Somatoform Flashcards
Be able to choose the correct diagnosis of a specific somatoform disorder, factitious disorder or malingering from an NBME-style vignette Describe the general strategy for managing somatoform disorders in primary care List some assessments that can assist with making a diagnosis of factitious disorder (e.g., C peptide)
5 types of somataform disorders
somatatization disorder hypochondriasis conversion disorder pain disorder body dysmorphic disorder
features useful in discriminating between somatatization disorder and physical illnes
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
pt using exaggerated, “histrionic terms”, inconsistant histories, presenting with depressed or anxious mood. Chronic and rarely remitting sx
somatization disorder
medical ddx of somatization disorder
MS, SLE, acute intermittent porphyria, hemochromatosis,
psych ddx of somatization disorder
anxiety/mood disorder, schizophrenia, delusional disorder
clusters of sx in somatization disorder
pain in many places
GI sx
sexual/reproductive sx
management of somatization disorder
frequent visits, short PE, discuss open ended questions, give more care than cure
drugs commonly used in somatization disorder
amiptriptyline/gabepentin for pain
bupropion for fatigue
SSRI or TCA for anxiety
non medical treatment for somatization disorder
light exercises, yoga, meditation, heat/cold acupuncture
diorder with “la belle indifference”
conversion
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.
conversion disorder
“Type of person” usually with conversion disorder
female, young, less sophisticated
ddx of conversion disorder
MS, seziure disorders, MG, periodic paralysis, guillain-Barre syndrome
how to manage conversion disorder
nor directly confronting, “suggestion” of recovery w/o intervetion, identfying conflict and finding resolution
person coming in with blindness or paralysis, who is in the middle of difficult work/home situation. not faking sx
conversion disorder
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.
hypochondriasis
possible medical treatment for hypochondriais
SSRI
pt preoccupied with imagined defect in appearance or markedly excessive concern with a minor physical anomaly. looking for plastic surgeon.
body dysmorphic disorder
meds for body dysmorphic syndrome
SSRIs, NOT antipsychotics
pain in various regions, not intentionally produced or feigned. Psychological factors has influence in onset, severity, exacerbation of pain
pain disorder
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
facitious disorder
common background of person with factitous disorder
healthcare/hospital worker, may have had severe illness as a kid.
how to tell if hypoglycemia is from self-injected insulin
insulin/C-peptide ratio is more than 1
person (look for jail/disability/opiates) who is faking or grossly exagerrating sx because of externa motivation
malingering
comorbities in maligering
antisocial personality disorder
