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Psychiatry pro +1700 > Somatic Symptoms and Related Disorders > Flashcards

Somatic Symptoms and Related Disorders Flashcards

1
Q

What is somatization?

A

The experiencing and communicating of emotional distress, as physical distress

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2
Q

What are the reasons for somatization?

A
  • A physical symptom may be perceived as a necessary ticket of admission to receive care from a clinician
  • Emotional disturbance have physical effects on the body
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3
Q

What are the characteristics of somatization symptoms? (3)

A
  • Vague
  • atypical
  • Impairment in functioning is disproportionately high relative actual pathology
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4
Q

What is the effect of varying levels of awareness of bodily sensations?

A

Higher level of awareness usually means seek more care

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5
Q

True or false: pts with somatizations disorders often overtly deny that symptoms might relate to psychological factors

A

True

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6
Q

What is the usual medical h/o pts with somatization disorder? (3)

A
  • long h/o vague symptoms
  • Complementary medicine use
  • Sensivity to medication
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7
Q

True or false: patient with somatization disorders are generally more sensitive to the side effects of the drug, but also to the main effect of the drug

A

False–More sensitive to the side effects, but less sensitive to the actual effect of the drug

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8
Q

What are the criteria for somatic symptoms disorder? (3)

A
  • One or more somatic symptoms that are distressing, or result in disruption in daily life
  • Excessive thoughts or behaviors related to the symptoms
  • Symptoms may vary, but state of being symptomatic persists
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9
Q

True or false: psychiatric problems comorbidities are common with somatic symptom disorder

A

True

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10
Q

What are the three signs that a patient may have excessive thoughts or behavior related to somatic symptom disorder?

A
  • Disproportionate and persistent thoughts about symptoms’ seriousness
  • persistent high levels of anxiety about health or symptoms
  • Excessive time and energy devoted to symptoms
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11
Q

What are the criteria for illness anxiety disorder (hypochondriasis)? (4)

A
  • Preoccupation with health to the exclusion of everything else
  • Somatic symptoms are not present or mild
  • High level of anxiety
  • Individual performs excessive health-related behaviors
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12
Q

What is the major difference between somatic symptom disorder, vs illness anxiety disorder?

A

IAD do not have a major symptom, or it is mild–it is more a general dis-ease about their health, whereas somatic symptom disorder is much more specific and distressing

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13
Q

What is the duration needed to diagnose illness anxiety disorder?

A

6 months

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14
Q

What is conversion disorder? (3 criteria)

A
  • One or more symptoms of altered voluntary motor or sensory function
  • Clinical findings show incompatibility between the symptom and recognized neurological or medical conditions
  • Significant distress/impairment
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15
Q

What is the approach to conversion disorder?

A

Rather than telling the patient their symptoms are not real, can reassure that there are no serious neurological causes

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16
Q

True or false: conversion disorder commonly occurs in individuals who actually have related pathology

A

True

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17
Q

What is factitious disorder?

A

(Munchausen’s syndrome)

  • Intentional production of symptoms
  • Goal is to assume the sick role
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18
Q

How is factitious disorder different from conversion disorder?

A

Conversion disorder is unconscious etiology, and the patient is not knowingly portraying false symptoms, whereas factitious disorder is conscious

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19
Q

Is malingering a psychological disorder?

A

No–lying for external reward

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20
Q

True or false: malingering is uncommon

A

True

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21
Q

What is the goal behind malingering?

A

To obtain some other desired benefit or outcome, not the sick role itself

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22
Q

What is the major issue with telling a patient with somatization disorder etc that their symptoms are all in their head?

A
  • Decreases care seeking

- Further dismisses mental disorders

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23
Q

What is the best way to handle pts with somatization disorder? (2)

A
  • Have them followed by one physician, and develop a trusting relationship
  • Have regular visits
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24
Q

True or false: you should avoid promising a cure with a pt

A

True

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25
Q

What is the drug category of choice for somatic symptom disorders?

A
  • SSRIs/SNRIs

- TCAs

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26
Q

Diagnostic and treatment efforts should focus on what part of the H and P with somatic symptom disorder?

A

Physical exam signs

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27
Q

What are the general features of impulse control disorders?

A

Problem controlling own emotions and actions, in a way that creates problems with others

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28
Q

What major personality trait is usually seen in impulse control disorders?

A

Disinhibition

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29
Q

Are impulse disorders usually considered externalizing or internalizing?

A

Externalizing

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30
Q

What is the biological cause of impulse control disorders?

A

Neurotransmitter dysregulation

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31
Q

What are the life consequences of impulse control disorders? (3)

A

-School suspension
-Accidents
-Job loss
etc

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32
Q

What is oppositional defiance disorder?

A

Angry/irritable mood OR argumentative/defiant behavior OR vindictiveness in interactions with one non-sibling

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33
Q

What are the 3 angry/irritable symptoms in the criteria for oppositional defiant disorder?

A
  • Frequent loss of temper
  • Touchy or annoyed easily
  • Often angry and resentful
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34
Q

What are the 4 argumentative/defiant symptoms in the criteria for oppositional defiant disorder?

A
  • Often argues with authority figures
  • Actively defies requests to comply with rules
  • Deliberately annoys others
  • Blames others for own mistakes
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35
Q

True or false: the s/sx of oppositional defiant disorder are always abnormal

A

False–normal if not consistent and/or significantly impacting functioning

36
Q

Which gender more commonly has oppositional defiant disorder? When?

