Somatic Symptoms & Related Disorders Flashcards
What is the etiology of Somatization?
unclear
T/F Somatic disorder is a benign disorder
FALSE
What two things does somatic disorder lead to?
disability and iatrogenic harm
What is the diagnosis of somatic symptom disorder?
basis of positive symptoms and signs RATHER THAN the absence of a medical explanation for somatic symptom
How long does a somatic symptom need to be present
6 mo
What is the screening tool for Somatic Symptom?
Patient Health Questionnaire (15 item)
What is disorder is a diagnosis of exclusion?
Somatic Symptom disorder
What things must be excluded in somatic symptom?
lack of physical or lab findings and factious disorder and malingering
What is the goal of treatment for somatic symptom?
is management not cure
When should appts be done for somatic symptom?
regular outpatient visits (4-8wks) NOT contingent upon SX
What is the treatment for somatic disorder?
SSRI, SNRI, TCAs
What is the dosing for meds for somatic disorder?
start lowest possible dose and increase slowly
What therapy works best for somatic disorder?
Cognitive Behavior therapy
What is conversion disorder?
abnormal nervous system functioning in the absence of structural pathology
What are symptoms seen in conversion disorder?
weakness, abnormal movements, non-epileptic seizures
What is the difference between conversion and malingering disorder?
symptoms are genuine and cause distress and/or psychosocial impairment
What are the ABCD of conversion disorder?
A. 1 or more symp of altered voluntary motor or sensory function
B. findings provide evidence of incompatibility between symptom and recognized medical conditions
C. symptom not better explained by other disorders
D. causes distress in social, work etc.
What is the 1st line txt for conversion disorder?
pt education about the syndrome
What may be all that necessary for recovery in minority of pts?
explanation of the diagnosis
What is the 2nd line txt for conversion disorder?
Cognitive Behavioral Therapy and PT
What is the 3rd line txt for conversion disorder?
Antidepressants, Hypnosis, Family therapy, group therapy
What is body dysmorphic disorder?
preoccupation w/ non-existent or slight defects in physical appearance, that the pt believe they look abnormal
Appearance in mirrors, exercising, starving self, staying home
body dysmorphic disorder
Causes distress, impaired functioning, and often associated w/ suicidal ideation and behaviors
Body dysmorphic disorder
When does body dysmorphic usually start?
around 17 yo
What do most pts w/ body dysmorphic seek for care?
dermatologic and surgical procedures
T/F Effective treatment is available for body dysmorphic?
TRUE
What are two symptoms of body dysmorphic disorder?
preoccupations and compulsions
What percentage of ppl report no change in appearance after cosmetic treatment?
91%
What is the most common comorbidity found with body dysmorphic?
depression
What percentage of pts have a history of SI and SA in body dysmorphic?
80% and 25%
What are 3 risk factors for Body dysmorphic disorder?
age on onset <17y
severe symp
comorbid substance use or PTSD
What is the med txt of body dysmorphic disorder?
SSRI antidepressants
What is the treatment of body dysmorphic disorder
Cognitive behavioral therapy
Patient and Family Education
T/F With successful txt, pt will often have relapses?
TRUE
What is malingering?
illness falsification to obtain external benefits
How is malingering described?
Not a psychiatric illness and no longer in DSM 5, but added a v-code (descriptor)
What 4 things should malingering be suspected in?
medicolegal context of presentation
marked discrepancy between the person’s claimed stress or disability and findings
Lack of cooperation during the dx and complying w/ prescribed txt
Presence in the pt of antisocial personality disorder
What is the test for malingering?
NO SINGLE TEST
How should malingering be managed?
referral to specialists as needed to r/o disease
What is factitious Disorder?
a factitious disorder imposed on self or others
What is the goal of those with factitious disorder?
NONE, achieving the patient role or sympathy towards the perpetrator
What are some symptoms that a patient might induce on themselves?
self-mutilation, fever, hemorrhage, hypoglycemia, seizures
How are symptoms usually presented in factitious disorder?
exaggerated and dramatic fashion
What is factitious disorder imposed on another?
someone creates illness for another person based on psychological benefit of the first person, such as sympathy or a relationship w/ clinicians
What is Medical Child Abuse
requires the provider to recognize the caregiver is exaggerating, fabricating, or inducing illness in a child
What should a medical provider do in medical child abuse?
review all of the child’s medical records
What should a medical provider do in factitious disorder?
obtain a comprehensive history and physical exam
confirm the history with other clinicians
Identify whether symptoms depend upon perpetrator’s presence
What is the treatment for factitious disorder?
contact CPS cancel scheduled but unnecessary surgeries Stop meds Correct iatrogenic damage Take out vascular access
