Somatic Symptom and Related Disorders; Non-adherence to Medical Treatment

Question 1

What is factitious disorder?

Answer 1

patient consciously reports false symptoms, or induces symptoms, with the goal of playing the “sick role”
-a condition in which a person, without a motive for reward, acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms, purely to attain (for themselves or for another) a patient’s role

Question 2

What is factitious disorder imposed on self?

Answer 2

Munchausen syndrome

• the patient falsifies physical or psychological symptoms or induces injury or disease to themselves
• when in another person (e.g a child) it is termed factitious disorder imposed on another (Munchausen syndrome by proxy)

Question 3

What is the tx for factitious disorder?

Answer 3

• conjoint confrontation by the PCP and the psychiatrist
• in factitious disorder imposed on another (e.g in a child)
• children must be removed by child protective services

Question 4

What is illness anxiety disorder (hypochondriasis)?

Answer 4

obsession with idea of having a serious but undiagnosed medical condition

• patient’s are worried about having or developing a serious illness
• this preoccupation is present for at least 6 months
• it is not better explained by another mental disorder (e.g obsessive-compulsive disorder and somatic symptom disorder)

Question 5

What is the tx for illness anxiety disorder (hypochondriasis)?

Answer 5

• group/insight-orientated therapy
• regular appts with a provider for reassurance
• medications (SSRIs): if concurrent/underlying anxiety or major depressive disorder

Question 6

What is somatic symptom disorder?

Answer 6

preoccupation with having a serious illness

• more than 1 somatic symptom(s) which are distressing to the patient or leads to a significant amount of disruption in the patient’s life
• the patient experiences excessive thoughts, feelings, and behaviors in relation to their somatic symptoms or their health concerns
• the somatic symptom must be persistent for >6 months although these symptoms dont have to always be present

Question 7

What is the tx for somatic symptom disorder?

Answer 7

have a single clinician as the designated primary caretaker

• schedule monthly visits and psychotherapy
• avoid unnecessary diagnostic testing unless indicated