Psychiatry- Somatisation Disorders

Question 1

Risk factors for somatisation disorders

Answer 1

• Much more common in females
• Substance abuses
• Anxiety, depression, personality disorder background
• Limited education
• Recent stressful event
• Family conflict
• Lower socioeconomic status

Question 2

What is undifferentiated Somatoform disorder

Answer 2

◦ Multiple, recurrent + frequently changing physical symptoms of 2 or more years
◦ Negative investigations with difficulty accepting results

Question 3

What is hypochondrial disorder

Answer 3

‣ Persistent belief in presence of serious underlying disease
‣ Often cancer
‣ Normal sensations misinterpreted as abnormal or distressing

Question 4

What is Factitious disorder (Munchausen’s Syndrome)

Answer 4

◦ Deliberately deceiving others into thinking they have a medical condition (when false) due to satisfaction in being sick
◦ Munchausen by Proxy: Child abuse- caregiver exaggerates child’s illness
◦ Falsify symptoms. Forge medical records, tamper with medical instruments

Question 5

What is malingering

Answer 5

‣ Lying or exaggerating symptoms for some gain
‣ E.g. financial, drugs etc

Question 6

What is dissociative disorder

Answer 6

◦ ‘Separating off’ certain memories from normal consciousness
◦ Coping mechanism from overwhelming stress
◦ Psychiatric symptoms:
◦ Amnesia
◦ Fugue state: amnesia and travel/wander and forget identity
◦ Stupor: unresponsive and only responds to intense stimuli (pain)

Question 7

What is conversion disorder

Answer 7

◦ Loss of motor or sensory function
◦ Patient does not consciously fake symptoms or seek material gain
◦ Hoover’s Sign:
◦ Tells difference between organic and non-organic leg paresis
◦ Non-organic leg paresis: pressure felt under paretic leg when lifting non-paretic leg against pressure due to involuntary contralateral hip extension

Question 8

General management of Somatoform disorders

Answer 8

1) Reassure + Explain:
◦ Be clear about negative clinical findings + link symptoms with psychological cause
◦ Acknowledge psychosocial distress
◦ Explain you will conduct no further investigations
◦ Emotional support:
◦ Elicit childhood experience of illness
◦ Encourage coping strategies
◦ Involve family who are reinforcing behaviour
◦ Treat underlying co-morbidities (e.g. depression)

2) CBT