Test 3 - SSD Flashcards
__% of pcp pt’s have a somatoform d.o
26%
somatic symptom d.o are higher incidence in (2)
single individuals
low social supports
incidence of somatic symptom d.o in gen pop
5-7%
somatization is linked to what 2 other d.o
dpn
anxiety
how are feelings expressed in early childhood
physical
ex alexithymia
somatothymia is same same
alexithymia
what is somatothymia/alexithymia
inability to express/describe one’s emotions
kids use __ language to express feelings
later, __ language is used to express thoughts and feelings
physical
verbal
somatic symptom and related d.o (6)
somatic symptom d.o
illness anxiety d.o
conversion d.o
psychological factors affecting other medical conditions
factitious d.o
other specified somatic sx
what are the other specified somatic symptoms
pseudocyesis
sx < 6 mo
what is pseudocyesis
thinking you’re pregnant
rf for childhood somatic sx d.o
inattentive parents
rf for somatic sx d.o (3)
not talking about feelings at home
early abuse
alcoholic parents
somatic sx disorder includes (4)
previous diagnoses of somatization d.o
undifferentiated somatoform d.o
hypochondriasis
some presentations of pain d.o
for dx, somatic sx d.o must
affect pt’s life in some way
criteria for somatic symptom d.o (3)
- somatic symptoms
- 2 out of 3 excessive thoughts, feelings. and behaviors related to the somatic symptoms or health concerns
- chronicity of 6 months
somatic symptom definition
excessive thoughts, feelings, and behaviors related to somatic symptoms or associated health concerns
how many thoughts, feelings, or behaviors must be present for dx of somatic symptom d.o
2 out of 3
what are the 3 thoughts, feelings, or behaviors that must be present for somatic symptom d.o dx
disproportionate and persistent concerns about the medical seriousness of one’s symptoms
high level of health-related anxiety
excessive time and energy devoted to these symptoms or health concerns
does a somatic symptom have to be continuously present for dx of somatic symptom d.o
no
but the state of being symptomatic must be chronic
how long must a pt be symptomatic for dx of somatic sx d.o
at least 6 months
optional specifiers for SSD
predominant somatic complaints (
predominant health anxiety
predominant somatic complaints is same-same
somatization d.o
predominant health anxiety is same same
hypochondriasis
what might you dx a pt w. if they present solely w. health-related anxiety w. minimal somatic sx
illness anxiety
hypochondriasis w.o somatic sx
illness anxiety d.o
5 criteria for illness anxiety d.o
preoccupation w. having or acquiring a serious illness
somatic sx are not present or mild
high level of anxiety about health or having or acquiring serious illness
related excessive behaviors
illness related preoccupation is not better accounted for by sx of another mental d.o
what is an example of excessive behavior related to illness anxiety d.o (2)
checking one’s body for signs of dz
repeatedly seeking info and reassurance from internet or other resources
ddx for illness anxiety d.o
panic d.o
ssd
gad
ocd
what is conversion d.o
physical symptoms suggesting neurological problem
2 types of conversion d.o physical sx
sensory impairment → any modality
paresthesias/paralysis
conversion d.o has __ onset, and
__ termination and reappearance
sudden
sudden
__% of conversion d.o self resolve in 1 month
90%
2 pt pops w. high incidence of conversion d.o
women
men in combat
t/f: conversion d.o is commonly misdiagnosed and overpathologized
t!
15-50% go on to receive medical dx
what is la belle indiference
“beautiful ignorance”
paradoxical absence of psychological distress despite having serious medical illness/sx related to health condition
la belle indifference accounts for __ of conversion d.o
⅓
ex of conversion d.o
blindness/paralysis that can not be explained by medical evaluation
mainstay of tx for conversion d.o
strong/consistent provider-pt relationship
recs for provider managing conversion d.o pt (3)
routine appointments
brief medical exams
consistent emotional support/reassurance
what should be avoided in tx for conversion d.o
narcotics
invasive procedures
is alexithymia typical of conversion d.o pt
yes
why should referral to mental health provider be used cautiously w. conversion d.o pt (2)
risk of pt feeling belittled
referring often futile
what is a factitious d.o
mental health d.o of deceiving others by appearing sick
what are the 2 factitious disorderes
malingering
munchausen’s syndrome
exaggerated physical or psychological sx motivated by external incentives
malingering
ex of malingering (4)
avoiding work
obtaining drugs
obtaining financial compensation
avoiding prosecution
intentional production of physical or psychological s/sx
factitious d.o/munchausen’s syndrome
motivation of factitious d.o/munchausen’s syndrome
assume the sick role → attention of caregiver
what is absent in munchausen’s syndrome
external incentives
ex money, time off work etc
tx considerations for munchausen’s
one pcp
regular visits
treat comorbidities - ex dpn
educate staff
reinforce positive behaviors
what is countertransferance
taking patient behavior personally
what does CCLING stand for
confidence
common
legitimize
idiopathic
nonprogressive
gradual
common
advise pt that symptoms are common
nonprogressive
not typical catastrophic condition
gradual
gradual remission expected
in terms of watchful waiting on satisfaction and anxiety among patients seeking care for unexplained conditions…
patients were generally satisfied w. consultation
had moderately low anxiety
no difference btw immediate testing and 4 week watchful waiting groups
many factors associated w. higher odds of pt satisfaction are related to
physician-patient communication
factors associated w. higher odds of pt satisfaction (5)
general satisfaction w. physician
feeling taken seriously
knowing seriousness of complaint after consult
provider discussing testing and not considering complaints unbearable
older provider age
factors associated with higher odds of pt anxiety (3)
expecting testing/referral
not knowing seriousness of complaints after consult
provider not seeing cause for alarm
anxiety about sx developing when not present
illness anxiety do
inability to put emotions to words → emotions become physical sx
alexathymia
psych do that focuses on neuro sx
conversion
malingering is a __ process
conscious
best tx for ssd
frequent office visits
build rapport
major difference btw schizotypal and schizoid pd
schizotypal has:
cognitive/perceptual distortions
eccentricities of behavior
pt feels empty all the time, abandoned, struggles w. pain
bpd
munchausen’s by proxy
ex mom faking child’s sx for attention
how to schedule apt’s for ssd
frequent office visits
goal to have pt question need for so many visits
