somatoform and factitious disorders

Question 1

somatization do: dx

Answer 1

• onset BEFORE age 30
• 4+ pain sx
• 2+ GI sx
• 1+ sexual/repro sx
• 1+ pseudoneuro sx

Question 2

somatization do: epidem

Answer 2

• females&raquo_space;» males
• lifetime prevalence 0.1-0.5%
• 50% have comorbid GMC
• 30% MZ twin concordance

Question 3

somatization do: prognosis and tx

Answer 3

• chronic, debilitating
• regularly scheduled visits with single PCP
• address psych issues slowly

Question 4

conversion do: dx

Answer 4

• 1+ neuro sx
• psych factors assoc with initiation/exacerbation of sx
• significant distress/impairment
• not limited to pain or sexual dysfn
• common: shifting paralysis, blindness, mutism, paresthesias, sz, globus hystericus

Question 5

conversion do: epidem

Answer 5

• women&raquo_space;> men
• onset most common in adol/early adult
• comorbid SCZ, MDD, anxiety dos

Question 6

conversion do: prognosis and tx

Answer 6

• most spontaneously recover
• insight-oriented psychotherapy, hypnosis, relaxation therapy if needed
• sx may be brief or last long time
• 25% will eventually have future episodes

Question 7

hypochondriasis: dx

Answer 7

• fear of having/getting dz, persists despite medical reassurance
  PERSISTS FOR 6+ MOS
• not of delusional intensity and not restricted to concern about appearance

Question 8

hypochondriasis: epidem

Answer 8

• men = women
• avg onset 20-30yo
• 80%: comorbid MDD or anxiety do

Question 9

hypochondriasis: prognosis

Answer 9

• episodic
• exacerbations under stress
• up to 50% improve significantly

Question 10

hypochondriasis: tx

Answer 10

• regularly scheduled visits to one PCP
• SSRIs for comorbid MDD or anxiety dos
• CBT!!

Question 11

body dysmorphic do: dx

Answer 11

• preoccupation with imagined defect in appearance or excessive concern about slight physical anomaly
• must cause significant distress

Question 12

body dysmorph do: epidem

Answer 12

• women > men
• unmarried > married
• avg onset: 15-20yo
• high comorbidity with MDD, anxiety do, psychotic do

Question 13

body dysmorph do: tx

Answer 13

• SSRIs may reduce sx in 50%

- onset usually gradual, sx may be chronic or wax/wane

Question 14

pain do: dx

Answer 14

• main complaint = pain at 1+ anatomic sites
• significant distress/impairment
• psychological factors play big role in pain

Question 15

pain do: epidem

Answer 15

• women&raquo_space; men
• avg onset: 30-50yo
• increased in 1st degree relatives, blue-collar workers
• increased incidence of MDD, anxiety do, substance abuse

Question 16

pain do: prognosis and tx

Answer 16

• usually increases in intensity for first months, often chronic and disabling
• SSRIs, biofeedback, hypnosis, psychotherapy

Question 17

factitious do: dx

Answer 17

= Munchhausen

• intentially produce signs/sx
• PRIMARY GAIN: assume sick role
• ABSENCE of secondary gain
• common sx: hallucinations, depression, pseudologia fantastica, fever, abd pain, sz, skin lesions, hematuria

Question 18

factitious do: epidem

Answer 18

• up to 5% of hosp pts
• increased incidence in hosp and health care workers
• assoc with higher intelligence, poor sense of ID, poor sexual adjustment
• hx of child abuse/neglect common

Question 19

factitious do: prognosis and tx

Answer 19

• repeated and long-term hosp common

- collect collateral! avoid early confrontation

Question 20

malingering

Answer 20

• SECONDARY GAIN

- men > women