious effects may include irritability, anorexia, amenorrhea or impotence, decreased libido, hypotension, dizziness, headache, visual disturbances, and cold intolerance.

Hypothyroidism

Fatigue occurs early in hypothyroidism, along with forgetfulness, cold intolerance, weight gain, metrorrhagia, and constipation. Related findings include coarse hair and alopecia; anorexia; edema; dry, flaky skin; and thinning nails.

Infection

With chronic infection (such as acute bacterial endocarditis), fatigue is commonly the most prominent symptom — and sometimes the only one. Low-grade fever and weight loss may accompany signs and symptoms that reflect the type and location of infection, such as burning upon urination or swollen, painful gums.

With acute infection, brief fatigue typically accompanies headache, anorexia, arthralgia, chills, high fever, and such infection-specific signs as cough, vomiting, or diarrhea.

Lyme disease

Besides fatigue and malaise, signs and symptoms of Lyme disease include intermittent headache, fever, chills, expanding red rash, and muscle and joint aches. In later stages of this tick-borne disease, patients may suffer arthritis, fluctuating meningoencephalitis, and cardiac abnormalities, such as a brief, fluctuating atrioventricular heart block.

Malnutrition

Easy fatigability is common in patients with protein-calorie malnutrition, along with lethargy and apathy. Patients may also exhibit weight loss, muscle wasting, sensations of coldness, pallor, edema, and dry, flaky skin.

Myasthenia gravis

The cardinal symptoms of myasthenia gravis are easy fatigability and muscle weakness, which worsen as the day progresses. They also worsen with exertion and abate with rest. Related findings depend on the specific muscles affected.

Myocardial infarction

With myocardial infarction (MI), fatigue can be severe but is typically overshadowed by chest pain. Related findings include dyspnea, anxiety, pallor, cold sweats, increased or decreased blood pressure, and abnormal heart sounds.

Narcolepsy

One or more of the following characterizes narcolepsy: hypersomnia, hypnagogic hallucinations, cataplexy, sleep paralysis, and insomnia. Fatigue is a common symptom as well.

Renal failure

Acute renal failure commonly causes sudden fatigue, drowsiness, and lethargy. Oliguria, an early sign, is followed by severe systemic effects: ammonia breath odor, nausea, vomiting, diarrhea or constipation, and dry skin and mucous membranes. Neurologic findings include muscle twitching and changes in personality and LOC, possibly progressing to seizures and coma.

With chronic renal failure, insidious fatigue and lethargy occur with marked changes in all body systems, including GI disturbances, ammonia breath odor, Kussmaul’s respirations, bleeding tendencies, poor skin turgor, severe pruritus, paresthesia, visual disturbances, confusion, seizures, and coma.

Restrictive lung disease

Chronic fatigue may accompany the characteristic signs and symptoms of restrictive lung disease: dyspnea, cough, and rapid, shallow respirations. Cyanosis first appears with exertion; later, even at rest.

Rheumatoid arthritis

With rheumatoid arthritis, fatigue, weakness, and anorexia precede localized articular findings: joint pain, tenderness, warmth, and swelling along with morning stiffness. Assessment findings may include enlarged lymph nodes, fever, leukopenia, anemia, subcutaneous nodules, pericarditis, and Raynaud’s phenomenon.

Systemic lupus erythematosus

Fatigue usually occurs in patients with systemic lupus erythematosus (SLE), along with generalized aching, malaise, low-grade fever, headache, and irritability. Primary signs and symptoms include joint pain and stiffness, butterfly rash, and photosensitivity. Also common are Raynaud’s phenomenon, patchy alopecia, and mucous membrane ulcers.

Thyrotoxicosis

With thyrotoxicosis, fatigue may occur with characteristic signs and symptoms, including an enlarged thyroid, tachycardia and palpitations, tremors, weight loss despite increased appetite, diarrhea, dyspnea, nervousness, diaphoresis, heat intolerance, amenorrhea and, possibly, exophthalmos.

Valvular heart disease

All types of valvular heart disease commonly produce progressive fatigue and a cardiac murmur. Additional signs and symptoms vary but generally include exertional dyspnea, cough, and hemoptysis.

Other causes

Carbon monoxide poisoning

With carbon monoxide poisoning, fatigue occurs along with headache, dyspnea, and confusion, and can eventually progress to unconsciousness and apnea.

Drugs

Fatigue may result from various drugs, notably antihypertensives and sedatives. In persons receiving cardiac glycoside therapy, fatigue may indicate toxicity.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Fatigue: Principal Causes of Fatigue
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

1. Physiologiccauses
2. Pathologic causes
   1. Anemia
   2. Infection
   3. Chronic disease
   4. Allergic disease
   5. Chronic fatigue syndrome
   6. Drugs
   7. Psychologic

» READ BOOK EXCERPT ONLINE »

Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

Fatigue: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Acquired immunodeficiency syndrome (AIDS).In addition to fatigue, AIDS may cause a fever, night sweats, weight loss, diarrhea, and a cough, followed by several concurrent opportunistic infections.

Adrenocortical insufficiency.Mild fatigue, the hallmark of adrenocortical insufficiency, initially appears after exertion and stress, but later becomes more severe and persistent. Weakness and weight loss typically accompany GI disturbances, such as nausea, vomiting, anorexia, abdominal pain, and chronic diarrhea; hyperpigmentation; orthostatic hypotension; and a weak, irregular pulse.

Anemia.Fatigue following mild activity is commonly the first symptom of anemia. Associated findings vary, but generally include pallor, tachycardia, and dyspnea.

Anxiety.Chronic, unremitting anxiety invariably produces fatigue, typically characterized as nervous exhaustion. Other persistent findings include apprehension, indecisiveness, restlessness, insomnia, trembling, and increased muscle tension.

Cancer.Unexplained fatigue is commonly the earliest sign of cancer. Related findings reflect the type, location, and stage of the tumor and typically include pain, nausea, vomiting, anorexia, weight loss, abnormal bleeding, and a palpable mass.

Chronic fatigue syndrome.Chronic fatigue syndrome, whose cause is unknown, is characterized by incapacitating fatigue. Other findings are a sore throat, myalgia, and cognitive dysfunction. Diagnostic criteria have been determined, but research and data collection continue. These findings may alter the diagnostic criteria.

Chronic obstructive pulmonary disease (COPD).The earliest and most persistent symptoms of COPD are progressive fatigue and dyspnea. The patient may also experience a chronic and usually productive cough, weight loss, barrel chest, cyanosis, slight dependent edema, and poor exercise tolerance.

Depression.Persistent fatigue unrelated to exertion nearly always accompanies chronic depression. Associated somatic complaints include a headache, anorexia (occasionally, increased appetite), constipation, and sexual dysfunction. The patient may also experience insomnia, slowed speech, agitation or bradykinesia, irritability, loss of concentration, feelings of worthlessness, and persistent thoughts of death.

Diabetes mellitus.Fatigue, the most common symptom in diabetes mellitus, may begin insidiously or abruptly. Related findings include weight loss, blurred vision, polyuria, polydipsia, and polyphagia.

Heart failure.Persistent fatigue and lethargy characterize heart failure. Left-sided heart failure produces exertional and paroxysmal nocturnal dyspnea, orthopnea, and tachycardia. Right-sided heart failure produces jugular vein distention and, possibly, a slight but persistent nonproductive cough. In both types, mental status changes accompany later signs and symptoms, including nausea, anorexia, weight gain and, possibly, oliguria. Cardiopulmonary findings include tachypnea, inspiratory crackles, palpitations and chest tightness, hypotension, a narrowed pulse pressure, a ventricular gallop, pallor, diaphoresis, clubbing, and dependent edema.

Hypercortisolism.Hypercortisolism typically causes fatigue, related in part to accompanying sleep disturbances. Unmistakable signs include truncal obesity with slender extremities, buffalo hump, moon face, purple striae, acne, and hirsutism; increased blood pressure and muscle weakness are other findings.

Hypothyroidism.Fatigue occurs early in hypothyroidism, along with forgetfulness, cold intolerance, weight gain, metrorrhagia, and constipation.

