Somatoform Disorders

Question 1

Somatoform disorder definition

Answer 1

• broad group of illnesses that have bodily signs as a major component
• pt’s with these believe their suffering come from some type of presumably undetected and untx’d bodily derangement

Question 2

Factitious disorder

Answer 2

• conscious feigning of illness/sx’s for primary gain
• intentional production of physical and psych sx’s including self inflicted cndtns mainly to gain the emotional care and attn that comes with playing the role of the pt
• **no external incentives present

Question 3

Munchauser syndrome

Answer 3

pt’s embellish personal history, psychiatric sx’s to gain hospital admission; move from hospital to hospital

Question 4

Factitious disorder by proxy

Answer 4

• intentional production or feigning of physical/psych sx’s in another person who is under an individual’s care
• **usually mother and child

Question 5

Factitious tx

Answer 5

-supportive confrontation, inpatient hospitalization

Question 6

Malingering

Answer 6

• conscious feigning of sx’s for obvious recognizable environmental goal : get out of jail/work, get money
• can stop producing S/S when they are no longer profitable or risk is too great

Question 7

Dissociative disorder essential features

Answer 7

-disruption in the usually integrated fxns of consciousness, memory, identity or perception of the environment

Question 8

Dissociative amnesia

Answer 8

• inability to recall important personal info, usually of a traumatic and stressful nature, that is too extensive to be explained by ordinary forgetfulness

Question 9

Dissociative amnesia main cause

Answer 9

trauma or stressful event

Question 10

Dissociative amnesia tx

Answer 10

-patience and hypnotherapy

Question 11

Dissociative fugue features

Answer 11

• unexpected travel away from home or one’s customary place of work, with inability to recall one’s past
• confusion about personal identity or assumption of new identity

Question 12

Main cause of Dissociative fugue

Answer 12

• due to tramatic circumstance, leading to an altered state of consciousness dominated by a wish to flee
• other causes: pts are struggling with extreme emotions or impulses that are in conflict with pts’s conscience or ego ideals

Question 13

Dissociative fugue tx

Answer 13

patience, hypnotherapy, elective psychodynamically oriented therapy

Question 14

Dissociative identity disorder DSM IV criteria:

Answer 14

• aka: Multiple personality disorder
• DSM IV criteria:
  1) presence of 2+ distinct identities or personality states ( each with its own relatively enduring pattern of perceiving, relating to, and thinking about environment and self)
  2) at least o2 of these identities or personality states recurrently take control of the person’s behavior
  3) Inability to recall important personal info that is too extensive to be explained by ordinary forgetfulness

Question 15

Dissociative Identity disorder features

Answer 15

• begins in childhood
• usually 10 personalities
• usually develop to help child develop with recurrent abuse
• personality states or identities referred to as alters, self-states, parts

Question 16

Dissociative identity disorder tx

Answer 16

• psychotherapy (psychoanalytic, behavioral, cognitive therapy)
• hypnotherapy
• meds to decrease depression and stabalize mood

Question 17

Body Dysmorphic D/o clinical features

Answer 17

• preoccupation with an imagined or grossly exaggerated defect in appearance that causes significant distress or impairment in areas of fxn’ing
• Women > men
• onset is adolescence but mean age of dx is 30 y/o
• comorbid with depression, anxiety and psychosis

Question 18

Body dysmorphic tx

Answer 18

-CBT and SSRIs (clomipramine or fluoxetine)

Question 19

Conversion disorder clinical features

Answer 19

• short course with sudden onset and resolution (90% resolve in few days)
• 2 to 3 times more common in women than men
• onset is adolescence or early adulthood
• more common in rural, low education or low SES

Question 20

Conversion disorder Diagnosis

Answer 20

• symptoms or deficits that affect voluntary motor or sensory fxns; illness is preceded by conflicts or other stressors
• sx’s suggest a neuro or medical cndtn but not cndtn can explain the ax’s
• sx’s occur after conflicts or stressors

Question 21

Common Conversion Disorder sx’s

Answer 21

• involuntary mvmnts
• tics
• torticollis
• seizures
• abnormal gait
• paralysis or weakness
• anesthesia
• blindness
• deafness
• psychogenic vomiting
• syncope
• urinary retention
• diarrhea

Question 22

Conversion disorder rx

Answer 22

• usually have spontaneous recovery
• supportive therapeutic rltnshp
• suggestion tx
• sodium amytal

Question 23

Hypochondriasis dx

Answer 23

• 6 months or more of a general and non delusional preoccupation with fears of having or idea that one has, a serious dz based on the person’s misinterpretation of bodily ax’s
• cannot have intensity of delusion or restricted to distress about appearance

Question 24

Hypochondriasis clinical features

Answer 24

• onset is young adulthood, 20-30 y/o
• 4-10% medical pts
• no gender bias
• cannot be persuaded and will remain despite negative phys exam and lab results

Question 25

Hypochondriasis tx

Answer 25

• group psychotherapy

- SSRI: only when have drug responsive cndtn

Question 26

Somatization disorder dx:

Answer 26

• illness of somatic complaints in multiple organ systems that occurs over a period of several yrs and results in significant impairment or treatment seeking or both
• must have 4 pain, 2 GI, 1 sexual, 1 pseudoneuro
• sx’s cannot be explained by medical cndtn

Question 27

4 pain, 2 GI, 1 sexual, 1 pseudoneuro =

Answer 27

• 4 pain of the: head, abdomen, back, joints, chest, extremities, rectum, during menstruation, sex or urination
• 2 GI: nasuea, bloating, vomiting, diarrhea
• 1 sexual: sexual indifference, ED, irregular menses, excessive menstrual bleeding
• 1 pseudoneuro: impaired coordination/balance, paralysis, or localized weakness, aphonia, urinary retention, loss of touch/pain sensations, seizures, blindness/deafness

Question 28

Somatization disorder differs from other somataform disorders by:

Answer 28

-multiplicity of complaints and multiple organ systems affected

Question 29

Somatization disorder tx:

Answer 29

• mainly psychotherapy

- regular appnts are helpful

Question 30

Somatoform pain disorder

Answer 30

• characterized by a presence of and focus on, pain in one or more body sites and sufficiently severe to come to clinical attn
• diagnostic focus is on the importance of psychological factors and degree of impairment caused by the pain

Question 31

Somatoform pain disorder tx

Answer 31

• psychodynamic therapy

- antidepressants: TCAs, SSRIs