wamss notes somatic disorders

Question 1

somatic symptom disorder

Answer 1

Symptoms that cannot be explained by a physical illness or injury, substance or mental illness that the patient feels as real and causes the pt anxiety/concern
Somatic: relating to or affecting the body, distinguished from the mind

Question 2

criteria of somatic symptoms disorder

Answer 2

A. One or more somatic symptoms that are distressing or result in significant disruption of daily life
B. Excessive thoughts, feelings or behaviours related to the somatic symptom as manifested
by at least one of:
1. Disproportionate & persistent thoughts about the seriousness of Sx
2. Persistently high levels of anxiety about Sx
3. Excessive time or energy devoted to these Sx or health concerns
C. Although any one somatic symptom may net be continuously present, the state of being
symptomatic is persistent typically for >6 months

Question 3

how is somatic symptom disorder different from factitious disorder

Answer 3

Factitious disorder: deliberately producing or feigning symptoms

Question 4

how is somatic symptom disorder different from malingering

Answer 4

Malingering: fabricating or exaggerating symptoms for secondary gain

Question 5

how is somatic symptom disorder different from illness anxiety disorder

Answer 5

Illness Anxiety disorder: anxious about having a serious disorder based on minor signs

Question 6

how is somatic symptom disorder different from conversion disorder

Answer 6

Conversion disorder: production of the symptoms are unconscious

Question 7

Tx for somatic symptom disorder

Answer 7

Often a chronic condition: management
Analgesic medications generally not helpful
Psychotherapy- CBT: Nil single Psychotherapeutic modality is effective with all pts
Validation of the pts experience
Referral: Pain clinic, physiotherapy
SSRI & TCA some evidence

Question 8

illness anxiety disorder

Answer 8

Preoccupation and anxiety about having a serious disorder based on minor signs and
symptoms and negative test results
The pts distress emanates not primarily from the physical complaint itself but rather from
their anxiety of the cause of the complaint
Formerly known as hypochondria

Question 9

criteria for illness anxiety disorder

Answer 9

A. Preoccupation with having or acquiring a serious illness
B. Somatic Sx are not present or are only mild
C. High level of anxiety about health
D. Pt performs excessive health-related behaviours (repeated checks) or maladaptive
avoidance (avoids doctors)
E. Illness preoccupation present for at least 6 months

Question 10

specifiers of illness anxiety disorder

Answer 10

Care-seeking type
Care-avoidant type

Question 11

Tx of illness anxiety disorder

Answer 11

Negative test results – only reassure a pt for a short amount of time
Regularly schedule doctor appointments rather than relying on multiple ‘as needed’ visits
Complaints and concerns taken seriously
Unnecessary test not performed to reassure the pt
CBT or relaxation techniques – some evidence
Treat comorbid mental illness

Question 12

factitious disorder

Answer 12

Falsification of medical or psychological signs associated with the intent of deception
This is in contrast to somatic and conversion disorders in which the underlying conflicts &
production of symptoms are unconscious

Question 13

criteria for factitious disorder

Answer 13

A. Falsification of physical or psychological signs or symptoms or induction of injury or
disease, associated with identified deception
B. Pt presents themselves to others as ill, impaired or injured
C. The deceptive behaviour is evident in the absence of external rewards

Question 14

specific types of factitious disorder

Answer 14

Munchausen Syndrome: factitious disorder involving repeated episodes seeking admission to
hospital
Factitious Disorder by Proxy: The individual presents another individual (victim) as ill
The perpetrator not the victim receives the diagnosis
Pseudologia Phantastica: behaviour of habitual or compulsive lying
Malingering: fabricating or exaggerating symptoms for secondary gain

Question 15

conversion disorder

Answer 15

functional neurological symptom disorder
Patients that present with neurological symptoms such as numbness, blindness, paralysis or
seizures which are not-consistent with organic causes that can be traced back to a
psychological trigger

Question 16

criteria for conversion disorder

Answer 16

A. One or more Sx of altered voluntary motor or sensory function.
B. Nil clinical findings of recognisable medical or neurological conditions
La Belle Indifference: Inappropriate lack of concern about ones illness

Question 17

La Belle Indifference:

Answer 17

Inappropriate lack of concern about ones illness

Question 18

motor symptoms of conversion disorder

Answer 18

weakness, paralysis, abnormal movements- tremor, dystonia, gait abnormalities, abnormal limb posturing

Question 19

pseudoseizures in conversion disorder

Answer 19

episodes of abnormal limb shaking with ‘apparent’ impairment of consciousness. EEG activity is normal during the seizure, there is not post ictal period & the frequency does not diminish with anticonvulsant Tx

Question 20

sensory symptoms in conversion disorder

Answer 20

reduced sensation, vision or hearing abnormalities

Question 21

cause of conversion disorder

Answer 21

Often occur in relation to a particular stressor
Often associated with other mental illness

Question 22

Tx of conversion disorder

Answer 22

Exclusion of medical cause
Management of comorbid mental illness
Psychotherapy & CBT