Dissociative, Somatoform, and Facticious disorders Flashcards
4 types of dissociative disorders
Which one is the most common?
Which one has the worst prognosis?
Dissociative
- Fugue
- Amnesia most common
- Identity disorder *worst prognosis)
- NOS
DSM for dissociative amnesia?
at least 1 episode of inability to recall personal identity information, but able to remember obscure details
patients report gap(s) in the recollection of a particular event
usually precipitated by a traumatic/stressful event
How to get patients with dissociative amnesia to try to remember things?
conduct interviews under hypnosis or Na-amobarbital or lorazepam - may help patients talk more freely
Patients with dissociative amnesia are highly comorbid with: 2
MDD and anxiety disorders
Prognosis of patients with dissociative amnesia?
good - many return to normal after minutes-days
diagnosis and treatment for dissociative amnesia?
conduct interviews under hypnosis or Na-amobarbital or lorazepam - may help patients talk more freely
psychotherapy; ø specific Rx is approved for amnesia
DSM for dissociative fugue?
how do these patients usually present?
- sudden, unexpected travel away from home + inability to recall one’s identity or past (may assume a new identity)
- pts are confused about new identity
pts are unaware of their amnesia/new identity; does not recall the period of the fugue; low anxiety despite their confusion
DDx of dissociative fugue?
dissociative amnesia dissociative identity disorder dementia delirium complex partial seizure bipolar d/o intoxication malingering
dissociative fugue treatment?
psychotherapy; ø specific Rx is approved for amnesia
What is dissociative identity disorder?
multiple personality disorder
DSM for dissociative identity disorder?
≥ 2 distinct personalities that take control of the person’s behavior; inability to recall personal personal information of one personality when the other is dominant
What are some of the social factors surrounding dissociative identity disorder?
When is this usually brought on? When is it usually diagnosed?
Usually F with prior history of trauma, esp. childhood physical or sexual abuse
Avg age of onset: 6
Avg age of diagnosis: 30
dissociative identity disorder is highly comorbid wtih:
MDD anxiety borderline personality disorder substance abuse suicide
How is dissociative identity disorder diagnosed and treated?
conduct interviews under hypnosis or Na-amobarbital or lorazepam - may help patients talk more freely
insight-oriented psychotherapy
What is depersonalization disorder (under DSM guidelines)
What is usually the precipitating factor?
persistent/recurrent feelings of detachment from one’s body, mental processes, or social situation; reality testing is intact!
STRESS
Depersonalization disorder is highly comorbid wtih
MDD
anxiety disorders
Treatment of depersonalization disorder?
anxiolytic or SSRI to treat associated sx of anxiety or MDD
What are the types of somatoform disorders? 7
somatization conversion hypochondriasis pain disorder body dysmorphic disorder undifferentiated somatoform disorder somatoform disorder NOS
How do patients with somatoform disorders present
enduring physical symptoms without an identifiable organic cause, which causes significant distress or impairment in social, occupational, or other area of functioning
TRULY BELIEVE that their symptoms are due to a medical problem; ie they are NOT consciously feigning symptoms
∆ btwn 1˚ gain and 2˚ gain
1˚ = unconscious defense against unacceptable internal conflicts
2˚ = unconscious external benefits (increased attention, decreased responsibility, avoidance of the law)
DSM for somatoform disorder
onset BEFORE 30 4 pain sx 2 GI sx 1 sexual/reproductive sx 1 pseudoneurological sx (localized weakness, sensation loss, tingling)
social history of a patient with somatoform disorder?
hx of sexual and/or physical abuse
treatment for patients with somatoform disorder?
regular scheduled visits with a single PCP who limits (but does not eliminate) medical workups in case there is an organic cause to the pain
address psychological issues - teach them how to be aware and express their emotions directly instead of developing physical sx
DSM for conversion disorder
≥ 1 neurological (sensory or motor) symptom that is not explained by a medical condition or intentionally feigned or produced, such as
- shifting paralysis
- blindness
- mutism
- paresthesias
- seizures
- globus hystericus (sensation of lump in throat)
patients are pretty calm and unconcerned (la bell indifference) when describing their symptoms
Ddx of conversion disorder? 5
Psomatization d/o undifferentiated somatoform d/o hypochondriasis facticious d/o malingering
Prognosis of conversion disorder?
