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Psych Mod 4 > Somatoform and Factitious Disorders > Flashcards

Somatoform and Factitious Disorders Flashcards

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1
Q

Somatoform Disorders

A

Category of disorders that present with physical symptoms that have no organic cause.

Truly believe their symptoms are due to medical problems and are not consciously feigning them

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2
Q

Examples Somatoform Disorders

A

somatization, conversion, hypochondriasis, pain, body dysmorphic

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3
Q

Primary gain of somatoform disorders

A

expression of unacceptable feelings as physical symptoms in order to avoid facing them

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4
Q

Secondary gain of somatoform disorders

A

Use of symptoms to benefit patient ie increased attention from others, decreased responsibilities, avoidance of the law

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5
Q

Demographics somatoform disorders

A

with the exception of hypochondriasis, SDs are more common in women

50% patients have comorbid mental disorders esp. anxiety and MDD

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6
Q

Somatization Disorder description

A

patients present with multiple vague complaints involving many organ symptoms.

long history of visits to doctors.

Symptoms not explained by medical condition

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7
Q

DSM IV criteria for Somatization Disorder

A

At least 2 GI symptoms
At least 1 sexual or reproductive symptom
At least 1 neuro symptom
At least 4 pain symptoms
Onset before 30
Cannot be explained by general medical condition or substance

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8
Q

Epidemiology of Somatization Disorder

A 
Women 5-20x more common
low socioeconomic groups
lifetime prevalence .1-.5%
50% have comorbid mental disorder
30% concordance in identical twins
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9
Q

Course of Somatization Disorder

A

Usually chronic and debilitating

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10
Q

Treatment of Somatization Disorder

A

frequent visits to PCP (won’t see a psych doc)
minimize secondary gain
meds should be avoided
relaxation therapy, hypnosis, individual and group psychotherapy

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11
Q

Conversion Disorder description

A

Present with at least one neuro symptom that cannot be explained

Onset ALWAYS preceded by psych stressor (but patient may not connect the two)

Patients often weirdly calm and unconcerned about their symptoms

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12
Q

Conversion Disorder Common symptoms

A 
Shifting Paralysis
blindness
mutism
paresthesias
seizures
globus hystericus (lump in throat)
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13
Q

DSM IV Conversion Disorder

A
  • At least 1 neuro symptom
  • psych factors ass. w/ initiation or exacerbation of symptom
  • symptom not intentionally produced
  • cannot be explained by med cond or sub. abuse
  • causes sig distress or impairment in social or occupational functioning
  • not accounted for by somatization disorder or other mental disorder
  • not limited to pain or sexual symptoms
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14
Q

Conversion Disorder Epidemiology

A
  • Common: 20-25% incidence in general medical settings
  • 2-5x more common women
  • onset at any age; more common adolescence or early adulthood
  • increased low socioeconomic groups
  • high incidence comorbid schizophrenia, MDD, anxiety
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15
Q

Conversion Disorder Differential Diagnosis

A

MUST rule out medical cause; 50% of patients with diagnosis eventually find medical reason

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16
Q

Conversion Disorder Course

A

symptoms resolve within 1 month

25% have future episodes esp. during stress

symptoms may resolve spontaneously after hypnosis or sodium amobarbital interview if the psych trigger can be uncovered

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17
Q

Conversion Disorder Treatment

A

Insight oriented psychotherapy, hypnosis, relaxation therapy

most patients recover spontaneously

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18
Q

Hypochondriasis Description

A

prolonged, exaggerated concern about health and possible illness

patients either fear having a disease or are convinced that one is present

misinterpret normal bodily symptoms as indicative of disease

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19
Q

DSM IV Hypochondriasis

A
  • Patients fear that they have a serious medical condition based on misinterpretation of normal body symptoms
  • fears despite appropriate medical eval
  • fears present for at least SIX MONTHS
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20
Q

Hypochondriasis Epidemiology

A

Men = Women
Average onset 20-30 yo
80% comorbid MDD or anxiety

21
Q

Hypochondriasis Differential Diagnosis

A

Must rule out underlying medical condition

Somatization disorder - hypochons are worried about disease, somats are worried about symptoms

22
Q

Hypochondriasis Course

A

Episodic-symptoms wax and wane
Exacerbations under stress
50% improve significantly

23
Q

Hypochondriasis Treatment

A

No cure
freq visits to ONE PCP who oversees care
Patients resistant to psychotherapy
Group or insight-oriented therapy can be helpful if patient is cooperative

