Health anxiety, somatisation, med unexplained sx and ED Flashcards
Somataform Disorders
Patients remain agitated after examinations and tests show either:
a) no detectable structural or physical abnormalities
or
b)show abnormalities insufficient to explain the severity of response
- the distress and functional impairment caused are real
Most common:
- Somatisation Disorder
- hypochondrial Disorder
- Body dysmorphic Disorder
Somatisation
multiple, recurrent and frequently changing physical sx with absence of physiological explanation
ICD-10:
- At least 2y of sx and no physiological explanation
- persistent refusalof reassurance from several doctors that there is no physical cause of sx
- some degree of impairment due to sx and resulting behaviour
Somatisation example sx
GI
- N and V
- abdo pain
- constipation
- diarrhoaea
sexual
- loss of labido
- ED
- menorhogea
Urinary
- dysurea
- frequency
- retention
- incontinence
neuro
- paralysis
- parasthesia
- seizures
- difficulty swallowing
Hypochondriacal Disorder
misinterpret normal bodily sensations and seek conformatory diagnosis as opposed to seeking relief/reassurance
Body dysmorphic disorder
- preocupied with imagined or minor defect
- has to impair funtioning
- Overvalued idea and not delusion (somatic delusional disorder)
functional, conversion and dissociative disorders
terms used interchangable where psychic pain is converted to somatic or physical sx
eg fibromyalgia, IBS, chronic cough, chronic back pain, atypical chest pain, ME, dissociative seizures, functional weakness and sensory distortians
Factitious Disorder or Malingering
Factitious disorder
- aka munchausen syndrome
- focus is on primary gain of assuming sick role
- often a manifestaion of psychological distress
Malingering
- focus is on secondary gain
- eg avoiding military service, criminal justice prosecution, obtaining drugs or benefits etc
Munchausen syndrome by proxy
- form of abuse (classically parent and child)
DDX
- undiagnosed unkown medical coditon
- udagnosed known medical condition
- functional (disociating/conversion) = usually clearly defined and isolated
- facticious disorxer
- malingering
- somataform disorder (somatisation, hypochondriacle, body dysmorphic disorder)
- other psychiatric disorder
Other psychiatric disorder
- depression and panic disorder = sx episodic with this conditon and go with tx
- GAD = not limited to physical worries
- Difficult as half of smatisation have psychiatric disorder
med unexplained thought process
- Physical disorder sufficient to cause sx excluded? (no? then more investigations)
- sx secondary to other psychiatric disorder?
- postive evidence of functional disorder? (hoover sign in neuro sx, pain relief on defaction in IBS, tnderness at specific pointsin fribromyalgia)
- abdnormal response to sz? ( undue concern of sx = somatisation, undue concern of presence of underlying disorder = hypochondriacle, and undue concern over appearance = body dysmorphic disorder)
- sx fabricated? (primary or secondary benefit?)
*Lots of sx in young think somatisation
Somatisation RF
Femal
childhood sex abuse
growing up with general stress
somatisation prognosis
- chronic episodic course with waxing/waning sx often excerbated by stress
- bettwe outcome if abrupt onset, mild and absence of comorbitdity
mx
Body DD
- CBT (+ERP)
- SSRIs if mod-severe
somatisation/hypochondriacal
-CBT to decrease Sx
Treat comorbid conditions
somatisation GP role
- regular fixed intervals
- increased support at times of stress
- take seriously and encourage to talk about emotions
- limit medications to and investigations to absolutely necessary
- teach coping mechanisms and consider psychiatrist
- high threshold for specialist referal and investigations
Explanation and advice for dissociative functional disorder
- state what is wrong (you have functional seizures
- state what is not wronge ( you don’t have epilepsy)
- describe mechanism (body not damaged by not working properly)
- try metaphor (software not hardware)
- explain diagnosis (share results)
- state you believe (don’t think you are making up sx)
- emphasize common and others suffer
- emphasize its gets better as there is no damage
- emphasize self help - there are things YOU can do
