Somatic symptoms and impulse control disorders Flashcards
definition: somatization
experiencing and communicating of emotional distress as physical illness
what are the reasons for somatization?
- emotional disturbances have physical effects upon the body (and vice versa)
- a physical symptom may be perceived as a necessary ticket of admission to receiving care from the clinician
- physical distress carries less shame and connotation of weakness than emotional distress
- dysfunctions in neuroendocrine system have been linked to functional disorders, including chronic fatigue syndrome and some kinds of chronic pain
- psychiatric illness
what are the attributes of patients with unexplained symptoms?
- vague / atypical symptoms
- multiple organ systems
- impairment in functioning may seem disproportionately high compared to observable pathology
- higher awareness of bodily sensations (and higher reactivity)
- denial that symptoms might relate to psychological factors
- sensitivity to side effects, unresponsive to therapeutic effects
what is required to care for patients with somatization?
more patience and caring
what are the criteria for somatic symptom disorder?
- one or more somatic symptoms that are distressing or result in significant disruption of daily life
- excessive thoughts, feeling, behaviors related to the symptoms:
- disporportionate and persistent thoughts about symptoms’ seriousness
- persistently high level of anxiety about health or symptoms
- excessive time and energy devoted to symptoms
need a distressing symptom you are worrying about
what is the difference between somatic symptom disorder and illness anxiety disorder?
- SSD: need a distressing symptom you are worrying about
- IAD: no symptoms
what are the criteria for illness anxiety disorder?
- preoccupation with health to the exclusion of everything else
- somatic symptoms are either not present or are mild
- high level of anxiety about health
- individual performs excessive health related behaviors or else exhibits maladaptive avoidance
- illness preoccupation must be present at least 6 months
how long must illness preoccupation be present to diagnose illness anxiety disorder?
6 months
are patients with illness anxiety disorder responsive to reassurance?
no
what are the criteria for conversion disorder?
- one or more symptoms of altered voluntary motor or sensory function
- clinical findings show incompatibility between the symptom and recognized neurological or medical conditions
- symptom causes clinically significant distress or impairment
can conversion disorder coexist with medically explained neuro disorders (e.g. seizures)?
yes
what should you tell a patient with conversion?
state that s/he has benign neuro dysfunction that is made worse by stress
features of factitious disorder
- intentional production of symptoms
- presents self to others as ill or injured
- goal is to assume sick role rather than obtain external rewards
MAKING SYMPTOMS ON PURPOSE
features of malingering
- not a psychiatric disorder
- lying (reporting symptoms that are not occurring)
- goal is to obtain some other desired benefit or outcome, not the sick role itself (disability, worker’s comp, release from jail / military)
what should you do for patients with unexplained symptoms?
- develop a trusting, empathic relationship
- stick with ONE primary care provider
- schedule regular visits so patient’s have access to you without needing to invent a symptom
- be honest when unsure about etiology
- diagnostic and treatment efforts should be guided by signs rather than symptoms
what medications can be used for somatic symptom disorder?
- SSRIs
- SNRIs (unexplained pain)
- TCAs
- psychotherapy (CBT, interpersonal)
what personality trait is associated with impulse control disorders?
DISINHIBITION
are impulse control disorders externalizing or internalizing?
considered EXTERNALIZING
definition: impulse control disorders
problems in controlling one’s own emotions and actions leading to behaviors that violate the rights of others or create significant conflict with authority or society
definition: oppositional defiant disorder
angry / irritable mood OR argumentative defiant behavior OR vindictiveness in interactions with one non-sibling with at least 4 symptoms in mood / behavior / vindictiveness
must impair functioning or create significant problems in relationships / school
is ODD more common in boys or girls? what age?
males prior to adolescence
children with ODD have a comorbid diagnosis of __________
ADHD
the best treatment style for ODD is __________-based
family
what is the pharmacologic treatment for ODD?
- risperidone for aggression (side effects)
- stimulants for ADHD
first line is still Parent Management Training)
definition: conduct disorder
repetitive behavior violating the basic rights of others or violation of age appropriate social norms (3 symptoms in past 12 months, or at least 1 in 6 months)
what is the symptom - age association for conduct disorder diagnosis?
- childhood: 1 symptom before 10
- adolescent: none before 10
what are the behavioral features of conduct disorder?
- lack or remorse / guilt
- callous lack of empathy
- unconcerned about performance
- shallow or deficient affect
does conduct order remit?
yes - majority of the time by adulthood
definition: intermittent explosive disorder
recurrent outbursts related to failure to control aggressive impulses, demonstrated by either:
- verbal or physical aggression (2x weekly for 3 mo) no resulting in physical damage
- behavioral outbursts that DO result in damage / destruction of property and/or physical injury to animals / people
what are the criteria for intermittent explosive disorder?
- aggressiveness grossly disproportionate to precipitating psychosis stressors or provocation
- outbursts not premeditated or achieve an objective / gain
- outbursts cause marked distress or impairment
- age 6 or older
- regret expressed
- usually lasts many years
what are the therapies for IED?
- relaxation training, modification of anger-inducing thoughts, coping skills
- SSRIs / BBs
what are the features of kleptomania?
- recurrent failure to resist objects not needed for personal use or monetary value
- increasing tension before committing theft
- pleasure / gratification or relief at time of theft
- stealing is not an expression of anger or vengeance, or in response to a delusion or hallucination
are kleptomaniacs aware their behavior is wrong / irrational?
yes (ego-dystonic)
