Somatoform Disorders Flashcards
What are somatoform disorders?
Disorders in which patients present with physical symptoms that have no organic cause
What is the difference between primary and secondary gain in somatoform disorders?
Primary: expression of unacceptable feelings as physical symptoms in order to avoid facing them
Secondary: Use of symptoms to benefit the patient (increased attention, decreased responsibilities…)
Which somatoform disorder is not more common in women?
Hypochondriasis
What is somatization disorder?
Patients present with multiple vague complalints involving many organ systems; symptoms cannot be explained by a medical disorder
What is the DSM-IV criteria for somatization disorder?
- At least two GI symptoms
- At least one sexual or reproductive symptoms
- At least one neurological symptom
- At least four pain symptoms
- Onset before age 30
- Cannot be explained by general medical condition or substance use
The is a greater prevalence of somatization disorder in ____ socioeconomic groups
Low
What is the course of somatization disorder?
Usually chronic and debilitating
How is somatization disorder managed?
Regularly scheduled frequent visits to a primary care practicioner (these patients will usually not agree to see a psychiatrist)
What are the DSM-IV criteria for conversion disorder? (7)
- At least one neurological symptom
- Psychological factors associated with initiation or exacerbation of symptoms
- Symptom not intentionally produced
- Cannot be explained by medical condition or substance abuse
- Causes significant distress or impairment in social or occupational functioning
- Not accoutned for by somatization disorder or other mental disorder
- Not limited to pain or sexual symptom
What is la belle indifference in terms of conversion disorder?
Patients are often surprisingly calm and unconcerned when describing their symptoms (which may include blindness or paralysis)
What are some common symptoms of conversion disorder?
What is Globus Hystericus
- Shifting paralysis
- Blindness
- Mutism
- Paresthesias
- Seizures
- Globus Hystericus - sensation of lump in throat
What is the incidence of conversion disorder in general medical settings?
20-25%
There is increased incidence of conversion disorder in _____ socioeconomic groups
low
What percentage of patients with conversion disorder eventually receive medical diagnoses?
50%
Symptoms of conversion disorder usually resolve in ______
1 month
What is the role of sodium amobarbitol in conversion disorder?
Symptoms may spontaneously resolve after hypnosis or sodium amobarbital interview if the psychological trigger can be uncovered during the interview
Although most patients spontaneously recover, what treatment options are available for conversion disorder?
Insight-oriented psychotherapy, hypnosis, or relaxation therapy if needed
What are the DSM-IV criteria for Hypochondriasis?
- Patients fear that they have serious medical condition based on misinterpretation of normal body symptoms
- Fear persists despite appropriate medical evaluation
- Fears present for at least 6 months
What is the average age of onset of hypochondriasis?
20-30 years old
80% of patients with hypochondriasis have coexisting… (2)
Major depression or anxiety disorder
What clinical features distinguish between somatization disorder and hypochondriasis?
Hypochondriacs are worred about disease whereas patients with somatization disorder are concerned about their symptoms
What is the course of hypochondriasis?
What percentage of patients improve significantly?
Episodic - symptoms may wax and wane periodically
50% of patients improve significantly
What is the management of hypochondriasis?
Management involves frequently scheduled visits to one primary care doctor who oversees the patient’s care
What are some characteristics of patients with body dysmorphic disorder?
They are extremely self-conscious about their appearance
Spend significant time trying to correct perceived flaws with makeup, dermatological procedures or plastic surgery
What are the DSM-IV criteria for body dysmorphic disorder?
- Preoccupation with an imagined defect in appearance or excessive concern about a slight physical anomaly
- Must cause significant distress in the patient’s life
What is the average age of onset of body dysmorphic disorder?
between 15 and 20
Body dysmorphic disorder is more common in (married/unmarried) persons
Unmarried
What is the course of body dysmorphic disorder?
Usually chronic; symptoms wax and wane in intensity
What is routinely unsuccessful in treating body dysmorphic disorder?
What reduces symptoms in 50% of patients?
Surgical or dermatological procedures are routinely unsuccessful in pleasing the patient
SSRIs reduce symptoms in 50% of patients
What are the DSM-IV criteria for pain disorder?
- Patient’s main complaint is pain at one or more anatomic sites
- The pain causes significant distress in the patient’s life
- The pain has to be related to psychological factors
- The pain is not due to a true medical disorder
What is acute pain disorder? Chronic?
Acute: < 6months
Chronic: > 6 months
What is the average age of onset of pain disorder?
What type of workers (white collar vs. blue collar) has increased incidence?
Average age of onset: 30-50 years old
Increased incidence in blue-collar workers
What other somatoform disorders should be ruled out in pain disorder?
Hyponchondriasis and malingering
What is the course of pain disorder?
Abrupt in onset and increase in intensity for first several months; usually a chronic and disabling course
What treatment is not helpful in treating pain disorder?
Why?
Analgesics are not helpful
Patients often become dependent on them
What are some beneficial treatments of pain disorder?
SSRIs, transient nerve stimulation, biofeedback, hypnosis, and psychotherapy
What type of gain is a prominent feature of factitious disorder?
Primary gain
What are the DSM-IV criteria for factitious disorder?
- Patients intentionally produce signs of physical or mental disorders
- They produce symptoms to assume the role of the patient
- There are no external incentives
- Either predominantly psychiatric complaints or predominantly physical complaints
What is Munchhausen syndrome?
Factitious disorder with predominantly physical complaints
These patients are very skilled at feigning symptoms necessitating hospitalization and often demand specific medications
What is Munchhausen syndrome by proxy?
Intentionally producing symptoms in someone else who is under one’s care in order to assume the sick role by proxy
>__% of all hospitalized patients have a factitious disorder
5%
Factitious disorder is more common in ______ (males/females)
males
What is a possible cause of factitious disorder relating to a patient’s history?
Many patients have a history of child abuse or neglect
Hospitalization resulting from abuse provided a safe, comforting environment, thus linking the sick role with a positive experience
What is important in managing a patient with factitious disorder?
Avoid unnecessary procedures and maintain a close liaison with the patient’s primary medical doctor
What is malingering?
What are common motivations?
Involves feigning of physical of psychological symptoms in order to achieve personal gain
Common motivations include avoiding the police, receiving room and board, obtaining narcotics and receiving monetary compensation
Malingering is more common in ____ (men/women)
Men
What is the most common between somatoform disorder, factitious disorder, and malingering?
Malingering
