SM_120b: Somatoform Disorders Flashcards
Somatic symptom and related disorders are ____
Somatic symptom and related disorders are a prominence of somatic symptoms associated with significant distress and impairment
Primary care patients with depression often present with ____
Primary care patients with depression often present with physical symptoms
Describe the DSM-5 criteria for somatic symptom disorder
Somatic symptom disorder DSM-5
- ≥ 1 somatic symptoms that are distressing or result in significant disruption in daily life
- Excessive thoughts, feelings, or behaviors related to somatic symptoms or associated health concerns, as manifested by ≥ 1 of: disproportionate / persistent thoughts about the seriousness of one’s symptoms, persistently high level of anxiety about health or symptoms, or excessive time and energy devoted to these symptoms or health concerns
- Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent
Somatization is ____
Somatization is the presence of recurrent and multiple medical symptoms with no discernible organic cause
(may lead to iatrogenesis)
To diagnose somatic symptom disorder, need to ____
To diagnose somatic symptom disorder, need to gather Hx form multiple sources over time
Somatization disorder occurs almost exclusively in ____ and onsets at age ____
Somatization disorder occurs almost exclusively in women and onsets at age ≤ 30
Describe red flags for detection of somatic symptom disorder
Red flags for detection of somatic symptom disorder
- Chartomegaly
- Complicated medical Hx
- Multiple diagnoses, procedures, treatments
- Multiple allergies and drug intolerances
- Popular disorders and diagnoses with poorly defined pathology or lack of objective indicators
Describe the mental status examination for somatic symptom disorder
Mental status examination for somatic symptom disorder
- Dramatic, demanding, histrionic, over the top
- Seductive dress and manner
- Requires abusable prescription
- Demanding behavior in hospital
- Speech patterns: non-psychotic thought disorder
Differential diagnosis for somatic symptom disorder includes ____ and ____ including ____ and ____
Differential diagnosis for somatic symptom disorder includes non-psychiatric disorders and psychiatric disorders including factitious disorder and malingering
Factitious disorder is ____ with ____
Factitious disorder is intentional act with unconscious motivation
(Primary gain: sick role)
Malingering is ____ with ____
Malingering (faking) is intentional act with conscious motivation
(Secondary gain: avoid negative and obtain positive)
Describe principles of treatment for somatic symptom disorder
Principles of treatment for somatic symptom disorder
- Make the diagnosis
- Identify and manage comorbid psychiatric disorders
- Reasonable work-up: objective findings
- Do not harm
- Non-confrontrational -> empathy
Effective treatment of somatic symptom disorder includes ____ and____
Effective treatment of somatic symptom disorder includes lasting empathetic doctor-patient relationship and exploring emotional problems, social and family factors, and symptom beliefs
____ is the primary treatment modality for somatic symptom disorder
CBT is the primary treatment modality for somatic symptom disorder
Describe DSM-5 criteria for conversion disorder
Conversion disorder DSM-5 criteria
- ≥ 1 symptoms of altered voluntary motor or sensory function
- Clinical findings provide evidence of incompatability between the symptoms and recognized neurological / medical conditions
- Symptom or deficit is not better explained by another condition
- Symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation
Diagnosis usually confirmed by a neurologist
Conversion disorder is also called ____
Conversion disorder is also called functional neurological symptom disorder
(not intentional)
Symptom pattern of conversion disorder includes ____, ____, ____, and ____
Symptom pattern of conversion disorder includes rapid symptom onset, Hoover’s sign / tunnel vision / atasia-abasia on physical exam, fluctuating symptom, and rapid clinical improvements
Hoover’s sign is ____ that occurs in ____
Hoover’s sign is identifies voluntary paresis and occurs in coversion disorder
Pathophysiology of conversion disorder involves ____
Pathophysiology of conversion disorder involves abnormally functioning CNS
Differential diagnosis for conversion disorder includes ____ or ____
Differential diagnosis for conversion disorder includes medical / neurological disorders or malingering
Conversion disorder most often onsets in ____ at age ____
Conversion disorder most often onsets in women at age 10-35
If someone has non-epileptic seizures, they are likely to have ____
If someone has non-epileptic seizures, they are likely to have conversion disorder
Prognosis for conversion disorder is ____
Prognosis for conversion disorder is poor
(good for individual conversion symptoms)
____ and ___ are important in talking to patients about conversion disorder
Openness and honesty are important in talking to patients about conversion disorder
____ is used to manage the motor symptoms of conversion disorder
Physical therapy is used to manage the motor symptoms of conversion disorder
(CBT used to reduce dysfunctional thoughts and improve coping)
Describe diagnostic criteria for illness anxiety disorder
Illness anxiety disorder diagnostic criteria
- Preoccupation with having or acquiring serious illness
- Somatic symptoms are not present
- There is a high level of anxiety about health and the individual is easily alarmed about personal health status
- Individual performs excessive health-related behaviors (checks body for symptoms) or exhibits maladaptive behavior
Describe diagnostic criteria for factitious disorder
Factitious disorder diagnostic criteria
- Falsification of physical or psychological signs / symptoms or induction of injury or disease with identified deception
- Individual presents themselves to others as ill, impaired, or injured
- Deceptive behavior is evident even in the absence of obvious external rewards
- Behavior is not better explained by another mental disorder
(often chronic)
Primary gain is ____
Primary gain is to assume sick role
(factitious disorder)
Secondary gain is to ___
Secondary gain is to obtain benefit (external motivation)
(financial, avoid unpleasant situation)
Types of factitious disorder are ____, ____, and ____
Types of factitious disorder are with predominantly psychological signs and symptoms, with predominantly physical signs and symptoms, and combined
Munchausen’s syndrome is ____
Munchausen’s syndrome is an extreme form of factitious disorder
- Wandering (peregrination): life of hospitalizations
- Antisocial behavior
- Iatrogenic medical conditions (gridiron abdomen)
- Extraordinarily complex medical Hx w/ above average level of medical knowledge
- Chaotic hospital course
- Often in medical fields
Munchausen’s by proxy is ____ with the purpose of ____
Munchausen’s by proxy is when a parent induces medical signs in a child with the purpose of assuming the sick role indirectly
Contrast factitious disorder and malingering
Contrast factitious disorder and malingering
- Factitious disorder patients usually report a variety of symptoms over different episodes, while malingerers tend to retain or recreate the same symptoms
- Factitious disorder patients are more likely to pursue painful tests and treatments, whereas malingerers are typically satisifed with hospitalization and benign diagnostic assessments
- Factitious disorder patients are more likely to have borderline personality disorder, while malingers are more likely to have antisocial personality disorder
Factitious disorder involves production of symptoms ____ with ____ motivation for ____ gain
Factitious disorder involves production of symptoms intentionally with unconscious motivation for primary gain (to be in sick role)
Malingering involves production of symptoms ____ with ____ motivation for ____ gain
Malingering involves production of symptoms intentionally with conscious motivation for secondary gain (financial / legal benefit)