sx may be brief or last for several weeks or longer; high recurrence rate
diagnosis and treatment of conversion disorder?
conduct interviews under hypnosis or Na-amobarbital or lorazepam - may help patients talk more freely
insight-oriented psychotherapy
What is hypochondriasis?
aka illness anxiety disorder
these patients have
- excessive behaviors (frequent checking body for illness, seeking reassurance from google), OR
- exhibit maladaptive avoidance (avoiding people who are mildly sick or refusing to travel far from their PCPs)
because they are preoccupied with fear of having/contracting a serious disease based on misinterpreting bodily symptoms despite medical evaluation and reassurance
DSM for hypchondriasis?
≥ 6 months of preoccupation with fear of having/contracting a serious disease based on misinterpreting bodily symptoms despite medical evaluation and reassurance; leads to significant impairment in functioning
hypochondriasis is usually comorbid with?
anxiety and depression, duh
treatment for hypochondriasis?
regular scheduled visits with a single PCP
CBT
SSRI for treatment of anxiety and depression
prognosis?
waxes and wanes; worsens under stress
What is body dysmorphic disorder?
- patients who are preoccupied with the body parts that they perceive as flawed or defective and have strong beliefs that they are unattractive or repulsive
- very self-conscious
- spend significant amount of time trying to correct the perceived flaws with makeup, procedures, or surgery
DSM for body dysmorphic disorder?
preoccupation with an imagined defect in appearance or excessive concern about a slight physical anomaly
body dysmorphic disorder is highly comorbid with:
depression
anxiety
psychotic disorders*
Who does body dysmorphic disorder usually happen in?
unmarried women btwn 15-20
Treatment of body dysmorphic disorder?
SSRIs
What characterizes pain disorder?
prolonged, severe discomfort without an adequate medical explanation (symptoms that are far in excess of the disease pathology)
DSM for pain disorder?
is it intentionally produced?
pain that is either
> 1 anatomic site (without radiation), OR
of sufficient severity to warrant clinical attention
not intentionally produced!
∆ btwn acute and chronic pain?
acute 6 mo
who is likely to suffer from pain disorder?
F, 30-50s
increased incidence in 1˚ relatives, blue-collar workers
pain disorder is highly comorbid with:
major depression
anxiety disorder
substance abuse (to treat pain)
Treatment of pain disorder?
What would you not treat them with?
SSRI
psychotherapy, biofeedback, hypnosis
NOT analgesics or narcotics because patients tend to become dependent on them
What is biofeedback therapy?
relaxation technique in which patients are trained to induce physiological ∆s that results in a relaxation response:
- alpha-waves on EEG
- vasodilation of peripheral capillaries
What is factitious disorder?
is this intentional or non-intentional?
is this considered to be 1˚ or 2˚ gain?
INTENTIONAL/CONSCIOUS production of medical or psychological symptoms in order to assume the role of a sick patient
aka PRIMARY gain (as there are no external incentives) - these patients tend to look for some kind of emotional gain, such as sympathy from others
Munchhausen syndrome is what type of disorder?
factitious disorder
factitious disorder is usually present in this patient population
hospital/health care workers; associated with higher intelligence, poor sense of identity, poor sexual adjustment
many with a history of child-abuse or neglect
factitious disorder is highly comorbid with:
borderline personality disorder
Malingering is coded on which Axis?
Axis I
What is malingering?
is this intentional or non-intentional?
is this considered to be 1˚ or 2˚ gain?
INTENTIONAL/CONSCIOUS feigning of physical or psychological symptoms in order to achieve a personal gain or external reward ($$, drugs)
SECONDARY gain
How do patients with usually present?
multiple vague complaints that do not conform to a known medical condition; often uncooperative and refuse to accept a good prognosis even after extensive medical evaluation
