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05 Psych > 15 Abuse and somatoform disorders > Flashcards

15 Abuse and somatoform disorders Flashcards

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0
Q

IPV dynamics

A
  • 6X per year events with lulls in between- this might contribute to denial/staying
  • Protecting partner to “not turn on family”
  • Isolation
  • changing standards
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1
Q

IPV

A

Assultive behavior to dominate, control, or punish an intimate, supposedly peer, relationship.

  • Phsyical 39% lifetime incidence 25% lifetime incidence of injury
  • Sexual 22% females forced to do something sexual (9% of those spouse, 46% someone they love)
  • Pet/property destruction
  • psychological battering/terrorism

Women are attacked more often by current former partner, men assaults are more non-IPV

Bisexuals have higher rates of IPV

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2
Q

Societal dynamics

A

Woman may not have means to survive on own

Woman may be denied help if husband is wealthy

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3
Q

IPV and injuries

A 
Facial injuries more commonly IPV
More healthcare visit vs. controls.
*trauma
*surgical disorders
*gynecologic
*induced abortion
*Med disorder
*obs.

More suicide attempts and psych visits

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4
Q

IPV cost

A

$439 per year per patient; 19.3 M yearly

8.1 billion impact including lost work etc.

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5
Q

IPV and kids

A

80-90% in assaultive homes witnessed assault

Adult problems are associated with adverse childhood events in a dose dependent manner

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6
Q

Abuse and health

A
  • Lead to impaired symptom reporting, worse med adherence (might not have even heard you), and inability to cope (resulting in bad coping strategies like alcohol etc.)
  • Constant stress changes endocrine axis
  • sleep disruption
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7
Q

Barriers to diagnosing and treating IPV

A

Patient:

  • Lack of trust
  • Safety jeopardized
  • Financial support jeopardized
  • shame and humiliation
  • futile resignation

Provider:

  • lack of knowledge
  • lack of skills and training
  • fear of offending patient
  • too close for comfort (personal experience)
  • Opening pandora’s box
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8
Q

IPV screen

A
  • In my practice I’m concerned about prevention and safety, especally in the family
  • Have you been hit, kicked, punched or otherwise hurt by someone in the last year? If so, by whom?
  • Do you feel safe in your current relationship
  • Is there a previous partner who is making you feel unsafe now?
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9
Q

IPV screen in family/relationship history

A

When did you and your partner meet?
What was the attraction?
What happens when you argue or fight?
Has your partner ever pushed, kicked, or grabbed you?

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10
Q

Good Interview skills

A
  • Ask specific behaviors
  • Avoid general emotionally charged terms like abuse, violence, and victim
  • Ask about various types of violence and responses: fear, injury, sexual assault, control
  • Ask about current problems from PREVIOUS RELATIONSHIPS
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11
Q

Helping IPV patients

A

SOS DOC
*support, belief, confidentiality
*safety: help assess danger- increasing frequency, weapons, substance
*options: safety planning and follow up- shelters, police, advocacy
*strengths - identify patient strengths- courage, care for kids etc.
*document- use qotes- not “claimed or alleged”
*Observations- detailed observations and pics with face and ruler (humanity and scale
- Assessment “consistent or inconsistent with MOI” include
perpetrator name
*Continuity- encourage follow up, connect to resources

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12
Q

IPV pitfalls

A
  • not asking when you have the chance
  • trivializing the violence
  • overreacting to violence or denial
  • simply recommending “getting out”
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13
Q

Sexual violence

A
  • non-consensual
  • Force or coercion
  • sexual in nature

LESS THAN 35% is reported
1in3 girls, 1in6 boys by 18

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14
Q

Rape definition

A

Any penetration of anus or vagina, or penetration of mouth with sex organ without consent.

