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psycopathology > Somatic Symptom And Dissociative Disorders > Flashcards

Somatic Symptom And Dissociative Disorders Flashcards

1
Q

Define somatic

A

Related to the body , especially as instinct of the mind

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2
Q

What are the somatic symptom and related disorders?

A
  • somatic symptom disorder
  • Illness anxiety disorder
  • Conversion disorder
  • Factitious disorder
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3
Q

What are the somatic symptoms and related disorders common features?

A

Prominence of somatic /health related symptoms associated with significant distress or impairment

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4
Q

What is the epidemiology Somatic Symptom and related disorders ?

A
  • 5-7% in the general population

- female to male ratio of 10:1

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5
Q

What is the onset and course somatic symptom and related disorders?

A
  • Onset in childhood and teen years, but lifetime onset
  • 20-25% acute symptom onset develop chronic somatic illness
  • experience of fluctuates with stress
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6
Q

What are the associated features of somatic symptom and related disorders?

A
  • Lengthy medical history with unremarkable exam findings

- Psychiatric co-morbidity (major depressive disorder, anxiety, drug dependence, histrionic trait )

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7
Q

What are the diagnostic criteria of Somatic Symptom disorder?

A
  • 1+ distressing/disruptive somatic symptom
  • Atleast one indicator of excessive thoughts/feelings/behaviors about the symptoms such as:
    1. disproportionate thoughts about the seriousness of the symptom
    2. High levels of anxiety about the symptom or health
    3. Excessive time/energy devoted to the symptom

Persistent symptomatology(usually 6+ months)

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8
Q

Describe diagnostic criteria of Somatic Symptom disorder (not what it is, just describe)

A
  • diagnosis of SSD focuses on the abnormal behaviors/thoughts/feelings in response to the distressing somatic symptom(s)
  • Focus is NOT on whether there is a medical explanation for the somatic symptom(s)
  • there could be a medical basis for their symptoms and still have SSD
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9
Q

What are the diagnostic criteria of Illness anxiety disorder?

A
  • preoccupation with having/acquiring a serious illness
  • Somatic symptoms are not present or, if present are mild
  • Patient performs excessive health-related behaviors or shows maladaptive avoidance
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10
Q

Differentiate SSD and IAD

A

SSD: patient has a distressing physical complaint with an excessive response to that distressing physical complaint. Might be a medical basis for the illness

IAD: patient does NOT have a distressing physical complaint but nonetheless worries about one’s health and is preoccupied by this worry

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11
Q

What are the general multifactorial causes of SSD and IAD (etiology)?

A
  • genetic predisposition (e.g. sensitivity to pain)
  • Personality trait of negativity
  • early life/family experiences (childhood physical, sexual, emotional abuse)
  • Delayed development of emotional intelligence (emotional trauma manifests as physical pain - emotional neglect)
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12
Q

What are cognitive biases that contribute to IAD and SSD(etiology)?

A

Cognitive biases

  • focus of attention on somatic symptoms
  • Negative interpretation of somatic symptoms
  • Negative feedback loop of interpretation and further anxious symptoms
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13
Q

What are behavioral biases that contribute to IAD a and SSD(etiology)?

A
  • patient may take on a sick role, leading to worse illness

- reinforced sick role behavior (attention, tangible rewards, avoidance of unpleasant tasks)

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14
Q

How can SSD and IAD be treated?

A
  • Medication -anti-anxiety/antidepressants in extreme cases, to assist with CBT
  • CBT
  • address delayed develop of delayed e,optional intelligence, especially for patients with long-standing paradigms
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15
Q

How can SSD and IAD be treated with CBT?

A
  • reduce the stress “spiral”(to avoid intensifying systems)
  • reduce excessive attention to bodily cues
  • Correct cognitive distortions about physical symptoms
  • reinforce “non-sick role”
  • Reduce avoidance of activities due to uncomfortable physical sensations
  • family therapy for dynamics and support
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16
Q

How can SSD and IAD treatment be found in medication?

A

Anti-anxiety/anti-depressants in extreme cases, to assist with CBT

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17
Q

What are the diagnostic criteria of Conversion disorder?

A
  • Altered voluntary motor or sensory function.
  • Symptom examples: weakness or paralysis, loss of balance, difficulty swallowing, abnormal movements, vision problems, hearing problems, speech problems, numbness
  • evidence of incompatibility between the symptom and neurological findings
  • incompatibility of the symptom with neurological disease a key feature of this diagnosis-rule our neurological cause
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18
Q

What are the conversion disorder subtype?

A
  • with weakness or paralysis
  • with abnormal movement
  • with swallowing symptoms
  • with speech symptoms
  • with attacks or seizures
  • with anesthesia or sensory loss
  • with special sensory symptom (e.g., blindness)
  • with mixed symptoms
19
Q

What is the onset and course of conversion disorder?

A

Typically sudden, after a major psychological stressor
-Symptoms may be symbolically related to the stressor (e.g., unable to move legs after learning about a friends paralysis)

- Often a “la belle indifference” reaction to the disability that suddenly emerges 
- usually short duration without recurrence
20
Q

Explain the etiology of Conversion Disorder

A

Neural basis: unknown. Perhaps somatosensory/ somatomotor cortex involvement

Psychological: Non-conscious transformation of psychological distress into neurological symptoms

Symptoms may appear suddenly following a stressful event, but not always identified

21
Q

How can conversion disorder be treated?

A

CBT
-goal is to elucidate and acknowledge any emotional basis to the symptoms

  • learn about conversion disorders in general, not caused by a neurological disorder or disease
  • Stress reduction techniques
  • Occupational therapies if paralysis, etc.

