Class 9 Flashcards
Name the somatic symptoms and related disorders
Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion Disorder - Functional Neurological Symptoms Disorder
Psychological Factors Affecting other Medical Conditions
Factitious Disorder
Other Specified Somatic Symptom and Related Disorder
Unspecified Somatic Symptom and Related Disorder
Somatic Symptom Disorder criteria
One or more somatic symptoms that are distressing or
result in significant disruption of daily life
Excessive thoughts, feelings, and behaviors…at least one ofthe following:
-Disproportionate and persistent thoughts about the
seriousness of one’s symptoms
-Persistently high level of anxiety about health or symptoms
-Excessive time and energy devoted to these symptoms
The state of being symptomatic is persistent typically
more than 6 months
Specify: predominate pain, persistent, mild (1B) moderate(2Bs), Severe (2Bs + multiple sx)
Epidemiology Somatic Symptom Disorder
5-6% Female:male = 2 3:1 Increased somatization with age Low socioeconomics, low education, rural onset 20s-30s
Illness Anxiety Disorder criteria
Preoccupation with having or acquiring a serious illness
Somatic symptoms are not present or only mild in
intensity
High level of anxiety about health, easily alarmed about
personal health status
Excessive health related behaviors or exhibits
maladaptive avoidance
Illness preoccupation minimum 6 months
Not better accounted for by another mental disorder
Specify: Care seeking type, Care avoidant type
Epidemiology Illness Anxiety Disorder
Gender Differences- None
Increased with age
Body Dysmorphic Disorder criteria
Preoccupation with one or more perceived defects or
flaws
Repetitive behaviors or mental acts in response
Significant distress or impairment
Appearance preoccupation in not better explained by
eating disorder
Specify: muscle dysmorphia, good or fair insight,
poor insight, absent insight/delusional beliefs
Epidemiology Body Dysmorphic Disorder
Female>=Male
Conversion Disorder criteria
One or more symptoms of altered voluntary motor or
sensory function
Clinical findings incompatible with neurological or
medical conditions
Not better explained by another disorder
Clinically significant distress or impairment
Specify: weakness or paralysis, abnormal movement,
swallowing symptoms, speech symptom, attacks or
seizures, anesthesia or sensory loss, special sensory
symptom (visual, olfactory, hearing), mixed symptoms
Clues to know it’s conversion disorder
Past history Secondary gain Belle indifférence: unconcerned about the problem Pain/ temperature split Vibration/ sensory split Changing pattern Give away weakness
Conversion disorder: good prognosis
Acute onset, comorbid psychiatric disorder,
change in marital status
Conversion disorder: course
30 60% chronic
Psychological Factors Affecting Other Medical
Conditions criteria
A medical symptom or condition is present
Psychological or behavioral factors adversely affect the
medical condition:
-Influence the course
-Interfere with treatment
-Present a well established health risk
-Influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention
Not better accounted for by another disorder
Specify: mild (increases medical risk), Moderate
(aggravates medical condition), Severe (results in
admission or ER visit), Extreme (life threatening ie:
avoiding treatment)
Factitious Disorder imposed on self criteria
Falsification of physical or psychological signs or
symptoms, induction of injury, disease, associated with
identified deception
Presents himself to others as ill, impaired, injured
Absence of obvious external rewards
Not better explained by another disorder
Specify: single or recurrent episodes
Factitious Disorder imposed on others criteria
Same Presents another individual (victim) to others as ill, impaired, injured Same Same Specify single or recurrent episodes
Munchhousen’s syndrome
Triad of:
Simulated illness
Pathological lying “pseudologica fantastica”
Wandering “peregrination”
Factitious Disorder epidemiology
Personality disorder
Antisocial (male)
Health Care workers (female)
Malingering
external incentive
Treatment of Somatoform Disorders
Rule out underlying medical illnesses Consultation Identify and treat physical components Investigate new symptoms Validate illness experience Provide a structure for help seeking Develop an illness model Treat comorbid psychiatric disorders Treat symptomatically Focus on optimizing functioning not eliminating symptoms Begin with life habits Elaborate psychological factors
Principles of treatment of Somatoform Disorders
The absence of a medical cause of physical
symptoms does not establish the presence of a
somatoform disorder
Review all medical work up
Consider the effects that a label of somatoform
disorder may have on future health care of the
patient
Treatment BDD illness anxiety disorder
resemble any other anxiety disorder
Treatment somatic symptom disorder
Requires structuring of chaotic symptoms and health
behaviour
Symptomatic treatment such as for pain
Consult letter for GP
Treatment conversion disorder
Physical rehabilitation approach
Hypnosis
Pharmacotherapy
Antidepressants (anxiety, depression, pain)
Antipsychotics for delusional level of illness
Benzodiazepines (sparingly)
Psychotherapy
CBT (+internet): THE BEST
Dynamic therapy (Abbass et al
Self guided therapies
MBSR
Comorbid SSD
anxiety, depression (the more physical sx you have, the more likely it’s depression), sud, histrionic personality disorder, BPD, OCPD, antisocial, PTSD
Etiology SSD
Genetic
Decrease in serotonin and endorphins
Psychodynamic: aggressive wishes towards others are transferred into physical complaints. Deserved punishment, defense against guilt, expression of low self-esteem
Family dynamics: some families have difficulty expressing emotions and resolving conflicts – child becomes ill to shift focus from conflict
Social learning: modeling
Transactional model of stress/ adaptation
SSD course
Fluctuating course. 1/3 improve significantly. Stressors. Easy on, easy off. Good prognosis: high socioeconomic status, treatment responsive anxiety/ depression, sudden onset, no personality, no GMC
Epidemiology conversion
+ W, left side of body 10-35 years, rural, low socioeconomic, low IQ, low education, military with combat.
*M: link with antisocial perso, involved in occupational/ military accident
Types od sx conversion
Paralysis, seizures, blindness
Coordination disturbance, urinary retention, deafness, anosmia, loss of pain sensations, pseudoyesis (false pregnancy)
Conversion vs SSD
conversion neurological in nature only
Primary gain
Excused from troublesome duties
Secondary gain
money
tertiary gain
gain for someone in the family
Malingering
for a secondary gain, an external reward
