Other Disorders Flashcards
What are the somatoform disorders?
The somatoform disorders are a group of psychiatric disorders that cause unexplained physical symptoms.
What is somatisation?
The tendency to experience psychological distress in the form of somatic symptoms and to seek medical help for these symptom
What are dissociative disorders?
Also known as conversion disorders.
Dissociative disorders are a range of conditions that can cause physical and psychological problems. Can occur following a traumatic life event.
This leads to the disruption of:
- Consciousness
- Memory
- Identity
- Perception
There is NO organic basis.
Give some symptoms of dissociate disorders
Partial/complete loss between memories of past, awareness of identity and immediate sensations, and control of bodily movements:
- feeling disconnected from yourself and the world around you
- forgetting about certain time periods, events and personal information
- feeling uncertain about who you are
- having multiple distinct identities
- feeling little or no physical pain
What is the theory behind dissociative/conversion disorders?
Conversion of anxiety symptoms into more
tolerable physical symptoms
Clinical signs of dissociate disorders
- Paralysis – 1/more limbs, or side of face/body
- Aphonia (loss of speech)
- Sensory loss – not fitting with dermatomes
- Seizures – generalised shaking, no tongue
biting/incontinence/injury - Amnesia – memory loss, most often for recent events
- Fugue – all features of dissociative amnesia, plus purposeful travel beyond usual every day range
How do dissociative disorders differ from factitious disorder or malingering?
unlike factitious disorders and malingering, the symptoms of somatoform disorders are not intentional or under conscious control of the patient
Management of dissociative disorders?
- Exclude organic nature of disease
- Acceptance and support
- Physical rehabilitation
- Treatment of comorbid mental disorder
- Clear presentation of diagnosis
- Avoid interventions which maintain the sick role/prolong abnormal features
- CBT/IPT, supportive psychotherapy
Which dissociative disorder is typically seen following traumatic or stressful events?
Dissociative amenesia (loss of memory)
Give some other dissociative disorders
- dissociative fugue
- dissociative stupor
- dissociative motor disorders
- dissociative anaesthesia
- trance and possession disorders
- dissociative compulsions (i.e. seizures with no organic basis)
- Gander syndrome
- Multiple personality disorder
What happens in dissociative fugue?
o Sudden, unexpected, memory loss and
confusion about identity or assumption of
another identity
o May last several months
o After fugue ends all memory of it is lost
What happens in trance and possession disorders?
o Temporary replacement of identity with a ghost/ spirit/deity/other person/animal/object
o Not seen by patient’s culture as acceptable
What happens in dissociative anaesthesia?
Loss of sensation
What happens in dissociative motor disorders?
Paralysis of muscle groups
Ataxia–> inability to stand or walk
What are somatoform disorders?
Medically unexplained symptoms
- Physical symptoms that cannot be accounted for by a physical disorder or other mental disorder
- Frequently accompanied by anxiety or depression
- Requests for medical investigations, in spite of repeated negative findings and reassurance
Management of somatoform disorders?
- Acceptance
- Clear and consistent explanation for the symptoms
- Reassure patient of continuing care
- Reduce/stop unnecessary medication
- Keep investigations to a minimum
- CBT and treatment of comorbid mental health disorders
Assessment of somatoform disorders?
- Look at previous medical records
- Full details of current symptoms
- Explore illness beliefs
- Explore psychiatric history
What childhood event are somatoform disorders typically associated with?
- Often history of childhood illness or increased parental anxiety
- Associated with childhood sexual abuse
Different somatoform disorders:
- Somatisation disorder
- Hypochondrial disorder
- Conversion disorder
- Persistent somatoform pain disorder
- Somatoform autonomic disorder
What is somatisation disorder?
- A long history of multiple, severe, frequently changing physical symptoms that cannot be accounted for by a physical disorder or other mental disorder
- Course chronic and fluctuating, often associated with disruption of social, interpersonal and family behaviour
Is somatisation disorder more common in males or females?
Females
What is hypochondrial disorder?
Persistent preoccupation with possibility of
having one or more serious and progressive physical disorders – eg cancer
Manifest persistent somatic complaints despite medical reassurance to the contrary
What population is at risk of hypochondrial disorder?
Med students (especially males)
What is malingering?
Manufacturing or exaggerating psychological and physical symptoms for a purpose other than assuming the sick role
For financial or other gain such as:
* Evading the police
* Claiming compensation
* Obtaining drugs – eg exaggerating pain to obtain morphine
* Obtaining shelter for the night
N.B. this is NOT a mental disorder
What is Munchausen Syndrome?
Factitious disorders are manufactured or exaggerated for the purpose of assuming the sick role
Fabricating signs of physical/mental disorder with primary aim of obtaining medical attention and treatment
What is an adjustment disorder?
A protracted response to a significant life event or life change characterised by significant emotional distress and disturbance that interferes with normal social functioning
E.g. migration, change of job, divorce, bereavement
Symptoms of adjustment disorder?
- Depressive symptoms
- And/or anxiety symptoms
- Inability to cope
- Not severe enough to warrant a diagnosis of
depressive or anxiety disorder - But impacts on social functioning
When do symptoms of adjustment disorder occur after the stressor?
- Occurs within 1 month of particular stressor
- Shouldn’t persist longer than 6 months after
stressor is removed
What are some risk factors for depression following bereavement?
- Previous history of depression
- Intense grief/depressive symptoms early on
- Few social supports
- Little experience of death
- Traumatic/unexpected death
A differential diagosis for adjustment disorder is Acute Stress Reaction (ASR). What is this?
This is a transient disorder that develops in response to exceptional physical and/or mental stress
How long does ASR typically last?
Typically subsides within hours or days. It should last no more than one month.
