Somatoform disorders

Question 1

how do we treat chronic fatigue syndrome?

Answer 1

graded exercise programme is the best we got

Question 2

what is the diagnostic criteria for chronic fatigue syndrome?

Answer 2

6 months or more, not due to medical problem

4 of the following 8:

1. post-exertion malaise lasting more than 24 hours
2. unrefreshing sleep
3. significant impairment of short-term memory or concentration
4. muscle pain
5. pain in the joints without swelling or redness
6. headaches of a new type, pattern, or severity
7. tender lymph nodes in the neck or armpit
8. a sore throat that is frequent or recurring

Question 3

if one identical twin develops SCZ, what is the lifetime risk that the other will also develop SCZ?

what about the little brother of one of these patients? (that is to say, what is the likelihood of a sibling having SCZ)

what is the lifetime risk of SCZ for a child with one parent with SCZ?

Answer 3

about 50%

for the regular sibling it is about 10%

for the child of a patient with SCZ, the risk is about 5%

Question 4

what are the symptoms in schizophrenia?

Answer 4

Positive symptoms - Psychotic symptoms, such as hallucinations, which are usually auditory; delusions; and disorganized speech and behavior

Negative symptoms - A decrease in emotional range, poverty of speech, and loss of interests and drive; the person with schizophrenia has tremendous inertia

Cognitive symptoms - Neurocognitive deficits (eg, deficits in working memory and attention and in executive functions, such as the ability to organize and abstract); patients also find it difficult to understand nuances and subtleties of interpersonal cues and relationships

Mood symptoms - Patients often seem cheerful or sad in a way that is difficult to understand; they often are depressed

Question 5

what condition is most commonly associated with Tourette syndrome?

Answer 5

OCD is the most common overlap

Question 6

what are the findings in MSE with someone with schizophrenia?

Answer 6

The patient may be unduly suspicious of the examiner or be socially awkward

The patient may express a variety of odd beliefs or delusions

The patient often has a flat affect (ie, little range of expressed emotion)

The patient may admit to hallucinations or respond to auditory or visual stimuli that are not apparent to the examiner

The patient may show thought blocking, in which long pauses occur before he or she answers a question

The patient’s speech may be difficult to follow because of the looseness of his or her associations; the sequence of thoughts follows a logic that is clear to the patient but not to the interviewer

The patient has difficulty with abstract thinking, demonstrated by inability to understand common proverbs or idiosyncratic interpretation of them

The speech may be circumstantial (ie, the patient takes a long time and uses many words in answering a question) or tangential (ie, the patient speaks at length but never actually answers the question)

The patient’s thoughts may be disorganized, stereotyped, or perseverative

The patient may make odd movements (which may elated to neuroleptic medication)
The patient may have little insight into his or her problems (ie, anosognosia)

Orientation is usually intact (ie, patients know who and where they are and what time it is)