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ICM - Exam 1 > Somatic Symptoms and related disorders > Flashcards

Somatic Symptoms and related disorders Flashcards

1
Q

Somatization =

Somatoform illness=

A

tendency to experience and communicate psychological or emotional distress as somatic (physical) symptoms

Somatoform illness= produces significant dysfunction in patient’s life

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2
Q

Factitious Disorder

A

symptoms are produced or feigned in order to appear ill, with no perceivable benefit to the patient

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3
Q

Malingering

A

symptoms are produced or feigned in response to an external incentive (e.g., avoid military service; obtain a settlement in a lawsuit, etc.).

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4
Q

DSM4 Somatoform Disorders Diagnostic Categories (7)

A
  1. Somatization Disorder
  2. Undifferentiated Somatoform Disorder
  3. Conversion Disorder
  4. Pain Disorder
  5. Hypochondriasis
  6. Body Dysmorphic Disorder
  7. Somatoform Disorder NOS
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5
Q

DSM5 Somatic Symptom and related disorders (5)

A
  1. Somatic Symptom Disorder
  2. Illness Anxiety Disorder
  3. Psychological Factors affecting other medical conditions
  4. Conversion Disorder (Functional Neurological Symptom Disorder)
  5. Factitious Disorder
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6
Q

Why So Many Changes between DSM IV and DSM V?

A
  1. — Overlapping previous diagnoses
  2. — Difficult for non‐psychiatric physicians to apply
  3. — Reduction of stigma
  4. — Potential for mind‐body dualism
  5. — Implication that symptoms were not “real”
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7
Q

Somatic Symptom Disorder patients are often ______ and _______.

A
  • Chronic, difficult to treat
  • High utilizers of the medical systems
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8
Q

3 Risks with somatic symptom patients

A
  1. Repetitive, unnecessary diagnostic testing
  2. Invasive medical / surgical workups
  3. Iatrogenic illness!
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9
Q

Somatic Symptom and Related Disorders higher in females or males?

A

Females

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10
Q

Somatic Symptom and Related Disorders - Observed in ____% of first degree female relatives of affected patients

A

10-20%

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11
Q

Somatic Symptom Disorder

A
  • Will absorb many former somatization disorder and hypochondriasis
  • —Presence of symptom, medically explained or not
  • —With Predominant Pain (formerly pain disorder)
  • —Health concerns as a central role in an individual’s life
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12
Q

Criteria for somatic symptom disorder (3)

A

A.One or more somatic symptoms…

B. Excessive thoughts, feelings, or behaviors…

C. the state of being symptomatic is persistent (typically more than 6 months).

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13
Q

Somatic Symptom disorder - Associated features

A
  • Frequent visits to doctor
  • May refuse to acknowledge contribution of psychological factors to symptoms
  • Co-morbid depressive symptoms are common
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14
Q

Somatic Symptom disorder - Pain

A

Excessive use of analgesics, narcotics

Course tends to be chronic and disabling

Patients on medical disability (vicious cycle)

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15
Q

Management of Somatic Symptom disorder (2)

A

Set realistic goals (reduced pain, not none)

Increase function

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16
Q

How is SSD rated?

A

“Clinician-rated severity” 3 item tool that assesses the severity of

17
Q

SSD is associated with high rates of _____, particularly ___ and ____

A

Comorbid medical conditions

Anxiety and depression

18
Q

Illness anxiety disorder =

Criteria?

A

Previously known as hypochondriasis

  • may or may not have a medical condition
  • heightened bodily sensations
  • intense anxiety about the possibility of an undiagnosed illness
  • devote excessive time and energy to health concerns
  • not easily reassured
19
Q

Mnemonic for IAD

A

4 D’s

  1. Disease fear
  2. Disease preoccupation
  3. Disease conviction
  4. Disability
20
Q

IAD gender prevalence

A

Equall in both men and women

21
Q

Risks in IAD

A

Risk for both missed diagnoses and iatrogenic complications

22
Q

IAD KEY criteria

A
  • Preoccupation with having or acquiring a serious illness.
  • Somatic symptoms are not present or, if present, are only mild in intensity.
23
Q

What else do you need to determine with IAD

A

You must specify whether the patient is:

  • Care‐seeking type
  • Care‐avoidant type
24
Q

Other name for conversion disorder

A

Functional Neurological Symptom Disorder

25
Q

FNSD requires What?

A

Clear evidence of incombatibility with neurological disease

26
Q

Criteria for Functional Neurological Symptom Disorder

A
  1. One or more symptoms of altered voluntary motor or sensory function
  2. Incompatibility between the symptoms and recognized neurological syndromes
  3. Symptoms are not better explained by another medical or mental disorder
  4. Symptoms cause distress and impairment
27
Q

Diagnostic Features of Functional Neurological Symptom Disorder (Symptoms)

A

motor- weakness or paralysis, tremors, dystonic movements, pseudoseizures

sensory- altered, reduced, absent skin sensation, vision, hearing, globus

28
Q

Diagnostic Features of Functional Neurological Symptom Disorder (Features of Sx)

A
  • Distractibility
  • Sensory symptoms that split at the midline
  • Gap between tested strength and function (strength testing vs walking on tiptoes)
  • “la belle indifference”
29
Q

FNSD Usually begins _______.

Duration?

A

In adolescence or early adulthood

Duration of episodes usually short with abrupt resolution (2 weeks)

30
Q

Does FNSD reoccur? What does that indicate?

A

recurrence is common and predicts a more chronic course

31
Q

5 factors that indicate a better prognosis in FNSD

A
  • Acute onset
  • Identifiable trauma or stressor at onset
  • Good health before incident
  • Above average IQ
  • Absence of other medical or psychiatric disorders
32
Q

How many FNSD patients eventually have a medical diagnosis?

A

20-25%

33
Q

Psychological Factors Affecting Other Medical Conditions - Key Criteria

A
  1. The factors have influenced the course of the medical condition
  2. The factors interfere with the treatment of the medical condition (e.g., poor adherence)
  3. The factors constitute additional well‐established health risks for the individual
34
Q

Fictitious disorder divided into:

A
  • —Imposed on Self
  • —Imposed on another (previously by proxy)
35
Q

Fictitious disorder is associated with ________

A

antisocial personality disorder

36
Q

Malingering is a _____ rather than a _____

A

Legal rather than medical diagnosis

37
Q

Management of somatic symptoms and disorders (7)

A
  1. Establish one physician
  2. Treat co-morbid anxiety and depression
  3. Maintain regular follow up, even when doing well
  4. Use objective evidence of disease to guide medical testing
  5. Gradually shift emphasis from physical complaints to discussing stressors
  6. Watch for drug abuse
  7. Protect from iatrogenic complications
38
Q
A

ICM - Exam 1 (8 decks)

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