100b - Somatoform Disorders

Question 1

What motivates patients with factitious disorder?

Answer 1

Desire to have the role of the patient (primary gain)

Remember: These patients are being unconsciously deceptive; they are not making a conscious effort to lie

(Vs. malingering, where goal is financial, legal - secondary gain)

Question 2

How does illness anxiety disorder differ from somatic symptom disorder or functional neurological disorder?

Answer 2

• Illness Anxiety Disorder = preoccupation w/ having or acquiring serious illness even though somatic symptoms are not present
• Somatoform Disorder = prominence of somatic symptoms associated w/ significant distress and impairment that mimic a physical illness
• Conversional Disorder (Functional Neurological Symptom Disorder) = neurologic symptoms w/o a neurological cause, but it causes significant stress and impairment
  
  • Symptoms: rapid symptom onset, positive Hoover’s sign, rapid clinical improvements
    
    • Hoover’s sign: say they can’t move their leg, put when you ask them to lift their other leg against your resistance, they will subconsciously move the leg that they said couldn’t move

Question 3

Describe the clinical presentation of factitious disorder

Answer 3

• 1 or more brief episodes
  
  • If multiple episodes, symptoms vary
• May have psychological symptoms, physical symptoms, or both
  
  • May have real medical symptoms (may be self induced)
  • Patient has the unconscious goal of being the patient/being cared for as a patient
• Onset in early adulthood
  
  • Usually after hospitalization

Question 4

Describe the clinical presentation of functional neurological disorder (previously conversion disorder)

Answer 4

• Rapid neurological symptom onset, rapid resolution
  
  • May be in the context of stress
• No neurologic cause (no stroke or motor neuron pathology)
• On exam, positive Hoover’s sign:
  
  • Hoover’s sign: say they can’t move their leg, put when you ask them to lift their other leg against your resistance, they will subconsciously move the leg that they said couldn’t move

Not intentionally produced or feigned by the patinet!

Question 5

What is the “classic presentation” of a patient with somatic symptom disorder?

Answer 5

• Chartomegaly
• Complicated medial history of symptoms that don’t make sense
• Many work-ups, medical/surgical procedures, failed treatments
• Multiple allergies
• Popular, poorly understood diagnoses
  
  • Fibromyalgia, IBD
• Psychiatric history likely

Question 6

In factitious disorder, symptoms are usually [consistent/variable] and are [intentionally/unintentionally] produced with [conscious/unconscious] motivation

Answer 6

In factitious disorder, symptoms are usually variable and are intentionally produced with unconscious motivation

Unconsciously motivated by primary gain (to assume the sick role)

Question 7

What are the two most common comorbidities of functional neurological disorder?

Answer 7

1/3 have comorbid neurological disorder in their lifetime

1/2 of non-epileptic seizure pts have epileptic seizures

Question 8

What is Munchausen’s by proxy?

Answer 8

Parent induces medical signs in a child with the purpose of assuming the sick role indirectly

(Munchausen’s is a severe form of factitious disorder)

Question 9

What causes Functional Neurological Symptom Disorder? (previously conversion disorder)

Answer 9

May be some or all of the following; key takeaway is that there is a CNS pathology leading to the symptoms

• Altered connectivity between areas involved in emotion, memory, exec control, movement
  
  • Due to disturbances in brain networks
• Disruption in emotional processing
  
  • May be the link between psychosocial risk factors and neuro symptoms

Question 10

Which somatoform disorder is caused by an abnormally functioning CNS?

Answer 10

Functional neurological disorder (previously conversion disorder)

Question 11

What is Munchausen’s syndrome?

Answer 11

Most extreme and notorious form of factitious disorder

• Life of hospitalizations
• Antisocial behavior
• Iatrogenic medical conditions
• Complex medical hx (w/ >average level of medical knowledge)
• Often work in medical fields

Question 12

In malingering, symptoms are usually [consistent/variable]and are [intentionally/unintentionally]produced with[conscious/unconscious] motivation

Answer 12

In malingering, symptoms are usually consistent and are intentionally produced with conscious motivation

Patient is fabricating symptoms for financial or legal gain (secondary gain)

Question 13

Criteria for Somatic Symptom Disorder:

Answer 13

• 1+ somatic symptoms that are distressing or result in significant disruption in daily life
• excessive thoughts, feelings, behaviors, anxiety about the seriousness of those symptoms