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Somatoform Disorders-Sweeny Flashcards

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1
Q

What are the common features of Somatoform disorder?

A
  • physical symptoms suggesting medical etiology
  • symptoms are not fully explained by a general medical condition, or by direct effects of substance, or by another mental disorder (i.e. Panic D/O)
  • symptoms must cause clinically significant distress or impairment in social, occupational, or other areas of functioning.
  • commonly seen in medical settings
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2
Q

What are the different types of somatoform disorders?

A
  • Somatization disorder
  • Undifferentiated Somatoform Disorder
  • Conversion disorder
  • Pain disorder
  • Hypochondriasis
  • Body Dysmorphic Disorder
  • Somatoform D/O, NOS
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3
Q

What is the criteria for Somatization Disorder?

A

4:2:1:1
Clinical Description:
A. Extended history of physical complaints before age 30
B. ***Must have 4 pain sx’s, 2 gastrointestinal symptoms, 1 sexual symptom, 1 pseudo neurological symptom

Substantial impairment (social or occupational)
C. Sx’s Cannot be explained by GMC
D. Symptoms NOT INTENTIONALLY produced or feigned (as in Factitious Disorder)

-mostly affects unmarried, low socioeconomic status females

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4
Q

Which comorbidities commonly occur with Somatization Disorder?

A

Major Depressive D/O, Panic D/O, and Substance-Related D/O

Frequently assoc with PD’s: Histrionic, Borderline, and Antisocial.

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5
Q

What is the treatment for Somatization Disorder?

A

psychotherapy to increase the pts awareness that sx’s might be psychological

-assign a “gatekeeper” physician and establish regular visits –> DO NOT REFER OUT

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6
Q

What is the criteria for Undifferentiated Somatoform Disorder?

A

A. One or more physical complaints (e.g. fatigue, loss of appetite, gastrointestinal or urinary complaints (NO 4:2:1:1)

B. Symptoms cannot be fully explained by known general medical condition OR in the presence of a GMC the symptoms are in excess of what would be expected from H&P/labs

C. Distress (occupational/social)

D. Duration: at least 6 months

E. Not better accounted for by another mental disorder

F. Symptom not intentionally produced or feigned

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7
Q

What is the criteria for Conversion Disorder?

A

STRESSOR
Clinical description:
-One or more sx’s or deficits affecting voluntary motor or sensory function (i.e. mutism, blindness, paralysis, amnesia, lump in throat, urinary retention, )
*Follow a stressor (often remit quickly)
-Lack physical or organic pathology
-Persons show “la belle indifference” vs. distress over sx’s
-Retain most normal functions, but lack awareness
-rare
-35 yo
-more common in rural areas and low socioeconomic status
-females>males

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8
Q

What comorbidities are common with conversion disorder?

A

personality disorders: dependent, histrionic, passive-aggressive, antisocial

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9
Q

What is thought to be the cause of Conversion Disorder?

A

Detachment from the past trauma and negative reinforcement

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10
Q

What is the treatment for Conversion Disorder?

A
  • Similar to somatization disorder
  • Core strategy is attending to the trauma
  • Remove sources of secondary gain
  • Reduce supportive consequences of talk about physical symptoms
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11
Q

What is the DSM IV criteria for Pain Disorder?

A

-Pain in one or more sites in the body associated with significant distress or impairment.

Course of sx’s:

  • initially may have been a clear physical reason
  • psychological factors play a major role in maintaining it

-3 sub-types: from pain judged to primarily result from psychological factors to pain judged to be due to a general medical condition (axis III not axis I)

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12
Q

What is the best treatment approach for Pain Disorder?

A

If medical treatments for existing physical conditions are in place and pain remains

OR

If the pain seems clearly related to psychological factors, psychological interventions are appropriate.

***Multi-disciplinary approach

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13
Q

What is Hypochondriasis?

A
  • Physical complaints without a clear cause for a minimum of 6 months duration
  • Severe anxiety about the possibility of having a serious disease – belief is not delusional
  • Patients have a difficult time identifying and acknowledging the symptoms as mental
  • Medical reassurance does not seem to help
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14
Q

What is the course of Hypochondriasis?

What are common comorbidities?

A
  • any age of onset, most common in early adulthood.
  • runs a CHRONIC course
  • males=females
  • comorbid: anxiety and depressive disorders
  • must consider an underlying medical condition as a differential*
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15
Q

What is the best treatment for hypochondriasis?

A
  • Challenge illness-related misinterpretations (CBT)and SSRI’s
  • Provide more substantial and sensitive reassurance
  • Stress management and coping strategies (symptoms can worsen with stress)
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16
Q

What is Body Dysmorphic Disorder? Who is affected?

A
  • Preoccupation with IMAGINED defect in appearance
  • Most common regions: face or head
  • Often display ideas of reference for imagined defect (i.e. hair thinning, wrinkles, scars, vascular markings, paleness, facial asymmetry)

*Suicidal ideation and behavior are common

  • males=females
  • onset: early 20s
  • chronic course
17
Q

What comorbidities are common with Body Dysmorphic Disorder?

A

OCD and Depression

suicide risk

18
Q

What is the treatment for Body Dysmorphic Disorder?

A
  • Treatment parallels that for obsessive compulsive disorder (Cognitive Behavioral Therapy)
  • Medications (i.e., SSRIs) that work for OCD provide some relief
  • Exposure and response prevention is also helpful
  • Plastic surgery-often found to be of no benefit
19
Q

What are some examples of Somatoform, NOS?

A
  • Pseudocyesis – false belief of being pregnant.
  • A disorder involving nonpsychotic hypochondriacal sx’s of less than 6 months duration.
  • A disorder involving unexplained physical complaints (e.g. fatigue or body weakness) < 6 mo
20
Q

What are Factitious Disorders?

A
  • Intentional production or feigning of physical or psychological problems
  • Behavior motivation is to assume the sick role
  • Often occur in health care work place (M>F)
  • Absence of external incentives (i.e. economic gain, avoiding legal responsibility, or improving physical well-being, as in Malingering)
  • normal–> above average IQ
21
Q

What is Factitious Disorder by Proxy?

A

-intentional production or feigning of physical or psychological signs or sx’s in another person who is under the individual’s care

(Munchausen syndrome by proxy – mandated Child Abuse Report)

22
Q

How does Malingering differ from Factitious Disorder?

A

In malingering, there is motivation (external incentives) for the faking of illnesses (there is no motivation in Factitious disorder)

*NOT considered an Axis I diagnosis

23
Q

What is Malingering?

A
  • Intentional production of false or grossly exaggerated physical or psychological symptoms
  • motivation=external incentives (ex: avoid work, avoid military duty or criminal prosecution, obtain drugs)
  • more common in men
  • avoid confrontation–> become aggressive
24
Q

What is dissociation?

A

When specific, anxiety-provoking thoughts, emotions, or physical sensations are separated from the rest of the psyche

Occurs in both psychiatrically disordered patients as well as in non-disordered individuals.

25
Q

What is Dissociative Identity Disorder (DID)?

A
  • dissociation of personality-2 or more distinct identities
  • Disturbance is not due to direct physiological effects of a substance or general medical condition.
  • Identities display unique behaviors, voice and posture

-many have a history of severe physical or sexual abuse

26
Q

Who is more commonly affected by DID and when is the typical onset?

A
  • females > males (9:1)

- onset: childhood (severe physical or sexual abuse)

27
Q

What is the treatment for DID?

A
  • Psychotherapy

- hypnosis: re-integration, identify cues triggering memory/trauma and dissociation

Psych (24 decks)

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