Somatic Disorders Flashcards
Describe the evolution of somatic disorders
- Hysteria: 2,000 yrs ago by the Greeks, symptoms came from uterus
- Briquet syndrome: at least 25/60 possible symptoms
- Somatization disorder: DSM3 in 1980, new criteria that reduced number of symptoms
- Somatic Symptom Disorder: DSM5, single symptom
Define Somatic Symptom Disorder (SSD)
- Chronic condition w/unexplained physical symptoms
- Almost exclusively in women
Symptoms suggestive of SSD
- Excessive or chronic pain
- Conversion symptoms
- Chronic, multiple symps that seem to lack an adequate explanation
- Complaints that don’t improve, despite treatment that helps most pts
- Excessive concern w/health or body appearance
Essential feature of SSD
High level of health anxiety by investing excessive time in health care or being excessively worried as to the seriousness of somatic symptoms
Describe the pain a/w somatic symptom disorder
- Typically, it does NOT: wax and wane w/time, diminish w/distraction (UNLIKE DSM 4 somatization disorder)
- It may respond only poorly to analgesics if at all
Describe illness anxiety disorder
- High anxiety coupled with a low threshold for alarm
- Seek reassurance, check for physical signs over and over
- SOME pts cope by avoiding appts though
Types of illness anxiety disorder
- Care seeking type (uses medical services more than normal)
- Care avoidant type (avoids medical care)
Describe conversion disorder
- S/s seem clinically inconsistent with any known medical illness
- Normal exam or bizarre result isn’t enough to affirm diagnosis
- Change in findings from positive to negative when a different test
- Impossible findings
Essential features of factitious disorders
May look like bona fide disease, but it isn’t:
- Simulating symptoms or physical signs (warming a thermometer in coffee)
- Complaint of psych symptoms
Types of factitious disorder
- Behaviors affect that person
- Behaviors affect another individual
Describe FDIS (factitious disorder imposed on self)
Sometimes take on symptoms of new and poorly investigated illnesses (“disorder du jour”)
Describe FDIA
- Munchausen’s by proxy (believe someone else is ill, induce symptoms)
- Child is almost always the victim
- More than 75% of perpetrators are female (usually the mother)
- Many have background in medicine
Mental status exam findings of somatic symptom disorder
- Preoccupation w/physical symptoms
- Mildly anxious, depressed
- NO evidence of thought disorder
- Insight and judgment appears limited
Define conduct disorder
- A child persistently violates rules or rights of others
- Sets fires, destroys property, repeated runaways
Define conduct disorder with limited prosocial emotions
Child has disordered conduct that is callous and disruptive, shows no remorse or regard for feelings of others
Define oppositional defiant disorder
- Multiple examples of negativistic behavior that persists for at least 6 months
- Pts are often angry and irritable
- Disobey or argue with authority figures
- Sometimes accuse others of their own misdeeds
What is the essential feature of primary disruptive and control disorders?
- Problems with regulation of behavior and emotions
- Actions are often illegal with consequent injury to perpetrator or others
Who is MC affected by primary disruptive and conduct disorders?
Males
Who MC shows oppositional behavior?
- Younger children (frequency tends to decline with older children)
- Worse at home
What predicts a worse outcome for oppositional defiant disorder?
Younger age and more severe symptoms
What disorder has a high comorbidity with ADHD and learning disorders?
Oppositional defiant disorder
Oppositional defiant disorder has a high comorbidity rate with what?
ADHD and learning disorders
Treatment of oppositional defiant disorder
- Therapy for child
- Parent management training (to avoid inadvertently reinforcing deviant behaviors)
How does conduct disorder present?
- As early as 2 yo
- Aggressive breaking of rules (beyond normal gender variance)
- During juvenile years and later, these symptoms can lead to arrest or other legal consequences
How many symptoms are required to diagnose conduct disorder?
3 of 15 symptoms
What forms can conduct disorder behavior manifest as?
- Anger and hostility (MC)
2. Lack of empathy and guilt
Treatment of conduct disorder
- Meds
- Parent management training
- Group therapy (under 12 yo helpful, worsens behavior in older)
Pharm treatment of conduct disorder
1st: stimulants
2nd: anticonvulsants
3rd: Lithium
(reduce aggression)
