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Behavioral Med: Test 4 > Somatoform Disorders > Flashcards

Somatoform Disorders Flashcards

1
Q

Examples of DSM IV Somatoform disorders

A 
Somatization Disorder
Hypochrondriasis
Pain Disorder
Body Dysmorphic Disorder
Conversion Disorder
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2
Q

Examples of DSM V Somatoform disorders

A

Conversion Disorder (all other crossed out)

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3
Q

Why have there been so many changes?

A
  1. Overlapping previous diagnoses
  2. Difficult for non-psychiatric physicians to apply
  3. Reduction of stigma
  4. Potential for mid-body dualism
  5. Implications that symptoms were not “real”
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4
Q

DSM 5 Changes

A
  1. Reduction in the number of diagnoses and sub-diagnoses
  2. Focus on positive symptoms
  3. Removal of medically unexplained symptoms
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5
Q

What is Somatic Symptom Disorder?

A
  1. New diagnosis
  2. Will absorb many former somatization disorder and hypochondriasis
  3. Presence of symptoms, medically explained or not
  4. With predominant pain (formerly pain disorder)
  5. Health concerns as a central role in an individual’s life
  6. Challenging patient population
    A. Chronic, difficult to treat
    B. High utilizers of the medical systems
  7. Risks
    A. Repetitive, unnecessary diagnostic testing
    B. Invasive medical / surgical workups
    C. Medically induced illness
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6
Q

DSM V Diagnostic Criteria: Somatic Symptom Disorder

A
  1. Excessive thought, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least ONE of the following:
    A. Disproportionate and persistent thoughts about the seriousness of one’s symptoms
    B. Persistently high level of anxiety about health or symptoms
    C. Excessive time and energy devoted to these symptoms or health concerns
  2. Although any one somatic symptoms may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months)
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7
Q

DSM Diagnostic Criteria Continued: Somatic Symptom Disorder SPECIFY IF

A
  1. Specify if:
    A. With predominant pain (previously pain disorder): This specifier is for individuals whose somatic symptoms predominantly involve pain
  2. Specify if:
    A. Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months)
  3. Specify current severity:
    A. Mild: only one of the symptoms specified in Criterion B is fulfilled
    B. Moderate: Two or more of the symptoms specified in Criterion B are fulfilled
    C. Severe: Two or more of the symptoms specified
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8
Q

Somatic Symptom Disorder: Facts

A
  1. 50% of patient presenting to outpatient medical clinics with a physical complaint do not have a medical condition
  2. Seen more in female population
  3. Those with fewer year of education
  4. Higher in minority ethic status and low socioeconomic status
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9
Q

Somatic Symptom Disorder: Clinical Presentation

A
  1. Pain symptoms
    A. Headache, back pain, dysuria, joint pain, diffuse pain, and extremity pain
  2. GI symptoms
    A. Nausea, vomiting, abdominal pain, bloating, gas, and diarrhea
  3. Cardiopulmonary symptoms
    A. Chest pain ,dizziness, SOB, and palpitations
  4. Neurological symptoms
    A. Fainting, pseudoseizures, amnesia, muscle weakness, dysphagia, double or blurred vision, difficulty walking, difficulty urinating, deafness, and hoarseness or aphonia
  5. Reproductive organ symptoms
    A. Dyspareunia, dysmenorrhea, and burning in sex organs
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10
Q

Somatic Symptom Disorder: Co-existing Disorders

A
  1. Depression
  2. Anxiety
  3. Personality disorders
    A. Avoidance
    B. Paranoia
    C. Self-defeating
    D. Obessive-compulsive
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11
Q

Somatic Symptom Disorder: Treatment

A
  1. Psychotherapy & pharmacotherapy jointly
    A. CBT, family therapy, psychoeducation, supportive therapy, stress management, and psychodynamic psychotherapy
    - Individual or group therapy
    B. Goals of therapy is to relieve symptoms rather than eliminate them
    C. Pharmacotherapy is mainly to treat depression or anxiety that is seen with these patients
    D. Many times the Somatic Symptom Disorder resolves when the co-morbid disorder is treated
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12
Q

Somatic Symptom Disorder: General Principles

A
  1. Schedule regular visits
  2. Establish a collaborative, therapeutic alliance with the patient
  3. Acknowledge and legitimize symptoms
  4. Communicate with other clinicians
  5. Evaluate for and treat diagnosable medical disease
  6. Limit diagnostic testing and referral to specialists
  7. Reassure that grave medical diseases have been ruled out
  8. Assess and treat the patient for psychiatric disorders
  9. Education patient about coping with physical symptoms
  10. Explicitly set the goal of treatment as functional improvement
  11. Evaluate and treat substance abuse and/or addiction
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13
Q

Illness Anxiety Disorder: DSM V Diagnostic Criteria

A
  1. Preoccupation with having or acquiring a serious illness
  2. Somatic symptoms are not present or, if present, are only mild in intensity.
  3. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status
  4. The individual performs excessive health-related behaviors or exhibits maladaptive avoidance
  5. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time
  6. The illness-related pre-ocupation is not better explained by another mental disorder, such as somatic symptom disroder, painc disorder, generalized anxiety disorder, body dysmorphic disorder, OCD, or delusional disorder

Specify whether:
A. Care-seeking type: medical care, including physician visits or undergoing tests and procedure, is frequently used
B. Care-avoidant type: medical care is rarely used

