Somatic Sx & Related Disorders

Question 1

somatic symptom disorder defined by presence of ___________.

Answer 1

multiple complaints that are not fully explained by physical factors, that result in medical attention or significant impairment

Question 2

How is somatic symptom disorder manifested?

Answer 2

At least 1 of following:

• Disproportionate/persistent thoughts about the seriousness of symptoms
• Persistently high anxiety about health/symptoms
• Excessive time/energy devoted to symptoms and health concerns

Question 3

Timing/duration of somatic symptom disorder symptoms

Answer 3

• persistent; usually more than 6 months

- chronic illness with fluctuations

Question 4

Complications of somatic symptom d/o

Answer 4

• Repeated surgeries
• Drug dependence
• Suicide attempts (completed not common)
• Marital separation/divorce

Question 5

Possible etiologies of somatic symptom d/o

Answer 5

temperamental factors, comorbid anxiety and depression, lower education, psychological abuse in childhood, recent stressful life events, familial pattern (learned), personality disorders

Question 6

somatic symptom d/o treatment

Answer 6

• No single superior approach
• Empathic, supportive, functional - Caution about ordering repetitive, unnecessary med/surg workups
• PCP can manage but consult is helpful (set firm limits on manipulations and attention-seeking)

Question 7

disorder with multiple domains of worry

Answer 7

generalized anxiety disorder

Question 8

general description of illness anxiety d/o

Answer 8

preoccupation and anxiety with having or acquiring a serious illness for at least 6 months

Question 9

Illness Anxiety d/o formerly called ______.

Answer 9

hypochondriasis

Question 10

Illness Anxiety d/o treatment

Answer 10

• Early referral to psych
• Consider SSRI for anxiety
• Schedule frequent, regular PEs to assure patient is being taken seriously. But avoid invasive diagnostics

Question 11

General definition of Conversion Disorder

Answer 11

Presence of symptoms of altered motor or sensory function that are incompatible with any recognized neurological or medical condition, causing significant distress/impairment

Question 12

Motor and sensory symptoms associated with conversion disorder

Answer 12

Motor: weakness, paralysis, abnormal movements such as tremor, dystonia, gait abnormalities, abnormal limb posturing

Sensory: altered, reduced or absent skin sensation, vision or hearing; abnormal generalized limb shaking with apparent impairment or loss of consciousness that resemble epileptic seizures (Psychogenic non-epileptic seizures), episodes resembling syncope or coma, dysphonia/aphonic, dysarthria, Globus, diplopia

Question 13

Age of

Conversion Disorder

Answer 13

10-35 yo

Question 14

Conversion disorder risk factors

Answer 14

Lower socioeconomic status, lower education, lack of psychological sophistication, rural settings

*No familial contribution

Question 15

Conversion disorder treatment

Answer 15

Goal: remove symptom

• Direct confrontation NOT recommended
• Reassurance and relaxation; consider CBT
• PCP should exclude physical illness, then treat
• If no improvement, referral for narcoanalysis, hypnosis, behavior therapy

Question 16

Define factitious disorder

Answer 16

Falsification of physical or psychological symptoms, or induction of injury/disease, with evidence of DECEPTIVE INTENT

No external gain is present

Question 17

2 types of factitious disorders

Answer 17

Munchausen: illness imposed on self

Proxy: illness imposed on another

Question 18

How can a patient with factitious disorder try to prove they have illness?

Answer 18

• Exaggerate symptoms
• Interfere with diagnostic tests (EKG leads, tamper lab species, rub thermometer)
• Self-cut or infect
• Inject unneeded insulin
• Take unneeded thyroid meds or anticoags
• Avoid immediate care to worsen sx’s