24
Q

Body Dysmorphic Disorder (BDD) Description

A

preoccupied with body parts they perceive as flawed or defective

flaws are minimal or imaginary but patients find them grotesque

extremely self conscious about appearance; go great lengths to try and correct w/ makeup, surgery, etc

25
Q

BDD DSM IV

A
  • preoccupation with an imagined defect in appearance or excessive concern about slight physical anomaly
  • must cause sig distress in the patient’s life
26
Q

BDD epidemiology

A 
women more than men
more common unmarried ppl
average age onset 15-20 yo
90% have MDD
70% have anxiety
30% are psychotic
27
Q

BDD Course/Prognosis

A

usually chronic; symptoms wax and wane in intensity

28
Q

BDD treatment

A

surgical or derm procedures are routinely unsuccessful in pleasing patient

SSRIs reduce symptoms in 50%

29
Q

Pain Disorder Description

A

prolonged, severe discomfort w/o adequate med explanation

pain often coexists w/ med condition but is not caused by it

patients often have history of multiple visits to doctors

can be acute (< 6 months) or chronic (> 6 months)

30
Q

Pain DSM IV

A
  • patient’s main complaint is of pain at one or more anatomic sites
  • pain causes sig distress
  • pain has to be related to psych factors
  • pain is not due to med disorder
31
Q

Pain Epidemiology

A 
women 2x
average age onset 30-50
inc. incidence in 1 deg relatives
inc. incidence in blue collar workers
patients have higher incid. of MDD, anxiety and sub. abuse
32
Q

Pain Diff Diagnosis

A

rule out underlying med condition

rule out hypochondriasis and malingering

33
Q

Pain Course

A

Abrupt onset and inc intensity for first few months; usu chronic and disabling course

34
Q

Pain Disorder Treatment

A

Analgesics NOT HELPFUL > patients may develop dependence

SSRIs, transient nerve stimulation, biofeedback, hypnosis, psychotherapy may help

35
Q

Factitious Disorder Description

A

patients intentionally produce medical or psychological symps in order to assume role of sick patient

primary gain is prominent feature of disorder

36
Q

Factitious DSM IV

A
  • Patients intentionally produce signs of physical or mental disorders
  • they produce the symptoms to assume the role of the patient (primary gain)
  • there are no external incentives (money)
  • either predominantly psychiatric complaints or predominantly physical complaints
37
Q

Commonly feigned symptoms factitious disorder

A

psychiatric - hallucinations, depression

medical- fever (by heating thermometer), abdominal pain, seizures, skin lesions, hematuria

38
Q

Munchhausen Syndrome

A
  • another name for factitious disorder with predominantly physical complaints
  • patients may take insulin, consume blood thinners, etc
  • often demand specific meds
  • very skilled at feigning symps that necessitate hospitalization
39
Q

Munchhausen syndrome by proxy

A

intentionally producing symptoms in someone else who is under one’s care (usually one’s children) in order to assume the sick role by proxy

40
Q

Epidemiology of Factitious Disorder

A
  • > 5% hosp. patients
  • inc. incid in males
  • higher incidence in hospital and health care workers
  • associated with higher intelligence, poor sense of identity, poor sexual adjustment
  • many patients history of child abuse or neglect (inpatient hospitalization = safe, comforting environment)
41
Q

Treatment factitious

A

important to avoid unnecessary procedures and maintain close liaison with patient’s PCP

patients confronted in the hospital usually leave

42
Q

Malingering definition

A

feigning physical or psychological symptoms in order to achieve personal gain

43
Q

Common motivations for malingering

A

avoiding the police, receiving room and board, obtaining narcotics, receiving monetary compensation

44
Q

Presentation of Malingering Patient

A
  • usually have multiple vague symptoms that do not conform to a known medical condition
  • usually long med history w/ many hospital stays
  • generally uncooperative and refuse to accept a good prognosis even after extensive eval
  • symptoms improve once desired objective is obtained
45
Q

Epidemiology of Malingering Patient

A

common in hospitalized patients; more common in men

46
Q

Distinguishing feature of somatoform disorders versus malingering or factitious

A

patients BELIEVE they are ill

47
Q

Distinguishing feature of factitious versus somatoform or malingering

A

patients PRETEND they are ill with no obvious external reward

48
Q

Distinguishing malingering (most common) versus somatoform or factitious

A

patients PRETEND they are ill with obvious EXTERNAL INCENTIVE

Psych Mod 4 (4 decks)

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