BMB 3 - Somatic Symptom Disorders; Dissociative Disorders; Obsessive-Compulsive Disorder Flashcards
A patient is experiencing somatic symptoms that affect multiple organ systems and are unexplained by medical work-up.
What is the likely diagnosis?
Somatic symptom disorder
Name the technical name for hypochondriasis?
Illness anxiety disorder
Describe some of the S/Sy of illness anxiety disorder.
- Preoccupation with having or getting a serious illness
- Symptoms are not present or are mild
- The individual often performs excessive health-related behaviors
- Can be care seeking or care avoiding
How is illness anxiety disorder treated?
Treatment involves CBT
(SSRIs may also be helpful)
Define functional neurological symptom disorder (conversion disorder).
Symptoms of altered voluntary motor or sensory function that are incompatible with recognized neurological or medical conditions
There is a high rate of conversion disorder in those with a history of ________ injury.
There is a high rate of conversion disorder in those with a history of brain injury.
What disorder is characterized by conscious falsification of one’s own physical or physiological symptoms associated with no identifiable motive other than to assume the sick role?
Factitious disorder
What disorder is characterized by conscious falsification of another’s physical or physiological symptoms associated with no identifiable motive other than to assume the sick role (usually a mother falsifying onto a child)?
Factitious disorder by proxy
What kind of occupation do individuals with factitious disorder typically hold?
A paraprofessional medical field
(are knowledgeable about medical terms)
What disorder is characterized by conscious falsification of physical or psychological symptoms motivated by external incentives or “secondary gain?”
Malingering
Following a traumatic event, a patient presents with retrograde amnesia of important autobiographical information (episodic memory).
What do you suspect?
Dissociative amnesia
How is dissociative amnesia managed?
Most cases resolve spontaneously
A patient presents in the emergency department with no idea who he is or how he got there. He seems cognitively normal and alert besides the complete loss of memory.
What do you expect?
Dissociative fugue
Define dissociative identify disorder.
A disruption of identity characterized by two or more distinct personality states accompanied by related alterations in affect, behavior, memory, etc.
Describe the relative strength/dominance of the identities in dissociative identity disorder.
A dominant personality exists that is aware of the other alters
Typically, there are how many personalities of dissociative identity disorder?
5 - 10
What disorder is characterized by experiences of unreality, detachment, and/or being an outside observer to one’s thoughts and/or feelings?
Depersonalization/derealization disorder
Is depersonalization/derealization disorder typically ego-syntonic or ego-dystonic?
Ego-dystonic
How is OCD defined in the DSM-V?
Obsessions and/or compulsions that are time consuming (>1 hr/day) or cause clinically significant distress or impairment in functioning
What are the obsessions associated with OCD?
Recurrent, persistent thoughts, urges, or mental images that are experienced as intrusive and unwanted and cause anxiety or distress
(The individual attempts to ignore or suppress them.)
What are the compulsions associated with OCD?
Repetitive behaviors or mental acts the person feels driven to perform in response to an obsession or according to rigid rules
(hand washing, ordering, checking or mental acts like counting, praying, repeating words — aimed at reducing distress or preventing some dreaded event)
What etiologies are associated with OCD?
Strong genetic component
Presumed dysregulation of serotonin
Prefrontal cortex and basal ganglia involvement (likely hyperactivity in cortico-striatal-thalamocortical (CSTC) circuits, specifically the ventral cognitive loop (orbitofrontal cortex, caudate nucleus, and dorsomedial thalamus) (parallel CSTC circuits that control affect, mood, oculomotor functions and one of these circuits is the ventral cognitive loop))
What pharmacological agents are used to treat patients with OCD?
SSRIs/SNRIs (usually in higher than normal doses; treatment response takes much longer, give it ~3 months to see results)
Clomipramine (a TCA)
What form of CBT is indicated for OCD?
What is the response rate?
Exposure and Response-Prevention (ERP)
80%
True/False.
ECT is not very effective in treating CBT but may be useful to some.
True.
_______tomy, is effective in 25-30% of refractory, severe OCD cases. Side effects- include seizures, urinary issues, and apathy.
Cingulotomy, is effective in 25-30% of refractory, severe OCD cases. Side effects- include seizures, urinary issues, and apathy.
(Deepbrain-stimulation of the cingulate cortex is also being studied.)
A patient presents with a persistent preoccupation with perceived defects/flaws in her appearance that are not observable or appear slight to others.
What is the diagnosis?
Body dysmorphic disorder
What are the first-line treatments for body dysmorphic disorder?
CBT + SSRIs
(avoid surgery)
Name the diagnosis characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value, due to perceived need to save the items and distress associated with discarding them.
Hoarding disorder
What is the most effective treatment for hoarding disorder?
CBT behavioral therapy
What disorder is more common in women and adolescents and is characterized by recurrent pulling out of one’s hair (usually the scalp), leading to hair loss, with repeated attempts to decrease or stop the hair pulling?
Trichotillomania
How is trichotillomania treated?
SSRIs or clomipramine
What disorder is characterized by recurrent skin picking resulting in skin lesions with repeated attempts to decrease or stop skin picking?
Excoriation disorder
How is excoriation disorder treated?
Fluoxetine
What disorder of altered 5-HT function and frontostriatal circuits is characterized by a magnitude of aggressiveness that is grossly out of proportion to the provocation/psychosocial stressor?
- Verbal or physical aggression towards property, animal or others individuals occurring 2x/week for 3mo, not resulting in damage, destruction or physical injury*
- OR*
- 3 outbursts involving damage, destruction or physical injury occurring within a 12mo period*
Intermittent explosive disorder
Although there is no FDA-approved treatment for intermittent explosive disorder, what treatments may be useful?
CBT, SSRIs, mood stabilizers, and atypical antipsychotics have some evidence
What disorder is characterized by multiple events of deliberate and purposeful fire setting?
NOTE: tension or affective arousal before the act; doing this not for any gain or because of delusion but because it causes arousal.
Pyromania
How is pyromania treated?
Therapy + fire education
Describe kleptomania.
Recurrent failure to resist impulses to steal objects that are not needed for personal use or monetary value
How is kleptomania treated?
CBT
(may try SSRIs or naltrexone)