Infection.With chronic infection, fatigue is commonly the most prominent symptom—and sometimes the only one. A low-grade fever and weight loss may accompany signs and symptoms that reflect the type and location of infection, such as burning upon urination or swollen, painful gums. Subacute bacterial endocarditis is an example of a chronic infection that causes fatigue and acute hemodynamic decompensation.

With acute infection, brief fatigue typically accompanies a headache, anorexia, arthralgia, chills, a high fever, and such infection-specific signs as a cough, vomiting, or diarrhea.

Lyme disease.In addition to fatigue and malaise, signs and symptoms of Lyme disease include an intermittent headache, a fever, chills, an expanding red rash, and muscle and joint aches. In later stages, patients may suffer arthritis, fluctuating meningoencephalitis, and cardiac abnormalities, such as a brief, fluctuating atrioventricular heart block.

Malnutrition.Easy fatigability is common in patients with protein-calorie malnutrition, along with lethargy and apathy. Patients may also exhibit weight loss, muscle wasting, sensations of coldness, pallor, edema, and dry, flaky skin.

Myasthenia gravis.The cardinal symptoms of myasthenia gravis are easy fatigability and muscle weakness, which worsen as the day progresses. They also worsen with exertion and abate with rest. Related findings depend on the specific muscles affected. (See Managing the patient with myasthenia gravis.)

Renal failure.Acute renal failure commonly causes sudden fatigue, drowsiness, and lethargy. Oliguria, an early sign, is followed by severe systemic effects: an ammonia breath odor, nausea, vomiting, diarrhea or constipation, and dry skin and mucous membranes. Neurologic findings include muscle twitching and changes in the patient's personality and level of consciousness, possibly progressing to seizures and coma.

With chronic renal failure, insidious fatigue and lethargy occur with marked changes in all body systems, including GI disturbances, an ammonia breath odor, Kussmaul's respirations, bleeding tendencies, poor skin turgor, severe pruritus, paresthesia, vision disturbances, confusion, seizures, and coma.

Systemic lupus erythematosus (SLE).Fatigue usually occurs with SLE along with generalized aching, malaise, a low-grade fever, a headache, and irritability. Primary signs and symptoms include joint pain and stiffness, a butterfly rash, and photosensitivity. Also common are Raynaud's phenomenon, patchy alopecia, and mucous membrane ulcers.

Valvular heart disease.All types of valvular heart disease commonly produce progressive fatigue and a cardiac murmur. Additional signs and symptoms vary, but generally include exertional dyspnea, a cough, and hemoptysis.

Other causes

Carbon monoxide poisoning.Fatigue occurs with carbon monoxide poisoning along with a headache, dyspnea, and confusion and can eventually progress to unconsciousness and apnea.

Drugs.Fatigue may result from various drugs, notably antihypertensives and sedatives. In those receiving cardiac glycoside therapy, fatigue may indicate toxicity.

Surgery.Most types of surgery cause temporary fatigue, probably due to the combined effects of hunger, anesthesia, and sleep deprivation.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Gait, bizarre [Hysterical gait]: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Conversion disorder.Conversion disorder is a rare somatoform disorder in which a bizarre gait or paralysis may develop after severe stress and isn't accompanied by other symptoms. The patient typically shows indifference toward his impairment.

Malingering.Malingering is a rare cause of bizarre gait, in which the patient may also complain of a headache and chest and back pain.

Somatization disorder.Bizarre gait is one of many possible somatic complaints. The patient may exhibit any combination of pseudoneurologic signs and symptoms—fainting, weakness, memory loss, dysphagia, vision problems (diplopia, vision loss, blurred vision), loss of voice, seizures, and bladder dysfunction. He may also report pain in the back, joints, and extremities (most commonly the legs) and complaints in almost any body system. For example, characteristic GI complaints include pain, bloating, nausea, and vomiting.

The patient's reflexes and motor strength remain normal, but peculiar contractures and arm or leg rigidity may occur. His reputed sensory loss doesn't conform to a known sensory dermatome. In some cases, he won't stand or walk (astasia or abasia), remaining bedridden although still able to move his legs in bed.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

 » Next page: Symptoms of Conversion Disorder

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