Autism and Somatic Disorders Flashcards
DSM 5 criteria for autism diagnosis
- Persistent deficits in social communication and interaction
- Restricted, repetitive patterns of behavior, interests of activities
At what point to autism symptoms tend to manifest
Six months-two years old.
Symptoms present in early development, often when social demands exceed limited capacities.
Describe the language of an autistic patient
Delays in expressive and/or receptive (following commands) language
Describe the social communication and interaction of an autistic patient
Lack of reciprocity (play alone)
Deficit in joint attention (parallel play)
Impaired nonverbal communication
Impaired social relationships
Restricted, repetitive behaviors of autistic patients often include (6)…
Repetitive behaviors (hand flapping) Insistence on sameness (difficulty with schedule changes) Restricted interests Sensory perception issues Motor delays Savant Skills
How do you scan for autism?
M-CHAT questionnaire
Name of the mercury containing preservative associated with vaccines
Thimerosal
Physical diagnosis findings associated with Autism
Growth Parameters (Head circumference) Skin exam (Woods Lamp) Neurological Exam (Focal neuro signs)
Treatment for autism
Psychosocial therapy
Behavioral Training
Difference between illness and disease
Illness – response of individual/family to symptoms
Disease – Pathophysiologic process associated with documentable physical lesions
What is Somatization?
Tendency to experience and communicate psychological or emotional distress as somatic (physical) symptoms
What is a Somatoform illness?
Somatization that produces significant dysfunction in a patient’s life
What is a factitious disorder?
Symptoms are produced or feigned in order to appear ill, with no perceivable benefit to the patient
What is malingering?
Symptoms are produced or feigned in response to an external incentive
Somatic Symptom and Related Disorders include
Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder Factitious Disorder Psychological Factors affecting other medical Conditions
The fancy name for conversion disorder
Functional Neurological Symptom Disorder
What are somatic disorder patients a difficult patient population to treat?
Chronic, difficult to treat
High utilizers of the medical systems
Three common risks of somatic system disorder diagnosis
Repetitive, unnecessary testing
Invasive medical and surgical workups
Medically induced illness
Gender most commonly afflicted with somatic disorders
Female
Criteria for somatic symptom disorder (4)?
- Chronic somatic symptom(s) about which people are excessively concerned, preoccupied, or fearful
- Significant distress and dysfunction
- Patients are rarely reassured and often find care inadequate
- Lasts for more than 6 months
Important tenant of management or somatic symptom disorder
Set realistic goals for reduced (not absent) pain
Increase function
Two diseases commonly comorbid with somatic symptom disorder?
Anxiety and Depression
Illness anxiety disorder was previously referred to as…
hypochondriasis
Symptoms seen in Illness Anxiety Disorder
4 Ds (Disease Fear, Disease Preoccupation, Disease Conviction, Disability)
What gender tends to get Illness Anxiety Disorder
Equal Prevalence
Major risk in Illness Anxiety Disorder patients…
Missing medical diagnoses due to symptoms being assumed to be IAD related
Iatrogenic complications
Treatment for illness anxiety disorder
Cognitive Behavioral Therapy
Relaxation and Supportive Psychotherapy
SSRIs
Functional neurological symptom disorder criteria…
Symptom(s) of altered voluntary motor or sensory fxn
Incompatibility of symptoms with recognized syndromes
Not better explained by another disorder
Distress and Impairment
Examples of motor symptoms seen in functional neurological symptom disorder
Weakness, Paralysis
Tremors
Dystonic Movements
Pseudoseizures
Examples of sensory symptoms seen in functional neurological symptom disorder
Distractibility
Sensory symptoms split at midline
Gap between tested strength and fxn
La belle indifference
What does la belle indifference refer to
When patients are very chill about symptoms they should be freaking out about
What gender is more prone to functional neurological symptom disorder?
Females
At what age do conversion disorder symptoms tend to develop?
Adolescence and early adulthood
How is functional neurological symptom disorder treated?
Treat anxiety/depression
Hypnosis
Frame to patient as “stress related”
Key criteria for psychological factors affecting other medical conditions?
Factors have influenced course of medical condition
Factors interfere with treatment of condition (adherance)
Factors constitute well-established health risks for the individual
Give two examples of psychological factors affecting other medical conditions
Obesity and diabetes Smoking and COPD Alcohol Abuse and Liver Disease Anxiety and Asthma Chronic Occupational Stress and Hypertension
Factitious disorder has what two types
Imposed on self and imposed on another (by proxy)
Key criteria of factitious disorder
Individual presents as ill, impaired, or injured
The behavior is deceptive with absence of obvious external rewards
What does Factitious Disorder by proxy tend to look like
Women age 20-40, often connected to health care acting on children
Somatic Symptom Disorder.
Voluntary or Involuntary Symptoms?
Conscious or unconscious motivation?
Involuntary
Unconscious
Factitious Disorder
Voluntary or Involuntary Symptoms?
Conscious or unconscious motivation?
Voluntary
Unconscious
Malingering
Voluntary or Involuntary Symptoms?
Conscious or unconscious motivation?
Voluntary
Conscious
