Somatic + Culture syndromes Flashcards
Amok
Depression then aggression/homicidal precipitated by perceived insult.
Dhat
Attribute symptoms to lose of sperm (white substance while urinating/defecating).
Koro
Fear penis will go into abdomen and cause death.
Latah
Provoked by state of surprise, trance state, where mechanically repeat words or gestures by other.
(South East Asia)
Zhar
Possession by spirits with laughing, yelling, hitting had against wall, singing, crying.
Khyal
Wind rises in body and causes panic attack.
Taijin Kyofusho
Convinced appearance or actions are inadequate/offensive (similar to olfactive reference syndrome).
Sangue Dormido
Neurological symptoms (seizure, paralysis, blindness).
Defences in somatization?
Repression
Displacement
Somatic symptom disorder
At least one distressing symptom
At least one excessive thoughts/feelings/behaviours related:
- Persistent thoughts about seriousness of symptom
- Persistently elevated anxiety about health/symptom
- Excessive time/energy devoted to health concerns
Symptomatic state persists (typically more than 6 months)
Somatic symptom disorder specifiers
With predominant pain
Persistent (> 6 months)
Severity
What do SSRIs treat in somatic symptom disorder?
Mood and anxiety symptoms but DON’T HELP SOMATIC SYMPTOM
Somatic symptom disorder co-morbidity rate?
80% depression or anxiety
Pain disorder co-morbidities?
Acute more with anxiety
Chronic more with depression
Somatic symptom disorder treatment
TCA & SSRIs for pain, co-morbidities
Analgesics generally not helpful
Maximize advantages of health and minimize disadvantages
Consistent reassurance by primary care
Illness anxiety disorder
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
Illness anxiety disorder specifiers
Care-seeking (majority)
Care-avoidant
Most common conversion symptoms?
PARALYSIS
BLINDNESS
MUTISM
How many conversion patients will eventually get causal medical diagnosis?
25-50%
Which symptoms do not correspond to conversion disorder?
PAIN
FATIGUE
SEX dysfunction
Functional neurological symptom disorder (conversion disorder)
At least one symptom of altered voluntary motor or sensory function
Clinical evidence of incompatibility between the symptom and recognized neurological or medical conditions
Conversion types
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
Conversion disorder acute vs. persistent
6 month cutoff
Which conversion types have bad prognosis?
Tremor
Seizure
Which conversion types have good prognosis?
Paralysis
Aphonia
Blindness
(aka the most common which is good I guess…)
Which side of brain more affected in conversion disorders in women?
LEFT
Which PDs associated with conversion disorder?
Histrionic
ASPD
Dependent
Risk factors for conversion disorder?
Rural
Low SES
Low education/IQ
MILITARY VETS
Waddell Signs in conversion disorder?
- Sensitivity to pressure
- Simulated maneuvers (don’t cause pain)
- False maneuver
- Neuroanatomy
- Hyperreaction
Hemianesthesia conversion finding?
Strict half-body split
Atasia-abasia conversion finding?
Inconsistent abilities in standing, walking, dancing in a normal manner.
Atasia = inability to stand upright unassisted Abasia = lack of motor coordination in walking
Hoover test
Pressure noted in hand under paralyzed leg during antagonistic contraction
Aphonia conversion finding?
CAN COUGH (cords closing)
Blindness conversion findings?
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
Conversion disorder treatment?
Reassurance
Physiotherapy
Treat co-morbidities
What’s most likely to be associated with pseudologica fantastic with peregrinating?
Factitious disorder
Difference between factitious and malingering?
No secondary gains in factitious
Clues for factitious disorder?
Eagerness for procedures
Reluctance for collateral
Medical professional
Co-morbid with MDD
Factitious imposed on a child results in death in what percentage?
6-9%!!!!!
Most frequent methods of factitious imposed on a child?
Poisoning
Smothering
Ganser syndrome?
Often seen in prisoners Non-sensical wrong answers State of consciousness, disoriented Somatic symptoms Pseudohallucinations
Malingering
V code in DSM-5
1% mental health
10-20% NCR evaluations
PD in adults
CD + anxiety in kids
Factitious disorder treatment
Face-saving strategies:
- self-hypnosis
- biofeedback
GP as gatekeeper
Prompt diagnosis
