CM: Somatic and Dissociative Disorders

Question 1

What is somatic symptoms disorder?

Answer 1

at least one somatic symptom that is distressing or causing significant disruption of daily life
person has one of the following: disproportionate and persistent thoughts about seriousness of symptoms, persistently high levels of anxiety, excessive time and energy devoted to symptom or health concerns

Question 2

What is the course of somatic symptom disorder?

Answer 2

usually multiple somatic concerns, usually pain
may or may not be associated medical condition
course often chronic and sig. disability may develop

Question 3

What is the multifactorial approach to treatment of somatic symptom disorder?

Answer 3

regular visits w PCP - can learn typical symptoms, minimizes redundant testing and polypharmacy, new symptoms not necessary to see doctor, can recognize patterns
psychiatric referral only after trust - collaborative, NOT transfer

Question 4

What is treatment approach to pts w somatic symptoms disorder where the predominant symptom is pain?

Answer 4

educate pt about mind-body duality of pain
multi-disciplinary approach: PCP keeps pain manageable - non-invasive and non-narcotics (anti-depressants w both NE and 5-HT actions), rehabilitation doctor to maintain fxning, psychotherapist for psych aspects

Question 5

What is conversion disorder?

Answer 5

motor and/or sensory symptoms incompatible w neurological or medical condition
typical = paralysis, blindness, mutism, seizures, hemianesthesia, ataxia

Question 6

What are possible physical exam findings in conversion disorder?

Answer 6

hoover’s sign, weak plantar-flexion walking on toes, tremor changes as person distracted, actively resists lifting of eyelids during “seizure”, vision loss –> tunnel vision

Question 7

What is the course of conversion disorder?

Answer 7

onset often associated w stress or traumatic event
La belle indifference - seeming indifference in face of physical symptoms that would normally elicit distress/despair
normally resolves w/i days to weeks, can recur or develop new symptoms during times of stress

Question 8

What is somatization?

Answer 8

psychological distress manifesting as physical symptoms
not necessarily pathologic
involves mind-body disconnect, not conscious or intentional, not imaginary
can be learned by modeling or conditioning

Question 9

What is the treatment of conversion disorder?

Answer 9

psychotherapy to help pts cope w symptoms

avoid telling them there’s no reason for the symptoms

Question 10

What is illness anxiety disorder?

Answer 10

preoccupation w having or acquiring serious illness in absence of significant somatic symptoms (hypochondriasis)
person performs excessive health-related behaviors or avoids going to the doctor

Question 11

What is the course of illness anxiety disorder?

Answer 11

only one equally common in males and females, usually f > m

episodes can last months to yrs but usually resolve eventually, exacerbations during times of stress

Question 12

What is the treatment of illness anxiety disorder?

Answer 12

same as for conversion disorder

Question 13

How can it be recognized if a psychological factor is affecting another medical condition?

Answer 13

close temporal relationship b/w psych factor and dev, exacerbation, or delayed improvement of condition
factors interfere w treatment
factors cause additional health risks
factors affect underlying physiology of condition, causing worsening or need for medical attention

Question 14

What are examples of psychological factors affecting other medical conditions?

Answer 14

psychological distress, problematic interpersonal interactions, maladaptive coping styles and health behaviors (could include non-compliance)

Question 15

What is factitious disorder?

Answer 15

rare psychological disorder, symptoms or evidence of dz is intentionally induced or produced by pt
for privileges of the sick role = sanctioned dependency, attention and sympathy from others

Question 16

What is Munchausen syndrome?

Answer 16

most severe form of factitious disorder - person basically lives to be a patient

Question 17

What is factitious disorder by proxy?

Answer 17

person (typically mom) produces symptoms or illness in child for privileges of sick role (child abuse)

Question 18

What is malingering?

Answer 18

NOT a psychiatric disorder, symptoms or evidence of dz intentionally induced or produced solely for personal benefit (provision of food and shelter, avoidance of jail, military duty, or work, obtaining drugs for abuse, etc)

Question 19

What is dissociation?

Answer 19

partitioning off certain mental/behavioral processes from one’s subjective sense of present reality
not necessarily pathologic (highway hypnosis), can help get through traumatic events but can prevent psychological healing if it persists

Question 20

What is dissociative amnesia?

Answer 20

inability to recall important personal information usually following emotionally traumatic event
ability to learn new info and remember non-personal info is intact, otherwise completely intact

Question 21

What is dissociative identity disorder?

Answer 21

2 or more identities/personalities/alters that repeatedly take control of person’s thoughts and behaviors
typically amnestic for existence and behavior of “alters”
previously multiple personality disorder
typically have childhood abuse hx

Question 22

What is depersonalization/derealization disorder?

Answer 22

persistent or recurrent feelings of unreality and detachment from one’s own mental and physical being or with respect to one’s surroundings

Question 23

What are some approaches to treatment of dissociative disorders?

Answer 23

long term psychodynamic psychotherapy
medication-assisted interviewing - rare
hypnosis
treatment of any comorbid psychiatric disorders