Somatoform

Question 1

5 types of somataform disorders

Answer 1

somatatization disorder
hypochondriasis
conversion disorder
pain disorder
body dysmorphic disorder

Question 2

features useful in discriminating between somatatization disorder and physical illnes

Answer 2

1) involvement of multiple organ systems
2) earlt onset and chronic course w/o development of physcal signs and structural abnormalites
3) absence of characteristic lab abnormalities of the suggested physical disorder

Question 3

pt using exaggerated, “histrionic terms”, inconsistant histories, presenting with depressed or anxious mood. Chronic and rarely remitting sx

Answer 3

somatization disorder

Question 4

medical ddx of somatization disorder

Answer 4

MS, SLE, acute intermittent porphyria, hemochromatosis,

Question 5

psych ddx of somatization disorder

Answer 5

anxiety/mood disorder, schizophrenia, delusional disorder

Question 6

clusters of sx in somatization disorder

Answer 6

pain in many places
GI sx
sexual/reproductive sx

Question 7

management of somatization disorder

Answer 7

frequent visits, short PE, discuss open ended questions, give more care than cure

Question 8

drugs commonly used in somatization disorder

Answer 8

amiptriptyline/gabepentin for pain
bupropion for fatigue
SSRI or TCA for anxiety

Question 9

non medical treatment for somatization disorder

Answer 9

light exercises, yoga, meditation, heat/cold acupuncture

Question 10

diorder with “la belle indifference”

Answer 10

conversion

Question 11

female pt presents with psuedoseziures, sensory loss, paralysis or gait issues, not conforming to known anatomical pathways and phycological mechanisms. No cause found, but is not intentially produced.

Answer 11

conversion disorder

Question 12

“Type of person” usually with conversion disorder

Answer 12

female, young, less sophisticated

Question 13

ddx of conversion disorder

Answer 13

MS, seziure disorders, MG, periodic paralysis, guillain-Barre syndrome

Question 14

how to manage conversion disorder

Answer 14

nor directly confronting, “suggestion” of recovery w/o intervetion, identfying conflict and finding resolution

Question 15

person coming in with blindness or paralysis, who is in the middle of difficult work/home situation. not faking sx

Answer 15

conversion disorder

Question 16

pt who comes in convinced that bodily signs and sx are that of a disease for more than 6 months. Not concerned about any body part cosmetic appearance, not delusional. Has doctor shopped and request frequent tests. fixated on particulat organ or disease.

Answer 16

hypochondriasis

Question 17

possible medical treatment for hypochondriais

Answer 17

SSRI

Question 18

pt preoccupied with imagined defect in appearance or markedly excessive concern with a minor physical anomaly. looking for plastic surgeon.

Answer 18

body dysmorphic disorder

Question 19

meds for body dysmorphic syndrome

Answer 19

SSRIs, NOT antipsychotics

Question 20

pain in various regions, not intentionally produced or feigned. Psychological factors has influence in onset, severity, exacerbation of pain

Answer 20

pain disorder

Question 21

pt intentionally producing sx to assume the role of a sick person, or the caregiver of a sick person for some unconcious reason. eagerly undergoes invasive procedures and operations

Answer 21

facitious disorder

Question 22

common background of person with factitous disorder

Answer 22

healthcare/hospital worker, may have had severe illness as a kid.

Question 23

how to tell if hypoglycemia is from self-injected insulin

Answer 23

insulin/C-peptide ratio is more than 1

Question 24

person (look for jail/disability/opiates) who is faking or grossly exagerrating sx because of externa motivation

Answer 24

malingering

Question 25

comorbities in maligering

Answer 25

antisocial personality disorder