120. Somatoform Disorders

Question 1

Somatic Symptom Disorder

• DSM5
• who
• course

Answer 1

A. 1+ somatic sx causing distress/disruption in daily life
B. Excessive, thoughts related to sx/health concerns
C. state of having sx persistent >6mo

Who: Almost ALL women in 20s

Course: high medical costs, chronic fluctuating course, higher risk of suicide; 2/3 have psych sx

Question 2

Tx for somatic Symptom disorder

Answer 2

1. Lasting & EMPATHETIC doctor-patient relationship - acknowledge their helplessness
2. CBT: target dysfx beliefs

Question 3

Conversion Disorder

- dx and signs

Answer 3

1. 1+ sx of altered voluntary motor/sensory fx (NEURO SX)
2. Incompatibility of sx and neuro findings
3. Sx not better explained
4. Sx causes significant distress/impairment
   - not intentionally produced/faked by pt
   - Hoover’s sign: cannot push leg down but can when they need to raise other leg

Question 4

Conversion disorder

• prevalence
• comorbidity
• prognosis

Answer 4

• 1/3 of patients in neuro clinic have it (onset age 10-35, most female)
• 1/3 have another neuro dx, 1/2 have epileptic seizures
• 90% have somatoform disorder, other coM - PDs, affective disorders, anxiety disorders, PTSD
  Prognosis: poor (60-80% still sx 6-10yrs later)

Question 5

Tx of Conversion Disorder

Answer 5

1. Inform: report results, validate pt concerns, reassure what it isn’t
2. PT!!! - for motor sx
3. CBT - reduce dysfx thoughts and improve coping

Question 6

What is Illness Anxiety Disorder?

Answer 6

1. Preoccupation with having/acquiring serious illness
2. Somatic sx NOT present
3. Anxiety about heath
4. Excessive health-related behaviors

Question 7

What is Factitious Disorder?

• type of gain
• subtypes

Answer 7

1. Falsification of physical/psychological signs/sx, or induction of injury/disease with DECEPTION
2. Pt presents as ill, impaired, injured
3. Deceptive behavior evident in absence of external reward
4. Behavior not better explained by another disorder

Primary Gain: desire to assume sick role (unconscious motivation)

A. with mainly psych sx
B. with mainly physical sx
C. combined psych/physical sx

Question 8

What is Munchausen’s Syndrome?

Answer 8

Most extreme form of factitious disorder

• wandering (life of hospitalizations)
• antisocial behavior
• iatrogenic medical conditions
• complex med hx
• chaotic hospital course

by proxy: parent induces medical signs in child

Question 9

What is malingering?

Answer 9

Sx are intentionally faked with conscious motivation (secondary gain: for financial/legal benefit)

• satisfied with hospitalization
• retain/recreate same sx each time