Somatic Symptom Disorder Flashcards
What are the screening sx for somatic syndrome disorder
PRESENTATION
Multiple symptoms present for ≥2yrs
- Patient refuses to accept reassurance or negative test results
Q
What physical sx trouble you?
- What are the top 3 things
o How has this affected your life?
- What kind of tests have you had, who are the specialists been involved
What is you interpretation of these normal specialist results ? insight
Are any of these symptoms related to your emotional state or stress levels?
o Do you think a lot about these sx?
What things are you worried about? How hard is it to get your mind off it?
o How much time do you spend
researching or seeing doctors for these sx?
DSM criteria for somatic syndrome disorder
A + B + C
A) ≥1 somatic sx that are distressing and affect daily living
B) Excessive thoughts, feelings and behaviours related to these sx – at least 1/3 must be present:
- Disproportionate and constant thoughts
about the seriousness of the sx
- Constant high level of anxiety about
health or sx
- Excessive time and energy devoted to
these sx
C) Being symptomatic for > 6 months (of the disorder not the symptom)
Differentials for somatic syndrome disorder
- Illness anxiety disorder (>6/12 of
disproportionate anxiety about illness
or anxiety about non-existent illness +
excessive health behaviours OR avoids hospitals)
o Factitious disorder (fake sx for
unknown gain)
o Malingering (fake sx for personal gain
o Conversion disorder (altered
movement/sensation)
Management of somatic syndrome disorder
examine, investigate once
Reassure of normal findings with laymans terms
1st line: Psychoeducation + CBT
Mindfulness/ relaxation / exercise.
2nd line: SSRI or SNRI eg. Venlafaxine maybe as adjunct if comorbid depression
- Address stressors,
- explain red flag sx of when to seek medical help,
- schedule regular review, try keep one regular clinician
- treat comorbid anxiety/depression
psychoeducate someone with somatic sx disorder
- Unexplained somatic symptoms are common
- Reassure that even if no explanation,
symptoms are genuinely felt - acknowledge patient suffering and distress - Education about relationship between
physical symptoms, emotions and
psychological factors - Avoid:
- Being judgemental, using terms such as “all in your head” and “psychological pain”
- Being dismissive of symptoms/concerns
- Enforcing psychological explanations
What is the expected presentation of illness anxiety disorder and treatment
- Persistent belief in the presence of an underlying serious disease e.g. cancer
- Patient refuses to accept reassurance or negative test results
- High anxiety about health
- Excessive health-related behaviours - checks body, avoids appointments/hospitals
- Somatic symptoms not present or mild
Treatment
- CBT + SSRI
DSM criteria for illness anxiety disorder
A. Preoccupation with having/acquiring a serious illness
B. Somatic symptoms are not present, or if present, are only mild. If another medical condition is present or there is a high risk of developing a medical condition (e.g. strong family history), the preoccupation is clearly excessive/disproportionate
C. High level of anxiety about health -
individual easily alarmed about personal health status
D. Individual performs excessive healthrelated behaviours (e.g. repeatedly checks body for signs of illness) or exhibits maladaptive avoidance (e.g. avoids hospitals
and doctor’s appointments)
E. Illness preoccupation present for ≥6
months, but specific illness that is feared may change
F. Illness-related preoccupation is not better explained by another psychiatric disorder e.g. somatic symptom disorder, panic disorder, generalised anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, delusional disorder (somatic type)
Specifiers
- Care-seeking type - medical care inc.
physician visits, undergoing tests/procedures
- Care-avoidant type - medical care rarely used
Presentation/ investigation/ treatment of conversion/ functional neurological symptom disorder
- ≥1 symptoms - Typically involves loss of motor/sensory function
- Typically after a stressful event
Ix
- head CT, imaging, tox screen,
Exam shows signs/ symptoms not consistent with neurological disease - eg. resistance to eye opening during seizure, Hoover sign, different exam findings with different tests (plantarflexion and tiptoe)
Treatment
- Hypnosis can be helpful, CBT
- sometimes physical therapy
DSM of functional neurological symptom disorder
A. ≥1 symptom of altered voluntary motor/ sensory function
B. Clinical findings provide evidence of
incompatibility between the symptom and recognised neurological/medical
conditions
C. Not better explained by another medical/mental disorder
D. Symptom/deficit causes clinically
significantly distress of impairment in
social, occupational or other important
areas of functioning or warrants medical evaluation
Specified with
- symptom type eg. with weakness
- acute <6months, persistence >6months
- w/without psychological stressor
What is the Factitious Disorder
(Munchausen’s Syndrome) vs malingering
- The intentional falsification of physical or psychological symptoms
- ‘By proxy’ - symptoms for someone else e.g. a child
Benefit of being in the sick role
Malingering: fraudulent simulation/exaggeration of symptoms with the intention of financial or other gain.
DSM-5 factitious disorder and a ddx
A. Falsification of physical/psychological
signs/symptoms, or induction of injury/
disease, associated with identified deception
B. Individual presents as ill/impaired/injured
C. Deceptive behaviour evident in the
absence of obvious external rewards
D. Behaviour not better explained by another psychiatric disorder e.g. delusional disorder or another psychotic disorder
Specifiers
- Single episode
- Recurrent episodes (≥2 events of falsification of illness/induction of injury)
DDx borderline
