Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Behavioral dynamics > Somatoform Disorders > Flashcards

Somatoform Disorders Flashcards

1
Q

what is somatization?

A

Physical symptoms that may not be fully explained by a known medical dx after appropriate work-up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

somatization can be caused or exacerbated by what?

A

psychiatric factors - Anxiety, depression, conflict, stressors, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the general reaction of somatization?

A

“over response” to symptoms
Subjectively believe themselves to be more ill or disabled than objective evidence would suggest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

risk factors for somatization

A
  1. female
  2. low socioeconomic status
  3. low education
  4. minorities
  5. FHX with chronic illnesses, hx of abuse/sexual trauma, comorbid psych disorder
    - esp anxiety, depression, personality disorders
    - somatization often improves when psych comorbdities are treated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the prevalence/epidemiology of Functional Neurological Symptom Disorder

A
  1. 1-3% of Neurology patients
  2. Lifetime incidence in women is ~33%
  3. 5-10% of hospitalized medical/surgical patients referred to psych
  4. Age - MC 10-35; can occur in all ages
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

presentation of functional neurologic symptom disorder

A
  1. neurologic symptom that do not correlate with the presence of organic neurologic disease
    - sensory function, motor function, or both
  2. Often have signs of inconsistency or incongruency
    - Hoover’s Sign - weakness with hip extension becomes strong when the contralateral leg is flexed
  3. symptoms - pseudoseizures, paralysis, blindness, mutism, paresthesia, anesthesia

ex: normal DTRs in patient with “paralyzed arm”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

criteria for functional neurological symptom disorder

A
  1. 1+ symptoms/deficits affecting voluntary motor or sensory function
  2. Clinical findings are incompatible with recognized neurological or medical condition
  3. not better explained by another medical or psychiatric condition
  4. Symptom(s)/deficit(s) cause clinically significant distress or impair social, occupational, or other important functions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

tx for functional neurological symptom disorder

A

Symptoms often resolve spontaneously

  1. Education about disorder
  2. Psychotherapy referral - insight-oriented or behavioral therapy
    - Goal: to improve function
  3. Explain that reversal of symptoms is possible
  4. Discuss tx of comorbid psych diagnoses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

prevalence of illness anxiety disorder

A
  1. ~2-7% of ambulatory pts
  2. men = women
  3. MC onset age 20-30
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

presentation of illness anxiety disorder

A
  1. predominant concern over the presence of a major disease
    - Concerns often start with misinterpretation of benign symptoms
    - extremely detailed hx
    - fixed on one disease or move to
    a new disease over time
    - Symptoms may wax/wane with stress
    - Unswayed by negative objective findings
    — May refuse to believe at all
    — reassured temporarily but soon have recurring concerns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

criteria for illness anxiety disorder

A
  1. Preoccupation with having or acquiring a serious illness
  2. Somatic symptoms are not present, or are mild. If another medical condition is present or there is high risk (strong FH), preoccupation is excessive and disproportionate
  3. High level of anxiety and easily alarmed about health status.
  4. Excessive health related behaviors or maladaptive avoidance
    - Repeatedly checks body for signs of illness
    - Avoids appts. & hospitals
  5. Symptoms ≥ 6 months
  6. Symptoms not better explained by another mental disorder.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

tx for illness anxiety disorder

A
  1. Frequent, regular visits to reassure pts they are not being abandoned and are being taken seriously
  2. Compassionate, tactful education on illness
  3. Ordering diagnostic studies only when indicated by objective evidence
  4. Therapy if pts are willing to go
  5. Medications - for comorbid psych disorders

often decline psychiatric referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

prevalence of Body Dysmorphic Disorder

A
  1. 1-5%
    - Most patients go to derm or plastic surgery
  2. men = women
  3. Age - MC 20-40
    - Many are unmarried
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

body dysmorphic disorder is believed to be related to what other psych comorbidity

A

OCD
Strong association with social anxiety disorder and major depressive disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

presentation of body dysmorphic disorder

A
  1. Preoccupation with specific aspects of appearance
    - vague, imperceptible to others, hard to understand
    - Specific body part(s) of concern may change over time
    - Believe others notice the “flaw” much more than they do
    - May excessively check mirrors or avoid reflective surfaces
    - May attempt to hide presumed deformity
  2. Almost all will avoid public exposure/interaction
    - Up to ⅓ totally housebound
    - Up to ⅕ attempt suicide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the common “problem” areas for body dysmorphic disorder

A

facial features, hair, breasts, genitalia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

criteria for body dysmorphic disorder

A
  1. Preoccupation with 1+ perceived defect / flaw in physical appearance that are not observable or appear slight to others
  2. repetitive behaviors / mental acts due to concern
    - Behaviors - mirror checking, excessive grooming, skin picking, reassurance seeking
    - Mental acts - comparing appearance to others
  3. Preoccupation causes distress or functional impairment
  4. The preoccupation is not better accounted for by another mental disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

specifiers for body dysmorphic disorder

A
  1. With muscle dysmorphia - idea that muscle mass is too small
  2. Insight specifiers:
    - good or fair insight - believes the disordered beliefs are likely not true
    - poor insight - believes the beliefs are probably true
    - absent insight / delusional beliefs: completely convinced beliefs are true
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

tx for body dysmorphic disorder

A
  1. SSRIs - off-label, but first-line pharmacotherapy
  2. Psychotherapy - CBT, cognitive restructuring with exposure therapy

“Correction” of perceived flaw almost never helpful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

prevalence of Somatic Symptom Disorder with Predominant Pain

A
  1. MC in women (2:1)
  2. Age - MC in older patients (40-50)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the MC somatoform disorder?

