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PSYCHIATRY > 5. Somatic Symtpom Disorders > Flashcards

5. Somatic Symtpom Disorders Flashcards

1
Q

Definition: patient’s suffering seems to be out of proportion to the actual severity of the physical problem

A

chronic “benign” pain

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2
Q

True or false: because somatiform disorders are not real pain, they only need CBT for treatment

A

FALSE: you absolutely need to reule out medical causes

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3
Q

True or false: somaticizing patients rarely ever have psychological concerns.

A

FALSE: some may acknowledge psychological concerns but may not see connection between somatic symptoms and precipitating stress conditions

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4
Q

What is the differential for somatic symptom and related disorders?

A
  • Adult anxiety disorders
  • Stress/trauma disorders
  • OCD
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5
Q

How do you treat somatic symptom and related disorders?

A
  • Do no harm (encourage healthy living)
  • Take good psycho-social history (know the patient and screen for depression and anxiety)
  • Consider somaticizing from beginning (but also rule out medical causes)
  • CBT
  • CAM
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6
Q

What is mind-body dualism?

A

real pain v. psychiatric problem (all pain is real pain)

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7
Q

When does somatic symptom disorder present?

A

before 30 yo (early)

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8
Q

What gender more commonly gets somatic symptom disorder?

A

women

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9
Q

What are risk factors for somatic symptom disorder?

A
  • Rural areas
  • Lower level of education
  • Chaotic life circumstances
  • Abuse history (often related to recent stress and h/o physical abuse and/or sexual molestation)
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10
Q

How does somatic symptom disorder differ from illness anxiety disorder?

A
  • SSD will have patient with multiple, vague and shifting somatic symptoms (dramatically described) that are medically unexplained or marginally explained
  • Illness anxiety disorder patients will have primary concerns of being ill and patients often have NO symptoms or minimal symptoms and ONE PREOCCUPATION at a time
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11
Q

What is Alexithymia? What disorder is it commonly seen in?

A

Alexithymia is the inability to express feelings (ex. hurt, fear, anger) in words. It is seen in somatic symptom disorder.

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12
Q

Comorbid depression is often seen in what somaticizing disorder?

A

SSD

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13
Q

What are some symptoms complained of by SSD patients?

A 
nervousness
back pain
weakness
joint pain
dizziness
extremity pain
fatigue 
nausea
HA
dyspnea
chestpain
constipation/bloating
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14
Q

How do you treat SSD?

A
  • offer routine visits to show concern and availability

- may respond to CBF

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15
Q

What is the old name for illness anxiety disorder?

A

hypochondriasis

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16
Q

What is the definition of illness anxiety disorder?

A

obsessional preoccupation with (or fear of) having a serious illness

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17
Q

How long must you have the preoccupations to be diagnosed with illness anxiety disorder?

A

lasts 6 months or more (where you cannot reassure the patient)

18
Q

How might you treat illness anxiety disorder?

A

CBT

19
Q

Definition: alteration or loss of physical functioning without explanatory pathology

A

conversion disorder

20
Q

True or false: conversion disorder is NOT consciously feigned

A

TRUE (psychological problems that are “converted” into medical problems)

21
Q

Who gets conversion disorder?

A

common in children

  • many have model for symptom
  • some are their own model (ex. pseudoseizures)
22
Q

When do conversion disorders usually start?

A

under overwhelming stress (ex. funerals, family arguments)

23
Q

What do patients with conversion disorder present with?

A

neurological symptoms (ex. paralysis, tunnel vision, seizures, numbness) but DOES NOT follow neuronal pathways

24
Q

True or false: conversion disorder commonly causes extreme anxiety in patients

A

FALSE: may lead to distress and impairment but may not cause much anxiety in the afflicted patient

25
Q

What treatments work for conversion disorder?

A
  • hypnosis or psychotherapy

- may require physical therapy

26
Q

Definition: patient engages in deception and manufactures medical or psychiatric symptoms

A

factitious disorder

27
Q

Definition: patient engages in purposeful self-injury, infliction, or feigning of illness

A

malingering

28
Q

What is the gain in factitious disorder?

A

primary gain (no external reward or gain, just want to get admitted and create interest and concern with the unusual and puzzling medical condition)

29
Q

What is the gain in malingering?

A

secondary gain (obvious potential rewards–like escaping punishment/work or achieving financial or other compensation)

30
Q

Who gets facitious disorders?

A

females > males; more commonly people with health-care related jobs

31
Q

Who participates in malingering?

A

prisoners
soldiers
anti-social personality disorder

32
Q

What type of disorder is Munchausen’s?

A

factitious disorder

33
Q

What type of treatment is used for facitious disorder?

A

empathetic interviewing?

34
Q

Definition: disruption, loss or absence of usual integration of memory, consciousness, and personal identity

A

dissociation

35
Q

True or false: dissociation is always abnormal

A

FALSE: dissociation can be a normal, protective response to trauma or intense and recurrent fear OR a pathological state when dissociation occurs repeatedly and out of context

36
Q

What is the presentation of dissociative disorders?

A

specific medical (cognitive) symptoms related to overwhelming anxiety states

37
Q

Definition: sudden amnesia related to traumatic exposures

A

dissociative amnesia

38
Q

Definition: sudden unexpected travel with inability to recall one’s past (often patient does not know own identity and is admitted as “John Doe”

A

dissociative fugue

39
Q

Definition: feeling like one is “on the outside looking in” or an observer of ones’ own actions

A

depersonalization disorder

40
Q

Definition: “multiple personality disorder” where a patient assumes one of several identities or “alters” when stressed

A

dissociative identity disorder

41
Q

What is the risk factor for dissociative identity disorder?

A

childhood trauma

PSYCHIATRY (9 decks)

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