Week 1 - PTSD and hypochondriasis

Question 1

What is bodily distress disorder (somatisation disorder) ?

Answer 1

the tendency to experience and communicate psychological distress as bodily/physical symptoms, and seek medical help for them.

Question 2

what are the symptoms of bodily distress disorder/somatisation disorder ?

Answer 2

• repeated presentation to healthcare with medically unexplained symptoms
• chronic presentation
• usually a long history of multisystem investigations without a diagnosis
• presents before 40 usually
• usually associated with comorbidities e.g anxiety or depression

Question 3

What is the difference between somatisation disorder and hypochondriasis ?

Answer 3

somatisation: concerns surrounding relief from symptoms presenting in various areas of body that are medically unexplained

hypochondriasis: rumination and fear that minor symptoms are a sign of serious disease

Question 4

What is the female:male ratio of somatisation disorder ?

Answer 4

5:1
female:male

Question 5

What is the female:male ratio of hypochondriasis ?

Answer 5

1:1

Question 6

What are some common psychiatric comorbidities associated with somatisation disorder ?

Answer 6

• depression
• emotionally unstable personality disorder/borderline personality disorder

Question 7

What are some common psychiatric comorbidities associated with hypochondriasis ?

Answer 7

• GAD (>50% of patients have GAD)
• depression
• OCD
• panic disorder

Question 8

What are some key features of a persons history/past that are commonly seen in somatisation disorder ?

Answer 8

• childhood illness
• parental preoccupation with illness
• childhood emotional/sexual abuse

Question 9

What are some key features of a persons history/past that are commonly seen in hypochondriasis ?

Answer 9

• childhood illness
• parental preoccupation with illness (with excess medical attendance)
• childhood emotional/sexual abuse
• neglect

Question 10

What are usually the difference in focus/concerns of the patient that is presenting with:
a) somatisation disorder ?
b) hypochondriasis ?

Answer 10

somatisation: current symptoms and relief from these, often indifferent to cause

hypochondriasis: investigation for underlying condition with concerns of something sinister/serious

Question 11

What is the insight of a patient suffering with somatisation disorder usually like ?

Answer 11

patient doesn’t mind if investigations are inconclusive and remains focussed on experience of symptoms and requesting relief.

Question 12

What is the insight of a patient suffering with hypochondriasis usually like ?

Answer 12

tends to be able to accept that worries are groundless, but unable to stop dwelling on them still.

unreassured by investigation findings and fears doctor has missed the underlying cause.

Question 13

What is the treatment for somatisation disorder and hypochondriasis ?

Answer 13

• CBT / talking therapies
• antidepressants for associated anxiety/depression

Question 14

What are 3 rating scales used in primary care to measure severity of depression and anxiety ?

Answer 14

• HAM-D (hamilton rating scale for depression)
• MADRS (montgomery-asberg depression rating scale)
• BPRS (brief psychiatric rating scale)

Question 15

What is the treatment for PTSD ?

Answer 15

• watchful waiting (mild PTSD)
• antidepressants
• CBT
• EMDR (eye movement desensitisation and reprocessing)

Question 16

What is EMDR (eye movement desensitisation and reprocessing)?

Answer 16

a therapy involving repeated rapid eye movement side to side (replicating REM sleep) that reframes the intensity of the memories to decrease their negative impact

Question 17

How many sessions of EMDR are recommended ?

Answer 17

6-12 sessions of 60-90 mins

Question 18

What are some possible adverse effects do EMDR ?

Answer 18

• sleep disturbance
• vivid dreams
• feeling more sensitive
• possible temporary increase in distress