Somatic + Culture syndromes

Question 1

Amok

Answer 1

Depression then aggression/homicidal precipitated by perceived insult.

Question 2

Dhat

Answer 2

Attribute symptoms to lose of sperm (white substance while urinating/defecating).

Question 3

Koro

Answer 3

Fear penis will go into abdomen and cause death.

Question 4

Latah

Answer 4

Provoked by state of surprise, trance state, where mechanically repeat words or gestures by other.
(South East Asia)

Question 5

Zhar

Answer 5

Possession by spirits with laughing, yelling, hitting had against wall, singing, crying.

Question 6

Khyal

Answer 6

Wind rises in body and causes panic attack.

Question 7

Taijin Kyofusho

Answer 7

Convinced appearance or actions are inadequate/offensive (similar to olfactive reference syndrome).

Question 8

Sangue Dormido

Answer 8

Neurological symptoms (seizure, paralysis, blindness).

Question 9

Defences in somatization?

Answer 9

Repression

Displacement

Question 10

Somatic symptom disorder

Answer 10

At least one distressing symptom

At least one excessive thoughts/feelings/behaviours related:

1. Persistent thoughts about seriousness of symptom
2. Persistently elevated anxiety about health/symptom
3. Excessive time/energy devoted to health concerns

Symptomatic state persists (typically more than 6 months)

Question 11

Somatic symptom disorder specifiers

Answer 11

With predominant pain
Persistent (> 6 months)
Severity

Question 12

What do SSRIs treat in somatic symptom disorder?

Answer 12

Mood and anxiety symptoms but DON’T HELP SOMATIC SYMPTOM

Question 13

Somatic symptom disorder co-morbidity rate?

Answer 13

80% depression or anxiety

Question 14

Pain disorder co-morbidities?

Answer 14

Acute more with anxiety

Chronic more with depression

Question 15

Somatic symptom disorder treatment

Answer 15

TCA & SSRIs for pain, co-morbidities
Analgesics generally not helpful
Maximize advantages of health and minimize disadvantages
Consistent reassurance by primary care

Question 16

Illness anxiety disorder

Answer 16

Pre-occupied with having/acquiring a serious illness
NO SOMATIC SYMPTOMS or mild

Pre-occupation clearly excessive or disproportionate (if have medical condition or risk of developing because of family history)

High anxiety and easily alarmed about personal health

Excessive health-related behaviours or maladaptive avoidance

Present for 6 months
Specific illness may change over time

Question 17

Illness anxiety disorder specifiers

Answer 17

Care-seeking (majority)

Care-avoidant

Question 18

Most common conversion symptoms?

Answer 18

PARALYSIS
BLINDNESS
MUTISM

Question 19

How many conversion patients will eventually get causal medical diagnosis?

Answer 19

25-50%

Question 20

Which symptoms do not correspond to conversion disorder?

Answer 20

PAIN
FATIGUE
SEX dysfunction

Question 21

Functional neurological symptom disorder (conversion disorder)

Answer 21

At least one symptom of altered voluntary motor or sensory function

Clinical evidence of incompatibility between the symptom and recognized neurological or medical conditions

Question 22

Conversion types

Answer 22

Weakness or paralysis
Abnormal movement (tremor, gait)
Swallowing symptoms
Speech symptoms
Attacks or seizures
Anesthesia or sensory loss
Special sensory symptom
Mixed symptoms

With psychological stressor
Without psychological stressor

Question 23

Conversion disorder acute vs. persistent

Answer 23

6 month cutoff

Question 24

Which conversion types have bad prognosis?

Answer 24

Tremor

Seizure

Question 25

Which conversion types have good prognosis?

Answer 25

Paralysis Aphonia Blindness (aka the most common which is good I guess...)

Question 26

Which side of brain more affected in conversion disorders in women?

Answer 26

LEFT

Question 27

Which PDs associated with conversion disorder?

Answer 27

Histrionic ASPD Dependent

Question 28

Risk factors for conversion disorder?

Answer 28

Rural Low SES Low education/IQ MILITARY VETS

Question 29

Waddell Signs in conversion disorder?

Answer 29

1. Sensitivity to pressure 2. Simulated maneuvers (don't cause pain) 3. False maneuver 4. Neuroanatomy 5. Hyperreaction

Question 30

Hemianesthesia conversion finding?

Answer 30

Strict half-body split

Question 31

Atasia-abasia conversion finding?

Answer 31

Inconsistent abilities in standing, walking, dancing in a normal manner. ``` Atasia = inability to stand upright unassisted Abasia = lack of motor coordination in walking ```

Question 32

Hoover test

Answer 32

Pressure noted in hand under paralyzed leg during antagonistic contraction

Question 33

Aphonia conversion finding?

Answer 33

CAN COUGH (cords closing)

Question 34

Blindness conversion findings?

Answer 34

Look at your hand - even blind patients can do this by proprioception I'm testing coordination - patient mimics new movements before realizing Sudden flash of bright light - patient flinches

Question 35

Conversion disorder treatment?

Answer 35

Reassurance Physiotherapy Treat co-morbidities

Question 36

What's most likely to be associated with pseudologica fantastic with peregrinating?

Answer 36

Factitious disorder

Question 37

Difference between factitious and malingering?

Answer 37

No secondary gains in factitious

Question 38

Clues for factitious disorder?

Answer 38

Eagerness for procedures Reluctance for collateral Medical professional Co-morbid with MDD

Question 39

Factitious imposed on a child results in death in what percentage?

Answer 39

6-9%!!!!!

Question 40

Most frequent methods of factitious imposed on a child?

Answer 40

Poisoning | Smothering

Question 41

Ganser syndrome?

Answer 41

``` Often seen in prisoners Non-sensical wrong answers State of consciousness, disoriented Somatic symptoms Pseudohallucinations ```

Question 42

Malingering

Answer 42

V code in DSM-5 1% mental health 10-20% NCR evaluations PD in adults CD + anxiety in kids

Question 43

Factitious disorder treatment

Answer 43

Face-saving strategies: - self-hypnosis - biofeedback GP as gatekeeper Prompt diagnosis