E2: Somatoform Disorders Flashcards
What conditions are often comorbid with somatic symptoms disorders?
Anxiety and depression
What are the 5 types of somatoform disorders?
- SSD
- Conversion disorder
- Illness anxiety disorders
- Body dysmorphic disorder
- Factitious disorder
What criteria must be meat for a diagnosis of SSD?
- One or more somatic symptoms that are distressing or result in significant daily disruption
- Excessive thoughts, feelings, or behaviors related to the somatic symptoms as manifest by at least one of: Disproportionate and persistent thoughts, high levels of anxiety, or excessive time and energy devotion
- present for at least 6 months
How do people with SSD often present?
- Complaints are usually colorful and exaggerated but lacking factual information
- inconsistent historians
- Often seek treatment from multiple providers
- takes multiple medications and undergoes multiple surgeries
What is the recommended treatment for SSD?
- CBT shown to decreased “health anxiety”
- Mindfullness
- Some benefit from amitriptyline or fluoxetine
- Regularly scheduled provider visits
What are the criteria for conversion disorder?
- > 1 symptoms of altered voluntary motor or sensory function that suggest a neurological or general medical condition
- Clinical findings provide evidence of incompatibility between symptoms and recognized neurological or medical conditions
- symptom or deficit is not better explained by another medical or mental disorder
- Significant distress
What is seen on physical exam in conversion disorder?
- Symptoms and physical exam are inconsistent
- PE is normal
What is the treatment of conversion disorder?
- Symptoms last from days to weeks and tend to remit spontaneously
- supportive, insight oriented psychotherapy for behavioral therapy can facilitate recover
- can use anxiolytics and relaxation techniques if appropriate
What are the criteria needed to have a diagnosis of illness anxiety disorder?
- A preoccupation with having or acquiring a serious disease
- No somatic symptoms, or if present are mild
- high level of anxiety about health
- Excessive health related behaviors or maladaptive avoidance
- At leads 6 months
What are the two types of illness anxiety disorder?
- Care seeking type (medical care or tests are frequently used)
- Care avoidant type (care is rarely used )
What is the recommended treatment for illness anxiety disorder?
- Best treated with reassurance and regular office visits
- Avoid unnecessary diagnostic procedures and medications
- individual or group therapy
What are the criteria needed to have a diagnosis of Body dysmorphic disorder?
- Preoccupation with an imagined defect in appearance that are not observable or appear slight to others
- Performing repetitive behaviors or mental acts in response to appearance concerns
- preoccupation results in significant distress or impairment in functioning
A continuum between body dysmorphic disorder and what other condition can exist?
Delusional disorder
What is the treatment of body dysmorphic disorder?
- Often pursue and receive medical/surgical treatments but these should be avoided
- CBT for false beliefs
- Behavior modifications and therapy
- Antidepressants
What criteria must be met for a diagnosis fo Factitious disorder imposed on self?
- Falsification of physical or psychological signs or symptoms, or induction of injury or disease associated with identified deception
- presents to others as ill, impaired, or injured
- external rewards for the behavior are absent
What are the criteria for a diagnosis fo Factitious disorder imposed on another?
- Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception
- Presents another individual (victim) to others as ill, impaired, or injured
- external rewards are absent
What is malingering?
- Not a psychiatric illness
- essential feature is intentional production of false or grossly exaggerated physical r psychological symptoms motivated by external reward
What is the treatment of malingering?
- Eliminate external incentive, which is the motivator
- Appropriate diagnostic evaluation are careful documentation
- confront the patient in a firm, confidential, and emphatic manner
