Somatoform Disorders

Question 1

Examples of physical symps that exemplify somatoform disorder

Answer 1

headaches, nausea, paresthesias, menstrual irregularities

Question 2

General Definition: somatoform disorder

Answer 2

physical symptom not explained by medical condition or substance abuse

Question 3

UNCONSCIOUS production of symptom, 2 possibilities?

Answer 3

1. Depressive or anxiety disorder

2. Somatization Disorder/Somatic Symptom Disorder/Conversion Disorder

Question 4

CONSCIOUS production of symptom, (2)?

Answer 4

1. Facticious disorder (Unconscious motivation)

2. Malingering (Conscious motivation)

Question 5

Somatoform Disorders as per DSM 4 (DSM 5) listing? (7 as per DSM4, 5 in DSM5)…

Answer 5

1. Conversion Disorder
2. Body Dysmorphic Disorder
3. Factitious Disorder
4. Malingering
5. Somatic Symptom Disorder (previously Somatization Disorder in DSM4)
6. Hypochondriasis (removed in DSM 5)
7. Pain Disorder (removed in DSM 5)

Question 6

General Characteristics of somatoform disorders?

Answer 6

Involve unconscious and social factors that result in both primary and secondary gain.

Question 7

Primary gain definition?

Answer 7

Internal /psychic motivations

Question 8

Secondary gain definition?

Answer 8

external motivations like housing, disability, drugs, etc.

Question 9

Incidence?

Answer 9

Increased in women, starts in early adulthood, worsens with stress,, have anxiety or depression too, impaired socially or on job

Question 10

Which somatoform disorders look genetic (tend to run in families?)

Answer 10

1. Somatization Disorder
2. Pain Disorder
3. Hypochondriasis

Question 11

Which somatoform disorders are increased with a fam hx of mood disorders and OCD?

Answer 11

Pain Disorder and Hypochondriasis

Question 12

Which somatoform disorder is increased with fam hx of alcoholism or antisocial personality disorder?

Answer 12

Somatization Disorder

Question 13

Neurotransmitter involved in somatoform disorders?

Answer 13

serotonin (hypofunction)

Question 14

CONVERSION DISORDER: criteria? (7)

Answer 14

1. sudden loss of sensation and voluntary motor
2. unconscious, no secondary gain, pt aware of symptom loss
3. preceded by psychological stress or conflict
4. unconcerned about symptoms (la belle indifference)
5. usually self limited (lasts less than a month)
6. more common in histrionic personality, depression of psychiatrically unsophisticated.(younguns, rural)
7. can shorten course with hypnosis, drug assisted interviewing
8. sensory: parasthesias, anesthesia, vision, hearing probs
9. globus hystericus (pathognomonic), seizures, shifting paralysis
10. dermatomes don’t match sensory loss, head moves vertical during seizures, can feel pain, sneeze during seizure, blindness has optokinetic form.

Question 15

BODY DYSMORPHIC DISORDER: criteria?

Answer 15

1. preocupation with imagined or insignificant body defect
2. Usually involves face/head (nose too big, breasts/body not symmetrical, etc)
3. not caused by eating disorder
4. common to use plastic surgery but rarely relieve symptoms
5. unconscious, no secondary gain, pt unaware of symptoms, very concerned and worried

Question 16

FACTITIOUS DISORDER: criteria?

Answer 16

1. feign sickness in yourself (or proxy) consciously
2. For primary gain-feel safe, cared for. And secondary gain-proud, smart, outsmarted physician
3. usually medical people
4. get angry and leave when confronted
5. interferes with work, school, life
6. no sure if true somatic disorder

Question 17

Symptoms of factitious disorder

Answer 17

grid abdomen (unnecessary surgeries), fever (heat therm, inject feces), hematuria (needlestick), seizures (caffeine, theophylline), skin lesions (chemical irritants easy places), tachycardia (meds), hypoglycemia (insulin inj), DVT (ligature)

Question 18

FACTITIOUS DISORDER BY PROXY: criteria

Answer 18

1, does it in child for attn on parent

2. considered child abuse, must be reported
3. parent has hx of child abuse or likes being expert in child’s care

Question 19

MALINGERING: CRITERIA?

Answer 19

1. Not a psych illness. Could be a crime.
2. conscious exaggeration of illness for gain (drugs, disability, leave of absence)
3. symptoms disappear after secondary gain
4. incarcerated and lawsuit involved peeps

Question 20

SOMATIZATION DISORDER: CRITERIA?

Answer 20

1. greater than or equal to 4 pain symptoms
2. 2 GI, 1 neuro, 1 sexual
3. onset before 30
4. Pt is unaware of symptoms, no secondary gain, worried.
5. chronic, rarely remit

Question 21

HYPOCHONDRIASIS: CRITERIA?

Answer 21

1. fear of having a really bad medical prob even in face of contradictory info
2. can cause dr shopping
3. unconscious, unaware of symptoms, worried and concerned, no secondary gain
4. must have symptoms for greater than 6 months
5. similar mech to GAD, OCD. renamed Illnes anxiety disorder

Question 22

PAIN DISORDER: CRITERIA?

Answer 22

1. PAIN WITHOUT CAUSE
2. can be acute (less than 6 months) or chronic (more than 6 months)
3. age of onset usually 30s or 40s
4. disabling and cause dependence on pain meds
5. unconscious, not aware of symptoms, worried or anxious

Question 23

SSRIs treat?

Answer 23

pain disorder, hychondriasis and body dysmorphic disorder.

Question 24

treat conversion disorder with what?

Answer 24

sodium amobarbital with drug induced interviewing and hypnosis.