Somatoform disorders + functional Sx

Question 1

What is Somatisation/Functional Symptoms? RF?

Answer 1

NO PHYSICAL CAUSE FOR A PHYSICAL SX

(1. ) Pts presenting with neurological Sx that do not have defined disease and are best described as having functional Sx.
(2. ) Persistent complains where there is no adequate examination/explanation

(3. ) Three main types:
- Pain in different locations
- Functional disturbance of organ system
- Complaints of fatigue or exhaustion

(4. ) Ix can cause iatrogenic harm
(5. ) RF = female, socioeconomic status, 30y, genetic link

Question 2

Clinical features of somatisation

Answer 2

(1. ) Physical symptoms of common mental health disorders
- May include palpitations or muscular tension in an anxiety disorder or lethargy and sleep disturbance in depression (NICE)

(2. ) Physical complaints and impairments either in the absence or presence observable/measurable tests, pathology.
(3. ) Greatly in excess of the degree of pathology: ‘excessive level’ of anxiety of stress - spend a lot of time and energy worrying about their symptoms
(4. ) It can be anything - can be specific like wrist pain, GI symptoms, sexual symptoms or something more general like fatigue
(5. ) Sx produced by pt is subconscious/involuntary, they are not going out their way to get these sx i.e. ‘malingering/sick note’.
(6. ) Array of Sx affecting multiple systems with no explanation (Negative tests and Ix)

Question 3

List 6 somatic related disorders

Answer 3

(1. ) Somatic Symptom disorder
(2. ) Illness anxiety disorder: Pt believe they have some specific disease despite constant reassurance, pt’s belief still stays the same.

(3. ) Conversion disorder: Sx that suggest serious disease of brain/nerves e.g. loss of vision, deafness, weakness, paralysis or numbness of arms or legs.
- Sx usually develop quickly in response to a stressful situation

(4. ) Psychological factors affecting other medical conditions
(5. ) Factitious disorder: mental disorder in which someone deceives others by appearing sick, by purposely getting sick or by self-injury

(6. ) Body dysmorphic disorder
- A lot of time worried and concerned about their appearance e.g. focussing on an apparent physical defect that other people cannot see.

Question 4

Mx of Somatic Disorders

Answer 4

• One physician as primary caretaker to see regularly
• Psychotherapy to cope with Sx
• Safeguarding
• Important to address ICE