Somatic symptom and related disorders

Question 1

Define somatic sx disorder

Answer 1

• 1 or more somatic sx
• present for at least 6 months
• distressing + disruptive
• with excessive thoughts, feelings, behaviors about sx/related to health (at least 1)
• sx cant be explained by AMC but exist
• sx produced unintentionally with no external gain

Question 2

Clues on history that are suggestive of Somatic sx disorder?

Answer 2

• abuse (childhood)
• social problems (work, home, spouse)
• cx / vague / inconsistent hx
• exagerrated sx
• conversion / dissociation

Question 3

How would you manage somatic sx disorder?

Answer 3

General

• good doc pt relationship
• dx + Rx comorbidities
• no unnecessary investigations
• provide info that will improve their QoL

Pharmacotherapy

• SSRI / TCA (chronic pain sx)
• avoid BZD + opioids

Question 4

Define Illness Anxiety Disorder

Answer 4

• preoccupation with fear of getting / having a serious disease
• at least 6 months
• increased anxiety about personal health
• maladaptive behav - care seeking or care avoidant
• preoccupation is obsessive if disease present or at high risk
• somatic sx = mild / ABSENT

Question 5

Define Conversion Disorder

(paralysis, anesthesia, seizures, speech, swallowing)

Answer 5

• 1 or more sx / deficits
• affecting voluntary motor / sensory fxn
• mimics neurological or GMC
• with / without psychological stressor
• 95% spontaneous remission

Question 6

Describe Factitious disorder

Answer 6

Imposed on self

• deception (produced intentionally)
• physical / psychological signs or sx
• present themselves as ill/impaired/injured
• no clear external rewards (attention, sympathy)

Imposed on others

• Munchausen sd
• as above
• present another person (often child, protect)

Question 7

What is Malingering?

Answer 7

• false / exaggerated physical or psychological sx
• produced INTENTIONALLY
• motivated by external reward / secondary gain (avoid work, financial compensation, get out of jail etc)