Somatic Sx D/o Flashcards
What are somatic sx d/o characterized by? (basically, what are they?)
Physical sx for which no underlying medical workup can identify a cause
__% of primary care pts exhibit medically unexplained sxs
30%
Somatic sx d/o are more common in (men/women), with a typical age of onset in the _____ but also in the ______
women; 20s; elderly
Somatic sx d/o are more common for lower _____ and lower ______
income; education level
What is the etiology of somatic sx d/o?
Unknown, likely genetic component as can run in families
Somatic sx must be presents for how long for official dx of somatic sx d/o? Must this be the same sx or many?
at least 6 mo
one single sx does not have to persist that entire time “sx migration
T/F Somatic sx d/o can affect multiple organ systems
true
In pts with somatic sx d/o, when does the preoccupation w/ their sx usually begin? How long can their sx last for?
usually begins early in life
months, years, or even decades
What general type of sx do pts with somatic sx d/o usually present with? Examples?
Sxs are often those which cannot be measured, pain, GI upset, malaise, blurry vision
What are some clues that a pt might have a somatic sx d/o?
Frequent clinical visits and “doctor shopping”
Frequent/multiple admissions (ED, inpt)
Unnecessary medical procedures
What aspect of illness/anxiety d/o interferes w/ a pt’s normal social functioning?
Incessant worry
Are pts with illness/anxiety d/o sx d/o reassured by negative medical tests?
No
Pts with illness/anxiety d/o may amplify/misinterpret normal _________
physiological experiences/sensations
What is the distress that pts with illness/anxiety d/o suffer from caused by? What is it NOT caused by?
NOT from the sxs, but what they feel the sxs mean, and the resulting anxiety and concern
Do men have a(n) higher/lower/equal prevalence of illness/anxiety d/o as women? In what population is illness/anxiety d/o rarely seen in?
men and women have similar prevalence; rarely found in children
What are some characteristics/actions of a pt w/ illness/anxiety d/o?
Pts are often hypervigilant about their health, monitor their bodies frequently for dz, may insist on multiple standard screening exams
When illness/anxiety d/o is seen in the elderly, what is often the focus of their d/o?
memory-related
Are Conversion D/o and Functional Neurological Sx D/o the same d/o?
Yes
Pts with conversion d/o usually have 1+ sx where (involuntary/voluntary) motor/sensory fxn is lost, and suggests an underlying _______ condition
voluntary; neuro/medical
In pts with conversion d/o, sx that are described (are not/are) consistent w/ a known neuro/medical illness
are not
T/F A precipitating psychological factor is not usually associated with onset of sx of a conversion d/o
False, it usually is, but is not required for dx
If the pt’s main complaint is limited to pain, then they are dx w/ ________
Somatic Sx D/o
In regards to conversion d/o, acute is ____ mos of sx, and chronic is _____ mos of sx
<6; >6
___-___% of pts admitted to neuro service have conversion d/o
20-25%
Conversion d/o is more frequent in _____, lower income/educational level, and ____ areas
women; rural
When is the typical age of onset of conversion d/o?
onset can be anywhere from childhood to adulthood
Many pts w/ conversion d/o have additional dx of….
other mental illnesses (mood or psychotic d/o)
Are sx of conversion d/o more permanent or more come-and-go?
Sx are transient
The best outcome of pts with conversion d/o is associated w/ what type of onset? In the absence of what?
acute onset with a clear precipitating stressor
in the absence of other comorbid neuro/medical conditions
What are some common complaints coming from a pt with conversion d/o? (x7)
Paralysis, abnml movements (twitching), aphonia, blindness, deafness, pseudoseizures, loss of sensation/anesthesia over part of body
How often are psychotropic medications needed in the tx of somatic sx d/o, illness/anxiety d/o, and conversion d/o?
Rarely are psychotropic meds needed, unless there is a clear co-morbid condition
Individual psychotherapy, cognitive behavioral therapy (has not/has) shown value in tx pts with somatic sx d/o, illness/anxiety d/o, and conversion d/o
has
SSRIs have been shown to improve_______ in the past in pts with somatic sx d/o, illness/anxiety d/o, and conversion d/o
hypochondriasis (DMS-IV dx)
If a pt with somatic sx d/o, illness/anxiety d/o, or conversion d/o presents with c/o ______, they may need inpatient tx
Dramatic sx (i.e. blindness, paralysis)
What is factitious d/o?
A d/o characterized by the intentional production or feigning of physical or psychological sx
Are there any clear external factors/incentives for faking sx in a pt with factitious d/o?
No
What is factitious d/o thought to be motivated by?
unconscious desires
Once factitious d/o is suspected/likely, what should be immediately obtained?
Psych consult
If you feel as though you have sufficient evidence to dx a pt with factitious d/o, how should you confront the pt?
in a non-threatening manner
Once evidence is obtained, their belongings and room can be searched (drugs, sharp objects)
Patients with factitious d/o often have a (short and uncomplicated/lengthy and complex) medical Hx
lengthy and complex
In a pt with factitious d/o, self reported signs and sx are usually described as…
Self-reported s/s are “textbook”
Pts with factitious d/o usually have an extensive hx of what?
Hx of excessive surgeries
Once you believe that a pt has factitious d/o, what should be done?
Obtain previous medical records, if possible, and speak w/ previous providers
What is the one condition that is not technically a somatic d/o that I am lumping into this section, and is actually characterized as an “Other Conditions” d/o?
Malingering!
Is malingering considered a mental d/o?
No
What is malingering?
The act of intentionally reproduction of sx/feigning illness for specific gain
Might might be considered “external incentives” for pts presenting with malingering?
missing work, monetary compensation, avoiding military obligation, obtaining drugs…
How should pts with malingering be handled?
Not really sure, no consensus on this matter – good luck!
