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PSYCH ROTATION > First Aid: Somatoform Disorders and Factitious Disorders > Flashcards

First Aid: Somatoform Disorders and Factitious Disorders Flashcards

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1
Q

What must always be done when you suspect a somatoform disorder?

A

Rule out organic causes of symptoms (ex. CNS disease, endocrine disorders, connective tissue disorders

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2
Q

List some examples of somatoform disorders.

A
  • Somatization disorder
  • Conversion disorder
  • Hypochondriasis
  • Pain disorder
  • Body dysmorphic disorder
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3
Q

Are those with somatoform disorders consciously feigning symptoms?

A

NO (they truly believe their symptoms are due to medical problems even though there is no organic cause for them)

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4
Q

What is primary gain?

A

Expression of unacceptable feelings as physical symptoms in order to avoid facing them

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5
Q

What is secondary gain?

A

Use of symptoms to benefit the patient (increase attention from others, decrease responsibilities, avoid the law)

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6
Q

What percentage of patients with somatoform disorders have comorid mental disorders (esp. anxiety and major depression)?

A

50%

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7
Q

What is the only somatoform disorder that is more common in men?

A

hypochondriasis (NOT IN DSM-V)

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8
Q

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.

A

Somatization disorder

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9
Q

What is the DSM-IV criteria for somatization disorder?

A
  • 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
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10
Q

What percent of patients presenting to primary care have a somatization disorder?

A

5-10%

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11
Q

What is the gender difference in somatization disorder?

A

women 5-20X greater chance

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12
Q

What is the lifetime prevalence of somatization disorder?

A

.1-.5%

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13
Q

What is SES prevalence for somatization disorder?

A

greater in low SES groups

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14
Q

What is the prognosis for somatization disorder?

A

-Usually chronic and debilitating

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15
Q

What is the treatment for somatization disorder?

A
  • Frequently scheduled visits to primary care
  • Use of medications with caution (only with a clear indication)
  • Relaxation therapy, hypnosis, etc.
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16
Q

What ALWAYS triggers the onset of conversion disorder?

A

Psychological stressor (though pt may not be able to connect the two)

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17
Q

What are the reactions of patients with conversion disorder when describing their s/s?

A

“la belle indifference”- suprisingly calm and unconcerned

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18
Q

What is the DSM-IV criteria for diagnosing conversion disorder?

A
  • 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
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19
Q

What are common symptoms of conversion disorder?

A
  • Shifting paralysis
  • Blindness
  • Mutism
  • Paresthesias
  • Seizures
  • Globus hystericus (sensation of lump in throat)
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20
Q

What is the prevalence of conversion disorder?

A

20-25% incidence in general medical settings

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21
Q

What gender more commonly gets conversion disorder?

A

2-5 times more common in women than men

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22
Q

When is conversion disorder usually diagnosed?

A

at any age (usually adolescence or early adulthood)

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23
Q

What is the SES relation to conversion disorder?

A

higher in low SES groups

24
Q

What are common comorbidities for conversion disorder?

A

Schizophrenia
Major depression
Anxiety disorder

25
Q

What percentage of patients diagnosed with conversion disorder eventually receive medical diagnoses?

A

50%

26
Q

What is the prognosis for conversion disorder?

A
  • Symptoms resolve within 1 month

- 25% of patients eventually have future episodes, especially during times of stress

27
Q

How might symptoms spontaneously resolve in patients with conversion disorder?

A

-After hypnosis
-After sodium amobarbital interview
(if you can uncover psychological trigger)

28
Q

What is the DSM-IV criteria for body dysmorphic disorder?

A
  • Preoccupation with imagined defect in appearance or excessive concern about a slight physical anomaly
  • Must cause significant distress in the patient’s life
29
Q

Who more commonly gets body dysmorphic disorder- men or women?

A

women > men

30
Q

Who more commonly gets body dysmorphic disorder- married or unmarried individuals?

A

unmarried

31
Q

What is the average age of onset for body dysmorphic disorder?

A

15-20 yo

32
Q

What percent of people with body dysmorphic disorder have comorbid MDD?

A

90%

33
Q

What percent of people with body dysmorphic disorder have comorbid anxiety disorder?

A

70%

34
Q

What percent of people with body dysmorphic disorder have comorbid psychotic disorder?

A

30%

35
Q

What is the treatment for body dysmorphic disorder?

A

SSRIs (reduce symtpoms in 50% of patients)

36
Q

What is the DSM-IV criteria for pain disorder?

A
  • 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
37
Q

What are the two types of pain disorder?

A

acute (6 months) and chronic (over 6 months)

38
Q

What gender is more likely to get pain disorder?

A

women 2X more likely

39
Q

What is the average age of onset for pain disorder?

A

30-50

40
Q

What is the SES relation for pain disorder?

A

increased in blue-collar workers

41
Q

What are common comorbidities for pain disorder?

A
  • Major depression
  • Anxiety disorder
  • Substance abuse
42
Q

What is the differential diagnosis for pain disorder?

A
  • Medical condition
  • Hypochondriasis
  • Malingering
43
Q

What is the prognosis for pain disorder?

A
  • Abrupt onset with increasing intensity for first several months
  • Usually chronic and disabling course
44
Q

What should NOT be used to treat pain disorder?

A

Analgesics (patients often become dependent)

45
Q

What is the treatment for pain disorder?

A
  • SSRIs
  • Transient nerve stimulation
  • BIofeedback
  • Hypnosis
  • Psychotherapy
46
Q

What is the prominent feature of factitious disorder?

A

primary gain

47
Q

What is the DSM-IV criteria for factitious disorder?

A
  • 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
48
Q

What are some commonly feigned symptoms in factitious disorder?

A
  • Hallucinations
  • Depression
  • Fever
  • Abdominal pain
  • Seizures
  • Skin lesions
  • Hematuria
49
Q

What is Munchhausen syndrome?

A

factitious disorder with predominantly physical complaints (demand specific meds and are skilled at feigning symtpoms)

50
Q

What is the prevalence of factitious disorder?

A

> 5% hospitalized patients

51
Q

What is the gender difference in factitious disorder?

A

increased in males

52
Q

Who typically has factitious disorder?

A

Hospital and health care workers

53
Q

What is the link between child abuse/neglect and factitious disorder?

A

Inpatient hospitalizations resulting from abuse provided safe and comforting environment (linking sick role with positive experience)

54
Q

What happens if someone with factitious disorder is confronted in the hospital?

A

they usually leave

55
Q

What is the goal in malingering?

A

secondary gain (avoiding police, obtaining narcotics, getting monetary compensation)

56
Q

What improves symptoms in malingering?

A

getting the secondary gain

57
Q

What gender more commonly performs malingering?

A

men

PSYCH ROTATION (18 decks)

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