Chapters 17, 18, 19

Question 1

What is somatic symptom disorder characterized by?

Answer 1

Characterized by a focus on somatic (physical) symptoms like pain or fatigue to the point of excessive concern, preoccupation, and fear

Question 2

DSM-5 criteria for somatic symptoms disorder

Answer 2

1. One or more somatic symptom that are distressing or disrupts daily life
2. Excessive thoughts, feelings or behaviors related to the somatic symptom such as:
   
   1. Disproportionate and persistent thoughts about the seriousness of symptoms
   2. Persistent high anxiety about health or symptoms
   3. Excessive time and energy devoted to these symptoms or health concern

Question 3

How do patients with somatic symptom disorder see their symptoms?

Answer 3

Patients see their symptoms as threatening, harmful, troublesome, and often fear the worst about their health

Question 4

When patients with somatic symptom disorder go to the doctor…

Answer 4

1. Provider unable to make clear diagnosis –> patient feeling discounted and misunderstood
2. Seeks help a lot but rarely alleviates patients concerns

Question 5

Illness anxiety disorder is characterized by..

Answer 5

Characterized by extreme worry and fear about the possibility of having a disease leading the frequent scanning of the body looking for signs of illness.

Question 6

DSM-5 criteria for Illness anxiety disorder

Answer 6

i. Preoccupation with having or acquiring a serious illness
ii. Somatic symptoms are not present or if present are mild
iii. High level of anxiety and easily alarmed about health
iv. Preforms excessive health related behaviors (checks body)
v. Illness preoccupation has been present for at least 6 months

Question 7

What happens when a patient with Illness anxiety disorder experiences stress?

Answer 7

Chronic and relapsing with symptoms increase during stressful times

Question 8

Thoughts with Illness anxiety disorder are..

Answer 8

Thoughts about illness are obsessive, intrusive, and hard to dismiss

Question 9

Do patients with Illness anxiety disorder go to the doctor?

Answer 9

1. Actual symptoms or complaints of symptoms are either mild or absent
2. Patient typically refuses a consult with mental health provider

Question 10

Conversion disorder is

Answer 10

1. functional neurological disorder
2. Abnormal pattern of cerebral activity
3. More common in females

Question 11

Risks factors for conversion disorder

Answer 11

low socioeconomic and educational status, low psychological sophistication, and rural setting

Question 12

Conversion diorder manifests as

Answer 12

1. neurological symptoms in absence of a neurological diagnosis
2. Deficits in voluntary motor or sensory functions including paralysis, blindness, movement disorders, gait disorder, numbness, loss of vision or hearing or episodes resembling epilepsy
3. La belle indifference: lack emotional concern about dramatic symptoms such as blindness

Question 13

Medication for treatment of somatic disorders

Answer 13

1. Unclear if medication treatment is useful
2. Must weigh the benefits against if people are going to misuse their medication or take it irregularly
3. TCAs and SSRIs may be helpful to reduce depressive symptoms, somatic responses and could help by affecting the nerve circuit that affect mood, fatigue, pain perception, GI distress and other somatic symptoms
4. May benefit form short term benzo use but must be monitored closely

Question 14

Patient with factitious disorder..

Answer 14

1. Consciously pretend to be ill to get emotional needs met and attain the status of patient
2. artificially, deliberately, and dramatically fabricate symptoms or self-inflict injury to assume the sick role
3. consciously conceal the true nature of illness
4. may report depression and suicidality after the death of a spouse spite the fact that it is not true or that he was not even married

Question 15

Sleep deprivation

Answer 15

1. A discrepancy between hours of sleep obtained and hours of sleep required for 2. Sleep deprivation has widespread implications for quality of life, health, and safety

Question 16

Anorexia is characterized by

Answer 16

Refusal to maintain minimally normal weight for their height and fear gaining weight

Question 17

How does a patient with anorexia behave?

Answer 17

Some restrict their food intake while others binge and purge

Question 18

How do you treat patients with anorexia?

Answer 18

1. Require long term treatment that may include periodic brief stays, outpatient psychotherapy, and pharmacological interventions
2. The patient has the greatest chance for success when the engage in individual, group, couples, and family therapy

Question 19

Recovery for anorexia

Answer 19

Recovery is considered a stage. This stage is defined by the percentage of ideal body weight that has been achieved, the extent to which self-worth is defined by shape and weight, and the amount of disruption existing in the patient’s personal life.

Question 20

DSM-5 criteria for anorexia

Answer 20

1. Restrictions of food relative to requirements leading to low body weight in the context of age, sex, developmental trajectory, and physical health.
2. Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain, even though add a significantly low weight
3. disturbance in the way in which one’s body’s weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of their current low body weight

Question 21

Bulimia is characterized by

Answer 21

1. Repeated episodes of binge eating followed by inappropriate behavior such as self-induced vomiting, misuse of laxatives, diuretics, use of other medications, fasting or excessive exercise
2. a significant disturbance in the perception of body shape and weight

Question 22

DSM-5 criteria for Bulemia

Answer 22

1. Recurrent episodes of binge eating
2. Recurrent inappropriate compensatory behaviors to prevent weight gain such as self-induced vomiting, misuse of laxatives, diuretics, or other medications fasting or excessive exercise
3. The binge eating and compensatory behaviors both occur on average at least once a week for three months
4. Self-evaluation is unduly influenced by body shape and weight
5. The disturbance does not occur exclusively during episodes of anorexia nervosa