Somatoform disorders Flashcards
what are the 7 somatoform disorders as per DSM-IV and 5?
- somatization disorder (now somatic symptom disorder)
- conversion disorder
- hypochondriasis (now illness anxiety disorder)
- body dysmorphic disorder
- pain disorder (not in 5)
- factitious disorder
- malingering
what is primary VS secondary gain?
primary: internal/psychic motivations (unsure why they want this)
secondary: external motivations (they want housing, disability, drugs, care)
- this can be positive, as in you want praising so you do well
somatoform disorders
- in men VS women?
- when do they start?
- comorbidity?
- function?
- increased incidence in women (equal in hypochondriasis)
- start in early adulthood and worsen with stress
- 50% have comorbid mental illness (anxiety, depression)
- cause impairment in social and/or occupational function
in which families are there increased somatoform disorder?
- antisocial personality disorder or alcoholism
- FH of mood disorder or OCD
- resiliency gene in serotonin-related gene pathways (reuptake pump)
what is somatization disorder (or somatic symptom disorder)? symptoms? onset? symptom production? gain?
unfounded pain that won’t go away, and is unexplained by medical causes after history, exam, labs, and tests
- needs >4 pain issues
- -2 GI + 1 sexual + 1 neurological symptom
- onset before age 30
- symptoms tend to be chronic, and complete remission is rare
- unconscious symptom production, no secondary gain
- -patient unaware of behaviors and symptom generation, very concerned and worried
what is conversion disorder? symptoms? onset? symptom production? gain?
sudden and dramatic loss of one or more voluntary motor and/or sensory functions suggesting neurologic etiology
- preceded by psychological stress/conflict, so presenting symptom has symbolic relationship with stressor and serves to decrease anxiety associated with it
- “la belle indifference” as uncaring/unconcerned about sudden symptoms
- self-limitied with remission < 1 mo
- common in psychiatrically unsophisticated, and those with depression or histrionic personality traits
- unconscious symptom production, no secondary gain
- -patient is aware of loss and symptom generation
how are somatization disorder, conversion disorder, body dysmorphic disorder, pain disorder, and hypochondriasis the same in terms of symptom production and gain? different?
all five have unconscious symptom production and no secondary gain
- in conversion disorder patient is aware of symptom generation, but “la belle indifference”
- in all the others, patient is unaware of behaviors and symptom generation (very concerned and worried)
what are motor problems possible in conversion disorder? how can they be “off”?
- shifting paralysis
- pseudoseizures (can sneeze or react to pain, or vertical instead of horizontal movements)
- globus hystericus (lump in throat)
what are sensory problems associated with conversion disorder? how can they be “off”?
- paresthesias (wrong dermatomes, pain radiates down instead of up)
- anesthesias (wrong dermatomes, pain radiates down instead of up)
- vision/hearing problems (blindness can still have optokinetic effects)
what is hypochondriasis? symptoms? onset? symptom production? gain?
fear or idea of having serious medical illness based on misinterpretation of bodily symptoms
- now part of generalized anxiety disorder, and called illness anxiety disorder (high health anxiety without somatic symptoms)
- persists despite negative findings and reassurance, and causes “doctor shopping”
- “symptoms” must last >6 mo
- unconscious symptom generation, no secondary gain
- -patient is unaware of behaviors and symptom generation, very concerned and worried
what disorders can SSRIs help treat? why?
can treat hypochondriosis, body dysmorphic disorder, and pain disorder
-due to similar etiology to OCD, GAD, and impulse control disorders
what is body dysmorphic disorder? symptoms? onset? symptom production? gain?
preoccupation with imagined problem or insignificant abnormality in appearance, usually involving face or head (hyperfocused on one thin)
- cannot be accounted for by eating disorder (while anorexics are BDD, they are filed under eating disorder)
- plastic surgery or medical interventions rarely relieve symptoms, but are commonplace
- unconscious symptom generation, no secondary gain
- -patient is unaware of behaviors and symptom generation, but is very concerned and worried
what is pain disorder? symptoms? onset? symptom production? gain?
in DSMIV only; protracted pain that is severe enough to cause patient to seek medical attention
- cannot be explained by physical causes; only one pain that ruins life instead of >4 of somatization)
- acute (6 mo)
- typical age of onset during 3rd or 4th decade of life
- can be disabling and cause dependence on pain medications
- unconscious symptom generation, no secondary gain
- -patient unaware of behaviors and symptom generation, but very concerned and worried
what is the differential diagnosis for somatoform disorders with unconscious symptom production?
must rule out unidentified organic illness first, no matter how ongoing this disease has been
-depression and anxiety can be great pretenders of many medical illnesses
explain management for somatoform disorders with unconscious symptom production?
- establish strong relationship - regular, short appointments; constant reassurance; empathy (typically psychiatry isn’t needed)
- identify and help decrease social stressors and motivations for primary gain
- symptoms recur with stress - psychopharmacology for co-morbid depression and/or anxiety
- SSRIs are useful for hypochondriasis, BDD, and pain disorder
- drug-assisted interviewing with Na amobarbital or hypnosis can help with conversion disorder (face-saving, refer to non-invasive physical or occupational therapy)
- interpersonal and cognitive behavioral therapy may be useful
what is factitious disorder? symptoms? onset? symptom production? gain?
Munchausen syndrome (“by proxy” if create medical problems in others)
- unknown weather true somatic disorder
- conscious feigning or production of physical/mental illness (symptoms) to receive attention from medical personnel, but unconscious motivation
- -assume “sick” role, with a primary gain to be cared for, feel proud, etc.
- -get angry and leave when confronted
- more common in medical personnel
- have negative impact on work, school, and/or social functioning
what are commonly feigned or produced signs/symptoms?
- abdominal pain (“grid abdomen” shows previous unnecessary surgical procedures)
- fever (heating thermometer)
- hematuria (blood from needle stick)
- seizures (take excess caffeine, theophylline)
- skin lesions (chemical dermatitis)
- tachycardia (drug-induced)
- hypoglycemia (insulin injection - increased insulin but low C-peptide)
- fever (inject feces)
- DVT (ligate own leg)
what is facticious disorder by proxy?
most commonly parent feigning or inducing illness in child to gain attention for him/herself
- considered child abuse and must be reported
- parent may have history of childhood abuse/neglect or serious childhood illness during which he/she felt cared for and protected by medical personnel
- -may also want to be expert in his/her child’s care
what is malingering? symptoms? onset? symptom production? gain?
in DSMIV only; NOT psychiatric illness (should be a crime)
- conscious simulation or exaggeration of physical or mental illness to achieve secondary gain (disability, drugs)
- symptoms improve as soon as secondary gain is obtained
- more frequently in incarcerated people
