Somatoform Disorders Flashcards
The expression of psychological or mental difficulties through physical symptoms.
Somatization
____________ takes a number of forms, ranging from preoccupation with potential or genuine, but mild physical problems to the development of actual physical pain, discomfort, or dysfunction.
Somatization
Somatic Symptom Disorder Etiologies and risk factors ?
Trauma, environment/childhood/ Sexual abuse
**physical manifestation of physiological problems , they doctor shop and spend large amount of money and time going to docs **
Somatic Symptom Disorder genetics ?
Unclear
Somatic Symptom Disorder DDx ?
Massive! First you need to R/O everything organic then: Body Dysmorphic Disorder Brief Psychotic Disorder Bulimia Caffeine-Related Psychiatric Disorders Cannabis Compound Abuse Malingering…very long list
Somatic Symptom Disorder prognosis ?
Generally good ( if they can come to point of acceptance)
Somatic Symptom Disorder medications ?
Rarely successfu.
Somatic Symptom Disorder procedures / therapy / surgery ?
Education letting the patient know that physical symptoms may be exacerbated by anxiety or other emotional problems.
meds not helpful cause there is no disease
Conversion Disorder prevalence ?
<1%. Female > Male. 20-40 year old range typical.
Conversion Disorder Etiology and risk factors ?
Hx of past physical abuse
Lower education / socioeconomic, rural populations
Conversion Disorder genetics ?
Unclear
Conversion Disorder DDx ?
Seizure including frontal lobe epilepsy
Syncope (cardiac, hypovolemic, orthostatic) -POTS
Movement disorders (tics, tremors, etc)
Sleep disorders
Psych disorders (panic, anxiety. PTSD,)
Malingering
Medication / Toxins / Heavy
Metals
Illicit drugs (esp. inhalants and hallucinogens)
Conversion Disorder prognosis ?
Variable but generally good
Conversion Disorder medications ?
Possibly TCAs,
haloperidol, also ECT
(possibly)
Conversion Disorder procedures / therapy / surgery ?
Challenging…
Consider hospital admission: The patient may not return for follow-up after being given a psychiatric diagnosis.
Avoid invasive diagnostic interventions
Conversion Disorder procedures / therapy / surgery ..continued ?
Tactful communication with patient:
Do not say, “There is nothing wrong with you.”
Do not inform them initially of a diagnosis of conversion disorder
Reassure the patient the symptoms are real even if you can not determine an underlying cause
Provide example of other disorders caused from stress such as hypertension, tension headaches)
Provide examples of emotions and symptoms i.e. fear causing a racing heart
Provide examples of subconscious coping mechanisms i.e foot taping, nail biting)
Tell them although no underlying medical condition was discovered, the prognosis for a spontaneous recovery if very good.
Be sure to provide a safe environment where the patient feels comfortable discussing and possibly provide alternative therapies such as complementary and alternative treatments such as guided imagery, yoga, biofeedback. This can help the patient feel in control of their symptoms and provide relief.
Body Dysmorphic Disorder prevalence ?
1-2%
Body Dysmorphic Disorder Etiology and risk factors ?
Major depression is a common comorbidity, occurring in ~60%
OCD
Body Dysmorphic Disorder genetics ?
UKN
Body Dysmorphic Disorder DDx ?
Anorexia Nervosa Anxiety / OCD / Social Anxiety Disorder Bipolar disease Conversion Disorders Depression Schizophrenia and Other Psychoses
Body Dysmorphic Disorder prognosis ?
Generally has a good prognosis. However, SUICIDE risk may be high.
Body Dysmorphic Disorder medications ?
SSRIs
Body Dysmorphic Disorder procedures / therapy / surgery ?
CBT (primary)
Illness Anxiety Disorder aka ?
Hypochondriasis
Illness Anxiety Disorder quote ?
“I’m concerned I have this DISEASE.”
usually a very long list
Illness Anxiety Disorder prevalence ?
Low. Male = Female
Illness Anxiety Disorder Etiology and risk factors ?
Trauma, environment/childhood
Illness Anxiety Disorder genetics ?
unclear
Illness Anxiety Disorder DDx ?
Massive! First you need to R/O everything organic then: Body Dysmorphic Disorder Brief Psychotic Disorder Bulimia Caffeine-Related Psychiatric Disorders Cannabis Compound Abuse Malingering…very long list
Illness Anxiety Disorder prognosis ?
good with tx.
Illness Anxiety Disorder medications ?
SSRIs
Illness Anxiety Disorder procedures / therapy / surgery ?
CBT
Illness Anxiety Disorder is what ?
Illness anxiety disorderis apreoccupation that physical symptoms are signs of a serious illness, even when there is no medical evidence to support the presence of an illness.
Illness Anxiety Disorder causes ?
People with anxiety illness disorder (IAD) are overly focused on, and always thinking about,their physical health. They have an unrealistic fear of having or developing a serious disease. This disorder occurs equally in men and women.
