Somatoform Disorders Flashcards
What are somatoform disorders?
A collection of mental disorders with features suggestive of physical illness.
- There are no detectable organic or neurophysiological abnormalities to explain these symptoms
- Symptoms occur unintentionally (unlike factitious and malingering disorders)
Somatisation disorder
- What are the main features?
- What are some of the common physical symptoms?
-Multiple, recurrent, frequently changing physical symptoms
- GI disturbance; N+V ect
- Skin problems; itching, burning, numbness ect
- Sexual or reproductive problems; loss of libido, erectile dysfunction ect
- Urinary problems; dysuria, frequency, retention, incontinence
- Neurological; paralysis, visual loss, sensory loss ect
-Pts should have numerous symptoms from almost all of these systemic groups, not just a few isolated symptoms
According to the ICD-10 what should be present?
-What is a negative result of multiple investigations?
- At least 2 years of symptoms with no adequate physical explanation
- Persistent refusal from the pt to accept reassurance from several doctors that there is no physical cause for the symptoms
- Some degree of functional impairment due to the symptoms and resulting behaviour.
-Iatrogenic disease, with explainable symptoms. Pts are often dependent on many medication, painkillers and sedative
Hypochonrial disorder
-What is the difference between somatisation disorder and hypochondrial disorder?
-What is the difference in what these 2 groups may ask for
- Somatisation disorder; pts express concern about numerous physical symptoms
- Hypochondrial disorders pts misinterpret normal bodily sensations and believe that they have a serious and progressive physical disease
- Hypochondrial disorder; ask for investigations to definitely diagnose a specific disease. They refuse accept reassurance from numerous doctors that they are fine
- Somatisation disorder will ask to treat a specific symptom
What is body dysmorphia?
-A variant of hypochondrial disorder where pts excessively imagine or accentuate a slight defect in their appearance
Factitious disorder and malingering
What is produced in these disorders?
What are pts focused on in factitious disorder?
Malingering pts focus on?
- Physical or psychological symptoms. Can be excessive with pts taking medication to mimic symptoms
- The gain of the sick role. This care seeking behaviour is often a sign of psychological distress. This can also be by proxy e.g a parent poisons their child so they can take care of them.
- They are focused on the secondary external gain of being diagnosed with a disease. This includes medication, benefits, avoiding prison or military service ect
What is the lifetime prevalence of somatisation disorder and what age is onset usually before?
-What is the sex ratio?
- 0.2-2% and usually before 25, often in adolescence
- M:F, 1:10
What is the lifetime prevalence of hypochondrial disorder?
- Age of onset?
- Sex ratio?
- 1-5%
- Usually in early adulthood
- Occurs equally in men and women
Episodes commonly follow what?
What are somatisation disorders due to, in part at least?
- Appearance of stressors
- Genetics, 1/5th of sufferes 1st degree relatives also have the condition
What is the course and progression like?
-A chronic episodic course with symptoms often exacerbated by stress
Treatment
- What does medication help with?
- What is the most effective strategy to help pts when requested?
-It helps treat symptoms to which the pt has an underlying condition, such as anxiety disorder
- Make appointments at fixed intervals, rather than seeing the pt when requested.
- Limit special investigations and medications unless really necessary.
- Help pts to think in terms of coping with their problems rather than curing them
- Try to involve family members in their care
