SomataformDisorders Flashcards
What does MUPS stand for?
Medically unexplained physical symptoms (MUPS)
Physical symptoms that prompt the suffer to seek health care but remain unexplained after an appropriate evaluation
Somatoform Disorders:
Some authors have suggested that the precise diagnosis given depends more on the diagnosing physician’s specialty than on any actual differences between the syndromes
Consequences of MUPS
impaired physician- patient relationship
- Physician frustration
Patient dissatisfaction
Psychosocial distress
Decreased quality of life
Increased rates of depression and anxiety Increased health care utilization
Types of Somatoform disordres
Smatization disorder, Conversion disorder, Pain disorder, Hypochondriasis, Body Dysmorphic disorder
Presence of physical symptoms that suggest a general medical condition, but are not explained by a medical condition
Psychosocial stress = somatic distress
Misinterpretation of normal physiological functions
Not consciously produced or feigned
Generalities of Somatoform Disorders
Criteria for Somatization Disorder
On exam
Multiple recurring physical complaints that begin before age 30
must have ALL of the following at SOME point
- 4 pain symptoms
- 2 non-pain GI symptoms
- 1 Sexual complain
- 1 pseudoneuro complaint
*not caused by known medical condition
1+ somatic symptom that are distressing or result in significant disruption of daily life
Excessive thoughts, feeling, or behaviors related to the somatic symptoms or associated health concerns as manifested by:
- Disproportionate and persistent thoughts about seriousness of symptoms
- Persistently high level of anxiety about health
- Excessive time and energy devoted to these symptoms
*State of being symptomatic is persistent (typically greater than 6 months)
Somatic Symptom Disorder
Somatic Symptom Disorder is characterized by:
1+ somatic symptom that are distressing or result in significant disruption of daily life
Excessive thoughts, feeling, or behaviors related to the somatic symptoms or associated health concerns as manifested by:
- Disproportionate and persistent thoughts about seriousness of symptoms
- Persistently high level of anxiety about health
- Excessive time and energy devoted to these symptoms
*State of being symptomatic is persistent (typically greater than 6 months)
Somatization disorder Epidemiology
General population: ___
Primary care setting: ___
0.01%
3%
Subsyndromal somatization disorder epidemiology
General population: ___
Primary care setting: ___
11%
20%
Where do we usually dx pts with somatization disorder?
do we see them in psych office?
Patients typically found in general medical setting. RARELY seek psychiatric care
Often refuse psychiatric care due to belief that symptoms are related to undiagnosed primary medical condition.
What does a typical Somatization disorder pt describe themselves?
What do their medical hx look like?
Patients describe themselves as “sickly”
Medical histories are circumstantial, vague, inconsistent and disorganized
Describe complaints in dramatic, exaggerated fashion Large number of outpatient visits
Frequent hospitalizations, Repetitive subspecialty referrals, Large number of diagnoses Multiple medications
What are some key Differential Diagnosis to consider when Dx Somatization Disorder
Primary Medical Disorders!
Disorders with transient nonspecific symptoms
Examples: MS, MG, SLE, AIDS, AIP, endocrine disorders Psychiatric conditions
Other somatoform disorders: Depression, Anxiety
The three features that most suggest a diagnosis of somatization disorder instead of another medical disorder are…
- Involvement of multiple organ systems
- Early onset and chronic course without development of physical signs or structural abnormalities
- Absence of laboratory abnormalities that are characteristic of the suggested medical condition
What are some Somatization Disorder Treament issues
Schedule regular follow-up visits
Perform a brief physical exam focused on the area of discomfort on each visit
Look closely for objective signs of disease rather than taking the patient’s symptoms at “face value”
Avoid unnecessary tests, invasive treatments, referrals and hospitalizations.
Avoid insulting explanations such as “the symptoms are all in your head”
Explain that stress can cause physical symptoms Set limits on contacts outside of scheduled visits
Benefits of Psychothearpy in tx Somatization Disorder
____ to long-term insight oreiented psychotherapy
Short-term dynamic teraphy has show _____
CBT has been shown _____
Not responsive
some efficacy
Effective
