liaison psych

Question 1

what is somatisation disorder preoccupied with

Answer 1

preoccupied with SYMPTOMS

Question 2

diagnosis somatisation

Answer 2

medically unexplained symptoms affecting multiple organ systems for 2 YEARS

Question 3

common symptoms in somatisation

Answer 3

GI- bloating, N &V, loose stools; CVR- breathlessness, pan; GU- dysuria, freq, discharge; skin- discolouration, strange sensations

Question 4

features somatisation

Answer 4

long complex medical histories. most frequently non specific and atypical.

Question 5

aetiology somatisation

Answer 5

childhood illness, Hx parental anxiety to illness, incr freq in 1st degree relative, childhood sexual abuse

Question 6

DDX somatisation

Answer 6

undiagnosed physical disorder, psych disorder, somatoform disorder

Question 7

what does pt with somatisation want from the consultation

Answer 7

diagnosis to explain the symptoms

Question 8

what is somatoform person preoccupied with

Answer 8

PAIN

Question 9

features somatoform disorder/diagnosis

Answer 9

severe and distressing pain, continuous and present for most days in any part of the body for 6 MONTHS

Question 10

what is hypochondriasis preoccupied with

Answer 10

diagnosis/disfigurement

Question 11

what is hypochondriasis and how long

Answer 11

health anxiety. for 6 MONTHS

Question 12

what can hypochondriasis be

Answer 12

overvalued fear of serious illness, or physical deformity

Question 13

what is bodydysmorphic disorder (hypochondriac)

Answer 13

normal variants in appearance misinterpreted as major

Question 14

what does a hypochondriac patient do and want at the end of consultation

Answer 14

reject advice and reassurance. wants the all clear

Question 15

what treatments can be used for somatoform disorders

Answer 15

CBT, SSRIs 2nd line

Question 16

what is conversion (dissociative disorder)

Answer 16

loss or disturbance in normal motor or sensory function

Question 17

what does conversion appear like initially

Answer 17

neurological, but symptoms will be clinically inconsistent or non anatomical

Question 18

features conversion

Answer 18

paralysis, speech loss, sensory loss, blind, non epileptic seizures, amnesia, fugue, stupor, trance

Question 19

why is it called conversion

Answer 19

repression of the conflict and conversion to physical symptoms

Question 20

what is fugue

Answer 20

dissociative state- unplanned wandering, journey from home. amnesia of personal identity

Question 21

management dissociative/conversion

Answer 21

supportive psychotherapy- explain temporary condition and no long lasting physical di1sability. prognosis good if short hx symptoms. ensure no organic basis, treat any underlying mood disorder

Question 22

secondary gain in conversion

Answer 22

not in diagnosis. but discuss with patient and family- is there avoidance of family conflict that is leading to maintenance of symptoms

Question 23

how do conversion and somatoform disorders differ

Answer 23

conversion have signs as well as symptoms. presents more acutely

Question 24

what is Munchausens/ factitious

Answer 24

deliberately feign or actually induce illness

Question 25

what happens in health anxieties

Answer 25

misinterpret normal bodily sensations for illness, increase anxiety makes symptoms worse

Question 26

when might physical illness lead to mental

Answer 26

medications eg steroids- depression; brain disease- depression; severe chronic illness- adjustment disorder, depression, anxiety

Question 27

when might mental illness lead to physical

Answer 27

medication eg antipsychotics- metabolic syndrome; decreased self care; decr adherence to medication and other treatment eg physio; refusal to eat or drink (severe depression)