Somatic symptoms

Question 1

What are somatic symptoms?

Answer 1

Psychological problems presenting as physical presentation.
multiple physical SYMPTOMS present for at least 2 years
patient refuses to accept reassurance or negative test results

Question 2

What is hypochondriosis?

Answer 2

patient believes have disease despite no evidence, commoner men, higher social class, shop around for drs
persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
patient again refuses to accept reassurance or negative test results

Question 3

What is body dysmorphic disorder?

Answer 3

false belief of body part being defective- commonly skin colour, spots. donimates their life.

Question 4

What is conversion dirorder?

Answer 4

result of trauma, block it out, present with symptoms even though nothing physically wrong eg blindness
typically involves loss of motor or sensory function
the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies

Question 5

What is factitious disorder?

Answer 5

also known as Munchausen’s syndrome

the intentional production of physical or psychological symptoms

Question 6

What is malingering?

Answer 6

deliberately feign symptoms - fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

Question 7

Give some examples of somatic disorders

Answer 7

specific eg back pain, fibromyalgia. Functional eg ibs and palpitations. Fatigue eg chronic fatigue syndrome

Question 8

How do you diagnose medically unexplained symptoms?

Answer 8

• rule out red flags
• examine mood
• consider if has 3 months of symptoms that affect function with no explanation

Question 9

How do you manage MUS?

Answer 9

Try to balance between appropriate and over investigations
Treat psych comorbidities
Communicate
Amitriptyline may help- start low as not dose dependent