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Psychiatry > Feb. 20 > Flashcards

Feb. 20 Flashcards

1
Q

Somatization

A
  • 2 complementary conditions
    1) physical complaints without any demonstrable physical findings
    2) the presence of psychosocial factors sufficient to initiate, maintain, or worsen the physical complaints
  • GI, sexual function, “pseudoneurological”, pain
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2
Q

Conversion Disorder

A

-Alteration or loss of physical functioning without explanatory pathology (focal paralysis non-epileptic seizures)

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3
Q

Body Dysmorphic Disorder

A

-pre-occupation with minor or imagined physical flaw, deformity, “imagined ugliness”

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4
Q

Factitious Disorder

A

-Purposeful self infliction of signs of illness or injury to elicit medical attention and care

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5
Q

Malingering

A

-purposeful self injury, infliction, of feigning of illness to escape punishment or achieve financial or other compensation

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6
Q

Somatoform Disorder NOS

A

-somatization that does not meet criteria for another disorder

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7
Q

Hypochondriasis

A

-conviction one has a particular disorder despite no evidence

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8
Q

Psychosomatic Disorders

A
  • conditions where stress plays a major role

- colitis, arthritis, asthma, ulcers, neurodermatitis, HTN, anorexia

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9
Q

Cognitive Behavioral Therapy

A

1) educate people about functioning of body’s stress response
2) explaining that “symptoms” patients are experiencing are normal stress responses
3) helping patients accept that they are misinterpreting bodily sensations as ominous
4) acknowledging stressor events as contributory causes of distress
5) suggesting that focusing on resolving or managing the stress will relieve the problem

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10
Q

Conversion Symptoms

A

-often respond to the exploration on underlying conflict when the person is in a deeply relaxed state such as hypnosis

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11
Q

Somatic Symptom & Related Disorders

A
  • somatic symptom disorder
  • illness anxiety disorder (hypochondriasis)
  • conversion disorder (functional neurological symptom disorder)
  • psychological factors affecting other medical conditions
  • factitious disorder
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12
Q

Obsessive-Compulsive Disorders

A
  • OCD
  • body dysmorphic disorder
  • hoarding disorder
  • trichotillomania (hair-pulling)
  • excoriation (skin-picking)
  • body-focused repetitive behavior that causes significant impairment or distress (nail biting, lip chewing)
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13
Q

Adult Anxiety Disorders

A
  • Panic DO

- involve somatic symptoms, lead to search for medical care, but the symptoms follow a classic pattern

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14
Q

Somatic Symptom Disorders

A

-involve unusual preoccupation with a wide variety of somatic symptoms

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15
Q

Stress/Trauma Disorders

A

-often associated with somatic distress; may require modification of approach (“trauma informed care”)

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16
Q

OC Disorders

A

-seen in plastic surgery, general practice & dermatology

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17
Q

Characteristics of Somatic Symptom Disorder

A
  • may start early in life
  • women&raquo_space; men
  • multiple & shifting somatic symptoms, often dramatically described
  • chaotic life circumstances & abuse history is common
  • medically unexplained or only marginally explained symptoms
  • comorbid depression is common; often missed
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18
Q

Prevalence of Somatic Symptom Disorder

A
  • 5-7% of the general population
  • more common in rural areas and less educated patients
  • often related to recent stress, history of physical abuse, and/or sexual molestation
  • alexithymia
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19
Q

Alexithymia

A
  • inability to express feelings in words

- many patients with “unfounded” somatic complaints are unable to express emotional hurt, fear, anger, etc. in words

20
Q

Most common Somatization Symptoms

A

-nervousness
-back pain
-weakness
-joint pain
-dizziness
-extremity pain
-fatigue
(nausea, headache, dyspnea, chest pain, abdominal bloating, constipation)

21
Q

Presenting Complaints of Somatization

A
  • can involve any organ system
  • urgent & compelling presentation
  • alexithymia (inability to express feeling in words, genuinely unaware of emotional & stressful issues, or their impact)
  • often result in unnecessary or unhelpful prescriptions & operations
22
Q

DDX of Somatization

A
  • anxiety disorder (chest pains)
  • major depression
  • conversion disorder (neurological)
  • schizophrenia (somatic delusions)
  • malingering (lying about symptoms)
  • unrecognized medical problem (multiple sclerosis, cancer)
  • chronic stress
23
Q

Illness Anxiety Disorder (Hypochondriasis)

A
  • preoccupation with having or acquiring a serious illness, often in the absence of symptoms, or with minimal symptoms
  • one preoccupation at a time, such as HIV, cancer, -lasts 6 months or more, can’t be reassured
  • primary concern is the idea of being ill
  • if symptoms are present, the preoccupation is clearly excessive
24
Q

