3 - PSY - Health Anxiety, Somatisation + Medically unexplained symptoms

Question 1

Health anxiety is an umbrella term encompassing…

Answer 1

excessive health related concerns

somatic perceptions

behaviours eg repeat reassurance seeking

reaction to illness out of proportion with whats expected

Question 2

Somatisation/medically unexplained symptoms definiton

Answer 2

psych distress is expressed through physical symptoms and subsequent medical help seeking

Question 3

hypochondriasis/hypochondriacal disorder - define

Answer 3

concerns about serious illness persists for at least six months causing clinically significant distress/impairment

must be able to name illness

max illnesses = 2

refuse to accept medical reassurance

Question 4

Somatisation disorder - features

Answer 4

multiple and variable physical Sx for at least 2y that cant be medically explained

causes persistent distress -> reassurance seeking + self medication

persistent refusal to accept medical reassurance

must be no. of Sx from at least two of these groups: GI, CV, GU, Skin+pain

Question 5

Factitious disorder

Answer 5

Munchausens
internal motivation with aim of adopting sick role

by proxy – pt imposes Sx to others eg child

may even self harm to give signs/symptoms

Question 6

Malingering

Answer 6

conscious manufacturing/exaggerating of Sx for secondary gain

Question 7

3 subtypes of health anxiety + description

Answer 7

cognitive type - health anx with high cog awareness and more pronounced fear of disease

somatising type - health anx with high symptom awareness and more pronounced bodily preoccupation

behavioural type - health anx with high disease conviction and avoidance

Question 8

DDx for hypochondriasis, somatisation, med unexplained Sx

Answer 8

depression and anxiety
personality disorder
organic conditions (MS, SLE) - vague initial Sx
psychosis/schiz - hypochondriacal delusions

medical disorders my coexist with medically unexplained Sx

Question 9

General principles in managing health anxiety/somatisation

Answer 9

primary care mostly

establish good therapeutic rapport with patient

investigations - do enough to rule out everything but don’t overdo

interaction with patients - apptmnt with same Dr to stop Dr shopping

make link between physical and psych factors

Question 10

Bio psycho social approach to health anx and somatisation

Answer 10

bio - weak evidence
psych - CBT and psychoeducation
social - involve network to improve support, encourage normal function