Hypnosis
Medications - no approved treatment for conversion disorder

22
Q

What is fictitious disorder?

A

Feigning physical or psychological symptoms, in self or others, in the absence of obvious external motivation

  • Primary gain is attention and being in the sick role
  • Imposed on oneself(Munchausen’s Syndrome)
  • Imposed on another (Munchausen’s Syndrome by proxy)
23
Q

What is the typical profile of someone with factitious disorder?

A

Patient has a past connection to medicine or worked in a health care profession

24
Q

What are the markers of factitious disorder?

A

Markers of factitious disorderm

  • Unexplained Persistent /recurrent symptoms
  • Inconsistent history
  • Dramatic presentation of severe symptoms
  • Symptoms influenced by observation
  • Insistence on a particular treatment
25
Q

What are treatment for Factitious disorder?

A

No specific treatment

  • individuals usually resist seeking psychiatric help, even when caught
  • Goal is to stop further unnecessary medical care and prevent iatrogenic problems
  • report “by proxy” cases to child protective services

Important differential: malingering

26
Q

What is Malingering disorder?

A

Individuals fakes/induces(feigns) physical or psychological symptoms in self/others for “external” rewards (e.g., avoiding work)

  • known as secondary gain
  • Complaints cease after gaining the reward
  • Malingering: feigns symptoms in oneself
  • Malingering by proxy: feigns symptoms in another individual
27
Q

What is Malingering disorder classified as?

A

Classified under other conditions that may be a focus of clinical attention

28
Q

What are the dissociative disorders?

A
  • Dissociative amnesia
  • Dissociative identity disorders
  • Depersonalization/realization disorder
29
Q

What are the common features of Dissociative disorders?

A
  • Splitting off from conscious awareness an aspect of itself (e.g., a memory)
  • Unconscious coping strategy fir stress

Evidence for the massive modularity hypothesis, limitation of conscious awareness, and reconstruction of memories

30
Q

What are the diagnostic criteria of dissociative amnesia?

A

Memory loss for autobiographical information not caused by another disorder

  • Localised: total loss of personal memory during a circumscribed period of time
  • Selective: some limited recall of personal memories during a circumcised period of time
  • Generalized: loss of personal memory of entire life up to and including triggering event
31
Q

What is a fugue?

A

Purposeful travel or bewildered wandering associated with amnesia for identity or other autobiographical information

32
Q

What must a doctor specify with dissociative amnesia?

A

Specify if a,media is with dissociative fugue

33
Q

What are the features of fugue?

A

Typical features of fugue:

Sudden onset
Brief(hours to days)
Unobtrusive lifestyle during fugue
Spontaneous termination of amnesia
Rarely occurs
34
Q

What is the key amnesia differential of dissociative amnesia?

A

Key amnesia differential: a mental status exam might help identify the type of memory problem exhibited

If biological : patient will have difficulty learning new information (anterograde memory loss) in addition to past memory loss

If psychological (dissociative): Patient learns new information well; only past memory loss (retrograde memory) will be present

35
Q

What are the diagnostic criteria of Dissociative identity disorder?

A

Disruption of individual density characterized by 2+ distinct personality states:

  • the primary (host)
  • an alter

Inability to recall personal information (as evidenced by frequent memory gaps in the primary personality while an alter takes control)

36
Q

What symptoms are associated with Dissociative identity disorder?

A
  • Dissociation

- Nuerological defense mechanisms

37
Q

DID is associated with smaller volumes of which functions?

A
  • Hippocampus
  • Amygdala
  • Parietal structures (perception and personal awareness)
  • Frontal structures (executive functioning)
38
Q

What are risk factors of dissociative identity disorders?

A

Childhood psychological trauma, lack of social support, and poor coping skills

39
Q

What are the neurobiological changes of dissociative identity disorder?

A
  • None noted previously, but recent

- Research implicates hippocampus

40
Q

How can dissociative identity disorder be treated?

A

Psychotherapy
-Long-term psychotherapy (CBT) to integrate personalities

  • Strong therapeutic alliance is required
  • Hypnosis May be used to help recover memories
  • Memories retrieval May trigger grief, rage, shame, guilt, depression and inner turmoil

Pharmological: none proven to be effective

41
Q

What are the diagnostic criteria of Depersonalization/Derealization disorder?

A

Depersonalization: Experiences of unreality, detachment or being an outside observer of one’s thoughts, feelings, sensations, body or actions

AND/OR

Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., objects and/or environment seem unreal or dreamlike)

42
Q

What the additional (non-diagnostic ) criteria of Depersonalization/derealization disorder?

A

Reality testing remains intact (i.e., the person knows the perceptual experience is just a misperception)

Additional criteria:

  • Symptoms result in functional impairment
  • Symptoms are not due the physiological effects of a substance or another medical condition (e.g., seizures)
  • Symptoms are not better explained by another mental disorder, such as panic disorder, acute stress disorder, PTSD, or another dissociative disorder
43
Q

Explain the etiology of Depersonalization/Derealization

A
  • Currently unknown
  • No known structural brain damage accounting for feelings of unreality or detachment
  • for dissociative disorders in general: primarily a dysfunction of memory retrieval
  • A “last ditch” effort to respond to overwhelmed coping mechanisms
44
Q

How can Dissociative Disorders be treated?

A
  • Typically involves some type of psychotherapy
  • Hypnosis May be used to help recover memories in a dissociative amnesia
  • Use of hypnosis should be used cautiously to avoid creation of false memories

psycopathology (23 decks)

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