10 13 2014 Somatization

Question 1

Somatization

Answer 1

behavior that results from bodily sensations or experiences

Question 2

Somatic symptom disorder

Answer 2

Characterized by one or more physics symptoms accompanied by:

1. disproportionate/ persistent thoughts about the seriousness of the disease
2. Excessive time or energy devoted to addressing the symptoms

Patient is not faking it, they may be exaggerating or misinterpreting body sensation
* cultural expression of mood and anxiety (asian and hispanics are not allowed to complain of objective symptoms but they can complain for physical ailments

Question 3

somatic amplification

Answer 3

seen with somatic symptom disorder

• decrease in the pain threshold
• very common for depressed patients

_greater tendency to report symptoms and indicate a disease

Question 4

Alexthymia

Answer 4

A- not
lex- read
Thym- feelings

-unable to be aware of one’s own feelings

Question 5

Complications of Somatic symptom disorder

Answer 5

1. unnecessary tests
2. unnecessary treatments : medication
3. unnecessary surgeries

Question 6

Illness anxiety disorder

Answer 6

same a somatic symptom disorder BUT without or mild somatic symptoms.
- preoccupation/ anxiety about an illness

Must persist for at least 6 months

Question 7

Conversion disorder

Answer 7

Sudden, dramatic loss of sensory or motor function (blindness or paralysis) often associated with a stressful life event.

More common in unsophisticated adolescents and young adults

Patients appear relatively unworried ( “ la belle indifference”)

Question 8

Psychological factors affecting other medical conditions

Answer 8

1. Emotional or behavioral issues that negatively impact medical problem
   - influencing course of illness
   - interfering with treatment
   - Adding a risk factor
   - Influencing underlying pathophysiology

NOT DIAGNOSIS IF ANOTHER DIAGNOSIS CAN BE MADE (tobacco use disorder)

Question 9

Fastitious Disorder (AKA Munchausen’s Syndrome)

Answer 9

Individual intentionally and falsely seeks medical attention either by faking an illness or causing harm to himself or herself to create an illness.

Persist despite lack of rewards.
Person knows that they are causing the illness.

Their goal is to be in the sick role.

Morbidity and mortality is a concern because of dire self-harm and complications of unnecessary medical and surgical interventions.

Question 10

Fatitious disorder by proxy

Answer 10

Usually biological mother (parent/guardian) induce illness in a child.

• CHILD ABUSE!

Person tends to have borderline personality disorder and has a background in health care. Goal is to be the provider.

Treatment: remove child and give psychotherapy to the perpetrator

Question 11

Pseudocyesis

Answer 11

fake pregnancy

may have all the symptoms but just are not pregnant.

Question 12

Strategy for the treatment of Somatic symptom and related disorders:

Answer 12

1. primary care physician is quarter back
2. schedule visits regularly (don’t want patient to feel that the only way to see you is when they are sick)
3. Focus evaluation on new symptoms
4. Goal of treatment = improve function not cure

Educate patient on condition and address co-morbid psychiatric conditions ( depression and anxiety)
- be careful with medication because patients tend to be sensitive to side effects ( somatic amplification)

Question 13

Malingering

Answer 13

faking an illness for secondary gain

- NOT a psychiatric disorder

Question 14

What are risk factors for malingering?

Answer 14

1. antisocial personality disorder
2. medical-legal situations

Presence of medical or psychiatric diagnosis does NOT exclude malingering