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KC2017 Behavioral Health > Somatic Symptom Disorders > Flashcards

Somatic Symptom Disorders Flashcards

1
Q

Somatic Symptoms and related disorders

A

Expressing psychological distress as body distress

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2
Q

DSM-5 Disorders

A

Somatic symptom disorder
Conversion disorder
Illness Anxiety Disorder (hypochondriasis)
Psychological factors affecting other medical conditions
Factitious Disorder (Munchausen Syndrome)

Also: undifferentiated somatoform disorder and somatoform disorder NOS

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3
Q

Somatic symptoms and other disorders DSM-V

A

Disproportionate and persistent thought about seriousness of one’s symptoms

Persistently high level of anxiety about health or symptoms

Excessive time and energy devoted to these symptoms or health concerns

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4
Q

Somatic Symptom Disorder etiologies

A

Etiology unknown

Anger suppression, avoid responsibilities

Family environment - abuse

Genetic (women = somatic symptom disorder, men= antisocial personality disorder)

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5
Q

Somatic symptom disorder

3 classic features

A
  1. Multiple system complaints
  2. Early onset, chronic course without physical signs
  3. Normal diagnostic studies are normal
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6
Q

Somatic symptom disorder

A

Very high levels of worry about illness and tendency to appraise symptoms as unduly threatening, harmful and often think worst about their health

These are distressing and alter every day life

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7
Q

Clinical findings

Somatic symptoms disorder

A
  1. Long complex medical hx (thick chart sign)
  2. Numerous invasive dz or tx procedure
  3. Multi-system c/o
  4. Fashionable diagnosis (Fibromyalgia, chronic fatigue syndrome, IBS)
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8
Q

Somatic Symptom Disorder Treatment

A

Single health care provider

Regularly scheduled appointment

Long term strategy

Group therapy

Meds no effective unless co-morbid psych

Provider should think of complaints as emotional expression
Chronic

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9
Q

Complications of Somatic Symptom Disorder

A

Failure to ID cause for s/s

Use of unnecessary and invasive do or surgical treatment

RX drug abuse

Can lead to helpless and dependent lifestyle

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10
Q

Conversion disorder

DSM-V

A

One or more symptoms of altered voluntary motor/sensory function

Clinical findings provide evidence of incompatibility between symptom and recognize neurological/medical conditions

Symptom not better explained by another medical or mental disorder

Symptom or deficit causes clinically significant distress or impairment in social, occupational or other important areas of functioning

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11
Q

Conversion is commonly found in:

A
  1. Rural populations
  2. Lower IQ
  3. Less educated
  4. Lower SES
  5. Military combat experience

Comorbities with other psychological disorders

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12
Q

Conversion disorder

Etiologies

A

May follow acute trauma

Repression of unconscious, intra-psychic conflict

Conversion of anxiety into physical symptoms

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13
Q

Conversion disorder

Clinical findings

A

Mimics dysfunction in voluntary motor or sensory system (blind, deaf, mute)

Motor involvement (gait, weakness, paralysis)

Exam doesn’t correlate

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14
Q

Psychodynamics

Conversion disorder

A

Primary gain: blindness prevents dealing with trauma

Secondary gain: pt benefits from illness

La belle indifference: lack of appropriate concern for severe symptoms

Identification: patient may take on characteristics of person imp. To them

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15
Q

Differential Dx

Conversion disorder

A

Must rule out medical disorder

If s/s disappear by suggestion, hypnosis, amobarbital/lorazepam = conversion disorder

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16
Q

Difference b/t Conversion disorder and somatic symptom disorder

A

Conversion = 1 s/s/ that violates law of H and P

Somatic symptom = multiple s/s

17
Q

Conversion disorder prognosis

A

Can recur (20-25% with in first yr

Need to make sure true dz is not overlooked

Failure to consider conversion disorder as do can lead to continued treatment

18
Q

Conversion disorder treatment

A

Usually have spontaneous resolution

Meds (benzos for anxiety, antidepressants)

Psychological (insight, behavior therapies)

19
Q

Illness anxiety disorder

A

Preoccupation with having or acquiring serious illness

Somatic symptoms NOT present or only mild

High level of anxiety about health and individual is easily alarmed

Excessive health related behaviors or maladaptive avoidance

Illness preoccupation present 6+ months

Illness preoccupation is not better explained by another mental disorder

20
Q

Etiology behind Illness Anxiety Disorder

A

Several theories of etiology

Lower pain threshold and tolerance

Social learning

May be variant of other mental disorder

Defense against guilt, sense of innate badness, low self esteem

21
Q

Clinical findings of illness anxiety disorder

A

No physical exam to correlate complaints

Patient focuses on fear and belief that disease is present more than symptoms

Continues in belief even when diagnostic studies are negative

Can have depression, anxiety

22
Q

Illness anxiety disorder

Treatment

A

Treat psychiatric symptoms with appropriate meds

Behavior therapy

Reassurance from clinician

Problem: remaining objective and not missing real disease

23
Q

Body dysmorphic disorder

Criteria

A

Preoccupation with 1+ defects or flaws in physical appearance that are not observable or appear slight

Repetitive behaviors or mental acts in response to appearance concerns

Preoccupation causes significant distress or impairment

Appearance preoccupation is not better explained by an eating disorder

24
Q

BDD is a somatic expression of

A

OCD

Is listed in DSM-V as OCD related

MC concern is facial features

25
Q

BDD presentation

A

Seek multiple plastic surgeries

Fear of humiliation due to imagined defect, may keep patient housebound

Spends hours per day looking in mirror

Long course, consists of freq. ups and downs, few times when patient is symptom free

26
Q

BDD treatment

A

surgery is contraindicated

Meds: SSRI drugs are effective

27
Q

Factitious Disorder

DSM-V

A
  1. Falsification of physical or psychological signs or symptoms, induction of injury or disease then patient presents to others as ill, impaired or injured
  2. Deceptive behavior is evident even in absence of obvious external rewards
  3. Behavior is not better explained by another mental disorder
  4. Inflicted in self or another (child)
28
Q

Factitious Disorder clinical findings

A

Present with nausea, vomiting, pain

Put blood in feces or urine, artificially elevate temp

Multiple hospital admissions, surgeries

Munchausen by proxy (to kid)

29
Q

Malingering

A

Factitious disorder

Exaggerates symptoms for external gain

Malingering is deliberate behavior for a known external purpose

30
Q

Factitious disorder malingering

Strongly suspect in presence of:

A

Medicolegal presentation

Marked discrepancy between claimed distress and objective findings

Lack of cooperation during elevation and in complying with prescribed treatment

Presence of antisocial disorder

31
Q

Common goal of people who malinger

A

In ER: obtaining drugs or shelter

In clinic: financial compensation

KC2017 Behavioral Health (11 decks)

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