Somatic Symptom Disorders +Obsessive compulsive Flashcards
Disorders
- somatic Sx disorder (mild, moderate, severe)
- Illness Anxiety Disorder
- Conversion disorder (funcitonal Neuro symptom disorder
- Factitious disorder
General elements
- no organ pathology to s/s
- Patients not reassured by negative findings
- Preoccupation w/ illness
- sick role w/o professional confirmation
Difficult Differential
- masked depression, anxiety
- adjustment disorder, PTSD
- Somatic Sx disorder
- childhood somatic sx
Somatic Sx Disorder
Criteria
6 months
*1+ somatic s/s not explained by condition
*1 cognitive behavioral (severity):
overconcern, anxiety, time devoted to seeking explanation, reduced quality of life
REPLACED SOMATIZATION Disorder
Somatic symptom disorder
- illness in the home when growing up
- doctor shopping
- s/s = pain, nausea, position sense, autonomic instability
- female, reproductive age
- influenced by media
- early personal experience of illness/sick role
- current stress/impairment
- alienates providers, patient feels isolated/misunderstood
Problems with current dagnosis
- depends of PROVIDER”s assessment of legitimacy (bias)
* notes but deflects attention from stressors + context
Language
- structural= promote search for solutions (sugery)
* functional/ non structural can lead to dismissiveness
Why these symptoms and not other?
- pain fibers unequally distributed
- most autonomic activity
- boundary with outside world is monitored w/ pain fibers
Rapid/delayed responses
- sensory info goes to amygdala, trigger HPA maybe
- Thalamus to cingulate Cortex + prefrontal
- cortex applies contex (memory), interpretation (language), regulates thalamus to connect to HPA
Beyond neuroanatomy
- immune factors
- homronal interactions w/ monamine neuro-transmitters (pain)
- other metabolic/endocrine factors (gluten sensitivity)
- role of poor sleep (FBM)
Female>male:
*ssds, depression, anxiety (age 14-45)
*”Chronic Episodic Disorders” (CEDs)
=Migraines, IBS, FBM/CFS, Pelvic pain, depression,
=highly co-morbid
=Females!
Sex influences
- testosterone
- female reproductive organs (endometriosis)
- E2/P regulate MOA transmiters (depression/pain often)
Gender influence
Stressors
- subordinate status
- social support need
- abuse / interpersonal trauma
Male variant psychosomatic disorder
*low back pain
Reaction to Stress?
MUPS
- ID in combat veterans (Gulf wars)
- low grade, persistent stress
- chronic civilian stress
- dissociation
Utility of SSD Dx
- includes real world complexity
- DON’T have to rule out everything medical for this
- tx: CBT, psychotherapy, some s/s respond to Rx (SNRI, tricyclics = low dose), exercise + restoration of sleep
Somatic symptom disorder =
Their RESPONSE to disease is part of the problem
Conversion symptoms
- non-epileptic seizure
- tunnel vision
- choking
- month after completing tx for injured finger, numbness in digits after
Non-epileptic seizure dx
- EEG monitoring
- no incontinence, tongue biting, injury
- prolactin levels high in post ictal
- Pseudosz in actual seizure people
Functional Neuro Sx disorder
- common in kids (visual complaints, dizziness, HA, not GI)
- not anatomical deficit distribution
- inexpressible dilemma/sudden stress
- respond to hypnosis, behavioral intervention, physical therapy
Illness Anxiety Disorder
- ”hypochdriasis”
* Believes they have a CONDITION, not symptoms
Factitious disorder
S/s
- want medical attention, not treatment
- seen in ER
- often seen w/ personality disorder
- can induce illness in child
- dangerous possibly
Factitious disorder
Tx
- investigate, observe
- check EHR
- confront empathically
- no exploratory surgery, tx
Malingering
Faking for gain
Antisocial
OCD vs OCPD (obsessive compulsive personality disorder)
OCD =
- ritual to undo worry
- stereotypic, elemental (basic instincts, drive : sex, aggression, danger, blasphemy)
- Anxiety (OCPD = irritability)
- professional/intelligence irrelevant
DSM 5
OCD
*Obsessions
*Compulsions (not realistic threat)
EXCLUDE = food obsessions, drug seeking, paraphilia, depressive rumination
Stereotypic Obsessions
- contamination
- symmetry
- Sin: offending, blaspheming
- Sin: aggression
- doubt
Obsessions
Subcortical/limbic
elemental, hardwired, overactive stress response
Change slowly with age
Types of compulsion
- 2ndary to obsession
- behavioral/mental
- Yielding: counting, checking, ordering, washing
- resisting = repeating thoughs/actions
- motor: tapping
Importance of compulsions
- simple/operant conditioning
- consume attention/time
- embarrassment
OCD scale
YBOCS
OCD
Epidemiology
- Boys more
- adult same
- relation : Tourette’s
- Female onset = postpartum (estrogen going away)
OCD
Path
CorticoThalamicStriatal (CTS) (learning), “hyperfrontality”
OCD
DDx
- depression
- schizophrenic
- heavy metals (lead)
- PANDAS (strep autoimmune reaction)
- tics (tourette’s)
- Head injury, other neuro
- meds, drugs
OCD
Tx
- avoid shaming
- explanation, education
- behavioral Tx (exposure/response VERY EFFECTIVE)
- Rx = SSRI fluvoxamine, chlorimipramine
- stereotactic surgery
OCD
Hoarding
- anxiety, fear of loss
- deprivation, isolation
- no known Tx
OCD
Trichotillomania
- hair pulling
- disfiguring
- causes embarrassment
- women more likely to be treated
- tension relieved by pullng
- Tx: SSRI maybe, CBT, WIgs
OCD
Body dysmorphic disorder
- EXCLUDE weight/shape preoccupation
* TX: SSRI, CBT
Excoriation disorder
- skin picking
* may cause infection
OC Spectrum
- great distress
- Pediatrics, obstetrics, derm, plastic surgery, psyc, neuro
- OC disorders = treatable, but not recognized by generalists
