Psych Somatic/Sensory DO

Question 1

Patient will present as → a 35-year-old female with c/o palpitations and chest pain for 2 days. She reports that she had been sweating with nausea and vomiting. She reports that she “checked her pulse which was about 156.” She denies any personal or family history of heart disease or anxiety disorders. She rated her chest pain as 10/10 “which radiates down my left arm and up my jaw.” ECG reads normal sinus rhythm. Troponin, CKMB and other labs were normal. When she was told that her labs were normal, she flopped onto the bed and started “seizing.” She stated, “I am seizing. Why won’t you help me?” When the ER PA calls her out, she got angry and left against medical advice.

Answer 1

Factitious DO

Question 2

Factitious DO

Answer 2

Factitious Disorder: (Malingering - For personal gain)
→ Disease Presentation:
Patient consciously reports false symptoms, or induces symptoms, with the goal of playing the “sick role

→ DSM-5: “Munchausen’s Syndrome”
WITHOUT A REWARD MOTIVE - patient acts like they have an illness by producing/exaggerating symptoms to obtain the “sick role”
“Munchausen’s Syndrome by Proxy” → factitious DO imposed on someone else (Gypsy Rose)

→ Treatment:
Conjoint PCP & Psych confrontation
Child must be removed by CPS

Question 3

Patient will present as → a 25-year-old male graduate engineering student who is at your office for the fourth time in 1 week to be sure he does not have chlamydia. Despite having one sex partner, he learned there is an increase in the incidence of STDs on campus. He reports that he has only had sex once but learned that chlamydia is hard to culture. He reports he may have dysuria intermittently but is not sure. He has been evaluated at each visit, and physical and laboratory examination has been completely normal each time.

Answer 3

Illness Anxiety DO

Question 4

Illness Anxiety DO

Answer 4

Illness Anxiety Disorder: “Hypochondriac”
→ Disease Presentation:
Obsession with the idea of having a serious but undiagnosed medical condition
→ DSM-5:
Worried about having/developing a serious illness
At least 6 MONTHS
No evidence/Physical symptoms
Maladaptive Avoidance of Situations
→ Treatment:
1st Line = Therapy
Regular reassurance appts
SSRIs = anxiety

Question 5

Patient will present as → a 25-year-old female who presents today with multiple complaints that have been ongoing for more than 6 months. She reports that “it all started about 10 months ago with pain in my neck, shoulders, back, legs, and feet.” She denies any trauma. There is no family history of juvenile rheumatoid arthritis or osteoarthritis. She stated that the pains do not respond to treatments, and they “just come and go making it difficult to hold a job.” She is constantly worried about her symptoms. Now, she has a headache, abdominal pain, bloating and “some seizures.” She previously had seen a headache specialist, gastroenterologist, and obtained a number of electrocardiograms in the emergency department. Their respective thorough workup was negative. Her mother had similar episodes as well. On physical exam, you note an anxious woman with a depressed affect. No significant physical exam findings are noted. Labs/imaging are all within normal range.

Answer 5

Somatic Symptom DO

Question 6

Somatic Symptom Disorder

Answer 6

Somatic Symptom Disorder:
→ Disease Presentation:
Preoccupation with having a serious illness

→ DSM-5:
PHYSICAL SYMPTOM that causes excessive thoughts, feelings and behaviors by the patient
Patient obsesses over a SYMPTOM (symptoms is real)
>6 MONTHS

→ Treatment:
Clinician-patient relationship with close follow up
CBT
Support / Biofeedback