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Behavioral Dynamics > Somatoform Disorders - Exam 3 > Flashcards

Somatoform Disorders - Exam 3 Flashcards

1
Q

Up to ____ of primary care patients display at least some degree of somatization.

___ of medical/surgical patients have no known organic cause for their symptoms

A

25%

10%

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2
Q

What is somatization?

A

“over response” to symptoms. Subjectively believe themselves to be more ill or disabled than objective evidence would suggest

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3
Q

What are risk factors for somatization? What substance? Describe a typical pt

A

female
low socioeconomic status
low education
minority
family member with chronic dz
hx of abuse
other psych disorders
unstable, dysfunctional families
alcohol abuse is present

Typically female, unmarried, non-white, poorly educated, and from rural area.

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4
Q

How does the DSM describe “somatoform disorders”?

A

diseases with physical symptoms not explained by a medical condition

Defined as a syndrome of multiple unexplained physical symptoms

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5
Q

_____ false belief or exaggerated perception that a body part is grotesque or defective

A

body dysmorphic disorder

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6
Q

multiple unexplained physical symptoms, often accompanied by a sense of urgency
Often have long, complicated medical histories
May have had multiple invasive diagnostic studies / procedures / treatments
May describe themselves as being “sickly” their whole lives

What am I?
What are the common systems affected?

A

Somatic symptom disorder

GI, reproductive, neuro
Symptoms - pain, N/V/D, bloating, dizziness, dysphagia, SOB

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7
Q

What is the DSM criteria for somatic symptoms disorder?

A

-1+ symptom that causes distress/disruption of daily life
- excessive thoughts, feelings, or behaviors related to somatic symptom
1. Disproportionate and persistent thoughts about seriousness of symptoms
2. Persistent high level of anxiety about health/symptoms
3. Excessive time and energy devoted to symptoms/health concerns

6+ months

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8
Q

What are the specifiers for somatic symptom disorder?

A

with predominant pain

persistent: severe impairment for longer than 6 months

severity:
Mild - 1 symptom described in criterion B
Moderate - 2+ symptoms described in criterion B
Severe - 2+ symptoms described in criterion B PLUS multiple somatic complaints (or one severe complaint)

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9
Q

What is the tx for somatic symptom disorder?

A

Best to coordinate care with one PCP
Schedule frequent, routine follow-ups

avoid new or excess diagnostic studies

no specific pharm management

psychotherapy!

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10
Q

_____ is marked by altered voluntary motor or sensory function. What was the previous name? What is the MC age range?

A

Functional Neurological Symptom Disorder

previously referred to as conversion disorder

women age 10-35

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11
Q

What are some theories of what causes Functional Neurological Symptom Disorder?

A

-trauma
-comorbid pysch disorders
-lower IQ
-less educated/socially sophisticated
any condition causing delayed verbal communication/impaired ability to articulate distress

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12
Q

-neurologic symptom(s) that do not correlate with the presence of organic neurologic disease
-Often have signs of inconsistency or incongruency
-Hoover’s sign
pseudoseizures, paralysis, blindness, mutism, paresthesia, anesthesia

What am I?

A

Functional Neurological Symptom Disorder

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13
Q

What is Hoover’s sign?

A
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14
Q

What is DSM criteria for Functional Neurological Symptom Disorder?

A

1+ symptoms/deficits affecting voluntary motor or sensory function

Clinical findings are incompatible with recognized neurological or medical condition

cause distress and not better explained by another medical/psych condition

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15
Q

What is the tx for Functional Neurological Symptom Disorder?

A

symptoms often resolve spontaneously
education about the disorder
therapy referral (insight-oriented or behavioral therapy)

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16
Q

_____ preoccupation with a serious illness (either having or developing it) with minimal to no somatic symptoms to support this concern. What is the older name for it?

A

Illness anxiety disorder

hypochondriasis

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17
Q

What are the pt factors for illness anxiety disorder?

A

equal in men and women
age 20-30
Believed patients may have low thresholds of, and tolerance for, physical discomfort
comorbid anxiety disorders

18
Q

predominant concern over the presence of a major disease
Concerns often start with misinterpretation of benign symptoms
Often have extremely detailed histories
May stay fixed on one disease or move to
a new disease over time
Symptoms may wax/wane with stress
Unswayed by negative objective findings aka refuse to believe it

A

illness anxiety disorder

19
Q

What is the DSM criteria for illness anxiety disorder?

A

Preoccupation with having or acquiring a serious illness

Somatic symptoms are not present

High level of anxiety and easily alarmed about health status

Excessive health related behaviors or maladaptive avoidance

more than 6 months

20
Q

What is the tx for illness anxiety disorder?

A

Frequent, regular visits

Compassionate, tactful education on illness

Ordering diagnostic studies only when indicated by objective evidence

Therapy can be helpful, if pts are willing to go

pts often decline psych referral!

medication for comorbid psych disorder

21
Q

_____ characterized by preoccupations with perceived appearance defects. “imagined ugliness”. What is the alternative name?

A

Body Dysmorphic Disorder (BDD)

dysmorphophobia

22
Q

What is the pt population for body dysmorphic disorder?

