L9: Somatoform Disorders Flashcards
Def of Somatoform Disorders
Excessive concerns about physical symptoms or health.
DSM5 types of Somatoform Disorders
- Somatic symptom disorder
- Illness anxiety disorder
- Conversion disorder
- Factitious disorder
- Malingering
Description of Somatoform Disorders
DSM 5 Criteria of Somatic Symptom Disorders
what is another name of Somatic Symptom Disorders?
Somatization
Duration of Somatic Symptom Disorders
At Least 6 Months
Specific types of Somatic Symptom Disorders
Symptoms of Somatic Symptom Disorders
Epidemeology of Somatic Symptom Disorders
Etiology of Somatic Symptom Disorders
DSM 5 Criteria of Somatic Autonomic Dysfunction
Def of Pain Disorder
- There is persistent severe and distressing pain (for at least 6 months and continuously on most days), in any part of the body, which cannot be explained adequately by a physiological process or a physical disorder.
Epidemeology of Pain Disorder
- Somatoform pain disorder is more common in women (F: M = 2:1) and occurs in older patients (40s to 50s).
- Acute pain (< 6 months) is associated with anxiety disorder.
- Chronic pain (> 6 months) is associated with depressive disorder.
Manamgmet of Somatic Symptom Disorders
DSM 5 Criteria of Illness Anxiety Disorder
What is another name of Illness Anxiety Disorder?
Hypochondriasis
Epidemeology of Illness Anxiety Disorder
What is another name of Conversion disorder?
Functional Neurological Symptom Disorder
Def of Conversion disorder
an illness associated with either deficits in motor or sensory function as a result of internal psychiatric conflict or secondary gain.
Characters of Conversion disorder
Patients convert psychiatric problems to a neurological problem and then spontaneously convert back to normal.
what are common symptoms of Conversion disorder?
sudden paralysis of one limb or loss of vision after a traumatic event or conflict.
DSM 5 Criteria of Conversion disorder
- One or more symptoms affecting voluntary motor or sensory function.
- The symptoms are incompatible with recognized medical disorders.
- Symptoms cause significant distress or functional impairment or warrant medical evaluation.
DSM 5 Subtypes of Conversion disorder
a. With paralysis or weakness
b. With abnormalities in movements
c. With swallowing symptoms
d. With epileptic seizures
e. With anesthesia or sensory loss
f. With special sensory symptoms
g. With mixed symptoms
Symptoms of Conversion disorder
How Pseudo seizure is differentiated from Genuine seizure?
Epidemeology of Conversion disorder
- Onset typically adolescence or early adulthood
- Often follows life stress
- Prevalence less than 1%
- More common in women than men (9>0)
- Often comorbid with: Other somatic symptom disorders, Major depressive disorder, Substance use disorders
Etiology of Conversion disorder
Biological factors: decrease in metabolism of dominant hemisphere; increase in metabolism of non-dominant hemisphere.
Psychoanalytic theory: conversion disorder is a result of the repression of underlying unconscious conflicts, with the subsequent conversion of anxiety symptoms into a physical symptom.
what is La Belle Indifference?
lack of concern about illness.
Primary & secondary gain of Conversion disorder
Managment of Conversion disorder
Classification of Factitious disorder
There are four types of factitious disorder:
- Predominantly psychiatric signs and symptoms.
- Predominantly physical signs and symptoms.
- Combined physical and psychiatric signs and symptoms.
- Munchausen syndrome (hospital addiction syndrome) or Munchausen syndrome by proxy (hospital addiction imposed on a child by his or her parent)
DSM 5 Criteria of Factitious disorder
Def of Munchausen syndrome by proxy
a form of childhood abuse that an individual must have presented another individual to others as injured, impaired or ill, without the intention of gaining obvious external reward.
DSM 5 Criteria of Malingering
- Intentional production or feigning of physical or psychological signs or symptoms
- Motivation is a result of external incentive (e.g. avoid military action or appearance in court, making a false claim of insurance, avoiding the police, obtaining narcotics, and receiving monetary compensation.)
is Malingering a mental illness?
No
Somatic symptom disorder patients typically express ………. over their condition and chronically perseverate over it while conversion disorder patients often have an abrupt onset of their neurological symptoms (blindness, etc.) but appear ………..
lots of concern, unconcerned
Compare between Conversion Disorder, Factitious Disorder & Malingering in terms of:
- Primary Gain
- Secondary Gain
- Motive
- Behaviour
- Significant Others
- Gender
- Symbolism
- Personality Disorder
- Abreaction
- Observation
Conversion disorder: patients ………. psychological distress or conflicts into neurological symptoms.
convert
what is Dissociation?
- Defined as an unconscious defense mechanism involving the segregation of any group of mental or behavioral processes from the rest of the person’s psychic activity.
What are Dissociative disorders?
There is a disruption in one or more mental functions, such as: memory, identity, perception, consciousness, or motor behavior.
Dissociative Disorders may be ………… , and the signs and symptoms of the disorder are often caused by …………
- sudden or gradual, transient or chronic
- psychological trauma
DSM 5 Types Dissociative Disorders
- Depersonalization / derealization
- Dissociative amnesia
- Dissociative identity disorder
Description of Depersonalization / derealization
- Alteration in the experience of the self and reality
Epidemeology of Depersonalization / derealization
- Estimated to affect as high as 19% of the general population.
- It is more common in women with a F: M ratio = 4:1
Etiology of Depersonalization / derealization
Severe stress, anxiety or depression.
General Characters of Depersonalization / derealization
- Perception of self is altered
- Triggered by stress or traumatic event
- No disturbance in memory
- No psychosis or loss of memory
- Often comorbid with anxiety, depression
- Typical onset in adolescence
- Chronic course
- Symptoms are not explained by substances, another dissociative disorder, another psychological disorder, or a medical condition
DSM 5 Criteria of Depersonalization / derealization
Managment of Depersonalization / derealization
- Usually responds to anxiolytics and to both supportive and insight-oriented therapy.
- As anxiety is reduced, episodes of depersonalization decrease.
Description of Dissociative amnesia
- Lack of conscious access to memory, typically of a stressful experience.
- The fugue subtype involves traveling or wandering coupled with loss of memory for one’s identity or past.
Epidemeology of Dissociative amnesia
- Most common dissociative disorder, has a prevalence of 6% in the general population.
- More often in women than in men
- More often in adolescents and young adults than in older adults.
Etiology of Dissociative amnesia
a result of severe psychological trauma, the patient temporarily and unconsciously shut down the memory of all events in life.
DSM 5 Criteria of Dissociative amnesia
- Inability to remember important personal information, usually of a traumatic or stressful nature, that is too extensive to be ordinary forgetfulness.
- The amnesia is not explained by substances, or by other medical or psychological conditions.
- Specify: Dissociative fugue subtype if: the amnesia includes inability to recall one’s past, confusion about identity, or assumption of a new identity, and sudden, unexpected travel away from home or work.
what is Dissociative fugue subtype of Dissociative amnesia?
DDx of Dissociative amnesia
Distinguishing other causes of memory loss from dissociation:
- Dementia: Memory fails slowly over time - Is not linked to stress - Accompanied by other cognitive deficits - Inability to learn new information.
- Memory loss after a brain injury.
- Substance abuse.
Managment of Dissociative amnesia
Description of Dissociative identity disorder
At least two distinct personalities that act independently of each other.
Epidemeology of Dissociative identity disorder
tends to affect women with a F:M ratio = 5:1
Etiology of Dissociative identity disorder
maltreatment and severe childhood trauma are predisposing factors.
Characters of Dissociative identity disorder
DSM 5 Criteria of Dissociative identity disorder
Etiology of Dissociative identity disorder (In Details)
Managment of Dissociative identity disorder
- Supportive psychotherapy in the initial stage. (Consider CBT when the patient is stable.”
- CBT is useful in dealing with the multiple cognitive distortions that the patient has.
- Antidepressants reduce depression and enable the mood to be stabilized.
Def of Other Specified or Not Specified Dissociative Disorders
They are disorders in which the predominant feature is a dissociative symptom, such as a disruption in consciousness or memory, but that does not meet the criteria for specific dissociative disorder.
what do Other Specified or Not Specified Dissociative Disorders include?
- Ganser’s syndrome
- Trance & Possession Disorders
what is Ganser Syndrome?
- give approximate answers, psychogenic physical symptoms, hallucinations and apparent clouding of consciousness.
What is Trance Disorder?
- There is temporary alteration of the state of consciousness, shown by any two of loss of the usual sense of personal identity.
- Narrowing of awareness of immediate surroundings and selective focusing on environmental stimuli.
- limitation of movements, postures and speech to repetition of a small repertoire.
What is Possession Disorder?
The individual is convinced that he or she has been taken over by a spirit, power, deity or other person
