10/11 Somatic Symptom Disorders - Tamburello

Question 1

somatization

Answer 1

behavior related to bodily sensations (real or imagined)

• “production of multiple, recurrent medical symptoms with no organic cause”

can be adaptive and maladaptive

Question 2

privileges and responsibilities of sick role

Answer 2

sick/not sick determination is made by healthcare professional

‘privileges’ of sick role

• time off from work/school
• accomodations
• attn
• relief from accountability
• money/disability

responsibilities of sick role

• do what it takes to leave that role ASAP

Question 3

illness behavior matrix

Answer 3

Question 4

somatic symptom disorder

dx

prevalence

Answer 4

one or more somatic symptoms with…

• disproportionate/persistent thoughts re: seriousness
• high level of anxiety about health/symptoms
• excessive time/energy devoted

symptoms lasting 6mo+

specifier: predominant pain

prevalence: 5-7%, more common in women, any age, higher prev in primary care setting

approx 75% of cases that would formerly have been attributed to hypochondriasis → SSD

Question 5

somatic symptom disorder theory

Answer 5

1. somatic amplification

• low threshold for unpleasant body sensations
• misinterpretation of body sensations

2. alexithymia : inability to read one’s emotions → misinterp of feelings as pain

3. cultural expression of mood/anxiety

Question 6

somatic symptom disorder risks

Answer 6

• unnecessary tests → false positives
• medications → side effects
• procedures/surgery → complications

Question 7

illness anxiety disorder

Answer 7

preoccupation/anxiety about illness

• somatic sx are either absent or mild
• excessive health-related behaviors/avoidance

approx 25% of cases that would formerly have been attributed to hypochondriasis → IAD

Question 8

conversion disorder

Answer 8

functional neurological symptom disorder

• neuro sx incompatible with recognized conditions

seen in 5% of referrals to neuro clinics

• often transient; may be associated with stress or trauma
• caused by psych factors
• usually no obvious external benefit (as expected in malingering)

basically a display of neurological signs (ex. pseudoseizure) without actual seizure etiology (abnormal EEG)

specify: acute or persistent (>6mo)

Question 9

psych factors affecting other medical conditions

Answer 9

emotional/behavioral issues that negatively impact a medical condition and…

• influence course of illness
• interfere with tx
• add risk factor
• influence underlying pathophys

ex. stress, poor coping, noncompliance, denial

Question 10

factitious disorder

Answer 10

aka Munchausen’s syndrome

dx:

• intentional or false presentation of self as ill, impaired, or injured
• persists despite lack of “obvious exernal reward”
• not psychotic, just want ‘sick privileges’

high morbidity/mortality from self-harm and medical complications

Question 11

factitious disorder imposed on another

Answer 11

Munchausen by proxy

• illness is induced in someone else (usually in a child by a parent)

in these cases, PARENT gets the dxmany have health care background or personality disorder

goal: be caregiver for a sick child

CHILD ABUSE! get the kid out of the home

Question 12

management of somatic symptom disorders

Answer 12

diagnoses of EXCLUSION

educate the patient:

• whether or not they are suffering is not in question
• not “in their head”
• should be a unifying diagnosis
• goal of tx: function, not cure

strategy:

• pick a person to run point (usually PCP)
• regularly scheduled visits (not acute/urgent)
• focused eval of new sx
• address psych comorbidities
• internal/external reinforcers (individ/group, physical, occupational/vocational therapy)

Question 13

malingering

Answer 13

knowlingly simulating an illness for external benefit

• common in antisocial personality disorder, legal situations

may have somatic or psychological sx

• NOT harmless → higher rate of eventual completed suicide in ER cases of deliberate self harm

NOT A PSYCH DISORDER but can be a focus of clinical concern

• existence of true illness doesnt exclude malingering or vice versa

Question 14

detecting malingering

Answer 14

• inconsistencies with examination
• inconsistencies in history, behaviors
• atypical vs typical sx
• psych testing

Question 15

management of malingering

Answer 15

REQUIRES MANAGEMENT

be careful! why?

• stigmatizing diagnosis
• need evidence before coming to concl that patient is feigning illness
• seek consultation (make sure that your dx is not unsupported by another physician/caregiver)

management

• identify what individual wants or needs → direct them to more adaptive methods of meeting needs
  
  • social worker, counselor, psych eval, etc