Somatic Disorders, Vertrees Flashcards
What is a somatic Sx anre related disorders
physical sx that defy medical investigation
what are the somatic Sx and related disorders
somatic Sx disorder
illness anxiety disorder
conversion disorder
somatic sx disorder
one+ somatic Sx that is distressing or disruptive
excessibe thoughts, feelings or behaviors related to it:
persistent thoughts about seriousness
persistent high anxiety about health
excessive time and E devoted to Sx
definition of persistence in relation to Sx
at least 6 mo
causes of somatic Sx disorder
health concerns
not reassured for long
utlizie excessive amounts of care
preoccupation with Sx starts early and often spans many years
illness anxiety disorder
preoccupation with having serious disease
no somatic Sx
easily alarmed
not reassured
avoid or excessive health related behaciors
duration of illness anxiety disroder
6+ mo
management somatic Sx and illness anxiety disorder
may remit legitimize suffering protect form iatrogenic harm reinforce patient physician relationship best managed in primary care setting
conversion disorder/Dx
illness of voluntary motor or sensory Sx
not intentionally produced (unconscious)
incompaticle with recognized conditions
precipitant for conversion disorder attack
emotion
ratio M:f conversion disorder
F:M 5:1
la belle indifference
conversion disorder
management of conversion disorder
spontaneous remission common for acute presentation
suggestion/hypnosis and benzos (short term)
behavior modification for persistent presentations
types of factitious disorder
imposed on self
imposed on another (Munchausens by proxy)
what are factitious disorders
conscious production of signs, Sx, diseases
want to be patient!! “primary gain”
what is secondary gain
seek medical care for tangible life benefits ($$)
effort vs motivation consciousness in factitious disorders
conscious effort
unconscious motivation
physical and psychological Sx factitious disorder
socially conforming young females in higher socioeconomic class intelligen and educated assoc with personality disorder likely
munchausans factitious disorder
triad: fabrication of disease, shifting complaints, intense frequenting different hospitals
men, lower socioeconomics
socially maladjusted
avg age 30
munchausans by proxy
mother or daughter
usually imposed on child or elderly
common Sx of factitious disorder
intestinal bleeding hematuria fever diarrhea hypoglycemia cancer non epileptic seizures irone deficiency anemia renal stones
mangement factitious disorder
confrontation
emphasize degree of emotional distress
emphasize behavior must reflect difficulty in communicating needs
prognosis poor
malingering
intentional production of illness
motivated by money, avoidance military, avoidance criminal prosecution, obtaining drugs, obtain shelter
presentation malingering
male
medicolegal presentation
disparity between disability/objective findings
lack of cooperation with eval/Tx
assoc with antisocial personality disorder
management for malingering
not known
management for malingering
not known
mechanism and motivation consciousness for somatic Sx, illness anxiety and conversions
unconscious mechanism
unconscious motivation
consciousness for mech and motivation factitious
mechanism conscious
motivation unconscious
consciousness for mech and motivation malingering
both conscious
rec Tx for factitious
supportive therapy
conversion more common in M or F
F
in M conversion more common
in combat veterans
plans for conversion Tx
relaxation, do nothing
