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Disciplines 3 Shea > Somatic Sxs > Flashcards

Somatic Sxs Flashcards

1
Q
  • Group of psychological illnesses in which bodily sxs are a major focus
  • Originate from faulty mind-body interactions
  • Pts CONVINCED that their suffering comes from undetected/untreated bodily derangement
  • ______ is an outlier
A

Somatic Symptom Disorder

Factitious Disorder

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2
Q

3 types of somatic sxs associated w/ significant distress and impairment

A
  • Affective
  • Cognitive
  • Behavioral
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3
Q

Are somatic sxs due to recognized medical condition?

A

May or may not be explained by recognized medical condition

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4
Q

Somatic Sx Disorder

  • Are concurrent medical illnesses common or uncommon?
  • Absence of medical explanation for sxs is required or not required?
  • How is the dx made?
A
  • common
  • not required
  • Dx based on abnormal response to sxs
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5
Q

Somatic Sx Disorder

  • Sxs are not under ____ or ____ control.
A
  • Voluntary
  • Conscious
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6
Q

Somatic Sx Disorder

  • Do males or females tend to report more somatic sxs?
  • Usually onsets at what age?
A
  • Females
  • Teenage years, but may not become “pathologic” until later in life
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7
Q

Somatic Sx Disorder

  • Commonly encountered in PCP setting
  • 5-10% of primary care pts have __ or more unexplained sxs
  • Common or rare for pts to seek mental health consult at initial sx onset?
A
  • 4
  • Rare
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8
Q

Higher prevalence of Somatic Sx Disorder in which 3 functional disorders?

A
  • Fibromyalgia
  • Irritable bowel syndrome
  • Chronic fatigue syndrome

(FIC)

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9
Q

4 “dimensions” of Somatic Sx Disorder

A
  • Bioligical Dimension
  • Psychological Dimension
  • Social Dimension
  • Sociocultural Dimension
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10
Q

“Heightened Attention”

A

Biological Dimension

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11
Q

“attention obtained from illness / learning”

A

Social Dimension

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12
Q

“Inversely related to social position”

A

Sociocultural Dimension

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13
Q

3 risk factors for Somatic Sx Disorder

A
  • Early traumatic experiences
  • Childhood chronic illness
  • Depressive / Anxiety disorders
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14
Q

Somatic Sx Disoder DSM criteria

  • ___ or more somatic sxs distressing / result in disruption of daily life
  • What is the MC sx?
  • “high level of worry”
  • “thinks the worst”
A
  • 1
  • Pain
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15
Q

Somatic Sx Disorder - DSM Criteria

  • Somatic sx or associated health concerns manifested by at least one of what 3 things?
A
  • Disproportionate / persistent thoughts about seriousness of sxs
  • Persistently high level of anxiety about health or sxs
  • Excessive time / energy devoted to these sxs or health concerns
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16
Q

Which patients w/ Somatic Sx Disorder rarely worry about the “illness?”

A

Young children, they are influenced by parental response.

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17
Q

Somatic Sx Disorder

  • State of being symptomatic is persistent, typically lasting more than __ months
  • (one sx may not be continuously present
A

6

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18
Q

4 common sxs in children w/ Somatic Sx Disorder

A
  • Abd pain
  • HA
  • fatigue
  • nausea
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19
Q

Specifiers of Somatic Sx Disorder:

  • Sxs predominantly involve ____
  • Persistent: characterized by ____ sxs, marked impairment, long duration of more than __ months
A
  • Pain
  • Severe
  • 6
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20
Q

Severity of Somatic Sx Disorder:

Mild, moderate, or severe?

  • Only 1 of sxs specified in Criterion B fulfilled
A

Mild

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21
Q

Severity of Somatic Sx Disorder:

Mild, moderate, or severe?

  • 2 or more sxs specified in Criterion B
A

Moderate

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22
Q

Severity of Somatic Sx Disorder:

Mild, moderate, or severe?

  • 2 or more of sxs specified in Criterion B fulfilled
  • PLUS, multiple somatic complaints
  • OR, 1 very severe somatic sx
A

Severe

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23
Q
  • What questionaire is used for Somatic Sx Disorder?
  • Higher scores associated w/ what 3 things?
A

PHQ-15

  • Poorer functioning
  • Increased health care utilization
  • More sxs of depression / anxiety
24
Q

PHQ scores

Minimal, low, moderate, or high?

  • 0-4
A

Minimal

25
Q

PHQ scores

Minimal, low, moderate, or high?

  • 5-9
A

low

26
Q

PHQ scores

Minimal, low, moderate, or high?

  • 10-14
A

Moderate

27
Q

PHQ scores

Minimal, low, moderate, or high?

  • 15-30
A

High

28
Q

Type of Somatic Sx Disorder?

  • Attention focused on somatic sxs
  • Attribution of normal bodily sensations to physical illness (degree of interpretation ranges, worry)
  • Related general medical condition
  • Fear that any physical activity will damage body (avoidance of physical activity)
A

Cognitive

29
Q

Type of Somatic Sx Disorder?

