Somatic Symptom Disorders Flashcards by Kevin G

What 4 characteristics do all somatic symptom disorders share?

Focus is on at least one physical (somatic) symptom
There are excessive thoughts, feelings or behaviors related to this symptom/s
Health concerns have taken on a central role in an individual’s life
Lasting for at least 6 months

How well did you know this?

Not at all

Perfectly

Patient presents with Generalized Anxiety Disorder complicated with Illness Anxiety Disorder. What is the diagnosis?

Generalized Anxiety Disorder

Illness Anxiety Disorder only diagnosed if it is the only diagnosis

How well did you know this?

Not at all

Perfectly

Complex Somatic Symptom Disorder

Think you’re sick all the time b/c only way to get attention from ppl

Many physical symptoms, extend over years, chronic fluctuating course

May include symptoms from multiple systems:
• Pain in different sites
• GI symptoms
• sexual symptoms
• neurological conversion symptom

Not intentionally produced

How well did you know this?

Not at all

Perfectly

Conversion disorder (Functional neurological symptom Disorder)

One or more symptoms or deficits are present that affect voluntary motor or sensory function
Not intentionally produced (not conscious)
Cannot be fully explained by a general medical condition, direct effects of a substance, or cultural understanding
Common types: motor symptoms, touch, vision, hearing, seizures, tremor
Symptoms are often preceded by conflicts or stressors (may not be discoverable)

How well did you know this?

Not at all

Perfectly

What is the only somatic symptom disorder that cannot be fully explained by a general medical
condition, direct effects of a substance, or cultural
understanding?

Conversion disorder (Functional neurological symptom Disorder)

How well did you know this?

Not at all

Perfectly

What defense mechanism serves as one of the reasons that we as physicians should not treat our own family members?

Denial

unconscious blindness to unpleasant facts

How well did you know this?

Not at all

Perfectly

What is Regression?

Going back to earlier learned behaviors under stress

ex: kids lose toilet training in the hospital

How well did you know this?

Not at all

Perfectly

What is Displacement?

Redirecting one’s feelings onto another target

How well did you know this?

Not at all

Perfectly

What is Transference?

Taking your previous experiences & transferring them onto the current situation
(going on all the time, but usually doesn’t get in the way – can be subset of Displacement)

How well did you know this?

Not at all

Perfectly

Factitious Disorder (Munchaussen)

Intentional feigning of or actual production of physical or psychological signs or symptoms
No obvious external incentives for the behavior (such as economic gain, avoiding legal responsibility, or improving living conditions)
Variant: Ganser syndrome – only psychological symptoms
Variant: “Munchausen Syndrome by proxy” – form of child maltreatment

How well did you know this?

Not at all

Perfectly

Major difference between Factitious Disorder & Malingering?

in Factitious Disorder, there is no obvious external benefit to being ill, whereas Malingering may be someone trying to stay out of jail or trying to get drugs

(behavior is conscious in both, motivation is unconscious in Factitious Disorder)

How well did you know this?

Not at all

Perfectly

What is Malingering?

• Behavior of producing psychological or physical
symptoms is conscious

• Motivation is unconscious and possibly related to
desiring advantages of sick role (secondary gain
becomes overwhelmingly important)

• Often have co-morbid psychiatric conditions, very
difficult childhood experiences, etc.

How well did you know this?

Not at all

Perfectly

What is the best way to schedule visits for a patient w/ a somatic symptom disorder?

Regular, frequent, brief appointments

How well did you know this?

Not at all

Perfectly

What 2 somatic symptom disorders are most likely to respond to psychotherapy?

Illness anxiety disorder (“hypochondriasis”)
&
Functional neurologic symptom disorder (“conversion disorder”)

How well did you know this?

Not at all

Perfectly

T or F? Somatic SYmptom Disorders are best treated with a combination of psychotherapy & pharmacological treatment?

False.
There is no pharmacological treatment for SSDs.
Psychotherapy is only/best Tx.

How well did you know this?

Not at all

Perfectly

Is a depressed mood necessary for Depression diagnosis?

No. Either depressed mood OR loss of interest/pleasure must be included

Criteria for Major Depression diagnosis?

5 or more symptoms over a 2wk period or longer
1 symptom must be either depressed mood or loss of interest/pleasure
Causes clinically significant distress and marked functional impairment
Rule out due to general medical condition, bereavement, adjustment reaction, substance related depression

What are the vegetative symptoms of Major Depressive disorder?

