Somatic Symptoms and related disorders

Question 1

Somatization =

Somatoform illness=

Answer 1

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

Somatoform illness= produces significant dysfunction in patient’s life

Question 2

Factitious Disorder

Answer 2

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

Question 3

Malingering

Answer 3

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

Question 4

DSM4 Somatoform Disorders Diagnostic Categories (7)

Answer 4

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

Question 5

DSM5 Somatic Symptom and related disorders (5)

Answer 5

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

Question 6

Why So Many Changes between DSM IV and DSM V?

Answer 6

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”

Question 7

Somatic Symptom Disorder patients are often ______ and _______.

Answer 7

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

Question 8

3 Risks with somatic symptom patients

Answer 8

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

Question 9

Somatic Symptom and Related Disorders higher in females or males?

Answer 9

Females

Question 10

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

Answer 10

10-20%

Question 11

Somatic Symptom Disorder

Answer 11

• 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

Question 12

Criteria for somatic symptom disorder (3)

Answer 12

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).

Question 13

Somatic Symptom disorder - Associated features

Answer 13

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

Question 14

Somatic Symptom disorder - Pain

Answer 14

Excessive use of analgesics, narcotics

Course tends to be chronic and disabling

Patients on medical disability (vicious cycle)

Question 15

Management of Somatic Symptom disorder (2)

Answer 15

Set realistic goals (reduced pain, not none)

Increase function

Question 16

How is SSD rated?

Answer 16

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

Question 17

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

Answer 17

Comorbid medical conditions

Anxiety and depression

Question 18

Illness anxiety disorder =

Criteria?

Answer 18

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

Question 19

Mnemonic for IAD

Answer 19

4 D’s

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

Question 20

IAD gender prevalence

Answer 20

Equall in both men and women

Question 21

Risks in IAD

Answer 21

Risk for both missed diagnoses and iatrogenic complications

Question 22

IAD KEY criteria

Answer 22

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

Question 23

What else do you need to determine with IAD

Answer 23

You must specify whether the patient is:

• Care‐seeking type
• Care‐avoidant type

Question 24

Other name for conversion disorder

Answer 24

Functional Neurological Symptom Disorder

Question 25

FNSD requires What?

Answer 25

_Clear evidence_ of incombatibility with neurological disease

Question 26

Criteria for Functional Neurological Symptom Disorder

Answer 26

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

Question 27

Diagnostic Features of Functional Neurological Symptom Disorder (**Symptoms**)

Answer 27

_motor_- weakness or paralysis, tremors, dystonic movements, pseudoseizures _sensory_- altered, reduced, absent skin sensation, vision, hearing, globus

Question 28

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

Answer 28

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

Question 29

FNSD Usually begins \_\_\_\_\_\_\_. Duration?

Answer 29

In adolescence or early adulthood Duration of episodes usually short with abrupt resolution (2 weeks)

Question 30

Does FNSD reoccur? What does that indicate?

Answer 30

recurrence is common and predicts a more chronic course

Question 31

5 factors that indicate a better prognosis in FNSD

Answer 31

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

Question 32

How many FNSD patients eventually have a medical diagnosis?

Answer 32

20-25%

Question 33

Psychological Factors Affecting Other Medical Conditions - Key Criteria

Answer 33

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

Question 34

Fictitious disorder divided into:

Answer 34

* —Imposed on Self * —Imposed on another (previously by proxy)

Question 35

Fictitious disorder is associated with \_\_\_\_\_\_\_\_

Answer 35

antisocial personality disorder

Question 36

Malingering is a _____ rather than a \_\_\_\_\_

Answer 36

Legal rather than medical diagnosis

Question 37

Management of somatic symptoms and disorders (7)

Answer 37

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**