Moses- Somatic Disorders Flashcards
What disorder is being described?
- HYPOCHONDRIASIS
- PRESENCE OF DISTRESSING SOMATIC SYMPTOMS PLUS ABNORMAL THOUGHTS, FEELINGS, AND BEHAVIORS IN RESPONSE TO THOSE SYMPTOMS.
- PATIENT = CHRONIC MEDICAL CONDITION + SOMATIC SYMPTOMS. ???? = SOMATIC SYMPTOM DISORDER.
- PAINFULLY DEPRESSED AND ANXIOUS
Somatic Disorders
• PRIMARY CARE PRACTITIONERS ENCOUNTER UNEXPLAINED AND PERPLEXING SOMATIC COMPLAINTS IN UP TO % OF THEIR PATIENTS
40
MEDICAL EXPLANATIONS FOR COMMON PHYSICAL COMPLAINTS SUCH AS MALAISE, FATIGUE, ABDOMINAL DISCOMFORT, AND DIZZINESS ARE FOUND ONLY % TO % OF THE TIME
15
20
What somatic disorder is being described?
-also must have actual physical complaints
Somatic symptom disorder
What somatic disorder is being described:
- also fear of becoming ill, does not have to have accompanying symptoms and usually mild
illness anxiety disorder (formerly hypochondriasis)
What somatic disorder is being described?
-also pt. is unaware of why symptoms are happening
conversion disorder ( also known as functional neurologic symptom disorder)
What somatic disorder is being described?
-also want attention, want to be a part of the medical process
Facticious disorder (formerly known as Munchausen’s syndrome/ Munchausen’s by proxy)
Which somatic disorder?
• A 32-YEAR-OLD MAN WITH NO MEDICAL HISTORY PRESENTS TO AN URGENT CARE CLINIC COMPLAINING OF “GAS IN THE STOMACH,” SHORTNESS OF BREATH, AND SQUEEZING BACK PAIN THAT PREVENTS HIM FROM WORKING. OTHER SYMPTOMS INCLUDE A “JUMPING SENSATION IN THE LEGS” AND “POOR CIRCULATION IN THE HANDS AND FEET.” HE IS UNSURE ABOUT WHAT CONDITION HE MIGHT HAVE. HE IS SO CONCERNED ABOUT HIS HEALTH THAT HE HAS BEEN SLEEPING IN HIS CAR NEAR THE HOSPITAL FOR THE PAST FEW DAYS. HE HAS SEEN NUMEROUS DOCTORS OVER THE PAST 6 MONTHS AND, AFTER AN EXTENSIVE MEDICAL WORKUP, HAS BEEN TOLD THERE ARE NO OBVIOUS MEDICAL PROBLEMS. HE DOES NOT TAKE ANY MEDICATIONS. HE SMOKES OCCASIONALLY AND DENIES ILLICIT DRUG USE. HE IS CURRENTLY UNEMPLOYED. BOTH PARENTS ARE HEALTHY WITH NO FAMILY HISTORY OF HEART DISEASE OR CANCER. THE PHYSICAL EXAMINATION REVEALS AN ANXIOUS AND SOMEWHAT DRAMATIC MAN WHO USES FREQUENT HAND GESTURES. HE REPEATEDLY STATES, “THERE IS SOMETHING WRONG WITH MY HEART.” THE LABORATORY STUDIES INCLUDING COMPLETE BLOOD COUNT, BASIC CHEMISTRY PANEL, AND THYROID STUDIES ARE NORMAL. HE DOES CONCEDE THAT THINGS HAVE BEEN STRESSFUL FOR HIM OVER THE LAST FEW MONTHS AND THAT HE NOTICED A TEMPORAL CORRELATION BETWEEN THE STRESS AND THE SYMPTOMS. HE IS MOTIVATED TO GET BETTER AND HAS NO DESIRE TO COLLECT DISABILITY.
Somatic symptom disorder
What is a course of action if you are unsure of the diagnosis?
Have someone else look at case to clarify and help with diagnosis
Somatic symptom disorder is ONE OR MORE SOMATIC SYMPTOMS THAT ARE DISTRESSING OR RESULT IN SIGNIFICANT DISRUPTION OF DAILY FOR GREATER THAN MONTHS
LIFE
6
What somatic disorder is being described?