• Sleep disturbance (midcycle/early morning awakening)
• Loss of appetite/ weight loss
• Constipation
• Diurnal mood variation
• Decreased energy/ high fatigue
• Decreased motivation
• Decreased attention/concentration/ ability to
think clearly
• Loss of libido

Diurnal mood variation in Depression vs. Anxiety?

Depression: worse in morning, better as day goes on (early wakening, shitty feeling)
Anxiety: feel alright in morning, worse later in the day as you realize how much you didn’t accomplish, etc.

Define “Psychosis”

The capacity to test “reality” as it is defined by others is lost.
The loss is more than “fleeting” and is not the result of an altered state of consciousness (e.g. being asleep).

Psychotic symptoms:

Delusion?

Fixed, false belief that cannot be shaken

in depression & bipolar, the delusion is dependent on person’s mood

Psychotic symptoms:

Hallucination?

Disturbance of perception

can be sight, touch, hearing, etc.

Most common type of hallucinations in depression/bipolar disorders or schizophrenia?

Auditory

Psychotic symptoms:

Catatonia?

Extreme disturbance of motor ability

May involve
• immobility (rigidity, waxy flexibility, psychic pillow)
• Movement stereotypy (posturing, grimacing, mannerisms)
• catatonic excitement (hyperactive, extremely agitated, purposeless)

Can result in exhaustion, rhabdomyolysis, acute renal failure and death if not treated

May be seen in any psychotic disorder

IS an EMERGENCY

What is Psychotic Depression?

``` • Loss of contact with reality • Mood congruent hallucinations and/ or • Mood congruent delusions • Possibility of catatonia ```

Differences in memory deficit in Depression vs. Dementia?

Dementia: - Remote memory more preserved than recent (can remember best friend from childhood) - Motivation doesn't help much Depression: - Remote & recent memory equally disturbed (b/c person isn't paying attention) - Memory improves w/ motivation

Mood disorder in Depression vs. Dementia?

Depression: Mood disorder is pervasive Dementia: Mood disorder fluctuates

Adjustment Disorder (Depression)

• Symptoms start within 3 months of identifiable stressor • Distress in excess of what would be expected but doesn’t reach criteria for major depressive disorder • Significant impairment in social/ occupational functioning • Not normal bereavement • Once stressor stops, symptoms stop w/in 6 mos

Persistent Depression Disorder (Dysthymic Disorder)

Depressed mood most of the time for at least 2 years, hasn’t gone away for more than 2 months at a time "not AS bad/depressed" ``` While depressed has 2 or more • Poor appetite or overeating • Insomnia or hypersomnia • Low energy/ fatigue • Low self-esteem • Poor concentration/ difficulty making decisions • Hopelessness ```

Is Major Depressive Disorder episodic or persistent?

Episodic | Persistent Depression Disorder is "persistent"

Premenstrual Dysmorphic Disorder (PDD)

* Occurs in late luteal phase and remits with onset of menses * ~75% of women experience minor sx, only 2-10% meet criteria for PMDD * Mood lability and irritability most months, starts week before menses and recedes post menses, causes significant distress but lasts only ~ 1 week * Hopelessness, sadness, low self-esteem, decreased interest in activities * Anxiety, difficulty concentrating * Lethargy, lack of energy, hypersonmia or insomnia, physical sx * Often, carbohydrate and salt cravings, may binge

2 specific types of Major Depression Disorder?

• Seasonal Affective Disorder (SAD): “Major depressive disorder with seasonal pattern” • Postpartum depression: “Major depressive disorder with peripartum onset” (beyond “baby blues”)

Major Depression w/ Peripartum Onset

* Often called Post-partum depression * More than normal “baby blues” (70-80% women postpartum) * Occurs within 4 weeks after childbirth (10-15% incidence) * Usually without psychosis * Postpartum psychosis (~0.1-0.2% incidence) can be very serious and lead to infanticide

Bipolar 1

* Usually starts with manic phase * Typically, cycles from mania to depression * May have only manic phases (no depressive) * Only need 1 manic phase to occur for Dx

Bipolar 2

- Depressive to hypomania only (hypomania feels good, so risk of patient not taking lithium) * Each phase lasts few weeks to months, long normal periods in between * “Rapid cycling” - less common, poor prognosis

Mania: Prognosis?

Very good WITH treatment ``` Poor untreated (70% to final stage) • very dysphoric, hopeless, desperate • frenzied, catatonia possible • Thinking disorganized, incoherent • Delusions, hallucinations • May be fatal - excitement or suicide ```

What is Echopraxia?

Acting out something you see | Tourette's