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Psyc Test 2 > Somatic Symptom Disorders +Obsessive compulsive > Flashcards

Somatic Symptom Disorders +Obsessive compulsive Flashcards

1
Q

Disorders

A
  • somatic Sx disorder (mild, moderate, severe)
  • Illness Anxiety Disorder
  • Conversion disorder (funcitonal Neuro symptom disorder
  • Factitious disorder
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2
Q

General elements

A
  • no organ pathology to s/s
  • Patients not reassured by negative findings
  • Preoccupation w/ illness
  • sick role w/o professional confirmation
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3
Q

Difficult Differential

A
  • masked depression, anxiety
  • adjustment disorder, PTSD
  • Somatic Sx disorder
  • childhood somatic sx
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4
Q

Somatic Sx Disorder

Criteria

A

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

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5
Q

Somatic symptom disorder

A
  • 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
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6
Q

Problems with current dagnosis

A
  • depends of PROVIDER”s assessment of legitimacy (bias)

* notes but deflects attention from stressors + context

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7
Q

Language

A
  • structural= promote search for solutions (sugery)

* functional/ non structural can lead to dismissiveness

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8
Q

Why these symptoms and not other?

A
  • pain fibers unequally distributed
  • most autonomic activity
  • boundary with outside world is monitored w/ pain fibers
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9
Q

Rapid/delayed responses

A
  • 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
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10
Q

Beyond neuroanatomy

A
  • immune factors
  • homronal interactions w/ monamine neuro-transmitters (pain)
  • other metabolic/endocrine factors (gluten sensitivity)
  • role of poor sleep (FBM)
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11
Q

Female>male:

A

*ssds, depression, anxiety (age 14-45)

*”Chronic Episodic Disorders” (CEDs)
=Migraines, IBS, FBM/CFS, Pelvic pain, depression,
=highly co-morbid
=Females!

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12
Q

Sex influences

A
  • testosterone
  • female reproductive organs (endometriosis)
  • E2/P regulate MOA transmiters (depression/pain often)
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13
Q

Gender influence

Stressors

A
  • subordinate status
  • social support need
  • abuse / interpersonal trauma
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14
Q

Male variant psychosomatic disorder

A

*low back pain

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15
Q

Reaction to Stress?

A

MUPS

  • ID in combat veterans (Gulf wars)
  • low grade, persistent stress
  • chronic civilian stress
  • dissociation
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16
Q

Utility of SSD Dx

A
  • 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
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17
Q

Somatic symptom disorder =

A

Their RESPONSE to disease is part of the problem

18
Q

Conversion symptoms

A
  • non-epileptic seizure
  • tunnel vision
  • choking
  • month after completing tx for injured finger, numbness in digits after
19
Q

Non-epileptic seizure dx

A
  • EEG monitoring
  • no incontinence, tongue biting, injury
  • prolactin levels high in post ictal
  • Pseudosz in actual seizure people
20
Q

Functional Neuro Sx disorder

A
  • common in kids (visual complaints, dizziness, HA, not GI)
  • not anatomical deficit distribution
  • inexpressible dilemma/sudden stress
  • respond to hypnosis, behavioral intervention, physical therapy
21
Q

Illness Anxiety Disorder

A
  • ”hypochdriasis”

* Believes they have a CONDITION, not symptoms

22
Q

Factitious disorder

S/s

A
  • want medical attention, not treatment
  • seen in ER
  • often seen w/ personality disorder
  • can induce illness in child
  • dangerous possibly
23
Q

Factitious disorder

Tx

A
  • investigate, observe
  • check EHR
  • confront empathically
  • no exploratory surgery, tx
24
Q

Malingering

A

Faking for gain

Antisocial

25
Q

OCD vs OCPD (obsessive compulsive personality disorder)

A

OCD =

  • ritual to undo worry
  • stereotypic, elemental (basic instincts, drive : sex, aggression, danger, blasphemy)
  • Anxiety (OCPD = irritability)
  • professional/intelligence irrelevant
26
Q

DSM 5

OCD

A

*Obsessions
*Compulsions (not realistic threat)
EXCLUDE = food obsessions, drug seeking, paraphilia, depressive rumination

27
Q

Stereotypic Obsessions

A
  • contamination
  • symmetry
  • Sin: offending, blaspheming
  • Sin: aggression
  • doubt
28
Q

Obsessions

Subcortical/limbic

A

elemental, hardwired, overactive stress response

Change slowly with age

29
Q

Types of compulsion

A
  • 2ndary to obsession
  • behavioral/mental
  • Yielding: counting, checking, ordering, washing
  • resisting = repeating thoughs/actions
  • motor: tapping
30
Q

Importance of compulsions

A
  • simple/operant conditioning
  • consume attention/time
  • embarrassment
31
Q

OCD scale

A

YBOCS

32
Q

OCD

Epidemiology

A
  • Boys more
  • adult same
  • relation : Tourette’s
  • Female onset = postpartum (estrogen going away)
33
Q

OCD

Path

A

CorticoThalamicStriatal (CTS) (learning), “hyperfrontality”

34
Q

OCD

DDx

A
  • depression
  • schizophrenic
  • heavy metals (lead)
  • PANDAS (strep autoimmune reaction)
  • tics (tourette’s)
  • Head injury, other neuro
  • meds, drugs
35
Q

OCD

Tx

A
  • avoid shaming
  • explanation, education
  • behavioral Tx (exposure/response VERY EFFECTIVE)
  • Rx = SSRI fluvoxamine, chlorimipramine
  • stereotactic surgery
36
Q

OCD

Hoarding

A
  • anxiety, fear of loss
  • deprivation, isolation
  • no known Tx
37
Q

OCD

Trichotillomania

A
  • hair pulling
  • disfiguring
  • causes embarrassment
  • women more likely to be treated
  • tension relieved by pullng
  • Tx: SSRI maybe, CBT, WIgs
38
Q

OCD

Body dysmorphic disorder

A
  • EXCLUDE weight/shape preoccupation

* TX: SSRI, CBT

39
Q

Excoriation disorder

A
  • skin picking

* may cause infection

40
Q

OC Spectrum

A
  • great distress
  • Pediatrics, obstetrics, derm, plastic surgery, psyc, neuro
  • OC disorders = treatable, but not recognized by generalists

Psyc Test 2 (7 decks)

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