Somatic symptoms and related disorders Flashcards
Illness Anxiety disorder def.
Illness anxiety disorder (hypochondriasis) is preoccupation with and fear of having a serious illness, despite medical evaluation and reassurance.
Diagnosis Criteria according to DSM-V of IAD
Preoccupation with having or acquiring a serious illness
Somatic symptoms are not present or, if present, are mild in intensity
High level of anxiety about health
Performs excessive health-related behaviors or exhibits maladaptive behaviors
Persists for at least 6 months
Not better explained by another mental disorder (such as somatic symptom disorder)
M:F of IAD
equal
Treatment of IAD
Regularly scheduled visits to one primary care physician.
CBT is the most useful of psychotherapies.
Comorbid anxiety and depressive disorders should be treated with selective serotonin reuptake inhibitors (SSRIs) or other appropriate psychotropic medications.
Cognitive behavioral therapy (CBT)
prognosis of IAD
Chronic but episodic—symptoms may wax and wane periodically.
Can result in significant disability.
Up to 60% of patients improve significantly.
Better prognostic factors include fewer somatic symptoms, shorter duration of illness, and absence of childhood physical punishment.
Somatic symptom disorder def
It’s the major diagnostic class, the diagnosis is made on the basis of positive symptoms and signs ( Distressing somatic symptoms plus abnormal thoughts, feelings, and behaviors in response to these symptoms)
The main distinctive characteristic of somatic symptom disorder is not the somatic symptoms per se but instead the way the pt. present and interpret them.
Diagnostic criteria according to DSM-V of SSD
One or more somatic symptoms (may be predominantly pain) that are distressing or result in significant disruption.
Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns.
Lasts at least 6 months**.
f:m of SSD
f more
Risk factors of SSD
Older age Fewer years of education Low socio-economic status Unemployment History of childhood sexual abuse
Treatment and prognosis of SSD
The course tends to be chronic and debilitating. Symptoms may periodically improve and then worsen under stress.
The patient should have regularly scheduled visits with a single primary care physician, who should minimize unnecessary medical workups and treatments.
Address psychological issues slowly. Patients will likely resist referral to a mental health professional.
The treatment is mainly psychotherapy
Conversion disorder
A mental condition in which a person complains from at least one neurological symptom (sensory or motor) e.g. blindness, paralysis. And it cannot be fully explained by a neurological condition
Which means Patients “convert” psychological distress or conflicts to neurological symptoms.
Surprisingly, patients are often calm and unconcerned (la belle indifference) when describing their symptoms.
Diagnosis criteria according to DSM-V of CD
At least one symptom of altered voluntary motor or sensory function.
Evidence of incompatibility between the symptom and recognized neurological or medical conditions.
Not better explained by another medical or mental disorder.
Causes significant distress or impairment in social or occupational functioning or warrants medical evaluation.
Common symptoms: Paralysis, weakness, blindness, mutism, sensory complaints (paresthesias), seizures, globus sensation (globus hystericus or sensation of lump in throat).
Conversion-like presentations in elderly patients have a higher likelihood of representing an underlying neurological deficit.
Treatment and prognosis of CD
The primary treatment is education about the illness. Cognitive behavioral therapy (CBT), with or without physical therapy, can be used if education alone is not effective.
While patients often spontaneously recover, the prognosis is poor, as symptoms may persist, recur, or worsen in 40–66% of patients.
Factitious Disorder
Patients intentionally produce symptoms of a psychological or physical illness because of a desire to assume the sick role, not for external rewards.
Münchhausen syndrome is another, older name for factitious disorder with predominantly physical complaints. Münchhausen syndrome by proxy is intentionally producing symptoms in someone else who is under one’s care (usually one’s children).
Diagnosis Criteria according to DSM-V of FD
Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.
The deceptive behavior is evident even in the absence of obvious external rewards (such as in malingering).
Behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.
Individual can present him/herself, or another individual (as in factitious disorder imposed on another).
Commonly feigned symptoms:
- Psychiatric—hallucinations, depression
- Medical—fever (by heating the thermometer), infection, hypoglycemia, abdominal pain, seizures, and hematuria
