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Question 1

Somatic Symptoms and Related Disorders

Answer 1

• Disorders with prominent somatic symptoms. Includes somatic symptoms disorders, illness anxiety disorder, coversion disorder, psychological factors affecting other medical conditions, factitous disorders, other specificied somatic symptoms and related disorders and unspecified somatic symptom and related disorders
• Diagnosis is made based on presence of symptoms and signs rather than absence of medical explaination - presence of medical diagnosis does not exclude possibility of co-morbid mental disorder. However, medically unexplained symptoms are still a key feature in conversion disorder where you much demostrate that symptoms are not consistent with meidcal pathophysiology

Question 2

Somatic Symptoms Disorder

Answer 2

• One or more symptoms that are distressing or result in significant disruption of daily life
• Excessive thoughts, feelings, or behaviours related to somatic symptoms or associated health concern charactreized by at least one of the following:
  
  • Disproportionate and persistent thoughts about the seriousness of one’s symptoms
  • Persistently high levels of anxiety about health or symptoms
  • Excessive time and energy devoted to these symptoms or health concers
• Symptomatic >6months (type symptoms may change within this period)
• Specificy if: with predominant pain; persistent (severe, marked impairment >6months)
• Diagnosis of somatic symptom disoder and a medical disorder are not mutually exclusive
• Patient may seek care from several doctors for the same symptoms; often unresponsive to medical intervention; unusually sensitive to medication side effects.
• A diagnosis of somatic symptom disorder is not made if symptoms only occur in the context of a major depressive episode

Question 3

Associated features of somatic symptoms

Answer 3

• Attention focused on somatic symptoms
• Attributed of normal boily sensations to physical illness
• Worry about illness
• Fear that physical activity may harm them
• Repeated body checking for abnormalities

Question 4

Illness Anxiety Disorder

Answer 4

• Preoccupation with having or acquiring a serious illness
• Somatic symptoms are not present, or if present, are only mild in intensity. If there is another medical condition or high risk of developing one the preoccupation is excessive and disproportionate.
• High level of anxiety about health and individual is easily alarmed about personal health status
• Individual perfroms excessive health related behaviours or shows maladaptive avoidance
• Illness preoccupation has been present for at least 6 months
• Illness related preoccupation is not better explained by another mental disorder
• Specifiy whether it is care seeking or care avoidant types

Question 5

Associated features of illness anxiety disorder

Answer 5

• In illness anxiety disorder somatic symptoms are either NOT present or mild
• Persons distress is not around physical complaint, but anxiety about the meaning, signifance, or cause of complaint.
• Concerns about undiagnosed disease do not respond to appropriate medical reassurance
• Illness becomes a central feature of identity and self-image

Question 6

Conversion Disorder (Functional Neurological Symptom Disorder)

Answer 6

• One or more symptoms of altered voluntary motor or sensory function
• Clincal findings provide evidence of incompatibility between the symptom and recognized neurological or medical conition
• Symptom or deficit is not better explained by anothe medical or mental disoder
• Symptoms cause clinically significant distress or impairment
• *Must of clear evidence of imcompatibility of disease. While the diagnosis of conversion disorder does not require judge that symptoms are not intentionally produced. However, definite evidence of feigning would suggest factitious disorder or malingering

Question 7

Psychological Factors Affecting other Medical Condition

Answer 7

• Presence of medical symptoms or condition
• Psychological or behavioural factors adversely affecting the medical condition in one of the following ways:
  
  • Factors have influenced the course of medical condition as shown by a close temporal associated between the psychological factors and development, exacerbation, or delayed recovery from the medical condition
  • Factors interfere with treatment of the medical condition
  • Factors constitute additional well-established health risks for the individual
  • Factors influence underly pathphysiology, preciptating ore exacerbating symptoms or necessitating medical attention
• Psychological and behavioural factors above are not better explained by another medical disorder
• *Psychological factors affects medical condition via the presence of behavours that adversely affect the medical condition by increasing risk of suffering, death, or disability

Question 8

Factitious Disorder Imposed on Self (or another)

Answer 8

• Falsification of physical or psychological signs or symptoms or induction of injury or disease (flasification or induction of a disease in another), associated with identified deception
• Individual presents themself as ill, impaired, or injured
• Deceptive behaviour is evident even in absence of obvious external rewards
• Behaviour is not better explained by another mental disorder, such as delusional disorder or antohre psychotic disorder

Question 9

Treatment Somatic Symptom Disoder

Answer 9

• Initial treatment: Primary care management with regularly scheduled visitis that do no depend on active symptoms. In these visitis work to establish a therapeutic allience, acknowledge and legitmize somatic sympomts, limit diagnostic testing and referrals to specialists, reassure that grave medical diseases have been ruled out - but be careful to bot do excessive reassurance as it may exacerbate fear or cause patient to think that symptoms are not being taken seriously, provide coping strategies, assess and treat comborbid psychiatric disorders, taper and discontinue unnecessary medications.
• Treatment resistant - CBT, mindfulness (70-90% will decline psychotherapy).
  
  • Amitriptyline - shows benefit for fatigue, functional symtpoms, global impairment, morning stifness, pain, sleep, and tender points.
  • Fluoxetine - benefits for functionals status, global well-being, morning stifness, sleep, and tender points.