somatic disorders Flashcards
clinical features of somatic symptom disorder
-evidence that severe disorder not present does not dissuade patient
-disease presentation may change over time
-if actual disorder present, anxiety is clearly excessive
clinical features of illness anxiety disorder
-belief they have serious illness despite evidence to the contrary
-disease presentation may change over time
-preoccupation interferes with relationships and occupational functioning
-few to none somatic complaints
clinical features of conversion disorder
-presents with neurological symptoms that are motor or sensory but incompatible with any known neurological disorder
what often preceded conversion disorder
stressors associated with psychological factors
diagnostic criteria for somatic symptom disorder
-1+ somatic complaint causing significant distress/functional impairment
-anxiety or preoccupation with symptoms
-symptoms present for at least 6 months
diagnostic criteria for illness anxiety disorder
-preoccupation with false belief of having or getting serious illness
-few to no somatic complaints
diagnostic criteria for conversion disorder
acute loss/alteration in motor or sensory function inconsistent with any neurological disease
what is a common manifestation of conversion disorder
non-epileptic seizures
what is one way to distinguish non-epileptic from epileptic seizures
epileptic has postictal rise in prolactin levels
primary gain
acheived by keeping internal conflicts out of conscious awareness. Symptoms represent an unconscious psychological conflict
secondary gain
patient receives tangible advantages from being sick
identification
bereaved person may take on symptoms experienced by deceased
pseudologia fantastica
mixing limited factual information with colorful/extensive fantasies in factitious disorder
predisposing factors for factitious disorder
-severe illness as a child
-grudge against medical system
-employment in healthcare
-significant past relationship with physician
what is the differentiating factor between somatic symptom disorder and conversion disorder
conversion disorder requires that symptoms are incompatible with any known neurologic disorder
most common personality disorders that are comorbid with somatic disorders
histrionic
dependent
antisocial
first line treatment for all somatic disorders
CBT
modest initial goals in treatment of somatic symptom disorder
-decrease frequency of medical visits
-commit to single PCP
-avoid unnecessary tests/procedures
what are some possible physical recommendations in the treatment of somatic symptom disorder
yoga
exercise
meditation
massage
medications for somatic symptom disorder
generally avoid unless comorbidities need treated
possible CBT methods that may be helpful in treating illness anxiety disorder
mindfulness training
exposure therapy
acceptance and commitment therapy
medication in the treatment of illness anxiety disorder
may be responsive to fluoxetine in addition to CBT
focus of behavioral interventions in treatment of conversion disorder
Improving:
-self-esteem
-capacity for emotional expression and assertiveness
-ability to communicate comfortable with others
what may be necessary for the treatment of chronic conversion disorder
PT
therapeutic intervention for psychological factors affecting other medical conditions
psychoeducation to clarify role psychological factors can have on disease state, course, and remission
focus of treatment in factitious disorder
management rather than cure
4 goals of treatment for factitious disorder
-reduce risk of morbidity/mortality
-address underlying emotional needs
-address and underlying psych dx
-be mindful of legal/ethical issues
etiology for conversion disorder according to behavioral theory
faulty childhood learning used with maladaptive behavioral responses for secondary gains and control of interpersonal relationships
etiology of conversion disorder according to psychoanalytic theory
primary gain of psychological conflict resolution through partial expression of conflict w/o conscious awareness of its significance
2 factors that underly most cases of factitious disorder
affinity for medical system
poor maladaptive coping skills
