Week 11 - Somatoform Disorders

Question 1

Experiencing and reported physical symptoms for which there are no discoverable organic causes or for which the organic factors which are present are insufficient to explain symptoms

Answer 1

Somatisation

Question 2

• A preoccupation with the fear or belief of having a serious illness, based on misinterpretation of benign physical signs or sensations as evidence of disease

Answer 2

Hypochondriasis

Question 3

Typical symptom duration for DSM-V Somatic symptom disorder

Answer 3

At least 6 months

Question 4

Conversion

Answer 4

One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition

Question 5

Examples of conversion

Answer 5

• Paralysis

- Loss of sensation

Question 6

Duration of hypochondriasis

Answer 6

At least 6 months

Question 7

• Preoccupation with an imagined defect in appearance

- If a slight physical anomaly is present, the person’s concern is markedly excessive

Answer 7

Body dismorphic disorder

Question 8

Common functional cardiorespiratory symptoms

Answer 8

• Breathlessness
• Palpitations
• Fatigue
• Dizziness

Question 9

• The patient commonly reports an inability to ‘get air into the lungs’
• Associated with visible or audible signs
• Situational breathlessness

Answer 9

Clinical characteristics of psychosomatic breathlessness

Question 10

• Sinus tachycardia or benign ventricular premature beats

- Enhanced awareness of their own heartbeat

Answer 10

Clinical characteristics of psychosomatic palpitations

Question 11

• May fluctuate throughout the day
• Often much worse after relatively minor exertion
• Frequently a chronic debilitating symptom

Answer 11

Clinical characteristics of psychosomatic fatigue

Question 12

• Obvious signs & gasping respiration
• respiratory tics (e.g. throat clearing)
• Inability to lie flat without bringing on gasping and chest tightness

Answer 12

Common physical signs in non-cardiac chest pain

Question 13

Aspects of assessment

Answer 13

• Expectations?
• History
• Patient attitudes about their symptoms
• Hyperventilation provocation test

Question 14

Aspects of management

Answer 14

• Plausible explanation
• Teach controlled breathing
• Minimise doctor-shopping
• Minimise use of drugs that can make it worse

Question 15

Controlled breathing technique

Answer 15

• Breath through nose rather than mouth
• Use diaphragm & move abdomen
• Hold breath for 10 seconds
• breath in and out while slowing counting to 3

Question 16

What kind of therapy is this:

• Attempt to replicate their symptoms by exersice, hyperventilation or breath holding
• Help them to reattribute their somatic symptoms
• Target avoidance
• Help them develop better coping strategies

Answer 16

CBT