Somatic symptom disorder, factitious disorder, malingering

Question 1

Management of somatic symptom disorder

Answer 1

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.

Question 2

characteristics somatic symptom disorder

Answer 2

medically unexplained and excessive healthcare use

Question 3

what also helps with somatic symptom disorder treatment

Answer 3

regularly scheduled visits and SSRI, SNRI, or TCAs have been helpful.

Question 4

what is a delusion disorder?

Answer 4

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

Question 5

treatment of delusional disorder

Answer 5

antipyschotics or psychotherapy

Question 6

fixed delusions without prominent hallucinations or other symptoms of psychosis

Answer 6

delusional disorder

may have a somatic type concern

Question 7

body dismorphic disorder

Answer 7

this a form of obsessive compulsive related disorder that involves a preoccupation iwth preceived ugliness or defects in appearance.

Question 8

illness anxiety disorder

Answer 8

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

Question 9

obsessive compulsive disorder

Answer 9

time consuming obsessions (intrusive thoughts, urges, images) and compulsions (repetitive behaviors) that are typically not delusional.

Question 10

somatic symptom disorder

Answer 10

excessive anxiety about multiple physical symptoms and are not delusional.

Question 11

treatment of somatic symptom disorder:

Answer 11

regularly scheduled visits, minimizing unnecessary testing and consultations and try for cognitive behavioral therapy.

Question 12

what is cognitive behavioral therapy?

Answer 12

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.

Question 13

medical therapy for somatic symptom disorder

Answer 13

SSRI is first line for medical treatment.

Question 14

factitious disorder

Answer 14

deliberately falsify or manipulate their own medical condition to appear ill for purposes of being in the sick role

Question 15

malingering

Answer 15

pts who intentionally falsify their medical conditio nfor external rewards to obtain or disability pay or drugs.

Question 16

factitious disorder is a

Answer 16

diagnosis of exclusion and alternative explanations must be explored.

Question 17

management of factitious disorder:

Answer 17

compassionate feedback about clinical findings and offering psychotherapy referral if pts is receptive

Question 18

illness anxiety disorder (hypochondriasis)

Answer 18

pt has minimal or no actual sypmtoms but is pre occupied with having a serious or undiagnosed specific dx (brain tumor)

Question 19

somatic symptom disorder is

Answer 19

excessive preoccupation with >1 unexplained somatic symptoms that would not explain this patients anxiety about multiple non somatic issues.

Question 20

somatization is

Answer 20

chronic history of unexplained physical symptoms findings and no exacerbating or alleviating factors.

Question 21

somatization definition is

Answer 21

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

Question 22

hypochondriasis is (illness anxiety disorder)

Answer 22

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.

Question 23

what is a medically unexplained symptom?

Answer 23

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.