Somatoform and Fictious disorders- Carlson Flashcards
What is the criteria for a somatic symptoms disorder?
Presence of physical symptoms:
-that suggest a medical condition but explanatory physical findings are absent and it is not caused by a substance or another med condition AND it causes signif clinical distress or impairment in social/occupational areas
(blank) is characterized by difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal.
alexithymia
What psychological factors are usually present with somatic symptoms disorder?
stress
dependency
limited insight
not psychologically-minded
What medical disorders do you need to rule out before diagnosing someone with somatic symptom disorder?
- MS
- systemic lupus erythematosus
- acute intermittent porphyria
- myasthenia gravis
- ALS
What psychiatric disorders do you need to rule out before diagnosing someone with somatic symptoms disorder?
- delusional disorder
- affective disorder
- anxiety disorder
How do physicians react to somatoform patients?
- scared they are missing something
- disgusted
- name-calling
- anger (giving in, indignant refusal to be manipulated, professional aloofness)
Where did the DSM place pain disorder?
Body dysmorphic disorder?
Factitious disorder?
under somatic symptom disorder
OCD
now part of somatic symptom and related disorders
What do we call hypochdriasis now?
illness anxiety disorder
What is the criteria of somatic symptom disorder?
- one or more somatic symptoms that are distressing or disrupt life
- excessive thoughts, feelings, or behaviors
- persistence of symptoms for 6 months
How will a person with somatic symptom disorder react to their symptoms?
- with high levels of anxiety about symptoms
- w/ excessive time and energy spent about them
- disproportionate thoughts about the seriousness of sx
What are 2 other names for somatic symptom disorder?
briquettes syndrome
histeria
What is the Lifetime prevalence of somatic symptom disorder?
0.1%-.4%
Who gets somatic symptom disorder more commonly, men or women?
Does it run in families?
women
- **Female to male ratio 10:1-20:1
- found in 10-20% first degree female relatives
- male relatives have an increased risk of somatization disorder, antisocial personality disorder, substance abuse disorder
What disorders and life events are often associated with somatic symptom disorder?
depression (2.8 X more likely)
GAD (2.5 X more likely)
History of physical and sexual abuse higher
Higher rates of childhood illness or fmaily member with chronic illness
When do you typically see somatic symptom disorder?
What type of doctor most commonly sees it first?
What does the mental status exam look like?
What will the symptoms fluctuate with?
What is the course like?
- teen onset
- gynecologist or neurologist
- dramatic, vague, complicated, seductive, manipulative and emotional
- stress
- chronic
What are some complications associated with somatic symptom disorder?
unnecessary surgical procedure
drug dependence
suicide attempts
relationship problems
How do you manage a SSD patient?
- establish good relationship
- see regularly
- be cautious with prescriptions and surgeries
- treat co-morbid psychiatric illnesses
- colleagial support
what is a conversion disorder?
What is the onset associated with?
Is it intentionally induced?
Symptoms or deficits affecting voluntary motor or sensory system (blindness, paralysis, dysphonia, seizures) THAT CANNOT be explaind by medical condition, substnace or behavior/experience
stress
no
What designates acute conversion disorder?
What designates chronic conversion disorder?
less than 6 months
greater than 6 months
What are the subtypes of conversion disorder?
- weakness or paralysis
- abnormal movements
- swallowing sx
- speech sx
- sensory
- seizure/convulsion
- mixed
When is the onset of conversion disorder?
What is the prevalence?
Is it more common in males or females?
What does prevalence decrease with?
10-35
.01%-.3% of pop
females
sociocultural development and knowledge
What can conversion disorder turn into in females?
somatic symptom disorder
What is conversion disorder associated with in men?
antisocial personality disorder
Does conversion disorder have a long duration and does it occur?
brief duration w/ recurrence is common
When is the prognosis of conversion disorder good?
with paralysis, aphonia, blindness
When is the prognosis of conversion disorder bad?
with tremor and seizures
The onset of conversion disorder typically follows (blank).
