Anxiety Disorders: Medically unexplained sx

Question 1

Define Somatoform Disorders

Answer 1

Symptoms are suggestive of a physical disorder but in the absence of a physiciological illness
Repeatedly seek medical attention when it has failed to benefit them

Question 2

Define Dissociative Disorder

Answer 2

Unpleasant/stressful events are converted to symptoms

Question 3

Describe the Social Aetiology (I.e. benefits of sick role behaviour) for patients with Somatoform Disorders

Answer 3

Primary Gain - Relief from stressful interpersonal expectations
Secondary Gain - Attention/Care/Financial Reward from others

Question 4

Describe the Biological, Psychological and social pathophysiology of Somatoform Disorders

Answer 4

Biological - Possible implication of Neuroendocrine Genes

Psychological - High association with PTSD/Physical and Sexual Abuse

social - adopting the ‘sick role’ in order to gain relief from stress

Question 5

Describe the two processes occurring in Dissociate Disorder

Answer 5

Dissociation - Separating off certain memories from normal consciousness - physiological defence mechanism that is used to cope with emotional conflict

Conversion - Distressing events transformed into physical symptoms

Question 6

what are some risk factors for somatoform and dissociative disorders? (CRAMPS)

Answer 6

childhood abuse

reinforcement of illness behaviours

anxiety disorders

mood disorders

personality disorders

social stressors

Question 7

There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Amnesia

Answer 7

Partial or complete memory loss for recent traumatic/stressful event

Question 8

There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Fugue

Answer 8

Unexpected physical journey away from surroundings followed by amnesia for this period

Question 9

There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Stupor

Answer 9

Reduction/Absence of voluntary movements/speech with normal tone

Question 10

There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Movement Disorder

Answer 10

Unable to perform movements under voluntary control

Question 11

There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Convulsions

Answer 11

Sudden unexpected spasmodic movements resembling epilepsy without LOC

Question 12

What is it and describe the ICD10 criteria of Somatisation (Briquets) Disorder and some describe some physical symptoms

Answer 12

multiple, recurrent and frequently changing physical symptoms not explained by physical illness

A - Two years of unexplainable physical symptoms
B - Preoccupation with symptoms causing physical distress and constantly seeking medical attention
C - Continuous refusal to accept reassurance
D - 6 or more physical symptoms

Question 13

Define Hyperchondriacal Disorder

Answer 13

Misinterprets normal bodily sensations which leads to non delusional preoccupation that they have a serious disease.

Refuse to accept reassurances from doctors.

Question 14

Define Dysmorphophobia

Answer 14

Excess preoccupation with barely noticeable/imagined defects in physical appearance

Question 15

Define Somatoform Autonomic Dysfunction

Answer 15

Symptoms are related to autonomic nervous system

Resp - Psychogenic Ventilation
GI - IBS
CVS - Da Costa’s Syndrome

Question 16

Any Somatoform disorder is likely a diagnosis of exclusion, however give three factors that may point towards this diagnosis

Answer 16

• Previous Mental Health Issues
• Symptoms in Multiple Body Systems
• Vague Symptoms
• Chronic course
• hx of extensive diagnostic testing
• Rejection of previous physicians

Question 17

Give two differential diagnoses for Somatoform Disorders

Answer 17

Malingering (Patient seeks advantageous consequences of being diagnosed with medical condition)

Munchausen’s (Individual wishes to adopt sick role for emotional gain

Question 18

Describe the management of Somatoform Disorder

Answer 18

• Antidepressants and Physical
• Exercise
• CBT
• Coping Strategies
• Encourage pleasurable private time
• Involve family where appropriate

Question 19

what is persistent somatoform pain disorder?

Answer 19

persistent and severe pain that cannot be fully explained by a physical disorder

pain usually occurs as a result of psychosocial stressor and emotional difficulties

Question 20

conversion disorder

Answer 20

neurological form of somatoform disorder

Question 21

hoover sign