SomataformDisorders Flashcards

1
Q

What does MUPS stand for?

A

Medically unexplained physical symptoms (MUPS)

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2
Q

Physical symptoms that prompt the suffer to seek health care but remain unexplained after an appropriate evaluation

A

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

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3
Q

Consequences of MUPS

A

impaired physician- patient relationship

  • Physician frustration

Patient dissatisfaction
Psychosocial distress
Decreased quality of life
Increased rates of depression and anxiety Increased health care utilization

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4
Q

Types of Somatoform disordres

A

Smatization disorder, Conversion disorder, Pain disorder, Hypochondriasis, Body Dysmorphic disorder

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5
Q

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

A

Generalities of Somatoform Disorders

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6
Q

Criteria for Somatization Disorder

On exam

A

Multiple recurring physical complaints that begin before age 30

must have ALL of the following at SOME point

  1. 4 pain symptoms
  2. 2 non-pain GI symptoms
  3. 1 Sexual complain
  4. 1 pseudoneuro complaint

*not caused by known medical condition

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7
Q

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)

A

Somatic Symptom Disorder

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8
Q

Somatic Symptom Disorder is characterized by:

A

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)

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9
Q

Somatization disorder Epidemiology

General population: ___

Primary care setting: ___

A

0.01%

3%

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10
Q

Subsyndromal somatization disorder epidemiology

General population: ___

Primary care setting: ___

A

11%

20%

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11
Q

Where do we usually dx pts with somatization disorder?

do we see them in psych office?

A

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.

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12
Q

What does a typical Somatization disorder pt describe themselves?

What do their medical hx look like?

A

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

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13
Q

What are some key Differential Diagnosis to consider when Dx Somatization Disorder

A

Primary Medical Disorders!

Disorders with transient nonspecific symptoms

Examples: MS, MG, SLE, AIDS, AIP, endocrine disorders Psychiatric conditions

Other somatoform disorders: Depression, Anxiety

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14
Q

The three features that most suggest a diagnosis of somatization disorder instead of another medical disorder are…

A
  1. Involvement of multiple organ systems
  2. Early onset and chronic course without development of physical signs or structural abnormalities
  3. Absence of laboratory abnormalities that are characteristic of the suggested medical condition
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15
Q

What are some Somatization Disorder Treament issues

A

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

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16
Q

Benefits of Psychothearpy in tx Somatization Disorder

____ to long-term insight oreiented psychotherapy

Short-term dynamic teraphy has show _____

CBT has been shown _____

A

Not responsive

some efficacy

Effective

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17
Q

What are the outcomes of pts with somatization disorders that use pyschopharm?

A

antiD limitations in treating, inconsistatn, high rates of discontinue

18
Q

1 + symptom affecting voluntary motor or sensory symptoms, suggesting neurological disorder, proceeded by acute, identifiable stressor [no longer needs to be proceeded by acute stressor]

A

Conversion Disorder

*

Clinical findings incompatible with symptom presentation and recognized medical or neurologic illness

1/3 patients have true neurological illness and 25% recur within the first year

19
Q

“la belle indifference”
Symptoms likely to occur following stress

Symptoms tend to conform to patients understanding of neurology

Inconsistent physical exam

A

clincal features of conversion disorder

20
Q

What is the tx for Conversion Disorder?

A

Conservative: reassure and provide physical and occupation therapy: we feel confident that after 3 sessions w/ PT you will be fully recovered.

Can do psychotherapies and posible Amytal interview

21
Q

Good and poor prognostic indicators of Conversion disorder

A

Good: onset following clear stressor, prompt tx, symtoms of paralysis, aphonia and blindness

Poor: delayed tx and symptoms of seizures or tremor

22
Q

Preoccupation with fears of having a serious illness that does not respond to reassurance after appropriate medical work

Belief not of delusional intensity and is n_ot restricte_d to concern about appearance
Duration of **at least 6 months **

A

Hypochondriasis

23
Q

Clincal features of Hypochondriasis

A

Bodily preoccupation
Disease phobia
Disease conviction
Onset in early adulthood
Chronic with waxing and waning of symptoms

24
Q

What are the General Apsects of tx of Hypochondriasis?