  • Repeated bodily checking for abnormalities
  • Frequent medical consults
A

Behavioral

30
Q

Severe cases of Somatic Sx Disorder assume a central role and lead to ____.

A

Invalidism: state of being abnormally preoccupied w/ one’s prolonged ill health

31
Q

Somatic Sx Disorder

  • High level of medical care utilization. Does this usually alleviate concerns?
  • What do these patients tend to do?
  • Are they responsive to medical interventions?
  • Common to have side effects from meds?
A
  • Rarely
  • Tend to seek care from multiple providers
  • Often unresponsive
  • Unusually sensitive to medication side effects
32
Q

2 comorbidities of Somatic Sx Disorder

A
  • Anxiety
  • Depression
33
Q

If a pt meets criteria for somatic sx disorder and another mental disorder, which is documented?

A

Both

34
Q

1st line tx for Somatic Sx Disorder

A

CBT

  • reduce physical sxs
  • reduce psychological distress
  • reduce disability
35
Q
  • Off label drug for Somatic Sx Disorder
  • What is it used for?
A

Fluoxetine

  • Improve functional status
  • Global well being
  • Morning stiffness
  • Pain
  • Sleep
  • Tender points
36
Q

Illness Anxiety Disorder was previously classified as _____.

A

Hypochondriasis

37
Q
  • Distress arises from unfound fear of having the disease rather than physical sxs
  • Concern and distress persist despite appropriate physical examination & diagnostic testing that are negative
A

Illness Anxiety Disorder

38
Q

Illness Anxiety Disorder more common in males or females?

A

Equal

39
Q

Pts w/ Illness Anxiety Disorder rarely seek a _____ consult at initial symptom onset.

A

Mental Health Consult

40
Q

What are the risk factors for Illness Anxiety Disorder?

A

No clear risk factors

41
Q

Illness Anxiety Disorder

  • Somatic sxs are not present, but if they are presents are ____.
  • Pt sometimes worry bc/ strong family hx for developing condition
  • Performs excessive health related behaviors
  • Exibits what?
A
  • Mild intensity
  • Exhibit maladaptive avoidance, avoids doctor appts and hospitals
42
Q

Illness Anxiety Disorder

  • Illness preocupation has been present for at least __ months, but the specific illness that is feared may change over that period of time.
A

6

43
Q

2 types of Illness Anxiety Disorder

A
  • Care-seeking type: medical care, including physician visits or undergoing tests & procedures, is frequently used
  • Care-avoidant type: Medical care rarely used
44
Q

Illness Anxiety Disorder

  • Normal physiological sensation: ____
  • Benign and self limited dysfunction: _____
  • Bodily discomfort not generally considered indicative of disease: _____
A
  • Orthostatic dizziness
  • Transient tinnitus
  • Belching
45
Q

3 ways in which Illness Anxiety Disorder affects daily activities

A
  • Repeatedly examines themselves
  • Spend excessive amts of time researching disease
  • Repeatedly seeks reassurance from family, friends, or medical providers
46
Q

Comorbidities of Illness Anxiety Disorder

A
  • “New DSM V diagnostic category so exact comorbidities are unknown”
  • Anxiety disorders
  • Depressive disorders
47
Q

Tx for Illness Anxiety Disorder (3 non-pharm)

  • What is the goal of tx?
A
  • Collaborate w/ mental health providers
  • Establish therapeutic alliance w/ pt
  • Schedule regular office visits NOT contingent upon active health concerns
  • Goal: functional improvement
48
Q

Steps of pharm tx for Illness Anxiety Disorder (3)

A
  • 1st line: CBT
  • CBT non-responders / declines CBT: off label SSRIs
  • If present, tx comorbidities
49
Q

Functional neurologic sx disorder

A

Conversion Disorder

50
Q
  • Neurologic sxs inconsistent w/ neurological disease, but cause distress/impairment
  • Sxs do not conform to known anatomical pathways and physiological mechanisms
A

Conversion Disorder (Functional Neurologic Sx Disorder)

51
Q

Postulated that presenting sxs tend to reflect pts own understanding of anatomy… (lower knowledge –> higher implausibility)

A

Conversion Disorder

52
Q

Conversion Disorder

  • Sxs produced/feigned intentionally?
  • Sxs thought to be an attempt to resolve conflict that _____.
A
  • Not intentional
  • patient feels inside
53
Q

Conversion Disorder more common in males or females?

A

Females

F:M 2-3 : 1

54
Q

3 risk factors of Conversion Disorder

A
  • Hx of childhood abuse/neglect
  • Stressful life events
  • Presence of neuro disease that causes similar sxs
55
Q

Etiology of Conversion Disorder

A

Poorly understood

56
Q

Conversion Disorder

  • 1 or more sxs of ______________
  • Can or cannot be turned on / off at will
A
  • altered voluntary motor or sensory function
  • Cannot
57
Q
A

Disciplines 3 Shea (13 decks)

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