SM_120b: Somatoform Disorders

Question 1

Somatic symptom and related disorders are ____

Answer 1

Somatic symptom and related disorders are a prominence of somatic symptoms associated with significant distress and impairment

Question 2

Primary care patients with depression often present with ____

Answer 2

Primary care patients with depression often present with physical symptoms

Question 3

Describe the DSM-5 criteria for somatic symptom disorder

Answer 3

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

Question 4

Somatization is ____

Answer 4

Somatization is the presence of recurrent and multiple medical symptoms with no discernible organic cause

(may lead to iatrogenesis)

Question 5

To diagnose somatic symptom disorder, need to ____

Answer 5

To diagnose somatic symptom disorder, need to gather Hx form multiple sources over time

Question 6

Somatization disorder occurs almost exclusively in ____ and onsets at age ____

Answer 6

Somatization disorder occurs almost exclusively in women and onsets at age ≤ 30

Question 7

Describe red flags for detection of somatic symptom disorder

Answer 7

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

Question 8

Describe the mental status examination for somatic symptom disorder

Answer 8

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

Question 9

Differential diagnosis for somatic symptom disorder includes ____ and ____ including ____ and ____

Answer 9

Differential diagnosis for somatic symptom disorder includes non-psychiatric disorders and psychiatric disorders including factitious disorder and malingering

Question 10

Factitious disorder is ____ with ____

Answer 10

Factitious disorder is intentional act with unconscious motivation

(Primary gain: sick role)

Question 11

Malingering is ____ with ____

Answer 11

Malingering (faking) is intentional act with conscious motivation

(Secondary gain: avoid negative and obtain positive)

Question 12

Describe principles of treatment for somatic symptom disorder

Answer 12

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

Question 13

Effective treatment of somatic symptom disorder includes ____ and____

Answer 13

Effective treatment of somatic symptom disorder includes lasting empathetic doctor-patient relationship and exploring emotional problems, social and family factors, and symptom beliefs

Question 14

____ is the primary treatment modality for somatic symptom disorder

Answer 14

CBT is the primary treatment modality for somatic symptom disorder

Question 15

Describe DSM-5 criteria for conversion disorder

Answer 15

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

Question 16

Conversion disorder is also called ____

Answer 16

Conversion disorder is also called functional neurological symptom disorder

(not intentional)

Question 17

Symptom pattern of conversion disorder includes ____, ____, ____, and ____

Answer 17

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

Question 18

Hoover’s sign is ____ that occurs in ____

Answer 18

Hoover’s sign is identifies voluntary paresis and occurs in coversion disorder

Question 19

Pathophysiology of conversion disorder involves ____

Answer 19

Pathophysiology of conversion disorder involves abnormally functioning CNS

Question 20

Differential diagnosis for conversion disorder includes ____ or ____

Answer 20

Differential diagnosis for conversion disorder includes medical / neurological disorders or malingering

Question 21

Conversion disorder most often onsets in ____ at age ____

Answer 21

Conversion disorder most often onsets in women at age 10-35

Question 22

If someone has non-epileptic seizures, they are likely to have ____

Answer 22

If someone has non-epileptic seizures, they are likely to have conversion disorder

Question 23

Prognosis for conversion disorder is ____

Answer 23

Prognosis for conversion disorder is poor

(good for individual conversion symptoms)

Question 24

____ and ___ are important in talking to patients about conversion disorder

Answer 24

Openness and honesty are important in talking to patients about conversion disorder

Question 25

____ is used to manage the motor symptoms of conversion disorder

Answer 25

Physical therapy is used to manage the motor symptoms of conversion disorder

(CBT used to reduce dysfunctional thoughts and improve coping)

Question 26

Describe diagnostic criteria for illness anxiety disorder

Answer 26

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

Question 27

Describe diagnostic criteria for factitious disorder

Answer 27

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)

Question 28

Primary gain is ____

Answer 28

Primary gain is to assume sick role

(factitious disorder)

Question 29

Secondary gain is to ___

Answer 29

Secondary gain is to obtain benefit (external motivation)

(financial, avoid unpleasant situation)

Question 30

Types of factitious disorder are ____, ____, and ____

Answer 30

Types of factitious disorder are with predominantly psychological signs and symptoms, with predominantly physical signs and symptoms, and combined

Question 31

Munchausen’s syndrome is ____

Answer 31

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

Question 32

Munchausen’s by proxy is ____ with the purpose of ____

Answer 32

Munchausen’s by proxy is when a parent induces medical signs in a child with the purpose of assuming the sick role indirectly

Question 33

Contrast factitious disorder and malingering

Answer 33

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

Question 34

Factitious disorder involves production of symptoms ____ with ____ motivation for ____ gain

Answer 34

Factitious disorder involves production of symptoms intentionally with unconscious motivation for primary gain (to be in sick role)

Question 35

Malingering involves production of symptoms ____ with ____ motivation for ____ gain

Answer 35

Malingering involves production of symptoms intentionally with conscious motivation for secondary gain (financial / legal benefit)