Somatic symptom and factitious disorders Flashcards
What are the somatic symptom/related disorders?
Somatic symptom disorder
Conversion disorder (functional neurologic symptom disorder)
Illness anxiety disorder
Psychological factors affecting other medical conditions
Factitious disorder
Other
DSM criteria for somatic symptom disorder
1 or more somatic symptoms that are distressing or result in significant disruption
Excessive thoughts, feelings, or behaviors related to the somatic symptoms
At least 6 months
Risk factors for somatic symptom disorder
Older age, less education, lower socioeconomic status, history of sexual abuse, unemployment
Management of somatic symptom disorder
Regularly scheduled visits with a single PCP, who should minimize unnecessary workup
Presentation of somatic symptom disorder
At least one (often more) physical symptom, seeking treatment from many doctors, getting lots of labs/procedures, etc with no findings
Presentation of conversion disorder
At least one neurological symptom (sensory or motor) that cannot be fully explained by a neurologic condition. Patients are calm/not worried when describing their symptoms.
DSM criteria for conversion disorder
At least one symptom of altered voluntary motor or sensory function
Incompatibility between symptom and known neuro syndromes
Causes significant distress or impairment in function
In what population is conversion-like presentation more likely to represent an underlying neuro disease?
Old people
Treatment of conversion disorder
Education about the illness, CBT and PT if education not effective
DSM criteria for illness anxiety disorder
Preoccupation with having or acquiring a serious illness
Somatic symptoms not present or, if present, mild
Performs excessive health-related behaviors or exhibits maladaptive behaviors
At least 6 months
Management of illness anxiety disorder
Regularly scheduled visits with one PCP
CBT helpful
Treat comorbid depression and anxiety with SSRIs, other drugs
Examples of “psychological factors affecting other medical conditions”
Anxiety worsening asthma
Denial of need for treatment of acute chest pain
Maladaptive health behaviors
Treatment for psychological factors affecting other medical conditions
Education and frequent follow-up with PCP
SSRIs and/or psychotherapy for underlying anxiety/depression
What is factitious disorder?
Intentionally falsifying medical or psychological signs/symptoms in order to assume the role of a sick patient
Puts them at legitimate risk of harm (central line infection, insulin injection, etc)
DSM criteria for factitious disorder
Falsification of signs/symptoms, or induction of injury/disease associated with deception
Deceptive behavior evident even in absence of external rewards (such as malingering)
Behavior not explained by other mental disorder
Can present as him/herself or another indervidual
