Somatic and Dissociative Disorders Flashcards
What is somatic symptom disorder?
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
What is the treatment for somatic symptom disorder
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.
Does somatic symptom disorder affect males or females more?
F>M
Also, 5-7% of the general population
What is illness anxiety disorder?
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
What types are illness anxiety disorder patients?
Patient can be care seeking or care avoiding
What is treatment for illness anxiety disorder?
Pts tend to feel ignored by the medical community— need education about illness from an empathetic health care provider + CBT
What is conversion disorder?
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
La belle indifference of conversion disorder
Lack of concern for a severe symptom
Risk factors for conversion disorder
Young, female, hx of mental illness
Specifiers for conversion disorder
Acute vs persistent
And
+/- psychological stressor
Conversion disorder treatment
Education about the disorder and support; resolves spontaneously
What is factitious disorder?
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
What is factitious disorder by proxy?
AKA Münchausen syndrome by proxy
Parent causing or claiming symptoms in a child- qualifies as child abuse or maltreatment
Clues for factitious disorder by proxy?
—Lengthy medical hx
—clinical presentation that is “textbook”
—Sophisticated medical vocabulary
—Demands for specific meds or procedures
What should you do if you suspect factitious disorder by proxy?
— seek records from other healthcare providers and confront with evidence in a non threatening way
What is malingering?
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
When should you suspect malingering?
—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
Is malingering more common for males or females?
Mostly males
What is dissociative identity disorder?
“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
Epidemiology of dissociative identity disorder
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
Common morbidity with dissociative identity disorder
Borderline PD is common comorbidity
Dissociative identity disorder treatment
R/O other psychotic illnesses + long term individual psychotherapy
What is Dissociative Amnesia?
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
What is dissociative fugue?
Dissociative amnesia subtype where they lose association with their identity and GO TRAVEL LMAO
They may assume a new identity
Medical workup for dissociative amnesia
Should look for neurological causes or toxins
Treatment for dissociative amnesia
Recovery tends to be spontaneous
Hypnosis may help recover memory
What is Depersonalization disorder?
Detached from their person, like being outside themselves watching themselves
What is derealization disorder?
Person is detached from their surroundings— foggy or dreamlike
Is reality testing intact in depersonalization/derealization disorder?
Yes
Depersonalization/derealization disorder can be a coping mechanism for….?
Acute trauma (MVA) or chronic stress
Depersonalization/derealization disorder transient experiences can occur when …?
When Sleep deprived or intoxicated with hallucinogens, marijuana, or alcohol
What should you R/O when considering depersonalization/derealization disorder?
R/O Depression, anxiety, panic disorder, PTSD, drug use, schizophrenia, and personality disorders
Treatment for depersonalization/derealization disorder?
No standard treatment guidelines exist—
- benzodiazepines for acute anxiety
- Hypnosis or CBT is often employed
