Somatic Symptoms & Related Disorders-Carlson

Question 1

What’s the deal with somatic symptom patients?

Answer 1

physical symptoms that could suggest a medical condition, not caused by a substance or medical condition
but it does cause distress & impairment in social/occupational areas

Question 2

What is alexithymia?

Answer 2

lack of emotional ability to talk about the real reason for the symptoms–psychological underpinning

Question 3

Do somatic patients experience dissociation?

Answer 3

potentially

Question 4

Which psychological factors might be present in somatic patients?

Answer 4

stress related
dependency (on others) can be a core issue
have limited insight–that their symptoms could be due to stress etc.

Question 5

What are some possible changes in brain structure according to 2011 neuroimaging review? Reflects the nature/nurture question.

Answer 5

perhaps increase in limbic system activity & generalized gray matter density in these patients

Question 6

What % of primary care visits involve somatic symptom complaints?

Answer 6

12-57.9% of primary care visits

sometimes we work them up too much–invasive workups, high costs of care

Question 7

What are some disorders that are medical & could explain what might be misconstrued as somatic symptoms?

Answer 7

MS
SLE
Acute intermittent porphyria
myasthenia gravis
ALS

Question 8

What are some psychiatric disorders that must be ruled out?

Answer 8

delusional disorders
affective disorders
anxiety disorders
Note: could be diagnosed w/ delusional disorder w/ somatic symptoms

Question 9

What are possible reaction of doctors to somatic patients?

Answer 9

fear–what if i miss an easily treatable illness

anger-give in to wishes, refusal to be manipulated, professional aloofness

Question 10

What is somatoform related disorder now? According to DSM5

Answer 10

Somatoform related disorders

NOW: somatic symptom & related disorders

Question 11

What are somatization disorders now considered? DSM5

Answer 11

somatization disorders–somatic symptoms disorder

Question 12

What is a pain disorder now considered? DSM5

Answer 12

pain disorder–>

somatic symptom disorder w/ pain subtype

Question 13

What is Somatoform Disorder NOS now considered according to DSM5?

Answer 13

undifferentiated somatoform disorder NOS–>Unspecified Somatoform Disorder

Question 14

What is a body dysmorphic disorder now considered?

Answer 14

Body dysmorphic disorders are listed under OCD disorders

Question 15

T/F DSM5 has now gotten rid of all NOS.

Answer 15

True.

Question 16

What is hypochondriasis now considered?

Answer 16

illness anxiety disorder

Question 17

what is factitious disorder now included under?

Answer 17

somatic symptom & related disorders

Question 18

What are the requirements for somatic symptom disorder?

Answer 18

one or more somatic symptoms that are distressing or result in significant disruption of daily life
excessive thoughts, feelings, behaviors
6 mo or more of this anxiety etc.

Question 19

What are other names for somatic symptom disorder?

Answer 19

Briquette’s syndrome

hysteria

Question 20

Which gender do you usu see somatic symptom disorder in?

Answer 20

females

Question 21

What are associated features of somatic symptom disorder?

Answer 21

depression 2.8X more frequent
Generalized anxiety disorder 2.5X more frequent
trauma
childhood illness

Question 22

What is the age onset of SSD?

Answer 22

onset in teens

Question 23

What does the MSE for a patient with somatic symptom disorder look like?

Answer 23

MSE: presentation dramatic, vague, complicated, seductive, manipulative, emotional
**symptoms fluctuate with stress

Question 24

What are some associated issues w/ patients with somatic symptom disorder?

Answer 24

unnecessary surgeries
drug dependence
suicide attempts
relationship problems

Question 25

What is the management strategy of patients with somatic symptom disorder?

Answer 25

long term relationship
regular intervals
careful about invasive procedures & addictive drug prescription
treat co-morbid psychiatric illnesses
collegial support

Question 26

What is conversion disorder?

Answer 26

symptoms or deficits affecting voluntary motor or sensory system: blindness, paralysis, dysphonia, seizures
onset related to stress
not intentionally induced
not explained by a medical condition etc.

Question 27

What are the types of conversion disorder?

Answer 27

acute 6 mo
weakness or paralysis 
abnormal movements
swallowing problems
speech problems
sensory problems
seizures

Question 28

Stats on conversion disorder?

Answer 28

onset 10-35

more common in females

Question 29

What is the clinical picture of conversion disorder?

Answer 29

onset following recent stress
symptom or deficit in voluntary motor system or sensory system
symptom or deficit makes little neurological sense
MSE: symptom indifference–don’t care that they have these symptoms
symptom or deficit may have symbolic meaning
brief in duration

Question 30

What is the management plan for a patient with conversion disorder?

Answer 30

supportive psychotherapy
determine stressors
help patients solve
positive expectations

Question 31

What is illness anxiety disorder criteria?

Answer 31

preoccupation with fears of having serious disease based on misinterpretation of bodily symptoms
not of delusional intensity
preoccupation persists after workup & reassurance
duration at least 6 mo
care-avoidant type less frequent

Question 32

What is malingering?

Answer 32

pretend to have a disorder

secondary gain–looking to avoid work or gain disability etc.

Question 33

What is the difference b/w factitious disorder & malingering?

Answer 33

factitious disorder-primary gain; what they get from the sick role. make stuff up.
malingering–get disability, secondary gain