EXCESSIVE THOUGHTS, FEELINGS, OR BEHAVIORS RELATED TO THE SOMATIC SYMPTOMS OR ASSOCIATED HEALTH CONCERNS AS MANIFESTED BY AT LEAST ONE OF THE FOLLOWING:
DISPROPORTIONATE AND PERSISTENT THOUGHTS ABOUT THE SERIOUSNESS OF ONE’S SYMPTOMS.
PERSISTENTLY HIGH LEVEL OF ANXIETY ABOUT HEALTH OR SYMPTOMS.
EXCESSIVE TIME AND ENERGY DEVOTED TO THESE SYMPTOMS OR HEALTH CONCERNS.
SPECIFY IF: WITH PREDOMINANT PAIN (PREVIOUSLY PAIN DISORDER): THIS SPECIFIER IS FOR INDIVIDUALS WHOSE SOMATIC SYMPTOMS PREDOMINANTLY INVOLVE PAIN.
What is an important specifier of somatic symptom disorder?
SPECIFY IF: WITH PREDOMINANT PAIN (PREVIOUSLY PAIN DISORDER): THIS SPECIFIER IS FOR INDIVIDUALS WHOSE SOMATIC SYMPTOMS PREDOMINANTLY INVOLVE PAIN.
What somatic disorder is being described:
PREOCCUPATION WITH HAVING OR ACQUIRING A SERIOUS ILLNESS.
SOMATIC SYMPTOMS ARE NOT PRESENT OR, IF PRESENT, ARE ONLY MILD IN INTENSITY.
IF ANOTHER MEDICAL CONDITION IS PRESENT OR THERE IS A HIGH RISK FOR DEVELOPING A MEDICAL CONDITION (E.G., STRONG FAMILY HISTORY IS PRESENT), THE PREOCCUPATION IS CLEARLY EXCESSIVE OR DISPROPORTIONATE.
THERE IS A HIGH LEVEL OF ANXIETY ABOUT HEALTH, AND THE INDIVIDUAL IS EASILY ALARMED ABOUT PERSONAL HEALTH STATUS.
THE INDIVIDUAL PERFORMS EXCESSIVE HEALTH-RELATED BEHAVIORS (E.G., REPEATEDLY CHECKS HIS OR HER BODY FOR SIGNS OF ILLNESS) OR EXHIBITS MALADAPTIVE AVOIDANCE (E.G., AVOIDS DOCTOR APPOINTMENTS AND HOSPITALS).
ILLNESS PREOCCUPATION HAS BEEN PRESENT FOR AT LEAST 6 MONTHS, BUT THE SPECIFIC ILLNESS THAT IS FEARED MAY CHANGE OVER THAT PERIOD OF TIME.
THE ILLNESS-RELATED PREOCCUPATION IS NOT BETTER EXPLAINED BY ANOTHER MENTAL DISORDER, SUCH AS SOMATIC SYMPTOM DISORDER, PANIC DISORDER, GENERALIZED ANXIETY DISORDER, BODY DYSMORPHIC DISORDER, OBSESSIVECOMPULSIVE DISORDER, OR DELUSIONAL DISORDER, SOMATIC TYPE.
Illness anxiety disorder
In order to diagnose illness anxiety disorder,
one mush have illness preoccupation for at least months
6
What are the 2 specified types of illness anxiety disorder?
CARE-SEEKING TYPE: MEDICAL CARE, INCLUDING PHYSICIAN VISITS OR UNDERGOING TESTS AND PROCEDURES, IS FREQUENTLY USED.
CARE-AVOIDANT TYPE: MEDICAL CARE IS RARELY USED.
Review the list of common motor, sensory, and visceral symptoms associated with conversion disorder:
Review the list of presentations of Facticious Disorder
What is the treatment guideline for Somatic Symptom and Related Disorders?
CARE MD
What does the A stand for in CARE MD?
Assess
What does the R in CARE MD stand for in treating somatic disorders?
Regular visits
What does the E stand for in CARE MD for treating somatic disorders?
Empathy (the biggest piece)
What does the M stand for in the acronym CARE MD for treating somatic disorders?
Med-psych interface
What does the D stand for in the acronym CARE MD for treating somatic disorders?
Do no harm
