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Psyc Test 2 > Somatic Disorder + OCD ID > Flashcards

Somatic Disorder + OCD ID Flashcards

1
Q

Somatic Symptom Disorder

Epi

A
  • 5-7% general prev
  • F>M
  • Occurs in all ages

Risk factors:

  • neuroticism
  • low SES
  • low education
  • recent stressful life events
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2
Q

Somatic Symptom Disorder

Criteria

A

Excessive distress (thoughts, feelings, or behaviors) resulting from one or more somatic symptom (MC pain)

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3
Q

Somatic Symptom Disorder

DDX

A

A known medical diagnosis causing the symptom and somatic sx d/o are not mutually exclusive

  • Panic d/o
  • GAD
  • Depression
  • Delusional d/o (somatic subtype)
  • Other dx in this table
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4
Q

Somatic Symptom Disorder

Course

A

Symptom(s) must be persistent (typically > 6 months)

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5
Q

Somatic Symptom Disorder

Tx

A
  • Do no harm (avoid unnecessary tx/tests)
  • Regular scheduled clinic visits (regardless of sx) to show concern but avoid unnecessary utilization of resources and doctor shopping
  • Help patients cope with sx (explain them, encourage diet, exercise, return to functioning). *Patient-PA relationship is therapy in and of itself.
  • Treat comorbid conditions (depression, anxiety). *SSRI may help illness anxiety d/o.
  • Psychotherapy behavior modification
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6
Q

Illness Anxiety Disorder

Epi

A
  • 2-5% of pts seen in primary care
  • M=F
  • “second year syndrome” in medical professionals in training
  • Onset early/middle adulthood, increases with age
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7
Q

Illness Anxiety Disorder

Criteria

A
  • Persistent preoccupation (anxiety, health-related behaviors) with having or acquiring serious illness
  • No somatic symptoms (or mild if there are)
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8
Q

Illness Anxiety Disorder

DDX

A

Adjustment d/o

Same ddx as above

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9
Q

Illness Anxiety Disorder

Course

A

Must be at least 6 months, but the specific illness one is preoccupied with may change in that time
Chronic and relapsing vs. transient

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10
Q

Illness Anxiety Disorder

Tx

A
  • Do no harm (avoid unnecessary tx/tests)
  • Regular scheduled clinic visits (regardless of sx) to show concern but avoid unnecessary utilization of resources and doctor shopping
  • Help patients cope with sx (explain them, encourage diet, exercise, return to functioning). *Patient-PA relationship is therapy in and of itself.
  • Treat comorbid conditions (depression, anxiety). *SSRI may help illness anxiety d/o.
  • Psychotherapy behavior modification
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11
Q

Conversion Disorder

Epi

A
  • 5% of referrals to neuro clinic
  • F>M (2:1 or 3:1)
  • Onset may be associated with stress or trauma
  • Onset usually late childhood/early adult
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12
Q

Conversion Disorder

Criteria

A
  • Altered voluntary motor or sensory function incompatible with clinical findings (nonepileptic seizures, focal paralysis)
  • Dissociative symptoms common at onset or during episodes
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13
Q

Conversion Disorder

DDX

A

Must have clear evidence of incompatibility with neuro disease

  • Depression
  • Panic
  • Body dysmorphic
  • Dissociative
  • Other dx in this tabl
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14
Q

Conversion Disorder

Course

A

May be transient or persistent

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15
Q

Conversion Disorder

Tx

A
  • Do no harm (avoid unnecessary tx/tests)
  • Regular scheduled clinic visits (regardless of sx) to show concern but avoid unnecessary utilization of resources and doctor shopping
  • Help patients cope with sx (explain them, encourage diet, exercise, return to functioning). *Patient-PA relationship is therapy in and of itself.
  • Treat comorbid conditions (depression, anxiety). *SSRI may help illness anxiety d/o.
  • Psychotherapy behavior modification
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16
Q

Factitious Disorder

Epi

A
  • 1% of hospital inpatients
  • History of child abuse/neglect
  • Patient familiar with health care, may be HCP
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17
Q

Factitious Disorder

Criteria

A
  • Purposeful self-infliction or falsification of signs of illness or injury to elicit medical care, even in the absence of external rewards
  • Inflicted injury may be serious requiring treatment
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18
Q

Factitious Disorder

DDX

A

Malingering - aim is an external reward ($, time off)

  • Borderline personality
  • Somatic sx
  • Conversion d/o
19
Q

Factitious Disorder

Course

A

Generally episodic

20
Q

Obsessive Compulsive Disorder

Epi

A
  • 2-3% prev
  • M=W
  • Onset late teens/early 20s (men earlier onset)
  • Associated with neurologic disorders (epilepsy, huntingtons, brain trauma, birth injury, Tourettes)
  • In peds, association w/ strep infection
21
Q

