Somataform disorders

Question 1

current DSM 5:

Answer 1

somatoform disorders
somatization disorder
hypochondriasis
pain disorder
body dysmorphic disorder
conversion disorder

Question 2

symptoms:

Answer 2

usually a lot of symptoms, rarely just one
A. Somatic Symptoms: One or more somatic symptoms that are distressing and/or result in significant disruption in daily life.
B. One or more of: Excessive thoughts, feelings, and/or behaviors related to these somatic symptoms or associated health concerns:
1) Disproportionate and persistent thoughts about the seriousness of one’s symptoms
2) Persistently high level of anxiety about health or symptoms
3) Excessive time and energy devoted to these symptoms or health concern
C. Chronicity: Although any one symptom may not be continuously present, the state of being symptomatic is persistent and lasts > 6 months.

Question 3

lack of a medical explanation:

Answer 3

does NOT mean you have a psychiatric diagnosis (sometimes things just go away, especially non-specific symptoms)

Question 4

is diagnostic testing theraputic?
long time psychotherapy?
anti-depressent?

Answer 4

not really, not really, only if they HAVE mdd

Question 5

illness Anxiety disorder:

Answer 5

excess worry with mild or absent symptoms

not normal health anxiety

Question 6

treatement for illness anxiety disorder:

Answer 6

establish good report, see these patients on a regular or routine basis (every 2 weeks, but not an email every day about the new illness) sometimes just supportive therapy can help

Question 7

conversion disorder:

Answer 7

physical symptoms with no physical sign? Patients look like they’re having a seizure but on an EEG they aren’t having seizures. Lose ability to walk. Man comes home and sees wife in bed and becomes blind

Question 8

physical malfunctioning with no explanation

Answer 8

patients actually don’t think this is a big deal and don’t freak out, maintain normal function

Question 9

what causes conversion disorder?

Answer 9

anxiety and worry transfered into physical symptoms

Question 10

sometime you can’t quantify ____ but you can quantify _____, so things manifest in a physical manner

Answer 10

psychological pain, physical

Question 11

with conversion disorder, you physically have

Answer 11

actual changes in physical brain, can be seen on mri

Question 12

sometimes, placebo effect is necessary:

Answer 12

iv with saline, emotional support, send to physical therapy, psychotherapy

Question 13

examples of factors affections medical conditions:

Answer 13

chronic occupational stress and hypertension
anxiety and asthma
depression and coronary artery disease
alcohol abuse and liver disease
smoking and COPD
Obesity and diabetes

Question 14

diff between conversion disorder and factitous disorder:

Answer 14

in factitous disorder, there are signs that the person is producing conscious impulses to want to be ill, some people who want to be “in the sick role” repeatedly visiting the hospital

Question 15

Munchausen syndrome

Answer 15

10% of factitious disorder patients
severe and chronic factitious disorders
pseudologia fantastica

Question 16

pactitious disorder by proxy

Answer 16

a person intentionally produces physical signs in a person under the first person’s care

Question 17

*Ganser’s syndrome

Answer 17

characterized by the use of approximate answers
patient who had back surgery says “the whole left side of my body is numb.” Therapist: “how old are you” “..43, …44” say 2+2=5, so they give approximate answers

Question 18

*Examples of factitious disorder

Answer 18

patients sneak drugs into the hospital and take medications to make them sick, or making their medical condition worse,
get legal help before checking their room
mom that purposely keeps child sick so they can feel like a great caretaker

Question 19

24 yo presents with new-onset blindness for which there is no physicologic or anatomic explanation. The patient says that his mother died recently, and he was unable to send her money bc he lost it gambling. He does not seem to be bother by his blindness:

Answer 19

conversion disorder

la belle indifference

Question 20

17 yo boy presents with "legs giving out" for 1 week. During the episodes he experiences a generalized weakness and is unable to move his arms and legs. The episodes last a few minutes. He is currently in the 11th grade and earns Bs and Cs. Further questioning reveals that his parents have recently separated after a long period of verbal abuse toward each other. His physical examination and neurologic workup are unremarkable.
body dysmorphic disorder
coversion disorder
factitious disorder
illness anxiety disorder
malingering

Answer 20

conversions disorder: evidenced by his altered sensory and motor functioning.

Patients with body dysmorphic disorder have a preoccupation with an imagined defect in appearance
Factitious disorder is intentionally producing the symptoms in order to assume the sick role as in factitious disorder

illness anxiety disorder is preoccupation with having a serious illness

Question 21

17 yo boy presents with “legs giving out” for 1 week. During the episodes he experiences a generalized weakness and is unable to move his arms and legs. The episodes last a few minutes. He is currently in the 11th grade and earns Bs and Cs. Further questioning reveals that his parents have recently separated after a long period of verbal abuse toward each other. His physical examination and neurologic workup are unremarkable.
what is the most effective treatment?
confrontation about intentionally producing symptoms
explaining that the symptoms are not real
reassurance that a cause will be found
suggestion that symptoms will improve with time
suggetion that the family begins therapy

Answer 21

although the deficits often remeit spontaneously, education about the illness and suggesting the symptoms will improve can facilitate the process. These patients do not intentionally produce their symptoms (as in factitious disorder) and explaining that their deficits are not real may aggravate the situation and worsen their problems. Whereas reassurance about their likely improvement is appropriate, implying that their symptoms are caused by a neurologic illness (assuming that this has been ruled out) would be inaccurate and may serve to reinforce their use of phyical symptoms.

