Somatic, OCD

Question 1

Somatic Symptom D/O

risk factors

Answer 1

neuroticism
low SES, low edu
recent stressful life event
female

Question 2

Somatic Symptom D/o (DSM criteria)

Answer 2

6 mo of being bothered by a somatic sx….

Excessive thoughts of the symptom/behaviors like..

• disprop worry about severity
• persistent anxiety about it
• excessive time devoted to it

Symptom itself doesn’t always have to be present for the whole 6 mo, but the worry does

Question 3

T/F: In somatic symptom d/o, there is not an actual other medical dx.

Answer 3

False - there can be

Question 4

Illness anxiety d/o or “second year syndrome”

Answer 4

May or may not have sx; if you do, they are mild

• preocc w/ getting/having a serious dz
• mild sx cause extreme worry
• performing excessive health checks OR opposite, avoiding dr

… and all this lasts for 6+ months

Question 5

Does illness anxiety d/o have a sex preference?

Answer 5

No.

2-5% ppl seen in primary care

Question 6

Conversion D/o Risk Factors and Onset

Answer 6

Female (2:1)
Stress/trauma can precipitate onset
Late childhood/early adult

Question 7

Conversion D/o

Answer 7

1+ altered voluntary motor or sensory function…
- incapatibility b/t sx neuro / medical condition
- unexplained by another medical disorder
- causes distress
~occ. dissociative sx~
no needed time course

Question 8

How to manage

• somatic sx d/o
• illness anxiety d/o
• conversion d/o

Answer 8

• do no harm (no unneeded tests)
• schedule reg appts to show concern
• explain sx
• tx dpn/anxiety w/ SSRI (if applicable
• psychotherapy if they need behavior modification

Question 9

Factious d/o
“Munchausen Syndrome”
risk factors

Answer 9

1% hospital inpatients
hx child abuse, neglect
familiar w/ healthcare

Question 10

Factious d/o

“Munchausen Syndrome”

Answer 10

• falsification of sx; or induction of injury/dz
• presents ill/injured/impaired
• deception in absence of rewards
• unexplained by other d/o

Question 11

OCD risk factors

Answer 11

• late teens-20s onset
• neurologic d/o
• peds: strep infection
• 85% comorbid DPN

Question 12

OCD

Answer 12

• Os, Cs, or both!
• O+C >1h/day, or distressing
• not attributable to drugs

no time course; usually chronic w/ gradual onset

Question 13

OCD tx

Answer 13

• psychotherapy
• SSRI high dose: dpn
• clomipramine
• antipsychotic (maybe)

Question 14

Body dysmorphic d/o - is there a sex preference?

Answer 14

No

Onset in adolescence/early adulthood

Question 15

Body dysmorphic d/o

Answer 15

• preocc w/ “flaw” (which is not noticed by others)
• repetitive behaviors related to the flaw (mirror check, etc)
• distress affects functioning
• not about fatness/weight

no time course, usually chronic

Question 16

Body dysmorphic d/o tx

Answer 16

CBT
SSRI - suicide common

They might get plastic surgery but it doesn’t help

Question 17

Hoarding d/o

Answer 17

• persistant diff parting possessions
• accumulation of clutter (still counts if fam picks it up)
• causes distress

chronic
onset 11-15, inference w/ functioning in 20s, and clinically sig in 30s

Question 18

Hoarding d/o tx

Answer 18

SSRI and CBT

challenge: pt have insight but cant get over “value” of belongings

Question 19

Trichotillomania

Answer 19

• hair pulling–> loss
• attempts to stop
• causes distress
• no derm condition
• not to fix a flaw
• chronic*

Question 20

Trichotillomania + Excoriation tx

Answer 20

SSRI/TCA
Behavioral therapy
Hyponosis
Cortisone if itching

Question 21

Excoriation

Answer 21

• skin pick -> lesions
• attempts to stop
• causes distress
• not induced medically
• not bc of tactile hallu, etc
• chronic*