What does the mental status exam look like for conversion disorder?
recent stress
symptom indifference
In conversion disorder, the symptoms or deficits have (blank) meaning in terms of primary and secondary gain
symbolic
How do you manage conversion disorder?
- supportive psychotherapy
- determine stressor(s)
- help patient problem solve
- positive expectations
- R/O treatable medical conditions
What is this: preoccupation with fears of having a serious disease based on misinterpretation of bodily symptoms ***Not of delusional intensity How long does this preoccupation last? What is the duration? What subtype is less frequently seen?
Illness Anxiety Disorder (hypochondiasis)
- persists after workup and reassurance
- at least 6 months
-care-avoidant type
When does Illness Anxiety Disorder begin (age)?
Which sex does it affect the most?
Is it chronic or acute?
Is it a relapsing condition?
What is it related to?
What is associated with a better prognosis?
What is the mental status exam like?
adulthood both sexes equally chronic stress higher SES = better prognosis Excessive concern about illness and narrowed existential focus
What is this:
- fears have a serious illness related to a single body sensation
- history of doctor shopping
- brings problem lists
- doubts physician competence
- creates insecurity in physician
- accepts extensive workups
- increased concern w/ negative workup
Illness Anxiety Disorder (hypochondiasis)
How do you manage illness anxiety disorder?
- develop trusting relationship with one primary caregiver
- reassurance and regular care
- R/O medical illness
- Treat any concurrent medical or psych illness
- Do partial PE w/ each brief visit
- encourage health-related activities
- behavior therapy or supportive psychotherapy
- SSRI
- establish stress-illness connection
What should you have the illness anxiety disorder patient do?
What do you do with that info? Where should the first monitoring occur?
- track symptoms four times daily
- find a causal relationship between these “symptoms” and patient stressors
- in office with patient
What is a factitious disorder?
What is the motivation?
Is there a level of conscious awareness?
- intential production of symptoms
- sick role
- some level of conscious awareness
In factitious disorder, what kind of symptoms are possible and what are they?
psychological and physical false symptoms
false symptoms= report of symptoms (headaches, voices), generating false evidence of illness (manipulating thermometer), faking evidence (taking warfarin to change blood clotting times)
What is this: Maladaptive (can be life threatening) Motivation unclear to patients Often underlying personality disorder May respond to treatment intervention Difficult and frustrating for physicians
factitious disorder
What sex is more affected by factitious disorder? Is it chronic or acute? What occupation gets it the most?
Females
Chronic
Medically related
What is this:
a type of factitious disorder.
Pnt travels from hospital to hospital for tx of factitious problems
Munchaushen Syndrome
What is Munchausen by proxy?
-children and dependents are the made sick by adult
What is malingering and why would you do it?
intentional production of signs and symptoms
-conscious motivation to get a clear external incentive (avoid military, avoid jail, obtain drugs obtain food and shelter)
What sex malingers more?
male
When should you suspect malingering?
Medicolegal presentation
Discrepancy in findings vs report
Lack of cooperation/ poor compliance
Clear external incentive
What is the common psychiatric presentation of malingering??
psychosis
memory deficits
suicidality
When can you have largely unconscious malingering?
It is estimated that there is (Blank) percent of malingering in civil damage action
with a claim or litigation
40%
What are some clues to find out if someone is malingering?
- Demanding medications
- Divulging symptoms too eagerly or dramatically
- Dependent or conditional threats of self-harm, violence, or litigation
(blank) disorder is more likely to have borderline personlity traits and pursue painful tests
factitious disorders
(blank) disorder is more likely to have varied symptoms
factitious disorder
(blank) disorder is more likely to be temporary, and have a history of antisocial personality traits
malingering
(Blank) disorder has unconsciou motivation and unconscious production of symptoms
somatic symptom disorder
