Somatoform Disorders and Eating Disorders Flashcards
what are somatization disorders
psychiatric disorders characterized by presence of somatic (physical) complaints
symptoms typically medically unexplainable and cause significant distress
what are types of somatization disorders
Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion Disorder
Factitious Disorder
what are clues to the presence of a somatization disorder?
vague history of present illness
inconsistent history
symptoms out of proportion to possible dx
symptoms rarely alleviated with tx
patient avoids physical exam
patient avoids providing previous records
frequent complaints of medication side effects
receiving care from multiple providers
extensive work-up with no diagnosis
multiple medial diagnosis on PMH
What is Somatic Symptom Disorder
aka Hypochondriasis
Females equal to or greater than males
avg age onset: 20-30 years
higher prevalence in pts with functional disorders (IBD, fibromyalgia, CFS)
many have co-occuring depression/anxiety
What are common symptoms of Somatic Symptom Disorder
Neuropsychiatric: memory impairment, numbness/tingling, impaired coordination
cardiopulmonary: dizziness, pleuritic chest pain, palpitations
Gastrointestinal: biliary colic, stomach cramps, IBD
Genitourinary: sexual dysfunction, pelvic cramps, urinary dysfunction
MSK: weakness pain, spasms
Sensory: blurred vision, tinnitus, hearing loss
Endocrine: hair loss, feeling hot or cold
what are screening tests for Somatic Symptom Disorders
PHQ-15 survey
Somatic Symptom Scale -8
What is conversion disorders
characterized by medically unexplained neurologic or motor symptoms
AKA functional Neurologic Symptom Disorders
- DOES NOT include pain
- symptoms more often evident on PE, but dont fit with known medical disorders
what are common symptoms of conversion disorders
weakness - paralysis, tics/tremors, other involuntary movements
tingling - numbness/ spasms
incoordiantion (falls) - ataxia, pesudoseizures, inability to ambulate
inability to speak (aphonia) - vision loss, hearing loss, slurred speech,
urinary retention - syncope, ‘lump in throat’, inability to swallow
when does conversion disorder typically begin
onset in late childhood to early adulthood
F> males (2:1)
higher incidence in: low SES, rural areas, Low education levels
what is the prognosis of conversion disorder
primary episodic with longer symptom free intervals
more transient that somatic episodic disorders
often spontaneous resolution of symptoms
what is illness anxiety disorder
characterized by excessive worry over having or getting an illness
+/- associated symptoms
epidemiology ill defined
what is the prognosis of Illness anxiety disorder
unclear
likely chronic with exacerbations
What is factitious disorder
aka munchausens syndrome
INTENTIONAL production or reigning of symptoms/illness
MAY appear medically explainable
not motivated by some secondary gain
can be induced in one’s self or another person (munchausen’s by proxy)
what is the presentation of factitious disorder
often presents in early adulthood - middle age
M>F
healthcare workers are at higher risk
what are ways patient may induce illness in factitious disorder
injection of a contaminated substance to induce infection
contaminating lab samples
secretive use of medications that aren’t indicated
self-inflicted wounds or worsening of surgical wounds
how are somatization disorders diagnosed
diagnosis of exclusion
undertake only LIMITED work-up
Schedule regular visits for reassurance
what is the treatment of somatization disorders
cautiously discuss relationship to anxiety/emotional state: exception- factitious disorder - patient should be confronted, may end symptoms
avoid surgery, procedures and medications: SSRIs show to be somewhat helpful
consult psychiatry - initiate CBT
what are types of eating disorders?
anorexia nervosa
bulimia nervosa
binge-eating disorder
what is anorexia nervosa
most commonly diagnosed in adolescence (14-18)
F>M (10-20x)
associated with several other psychiatric diagnoses
higher prevalence with occuaptions/sports that require control of body weight
what is anorexia nervosa associated with
NT, hormonal and brain changes
what is a patients BMI with a severe anorexia nervosa
BMI 15-15.99
if a patient with anorexia nervosa presents with a BMI of 12-18.5 what is the severity level of their disorder
mild anorexia
what is the treatment of anorexia nervosa
mostly outpatient
no effective pharmacologic treatment - should treat comorbid psych disorders
CBT and MANTRA
what is MANTRA
Maudsley Anorexia Nervosa Treatment for adults - 12 months, family based therapy
who gets inpatient treatment with anorexia nervosa
severe disease (BMI < 16)
hypotension or hypothermia
electrolyte imbalances
suicidal ideation or psychosis
failure of outpatient treatment
what is the prognosis of patients with anorexia nervosa
25-40% will achieve remission
other proportion will remain symptomatic
untreated anorexia - mortality rate 5/1,000
what is refeeding syndrome
if someone in starvation is fed too much, too quickly it may result in:
- hypophosphatemia
-hypomagnesemia
-hypokalemia
-thiamine deficiency
-salt and water retention
what is bulimia nervosa
more common than anorexia
F>M
tends to develop later than anorexia (late adolescence to early adulthood)
more likely to be normal weight
what are high risk groups for bulimia nervosa
high achievers, parental neglect, history of depression, SUD
what is the bulimia nervosa cycle
binge, interruptions or feelings of physical discomfort, guilt, depression, self-disgust, compensatory behaviors, symptom free interval, binge loop
when is bulimia nervosa considered extreme
14+ episodes of compensatory behaviors per week
what are subtypes of bulimia nervosa
purging: self-induced vomiting, laxatives, diuretics
non-purging: dieting/fasting, exercise, common in higher BMI
what are less common medical complications of bulimia nervosa
electrolyte disturbances (hypokalemia)
dehydration
elevated amylase levels, pancreatitis
menstrual irregularities or amenorrhea
hypotension/bradycardia
esophageal/gastric tears
what is the treatment of bulimia nervosa
most treated outpatient
less likely to need hospitalization than anorexia
what is binge-eating disorders
most common
F>M
usually older age at onset
more likely to be overweight
significant overlap with bulimia
what are the goals of eating disorder treatments
restore normal body weight
change restrictive/binging/purging behaviors
therapy: CBT, behavior changes, group/individual psychotherapy, family therapy
