Psychosomatic Disorders Flashcards
Somatic Symptom Disorder
Experiencing signif physical symptoms for which there is no apparent cause
Aka hypochondriasis
-commonly appears between 20-30 yo
Misinterpret bodily feelings as being something more
- excessive thoughts, feelings, behaviors related to symptoms
- State of being symptomatic persists even though symptoms vary
Somatic Disorder Treatment
Psychotherapy
- group therapy for support
- CBT can be helpful if they will comply
Regular visits to the doctor to provide reassurance, but don’t over evaluate…protect from unnecessary tests
Illness Anxiety Disorder
Few to no somatic complaints, just worried that they are ill
Diagnosis
- Preoccupied with having or getting a serious illness
- Somatic symptoms, if present, are mild
- Pt has high health anxiety & easily alarmed
- Excessive health maintenance behavior or health avoidance behavior
- Preoccupation for at least 6 months!
- R/O other possible diagnoses
Illness Anxiety Disorder Treatment
Frequent but brief visits with PCP
- education
- psychotherapy– relaxation, exposure-response prevention
Psychiatric Referral
Anti-anxiety meds may reduce distress
-Zoloft
Conversion Disorder
aka Functional Neurological Symptom Disorder
Neuro symptoms that have a psych origin
ex: hysterical blindness
W > M
-early adulthood (rare after 35 yo)
Unconscious process, presumed underlying psychological conflict / onset linked to stressful event
Conversion Disorder Diagnosis
One or more neuro symptoms
Exam findings are not compatible with known neurological conditions
R/O other mental disorders
Symptoms cause significant distress
Conversion Disorder Physical Exam Tricks
-Drop patients hand towards face- probably wont hit themself in face (not actually paralyzed)
Sx: Aphonia –> ask them to cough
Sx: Tunnel Vision –> peripheral fields test
Sx: Blindness –> swinging flashlight test (if blind they should have no reaction)
Conversion Disorder Treatment
Must establish a trusting doctor-patient relationship
Difficult to treat because they think they have a physical problem, not a psychological problem
Assure their family that they are not “faking it” – they cannot control this problem consciously
Psychotherapy to identify stressor & reduce their anxiety around it
Psychological Factors Affecting Other Medical Conditions
- diagnostic criteria
- treatment
ex: Patient with chronic back pain
- somatic influence –> pt has back pain
- psychological –> how they cope with it
- environment –> are they getting special treatment?
Diagnostic Criteria
- A medical condition is present
- Psychological/behavioral factors affecting that condition that may be causing…
- -delay in recovery
- -interfering with treatment
- -factors part of another condition affecting it (ex: anxiety influencing asthma –> anxiety worsens SOB)
Treatment
- clarify diagnosis
- identify overt psychosocial stressors
- Refer to clinical health psychology
- concurrent treatment of mood/anxiety
Factitious Disorder (aka Muchausen’s)
Simulate, induce, or aggrivate an illness to receive medical attention
Imposed on self or imposed on another (often a child)
Dx:
- symptoms don’t respond to treatment appropriately
- few visitors
- multiple drug allergies
- goal is to maintain the “sick role”
Tx:
- imposed on self –> frequent, friend visits with same provider
- imposed on another –> child in danger, call CPS
Malingering
Not a real psych disorder
Intentional production of symptoms to get some known secondary gain
- financial
- drug seeking
- disability lawsuit
Signif discrepancy between subjective complaints vs. objective data
Malingering is commonly associated with what other personality disorder?
Antisocial
Treatment for Malingering?
Not treatable…practice defensive medicine –> good documentation, send them for secondary opinions
confronting malingerer is controversial but often advised
- prevent repeat activity
- issues may not always be greedy or illegal