Obsessive Compulsive Disorder

Criteria

A

*Presence of obsession and/or compulsion
Consuming >1 hour daily (or highly interfering w/ life)
*Experienced as intrusive and inappropriate, causing anxiety/distress

22
Q

Obsessive Compulsive Disorder

DDX

A
  • Obsessive compulsive personality
  • GAD
  • Schizophrenia
  • PTSD
  • Eating d/o (and any Dx in this table)

70-80% have comorbid major depression

23
Q

Obsessive Compulsive Disorder

Course

A

*Usually gradual onset

  • 85% chronic
  • 10% progressive/ deteriorating
  • 2% episodic
  • **But with treatment, remission is possible
24
Q

Obsessive Compulsive Disorder

Tx

A
  • Behavior and psychotherapy
  • SSRI at higher doses than required for depression, and response takes longer
  • Clomipramine (TCA)
  • Antipsychotic (sometimes
25
Q

Body dysmorphic disorder

Epi

A
  • 1-3% prev
  • M=W
  • Onset in adolescence or early adulthood
  • 75% do not marry, divorce is common if they do
  • Some go on disability (housebound due to embarrassment)
  • Some undergo plastic surgery
26
Q

Body dysmorphic disorder

Criteria

A

*An incapacitating preoccupation with a physical defect or flaw that is/are not seen or appear slight to others. *Performs repetitive behaviors (mirror checking, excess grooming) or mental acts (comparing to others).

27
Q

Body dysmorphic disorder

Course

A
  • Tends to be chronic but fluctuates in severity
  • Full remission is rare
  • Suicidality is common
  • Cosmetic surgery does not actually change the patient’s preoccupation
28
Q

Body dysmorphic disorder

Tx

A
  • CBT
  • SSRI
  • Those with delusional form, try adding a 2nd gen antipsychotic
29
Q

Hoarding Disorder

Epi

A

Good prev data not available.
Some findings:
*Point prevalence survey estimates 2-6%

Risk factors:

  • stressful/traumatic life events prior to onset
  • Indecisive temperament
  • Familial
30
Q

Hoarding Disorder

Criteria

A
  • Difficulty/distress parting with possessions, regardless of their actual value, leading to accumulation that makes living areas cluttered and not functional
  • Note: 80% have the specifier “with excess acquisition” (compulsive shopping etc)
31
Q

Hoarding Disorder

DDX

A
  • OCD
  • MDD (from low energy)
  • Delusional conditions (schizo)
  • Cognitive deficits (brain trauma, stroke, dementia, *Prader-Willi etc)
  • Autism spectrum
  • ***distinguishing factor is emotional attachment to items
32
Q

Hoarding Disorder

Course

A

*Chronic

  • First sx around age 11-15, *interfering function by mid 20s,
  • Clinically significant by mid-30s and severity increases with age
33
Q

Hoarding Disorder

Tx

A
  • Might benefit from SSRIs, CBT.
  • Challenging treatment.

*Patients do have insight into the problem, yet cannot overcome the perceived value of belongings

34
Q

Trichotillomania

Epi

A
  • 1-4% prev in adolescents and college students

* Mostly female

35
Q

Trichotillomania

Criteria

A
  • Hair loss from pulling out one’s own hair. (anywhere on body, if on scalp it is hidden)
  • Repeated attempts to stop.
36
Q

Trichotillomania

DDX

A

*Body dysmorphic d/o
Dermatologic condition
*Comorbid mood and anxiety disorders common.

37
Q

Trichotillomania

Course

A

Chronic with fluctuating severity.

38
Q

Trichotillomania

Tx

A
  • Behavioural: habit reversal
  • Pharm: SSRI or clomipramine (TCA), topical steroids if itching prompts pulling
  • Hypnosis
39
Q

Excoriation

Criteria

A
  • Recurrent skin picking resulting in skin lesions. (MC site is face; might cause serious infxn)
  • Repeated attempts to stop.
40
Q

Excoriation

DDX

A
  • Substance use (cocaine)
  • Derm conditions (scabies, psoriasis, etc)
  • Psychosis (delusions/ hallucinations)
  • Body dysmorphic
  • Self-injury
41
Q

Excoriation

Course

A
  • Chronic with fluctuating severity

* Few seek treatment

42
Q

Excoriation

Tx

A
  • Not well established. *Usually treated similar to trichotillomania
  • (SSRI + habit reversal)
43
Q

Substance/med induced OCD

Criteria

A

Obsessions, compulsions, body-related repetitive behaviors (skin picking, hair pulling etc) that occurs during intoxication or withdrawal from substance or with medication use

44
Q

Body Dysmorphic Disorder

DDX

A
  • Eating disorder (preoccupation in BDD does not concern body fat or weight)
  • Depression and social phobia common comorbidities
  • Some are delusional about the defect, but not given delusional disorder dx

Psyc Test 2 (7 decks)

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