Somatic symptom disorder, factitious disorder, malingering Flashcards
Management of somatic symptom disorder
schedule regular visit with same provider
limit unnecessary work up and referral to specialists
reassure that serious illness has been ruled out
legitimize symptoms but make functional improvement the treatment goal
Legitimize symptoms but make functional improvement the treatment goal — decrease stress and improve coping mechanisms
mental health referral only physician - pt relationship is well established.
characteristics somatic symptom disorder
medically unexplained and excessive healthcare use
what also helps with somatic symptom disorder treatment
regularly scheduled visits and SSRI, SNRI, or TCAs have been helpful.
what is a delusion disorder?
1 or more delusions, other psychotic symptoms absent or not prominent.
Behavior that is not obviously bizarre or odd and able to function apart from delusions
common themes are infestation, foul body odor or deformity
treatment of delusional disorder
antipyschotics or psychotherapy
fixed delusions without prominent hallucinations or other symptoms of psychosis
delusional disorder
may have a somatic type concern
body dismorphic disorder
this a form of obsessive compulsive related disorder that involves a preoccupation iwth preceived ugliness or defects in appearance.
illness anxiety disorder
fear of having a serious undiagnosed medical illness but they are not delusional and can acknowledge the possibility they do not have the feared illness.
They do not have somatic symptoms
obsessive compulsive disorder
time consuming obsessions (intrusive thoughts, urges, images) and compulsions (repetitive behaviors) that are typically not delusional.
somatic symptom disorder
excessive anxiety about multiple physical symptoms and are not delusional.
treatment of somatic symptom disorder:
regularly scheduled visits, minimizing unnecessary testing and consultations and try for cognitive behavioral therapy.
what is cognitive behavioral therapy?
addresses distorted health beliefs and expectations and with behavioral techniques (systematic desensitization, progressive muscle relaxation, graduated exercise programs) and helpful for improving coping skills and daily functioning.
medical therapy for somatic symptom disorder
SSRI is first line for medical treatment.
factitious disorder
deliberately falsify or manipulate their own medical condition to appear ill for purposes of being in the sick role
malingering
pts who intentionally falsify their medical conditio nfor external rewards to obtain or disability pay or drugs.
factitious disorder is a
diagnosis of exclusion and alternative explanations must be explored.
management of factitious disorder:
compassionate feedback about clinical findings and offering psychotherapy referral if pts is receptive
illness anxiety disorder (hypochondriasis)
pt has minimal or no actual sypmtoms but is pre occupied with having a serious or undiagnosed specific dx (brain tumor)
somatic symptom disorder is
excessive preoccupation with >1 unexplained somatic symptoms that would not explain this patients anxiety about multiple non somatic issues.
somatization is
chronic history of unexplained physical symptoms findings and no exacerbating or alleviating factors.
somatization definition is
multiple physical concerns noted throughout a period of many years including 4 separate pain symptoms, 2 separate GI symptoms, one sexual symptom as well as pseudoneurological symptom
hypochondriasis is (illness anxiety disorder)
patients who have persistent for 6 months fears or beliefs of having a concerning medical diagnosis due to misinterpretation of typical mild somatic symptoms
they don’t have a condition but misinterpret symptoms and then get worried about it.
what is a medically unexplained symptom?
MUS - continuum of physical and mental health somatic symptoms.
Most appropriate management is avoid testing and obtain all previous records
then try to approach each symptom in a focused manner and diligently review any previous diagnostic evaluations.