A

General aspects

Establishment of trust

History taking

Identification of stressors

Education

25
Q

What tx therapies are best for Hypochondriasis?

A

Cognitive Behavioral Therapy

Supportive therapy

Pharmacotherapy: seratonin meds most beneficial

26
Q

Pervasive feeling of ugliness of some aspect of their appearance despite a normal or nearly normal appearance.

If slight physical anomaly is present, person’s concern is markedly excessive.

A

Body Dysmorphic Disorder

27
Q

Clincal apperance of Body dysmporphic disorder

age of onset

appearance preoccupation

Compulsive behaviors

A

between 15-30 y/o

Apprearace preoccupation of: any body part, most the face/forehead

think about flaws 3-8 hrs/day

compulsive: intent to examine, improve, seek reassurance or hide percieved defect

28
Q

What Comorbitities and DDx need to be taken into account in persons w/ Body Dysmorphic Disorder

A

MDD: 60-80%

Social phobia: 38%

Substance use: 36%

OCD: 30%

Personality disorder: 57-100% especially Avoidant

29
Q

What are the tx options for Body Dysmorphic Disorder

A

Avoid iatrogenic harm! Dont do corrective surgery, not a cure!

CBT is best

Use SEratonin-specific drgus but takes much longer to improve and at higher doses

30
Q

Differ from somatoform disorders in that signs and symptoms are INTENTIONALLY PRODUCED

Methods of inducing illness: Exaggerations, Lies Tampering with tests to produce positive results, Manipulations that cause actual physical harm

A

Deception Syndromes: Factious disorder or Malingereing

*distinguished based on motive

31
Q

Intentionally exaggerates or induces signs and symptoms of illness.

Motivation is to assume the sick role

External incentives for the illness inducing behavior **are absent **

A

Factitious Disorder

32
Q

Prevalence in general population is unknown

Diagnosed in about 1% of patients seen in psychiatric consultation in general hospitals

A
33
Q

Possible etiology for Factitious Disorder

A

hard to tell bc most resist pych intervention. Often suffered childhood abuse and frequent hospitalizations thus hospital was considered safe

Self-enhancement model: may be a means of increasing or protecting self-esteem

34
Q

10% of factitious disorder patients

Severe and chronic factitious disorder

Pseudologia fantastica (broad, elaborate stories about how they became ill)

A

Munchausen syndrome (type of Severe Factitious disorder)

35
Q

A person intentionally produces physical signs or symptoms in another person under the first person’s care

A

Facticious disorder by proxy

36
Q

DDx of Facticious Disorder

A

Must establish the intentional and conscious production of symptoms

Direct evidence Excluding other causes

True physical illness
Other somatoform disorders Malingering

37
Q

Predisposing factors to Facticious Disorder

A

True physical disorders in childhood leading to extensive medical treatment

Employment (present or past) as a medical paraprofessional

Severe personality disorder

Borderline personality disorder is the mostprevalent

38
Q

How do we manage a pt with Facticious Disorder

A

No specific treatment shown effective

Early identification
Prevent iatrogenesis
Beware of negative countertransference

Be mindful of legal and ethical issues

Address any psychiatric diagnosis underlying the factitious disorder diagnosis

Rarely allowed by the patient

39
Q

The intentional production of feigning illness

Motivated by external incentives: drugs, litigation, financial compensation, avoidance of work/military, evade criminal prosecution

A

Malingering

40
Q

When should you consider a pt has Malingering disorder

A

Medicolegal presentaiton, marked dsicrepancy btwn persons claimed stress and objective findings, lack of cooperation with eval and tx, antisocial personality disorder