Somatoform

Question 1

Major difference between somatization & conversion disorder

Answer 1

• somatization: complaints of different systems of the body; distressed by their sx
• conversion: usually only complain of sx from one body systems, they don’t appear to be bothered or are indifferent about them

Question 2

Major difference between somatization & illness anxiety disorder

Answer 2

• Illness anxiety disorder worries about getting a disease
• Somatic symptom disorder worries about getting the
• *worst possible disease**
• if symptoms of anxiety last longer than 6 months it is typically illness anxiety disorder

Question 3

Major difference between factitious disorder and malingering

Answer 3

• The presence of a clearly definedable goal or external motivation for their behavior is present in malingering
• Factitious disorder will consciously produce the symptoms however there is no conscious motivator/secondary gain

Question 4

Describe the symptoms of somatic disorder

Answer 4

• Patients believe these are real (they are distressing & impairing)
• 10-15% of PCP visits

(diiferentiates from malingering & facticious)

Question 5

Somatic Symptom Disorder Specifiers (5)

Answer 5

1. With predominant pain
2. Persistent (sx for 6 months)
3. Mild: 1 sx from criteriorn B
4. Moderate: 2 + sx from criterior B
5. Severe: 2 + sx from criterion B + multiple somatic complaints (or one very severe one)

Question 6

Define primary gain

Answer 6

Unconscious expression of unacceptable feelings as physical symptoms to avoid facing them

Question 7

Define secondary gain

Answer 7

–Use of symptoms to benefit the individual (attention, avoid or reduce responsibility, financial reward, avoid legal responsibility)

Question 8

Somatic symptom disorder: cognitive risk factors (3)

Answer 8

1. Sensitization to pain
2. Heightened attention to bodily Sensations
3. Attribution of bodily symptoms to possible medical illness

Question 9

Somatic symptom disorder has a history of _____

Answer 9

somatizing in the past

Question 10

Somatic symptom disorder symptoms persist for _______ (how long).

Answer 10

6 months

Question 11

Somatic symptom disorder: symptoms and treatments become _______.

Answer 11

central to their lives

Question 12

Cultural factors associated with somatic symptom disorder (2).

Answer 12

1. Culture dictates treatment seeking for these issues
2. Example of idioms of distress: burnout, gas, too much heat in the body, burning of the head

Question 13

Somatic symptom disorder treatments

Answer 13

1. Antidepressants (SSRI, SNRI, TCA)
2. CBT
3. Relaxation techniques

(DO NOT give opioids)

Question 14

CBT for somatic symptom disorder focuses on :

Answer 14

1. Alleviate rather than eliminate the symptoms
2. Minimize impairment
3. Encourage assertiveness and caring for themselves

(you can write in the chart that you provided reassurance; multidisciplinary approach)

Question 15

Somatic symptom disorder patients may require frequent appointments for _____.

Answer 15

Reassurance: it helps them to know that you care by examining them and reassuring them that they are not going to die from anyting in the immediate future

(you may see them once per week until their symptoms decrease. This will also save them from unnecessary ER visits; taxing the healthcare system)

Question 16

Define illness anxiety disorder

Answer 16

Patient expresses anxiety about becoming ill

(impairment is due to fear rather than symptoms- if there are sx, they are mild; this used to be called hypochondriasis)

Question 17

Illness anxiety disorder specifiers

Answer 17

1. Care-seeking type: Medical care, including physician visits or undergoing tests and procedures is frequently used.
2. Care-Avoidant type: Medical care is rarely used

Question 18

Illness anxiety disorder: general management (3)

Answer 18

1. Frequent chest check-ups until they get better
2. Have them bring a list of concerns → address each one
3. How to tune out normal bodily sensations

(essentially: you’re coaching them; be empathetic to fears, do NOT tell them ‘its all in your head’)

Question 19

Illness anxiety disorder treatment

Answer 19

Same as somatic symptom disorder + Psychoeducation

(somatic symptoms disorder tx: relaxation tech., meds, CBT)

