Health Anxiety, Somatization and unexplained disorders

Question 1

Health Anxiety definition

Answer 1

excessive health-related concerns with somatic perceptions and reassurance seeking behaviors

Question 2

Somatisation definition

Answer 2

psychological distress manifesting in physical symptoms - help-seeking

Question 3

Hypochondria disorder definition

Answer 3

> 6 month of persistent worry about having a serious illness despite having medical reassurance

Question 4

What sex is affected more by health anxiety + by how much

Answer 4

F>M 10:1

Question 5

What are the 3 subtypes of health anxiety disorders + what are their definitions

Answer 5

1) cognitive - increased cognitive awareness + increased fear
2) somatizing - increased symptom awareness and more body symptoms
3) behavioural - increased disease conviction and avoidance

Question 6

.

Answer 6

.

Question 7

how do you diagnose a somatisation disorder

Answer 7

must be >2 years of multiple physical symptoms involving at least 2 different organ symptoms with multiple items, and can’t be medically explained

reassurance is not effective

Question 8

How do you diagnose a hypochondria disorder

Answer 8

> 6 months of a persistent belief of the presence of 1-2 serious physical diseases
OR
preoccupation with belief and symptoms that cause functional impairment and help-seeking
OR
persistent refusal to accept medical reassurance

Question 9

What is a factitious disorder

Answer 9

AKA Munchausen’s

feigns/exaggerates symptoms for no reason, often causing self harm in order to gain medical attention

Question 10

what is the definition of malingering

Answer 10

conscious manufacturing of symptoms for secondary gain

Question 11

what are some examples of abnormal illness behaviour

Answer 11

going to Drs often 
Not wanting to get better
Denying an issue
illness behavior continuing beyond an appropriate timescale
too many tablets/aids

Question 12

what is the definition of a dissociative/conversion disorder

Answer 12

Traumatic event leading to disruption in previously functional areas of consciousness, memory, identity or perception E.g. someone with amnesia after a significant event

There is often no insight

Question 13

what are some common presentations of conversion/dissociative disorders

Answer 13

Amnesia
Stupor
Motor Disturbance
Fuge 
Trance
Sensory loss
Pseudo-seizures

Question 14

What are the most common comorbidities that accompany somatoform disorders (+%s)

Answer 14

Anxiety (33%)
Depression (50%) 
Phobias
Schizophrenia 
OCD
Panic disorder

Question 15

What important comorbidity is NOT associated with somatoform disorders

Answer 15

Drug use

Question 16

Wha are the principles of management for somatiform disorders

Answer 16

1) Keep in primary care
2) Establishing a good rapport is essential - ensure the patient is heard and move convo from a ‘cure’ to symptom management
3) limit jargon use
4) schedule regular appointments with same healthcare professional
5) attempt to introduce psychological component of disease

Question 17

BioPsycoSocial approach for somatoform disorders

Answer 17

BIO
usually long term effectiveness weak 
SSRI/SNRI may be useful 
hypochondrial delusion = antipsychotic
AVOID BENZOs

PSYCHO
CBT
psychoeducation

SOCIAL
encourage normal function
involve supportive network

Question 18

what is the link between physical and mental health

Answer 18

Schizophrenia
2x risk of death from CVD
3x risk of death from resp disease
3x as likely to smoke

Stress is linked to increased cancer mortality

Depression
increased risk of ischaemic heart disease
2x as likely to smoke

Question 19

What are the differentials for medically unexplained symptoms

Answer 19

Depression/Anxiety
Some organic disorder (ME,SLE)
dissociative/conversion disorder
Psychosis/Schizophrenia

Question 20

What are the best ways to tell between a real disease presentation and some somatisation

Answer 20

no explanation for disease occurring

complaint is exaggerated/out of proportion for disease state