Lectures 86, 87: Somatic Syndromes Flashcards
Somatic symptoms are associated with significant…
Distress and impairment
In malingering disorder, what is conscious/unconscious?
Production of symptoms AND motivation are conscious
In somatic symptom conversion, what is conscious/unconscious?
Production of symptoms AND motivation are unconscious
In factitious disorder, what is conscious/unconscious?
Production of symptoms is conscious BUT motivation is unconscious
Somatic symptom disorder requires…(3)
- Symptom; 2. Disproportion concern related to symptom; 3. 6 months “symptomatic”
What disorder is associated with the following statement: health concerns may assume a central role in the individual’s life
Somatic symptom disorder
How might someone with somatic symptom disorder feel about medical care they receive?
Often feel that treatment is inadequate
Describe presentation and course of somatic symptom disorder
Begins during adolescence, worsen into mid-20s, females > males, chronic, lives dominated by medical procedures which WORSEN course
Describe etiology of somatic symptom disorder (3)
Hx abuse, learned behavior, belief that problems are physical and can be cured by doctor
Key in treatment of somatic symptom disorder
Recognize disorder and treat with sensitivity
Conversion disorders primary characteristic. Some examples?
One or more symptoms of altered voluntary motor/sensory function; weakness, altered senses, tremor
What are two opposite responses to symptoms a person with conversion disorder might have?
La belle indifference (indifference to symptoms) or dramatic/histrionic presentation
In conversion disorder, symptoms are voluntary/involuntary
Involuntary
Conversion disorder symptoms often respond to…
Suggestion
Describe gender preference and another association with conversion disorder
Female > male; lower education achievement/psychological sophistication
Onset of conversion disorder is ________ and course is generally _______-___________
Acute; self-limited
Onset of conversion disorder precipitated by…Cultural relevance of this?
Stress: conversion of psychological conflict –> physical symptom; some cultures it is more acceptable to have physical rather than psychological complaints
Factitious disorder and malingering both involve…What distinguishes them?
Feigning symptoms without underlying pathology; motivation for symptom production
Describe factitious disorder
Falsification of symptoms or induction of injury, associated with identified deception
What might someone with factitious disorder do? (3)
Manipulate diagnostic instruments to give false readings, tamper with lab specimens, cause actual tissue damage
Munchausen’s is diagnosed more often in (gender) characterized by…
Men; simulation of disease
Is factitious disorder serious?
Yes: often unrecognized with significant morbidity
How to recognize factitious disorder (4)
Discrepancies b/t findings and history, atypical illness course, failure to respond to therapies, resistance to releasing medical records
Etiology of factitious disorder is related to the desires to…
Be the sick person: receive empathy, often related to early abuse or a recent stressor
If a person is falsifying disease in another, it is called…
Factitious disorder imposed on another
Managing factious disorder requires both _____ and ______ management, both involve
Acute and chronic; psych consultation
Malingering is not…why?
A psychiatric diagnosis; for some gain
Management of malingering first involves recognizing…
The motivation behind it
Red flags for medically unexplained syndromes
Many somatic complaints + anxiety/depression + past history of “poorly defined medical disorders”
Describe arm drop test findings
Non-organic illness, arm will miss face
What tends to be normal in non-medical illnesses? This is associated with what non-medical gait?
Reflexes/Babinski; Dragging monoparetic gait
Hoover’s sign
Involuntary extension of the “paralyzed” leg occurs when flexing the contralateral (normal) leg against resistance
How can the sternum or forehead be used to detect sensory psychogenic?
Sternum/skull vibrates as a unit –> sensory loss should NOT stop at midline
How to test to see if a tremor is psychogenic?
Have them do tremor on other side voluntarily with different frequency –> will entrain the frequency on the other side
Psychogenic gaits tend to…(3)
Rapid onset, show significant variability, and demonstrate improvement with distraction
Describe Astasia-Abasia
Dramatic gait: patient lurches wildly and falls only when there is someone or something nearby to catch them
How to test to see if something is pyschogenic blindness (tasks [1] and exam [3])
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
Psychogenic seizures are usually NOT…name some other hallmarks (6)
Stereotyped (all different); slow down at end, asynchronous body movements, side-to-side head throwing, eyes closed, crying/moaning, clenched mouth
Are psychogenic seizures common?
Yes! Maybe up to 50% of those presenting with seizures in hospital
Important other seizure on differential for psychogenic seizures?
Frontal lobe seizure
In a psychogenic seizure, tongue biting is where (as opposed to where in non-psych seizures)
Tip; lateral
Psychogenic coma: eyes/vestibular (4)
Eye lid fluttering, pupils small/reactive, nystagmus to OKN drum, calorics intact
Psychogenic coma: sternal rub
They will withdraw
