Somatic disorder

Question 1

What is somatization?

Answer 1

Physical Sxs that mimic a disease that isn’t there.

Psychological distress felt in a physical form

Question 2

Symptoms associated with somatic nervous system, such as?

Answer 2

Pain
Tremors
Fatigue
Paralysis 
Shortness of breath

Question 3

At least one somatic symptom with disruption of normal life

Excessive thoughts/feelings/behaviors related to the sxs with at least one of these:
Thoughts OOPT the seriousness
Persistent high anxiety about the sxs
Excessive time devoted to the sxs

State of being symptomatic continuously is present

Answer 3

Somatic Symptom Disorder

Question 4

Variable severity of Somatic symptom disorder…

Mild: Only one criterion B
Moderate: Two or more criterion B
Severe: Two or more criterion B plus multiple somatic complaints or one very severe sx

Answer 4

Criterion B =

Thoughts OOPT the seriousness
Persistent high anxiety about the sxs
Excessive time devoted to the sxs

Question 5

Typically multiple symptoms but not always
*Pain is most commonly present (fatigue)
Sxs can be specific or nonspecific
Patients tend to have very high levels of worry about illness
*May become a feature of one’s identity and dominate interpersonal relationships
“Doctor shopping” for the same symptoms
Symptoms may be unresponsive to medical intervention

Answer 5

Somatic Symptom Disorder

Question 6

For somatic symptom disorder… “state of continuously present” means how long?

Answer 6

6 months

Question 7

Somatic sxs w/o an evident medical explanation are NOT sufficient to make this diagnosis…

Answer 7

Somatic symptom disorder (remember… r/o eiologic causes first)

Question 8

Panic d/o vs SSD?

Answer 8

Panic d/o is typically more transient or acute

Question 9

GAD vs SSD?

Answer 9

GAD is more anxious about all kinds of things.. not just their sxs

Question 10

TX for somatic symptom disorder

Answer 10

Social and peer support, to include coming to appointments to learn how to live with the patient

Question 11

No real medication helps

Avoid using medication to replace appointments

(Refractory cases may respond to SSRI/SNRI antidepressants (UTD)…This could exacerbate symptoms though (UTD))

Answer 11

Somatic symptom disorder

strongly consider consult w/ psychiatry if considering SSRI/SNRI

Question 12

Schedule regular visits
Establish collaborative, therapeutic alliance with the patient (don’t blow them off)
Acknowledge and legitimize symptoms as appropriate
Coordinate care with other providers/specialists so everyone is on same page
Evaluate and treat medical conditions which are present
Limit diagnostic tests and specialist referrals, and focus on education
MUCH reassurance that nothing has been missed
Treat any comorbid psych diagnoses (depression/anxiety/etc.)
CLEARLY set the treatment goal as functional improvements
Evaluate and treat any underlying substance abuse/self-medication issues

Answer 12

Somatic symptom disorder

Question 13

Worried they MAY have or acquire a serious illnes

Somatic sxs absent or minimal

High anxiety about health and over alarmed about health status

Excessive health related behavior or maladaptive behavior

Answer 13

Illness Anxiety Disorder

AT LEAST 6 months

Question 14

Preoccupation with having or acquiring a serious, undiagnosed medical illness

NO somatic Sxs but a lot of anxiety about getting the illness

Thought to be chronic and relapsing

Answer 14

Illness Anxiety Disorder

Question 15

High quality patient provider relationship can be very helpful

Treat as you would somatic symptom disorder

Answer 15

Illness Anxiety Disorder tx

Question 16

At least one sx of altered voluntary motor or sensory function

Objective evidence of incompatibility between sxs and known neurological disorder

Answer 16

Conversion disorder

stay at superficial level… will need LOTS of specialists to treat/manage this…

Question 17

Motor: weakness or paralysis, tremors, abnormal limb posturing, speech changes

Sensory: abnormal skin sensation, vision/hearing changes, globus sensation

Could mimic seizures, syncope, coma

Answer 17

Conversion disorder

Avoid making this diagnosis just because a symptom is bizarre

Question 18

Tx for conversion disorder?

Answer 18

Non-pharmacologic (hypnosis)

No real medication helps
Avoid using medication to replace appointments

Question 19

Falsified signs or symptoms or induced injury or disease with identified deception

Presents themselves as affected

Deception evident without signs of secondary gain

Answer 19

Factitious disorder

Question 20

A patient purposefully deceives and falsifies signs and symptoms

Can be falsified about ones self or another

Answer 20

Factitious Disorder

Question 21

Tx for factitious disorder?

Answer 21

non-pharmacological

Early psych consult is indicated (conjoint confrontation, biofeedback/self-hypnosis, double blind)