Somatic Sx and related disorders

Question 1

Somatic Symptom Disorder

Answer 1

Distressing or disruptive somatic symptoms

• excessive thoughts, feelings, behaviors about Sx or related health worries about (at least one)
  
  • excessive thoughts about seriousness of Sx
  • excessive anxiety about Sx or health
  • excessive time n energy spent on Sx or health concerns
• symptomatic >6mo

Typical Hx

• past: abuse
• recent: marital problems, interpersonal or occupational problems

Question 2

Hx suspicious of SSD

Answer 2

• complicated medical Hx
• exaggerated Sx
• vagueness
• inconsistency
• presence of conversion
• presence of dissociation

Question 3

SSD Diff Dx (also for illness anxiety disorder)

Answer 3

1. True disease
2. Other somatic symptom and related disorders
   - illness anxiety disorder
   - conversion disorder
   - psychological factor affecting another medical condition
   - factitious disorder
3. Anxiety disorders
   - generalized anxiety disorder
   - panic disorder
4. Mood disorders
   - major depressive disorder
   - persistent depressive disorder
5. OCD and related
   - OCD
   - body dysmorphic disorder
6. Psychotic disorders
   - Schizophrenia
   - schizoaffective disorder
   - delusional disorder, somatic type

Question 4

SSD Mx

Answer 4

1. Form a good doctor patient relationship - crucial
2. Look for treatable conditions
3. Seek comorbid psychiatric conditions (anxiety disorders, depressive disorders, bipolar and related, OCD, psychotic)
4. Minimize unnecessary interventions
5. Refer for CBT and psychoherapy

Amitriptyline or SSRI’s may be helpful for chronic pain of any origin

Question 5

Illness anxiety disorder

Answer 5

Preoccupation with having or getting serious illness

• much anxiety about health
• excessive health related behaviors or maladaptive avoidance
• no somatic Sx, or only mild
• if physical condition exists, preoccupation is clearly excessive
• duration >6mo

Question 6

IAD Specifiers

Answer 6

Care-seeking type

Care avoidant type

Question 7

Conversion Disorder

Answer 7

(aka functional neurological symptom disorder)

Sx about changes in sensory and voluntary motor function that ire incompatible with recognized neurological or medical conditions

• significant distress/impairment in functioning
• not better explained by another medical/mental disorder

Question 8

Conversion disorder specifiers

Answer 8

• with weakness or paralysis
• with abnormal movements
• with swallowing symptoms
• with speech symptoms
• with attacks or seizures
• with anesthesia or sensory loss
• with special symptom categories
• with mixed symptoms

Either with or without a psychological stressor

Question 9

Factitious disorder - 2 types

Answer 9

-symptoms are produced intentionally and in order to deceive

Imposed on self
-deception about physical or psychological Sx, having the person presenting himself as ill, impaired or injured, without any clear external rewards

Imposed on another
=presents another person as ill, impaired or injured

-single episode or recurrent

Question 10

Malingering

Answer 10

Symptoms and signs are produced by deception with a specific external incentive, like being medically boarded, getting out of jail, insurance claims etc.