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5. Psychiatry > 2- Somatoform disorders > Flashcards

2- Somatoform disorders Flashcards

1
Q

Do somatic system d/o typically present more often to PCP or psychiatry?

A

PCP

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2
Q

SSD are typically comorbid w/ what other mental d/o?

A

Anxiety and depression

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3
Q

What motivates a pt w/ somatic system d/o to seek tx?

A

Primary gain - unconscious defense against unacceptable internal conflicts

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4
Q

What is the motivation for a pt w/ sx of malingering?

A

Actions/behaviors for “secondary gain”/external benefit

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5
Q

What are the physical sx of pt w/ SSD?

A

Multiple complaints w/ multiples organs systems

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6
Q

What are the physical sx of pt w/ Conversion d/o?

A

Neurological complaints

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7
Q

What are the physical sx of pt w/ Illness anxiety d/o?

A

Any complaint attributed to serious disease

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8
Q

What are the physical sx of pt w/ body dysmorphic d/o (BDD)?

A

False perception or exaggeration of physical appearance

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9
Q

What are d/o associated w/ intentionally produced sx?

A

Malingering (for external goal/gains)

Factitious d/o (“sick role”)

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10
Q

What are disorders associated w/ unintentionally produced sx? (4)

A

SDD
Conversion d/o
Illness Anxiety d/o
BDD

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11
Q

What is the DSM5 criteria for SDD? (3)

A
  1. 1+ somatic sx that are distressing or result in significant daily disruptions
  2. Excessive thoughts, feeling, behaviors related to somatic sx manifested by 1+ of the following
    - disproportionate/persistent thoughts, persistent high level anxiety, excessive time/energy devotion
  3. Present 6+ months
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12
Q

How do pts with SDD typically present their HPI?

A
  • Exaggerated but lack factual info
  • See multiple PRs
  • Take many meds/hx of lots of procedures/tx
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13
Q

What PCP screening tool is used for SDD (not diagnostic)?

A

The Somatic Symptom Scale-8

score 0-32

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14
Q

What is the CARE-PA approach to SDD?

A 
Consult w/ psychiatry or CBT
Assessment for other illnesses
Regular (frequent) visits
Empathy (validate)
Psychiatric-medical interface
Assurance
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15
Q

What is the tx for SDD?

A

CBT/Mindfulness
+/- Meds (TCA + meds if other psych d/o)
Regular visits

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16
Q

What is the DSM5 criteria for conversion disorder? (4)

A
  1. ≥ 1 sx of altered voluntary motor or sensory function
  2. Clinical findings don’t support dysfunction/sx
  3. Not better explained by another medical/mental d/o
  4. Impairment in functioning
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17
Q

Sx in conversion disorder conform to what the pt THINKS, not physiological principles. What are the most common sx in conversion disorder?

A

Sensory deficits, motor deficits, or pseudo-seizures

*PE will be inconsistent w/ normal neuro exam

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18
Q

Before making a dx of conversion disorder, what must be ruled out?

A

Must r/o any underlying neurologic etiology

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19
Q

What is the tx for conversion d/o?

A

Sx spontaneously resolve

Validate pt, be supportive, consult w/ psych

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20
Q

What is the difference b/w SSD and Illness anxiety disorder?

A

SDD w/ somatic sx

IAD w/ preoccupation of disease/health

21
Q

What is the DSM5 criteria for IAD? (6)

A
  1. Preoccupation w/ having a serious disease
  2. No/mild somatic sx or excessive preoccupation another medical condition
  3. High level of anxiety about health
  4. Excessive health related behaviors or maladaptive avoidance
  5. ≥ 6 months
  6. Not better accounts for by another mental d/o
22
Q

What are the important specifiers for IAD?

A

Do they seek care
OR
Do they avoid care

23
Q

IAD is often associated w/ what?

A

Serious illness in childhood or in a family member

24
Q

What is the tx for IAD?

A

Reassurance/regular dr. visits
Avoid unnecessary procedures/meds
Individual/group therapy

25
Q

What is the DSM5 criteria for BDD? (4)

A
  1. Preoccupation w/ imagined defect in appearance not observable or appears slight to others
  2. Repetitive behaviors or mental acts in response to appearance concerns
  3. Causes distress/impairment
  4. Not better accounted for by concerns w/ fat or weight due to an eating disorder
26
Q

What are the specifiers for BDD? (2)

A
  1. W/ or w/o muscle dysmorphia

2. Degree of insight

27
Q

What is the #1 co-exisiting d/o to BDD?

