First Aid: Somatoform Disorders and Factitious Disorders Flashcards
What must always be done when you suspect a somatoform disorder?
Rule out organic causes of symptoms (ex. CNS disease, endocrine disorders, connective tissue disorders
List some examples of somatoform disorders.
- Somatization disorder
- Conversion disorder
- Hypochondriasis
- Pain disorder
- Body dysmorphic disorder
Are those with somatoform disorders consciously feigning symptoms?
NO (they truly believe their symptoms are due to medical problems even though there is no organic cause for them)
What is primary gain?
Expression of unacceptable feelings as physical symptoms in order to avoid facing them
What is secondary gain?
Use of symptoms to benefit the patient (increase attention from others, decrease responsibilities, avoid the law)
What percentage of patients with somatoform disorders have comorid mental disorders (esp. anxiety and major depression)?
50%
What is the only somatoform disorder that is more common in men?
hypochondriasis (NOT IN DSM-V)
Pt presents to a new primary care physician with multiple vague complaints involving multiple organ systems after claiming none of his other doctors could help him or find anything wrong.
Somatization disorder
What is the DSM-IV criteria for somatization disorder?
- At least 2 GI symptoms
- At least 1 sexual or repro symptom
- At least 1 neuro symptom
- at least 4 pain sx
- Onset BEFORE AGE 30
- Cannot be explained by general medical condition or substance use
What percent of patients presenting to primary care have a somatization disorder?
5-10%
What is the gender difference in somatization disorder?
women 5-20X greater chance
What is the lifetime prevalence of somatization disorder?
.1-.5%
What is SES prevalence for somatization disorder?
greater in low SES groups
What is the prognosis for somatization disorder?
-Usually chronic and debilitating
What is the treatment for somatization disorder?
- Frequently scheduled visits to primary care
- Use of medications with caution (only with a clear indication)
- Relaxation therapy, hypnosis, etc.
What ALWAYS triggers the onset of conversion disorder?
Psychological stressor (though pt may not be able to connect the two)
What are the reactions of patients with conversion disorder when describing their s/s?
“la belle indifference”- suprisingly calm and unconcerned
What is the DSM-IV criteria for diagnosing conversion disorder?
- At least 1 neuro symptom
- Psychological factors associated with initiation or exacerbation of symptom
- Symptom not intentionally produced
- Cannot be explained by medical condition or substance use
- Causes significant distress or impairment in social or occupational functioning
- Not accounted for by somatization disorder or other mental disorder
- Not limited to pain or sexual symptom
What are common symptoms of conversion disorder?
- Shifting paralysis
- Blindness
- Mutism
- Paresthesias
- Seizures
- Globus hystericus (sensation of lump in throat)
What is the prevalence of conversion disorder?
20-25% incidence in general medical settings
What gender more commonly gets conversion disorder?
2-5 times more common in women than men
When is conversion disorder usually diagnosed?
at any age (usually adolescence or early adulthood)
What is the SES relation to conversion disorder?
higher in low SES groups
What are common comorbidities for conversion disorder?
Schizophrenia
Major depression
Anxiety disorder
What percentage of patients diagnosed with conversion disorder eventually receive medical diagnoses?
50%
What is the prognosis for conversion disorder?
- Symptoms resolve within 1 month
- 25% of patients eventually have future episodes, especially during times of stress
How might symptoms spontaneously resolve in patients with conversion disorder?
-After hypnosis
-After sodium amobarbital interview
(if you can uncover psychological trigger)
What is the DSM-IV criteria for body dysmorphic disorder?
- Preoccupation with imagined defect in appearance or excessive concern about a slight physical anomaly
- Must cause significant distress in the patient’s life
Who more commonly gets body dysmorphic disorder- men or women?
women > men
Who more commonly gets body dysmorphic disorder- married or unmarried individuals?
unmarried
What is the average age of onset for body dysmorphic disorder?
15-20 yo
What percent of people with body dysmorphic disorder have comorbid MDD?
90%
What percent of people with body dysmorphic disorder have comorbid anxiety disorder?
70%
What percent of people with body dysmorphic disorder have comorbid psychotic disorder?
30%
What is the treatment for body dysmorphic disorder?
SSRIs (reduce symtpoms in 50% of patients)
What is the DSM-IV criteria for pain disorder?
- Pt’s main complaint is of pain at 1 or more sites
- Pain causes significant distress in the patient’s life
- Pain has to be related to psychological factors
- Pain is not due to a true medical disorder
What are the two types of pain disorder?
acute (6 months) and chronic (over 6 months)
What gender is more likely to get pain disorder?
women 2X more likely
What is the average age of onset for pain disorder?
30-50
What is the SES relation for pain disorder?
increased in blue-collar workers
What are common comorbidities for pain disorder?
- Major depression
- Anxiety disorder
- Substance abuse
What is the differential diagnosis for pain disorder?
- Medical condition
- Hypochondriasis
- Malingering
What is the prognosis for pain disorder?
- Abrupt onset with increasing intensity for first several months
- Usually chronic and disabling course
What should NOT be used to treat pain disorder?
Analgesics (patients often become dependent)
What is the treatment for pain disorder?
- SSRIs
- Transient nerve stimulation
- BIofeedback
- Hypnosis
- Psychotherapy
What is the prominent feature of factitious disorder?
primary gain
What is the DSM-IV criteria for factitious disorder?
- Patients intentionally produce signs of physical or mental disorders
- They produce symptoms to assume role of patient
- There are no external incentives (ex. $)
- Either predominantly psychiatric complaints or predominantly physical complaints
What are some commonly feigned symptoms in factitious disorder?
- Hallucinations
- Depression
- Fever
- Abdominal pain
- Seizures
- Skin lesions
- Hematuria
What is Munchhausen syndrome?
factitious disorder with predominantly physical complaints (demand specific meds and are skilled at feigning symtpoms)
What is the prevalence of factitious disorder?
> 5% hospitalized patients
What is the gender difference in factitious disorder?
increased in males
Who typically has factitious disorder?
Hospital and health care workers
What is the link between child abuse/neglect and factitious disorder?
Inpatient hospitalizations resulting from abuse provided safe and comforting environment (linking sick role with positive experience)
What happens if someone with factitious disorder is confronted in the hospital?
they usually leave
What is the goal in malingering?
secondary gain (avoiding police, obtaining narcotics, getting monetary compensation)
What improves symptoms in malingering?
getting the secondary gain
What gender more commonly performs malingering?
men
