120b - Somatoform Disorders

Question 1

What motivates patients with factitious disorder?

Answer 1

Desire to have the role of the patinet (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 symtom disorder or functional neurological disorder?

Answer 2

No physical symtoms present in illness anxiety disorder

• Physical symptoms in SSD (upset stomach, pain, headache)
• Neurological symptoms in FND (can’t lift leg, facial droop)

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)
  • Pt 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

Not intentionally produced or feigned by the patinet!

Question 5

What is the “classic presentation” of a patinet 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

What mental status exam findings may be associated with somatic symptom disorder?

Answer 6

• Demanding, histrionic, dramatic
• Seductive dress and manner
• Demanding behavior in the hospital
  
  • “Require” an abusable prescription b/c nothing else works

Question 7

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

Answer 7

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 8

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

Answer 8

1/3 have comorbid neurological disorder in their lifetime

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

Question 9

What is Munchausen’s by proxy?

Answer 9

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 10

What causes FDN (previously conversion disorder)

Answer 10

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 11

Which somatoform disorder is caused by an abnormally functioning CNS?

Answer 11

Functional neurological disorder (previously conversion disorder)

Question 12

What is Munchausen’s syndrome?

Answer 12

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 in medical fields

Question 13

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

Answer 13

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

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