PSYCH - somatic complaints

Question 1

What is the interaction of distress and pain?

Answer 1

• Pain can cause psychological distress
  
  • Psychological distress can cause pain
  • They are intertwined and linked. Sometimes you have to treat both

Question 2

What are patients worried about with somatic complaints?

Answer 2

• You’ll dismiss the pain as “all in their head”

* So ask about the physical symptoms and get a good history

Question 3

What do you need to help patients understand about their pain?

Answer 3

• The emotional impact it has on their life
• Ask about impact of symptons on life (function at work and home)
• Make statements that help that connection
○ Your pain might really aggravate your anxiety, and when anxious, it’s hard to deal with pain

Question 4

To help determine pain and distress (psycohological) what do you need to look for?

Answer 4

• Look for psychiatric ocmorbidities
• Ask about depression, anxiety, trauma, or psych symptoms that come up
• Determine if psych conditions are before or after pain/physical symptoms
• Help them make the connection between the physical and mental symptoms
○ Wow, no wonder you’re experienceing (blank) after those events
○ I think your struggles with )blank) make it harder to deal with physical pain

Question 5

What are the three DSM-5 diagnoses that are primary psychological causes of somatic/physical pain?

Answer 5

• Somatic symptom disorder
  
  • Conversion disorder
  • Factitious disorder
  • These are often comorbid with known physical diagnoses

Question 6

What is somatic symptom disorder?

Answer 6

• Persistent somatic symptoms associated with disproportionate thoughts, feelings, and behaviors related to these symptoms

Question 7

What is factitious disorder?

Answer 7

• Symptoms are falsified
○ Surreptitious admin of insulin to produce low blood glucose and symptoms
• There is no obvious secondary gain
○ If there is secondary gain = malingering
• Primary gain of obtaining nurturing/attention by being in the sick role is motivation for patient’s behavior
○ Often unconscious motivation
• Aka - munchausen syndrome

Question 8

What is conversion disorder?

Answer 8

• Symptoms are pseudo-nerological
○ Headache, seizures, paralysis, blindness
• Largely unconscious expression of the patient’s psychological distress