BMB 3 - Somatic Symptom Disorders; Dissociative Disorders; Obsessive-Compulsive Disorder

Question 1

A patient is experiencing somatic symptoms that affect multiple organ systems and are unexplained by medical work-up.

What is the likely diagnosis?

Answer 1

Somatic symptom disorder

Question 2

Name the technical name for hypochondriasis?

Answer 2

Illness anxiety disorder

Question 3

Describe some of the S/Sy of illness anxiety disorder.

Answer 3

• 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

Question 4

How is illness anxiety disorder treated?

Answer 4

Treatment involves CBT

(SSRIs may also be helpful)

Question 5

Define functional neurological symptom disorder (conversion disorder).

Answer 5

Symptoms of altered voluntary motor or sensory function that are incompatible with recognized neurological or medical conditions

Question 6

There is a high rate of conversion disorder in those with a history of ________ injury.

Answer 6

There is a high rate of conversion disorder in those with a history of brain injury.

Question 7

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?

Answer 7

Factitious disorder

Question 8

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)?

Answer 8

Factitious disorder by proxy

Question 9

What kind of occupation do individuals with factitious disorder typically hold?

Answer 9

A paraprofessional medical field

(are knowledgeable about medical terms)

Question 10

What disorder is characterized by conscious falsification of physical or psychological symptoms motivated by external incentives or “secondary gain?”

Answer 10

Malingering

Question 11

Following a traumatic event, a patient presents with retrograde amnesia of important autobiographical information (episodic memory).

What do you suspect?

Answer 11

Dissociative amnesia

Question 12

How is dissociative amnesia managed?

Answer 12

Most cases resolve spontaneously

Question 13

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?

Answer 13

Dissociative fugue

Question 14

Define dissociative identify disorder.

Answer 14

A disruption of identity characterized by two or more distinct personality states accompanied by related alterations in affect, behavior, memory, etc.

Question 15

Describe the relative strength/dominance of the identities in dissociative identity disorder.

Answer 15

A dominant personality exists that is aware of the other alters

Question 16

Typically, there are how many personalities of dissociative identity disorder?

Answer 16

5 - 10

Question 17

What disorder is characterized by experiences of unreality, detachment, and/or being an outside observer to one’s thoughts and/or feelings?

Answer 17

Depersonalization/derealization disorder

Question 18

Is depersonalization/derealization disorder typically ego-syntonic or ego-dystonic?

Answer 18

Ego-dystonic

Question 19

How is OCD defined in the DSM-V?

Answer 19

Obsessions and/or compulsions that are time consuming (>1 hr/day) or cause clinically significant distress or impairment in functioning

Question 20

What are the obsessions associated with OCD?

Answer 20

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.)

Question 21

What are the compulsions associated with OCD?

Answer 21

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)

Question 22

What etiologies are associated with OCD?

Answer 22

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))

Question 23

What pharmacological agents are used to treat patients with OCD?

Answer 23

SSRIs/SNRIs (usually in higher than normal doses; treatment response takes much longer, give it ~3 months to see results)

Clomipramine (a TCA)

Question 24

What form of CBT is indicated for OCD?

What is the response rate?

Answer 24

Exposure and Response-Prevention (ERP)

80%

Question 25

True/False.

ECT is not very effective in treating CBT but may be useful to some.

Answer 25

True.

Question 26

_______tomy, is effective in 25-30% of refractory, severe OCD cases. Side effects- include seizures, urinary issues, and apathy.

Answer 26

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.)

Question 27

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?

Answer 27

Body dysmorphic disorder

Question 28

What are the first-line treatments for body dysmorphic disorder?

Answer 28

CBT + SSRIs

(avoid surgery)

Question 29

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.

Answer 29

Hoarding disorder

Question 30

What is the most effective treatment for hoarding disorder?

Answer 30

CBT behavioral therapy

Question 31

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?

Answer 31

Trichotillomania

Question 32

How is trichotillomania treated?

Answer 32

SSRIs or clomipramine

Question 33

What disorder is characterized by recurrent skin picking resulting in skin lesions with repeated attempts to decrease or stop skin picking?

Answer 33

Excoriation disorder

Question 34

How is excoriation disorder treated?

Answer 34

Fluoxetine

Question 35

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*

Answer 35

Intermittent explosive disorder

Question 36

Although there is no FDA-approved treatment for intermittent explosive disorder, what treatments may be useful?

Answer 36

CBT, SSRIs, mood stabilizers, and atypical antipsychotics have some evidence

Question 37

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.

Answer 37

Pyromania

Question 38

How is pyromania treated?

Answer 38

Therapy + fire education

Question 39

Describe kleptomania.

Answer 39

Recurrent failure to resist impulses to steal objects that are not needed for personal use or monetary value

Question 40

How is kleptomania treated?

Answer 40

CBT

(may try SSRIs or naltrexone)