Somatoform Disorders and Eating Disorders

Question 1

what are somatization disorders

Answer 1

psychiatric disorders characterized by presence of somatic (physical) complaints
symptoms typically medically unexplainable and cause significant distress

Question 2

what are types of somatization disorders

Answer 2

Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion Disorder
Factitious Disorder

Question 3

what are clues to the presence of a somatization disorder?

Answer 3

vague history of present illness
inconsistent history
symptoms out of proportion to possible dx
symptoms rarely alleviated with tx
patient avoids physical exam
patient avoids providing previous records
frequent complaints of medication side effects
receiving care from multiple providers
extensive work-up with no diagnosis
multiple medial diagnosis on PMH

Question 4

What is Somatic Symptom Disorder

Answer 4

aka Hypochondriasis
Females equal to or greater than males
avg age onset: 20-30 years
higher prevalence in pts with functional disorders (IBD, fibromyalgia, CFS)
many have co-occuring depression/anxiety

Question 5

What are common symptoms of Somatic Symptom Disorder

Answer 5

Neuropsychiatric: memory impairment, numbness/tingling, impaired coordination
cardiopulmonary: dizziness, pleuritic chest pain, palpitations
Gastrointestinal: biliary colic, stomach cramps, IBD
Genitourinary: sexual dysfunction, pelvic cramps, urinary dysfunction
MSK: weakness pain, spasms
Sensory: blurred vision, tinnitus, hearing loss
Endocrine: hair loss, feeling hot or cold

Question 6

what are screening tests for Somatic Symptom Disorders

Answer 6

PHQ-15 survey
Somatic Symptom Scale -8

Question 7

What is conversion disorders

Answer 7

characterized by medically unexplained neurologic or motor symptoms
AKA functional Neurologic Symptom Disorders
- DOES NOT include pain
- symptoms more often evident on PE, but dont fit with known medical disorders

Question 8

what are common symptoms of conversion disorders

Answer 8

weakness - paralysis, tics/tremors, other involuntary movements
tingling - numbness/ spasms
incoordiantion (falls) - ataxia, pesudoseizures, inability to ambulate
inability to speak (aphonia) - vision loss, hearing loss, slurred speech,
urinary retention - syncope, ‘lump in throat’, inability to swallow

Question 9

when does conversion disorder typically begin

Answer 9

onset in late childhood to early adulthood
F> males (2:1)
higher incidence in: low SES, rural areas, Low education levels

Question 10

what is the prognosis of conversion disorder

Answer 10

primary episodic with longer symptom free intervals
more transient that somatic episodic disorders
often spontaneous resolution of symptoms

Question 11

what is illness anxiety disorder

Answer 11

characterized by excessive worry over having or getting an illness
+/- associated symptoms
epidemiology ill defined

Question 12

what is the prognosis of Illness anxiety disorder

Answer 12

unclear
likely chronic with exacerbations

Question 13

What is factitious disorder

Answer 13

aka munchausens syndrome
INTENTIONAL production or reigning of symptoms/illness
MAY appear medically explainable
not motivated by some secondary gain
can be induced in one’s self or another person (munchausen’s by proxy)

Question 14

what is the presentation of factitious disorder

Answer 14

often presents in early adulthood - middle age
M>F
healthcare workers are at higher risk

Question 15

what are ways patient may induce illness in factitious disorder

Answer 15

injection of a contaminated substance to induce infection
contaminating lab samples
secretive use of medications that aren’t indicated
self-inflicted wounds or worsening of surgical wounds

Question 16

how are somatization disorders diagnosed

Answer 16

diagnosis of exclusion
undertake only LIMITED work-up
Schedule regular visits for reassurance

Question 17

what is the treatment of somatization disorders

Answer 17

cautiously discuss relationship to anxiety/emotional state: exception- factitious disorder - patient should be confronted, may end symptoms
avoid surgery, procedures and medications: SSRIs show to be somewhat helpful
consult psychiatry - initiate CBT

Question 18

what are types of eating disorders?

Answer 18

anorexia nervosa
bulimia nervosa
binge-eating disorder

Question 19

what is anorexia nervosa

Answer 19

most commonly diagnosed in adolescence (14-18)
F>M (10-20x)
associated with several other psychiatric diagnoses
higher prevalence with occuaptions/sports that require control of body weight

Question 20

what is anorexia nervosa associated with

Answer 20

NT, hormonal and brain changes

Question 21

what is a patients BMI with a severe anorexia nervosa

Answer 21

BMI 15-15.99

Question 22

if a patient with anorexia nervosa presents with a BMI of 12-18.5 what is the severity level of their disorder

Answer 22

mild anorexia

Question 23

what is the treatment of anorexia nervosa

Answer 23

mostly outpatient
no effective pharmacologic treatment - should treat comorbid psych disorders
CBT and MANTRA

Question 24

what is MANTRA

Answer 24

Maudsley Anorexia Nervosa Treatment for adults - 12 months, family based therapy

Question 25

who gets inpatient treatment with anorexia nervosa

Answer 25

severe disease (BMI < 16)
hypotension or hypothermia
electrolyte imbalances
suicidal ideation or psychosis
failure of outpatient treatment

Question 26

what is the prognosis of patients with anorexia nervosa

Answer 26

25-40% will achieve remission
other proportion will remain symptomatic
untreated anorexia - mortality rate 5/1,000

Question 27

what is refeeding syndrome

Answer 27

if someone in starvation is fed too much, too quickly it may result in:
- hypophosphatemia
-hypomagnesemia
-hypokalemia
-thiamine deficiency
-salt and water retention

Question 28

what is bulimia nervosa

Answer 28

more common than anorexia
F>M
tends to develop later than anorexia (late adolescence to early adulthood)
more likely to be normal weight

Question 29

what are high risk groups for bulimia nervosa

Answer 29

high achievers, parental neglect, history of depression, SUD

Question 30

what is the bulimia nervosa cycle

Answer 30

binge, interruptions or feelings of physical discomfort, guilt, depression, self-disgust, compensatory behaviors, symptom free interval, binge loop

Question 31

when is bulimia nervosa considered extreme

Answer 31

14+ episodes of compensatory behaviors per week

Question 32

what are subtypes of bulimia nervosa

Answer 32

purging: self-induced vomiting, laxatives, diuretics
non-purging: dieting/fasting, exercise, common in higher BMI

Question 33

what are less common medical complications of bulimia nervosa

Answer 33

electrolyte disturbances (hypokalemia)
dehydration
elevated amylase levels, pancreatitis
menstrual irregularities or amenorrhea
hypotension/bradycardia
esophageal/gastric tears

Question 34

what is the treatment of bulimia nervosa

Answer 34

most treated outpatient
less likely to need hospitalization than anorexia

Question 35

what is binge-eating disorders

Answer 35

most common
F>M
usually older age at onset
more likely to be overweight
significant overlap with bulimia

Question 36

what are the goals of eating disorder treatments

Answer 36

restore normal body weight
change restrictive/binging/purging behaviors
therapy: CBT, behavior changes, group/individual psychotherapy, family therapy