Somatic Symptom Disorders and Malingering

Question 1

symptoms suggest physical defect, no physiological basis can be found, unconscious production of physical symptoms, symptoms not voluntary

Answer 1

somatoform disorders (DSMIV)

Question 2

*DSMV somatic symptom and related disorders

Answer 2

somatic symptom disorder, illness anxiety disorder, conversion disorder, factitious disorder, other (psuedocyesis=false pregnancy)

Question 3

another name for functional neurological symptom disorder

Answer 3

conversion disorder

Question 4

what does somatic symptom disorder replace?

Answer 4

somatization disorder, undifferentiated somatoform disorder, hypochondriasis, pain disorder

Question 5

*describe the criteria for somatic symptom disorder

Answer 5

1+ disrupting daily life, excessive thoughts, feelings, behaviors with 1+ persistent serious thoughts, persistent anxiety, excessive time and energy devoted to the symptom or healthcare, for longer than 6 months

Question 6

*criteria of illness anxiety disorder

Answer 6

somatic sx are absent or mild, preoccupation with having or acquiring a serious illness, greater than 6 months duration (persistent or intermittent)

Question 7

*criteria of conversion disorder

Answer 7

unintentionally produced symptoms or deficits affecting voluntary motor or sensory function (neurological), sx do not conform to known anatomical pathways and physiological mechanisms

Question 8

common presentations of conversion disorder

Answer 8

pseudoseizures, blindness, paralysis, deafness, sensory loss, paralysis or gait issues

Question 9

what is “la belle indifference”?

Answer 9

naïve, inappropriate lack of emotion or concern for the perceptions by others of ones disabilities

Question 10

conversion disorders are more often seen in this class, and more in this gender

Answer 10

young, less sophisticated people; males more than females; often in a conflictual situation

Question 11

differential dx of conversion disorder

Answer 11

MS, seizure, myasthenia gravis, periodic paralysis, myoglobinuric myopathy, Guillain-Barre syndrome

Question 12

management of conversion disorder

Answer 12

no direct confrontation, conservative approach of reassurance and relaxation, suggestion of recovery, identifying underlying conflict

Question 13

*disorder in which physical or psych symptoms are intentionally produced to assume a sick role

Answer 13

factitious disorder

Question 14

*criteria of factitious disorder

Answer 14

conscious/voluntary symptom production; motivation to assume the sick role is assumed to be UNconscious

Question 15

factitious disorder often seen in this profession

Answer 15

healthcare

Question 16

example of factitious disorder

Answer 16

self-injection of insulin to present with hypoglycemia

Question 17

blood count to check for hypoglycemic presentation when suspicious of factitious disorder

Answer 17

increased serum insulin/C-peptide ratio > 1.0 during a hypoglycemic episode

Question 18

somatic symptom disorder management

Answer 18

short, frequent doctors visits, short physical, non-invasive, discuss fears and emotions to prevent new symptoms and decrease ER admissions

Question 19

what does BATHE stand for and what is this method used for?

Answer 19

management of somatic symptom disorder: background, affect, trouble, handle, empathy

Question 20

pharmacological management of somatic symptom disorder

Answer 20

deal with dominant symptom: pain meds, anti anxiety meds

Question 21

life style changes as somatic symptom disorder management

Answer 21

light exercise, yoga, meditation, walks, vitamins

Question 22

intentional production of false or exaggerated physical or psych symptoms

Answer 22

malingering

Question 23

what motivates malingering?

Answer 23

external incentives: getting out of work, obtaining financial comp, evading criminal prosecution, obtaining drugs

Question 24

nmbe vignettes usually use this to clue into malingering

Answer 24

jail/disability/opiates

Question 25

any combo of the following should be strongly suspicious for malingering

Answer 25

medicolegal context, marked discrepancy between persons claims and objective findings, lack of cooperation during eval and compliance, presence of antisocial personality disorder

Question 26

in malingering, the symptom production if ____ and the motivation is _____

Answer 26

conscious, conscious

Question 27

in factitious disorder, the symptom production is ____, motivation is _____

Answer 27

conscious, unconscious

Question 28

in somatic symptom disorder, the symptom production is _____, motivation is ______

Answer 28

unconscious, unconscious