Somatic disorders, eating disorders

Question 1

Somatic symptoms and related disorders. General theme

Answer 1

• Share a common feature: prominence of somatic symptoms associated with significant distress and impairment. - It is not just the somatic symptoms, its the way they present and interpret them - abnormal thoughts feelings and behaviours in response to these symptoms. - Many factors can lead to these symptoms

Question 2

Clinical présentation of somatic symptom disorder (SSD)

Answer 2

• Individual exhibits somatic symptoms that are distressing or disrupt daily life and devotes to these somatic symptoms excessive thoughts (disproportionate and persistent thoughts about the seriousness of one’s symptoms) - Excessive behaviours (excessive time and energy devoted to these symptoms or health concerns) - Individuals appraise their bodily symptoms as unduly, threatening, harmful or even catastrophic for their health, even when there is evidence to the contrary. - they may seek care from multiple doctors

Question 3

Etiopathogenesis of SSD

Answer 3

Psychological factors: - Negative emotionality - heightened attention to bodily sensations - Attribution of bodily symptoms to possible illness rather than it being a normal phenomena - Depression and anxiety risk factors Social factors: - Childhood sexual/physical abuse or neglect, female sex, older age lower education, unemployment, stressful life events, concurrent chronic physical illness

Question 4

Functional consequences of SSD

Answer 4

• Health related quality of life is impaired, both physically and mentally - In severe SSD the health and social impairment is marked and can lead to invalidism

Question 5

Differential diagnosis of SSD

Answer 5

• Generalised anxiety disorder - Depressive disorders are commonly accompanied by somatic symptoms however core depressive symptoms of low mood and anhedonia differentiate them from somatic symptom disorder - Illness anxiety disorder - if the individual has extensive worries about health but no (or minimal) somatic symptoms - Delusional disorder. Somatic type

Question 6

Hypochondriasis (Illness anxiety disorder) (IAD)

Answer 6

• Individual is preoccupied with having undiagnosed serious illness, although somatic symptoms are to present or minimal - The individual is very anxious about their health, is easily alarmed about illness e.g. hearing about someone else falling ill may trigger even a panic attack - Individual researches their suspected disease excessively, adopts maladaptive avoidance of situations (e.g. doesnt visit family, exercise) - Negative tests or physicians reassurance generally do not alleviate their worries. - They highly utilise medical services, goes to multiple docs, multiple tests - They are generally dissatisfied with their medical care

Question 7

Development and course of IAD

Answer 7

The course is chronic and onset in adulthood - Specific illness that is feared may change over time and health-related anxiety usually increases with age

Question 8

Etiopathogenesis of IAD

Answer 8

Psychosocial factors - childhood abuse, serious childhood illness, major life stress, serious but ultimately benign threat to the individual’s health are risk factors

Question 9

Conversion disorder (functional neurological symptom disorder) - CD

Answer 9

• The individual has symptoms of altered voluntary motor or sensory function

Question 10

Motor symptoms of CD

Answer 10

• Weakness or paralysis - Abnormal movements (e.g. tremor dystonic movement, myoclonus, gait abnormalities, abnormal limb posturing)

Question 11

Sensory symptoms of CD

Answer 11

• Include altered, reduced, absent skin sensation (anaesthesia) - Visual, olfactory or hearing disturbance other symptoms include: - Swallowing symptoms - Absent speech - Altered articulation

Question 12

Development and course of CD

Answer 12

Onset may be associated with psychological or physical stress and may occur throughout life course. - Symptoms can be transient

Question 13

Etiopathogenesis of CD

Answer 13

Biological factors - Presence of neurological or somatic disease that causes either similar symptoms or is a risk factor for conversion disorder Psychosocial factors - Childhood abuse and neglect, maladaptive personality traits, stressful life events and receive of disability benefits are risk and negative prognostic factor for conversion disorder

Question 14

Functional consequences of CD

Answer 14

Substantial distress, disability and impairment in social, academic/professional functioning

Question 15

Differential diagnosis of CD

Answer 15

Neurological disease - That might better explain the symptoms is the main different diagnosis - Conversion disorder may co-exist with a neurological disease

Question 16

Psychological factors affecting medical conditions

Answer 16

• Individual has psychological or behavioural problems, but not a mental disorder (e.g. maladaptive personality traits, maladaptive relationship and coping styles e.g. denial of symptoms; psychological distress; stressful life events etc that adversely affected their illness - These psychological factors influence the outcome of their illness as shown by a temporal association between the factors and the development, exacerbation of or delayed recovery from the illness

Question 17

Differential diagnosis

Answer 17

• Mental disorders - frequently result in medical complications (e.g. alcohol and tobacco use disorder) if an individual has a mental disorder that adversely affects illness, the diagnosis of the mental disorder is given. - Adjustment disorders. Psychological or behavioural symptoms that develop in response to a medical condition are an adjustment disorder (a psychological response to a stressor) e.g. individual with anxiety that is precipitated whenever he becomes enraged would be diagnosed as having “psychological factors affected other medical conditions” where as an individual with angina who develops maladaptive anticipatory anxiety would be diagnosed as having an “adjustment disorder with anxiety”

Question 18

Treatment of somatic symptom disorders

Answer 18

Pharmacotherapy - Used for comorbid syndromes of somatic symptom disorders e.g. antidepressants, tranquillisers for comorbid depressive and anxiety disorders Psychotherapy - Group, individual insight oriented, behaviour and cognitive psychotherapy often benefit patients with somatic symptoms disorders

Question 19

Eating disorders

Answer 19

1. Anorexia nervosa
2. Bulimia nervosa

The essental features of the eating disorders are severe disturbances in eating behaviour and in perception of body shape and weight that significantly impairs physical health and pyschosocial functioning

Question 20

Anorexia nervosa

Answer 20

• Individual refuses to maintain a minimally normal weight
• Individual has intense fear of losing weight