Psych - Somatoform Disorders

Question 1

Somatoform Disorders

Answer 1

Illnesses in which physical symptoms present with NO DETERMINED underlying pathology

Question 2

Somatization

Answer 2

Describes a process by which psychological symptoms manifest as physical symptoms that are unattributable to any diagnosable underlying pathology in the patient

Either conscious or unconscious, the somatic process unifies the mind and the body - thus we have to treat the psychological symptoms in order to treat the physical!

Spectrum of somatization, from LEAST to MOST severe:

Psychosomatic
Somatoform
Factitious
Malingering

Question 3

Psychosomatic/Psychological Factors Affecting Medical Conditions (PFAMC)

Answer 3

There must be a DIAGNOSABLE, UNDERLYING MEDICAL CONDITION (heart failure) that is SECONDARILY COMPLICATED BY PSYCHOLOGICAL FACTORS of the patient

These factors affect the course of the disease in any number of ways:

1) Direct influence on the disease process - cigarette addiction will exacerbate asthma
2) Interference with treatment - denial of HIV can prevent patient from adhering to their medications
3) Constitute additional health risks – MDD can increase mortality amount TBI patients through suicide or self harm
4) Cause stress-related physiologically responses that exacerbate the underlying condition

Prevalence of PFAMC is very high, and thus clinicians of every field must build psychological coping mechanisms and treatments into the overarching regimens of their patients

CV, Immune, and GI systems are all very much affected by STRESS

Question 4

SOMATOFORM DISORDERS

Answer 4

Unifying factor is the presence of UNEXPLAINABLE PHYSICAL SYMPTOMS that are NOT PHYSICALLY PRODUCED

Somatoform disorder, conversion disorder, hypochondriasis, body dysmorphic disorder, pain disorder

Does the patient have preoccupation with their disease? Do they think the worst about their health or catastrophize despite medical opinion to the contrary? Do they ruminate/dwell on their illness? If EACH of these are satisfied, a somatoform diagnosis should be considered

Question 5

Somatoform Disorder

Answer 5

Much more common in WOMEN, presents with symptoms with NO EXPLANATION BEFORE the age of 30

Present repeatedly for medical care, despite NEGATIVE WORKUPS or with diagnoses that are incongruent with their symptoms

Pain, GI, Sexual and Neurological are often present

The symptoms are often DRAMATIC, WORRISOME to the clinician , NOT INTENTIONALLY PRODUCED

Rare - less than 0.4% of the population, patients with this compose ALMOST 5% OF THE PATIENT LOAD IN A TYPICAL OUTPATIENT PRACTICE

Question 6

Hypochondriasis

Answer 6

Preoccupation with the FEAR OF HAVING A DISEASE or being DISEASES DESPITE ASSURANCES OF HEALTH FROM PHYSICIANS

Often appears in patients with panic disorders or history of panic attacks

Closely related to the anxiety disorders (overly anxious about getting a disease) and may be a form of OCD; Medical Student Disease syndrome!!!

SSRI are effective

Question 7

Pain Disorder

Answer 7

Any person confronted with chronic pain, will - to some degree - also suffer psychologically

BUT there are specific behavioral patterns associated with chronic pain

Patients will typically respond in one of two ways –> they will do their best to embrace an adjusted lifestyle, or they will completely shut down and never leave their most comfortable places

For those who “shut down” –> CBT, physical therapy, pain specific antidepressants (TCAs, SNRIs) can prove helpful; these are helpful for people with BOTH chronic and neuropathic pain and depression

Question 8

Conversion Disorder

Answer 8

Characterized by acute neurologic deficits INCONSISTENT with a neuro disorder! Due to psychological factors that manifest in psychogenic non-epileptic seizures (DONT lose consciousness)

More common in women of low socioeconomic status

Due to an acute stress and intrapsychic conflicts

La Belle Indifference – patient who doesn’t care anymore that she lost control of her body –> NOT AN ACCURATE DIAGNOSTIC SIGN anymore

The video of the girls from NY…

Question 9

Body Dysmorphic Disorder

Answer 9

Preoccupation with an imagined defect in appearance

Rare, but very important in the setting of plastic surgery!

Anorexia nervosa, OCD or delusional disorders (patient thinks they are infested with mites) may often present comorbidly or share traits with BDD

Treat with SSRI

Question 10

Causes of Somatoform disorders

Answer 10

Environmental factors like PARENTAL MODELING OF SOMATICIZING behavior, or CHILDHOOD TRAUMA are powerful predictors

Question 11

FACTITIOUS DISORDER

Answer 11

Patients suffering from factitious disorder intentionally produce or feign a psychological or physical illness

Patient who injects fecal matter into his IV lines!!!!! EW

These patients PURPOSELY HURT THEMSELVES (difference from the somatoform spectrum)

Though conscious of what they are doing, these patients do NOT KNOW why they do what they do! A clear secondary goal is absent; feels the need to assume the “sick role” (this is the difference from Malingering)

1/3000 admissions; ~5 cases a year

MUNCHAUSEN’S BY PROXY –> Severe Form of factitious disease –> occurs when a caregiver inflicts intentional harm on their child/whoever they are caring for to the point of hospitalization; this is to gain sympathy from others, or gain the “hero” card

Question 12

MALINGERING

Answer 12

Very similar to factitious, except for one huge difference: MALINGERING PATIENTS INDUCE ILLNESS OR HARM FOR A KNOWN REASON OR SECONDARY GAIN

Cash, drugs, disability payments

Whenever a patient seems more interested in the documentation of their illness rather than the potential treatments, expect malingering

Don’t be afraid to set limits or involve the legal system when necessary!