Somatic and Dissociative Disorders

Question 1

What is somatic symptom disorder?

Answer 1

Persistent, excessive concern about somatic symptoms for >/= to 6 months. Joint pain, muscle pain, headaches, nausea, dizziness, palpitations, paresthesias etc.
Pts have frequent use of medical facilities despite lack of medical evidence for an organic disorder— causes significant disruption in daily life

Question 2

What is the treatment for somatic symptom disorder

Answer 2

Understand that their suffering is real
An empathetic and caring health care provider relationship is key.

In regular brief visits, emphasize that the symptoms do not appear life threatening or disabling, goal is functioning at the highest level possible.

Question 3

Does somatic symptom disorder affect males or females more?

Answer 3

F>M

Also, 5-7% of the general population

Question 4

What is illness anxiety disorder?

Answer 4

Preoccupation with having or acquiring a serious undiagnosed illness or acquiring a serious illness for >/= to 6 months. Actual symptoms are either mild or just absent but they are easily alarmed about their health status.
*NOT reassured by negative tests or benign courses.

They perform excessive health related behaviors or have maladaptive avoidance. You have to specify whether they are care seeking or care avoiding

Question 5

What types are illness anxiety disorder patients?

Answer 5

Patient can be care seeking or care avoiding

Question 6

What is treatment for illness anxiety disorder?

Answer 6

Pts tend to feel ignored by the medical community— need education about illness from an empathetic health care provider + CBT

Question 7

What is conversion disorder?

Answer 7

Neurological sx that cannot be fully explained by a neuro condition; blindness, deafness, paralysis, weakness, paresthesias, nonepileptic seizures, numbness, aphonia, and abnormal movements.

Pt unintentionally converts psychological distress into actual neurological symptoms that are inconsistent with the pathophysiology of a neurological condition.

Often precipitated by a psychological stressor

Question 8

La belle indifference of conversion disorder

Answer 8

Lack of concern for a severe symptom

Question 9

Risk factors for conversion disorder

Answer 9

Young, female, hx of mental illness

Question 10

Specifiers for conversion disorder

Answer 10

Acute vs persistent
And
+/- psychological stressor

Question 11

Conversion disorder treatment

Answer 11

Education about the disorder and support; resolves spontaneously

Question 12

What is factitious disorder?

Answer 12

Intentional production of physical or psychological signs or symptoms for NO obvious external gain.

Primary reason is to seek the “sick role” to win attention, nurturance, victimhood.

Ex:

• Feign illness by faking seizure or syncope
• falsify lab results by adding blood to a urine specimen
• aggravating an existing ailment by causing a wound to not heal

Question 13

What is factitious disorder by proxy?

Answer 13

AKA Münchausen syndrome by proxy

Parent causing or claiming symptoms in a child- qualifies as child abuse or maltreatment

Question 14

Clues for factitious disorder by proxy?

Answer 14

—Lengthy medical hx
—clinical presentation that is “textbook”
—Sophisticated medical vocabulary
—Demands for specific meds or procedures

Question 15

What should you do if you suspect factitious disorder by proxy?

Answer 15

— seek records from other healthcare providers and confront with evidence in a non threatening way

Question 16

What is malingering?

Answer 16

Intentional production of false or grossly exaggerated physical or psychological symptoms *motivated by external incentives
*avoiding work/military duty, evading criminal prosecution, drug seeking

Personal gain is obvious

Question 17

When should you suspect malingering?

Answer 17

—if its vague, unverifiable symptoms
—Marked discrepancies between claims and objective findings
—lack of cooperation with evaluation and treatment recommended
—Hx of antisocial personality disorder

Question 18

Is malingering more common for males or females?

Answer 18

Mostly males

Question 19

What is dissociative identity disorder?

Answer 19

“Multiple Personality disorder”
At least 2 distinct personality states alternate in controlling patients decisions and behavior

Recurrent gaps in recall of information between personalities

Does cause significant distress or impairment of functioning

Question 20

Epidemiology of dissociative identity disorder

Answer 20

Rare, childhood onset

90% have history of abuse or neglect

Not part of a broadly accepted cultural or religious practice and not d/t substance or medical condition

High risk of suicide attempts and self harm

Question 21

Common morbidity with dissociative identity disorder

Answer 21

Borderline PD is common comorbidity

Question 22

Dissociative identity disorder treatment

Answer 22

R/O other psychotic illnesses + long term individual psychotherapy

Question 23

What is Dissociative Amnesia?

Answer 23

Acute inability to recall important autobiographical information.

Usually follows severe stress, trauma, or shock (combat, natural disasters)

Not better explained by dissociative identity disorder, PTSD, acute stress disorder, somatic sx ds or a neurocognitive disease

Question 24

What is dissociative fugue?

Answer 24

Dissociative amnesia subtype where they lose association with their identity and GO TRAVEL LMAO

They may assume a new identity

Question 25

Medical workup for dissociative amnesia

Answer 25

Should look for neurological causes or toxins

Question 26

Treatment for dissociative amnesia

Answer 26

Recovery tends to be spontaneous

Hypnosis may help recover memory

Question 27

What is Depersonalization disorder?

Answer 27

Detached from their person, like being outside themselves watching themselves

Question 28

What is derealization disorder?

Answer 28

Person is detached from their surroundings— foggy or dreamlike

Question 29

Is reality testing intact in depersonalization/derealization disorder?

Answer 29

Yes

Question 30

Depersonalization/derealization disorder can be a coping mechanism for….?

Answer 30

Acute trauma (MVA) or chronic stress

Question 31

Depersonalization/derealization disorder transient experiences can occur when …?

Answer 31

When Sleep deprived or intoxicated with hallucinogens, marijuana, or alcohol

Question 32

What should you R/O when considering depersonalization/derealization disorder?

Answer 32

R/O Depression, anxiety, panic disorder, PTSD, drug use, schizophrenia, and personality disorders

Question 33

Treatment for depersonalization/derealization disorder?

Answer 33

No standard treatment guidelines exist—

• benzodiazepines for acute anxiety
• Hypnosis or CBT is often employed