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Psychiatry > Somatoform disorders and physical health > Flashcards

Somatoform disorders and physical health Flashcards

1
Q

Psychiatric presentation of multiple sclerosis

A

25% mood disturbance: bland euphoria/depression

25% cognitive deficits

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2
Q

Psychiatric presentations of Parkinson’s

A

Depression

Dementia

DAergic therapy –> psychosis/disinhibition

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3
Q

Prevalence of psychiatric presentations of SLE

A

5% at presentation

50% lifetime prevalence

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4
Q

Psychiatric presentations in SLE

A

Delirium

Mood disorder

Psychosis

Seizures

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5
Q

Psychiatric presentation of HIV

A

10-20% of AIDS patients will get dementia

Insidious memory loss, attention, concentration

Myoclonus/seizures

Apathy/social withdrawal

Depression psychosis

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6
Q

Psychiatric presentation of Cushing’s disease

A

severe depression

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7
Q

Psychiatric presentation of hyperthyroidism

A

Anxiety

Mania, psychosis, delirium

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8
Q

Psychiatric presentation of hypothyroidism

A

Mental slowing, depressive symptoms

May persist despite thyroxine replacement

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9
Q

Psychiatric presentations of hypercalcaemia

A

25% cognitive impairment

50% Psychosis, delirium, mood disorder

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10
Q

Subcategories of somatoform disorder

A

Hypochondriasis

Dysmorphophobia

Somatization disorder

Persistent somatoform pain disorder

Dissociative/conversion disorder

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11
Q

Main feature of condition is concern with having a disease

A

Hypochondriasis

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12
Q

Main feature of condition is innappropriate concern with size/shape/deformity of body part

A

Dysmorphophobia

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13
Q

Main feature of conditions is concern with somatic symptoms

A

Somatization disorder

Persistent somatoform pain disorder

Undifferentiated somatoform disorder

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14
Q

Important to exclude in assessment of somatoform disorder

A
  • Physical cause of symptoms
  • Depression/anxiety (insufficient to explain symptoms)
  • Psychosis w/ somatic hallucinations
  • Malingering
  • Dissociative/conversion disorder
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15
Q

Time criterion for somatization disorder

A

>= 2 years of symptoms

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16
Q

Consultation criteria for somatization disorder

A

>3 consultations w/ refusal to accept medical advice that there is no physical cause

17
Q

Symptom criteria for somatization disorder

A

>=6 symptoms from >=2 systems

18
Q

Criteria for somatization disorder

A

Time

Consultations

Symptoms

19
Q

Undifferentiated somatoform disorder vs somatization disorder

A

Shorter duration, fewer symptoms

20
Q

Loss of specific physical function

A

Conversion/dissociative disorder

21
Q

Time criterion for all somatoform disorders apart from somatization disorder

A

6 months

22
Q

Treatment of hypochondriasis

A

Avoid unnecessary treatment (biggest cause of harm)

CBT, behavioural activation therapy, formulations

Antidepressants (even in absence of depression)

23
Q

Pharmacological treatment of persistent somatoform pain disorder

A

SNRIs

Tricyclic antidepressants

24
Q

Psychiatric associations with somatoform disorders

A

Depression

Anxiety

Personality disorder

(May overlap or coexist with somatoform disorder)

25
Q

Distinction between factitious disorder and malingering

A

Absence of external motivation in factitious disorder (c.f. malingering)

Factitious disorder is a psychiatric disorder

26
Q

Thoughts to elicit in MSE of suspected somatoform disorder

A
  • Preoccupation with health/specific illness: how is your health?
  • Expectation from consultation: what do you think is causing it? What would help?
27
Q

Perceptions to elicit in somatoform disorder

A
  • Many aches and pains?
  • Symptoms your doctor can’t explain?
  • What do you think about your appearance?
28
Q

Prevalence of psychiatric disorder in medical/surgical outpatients

A

1/3 of attendees

29
Q

Important psychiatric cause of chest pain, dizziness, tingling

A

Panic disorder

30
Q

Important psychiatric cause of deterioration of medical/surgical conditions

A

depression

31
Q

Diagnostic algorithm for unexplained medical complaints

A
32
Q

Presentation of psychiatric disorders in medical settings

A

Unexplained medical symptoms

Behavioural management problem

Deterioration of preexisting medical disease

33
Q

Factitious illness vs hypochondriasis

A

Hypochondriasis: Anxiety disorder, fear of having a disease, vague symptoms

Factitious illness: Pretending to have ysmptoms to get medical attention (2ry gain)

34
Q

Clinical features of hypochondriasis

A

Persistent anxiety about having a specific disease(s) in spite of medical reassurance

35
Q

Conversion/dissociative disorder features

A

Partial/complete loss of normal integration between memories/awareness of identity and immediate sensations/movement

Physical illness in absence of pathology produced through unconscious mechanisms (psychological –> physical stress)

Psychiatry (20 decks)

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