A

Somatic Symptom Disorder with Predominant Pain

22
Q

presentation of Somatic Symptom Disorder with Predominant Pain

A
  1. predominant focus on symptom of pain in 1+ areas
    - Varying types of pain
    - long hx of medical and surgical care
    - May deny any other sources of negative emotion and state if it weren’t for pain, life would be good
  2. Pain may have an associated medical condition, but psych factors are seen to play a major role with the pain
  3. Symptom is not intentionally produced or feigned
23
Q

criteria for Somatic Symptom Disorder with Predominant Pain

A
  1. 1+ somatic symptom *predominantly involving pain that causes distress or significant disruption of daily life
  2. Excessive thoughts, feelings, or behaviors related to somatic symptom or associated health concerns manifested by 1+ of the following:
    - Disproportionate and persistent thoughts about seriousness of symptoms
    - Persistent high level of anxiety about health/symptoms
    - Excessive time and energy devoted to symptoms/health concerns
  3. Patient has symptoms for >6 months
    This is not limited to one location
24
Q

tx for somatic symptom disorder with predominant pain

A
  1. alleviation of underlying psych symptoms and aggravating environmental factors
    - NSAIDs - first-line if analgesics are indicated
    - Avoid opiates; if prescribed - fixed-dose rather than PRN
    - Psych meds - antidepressants that have shown benefit in chronic pain may be helpful
    — SNRIs > SSRIs; TCAs also useful
25
Q

causes of somatization

A
  1. Illness provides isolated person with a social support otherwise not available.
  2. less stigmatized than psychiatric illness
  3. used as rationalization for failures in occupation, social, or sexual roles.
  4. hypersensitive to somatic symptoms (more commonly seen w/ depression, anxiety).
  5. can be a means of obtaining nurturance.
  6. Behavior was learned in childhood.
  7. a power tool to manipulate
  8. Sick role provides incentives - disability payments, avoidance of social responsibilities.
  9. a “cry for help.”
  10. Seen with trauma - physical or sexual child abuse.
  11. Symptoms of psychological disorders (MDD, Panic disorder) can be incorrectly attributed to physical disease.
  12. Can be inadvertently physician influenced - symptomatic treatment or “fashionable diseases¹” (chemical sensitivities)
25
Q

Many physical symptoms affecting many organ systems
what disorder?

A

Somatization Disorder

25
Q

Neurological complaints inconsistent with neurological disease
Marked by altered voluntary motor or sensory function
what disorder?

A

Conversion Disorder / Functional Neurological Symptom Disorder

26
Q

Persistent belief that a patient has a serious medical illness
what disorder?

A

Hypochondriasis / Illness Anxiety Disorder

26
Q

Most patients with Somatic Symptom Disorder would have been diagnosed with what with prior criteria?

A

hypochondria, pain disorder, and somatization disorder

26
Q

Defined as a syndrome of multiple unexplained physical symptoms

A

Somatic Symptom Disorder

26
Q

False belief or exaggerated perception that a body part is grotesque or defective

A

Body Dysmorphic Disorder

26
Q

Pain that is solely related to or severely exacerbated by psychological factors

A

Pain Disorder / Somatic Symptom Disorder with Predominant Pain

26
Q

a new pt of yours has had multiple unexplained physical symptoms and an extensive medical history including multiple invasive diagnostic studies / procedures / treatments.
What could you be suspicious of?

A

Somatic Symptom Disorder

26
Q

common systems affected in Somatic Symptom Disorder

A

GI, reproductive, neuro
Symptoms - pain, N/V/D, bloating, dizziness, dysphagia, SOB

27
Q

what is the criteria for somatic symptom disorder

A
  1. 1+ somatic symptom that causes distress or significant disruption
  2. Excessive thoughts, feelings, or behaviors related to somatic symptom or associated health concerns manifested by 1+ of the following:
    - Disproportionate and persistent thoughts about seriousness of symptoms
    - Persistent high level of anxiety about health/symptoms
    - Excessive time and energy devoted to symptoms/health concerns
  3. symptoms for >6 months
    - not limited to one somatic symptom
27
Q

what is the scoring for SSS-8?

A
  • 0-3 = minimal/none
  • 4-7 = low
  • 8-11 = medium
  • 12-15 = high
  • 16-32 = very high
27
Q

what are the specifiers for somatic symptom disorder?

