Lectures 86, 87: Somatic Syndromes

Question 1

Somatic symptoms are associated with significant…

Answer 1

Distress and impairment

Question 2

In malingering disorder, what is conscious/unconscious?

Answer 2

Production of symptoms AND motivation are conscious

Question 3

In somatic symptom conversion, what is conscious/unconscious?

Answer 3

Production of symptoms AND motivation are unconscious

Question 4

In factitious disorder, what is conscious/unconscious?

Answer 4

Production of symptoms is conscious BUT motivation is unconscious

Question 5

Somatic symptom disorder requires…(3)

Answer 5

1. Symptom; 2. Disproportion concern related to symptom; 3. 6 months “symptomatic”

Question 6

What disorder is associated with the following statement: health concerns may assume a central role in the individual’s life

Answer 6

Somatic symptom disorder

Question 7

How might someone with somatic symptom disorder feel about medical care they receive?

Answer 7

Often feel that treatment is inadequate

Question 8

Describe presentation and course of somatic symptom disorder

Answer 8

Begins during adolescence, worsen into mid-20s, females > males, chronic, lives dominated by medical procedures which WORSEN course

Question 9

Describe etiology of somatic symptom disorder (3)

Answer 9

Hx abuse, learned behavior, belief that problems are physical and can be cured by doctor

Question 10

Key in treatment of somatic symptom disorder

Answer 10

Recognize disorder and treat with sensitivity

Question 11

Conversion disorders primary characteristic. Some examples?

Answer 11

One or more symptoms of altered voluntary motor/sensory function; weakness, altered senses, tremor

Question 12

What are two opposite responses to symptoms a person with conversion disorder might have?

Answer 12

La belle indifference (indifference to symptoms) or dramatic/histrionic presentation

Question 13

In conversion disorder, symptoms are voluntary/involuntary

Answer 13

Involuntary

Question 14

Conversion disorder symptoms often respond to…

Answer 14

Suggestion

Question 15

Describe gender preference and another association with conversion disorder

Answer 15

Female > male; lower education achievement/psychological sophistication

Question 16

Onset of conversion disorder is ________ and course is generally _______-___________

Answer 16

Acute; self-limited

Question 17

Onset of conversion disorder precipitated by…Cultural relevance of this?

Answer 17

Stress: conversion of psychological conflict –> physical symptom; some cultures it is more acceptable to have physical rather than psychological complaints

Question 18

Factitious disorder and malingering both involve…What distinguishes them?

Answer 18

Feigning symptoms without underlying pathology; motivation for symptom production

Question 19

Describe factitious disorder

Answer 19

Falsification of symptoms or induction of injury, associated with identified deception

Question 20

What might someone with factitious disorder do? (3)

Answer 20

Manipulate diagnostic instruments to give false readings, tamper with lab specimens, cause actual tissue damage

Question 21

Munchausen’s is diagnosed more often in (gender) characterized by…

Answer 21

Men; simulation of disease

Question 22

Is factitious disorder serious?

Answer 22

Yes: often unrecognized with significant morbidity

Question 23

How to recognize factitious disorder (4)

Answer 23

Discrepancies b/t findings and history, atypical illness course, failure to respond to therapies, resistance to releasing medical records

Question 24

Etiology of factitious disorder is related to the desires to…

Answer 24

Be the sick person: receive empathy, often related to early abuse or a recent stressor

Question 25

If a person is falsifying disease in another, it is called…

Answer 25

Factitious disorder imposed on another

Question 26

Managing factious disorder requires both _____ and ______ management, both involve

Answer 26

Acute and chronic; psych consultation

Question 27

Malingering is not…why?

Answer 27

A psychiatric diagnosis; for some gain

Question 28

Management of malingering first involves recognizing…

Answer 28

The motivation behind it

Question 29

Red flags for medically unexplained syndromes

Answer 29

Many somatic complaints + anxiety/depression + past history of “poorly defined medical disorders”

Question 30

Describe arm drop test findings

Answer 30

Non-organic illness, arm will miss face

Question 31

What tends to be normal in non-medical illnesses? This is associated with what non-medical gait?

Answer 31

Reflexes/Babinski; Dragging monoparetic gait

Question 32

Hoover’s sign

Answer 32

Involuntary extension of the “paralyzed” leg occurs when flexing the contralateral (normal) leg against resistance

Question 33

How can the sternum or forehead be used to detect sensory psychogenic?

Answer 33

Sternum/skull vibrates as a unit –> sensory loss should NOT stop at midline

Question 34

How to test to see if a tremor is psychogenic?

Answer 34

Have them do tremor on other side voluntarily with different frequency –> will entrain the frequency on the other side

Question 35

Psychogenic gaits tend to…(3)

Answer 35

Rapid onset, show significant variability, and demonstrate improvement with distraction

Question 36

Describe Astasia-Abasia

Answer 36

Dramatic gait: patient lurches wildly and falls only when there is someone or something nearby to catch them

Question 37

How to test to see if something is pyschogenic blindness (tasks [1] and exam [3])

Answer 37

Ask patient to do something that you don’t need to see to do just fine (sign name, touch fingers together); normal pupils, normal fundoscopic exam, nystagmus to OKN drum

Question 38

Psychogenic seizures are usually NOT…name some other hallmarks (6)

Answer 38

Stereotyped (all different); slow down at end, asynchronous body movements, side-to-side head throwing, eyes closed, crying/moaning, clenched mouth

Question 39

Are psychogenic seizures common?

Answer 39

Yes! Maybe up to 50% of those presenting with seizures in hospital

Question 40

Important other seizure on differential for psychogenic seizures?

Answer 40

Frontal lobe seizure

Question 41

In a psychogenic seizure, tongue biting is where (as opposed to where in non-psych seizures)

Answer 41

Tip; lateral

Question 42

Psychogenic coma: eyes/vestibular (4)

Answer 42

Eye lid fluttering, pupils small/reactive, nystagmus to OKN drum, calorics intact

Question 43

Psychogenic coma: sternal rub

Answer 43

They will withdraw