First Aid CH12 Somatic Sxs & Factitious

Question 1

define somatic sx disorderS

Answer 1

disorders where pts present with somatic (body) sxs that are associated w/ sig functional distress, pt may or may not actually have a true medical condition, pt is fixated on somatic sxs and the concurrent emotions

Question 2

what are some somatic sx and related disorders?

Answer 2

somatic sx disorder
conversion disorder
illness anxiety disorder
factitious disorder
psychological factors affecting other medical conditions

Question 3

define somatic sx disorder

Answer 3

pt presents with at least 1 physical sx that they seek numerous work-ups and procedures for

• predominantly pain
• sxs must last at least 6 months

Question 4

risk factors for somatic sx disorder

Answer 4

F, older age, fewer years of education, lower socioeconomic status, unemployment, h/o sexual abuse

Question 5

prognosis for somatic sx disorder

Answer 5

chronic and debilitating, difficult to treat as pt will resist suggestions they’re dealing with mental health disorder

Question 6

define malingering

Answer 6

conscious feigning of sxs/medical condition in order to gain something

Question 7

define conversion disorder

Answer 7

pt has at least one neuro sxs (sensory or motor) that can’t be fully explained by a neurological condition, the pt is typically calm and unconcerned (la belle indifference), pts “convert” psychological distress to neuro sxs
- ex of sxs: blindness, paralysis, paresthesia, weakness, mutism, seizure, globus sensation (lump in throat)

Question 8

globus hystericus

Answer 8

lump in throat

Question 9

la belle indifference

Answer 9

calm and unconcerned

Question 10

tx of conversion disorder

Answer 10

education about illness, CBT, pts often spontaneously recover but recurrence is common (chronic)

Question 11

define illness anxiety disorder

Answer 11

pt preoccupied (has high lvl of anxiety) w/ having or acquiring a serious illness, somatic sxs often not present

Question 12

how long must illness anxiety disorder persist for?

Answer 12

6 months

Question 13

2/3rds of pts w/ illness anxiety disorder have?

Answer 13

coexisting major mental disorder

Question 14

tx and prognosis for illness anxiety disorder

Answer 14

PCP visits, CBT

- prognosis is okay, 60% of pts improve sig

Question 15

define psychological factors affecting other med conditions

Answer 15

psychological or behavioral factors that adversely affect a medical sx/condition by influencing treatment plans or precipitating further health risk (ex: depression)

Question 16

define Facticious Disorder (Munchhausen syndrome)

Answer 16

“pt” intentionally falsifies medical or psychological sxs (in self or another) in order to assume role of a sick pt (even to the extremes: central line, insulin inj) without want of external rewards

Question 17

what’s the prominent feature of Factitious Disorder?

Answer 17

absence of external rewards wanted by pt (unlike malingering), pt wants to assume sick role

Question 18

who’s more likely to have factitious disorder?

Answer 18

healthcare workers who’ve learned how to feign sxs, people w/ h/o illness and hospitalization, people w/ h/o childhood physical or sexual abuse

Question 19

tx for factitious disorder?

Answer 19

nonthreatening confrontation, though repeated long-term hospitalizations are common

Question 20

define malingering

Answer 20

intentional reporting of physical or psychological sxs to achieve personal gain

Question 21

reasons someone may use malingering

Answer 21

avoid police, receive room and board, obtain narcotics, recieve monetary compensation, avoid work

Question 22

what is malingering not?

Answer 22

a mental illness

Question 23

malingering presentation

Answer 23

multiple vague complaints that aren’t specific to a known medical condition, pts have a long medical history, uncooperative if what they want isn’t given and improve once desired objective is obtainted