A

Males

Prior to adolescence

37
Q

What are the risk factors for oppositional defiant disorder?

A
  • Frequent changes of caregivers

- Parenting is harsh or neglectful

38
Q

True or false: oppositional defiant disorders that are consistent across settings are more severe

39
Q

What is the general progression of oppositional defiant disorder if kids are:

  • Argumentative/vindictive
  • Angry, irritable
A
  • Argumentative / vindictive = Conduct disorder

- Angry, irritable = emotional disorders

40
Q

True or false: moderate levels of ODD are developmentally abnormal

41
Q

True or false: most kids with ODD will progress to conduct disorder?

A

False–most do not progress, but most kids with conduct disorder have ODD first

42
Q

What are the risks of untreated ODD?

A

Elevated risk for developing MDD or anxiety disorder d/t seeing self as “bad”

43
Q

What is the treatment for ODD?

A

Parent management training:

  • Improve relationship
  • Increase positive reinforcement
  • Non-coercive discipline
44
Q

True or false: aggressive discipline tends to make more aggressive kids

45
Q

What is the pharmacologic treatment for ODD? (2)

A
  • Risperidone

- Stimulants if comorbid ADHD

46
Q

What is conduct disorder?

A

(Like antisocial PD in kids)

-Repetitive behavior violating the basic rights of others or violation of age appropriate social norms

47
Q

What are the four major areas in the diagnostic criteria for conduct disorder?

A
  • Aggression toward people / animals
  • Destruction of property
  • Deceitfulness or theft
  • Serious violation of rules
48
Q

There is a worse prognosis if conduct disorder is early or late?

49
Q

What defines childhood onset of conduct disorder?

A

At least one symptom before age 10

50
Q

What defines adolescent onset of conduct disorder?

A

no symptoms before age 10

51
Q

What are the characteristics that kids with CD must have to be diagnosed as such? (5)

A
  • Lack of remorse or guilt
  • Callous lack of empathy
  • Unconcerned about performance
  • Shallow or deficient affect
  • Thrill seeking
52
Q

Are males or females more likely to get CD?

53
Q

What is the prognosis for CD?

A

Most of the time, the disorder remits by adulthood

54
Q

What is the major comorbidity of CD?

A

Substance abuse

55
Q

What is the major difference between ODD and CD?

A

CD has repetitive violation of the rights of others, without remorse

56
Q

True or false: there is an increased risk of suicide with CD

57
Q

What is intermittent explosive disorder (IED)?

A

Recurrent outbursts related to failure to control aggressive impulses, and aggression out of proportion to the provocation

58
Q

What is the major difference between IED and CD?

A

IED pts have remorse

59
Q

What are the two symptoms of IED?

A

Verbal or physical aggression

-Behavior outbursts that DO result in damage/destruction of property and/or physical injury to people

60
Q

What is the age that IED can be diagnosed at?

61
Q

What is the major risk of somatic symptom disorder?

A

Crying wolf label, and missing actual pathology

62
Q

In whom is factitious disorder common in?

A

Healthcare workers or their adult children

63
Q

Can you diagnose ODD if the behaviors are only seen between siblings

64
Q

What is the major comorbidity with ODD?

65
Q

What are the two major temperamental risk factors for CD?

A
  • Below average IQ

- Impulsivity

66
Q

What are the three major environmental risk factors for CD?

A
  • Parental abuse/neglect
  • Peer rejection
  • Poor school performance
67
Q

What are the genetic risk factors for CD?

A
  • family h/o CD, ADHD, or substance use

- Reduced autonomic fear conditioning

68
Q

Do IED pts seek reward for their actions?

A

No–just a blown out of proportion to stimulus

69
Q

What is the usual onset and duration of IED?

A

Impulses arise quickly, and subside within 30 minutes

70
Q

True or false: IED pts generally have regret with their actions

71
Q

What is the common past history of pts with IED?

A

H/o trauma

72
Q

What age does IED usually start?

A

late childhood, adolescence

73
Q

What happen to the prevalence of IED as people age?

74
Q

How long does IED tend to last?

A

years, but can have long periods episode free

75
Q

What is the psychotherapy treatment for IED? (2)

A
  • relaxation therapy

- CBT

76
Q

What is the pharmacological therapy for IED?

A
  • Anticonvulsants

- SSRIs

77
Q

What is kleptomania, and what are the four diagnostic criteria?

A
  • Recurrent failure to resist stealing objects
  • Increasing tension before committing theft
  • Pleasure, gratification at time of theft
  • Stealing is NOT an expression of anger, vengeance, or in response to a delusion/hallucination
78
Q

True or false: kleptomaniacs generally feel no remorse with stealing

79
Q

Which gender is more commonly afflicted with kleptomania?

80
Q

What is the major difference between kleptomania and normal stealing?

A

kleptomania is not about want or desire, more about the act itself

81
Q

What is the treatment for Kleptomania?

A

naltrexone

?

82
Q

What is pyromania, and what are the 5 diagnostic criteria?

A
  • repeated, deliberate fire setting
  • Tension before the act
  • Fascination with fire
  • Pleasure when setting fires
  • Not done for gain
83
Q

Which gender is more commonly afflicted with pyromania?

84
Q

true or false: there is often little or no remorse with pyromania

85
Q

What is the treatment of pyromania?

A

unknown, but CBT

86
Q

True or false: the earlier onset of pyromania, the harder it is for fix

A

False–easier

Psychiatry pro +1700 (28 decks)

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