Unexplained symptoms

Question 1

What is a somatisation disorder

Answer 1

multiple physical SYMPTOMS present for at least 2 years

patient refuses to accept reassurance or negative test results

Question 2

What is an illness anxiety disorder

Answer 2

Illness anxiety disorder (hypochondriasis)
persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
patient again refuses to accept reassurance or negative test results

Question 3

What is a conversion disorder

Answer 3

typically involves loss of motor or sensory function
the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies

Question 4

What is a dissociative disorder

Answer 4

dissociation is a process of ‘separating off’ certain memories from normal consciousness
in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
dissociative identity disorder (DID) is the new term for multiple personality disorder as is the most severe form of dissociative disorder

Question 5

What is a factitious disorder

Answer 5

Factitious disorder
also known as Munchausen’s syndrome
the intentional production of physical or psychological symptoms

Question 6

What is malingering

Answer 6

fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

Question 7

What is Charles-bonnet syndrome

Answer 7

persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness

Generally against background of visual impairment and insight is usually preserved

Question 8

What other agents are useful in alcohol withdrawal besides benzos and chlordiazepoxide

Answer 8

Carbamazepine

Question 9

What is an obsession

Answer 9

defined as an unwanted intrusive thought, image or urge that repeatedly enters the person’s mind

Question 10

What is a compulsion

Answer 10

repetitive behaviours or mental acts that the person feels driven to perform

Question 11

Aetiology of OCD

Answer 11

genetic
psychological trauma
pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS)

Question 12

OCD associations

Answer 12

depression (30%)
schizophrenia (3%)
Sydenham's chorea
Tourette's syndrome
anorexia nervosa

Question 13

OCD mx if mild functional impairment

Answer 13

low-intensity psychological treatments: cognitive behavioural therapy (CBT) including exposure and response prevention (ERP)
If this is insufficient or can’t engage in psychological therapy, then offer choice of either a course of an SSRI or more intensive CBT (including ERP)

Question 14

OCD mx if moderate functional impairment

Answer 14

offer a choice of either a course of an SSRI (any SSRI for OCD but fluoxetine specifically for body dysmorphic disorder) or more intensive CBT (including ERP)

Question 15

OCD if severe functional impairment

Answer 15

offer combined treatment with an SSRI and CBT (including ERP)

Question 16

How long should SSRI treatment be continued for in OCD

Answer 16

if treatment with SSRI is effective then continue for at least 12 months to prevent relapse and allow time for improvement

If SSRI ineffective or not tolerated try either another SSRI