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Psychiatry > Dissociative, Somatoform, and Facticious disorders > Flashcards

Dissociative, Somatoform, and Facticious disorders Flashcards

1
Q

4 types of dissociative disorders
Which one is the most common?
Which one has the worst prognosis?

A

Dissociative

  • Fugue
  • Amnesia most common
  • Identity disorder *worst prognosis)
  • NOS
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2
Q

DSM for dissociative amnesia?

A

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

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3
Q

How to get patients with dissociative amnesia to try to remember things?

A

conduct interviews under hypnosis or Na-amobarbital or lorazepam - may help patients talk more freely

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4
Q

Patients with dissociative amnesia are highly comorbid with: 2

A

MDD and anxiety disorders

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5
Q

Prognosis of patients with dissociative amnesia?

A

good - many return to normal after minutes-days

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6
Q

diagnosis and treatment for dissociative amnesia?

A

conduct interviews under hypnosis or Na-amobarbital or lorazepam - may help patients talk more freely

psychotherapy; ø specific Rx is approved for amnesia

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7
Q

DSM for dissociative fugue?

how do these patients usually present?

A
  • 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

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8
Q

DDx of dissociative fugue?

A 
dissociative amnesia
dissociative identity disorder
dementia
delirium
complex partial seizure 
bipolar d/o
intoxication
malingering
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9
Q

dissociative fugue treatment?

A

psychotherapy; ø specific Rx is approved for amnesia

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10
Q

What is dissociative identity disorder?

A

multiple personality disorder

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11
Q

DSM for dissociative identity disorder?

A

≥ 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

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12
Q

What are some of the social factors surrounding dissociative identity disorder?

When is this usually brought on? When is it usually diagnosed?

A

Usually F with prior history of trauma, esp. childhood physical or sexual abuse

Avg age of onset: 6
Avg age of diagnosis: 30

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13
Q

dissociative identity disorder is highly comorbid wtih:

A 
MDD
anxiety
borderline personality disorder
substance abuse
suicide
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14
Q

How is dissociative identity disorder diagnosed and treated?

A

conduct interviews under hypnosis or Na-amobarbital or lorazepam - may help patients talk more freely

insight-oriented psychotherapy

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15
Q

What is depersonalization disorder (under DSM guidelines)

What is usually the precipitating factor?

A

persistent/recurrent feelings of detachment from one’s body, mental processes, or social situation; reality testing is intact!

STRESS

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16
Q

Depersonalization disorder is highly comorbid wtih

A

MDD

anxiety disorders

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17
Q

Treatment of depersonalization disorder?

A

anxiolytic or SSRI to treat associated sx of anxiety or MDD

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18
Q

What are the types of somatoform disorders? 7

A 
somatization
conversion
hypochondriasis
pain disorder
body dysmorphic disorder
undifferentiated somatoform disorder
somatoform disorder NOS
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19
Q

How do patients with somatoform disorders present

A

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

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20
Q

∆ btwn 1˚ gain and 2˚ gain

A

1˚ = unconscious defense against unacceptable internal conflicts

2˚ = unconscious external benefits (increased attention, decreased responsibility, avoidance of the law)

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21
Q

DSM for somatoform disorder

A 
onset BEFORE 30
4 pain sx
2 GI sx
1 sexual/reproductive sx
1 pseudoneurological sx (localized weakness, sensation loss, tingling)
22
Q

social history of a patient with somatoform disorder?

A

hx of sexual and/or physical abuse

23
Q

treatment for patients with somatoform disorder?

A

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

24
Q

DSM for conversion disorder

A

≥ 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

25
Q

Ddx of conversion disorder? 5

A 
Psomatization d/o
undifferentiated somatoform d/o
hypochondriasis 
facticious d/o
malingering
26
Q

Prognosis of conversion disorder?

A

sx may be brief or last for several weeks or longer; high recurrence rate

27
Q

diagnosis and treatment of conversion disorder?

A

conduct interviews under hypnosis or Na-amobarbital or lorazepam - may help patients talk more freely

insight-oriented psychotherapy

28
Q

What is hypochondriasis?

A

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

29
Q

DSM for hypchondriasis?

A

≥ 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

30
Q

hypochondriasis is usually comorbid with?

A

anxiety and depression, duh

31
Q

treatment for hypochondriasis?

A

regular scheduled visits with a single PCP
CBT
SSRI for treatment of anxiety and depression

32
Q

prognosis?

A

waxes and wanes; worsens under stress

33
Q

What is body dysmorphic disorder?

A
  • 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
34
Q

DSM for body dysmorphic disorder?

A

preoccupation with an imagined defect in appearance or excessive concern about a slight physical anomaly

35
Q

body dysmorphic disorder is highly comorbid with:

A

depression
anxiety
psychotic disorders*

36
Q

Who does body dysmorphic disorder usually happen in?

A

unmarried women btwn 15-20

37
Q

Treatment of body dysmorphic disorder?

A

SSRIs

38
Q

What characterizes pain disorder?

A

prolonged, severe discomfort without an adequate medical explanation (symptoms that are far in excess of the disease pathology)

39
Q

DSM for pain disorder?

is it intentionally produced?

A

pain that is either
> 1 anatomic site (without radiation), OR
of sufficient severity to warrant clinical attention

not intentionally produced!

40
Q

∆ btwn acute and chronic pain?

A

acute 6 mo

41
Q

who is likely to suffer from pain disorder?

A

F, 30-50s

increased incidence in 1˚ relatives, blue-collar workers

42
Q

pain disorder is highly comorbid with:

A

major depression
anxiety disorder
substance abuse (to treat pain)

43
Q

Treatment of pain disorder?

What would you not treat them with?

A

SSRI
psychotherapy, biofeedback, hypnosis

NOT analgesics or narcotics because patients tend to become dependent on them

44
Q

What is biofeedback therapy?

A

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
45
Q

What is factitious disorder?
is this intentional or non-intentional?
is this considered to be 1˚ or 2˚ gain?

A

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

46
Q

Munchhausen syndrome is what type of disorder?

A

factitious disorder

47
Q

factitious disorder is usually present in this patient population

A

hospital/health care workers; associated with higher intelligence, poor sense of identity, poor sexual adjustment

many with a history of child-abuse or neglect

48
Q

factitious disorder is highly comorbid with:

A

borderline personality disorder

49
Q

Malingering is coded on which Axis?

A

Axis I

50
Q

What is malingering?
is this intentional or non-intentional?
is this considered to be 1˚ or 2˚ gain?

A

INTENTIONAL/CONSCIOUS feigning of physical or psychological symptoms in order to achieve a personal gain or external reward ($$, drugs)
SECONDARY gain

51
Q

How do patients with usually present?

A

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

Psychiatry (12 decks)

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