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14
Q

Illness Anxiety Disorder: Facts

A
  • Similar to hypochondriasis
  • Onset in early adulthood
  • Rarely begins after age 50
  • Seen in both sexes equally
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15
Q

Illness Anxiety Disorder: Clinical Presentation

A
  1. Particular bodily function
    - Bowel movements
  2. Normal variation in function
    - Hear rate or blood pressure
  3. Vague somatic sensation
    - “tired heart”
  4. Minor symptoms
    - Cough, small sore, or headache
  5. Diagnosis
    - Cancer or AIDS
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16
Q

Illness Anxiety Disorder: Comorbidities

A
  1. Co-morbid psychopathology:
    -GAD 71 %
    -Dysthymic Disorder 45%
    -MDD 43%
    -Phobias 43%
    -Somatic Symptom Disorder 21%
    -Panic Disorder 17%
    -Substance Use Disorder 17%
  2. Personality Disorders
    -OCPD 56%
    -Avoidant 41%
    -Paranoid 37%
    -Schizotypal 25%
    -Borderline 24%
    -Schizoid 22%
    -Narcissistic 22%
17
Q

Illness Anxiety Disorder: Treatment

A
  1. Both medical and psychiatric care
  2. Treat in primary care setting with MH clinician serving as consult to provide psychotherapy or pharmacotherapy
  3. First line treatment is psychotherapy
    - CBT
    - Behavioral stress management
    - Brief psychodynamic psychotherapy
    - Psychoeducation
  4. Pharmacotherapy
    - Use SSRI’s
18
Q

Conversion Disorder: DSM V Diagnostic Criteria

A

A. One or more symptoms of altered voluntary motor or sensory function
B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions
C. The symptom or deficit is not better explained by another medical or mental disorder
D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation

19
Q

What is conversion disorder?

A

This disorder is characterized by neurologic symptoms that are inconsistent with a neurological disease, but cause distress and/or impairment. This disorder is common in clinical setting and often has a poor prognosis.

Facts

  • All ages, but rare before age 10
  • Females > Males
20
Q

Conversion Disorder: Clinical Presentation

A
  • Non-epileptic seizures
  • Weakness and paralysis
  • Movement disorders
  • Speech disturbances
  • Globus sensation
  • Sensory complaints
  • Visual symptoms
  • Cognitive symptoms
21
Q

Conversion Disorder: Comorbid Disorders

A 
1. Psychiatric co-morbidity occurs in up to 90% of patients with Conversion Disorder
A. MDD
B. GAD
C. Panic Disorder
D. Dissociative Disorders
E. Personality Disorder
-Borderline
-Histrionic
-Narcissistic
22
Q

Conversion Disorder: Treatment

A
  1. First-line treatment is education about the diagnosis
  2. Second-line treatment is CBT & PT
  3. Third-line treatment is pharmacotherapy
    A. SSRI’s
    B. Hypnosis
    C. Psychodynamic psychotherapy
23
Q

Psychological Factors affecting other medical condition: DSM V Diagnostic Criteria

A
  1. A medical symptom or condition (other than a mental disorder) is present
  2. Psychological or behavioral factors adversely affect the medical condition is one of the following ways:
    A. The factors have influenced the course of the medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation or, or delayed recover from, the medical condition
    B. The factor interfere with the treatment of the medical condition
    C. The factors constitute additional well-established health risks for the individual
    D. The factor influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention
  3. The psychological and behavioral factors in Criterion B are not better explained by another mental disorder (panic disorder, MDD, PTSD)
    A. Specify current severity:
    -Mild: increase medical risk (inconsistent adherence with anti-hypertension treatment)
    -Moderate: aggravates underlying medical condition (anxiety aggravating asthma)
    -Severe: results in medical hospitalization or emergency room visit.
    -Extreme: results in severe, life-threatening risk (ignoring heart attack symptoms)
24
Q

Psychological Factors Affecting other Medical Conditions : Examples

A
  1. Chronic occupation stress and hypertension
  2. Anxiety and asthma
  3. Depression and coronary artery disease
  4. Alcohol abuse and liver disease
  5. Smoking and COPD
  6. Obesity and diabetes
25
Q

Factitious Disorder: DSM V Diagnostic Criteria

A
  1. Factitious Disorder Imposed on Self or another
    A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception
    B. The individual presents himself or herself to others as ill, impaired, or injured
    C. The deceptive behavior is evident even in the absence of obvious external rewards
    D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder

Specify:
A. Single episode
B. Recurrent episodes: (two or more events of falsification or illness and/or induction of injury)

26
Q

Factitious Disorder: Clinical Presentation

A
  1. Confabulated history alone (cancer, AIDS, PE)
  2. Faking symptoms only (chest pain, dizziness, paralysis, blindness)
  3. Creating a “real” illness by artificial means (ingestion of thyroid hormone, laxatives, and anticoagulants, or injection of contaminants such as feces, bacteria, sputum, milk, kerosene)
  4. Mimicking bleeding by swallowing, instilling, or letting blood
  5. Embellishing old real illness or genetic defects in the contact of simulated disease (complaining of head trauma when there is a congenitally constricted pupil)
  6. Tampering with instruments, thermometers, Ivs, or laboratory specimens

Behavioral Med: Test 4 (5 decks)

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