Conversion Disorder

A
  • symptoms typically look neurological (paralysis, seizures, tunnel vision, numb)
  • sx do not follow known neural pathways
  • not consciously feigned
  • causes sig. distress or impairment
  • often starts under overwhelming stress (funerals, family arguments, etc.)
  • approx. 5% of referrals to neurology clinics
25
Q

Treatment of Somatization

A
  • hypnosis (tend to be suggestible)
  • family counseling
  • cognitive behavior therapy z9reinforce healthy behavior & more effective problem solving)
  • physical therapy
26
Q

Factitious Disorder

A
  • patient feigns medical or psychiatric illness, with primary goal of getting admitted (or having child admitted) to hospital
  • ex: purposely-inflicted infections, faked lab findings (hematuria), claims of mental problems arising from “trauma” that never happened
  • behavior occurs in the absence of an external reward or gain
  • Patient engages in willful deception
27
Q

Factitious Disorder Imposed an Another

A
  • Muenchhausen’s by proxy
  • if a person imposes feigned illness on another (child, pet, elderly patient), the perpetrator is given this diagnosis
  • the victim may be given an “abuse” diagnosis
28
Q

Malingering

A

-patient also feings illness, but the potential rewards are obvious: insurance money, time off from work, discharge from jail into hospital care, etc.

29
Q

Dissociative Disorders (Amnestic States)

A
  • not considered “somatic symptom disorders” but also involve specific medical (cognitive) symptoms, related to overwhelming anxiety states
  • may look neurological and deserve a thorough workup
30
Q

Dissociative Amnesia

A

-sudden amnesia, often related to traumatic experiences

31
Q

Dissociative Fugue

A
  • sudden unexpected travel with inability to recall one’s past
  • often the patient does not know his own identity
32
Q

Depersonalization Disorder

A

-feeling like one is “on the outside looking in”

33
Q

Dissociative Identity Disorder

A

(multiple personality)

  • assuming one of several “identities” or alters when stressed
  • usually related to childhood trauma
  • controversial diagnosis
34
Q

Obsessions

A
  • recurrent, persistent, intrusive thoughts, impulses, or images
  • not simply excessive worries about real life problems
  • patients can’t ignore or suppress such thoughts, impulses, or images
  • patient recognizes that the thoughts, impulses, or images are a product of his/her own mind (not imposed from without as in thought insertion), but feels compelled to act on them
35
Q

Delusions

A

-unshakable false beliefs, firmly held

36
Q

Common Compulsions

A
  • checking, washing, counting, confessing, symmetry/precision, hoarding
  • > 50% have more than 1
37
Q

Body Dysmorphic Disorder

A
  • characterized by preoccupation (obsession) with imagined defects of face and body, & the compulsion to do something about it
  • patients are: frequent clients of plastic surgeons, consumers of “recreational surgery” (nose jobs, tummy tucks, breast surgery, face lifts, botox & silicone injections)
  • usually dissatisfied with the results, often start law suits
38
Q

Treatment of Somatic Symptom Disorders

A
  • encourage healthy living
  • good psycho-socal history, know patient as person, screen for depression/anxiety
  • do not get trapped into mind-body dualism
  • support, boundaries, calm reassurance, regular visits
  • adjunctive treatments (massage, support group, T’ai Chi, biofeedback)
  • meds & depression and anxiety
39
Q

Complementary & Alternative Medicine

A

-models, practices, & procedures that are generally regarded as lying outside the domain of contemporary biomedicine

40
Q

Complementary

A

-used in conjunction with

41
Q

Alternative

A

-used instead of convention medicine

42
Q

Classifications of Complementary Medicine

A

1) alternative medical systems (homeopathy)
2) Mind-body interventions (prayer)
3) Biologically-Based Therapies (diet supplements)
4) Manipulative/Body based methods (massage)
5) Energy Therapies

43
Q

Acupuncture

A
  • component of traditional Chinese medicine
  • consists of broad spectrum of interventions including herbal therapy, dietary therapy, Qi going exercises, tunia massage, and acupuncture/moxibustion
44
Q

Chirotrctic

A

-concerned with the relationship b/w the structure & function of the spine, and how it affects the nervous system and body function

45
Q

Subluxation

A

-loss of structural integrity

46
Q

adjustment

A

-joint manipulation

47
Q

Naturopathy

A

1) nature has power to heal, physicians role to enhance self-healing process
2) treat the whole person so that every aspect of patients natural defenses & function is brought into harmonious balance
3) “first do no harm” utilize methods that are non-toxic & non-invasive
4) identify & treat cause, in contrast to suppressing symptoms
5) prevention is important
6) doctors should be teachers & educate the patient about their health responsibility

Psychiatry (7 decks)

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