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Psychiatry > Somatoform Disorders > Flashcards

Somatoform Disorders Flashcards

1
Q

What are somatoform disorders?

A

Disorders in which patients present with physical symptoms that have no organic cause

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2
Q

What is the difference between primary and secondary gain in somatoform disorders?

A

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…)

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3
Q

Which somatoform disorder is not more common in women?

A

Hypochondriasis

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4
Q

What is somatization disorder?

A

Patients present with multiple vague complalints involving many organ systems; symptoms cannot be explained by a medical disorder

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5
Q

What is the DSM-IV criteria for somatization disorder?

A
  • 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
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6
Q

The is a greater prevalence of somatization disorder in ____ socioeconomic groups

A

Low

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7
Q

What is the course of somatization disorder?

A

Usually chronic and debilitating

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8
Q

How is somatization disorder managed?

A

Regularly scheduled frequent visits to a primary care practicioner (these patients will usually not agree to see a psychiatrist)

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9
Q

What are the DSM-IV criteria for conversion disorder? (7)

A
  • 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
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10
Q

What is la belle indifference in terms of conversion disorder?

A

Patients are often surprisingly calm and unconcerned when describing their symptoms (which may include blindness or paralysis)

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11
Q

What are some common symptoms of conversion disorder?

What is Globus Hystericus

A
  • Shifting paralysis
  • Blindness
  • Mutism
  • Paresthesias
  • Seizures
  • Globus Hystericus - sensation of lump in throat
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12
Q

What is the incidence of conversion disorder in general medical settings?

A

20-25%

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13
Q

There is increased incidence of conversion disorder in _____ socioeconomic groups

A

low

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14
Q

What percentage of patients with conversion disorder eventually receive medical diagnoses?

A

50%

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15
Q

Symptoms of conversion disorder usually resolve in ______

A

1 month

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16
Q

What is the role of sodium amobarbitol in conversion disorder?

A

Symptoms may spontaneously resolve after hypnosis or sodium amobarbital interview if the psychological trigger can be uncovered during the interview

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17
Q

Although most patients spontaneously recover, what treatment options are available for conversion disorder?

A

Insight-oriented psychotherapy, hypnosis, or relaxation therapy if needed

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18
Q

What are the DSM-IV criteria for Hypochondriasis?

A
  • 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
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19
Q

What is the average age of onset of hypochondriasis?

A

20-30 years old

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20
Q

80% of patients with hypochondriasis have coexisting… (2)

A

Major depression or anxiety disorder

21
Q

What clinical features distinguish between somatization disorder and hypochondriasis?

A

Hypochondriacs are worred about disease whereas patients with somatization disorder are concerned about their symptoms

22
Q

What is the course of hypochondriasis?

What percentage of patients improve significantly?

A

Episodic - symptoms may wax and wane periodically

50% of patients improve significantly

23
Q

What is the management of hypochondriasis?

A

Management involves frequently scheduled visits to one primary care doctor who oversees the patient’s care

24
Q

What are some characteristics of patients with body dysmorphic disorder?

A

They are extremely self-conscious about their appearance

Spend significant time trying to correct perceived flaws with makeup, dermatological procedures or plastic surgery

25
Q

What are the DSM-IV criteria for body dysmorphic disorder?

A
  • Preoccupation with an imagined defect in appearance or excessive concern about a slight physical anomaly
  • Must cause significant distress in the patient’s life
26
Q

What is the average age of onset of body dysmorphic disorder?

A

between 15 and 20

27
Q

Body dysmorphic disorder is more common in (married/unmarried) persons

A

Unmarried

28
Q

What is the course of body dysmorphic disorder?

A

Usually chronic; symptoms wax and wane in intensity

29
Q

What is routinely unsuccessful in treating body dysmorphic disorder?

What reduces symptoms in 50% of patients?

A

Surgical or dermatological procedures are routinely unsuccessful in pleasing the patient

SSRIs reduce symptoms in 50% of patients

30
Q

What are the DSM-IV criteria for pain disorder?

A
  • 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
31
Q

What is acute pain disorder? Chronic?

A

Acute: < 6months

Chronic: > 6 months

32
Q

What is the average age of onset of pain disorder?

What type of workers (white collar vs. blue collar) has increased incidence?

A

Average age of onset: 30-50 years old

Increased incidence in blue-collar workers

33
Q

What other somatoform disorders should be ruled out in pain disorder?

A

Hyponchondriasis and malingering

34
Q

What is the course of pain disorder?

A

Abrupt in onset and increase in intensity for first several months; usually a chronic and disabling course

35
Q

What treatment is not helpful in treating pain disorder?

Why?

A

Analgesics are not helpful

Patients often become dependent on them

36
Q

What are some beneficial treatments of pain disorder?

A

SSRIs, transient nerve stimulation, biofeedback, hypnosis, and psychotherapy

37
Q

What type of gain is a prominent feature of factitious disorder?

A

Primary gain

38
Q

What are the DSM-IV criteria for factitious disorder?

A
  • 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
39
Q

What is Munchhausen syndrome?

A

Factitious disorder with predominantly physical complaints

These patients are very skilled at feigning symptoms necessitating hospitalization and often demand specific medications

40
Q

What is Munchhausen syndrome by proxy?

A

Intentionally producing symptoms in someone else who is under one’s care in order to assume the sick role by proxy

41
Q

>__% of all hospitalized patients have a factitious disorder

A

5%

42
Q

Factitious disorder is more common in ______ (males/females)

A

males

43
Q

What is a possible cause of factitious disorder relating to a patient’s history?

A

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

44
Q

What is important in managing a patient with factitious disorder?

A

Avoid unnecessary procedures and maintain a close liaison with the patient’s primary medical doctor

45
Q

What is malingering?

What are common motivations?

A

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

46
Q

Malingering is more common in ____ (men/women)

A

Men

47
Q

What is the most common between somatoform disorder, factitious disorder, and malingering?

A

Malingering

48
Q
A

Psychiatry (18 decks)

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