Psychiatry-Somatic Symptom Disorder Flashcards
What criteria must a patient meet to be diagnosed with a somatic symptom disorder?
1) Distressful symptoms causing disruption of daily living 2) Excessive behavior revolving around the symptoms 3) 6 months duration. “It’s the way they communicate”
What associated symptoms often accompany somatic symptom disorders?
Major Axis I (anxiety, depression), Personality disorders, History of abuse (due to lack of empathy), Chronic illness in the family and Hostility or Denial.
What diseases are difficult to diagnose and may entice you to diagnose a patient with somatic symptom disorder?
MS, SLE, endocrine disorders, panic disorder (episodes of acute onset of fear w/accompanying physical symptoms), adjustment disorder (physical symptoms from new stress)
A patient comes to see you with a laundry list of different symptoms that include loss of balance, seizures, tremors, blindness, deafness and hallucinations. All medical tests have come back negative. Is this a somatic symptom disorder?
No. This is more like functional neurological symptom disorder. Usually one or more symptoms of altered voluntary motor or sensory function follow a stressor.
What is the most common somatic symptom disorder?
Conversion disorder
What are the characteristics of conversion disorder as patients get older?
3rd decade (20’s) = non-epileptic seizures. 4th decade = motor symptoms. Note that patients are not conscious of these symptoms.
How does conversion disorder differ from somatic symptom disorder?
There cannot be any pathologic conditions in conversion disorder.
What associated psychiatric conditions often accompany conversion disorder?
Axis I (anxiety, depressive & personality disorders), substance abuse and neurological conditions.
How might you determine if a person is having a psychogenic non epileptic seizure?
Still respond to reflexes during seizure, no incontinence, random convulsions, they won’t look at you (Geotropic eye test), few lacerations and non-elevated Prolactin levels.
You are assessing a patient who has difficulty performing various tasks throughout the day and has severe pain when walking. However, when they are distracted and walking with you down the hall they walk normal. What is this called?
Psychogenic gait astasia abasia
What clinical maneuvers can you do to assess for a psychogenic seizure?
Drop his hand on his face, sternal rub, geotropic eye test, tuning fork, Hoover’s sign (counter pressure when lifting their healthy leg).
What is the difference between factitious conversion disorder and normal conversion disorder?
In normal conversion disorder the person does not know the event is happening and is not trying to deceive you.
What is the correct term for hyperchondriasis?
Illness anxiety disorder (either constantly seeking or constantly avoiding doctors)
What are most anxiety disorders treated with?
Cognitive behavior therapy and SSRIs