A
  1. With predominant pain: previously deemed pain disorder; somatic sx mostly related to pain
  2. Persistent: severe sx, marked impairment, and long duration (>6 months)
  3. Severity:
    - Mild - 1 symptom described in criterion B
    - Moderate - 2+ symptoms described in criterion B
    - Severe - 2+ symptoms described in criterion B PLUS multiple somatic complaints (or one severe complaint)
27
Q

tx for somatic symptom disorder

A
  1. Have one PCP
    - frequent f/u
    - Avoid new or excess diagnostic studies
    - Tx for comorbid psych disorders as appropriate - Commonly panic disorder, MDD
    - Psychotherapy - can reduce health expenditures by up to 50%
28
Q

Intentionally faking symptoms to assume “patient” role
Behavior persists even with no obvious external rewards
Motivation is to assume the sick role
what is this disorder?

A

Factitious disorder

29
Q

what are the guidelines for tx of somatic symptom disorder

A
  1. Relationship with PCP
    - Regular, scheduled visits
    - Acknowledge and legitimize symptoms
    - Reassure that serious medical diseases have been ruled out
    - Educate on coping with physical symptoms
  2. Management of complaints
    - Communicate with other clinicians
    - Evaluate and treat diagnosable medical disease
    - Limit diagnostic testing and specialist referrals
    — Consider psychotherapy referral
    - Evaluate and treat comorbid psych disorders and substance abuse
    - Explicitly set the goal of treatment as functional improvement
30
Q

intentional induction of symptoms on a victim other than the patient with the disorder

A

Munchausen Syndrome by Proxy
- form of abuse
- Usually severe cases
- “factitious disorder by proxy”

31
Q

risk factors for factitious disorder

A
  1. Female gender
    - Munchausen syndrome - male
  2. Unmarried
  3. Healthcare workers
  4. Possible association with
  5. childhood abuse
32
Q

presentation of factitious disorder

A

Presentation with psychological or physical signs or symptoms of illness
1. May have different accounts of illness to different clinicians
- Evasive about history - may refuse to share medical records
- Often have been seen at multiple facilities by multiple providers
2. Multiple methods of causing s/s
- Misusing medication to induce s/s
- Interfering with or contaminating test results
- Coach others to provide correlating history to providers
- Nonadherence to care plans to aggravate pre-existing illness
- Inflicting injuries directly to self
- Forging medical records

33
Q

criteria for factitious disorder

A
  1. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.
  2. Individual presents themself to others as ill, impaired or injured
  3. Deceptive behavior is evident, even in absence of obvious external rewards
  4. Behavior not better explained by another mental disorder
34
Q

common symptoms for factitious disorder

A

poor wound healing, pain, seizures, hypoglycemia, GI symptoms, depression, suicidal thoughts

  1. Agree to complex work-ups, specialty consults, and invasive procedures
    - Strongly adverse to psychiatric consult
  2. Classically have few visitors in hospital
  3. Symptoms may be unusual or rare - “zebras”
35
Q

what is the severe form of factitious disorder

A
  1. Often involves aliases and “wandering” from one hospital or clinic to another
  2. Classically present to ER on night/weekends
    - Dramatic, often severe symptoms
    - May have extraordinary personal histories
    - Inconsistent objective findings with reported symptoms
  3. Often have failure to respond to standard treatment
  4. Often become upset or angry when confronted
    - May sign out against medical advice (AMA)
36
Q

presentation of factitious disorder imposed on another

A

Mother inflicting symptoms of illness onto child

Clues to Diagnosis:
1. Historical data is not congruous with objective findings
2. Illness is often recurrent, unexplained, prolonged, or unusual
3. Often limited or no response to standard therapy
4. S/S worsen - when victim is around perpetrator, when victim is about to be discharged
5. S/S improve - when victim is not around perpetrator
- May seem to lack concern over victim’s health
- May be surprisingly agreeable to invasive procedures

37
Q

tx for factitious disorders

A
  1. Single provider to coordinate care
    - Compassionate discussion of diagnosis
  2. Psychotherapy - if pts agree to go
  3. Tx of comorbid psych disorders
  4. By proxy - inflicting illness on others is a criminal act and must be reported
    - Social work/protective agencies involved
38
Q

Characterized by intentional faking of s/s to appear ill, impaired, or injured
Simulating illness or exacerbating pre-existing illness
Secondary motivation - Financial gain, medications, legal gain, avoid responsibility
what is this disorder?

A

Malingering

39
Q

what makes Malingering different than factitious disorder

A
  1. Secondary motivation beyond simply “being the pt”
    - Financial gain, medications, legal gain, avoid responsibility
    - S/S may improve once goal is achieved
  2. Often avoid excessive diagnostic and therapeutic procedures, especially painful or invasive ones
40
Q

20% of malingering pt can be seen where?

A

pain clinics

41
Q

tx for malingering

A

difficult due to patient denial of malingering
- Caution to avoid being manipulated by patient to achieve their secondary goal
- Must still treat any underlying medical conditions

Behavioral dynamics (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions