Somatic Symptom Disorders and Malingering Flashcards
symptoms suggest physical defect, no physiological basis can be found, unconscious production of physical symptoms, symptoms not voluntary
somatoform disorders (DSMIV)
*DSMV somatic symptom and related disorders
somatic symptom disorder, illness anxiety disorder, conversion disorder, factitious disorder, other (psuedocyesis=false pregnancy)
another name for functional neurological symptom disorder
conversion disorder
what does somatic symptom disorder replace?
somatization disorder, undifferentiated somatoform disorder, hypochondriasis, pain disorder
*describe the criteria for somatic symptom disorder
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
*criteria of illness anxiety disorder
somatic sx are absent or mild, preoccupation with having or acquiring a serious illness, greater than 6 months duration (persistent or intermittent)
*criteria of conversion disorder
unintentionally produced symptoms or deficits affecting voluntary motor or sensory function (neurological), sx do not conform to known anatomical pathways and physiological mechanisms
common presentations of conversion disorder
pseudoseizures, blindness, paralysis, deafness, sensory loss, paralysis or gait issues
what is “la belle indifference”?
naïve, inappropriate lack of emotion or concern for the perceptions by others of ones disabilities
conversion disorders are more often seen in this class, and more in this gender
young, less sophisticated people; males more than females; often in a conflictual situation
differential dx of conversion disorder
MS, seizure, myasthenia gravis, periodic paralysis, myoglobinuric myopathy, Guillain-Barre syndrome
management of conversion disorder
no direct confrontation, conservative approach of reassurance and relaxation, suggestion of recovery, identifying underlying conflict
*disorder in which physical or psych symptoms are intentionally produced to assume a sick role
factitious disorder
*criteria of factitious disorder
conscious/voluntary symptom production; motivation to assume the sick role is assumed to be UNconscious
factitious disorder often seen in this profession
healthcare
example of factitious disorder
self-injection of insulin to present with hypoglycemia
blood count to check for hypoglycemic presentation when suspicious of factitious disorder
increased serum insulin/C-peptide ratio > 1.0 during a hypoglycemic episode
somatic symptom disorder management
short, frequent doctors visits, short physical, non-invasive, discuss fears and emotions to prevent new symptoms and decrease ER admissions
what does BATHE stand for and what is this method used for?
management of somatic symptom disorder: background, affect, trouble, handle, empathy
pharmacological management of somatic symptom disorder
deal with dominant symptom: pain meds, anti anxiety meds
life style changes as somatic symptom disorder management
light exercise, yoga, meditation, walks, vitamins
intentional production of false or exaggerated physical or psych symptoms
malingering
what motivates malingering?
external incentives: getting out of work, obtaining financial comp, evading criminal prosecution, obtaining drugs
nmbe vignettes usually use this to clue into malingering
jail/disability/opiates
any combo of the following should be strongly suspicious for malingering
medicolegal context, marked discrepancy between persons claims and objective findings, lack of cooperation during eval and compliance, presence of antisocial personality disorder
in malingering, the symptom production if ____ and the motivation is _____
conscious, conscious
in factitious disorder, the symptom production is ____, motivation is _____
conscious, unconscious
in somatic symptom disorder, the symptom production is _____, motivation is ______
unconscious, unconscious