Question 22

42 yo returns to his internist for the fourth time in 5 months with the same complaints of intermittent numbness of his fingers and indigestion. Although his medical workup has been unremarkable, this has failed to reassure him. He remains anxius and is now concerned that he has celiac disease and requests a GI consultation. Which of the folllowing is the most likely diagnosis?
body dysmorphic disorder
coversion disorder
factitious disorder
illness anxiety disorder
malingering

Answer 22

illness anxiety disorder

Question 23

a 32 yo divorced woman is admitted for 2nd and 3rd degree burns to her right hand, which she attributes to accidentally spilling hot oil while she was cooking dinner. Upon evaluation, the surgeon recognizes the patient as someone he had treated for similar burns on the same hand 3 months ago. Further detail review of her medical records reveals that this is her sixth burn-related injury in 2 years. Which of the following is the most likely diagnosis?
body dysmorphic disorder
coversion disorder
factitious disorder
illness anxiety disorder
malingering

Answer 23

factitious disorder

patients with factitious disorders consciously produce symptoms to present as ill or impaired (maintain the “sick role”)

Question 24

you are asked to evaluate a 36 yo patient who reports depressed mood and suicidal ideation. During your examination you notice the prisoner responds to your questions with approximate answers
body dysmorphic disorder
ganser syndrome
munchausen syndrome
illness anxiety disorder
malingering

Answer 24

Ganser Syndrome: characterized by giving approximate or ridiculous answers to questions

Question 25

a 49 yr old complains of HA, memory loss, disorientation and occasional paralysis that affects his arms and lasts several hours. During the MSE you notice that the patient is giving approximate answers to many questions (2+2=5, there are 6 toes on the foot):
amok
Ganswer syndrome
factitious disorder
illness anxiety disorder
malingering

Answer 25

Ganser Syndrome

approximate answers and talking past the point, presenting with amnesia, disorientation, conversion symptoms, etc

Question 26

2 yo is referred to you for evaluation due to suspicion that the child is the victim of physical abuse secondary to munchausen syndrome by proxy. Which of the following family members is usually the perpetrator who fabricates the presenting illness?

Answer 26

mother
mother is most commonly the perpetrator of intentionally producing physical or psychological symptoms in her child in order to assume the sick role by proxy the victim is usually a preschool child

Question 27

26 yo is admitted for sepsis. Her roomate reports that she found the patient with a needle and syringe full of what the patient admitted was toilet water. The patient’s physical examination reveals iv needlemarks not made by hospital staff. Records show she was admitted 1 year ago for drinking drain cleaner:

Answer 27

factitious disorder

Question 28

36 yo is referred by her gynecologist who reports a long history of sexual and other nonspecific complaints that have apparently shown no evidence of verifiable disease. The gynecologist further relates that she believees this patient has a long history of doctor shopping. On interview, the patient complains of physical pain in her back, belly, chest, excessive menstrual bleeding, constipation and lactose intolerance. She poitns out that “nobody’s been able to figure out why I can’t feel anything on the back side of my arm.” She had multiple surgeries for abdominal complaints in the past, all with no significant findings or findings inconsistent with her complaints. She relates that “I’ve always been sickly, most of my life.”

Answer 28

somatization disorder describes the condition suffered by individuals who have a long history of multiple somatic complaints (gastrointestinal, sexual, and neurologic) that despite exhaustive medical workups, have either no identifiable cause or are out of proprotion to the medical findings. These patients often describe themselves as having been “sickly their whole lives” and presumabley in their frustration with doctors’ inability to find reasons for their problems, chronically “doctor shop.”

Question 29

You are asked by the surgical service at your hospital to see a 34 yo woman well knowon to them from previous admissions with a number of vague complaints that have no obvious physical cause: abdominal pain, headache, and lower back pain. She appears tearful and says that although she does not think she has anything seirous, tells you she just wants to figure it all out so she can get home;
body dysmorphic disorder
coversion disorder
factitious disorder
somatization disorder
illness anxiety disorder

Answer 29

somatization disorder
caused by multiple physical complaints that cannot be explained by any objective physical finding. As in this case, patients’ symptoms frequently date back many years and have prompted multiple doctor visits, even hospitalizations.

Question 30

which of the following is the most likely motivation for factitious disorder?
motivation is unconscious and thus patient is not aware of it
desire to avoid jail
desire to take patient role
desire to obtain compensation
desire to obtain narcotics

Answer 30

assume the sick role and be taken care of.

Question 31

which personality disorder is most likely to occur comarbidly with factitious disorder?
antisocial
avoidant
borderline
obsessive-compulsive
schizoid

Answer 31

borderline

Question 32

which is most inline with factitious disorder?
feigning psychosis to avoid criminal charges
lying about back pain to receive time off work
pseudoseizures in the context of a family conflict
placing feces in urine to receive treatment for uti
recurrent fears of having a serious illness

Answer 32

placing feces in urine to receive treatment for uti

other examples: injecting insulin to create hypoglycemia, taking anticoagulants to fake a bleeding disorder, contaminating urine samples with feces to simulate a urinary tract infection

pseudoseizures are an example of a conversion disorder
fear of having a serious disease casused by the misinterpretation of bodily sensations is charateristic of illness anxiety disorder