A

20-40 men and women
unmarried
related to OCD
strongly associated with social anxiety disorder and MDD

23
Q

Preoccupation with specific aspects of the patient’s appearance
Believe others notice the “flaw” much more than they do
Almost all will avoid public exposure/interaction
Up to ___ are housebound
up to __ will attempt suicide

What am I?
What are the common problem areas?

A

Body Dysmorphic Disorder

1/3 housebound
1/5 attempt suicide

facial features, hair, breasts, genitalia

24
Q

What is the DSM criteria for body dysmorphic disorder?

A

Preoccupation with 1+ perceived defect / flaw in physical appearance that are not observable or appear slight to others

At some point during disorder, patient performs repetitive behaviors or mental acts due to concern
-Behaviors - mirror checking, excessive grooming, skin picking, reassurance seeking
-Mental acts - comparing appearance to others

25
Q

Body Dysmorphic Disorder with muscle dysmorphia is ????

A

idea that muscle mass is too small

26
Q

What is tx for body dysmorphic disorder?

A

***“Correction” of perceived flaw (plastic surgery, dental work, etc.) almost never helpful

SSRI: off label but considered first line

Psychotherapy - CBT, cognitive restructuring with exposure therapy

27
Q

Most patients likely have some degree of physical disease that causes pain, but their response is what determines abnormal illness behavior aka out of proportion pain

A

Somatic Symptom Disorder with Predominant Pain

28
Q

What is the MC somatoform disorder? What are the pt related factors?

A

Somatic Symptom Disorder with Predominant Pain

women
40-50
Possible somatic expression of depression
Possible relation to guilt - “deserving” pain

29
Q

varying types of pain
Often have long hx of medical and surgical care
May deny any other sources of negative emotion and state if it weren’t for pain, life would be good
Pain may have an associated medical condition, but psych factors are seen to play a major role with the pain
Symptom is not intentionally produced or feigned

What am I?
How long does it have to occur?

A

Somatic Symptom Disorder with Predominant Pain

pain for more than 6 months (does NOT have to be the same area of the body for the entire 6 months, just pain in general)

30
Q

What is the tx for Somatic Symptom Disorder with Predominant Pain?

A

alleviation of underlying psych symptoms and aggravating environmental factors

May have to deal with opiate addiction or dependence

NSAIDs are first line if analgesics are indicated
Avoid opiates; if prescribed - fixed-dose rather than PRN

Psych meds - antidepressants SNRIs TCAs also useful. that have shown benefit in chronic pain may be helpful

31
Q

______ intentionally faking symptoms to assume “patient” role.

A

Factitious disorder

32
Q

What are good guidelines for treatment for somatization disorders?

A
33
Q

What is factitious disorder? What is another name for it?

A

**Characterized by intentional faking of s/s to appear ill, impaired, or injured
**Behavior persists even with no obvious external rewards
**Motivation is to assume the sick role

Munchausen Syndrome

34
Q

What is Munchausen Syndrome by Proxy?

A

intentional induction of symptoms on a victim other than the patient with the disorder

aka a person makes someone else sick for the attention

35
Q

What are risk factors for factitious disorder?

A

female gender
unmarried
healthcare workers
possible association with childhood abuse

36
Q

Presentation with psychological or physical signs or symptoms of illness
May have different accounts of illness to different clinicians
Often have been seen at multiple facilities by multiple providers
Misusing medication to induce s/s
Interfering with or contaminating test results
Coach others to provide correlating history to providers
Nonadherence to care plans to aggravate pre-existing illness
Inflicting injuries directly to self
Forging medical records

What am I?
What is the major red flag?

A

factitious disorder
Often have been seen at multiple facilities by multiple providers

37
Q

What is the DSM criteria for factitous disorder?

A

Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.

Individual presents themself to others as ill, impaired or injured

Deceptive behavior is evident, even in absence of obvious external rewards

38
Q

poor wound healing,
pain, seizures, hypoglycemia, GI symptoms, depression, suicidal thoughts
Agree to complex work-ups, specialty consults, and invasive procedures
DO NOT WANT TO SEE PSYCH
few visitors in the hospital
aliases and wandering from one hospital or clinic to another
Classically present to ER on night/weekends
Often have failure to respond to standard treatment
Often become upset or angry when confronted

What am I?

A

factitious disorder

39
Q

Historical data is not congruous with objective findings
Illness is often recurrent, unexplained, prolonged, or unusual
Often limited or no response to standard therapy
S/S worsen - when victim is around perpetrator, when victim is
about to be discharged
S/S improve - when victim is not around perpetrator
Caregiver is VERY closely involved with the care team

What am I?

A

Factitious disorder Imposed on Another

aka mother inflicting symptoms of illness onto child

40
Q

What is the tx for factitious disorder?

A

single provider!!
therapy
tx fo comorbid psych disorder

41
Q

What is malingering? Do pts want excessive work ups?

A

Characterized by intentional faking of s/s to appear ill, impaired, or injured for a PERSONAL GAIN!!!

Financial gain, medications, legal gain, avoid responsibility

**Often avoid excessive diagnostic and therapeutic procedures, especially painful or invasive ones

42
Q
A

Behavioral Dynamics (16 decks)

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