Psych- Somatic Symptom and Related Disorders

Question 1

The diagnosis of Somatic Symptom disorder is based on ….

Answer 1

Distressing somatic symptoms

+

Abnormal thoughts, feelings and/or behaviors in response to these symptoms

Question 2

Somatic Symptom Disorder Criteria

Answer 2

**Distressing Somatic symptoms that disrupt daily life and lasting > 6months **

_Symptoms include one of the following: _

• persistent thoughts about the seriousness of symptoms
• persistent anxiety about the health or symptoms
• excessive time and energy devoted to symptoms or health concerns

Question 3

Persistent somatic symptoms are more associated with these populations of people…

Answer 3

Older, Female, low SES, Little education, unemployed

Sexual abuse or other child adversity in history

concurrent medical illness

Comorbid psych illness - depression, anxiety, panic

Question 4

What is illness anxiety disorder and how does it present?

Answer 4

Preoccupation of having or acquiring serious illnes sbut somatic symptoms are mild or absent

Have a high level of anxiety/alarm about health and exhibit either 1) excessive health behaviors or 2) maladaptive avoidance

Question 5

What are characteristics of people who get IAD?

Answer 5

MEN AND WOMEN ARE EQUAL

Thick chart patient

relationship with health care providers tinged with hostility and frustration

Depression and Anxiety common with it

Question 6

What is the best way to manage a patient with IAD or SSD?

Answer 6

1 primary physicial with regularly schedule appointments that ar_e NOT contingent on symptoms _

Regular physical exams

Invasive testing based on OBJECTIVE physical abnormalities

Keep meds to a minimum bc they get all of the negative side effects

Take them seriously!

ID comorbidity - depression, anxiety, pain

Question 7

What is Conversion Disorder (aka Functional Neurological Symptom disorder)?

Answer 7

Rapid and sudden onset of loss of /one or more symptoms of altered voluntary motor or sensory function that is incompatible with neuro or medical diagnosis

Deficit/symptom causes significant distress or impairment and can not be better explained by another medical or mental disorder

• [Generally occurs following a severe stressor]*
• THEY HAVE THE SYMPTOM BUT IT IS NOT DUE TO UNDERLYING PROBLEM*

Question 8

What are some diagnostic clues for Conversion disorder (aka Functional Neurological Symptom Disorder)?

Answer 8

Pseudo-seizures = Non-epileptic seizures on EEG during seizure

Aphonia but cough intact (meaning vocal cords can close)

Symptoms do NOT conform to known anatomical pathways - ex exact midline

Intact Reflexes

Tubular visual fields

HOOVER’s Sign - Surreptitious strength testing

Weak ankle plantar flexion in bed but can walk on tiptoes

Comatose pt does not allow hand to fall on face

Question 9

What kinds of people develop conversion disorder?

Answer 9

Women

More common in rural areas

Onset late childhood/early adulthood

Psychologic Factors

Question 10

What psychologic factors predispose for conversion disorder?

Answer 10

history of conversion symptoms or somatization disorder!

Associate psychopathology

Model for symptom (people wtih non-epileptic seizures are ppl w epilepsy)

Emotional stress prior to onset!!!!

history of sexual abuse

youngest child of same sex

Question 11

What is La Belle Indifference? When do you see that?

Answer 11

its when a person with conversion disorder doesn’t care about their symptom

Question 12

What should you NOT do in treatment of conversion disorder?

Answer 12

Confront the patient that the symptoms are psychological …can be harmful

Question 13

How can you treat conversion disorder/remove the symptom?

Answer 13

REassurance

Suggestions - predict step-wise recovery

attitude of supportive optimism

hypnosis

resolve psychosocial stresses

psychotherapy

Question 14

What is “Psychological factors affecting other medical conditions?”

Answer 14

Pt has a medical condition or symptom and his/her psychological or behabioral factors adversely affect medication condition in one of these ways:

• the course of condition
• interfering wiht treatment (adherence)
• adding additional health risks
• influencing underlying pathophysiology

Question 15

What are some examples of “psychological factors affecting other medical conditions?”

Answer 15

ex. Girls w/ diabetes want to lose weight and manipulate their insulin therapy
ex. angina precipitated by frequent bouts of rate
ex. poor coping to stressful life events and worsening migraines

Question 16

What is Pseduocyesis?

Answer 16

False belief of being pregnant with objective signs and symptoms of prenancy

Question 17

What is Factitious Disorder (imposed on self)?

Answer 17

Falsification of physical signs/symptoms or injury with deceptive behavior in the absence of obvious external rewards

the GOAL is to achieve the role of the patient

Question 18

What is the classic presentation of Munchausen’s Type Factitious Disorder?

Answer 18

MEN PATIENTS!!!

history of multiple hospitalizations in wide range of geographic locations using aliases

PResents history in dramatic manner - Pseudologia Fantastica

unusually submissive to hospitalization / invasive procedures

history of either self-mutilation or AMA discharges

Question 19

What is the presentation of Non-Munchausen’s Type FActicitous Disorder?

Answer 19

Female

Non-wandering

Unmarried

Young

History of medical or nursing training

Question 20

how do you manage someone with factitious disorder?

Answer 20

establish rapport

non-punitive supportive confrontation

Present the evidence and stress patients strengths and long history of suffering

OR non-confrontation techniques

-inexact interpretations, therapuetic double blind or face-saving techniques like hypnosis or biofeedback

Question 21

What is factitious disorder imposed on another?

Answer 21

Falsification of physical or psychological signs or symptoms in another (often mother child or caregiver position)

Deceptive behavior with absence of obvious external rewards

Diagnosis to the perpetrator

Question 22

What is malingering?

Answer 22

Conscious feigning of signs and symptoms for clearly identifiable external incentive or reward … like avoiding work, money, evading prosecution, or drug seeking

Question 23

What is Body Dysmorphic Disorder and under what category is it classified?

Answer 23

Classified under OCD!!!

Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others and then repetitive behavirors or metnal acts

Significant distress and preoccupation with appearance even though they know its silly (or even if they are convinced beliefs are true)

Question 24

When does Body Dysmorphic Disorder present and what is the course?

Answer 24

Age of onset around 12 or 13 and most cases before age 18 yo

high rates of suicide and comorbid major depression and social anxiety disorder

Can become housebound from it

Can lead to repetitive surgeries

Question 25

Treatment for Body Dysmorphic behaviors?

Answer 25

NO SURGERY

SSRIs are good for treatment of OCD

CBT can be helpful

chronic disorder needing lifelong treatment

Question 26

Compare and contrast conversion disorder, factitious disorder, and malingering

Answer 26

Conversion Disorder --> true symptom unconsciously produced

Factitious Disorder –> fake symptoms consciously produced for UNCONSCIOUS reasons

Malingering –> fake symptoms consciously produced for Conscious reasons

Question 27

compare and contrast SSD with IAD

Answer 27

SSD - excessive thoughts/feelings about somatic symptoms that disrupt daily life

IAD - disease fear/conviction with minimal somatic symptoms