Factitious disorder, illness anxiety, somatic sx disorder

Question 1

somatic sx disorder

Answer 1

present with at least 1 physical sx. Frequently seek tx from many doctors –> extensive lab work up, diagnostic procedures, hospitalizations and/or surgeries. lots of concern over condition and preservate over it.
sx predominately pain, distressing or result in significant disruption
excessive thoughts, feelings or behaviors related to somatic sx or associated health concerns
course = chronic and debilitating, regularly scheduled visits with single PCP to dec work up and tx.
address psych issues slowly

Question 2

conversion disorder (functional neurological sx disorder)

Answer 2

at least one neuro sx not explained by another condition. usu calm and unconcerned when describing their sx
“patients convert psych distress to neuro sx”
1. at least 1 sx of altered voluntary motor or sensory fx
2. cannot be fully explained by neuro condition
3. patients calm and unconcerned (la belle indifference) when describing sx
4. causes severe distress/impairment warranting medical eval
5. common sx: paralysis, weakness, blindness, mutism, sensory complaints, sx, globus sensation (lump in throat)

tx: CBT, PT

Question 3

illness anxiety disorder

Answer 3

aka hypochondriac
1. preoccupation with having or acquiring serious illness
2. somatic sx not present or mild
3, high level of anxiety about health
4. performs excessive health related behaviors or maladaptive behaviors
5. 6+ months, not somatic sx disorder
men equally affected
regular PCP visit, CBT and SSRIs

Question 4

Factitious disorder

Answer 4

aka Munchhausen
intentionally falsify medical or psych sx to assume role of sick patient (causes danger central line infx, insulin injections)
ABSENCE OF REWARD
1. falsification of psych or physical signs or induction of injury or disease, associated with deception
2. deception evident even in absence of external reward
3. not explained by another mental disorder (delusional or psychosis)
4. can present own self
commonly feigned sx: hallucinations, depression, fever (heat thermometer), infection, hypoglycemia, abd pain, seizures, hematuria
tx: collect collateral info from family and other treaters

Question 5

malingering

Answer 5

intentional reporting of physical or psychological sx to achieve personal gain: avoiding police, receiving housing, narcotics, money, SSDI),
NOT a mental illness

presents with multiple vague complaints that dont conform to known medical condition
long medical history, many hosp stays, uncooperative and refuse to accept good prognosis, sx improve once objective is obtained

Question 6

Difference btw somatic sx, factitious and malingering

Answer 6

somatic: patient BELIEVES they are ill and do NOT intentionally produce or feign sx

Factitious: intentionally produce sx of illness because of a desire to assume the SICK role, not external reward
malingering: intentionally feign sx for EXTERNAL reward