The way people withIAD think about their physical symptoms can make them more likely to have this condition. As they focus on and worry about physical sensations, a cycle of symptoms and worry begins, which can be hard to stop.
It is important to realize that people withIAD do not purposely create these symptoms. They are unable to control the symptoms.
People who have a history of physical or sexual abuse are more likely to have IAD.But this does not mean that every person with IAD has a history of abuse.
Illness Anxiety Disorder sxs. ?
People withIAD are unable to control their fears and worries. They often believe any symptom or sensation is a sign of a serious illness.
They seek out reassurance from family, friends, or health care providers on a regular basis. They feel better for a short time and then begin to worry about the same symptoms or new symptoms.
Symptoms may shift and change, and are often vague. People withIAD often examine their own body.
Some may recognize that their fear of having a serious disease is unreasonable or unfounded.
Illness anxiety disorder is different from somatic symptom disorder. With somatic symptom disorder, the person has physical pain or other symptoms, but the medical cause is not found.
Factitious Disorder aka ?
Munchausen Disorder
- *NOT seeking external rewards
- *
Factitious Disorder prevalence ?
Unclear and believed <1% with women aged 20-40 years
Factitious Disorder Etiology and risk factors ?
Having other mental disorders or medical conditions in childhood or adolescence that resulted in extensive medical attention
Holding a grudge against the medical profession or having had an important relationship with a physician in the past
Having a personality disorder, especially borderline, narcissistic, or antisocial personality disorder
Factitious Disorder genetics ?
unclear
Factitious Disorder DDx ?
Need to R/O other causes then look to psych causes: Conversion Disorders Delusional Disorder Depression Schizophrenia / Somatoform Disorders
Factitious Disorder prognosis ?
Fair to poor
Factitious Disorder medications ?
None except for underlying conditions if identified
Factitious Disorder procedures / therapy / surgery ?
Challenging
When in the ER if a suspicion, direct care to the immediate presenting symptom. If suspected this patient will need a comprehensive psychiatric evaluation
Malingering described as ?
The intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs.
Malingering is technically not what ?
Technically, this is NOT considered a mental illness but can occur in the context of a mental illness
Malingering they are Seeking external rewards, which is opposite of what ?
Factitious Disorder - NOT seeking external rewards
Malingering considerations ?
According to the DSM-5, malingering should be suspected in the presence of any combination of the following:
Medico-legal presentation (eg, an attorney refers patient, a patient is seeking compensation for injury)
Marked discrepancy between the claimed distress and the objective findings
Lack of cooperation during evaluation and in complying with prescribed treatment
Malingering often is associated with an antisocial and histrionic personality disorders
The most common goals of people who malinger in the emergency department are obtaining drugs and shelter.
In the clinic or office, the most common goal is financial compensation
Malingering common causes ?
Workers’ compensation claims
Desire for drugs
Malingering differentiated by what ?
Differentiated from factitious, conversion and somatic disorders by the presence of external incentives.
Somatic Symptom Disorder causes ?
SSD usually begins before age 30. It occurs more often in women than in men. It’s not clear why some people develop this condition. Certain factors may be involved:
Having a negative outlook or personality
Being more physically and emotionally sensitive to pain and other sensations
Family history or upbringing
Genetics
People who have a history of physical or sexual abuse may be more likely to have this disorder. But not every person with SSD has a history of abuse.
SSD is similar to illness anxiety disorder. This is when a person is overly anxious about becoming sick or developing a serious disease. The person fully expects they will at some point become very ill. But unlike SSD, there are few or no actual symptoms.
Somatic Symptom Disorder sxs. ?
Physical symptoms that can occur with SSD may include:
Pain
Fatigue or weakness
Shortness of Breath
Symptoms may be mild to severe. A person may have one or more symptoms. They may come and go or change. Symptoms may be due to a medical condition. They also may have no clear cause.
How a person feels and behaves in response to these physical sensations are the main symptoms of SSD. These reactions must persist for 6 months or more. A person with SSD may:
Feel extreme anxiety about symptoms
Feel concern that mild symptoms are a sign of serious disease
Go to the doctor for multiple tests and procedures, but not believe the results
Feel that the doctor does not take their symptoms seriously enough or has not done a good job treating the problem
Spend a lot of time and energy dealing with health concerns
Have trouble functioning because of thoughts, feelings, and behaviors about symptoms
Somatic Symptom Disorder what is it ?
occurs when a person feels extreme anxiety about physical symptoms such as pain or fatigue. The person has intense thoughts, feelings, and behaviors related to the symptoms that interfere with daily life.
A person with somatic symptom disorder (SSD) is not faking their symptoms. The pain and other problems are real. They may be caused by a medical problem. Often, no physical cause can be found. But it’s the extreme reaction and behaviors about the symptoms that are the main problem.
- *there is no diseases it is a worry of the sxs. ( i have to pee all the time im not concerned about UTI)
- *
