Adjustment Disorders and Somatisation Flashcards
What is adjustment disorder?
A diagnosis of exclusion
Onset of symptoms usually within 1 month of traumatic / difficult event and usually length of symptoms is <6 months
What events may trigger adjustment disorder?
Bereavement
Changing schools / jobs
Moving area
Condition would not have occurred without the precipitating event but someone’s personality and resilience to stress can increase their risk of adjustment disorder (ie would something else have happened at another time that would also have set it off?)
How is adjustment disorder different from PTSD?
PTSD has acute anxiety and panic symptoms as well as hyper-vigilance and hyer-reactivity, as well as flashbacks
Adjustment disorder = more subtle
- Mild symptoms of depression and anxiety
- The feeling of inability to cope
In more extreme cases, may develop conduct disorder - reckless driving, aggressive behaviour and truancy are examples
What differentials should be excluded before diagnosing adjustment disorder?
PTSD
Depression
Anxiety
(note normal grief reaction can last up to 6 months after someone has died)
What is the management of adjustment disorder?
Reassurance that the reaction is temporary
CBT
What two variables should be considered when determining if someone’s response to an event is an appropriate psychological response or when it becomes a mental health problem?
The nature and severity of event
The nature and severity of the patient’s reaction to the life event
List four categories of ways in which people may respond to stress
1) Adjustment reaction
2) Acute stress reaction or PTSD
3) Dissociative disorder
4) Another major mental illness eg depressive illness, anxiety or psychotic disorder
Differentiate between an acute stress reaction and PTSD
Stressor must be traumatic = a stressor that occurs outside of the range of normal human experience and would be experienced as traumatic by any normal person
Acute stress reaction - occur immediately after of within a few minutes of stressor:
- Combat fatigue
- Dazed
- Narrowing of attention
- Inability to process external stimuli and disorientation
- Amnesia for the episode
Usually resolves in a few hours
PTSD occur within 6 months
What is dissociative disorder?
Disruption in naturally occurring functions of consciousness, memory, identity, perception and movement
Awareness and control of behaviour becomes separate from the individuals personality
Not open to voluntary control
ICD-10 requires there to be evidence of psychological causation (stressor)
What are people with dissociative disorder often rediagnosed as having?
Epilepsy
Depression
Schizophrenia
What types of dissociation are commonly associated with severe prolonged depression and anxiety?
Depersonalisation - person feels like their body is in some way strange or unreal
Derealisation - external reality seems strange of unreal
What are the seven stages of grief?
1) Shock
2) Denial
3) Anger
4) Bargaining
5) Depression
6) Testing - seeking realistic solutions
7) Acceptance
Over what time period is experiencing symptoms considered an adjustment disorder?
> 6 months = form of adjustment disorder
List some reactions people may experience that are not characteristic of a normal bereavement reaction
Guilt about other things other than the action taken or not taken by the pt at the time of their loved ones death
Thoughts of death that extend beyond thinking that they would be better off dead or would have rather been the one that died instead of their loved one
Morbid preoccupation with worthlessness
Marked psychomotor retardation
Prolonged and marked functional impairment
Hallucinatory experiences other than the pt thinking they are occasionally seeing or hearing the deceased loved one
What are somatisation disorders?
Psychological disorders that exhibit physical symptoms or take the form of physical disorders
No discernable physical or organic reason for these symptoms, leading to the presumption that they are caused by a psychological disorder
Do not happen voluntarily and are completely beyond the individuals control
What are the two most common forms of somatisation?
1) Somatisation disorder (Briquet’s syndrome) = specific symptoms they complain of
- S for somatisation and S for symptoms
2) Hypochondrial disorder = people are convinced of having a specific disease
- Pt misinterpret normal bodily sensations and think that it means they have a serious medical disease
- Eg they think they have HIV or cancer
What are the most common symptoms complained of in somatisation?
GI - n&v, diarrhoea, food intolerance, belching, regurgitation, abdo pain, constipation
Skin - itching, burning, numbness
Sexual - loss of libido, ejaculatory or erectile dysfunction, irregular menses, dysmenorrhoea
Urinary - dysuria, freq, urinary retention
Neuro - paralysis, sensory loss, hearing of vision loss, diplopia, seizures, difficulty swallowing, impaired coordination
NB pt must have numerous symptoms from more than one of these groups (not just one symptom in isolation)
What are pt with somatisation disorders highly at risk of?
Iatrogenic complications
Eg multiple abdo adhesions from having multiple explorative laparoscopies
What is the ICD-10 for somatisation disorder?
1) At least 2 years of symptoms with no organic explanation found
2) Persistent refusal by the pt to accept reassurance from several doctors that there is no physical cause
3) Some degree of functional impairment due to the symptoms and resulting behaviour
How can a pt behaviour help to distinguish between somatisation and hypochondriacal disorder?
Often in somatisation disorder, pt ask for TREATMENT for their symptoms
In hypochondriacal disorder the pt becomes fixated on the diagnosis and so they will often be demanding INVESTIGATIONS to confirm this diagnosis
What is body dysmorphic syndrome?
A specific type of hypochondriacal disorder where people become concerned / preoccupied with a specific defect or deformity eg a crooked nose or ugly hands
What is conversion disorder?
A perceived loss of motor or sensory function
- Psychological pain is concerted into the somatic or phyiscal form
- Often neurological symptoms eg paralysis, blindness, sensory loss, peripheral visual loss ‘looking down tube’
How is a conversion disorder different from a factitious disorder?
In factitious disorder the pt purposefully feigns symptoms
In conversion disorder the motor and sensory loss are involuntarily experienced
