Somatoform Disorders Flashcards
Given an unexplained physical symptom, what are the unconscious producers of this syndrome? What are the conscious producers?
Unconscious: Depressive/Anxiety Disorder; Somatic Symptom Disorder/Conversion Disorder/other Somatoform Disorders. For conscious production, the motivation matter. Conscious production, Conscious motivation: Malingering. Conscious production, Unconscious motivation: Factitious Disorder.
Diagnose Somatic Symptom Disorder. When does it onset? What is the course? How is it produced? Is there gain? Is the patient aware of symptom generation? Is the patient concerned?
4+ pain issues (GI, sexual, neurological – none can be adequately explained). Onset before age 30, with chronic symptoms and rarely complete remission. UNCONSCIOUS, NO SECONDARY GAIN, UNAWARE OF SYMPTOM GENERATION, VERY CONCERNED
What is conversion disorder? When does it onset? What is the course? How is it produced? Is there gain? Is the patient aware of symptom generation? Is the patient concerned?
“Sudden & dramatic loss of 1+ voluntary motor &/or sensory functions suggestive of neurological lesion.” Usually preceded by psychological stress and symbolic to this stress in serving to reduce associated anxiety. Usual remission in
What is hypochondriasis/illness anxiety disorder? What is the course? How is it produced? Is there gain? Is the patient aware of symptom generation? Is the patient concerned? Will drug tx help?
“Fear of having a serious medical illness based on misinterpretation of bodily symptoms.” Course is usually 6+ months and persists despite negative findings. UNCONSCIOUS, NO SECONDARY GAIN, UNAWARE OF SYMPTOM GENERATION, VERY CONCERNED. SSRIs may help.
What is body dysmorphic disorder? How is it produced? Is there gain? Is the patient aware of symptom generation? Is the patient concerned?
“Preoccupation with an imagined problem or insignificant abnormality in appearance, usually involving the face or neck, not accounted for by an eating disorder.” UNCONSCIOUS, NO SECONDARY GAIN, UNAWARE OF SYMPTOM GENERATION, VERY CONCERNED
What is pain disorder? When does it onset? What is the course? How is it produced? Is there gain? Is the patient aware of symptom generation? Is the patient concerned?
“Protracted pain severe enough to cause patient to seek medical attention, but not explained by physical cause.” Onsets 30s-40s. Can be acute 6 mo. UNCONSCIOUS, NO SECONDARY GAIN, UNAWARE OF SYMPTOM GENERATION, VERY CONCERNED
How should somatiform disorders be managed? Is psychiatry needed?
Simplify everything? Have one managing PCP that must clear all procedures and referrals to specialists. First, rule out organic causes: obtain all recorders, talk to providers and family members…Have frequent, focused medical visits, avoiding over-medicalizing or over-procedurizing the patient. Show constant reassurance and empathy. Decrease social stressors and motivations for primary gain. Psychiatry should not be needed!
What have SSRIs shown to be useful for? When would sodium amobarbital or hypnosis be used?
Anything with co-morbid depression &/or anxiety. Hypochondriasis, BDD, Pain disorder. Can use sodium amobarbital or hypnosis for conversion disorder.
What is factitious disorder? How are symptoms produced? What are the gains? When confronted, what do these people do?
“Conscious feigning or production of physical or mental illness in order to receive attention.” A primary gain be an assumption of the sick role and feeling sage and cared for. A secondary gain be feeling able to “figure things out” that the doctor cannot. When confronted, these patients get angry and leave quickly.
What is malingering? How are symptoms produced? What are the gains? What happens to symptoms?
“Conscious simulation or exaggeration of physical/mental illness to achieve secondary gain – drugs, disability, etc.” Symptoms improve as soon as secondary gain is achieved.
