somatic disorders

Question 1

somatization

Answer 1

tendency to experience and communicate psychological distress as physical symptoms, in the absence of identifiable pathology

Question 2

alexithymia

Answer 2

individuals who have difficulty expressing emotions verbally

Question 3

work-up should be limited to-

Answer 3

objective findings of disease (in order to avoid unnecessary tests and treatments)

Question 4

patient goals should be aimed at-

Answer 4

restoration of function, not resolution of symptoms

Question 5

difference between DSM 4 and 5 for somatization disorders

Answer 5

DSM 4- focused on the unexplained symptoms

DSM 5- focuses on disproportionate affect, behavior and cognition

Question 6

somatic symptom disorder

Answer 6

patients have symptoms that cause significant disruption to daily life, present for 6+ months, with high level of anxiety, excessive time/energy devoted, persistent thoughts about seriousness

Question 7

illness anxiety disorder

Answer 7

worried well, symptoms present for at least 6 months

Question 8

precipitants of illness anxiety disorder (4)

Answer 8

major life stress, serious threat to health, childhood abuse, serious childhood illness

Question 9

conversion disorder

Answer 9

altered voluntary motor or sensory function that is incompatible with medical work-up and causes significant distress/impairment

Question 10

primary gain

Answer 10

expressed disorder provides a partial solution to an intra-psyche problem; patient is often unaware of this

Question 11

secondary gain

Answer 11

patient is unconsciously motivated to assume the sick role and seek privileges afforded to a sick person by society

Question 12

diagnosis of conversion can only be made if-

Answer 12

there is true absence of disease

Question 13

test for hemi-anesthesia

Answer 13

in conversion disorder: strict splitting of the midline

Question 14

test for paralysis

Answer 14

in conversion disorder: hand falls next to face; pressure from heel noted in examiners hand

Question 15

test for pseudoseizures

Answer 15

in conversion disorder: closed eyes resist opening, no increase in serum prolactin

Question 16

test for unilateral tremor

Answer 16

in conversion disorder: tremor changes with distraction

Question 17

test for bilateral blindness

Answer 17

in conversion disorder: patient unable to look in the direction of hand; unable to touch index fingers

Question 18

non-epileptic seizures are most common in-

Answer 18

patients with epilepsy

Question 19

pseudocyesis

Answer 19

false belief of being pregnant that is associated with objective signs of pregnancy

Question 20

factitious disorder

Answer 20

falsification of physical or mental symptoms with primary motivation to assume the sick role

Question 21

most common personality disorder associated with factitious disorder

Answer 21

borderline PD

Question 22

sign of laxative abuse

Answer 22

phenolphthalein in stool

Question 23

signs of factitious hypoglycemia (2)

Answer 23

exogenous insulin- low C peptide*

PO agent- urine glyburide level

Question 24

signs of factitious hyperthyroidism (2)

Answer 24

exogenous T4- absent goiter, absent anti-TSH receptor antibodies*

Question 25

signs of factitious fever (2)

Answer 25

manipulation of thermometer, difference between temperature and pulse

Question 26

signs of factitious wounds (2)

Answer 26

multiple organisms/culture suggests uncommon source

Question 27

malingering

Answer 27

intentional production of false/exaggerated problems motivate by external incentives

Question 28

personality disorder associated with malingering

Answer 28

anti-social