Somatic Symptom and Related Disorders Flashcards
What is the common feature of patients who have a somatic symptom disorder?
prominence of somatic symptoms associated with significant distress and impairement
What is the diagnostic criteria for somatic symptom disorder (SSD)?
1) >1 distressing/disruptive somatic symptom
2) At least one indicator of excessive thoughts/feelings/behaviors about the symptom(s)
3) Persistent symptomatology (usually >6 months)
Can an individual have a medical illness and still have SSD?
YES
What is the diagnostic criteria for a patient with illness anxiety disorder (IAD)?
1) Preoccupation with having/acquiring a serious illness despite not having any symptoms
2) High anxiety in regards to health
3) Excessive health related behavior are performed or exhibits maladaptive avoidance
4) Illness preoccupation has been present >6 months
What are the two specifiers for IAD?
IAD, care seeking type
IAD, care avoidant type
What are two differentials for SSD and IAD?
Delusional Disorder (DD), Somatic Type -->belief is held with much higher intensity Body Dysmorphic Disorder---> concern is more appearance based
There are a number of reasons that some individuals, with SSD and IAD, are more keenly aware of and distressed by physical symptoms, each card will go through one. 1–>
- Physiological Factors –> Overactivity of key brain regions involved in unpleasantness of bodily sensations
2nd reason for more keen awareness of and distress in physical symptoms of SSD and IAD patients. 2–?
- Cognitive Biases –> over attentiveness to and overly negative interpretations about somatic symptoms
3rd reason for more keen awareness of and distress in physical symptoms of SSD and IAD patients, 3–>?
- Behavioral Consequences –> person may assume the sick role or get reinforced for sick role behavior
What are some treatments for SSD and IAD?
Cognitive-Behavioral Therapy:
- reduces stress
- reduces excessive attention to bodily cues
- correct cognitive distortions about physical symptoms
- reinforce non sick role behavior
What is the diagnostic criteria for a patient with conversion disorder (functional neurological syndrome)?
1) Altered voluntary motor or sensory function
2) Evidence of incompatibility between the symptom and neuro conditions
What is the onset and course for a patient with conversion disorder?
sudden (After a major stressor)
indifference reaction to their disability
short duration without recurrence
What is the common etiology for patients with conversion disorder?
some sort of psychological stress that is then converted into neuro symptoms
What is the treatment for a patient with conversion disorder?
psychotherapy
Describe in general terms factitious disorders
patient fakes/induces physical or psychological symptoms, in self or others, in absence of external rewards
What does factitious disorder imposed on self mean?
aka munchausens syndrome
patient fakes symptoms in oneself
what does factitious disorder imposed on another mean?
aka munchausens syndrome by proxy
patient fakes symptoms in another person
What are some symptoms associated with a person who has factitious disorder?
1) Unexplained persistent/recurrent symptoms
2) Inconsistent medical history
3) Dramatic presentation of history and symptoms
4) Symptoms influenced by observation
5) Insistence on particular treatment
6) Grid abdomen
What is the treatment for factitious disorder?
NONE
What is the differential diagnosis for a patient with factitious disorder
Malingering
In malingering a person also fakes/induces physical or psychological symptoms in self others. What is the difference then in malingering and factitious disorders?
Factitious –> does not seek external reward
Malingering –> person seeks external reward
What does malingering by proxy mean?
fakes symptoms in another individual
After covering her childs face with a pillow to induce cardiac arrest, a young mother calls 911 to report that her child’s heart inexplicable stopped beating, which required her to perform CPR. What is the diagnosis?
You need more information about the mother’s motivation
If in the mother and child CPR example, the question would of mentioned some internal reason (to indirectly assume the sick role by having a sick child) for putting the child in cardiac arrest, what would the diagnosis be?
Factitious Disorder, imposed on another
If in the mother and child CPR example, the question would of mentioned some external motivation (to have a good excuse for not going to work the next day) for putting the child in cardiac arrest, what would the diagnosis be?
Malingering, by proxy