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15
Q

Non stranger sexual iolence

A
  • Betrays trust and may change victims perception of world and trust
  • Uses deceit, manipulation and secrecy
16
Q

Trauma reactions

A
  • Control is lost—>
  • attempt to regain control and personal safetty
  • perception or belief that one is unable to defend or care for oneself –>
  • One reasserts control by using coping stratigies and problem solving skills based in previous practice.
17
Q

Psychological trauma

A
  • Decreased hippocampal and amygdalar volume
  • alters cortisol and neurotransmitters
  • diminishes left and right hemisphere integration
18
Q

MUPS

A

Medically unexplained Physical symptoms

19
Q

Somatization disorder

A

Criteria at some point:

  • 4 pain symptoms
  • 2 non-pain GI symptoms
  • 1 sexual complaint
  • 1 pseudo-neurological complaint

Not explained by other condition
Not intentional

20
Q

Somatization disorder clinical features

A 
Patients describe themselves as "sickly" 
  -circumstantial, vague, inconsistent, disorganized history
  -dramatic exaggerated claims
many OP visits
Frequent IP visits
Subspecialty referrals
Many diagnoses
multiple meds
21
Q

Clues to somatization disorder

A
  • Multiple organ systems
  • early onset and chronic course without physical signs or structural abnormalities
  • absence of lab abnormalities
22
Q

Somatization Tx

A

Scheduled regular visits
Focused brief exam
Look for objective signs of disease- be skeptical
Avoid excess tests, inasive treatment, referrals, and IP
explain that stress can cause symptoms
set limits on contacts outside of visits

  • CBT effective
  • Not responsive to long term insight oriented psychotherapy
  • Short term dynamic therapy helps

Psychopharm:
Antidepressants show partial response (unknown long term efficacy)

23
Q

Conversion disorder

A
  • 1 or more voluntary motor or sensory symptom of supposed neurological origin preceded by a stressor (V no stressor)
  • clinical findings incompatible with symptom presentation and recognized medical/neuro illness
  • 1/3 have real neuro disease
  • 25% recur in 1st year
24
Q

Conversion disorder clinical features

A
  • La belle indifference”
  • symptoms follow stress
  • symptoms conform to patients understanding of neurology
  • inconsistent physical exam
25
Q

Conversion disorder Tx

A
  • Conservative
    • suggestible- We are sure you will improve with a few sessions of physical therapy
  • psychotherapies
  • amytal interview/hypnosis
26
Q

Conversion disorder prognosis

A

Good:

  • onset after stressor
  • prompt treatment
  • Paralysis, aphonia, blindness

Bad:

  • delayed treatment
  • siezure
27
Q

Pain disorder

A
  • Pain predominates focus and is severe enough for clinical eval
  • complaints significantly change with psychological factors
    • genesis of pain
    • severity of pain
    • Maintainance of pain
  • pain not intentionally produced or feigned
28
Q

Hypocondriasis [Illness anxiety disorder]

A
  • fears of serious illness
  • not delusional in intensity and not restricted to concern of appearance
  • > 6 months
  • [Somatic symptoms if present are mild]
  • [High health anxiety and easily alarmed about health]
29
Q

Hypochondriasis Tx

A

Cultivate DPR
CBT
Supportive therapy
SSRIs

30
Q

Body dysmorphic disorder [OCD anxiety disorder]

A
  • Pervasive feeling of ugliness despite normal or near normal appearance
  • Concern of any anomaly is markedly excessive
  • [repetitive behaviors or mental acts in response]
31
Q

BDD features

A
  • 12% derm patients, 6-15% cosmetic surg
  • 15-30 YO
  • Think about flaw (usuallyface or head) 3-8 hrs/day
  • compulsive behavior to examine, improve, seek reassurance, or hide defect
32
Q

BDD Tx

A
  • DO NOT TRY TO FIX / CREATE IATROGENIC HARM
  • CBT
  • SSRIs- HIGH DOSE LONG DURATION
33
Q

Facetious disorder

A
  • Intentionally exaggerates or induces SSx
  • Motivation to assume sick role
  • No external motives

(10% Münchausen -severe and chronic)
(by proxy- someone else i.e. mother smothers child)
(Gansers - approximate answers)

  • many suffered childhood abuse (hospitals safe),or childhood health problems
  • may be means of increasing self esteem
  • associated with medical paraprofessionals, and Borderline personality disorder

05 Psych (8 decks)

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