Question 20

Conversion disorder specifiers: 3 categories

Answer 20

1. Type symptoms
2. Length: acute/persistent
3. Stress: with or w/o psychological stress

Question 21

Illness Anxiety Disorder: length of time specifier

Answer 21

1. acute: less than 6 months
2. persistent: more than 6 months

Question 22

Conversion disorder specifiers : type of symptoms (1st category) (6)

Answer 22

1. Abnormal movement
2. Attacks or seizures
3. Anesthesia or sensory loss
4. Weakness or paralysis
5. Mixed symptoms
6. Swallowing symptoms

Question 23

What is the most common kind of conversion disorder

Answer 23

Pseudoseizures

(they will display indifference to symptoms)

Question 24

How is conversion disorder established?

Answer 24

1. ruling out other medical or neurological illness
2. identify psychological factors involved in sx

(pts have difficulty discussing or identifying emotions and feelings; they don’t recognize major stressors)

Question 25

Conversion Disorder treatment (5)

Answer 25

1. Therapy: stress mgmt
2. Physical therapy (may preserve dignity allow allow conversion sx to dissipate)
3. Hypnosis
4. Reassurance
5. Meds
6. CBT

(bottom 3 also for the somatic sx disorder and illness anxiety disorder)

Question 26

Which conditions consist of a patient to mimicking physical and emotional illness are amnesia?

Answer 26

Factitious disorder and malingering

(Sometimes they don’t know why they’re doing it. It requires a lot of empathy and understanding to treat them)

Question 27

Munchausen syndrome

Answer 27

Patients moved from hospital to hospital simulating various illness

Question 28

Munchausen by proxy

Answer 28

Parent induces are stimulates illness in his or her child so that the child’s repeatedly hospitalized

(this is child abuse⇒must protect them; both will require psychotherapy)

Question 29

Strategies patient use to feign illness

Answer 29

1. Report symptoms suggesting an illness, without having them
2. Produce false evidence of an illness
3. Intentionally produce symptoms of an illness

Question 30

Factitious disorder etiology

Answer 30

Emotional deprivation from absent or inattentive parents → patient may recreate nurturing atmosphere from caregivers

Question 31

Which of these disorders is conscious unconscious?

Answer 31

Malingering is the only one that is conscious

Question 32

Somatic symptom disorder or anxiety illness disorder are the only ones who _________ (consiously/unconsciously) produce their symptoms.

Answer 32

Unconsciously

Question 33

Factitious disorder clues (5)

Answer 33

1. Medical hx does not correspond to the pt’s health & vigor
2. Textbook clinical presentation
3. Sophisticated medical vocabulary
4. Demand specific medications are treatments
5. Excessive surgical history

(do not jump to conclusions. this is a delicate situation)

Question 34

Factitious disorder treatment (4)

Answer 34

1. Diagnose them (avoid unnecessary procedures)
2. Legal consultation
3. Obtain sufficient evidence→ attending physician and Consulting psychiatrist confront patient
4. Supportive psychotherapy

Question 35

Malingering

Answer 35

Intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives

(not a DSM-5 disorder)

Question 36

Motivations for Malingering (2)

Answer 36

1. Avoiding: military conscription or duty, work, ciminal charges
2. Gain: financial compensation, drugs, better living conditions

(ex: its hot out or cold out and they don’t have shelter, they’ll go to the ER & say they’re suicidal)

Question 37

Malingering Clues (4)

Answer 37

1. Symptoms vague, subjective & unverifiable
2. Discrepancy between claimed disability & findings
3. Lack of cooperation (dx & trmt process)
4. Legal trouble

Question 38

_______ is the most common personality disorder to perpetrate malingering

Answer 38

Antisocial personality disorder

Question 39

Malingering treatment

Answer 39

No consensus; there is a fine line: confrontation may lead to better deception in the future, the patient is ill may allow for giving up symptoms and response to treatment (they have to play along)