psych somatoform and factitious disoders

Question 1

difference between primary and secondary gain

Answer 1

primary is when symptoms are a defense against internal conflict; secondary, symptoms provide unconscious external benefits (attention from others, avoidance of the law, etc)

Question 2

examples of somatoform disorders

Answer 2

somatization disorder, conversion, hypochondriasis, painn disorder, body dysmorphic disorder, undifferentiated somatoform disorder

Question 3

somatization disorde

Answer 3

multiple, nonspecific physical sx involving many organ systems; onset before age 30 (crucial criterion!)

Question 4

somatization disorder DSM criteria

Answer 4

onset before age 30, at least four pain symptoms, at least two GI sx, at least one sexual or repor sx; at least one neuro sx; when a medical condition is present, complaints are in excess of what would be expected;sx not intentionally produced

Question 5

prognosis of somatization disorder

Answer 5

sx may periodically improve but are worse with stress

Question 6

tx of somatization disorder

Answer 6

patient should have single primary care doc who limits (but does not eliminate) testing; address psych issues slowly

Question 7

conversion disorder

Answer 7

patients have a neuro sx that cannot be explained by a medical disorder; patients are calm and unconcerned when describing sx; examples incl blindness, paralysis, paresthesia

Question 8

diagnosis of conversion disorder

Answer 8

at leat one neuro sx; psych factors assoc with initiation or exacerbation of sx; not intentionally feigned; not limited to pain or sex dysfunction

Question 9

common sx in conversion disorder

Answer 9

shifting paralysis, blindess, mutism, paresthesias, seizures, globus hystericus (sensation of lump in throat)

Question 10

onset of coversion disorder

Answer 10

can be any age but most common in adolescence or early childhood

Question 11

conversion- treatment

Answer 11

most patients spontaneously recover but you can do psychotherapy

Question 12

hypochondriasis dsm criteria

Answer 12

preoccupatin with fear of having or contracting a serious disease, based on misinterpreting bodily sx; persists despite medical eval and reassurance; not of delusional intensity and not restricted to a circumscribed concern about appearance ;persists for at least 6 mos

Question 13

hypochondriasis must persist for at least how long?

Answer 13

six mos

Question 14

hypochondriasis epi

Answer 14

men affected as often as women; average age of onset is in their 20s; eighty percent have coexisting MD or anxiety

Question 15

treatment for hypochondriasis

Answer 15

regularly scheduled visits to one PCP; treat comorbid anxiety or depression with SSRI; CBT can also be used

Question 16

prognosis of hypochondriasis

Answer 16

sx wax and wane; exacerbations may occur under stress; up to half of patients improve significantly

Question 17

body dysmorphic disorder

Answer 17

preoccupied with body parts that they percieve as flawed; try to correct flaws with makeup, derm procedures, or plastic surgery

Question 18

average onset of body dysmorphic disorder

Answer 18

between ages 15 and 20

Question 19

treatment for body dysmorphic disorder

Answer 19

SSRIs

Question 20

pain disorder

Answer 20

patients have prolonged severe discomfort without adequate medical explanation; the pain often coexists with a medical condition but is not directly caused by it or not ully accounted for by it

Question 21

pain disorder timeframe

Answer 21

can be acute (less than 6 mos) or chronic (greater than 6 mos)

Question 22

dsm criteria for pain disorder

Answer 22

pain at one or more anatomic sites, of sufficient severity to warrant clinical attention

Question 23

epidemiology of pain disorder

Answer 23

women are twice as likely to have it as men; average age is 30-50; higher incidence in blue collar workers

Question 24

treatment of pain disordre

Answer 24

SSRIs, biofeedback, hypnosis, and psychotherapy; analgesics are not helpful

Question 25

prognosis for pain disorder

Answer 25

usually increases in the first several months and then becomes chronic and debilitating

Question 26

factitious disorder

Answer 26

intentionally produce medical or psych sx in order to assume the role of a sick ptient; primary gain is a prominent feature

Question 27

difference between fictitious disorder and malingering

Answer 27

in factitious disorder, you don’t have secondary gain; in malingering, you do

Question 28

factitious disorder is assoc with what?

Answer 28

hospital workers, higher intelligence, poor sense of identity and poor sexual adjustment

Question 29

malingering

Answer 29

feigning of physical or psych sx in order to achieve personal gain (external motivations)

Question 30

malingering epi

Answer 30

more common in men than women;

Question 31

somatization disorder versus conversion disorder presentation

Answer 31

in somatization disorder, the patient expresses a lot of concern over the condition; in conversion, the person is apathetic

Question 32

hypochondriasis is the only somatiform disorder that does not have a higher frequency in women

Answer 32

right

Question 33

Munchausen syndrome

Answer 33

another name for factitious disorder, with predominently physical complaints

Question 34

Munchausen syndrome by proxy

Answer 34

intentionally producing sx in someone else who is under one’s care (usually child)