Somatic Sxs Flashcards
- 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
Somatic Symptom Disorder
Factitious Disorder
3 types of somatic sxs associated w/ significant distress and impairment
- Affective
- Cognitive
- Behavioral
Are somatic sxs due to recognized medical condition?
May or may not be explained by recognized medical condition
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?
- common
- not required
- Dx based on abnormal response to sxs
Somatic Sx Disorder
- Sxs are not under ____ or ____ control.
- Voluntary
- Conscious
Somatic Sx Disorder
- Do males or females tend to report more somatic sxs?
- Usually onsets at what age?
- Females
- Teenage years, but may not become “pathologic” until later in life
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?
- 4
- Rare
Higher prevalence of Somatic Sx Disorder in which 3 functional disorders?
- Fibromyalgia
- Irritable bowel syndrome
- Chronic fatigue syndrome
(FIC)
4 “dimensions” of Somatic Sx Disorder
- Bioligical Dimension
- Psychological Dimension
- Social Dimension
- Sociocultural Dimension
“Heightened Attention”
Biological Dimension
“attention obtained from illness / learning”
Social Dimension
“Inversely related to social position”
Sociocultural Dimension
3 risk factors for Somatic Sx Disorder
- Early traumatic experiences
- Childhood chronic illness
- Depressive / Anxiety disorders
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”
- 1
- Pain
Somatic Sx Disorder - DSM Criteria
- Somatic sx or associated health concerns manifested by at least one of what 3 things?
- 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
Which patients w/ Somatic Sx Disorder rarely worry about the “illness?”
Young children, they are influenced by parental response.
Somatic Sx Disorder
- State of being symptomatic is persistent, typically lasting more than __ months
- (one sx may not be continuously present
6
4 common sxs in children w/ Somatic Sx Disorder
- Abd pain
- HA
- fatigue
- nausea
Specifiers of Somatic Sx Disorder:
- Sxs predominantly involve ____
- Persistent: characterized by ____ sxs, marked impairment, long duration of more than __ months
- Pain
- Severe
- 6
Severity of Somatic Sx Disorder:
Mild, moderate, or severe?
- Only 1 of sxs specified in Criterion B fulfilled
Mild
Severity of Somatic Sx Disorder:
Mild, moderate, or severe?
- 2 or more sxs specified in Criterion B
Moderate
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
Severe
- What questionaire is used for Somatic Sx Disorder?
- Higher scores associated w/ what 3 things?
PHQ-15
- Poorer functioning
- Increased health care utilization
- More sxs of depression / anxiety
PHQ scores
Minimal, low, moderate, or high?
- 0-4
Minimal
PHQ scores
Minimal, low, moderate, or high?
- 5-9
low
PHQ scores
Minimal, low, moderate, or high?
- 10-14
Moderate
PHQ scores
Minimal, low, moderate, or high?
- 15-30
High
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)
Cognitive
Type of Somatic Sx Disorder?
- Repeated bodily checking for abnormalities
- Frequent medical consults
Behavioral
Severe cases of Somatic Sx Disorder assume a central role and lead to ____.
Invalidism: state of being abnormally preoccupied w/ one’s prolonged ill health
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?
- Rarely
- Tend to seek care from multiple providers
- Often unresponsive
- Unusually sensitive to medication side effects
2 comorbidities of Somatic Sx Disorder
- Anxiety
- Depression
If a pt meets criteria for somatic sx disorder and another mental disorder, which is documented?
Both
1st line tx for Somatic Sx Disorder
CBT
- reduce physical sxs
- reduce psychological distress
- reduce disability
- Off label drug for Somatic Sx Disorder
- What is it used for?
Fluoxetine
- Improve functional status
- Global well being
- Morning stiffness
- Pain
- Sleep
- Tender points
Illness Anxiety Disorder was previously classified as _____.
Hypochondriasis
- 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
Illness Anxiety Disorder
Illness Anxiety Disorder more common in males or females?
Equal
Pts w/ Illness Anxiety Disorder rarely seek a _____ consult at initial symptom onset.
Mental Health Consult
What are the risk factors for Illness Anxiety Disorder?
No clear risk factors
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?
- Mild intensity
- Exhibit maladaptive avoidance, avoids doctor appts and hospitals
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.
6
2 types of Illness Anxiety Disorder
- Care-seeking type: medical care, including physician visits or undergoing tests & procedures, is frequently used
- Care-avoidant type: Medical care rarely used
Illness Anxiety Disorder
- Normal physiological sensation: ____
- Benign and self limited dysfunction: _____
- Bodily discomfort not generally considered indicative of disease: _____
- Orthostatic dizziness
- Transient tinnitus
- Belching
3 ways in which Illness Anxiety Disorder affects daily activities
- Repeatedly examines themselves
- Spend excessive amts of time researching disease
- Repeatedly seeks reassurance from family, friends, or medical providers
Comorbidities of Illness Anxiety Disorder
- “New DSM V diagnostic category so exact comorbidities are unknown”
- Anxiety disorders
- Depressive disorders
Tx for Illness Anxiety Disorder (3 non-pharm)
- What is the goal of tx?
- Collaborate w/ mental health providers
- Establish therapeutic alliance w/ pt
- Schedule regular office visits NOT contingent upon active health concerns
- Goal: functional improvement
Steps of pharm tx for Illness Anxiety Disorder (3)
- 1st line: CBT
- CBT non-responders / declines CBT: off label SSRIs
- If present, tx comorbidities
Functional neurologic sx disorder
Conversion Disorder
- Neurologic sxs inconsistent w/ neurological disease, but cause distress/impairment
- Sxs do not conform to known anatomical pathways and physiological mechanisms
Conversion Disorder (Functional Neurologic Sx Disorder)
Postulated that presenting sxs tend to reflect pts own understanding of anatomy… (lower knowledge –> higher implausibility)
Conversion Disorder
Conversion Disorder
- Sxs produced/feigned intentionally?
- Sxs thought to be an attempt to resolve conflict that _____.
- Not intentional
- patient feels inside
Conversion Disorder more common in males or females?
Females
F:M 2-3 : 1
3 risk factors of Conversion Disorder
- Hx of childhood abuse/neglect
- Stressful life events
- Presence of neuro disease that causes similar sxs
Etiology of Conversion Disorder
Poorly understood
Conversion Disorder
- 1 or more sxs of ______________
- Can or cannot be turned on / off at will
- altered voluntary motor or sensory function
- Cannot
