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BM: Unit 4 > Somatoform Disorders > Flashcards

Somatoform Disorders Flashcards

1
Q

What are the DSM-IV recognized somatoform disorders?

A
  1. Somatization Disorder
  2. Hypochrondriasis
  3. Pain Disorder
  4. Body Dysmorphic Disorder
  5. Conversion Disorder
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2
Q

What are the DSM-V recognized somatoform disorders?

A
  1. Somatic Symptom Disorder
  2. Illness Anxiety Disorder
  3. Conversion Disorder (Functional Neurological Symptom Disorder)
  4. Psychological Factors affecting other medical conditions
  5. Factitious Disorder

A. Reduction in the number of diagnoses and sub-diagnoses
B. Focus on positive symptoms
C. Removal of medically unexplained symptoms

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3
Q

Why so many changes between DSM-IV and V?

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

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
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5
Q

Why are somatic symptoms disorders challenging to treat?

A
  1. Chronic, difficult to treat

2. High utilizers of the medical systems

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6
Q

What are the risks of somatic symptoms disorders?

A
  1. Repetitive, unnecessary diagnostic testing
  2. Invasive medical / surgical workups
  3. Medically induced illness
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7
Q

What is the epidemiology of somatic symptom disorder?

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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8
Q

What may be the clinical presentation for somatic symptom disorder?

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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9
Q

What coexisting psych disorder are present w/ somatic symptom disorder?

A
  1. Depression
  2. Anxiety
  3. Personality disorders
    A. Avoidance
    B. Paranoia
    C. Self-defeating
    D. Obsessive-compulsive
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10
Q

What is the goal of therapy for somatic symptom disorder?

A

Goals of therapy is to relieve symptoms rather than eliminate them

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11
Q

What is the treatment for somatic symptom disorder?

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

What are the general principles for somatic symptom disorder?

A

Schedule regular visits
Establish a collaborative, therapeutic alliance with the patient
Acknowledge and legitimize symptoms
Communicate with other clinicians
Evaluate for and treat diagnosable medical disease
Limit diagnostic testing and referral to specialists
Reassure that grave medical diseases have been ruled out
Assess and treat the patient for psychiatric disorders
Education patient about coping with physical symptoms
Explicitly set the goal of treatment as functional improvement
Evaluate and treat substance abuse and/or addiction

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13
Q

What are the DSM-V criteria for Illness Anxiety Disorder?

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 disorder, painc disorder, generalized anxiety disorder, body dysmorphic disorder, OCD, or delusional disorder
  7. 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

What are the epidemiological facts about illness anxiety disorder?

A
  1. Similar to hypochondriasis
  2. Onset in early adulthood
  3. Rarely begins after age 50
  4. Seen in both sexes equally
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15
Q

What is the clinical presentation for illness anxiety disorder?

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

What are the comorbid pathologies for illness anxiety disorder?

A
  1. GAD 71 %
  2. Dysthymic Disorder 45%
  3. MDD 43%
  4. Phobias 43%
  5. Somatic Symptom Disorder 21%
  6. Panic Disorder 17%
  7. Substance Use Disorder 17%
  8. Personality Disorder
    A. OCPD 56%
    B. Avoidant 41%
    C. Paranoid 37%
    D. Schizotypal 25%
    E. Borderline 24%
    F. Schizoid 22%
    G. Narcissistic 22%
17
Q

What are the treatment guidelines for illness anxiety disorder?

A
  1. Both medical and psychiatric care

2. Treat in primary care setting with MH clinician serving as consult to provide psychotherapy or pharmacotherapy

18
Q

What is first line treatment for illness anxiety disorder?

A
  1. CBT
  2. Behavioral stress management
  3. Brief psychodynamic psychotherapy
  4. Psychoeducation
19
Q

What is the pharmacological therapy for illness anxiety disorer?

A

Use SSRI’s

20
Q

What are the DSM-V criteria for conversion/functional neurological symptom disorder?

A
  1. One or more symptoms of altered voluntary motor or sensory function
  2. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions
  3. The symptom or deficit is not better explained by another medical or mental disorder
  4. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation
21
Q

define 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.

22
Q

Who is more likely to have conversion disorder?

A
  1. All ages, but rare before age 10

2. Females > Males

23
Q

What is the clinical presentation of conversion disorder?

A
  1. Non-epileptic seizures
  2. Weakness and paralysis
  3. Movement disorders
  4. Speech disturbances
  5. Globus sensation
  6. Sensory complaints
  7. Visual symptoms
  8. Cognitive symptoms
24
Q

What co-morbid disorders are present with conversion disorder?

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
25
Q

What is first line treatment in conversion disorder?

A

First-line treatment is education about the diagnosis

26
Q

What is second line treatment in conversion disorder?

A

Second-line treatment is CBT & PT

27
Q

What is third line treatment in conversion disorder?

A
  1. Third-line treatment is pharmacotherapy
    A. SSRI’s
    B. Hypnosis
    C. Psychodynamic psychotherapy
28
Q

What are the DSM-V criteria for psychological factors affecting other medical conditions?

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)
    Specify current severity:
    A. Mild: increase medical risk (inconsistent adherence with anti-hypertension treatment)
    B. Moderate: aggravates underlying medical condition (anxiety aggravating asthma)
    C. Severe: results in medical hospitalization or emergency room visit.
    D. Extreme: results in severe, life-threatening risk (ignoring heart attack symptoms)
29
Q

What psychological factors affect other medical conditions?

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
30
Q

What are the DSM-V criteria for factitious disorder imposed on self?

A
  1. Factitious Disorder Imposed on Self
    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
    E. Specify:
    -Single episode
    -Recurrent episodes: (two or more events of falsification or illness and/or induction of injury)
31
Q

What are the DSM-V criteria for factitious disorder imposed on others?

A
  1. Falsification Disorder Imposed on Another
    A. Falsification of physical or psychological sign or symptoms, or induction of injury or disease, in another, associated with identified deception
    B. The individual presents another individual (victim) 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
    E. Specify
    -Single episode
    -Recurrent episodes: (two or more events of falsification of illness and/or induction or injury)
32
Q

What is the clinical presentation of factitious disorder?

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

BM: Unit 4 (5 decks)

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