A

Depression

also social phobias, substance abuse, OCD

28
Q

BDD can exist on a continuum with what other disorder?

A

Delusional disorder

29
Q

What is the tx for BDD?

A

Avoid medical surgeries/procedures

CBT for false belief

Behavior modification/therapy

+/- antidepressants

30
Q

What is the most effective tx for SSDs?

A

CBT (sx focused NOT relaxation techniques)

31
Q

What makes CBT most effective in pts w/ SDDs?

A

Homework/journalling triggers/thoughts/behavior

Then have therapist provide alternative explanation to the pts interpretations

32
Q

What is the goal psychoeducation in SDD?

A

Teach pt to recognize their thoughts, emotions, behavior that lead to somatic preoccupation and provide better coping strategies

33
Q

What is the DSM5 criteria for factitious disorder imposed on self? (4)

A
  1. Falsification of physical sx
  2. Present to others as ill/injured
  3. External rewards for behavior are absent
  4. Not better explained by another mental d/o
34
Q

What are specifiers for factitious disorder?

A

Single or recurrent episodes

35
Q

What is the DSM5 criteria for factitious disorder imposed on another? (4)

*Previously munchausen

A
  1. Falsification of physical sx in another, associated w/ deception
  2. Present another individual (victim) to others as ill
    injured
  3. External rewards for behavior are absent
  4. Not better explained by another mental d/o
    * Perpetrator, not the victim receives the dx
36
Q

What will medical hx show for pt w/ factitious disorder?

A

Multiple Dr. visits/hospitalizations

  • Extensive knowledge of medical terminology
  • Eager to undergo test/procedures
37
Q

What is the tx for factitious d/o?

A

None

Goal is to recognize d/o early and prevent unnecessary medical tx

38
Q

Is malingering a psychiatric illness?

A

NO (it is a behavior)

39
Q

What is the goal of malingering?

A

Intentional production of false physical or psychological sx motivated by external incentives (ex: avoid work/military duty, obtain meds/money)

40
Q

What is a trigger for onset of malingering?

A

Response to environmental incentive

41
Q

What is the tx for malingering?

A

Eliminate external incentive

Confront pt with knowledge of their actions

42
Q

What is important to do w/ malingering pts?

A

Careful documentation of encounters as threats may be common

43
Q

41 y/o M admitted to the hospital after he suddenly went blind. He does not seem overly concerned w/ sudden lack of vision. The only time he gets upset is when discussing his mother’s recent death. His eye and neuro exams are normal and inconsistent w/ sx. A head CT is negative. What is your suspected dx?

A

Conversion d/o

44
Q

39 y/o F feels tired, weak, and “just not well”. Her mild sx often keep her from going to work and she is becoming increasingly worried. For the past 4 yrs, she has thought she has hep C which causes fatigue, myalgia, loss of energy and dull abdominal pain. Repeat labs and imaging has revealed no abnormalities but she doesn’t think they are accurate. She is takin vitamins and other natural products to “cure” her sx. What is your suspected dx?

A

Illness anxiety disorder

45
Q

34 F presents w/ recurrent abd pain associated w/ bloating, N/V. She has undergone 5 abd surgeries over the past 10 yrs w/ no definitive findings. She has multiple other complaints. She says that no one has found a cause or tx for her sx and she has seen MANY different clinicians. She is extremely agitated and worries that nothing is helping her. She is about to work despite her symptoms but is running out of sick days. What is tour suspected dx?

A

Somatic symptom d/o

46
Q

25 y/o F is anxious about the way she looks. She has been obsessed with her face and states something is wrong. She has had 7 plastic surgeries to correct the issues but is still unsatisfied. She isolates herself from other so they can’t see her. What is your suspected dx?

A

BDD

47
Q

27 y/o F is evaluated in ER for severely infected arm. She is on several ABX but continues to have infection. Psych consult is ordered after a nurse saw the pt deliberately contaminate her arm. When confronted, the pt wants to leave the hospital. What is your suspected dx?

A

Factitious disorder imposed on self

48
Q

29 y/o M complains of severe neck pain following a minor traffic accident. He claims the pain prevents him from working and his lawyer was able to get him a large settlement from his insurance for time lost at work. Pt tells a friend that he exaggerated the pain to get extra money for vacation. What is your dx?

A

Malingering

49
Q

Mom reports her 7 y/o often experiences sever abdominal pain. Childs medical record shows many office visits and 3 surgeries. When mom is confronted about falsifying the pt’s sx, she grabs her child and flees the office. What is your suspected dx?

A

Factitious disorder imposed on another

5. Psychiatry (19 decks)

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