somatiform disorders Flashcards
primary gain
internal, psychic motivations. patient unaware.
secondary gain
need housing, drugs, etc. malingering.
where are these more common?
women. (although equal in hypochondriasis) tend to start in early adulthood and worsen with stress.
are there comorbidities?
yes. 50% have comorbidities, such as anxiety and depression.
somatization disorder/somatic symptom disorder
there must be 4 or more symptoms: 2 GI, 1 sexual, 1 neurological, none that are adequately explained by medial history, lab tests, etc.
this is largely unconscious and the patient is unaware.
when is the onset of somatization?
before 30
are the symptoms chronic?
yes. chronic and rarely remiss
conversion disorder
sudden and dramatic loss of one or more voluntary motor and or sensory functions suggesting neurological etiology.
this must be preceded by psychological stress or conflict. the presenting symptom will have a symbolic representation with the stressor and serves as to decrease anxiety associated with it.. la belle indifference
la belle indifference
common, where the patient seems unconcerned or uninterested in the symptoms.
what is the course of conversion disorder?
usually self-limiting and only lasts about a month.
who is more likely to get a conversion disorder
psychiatrically unsophisticated and those with depression or histrionic personality
common motor symptoms of conversion
shifting paralysis, pseudoseizures, globus hystericus.
common sensory symptoms of conversion disorders
parethesis, anesthesis, vision and hearing problems.
common mistakes seen in conversion disorder
wrong dermatomes, blindness yet still has optokinetic effects, during seizure can sneeze or react to pain, pain radiates down instead of up, seizure head movements are vertical (not horizontal).
hypchondriasis
fear or idea of having a serious medical condition based on misinterpretation of physical symptoms.
does hypochondriasis get better with negative diagnosis
no usually persists, despite medical evidence. this leads to doctor shopping.
body dimorphic disorder
preoccupation with an imagined problem or insignificant abnormality in appearance.
what common places on the bey effects BDD
usually the head or face.
pain disorder
protracted pain that is severe enough for the patient to seek medical advice. there are acute and chronic features. acute is less than 6 months, chronic is greater than.
typical age of onset for pain disorder
30-40
how bad isn the pain in pain disorder
can be debilitating and cause medication dependence.
what are the great pretenders of medical illnesses?
depression and anxiety
how do we manage the somatization disorders?
strong doctor-patient relationship. regular, short appointments with constant reassurance and empathy.
is psychiatry typically needed with somatization
no.
what meds might work for somatization?
SSRIs fo depression and pain.
factitious disorders
munchausen syndrome. conscious feigning or production of physical or mental disorders to receive attention from medical personnel. to assume the sick role and sometimes secondary gain to feel smarter when talking with health care people.
how do these patients react when they are confronted
they get angry and leave quickly
who is more common to have a munchausen’s
people who work in the medical field.
common symptoms in muchausen’s disease
abdominal pain, fever, hematuria, seizures, skin lesion, tachycardia (drug induced), hypoglycemia (insulin injection), fever (inject feces), DVT by using ligature.
what can cause unconscious production of symptoms?
depression/anxiety, somatization disorders.
what causes conscious purposeful production of symptoms but unconscious motivation
facticious disorder
what causes conscious motivations and conscious production of symptoms.
malingering
