Flashcards in 23. Somatoform Disorders Deck (43)
what are the 3 distinct clinical disorders that are very similar to each other in this area?
not a mental disorder. represents a conscious faking of sx in order to obtain a conscious goal.
define factious disorder
conscious attempt to simulate illness, by falsifications of sx or direct intervention to produce physical signs (injecting air into tissues to simulate gas forming infection)
somatoform disorders: conscious? lying? self-harm?
NOT conscious, does not involve lying or deliberate self-harm
with somatic complaints, what else might be going on?
depression and anxiety can present with somatic complaints as the most prominent symptoms. also, anxiety, substance abuse, psychotic disorders, dementia, personality disorders
somatoform disorders: general overview?
symptoms suggest general medical disorders, but no underlying disease can be demonstrated, no evidence that the patient is faking it or inducing clinical data. plea for human contact and support rather than a form of manipulation.
what are primary goals of treatment of somatoform disorders?
avoiding unnecessary diagnostic procedures, relief of suffering
what parts of the history may tip us off about somatoform disorders?
a long history of being a patient, intense interest in details of sx, vague ailments, doctor shopping.
psychological probing of someone with a somatoform disorder may reveal what?
masochism, guilt, dependency, hostility, anger.
what are the various types of somatoform disorders?
-unndifferentiated somatoform disorder
-body dysmorphic disorder
-delusional d/o, somatic type
-psych factors affecting med condition
-MDD with psychotic sx
-DSM5: illness anxiety, with care avoidance or care excess
hypochondriasis: patient cognitions?
preoccupation with belief that they have a terrible disease, which dominates their interactions with clinicians. normal sensations are magnified.
usually presents with a detailed, obsessive history of sx.
NOT a delusional disorder (may be able to reality test, change focus)
ongoing relationship with an empathetic caregiver. scheduled appointments without requirement of a symptom to present.
CBT good adjunct
somatization disorder: age of onset?
adolescence or early adulthood (prior to age 30)
somatization disorder: definition?
drama, onset prior to 30y, multiple vague symptoms commonly affecting GI, CV, reproductive and neuro systems (must affect all of these systems at different times)
somatization disorder: past history that is common?
psychiatric disorders, substance abuse, sociopathy
somatization disorder: treatment
management rather than cure. frequent scheduled visits, emotional support, minimized tests/meds. psychotherapy may or may not be useful; pt has to be willing and have insight
CBT may be good
undifferentiated somatoform disorder (NOS)
one or more complaints that cannot be accounted for by a known medical condition, persist for more than 6 months. usually vague sx, like fatigue, weakness, loss of appetite.
conversion disorder: def
alteration in physical functioning involving the sensory or voluntary motor system. expression of psych conflict rather than a disease.
excludes PAIN or sexual dysfunct.
preceded by stress/conflict
conversion disorder: required for dx?
linkage to psychological stressors or conflict is required for diagnosis.
conversion disorder: what does it represent?
classically represents attempt by the sufferer to communicate a conflict via somatic means something which cannot be expressed verbally.
what is primary gain?
function of the system to keep a psych conflict or need out of conscious awareness.
what is secondary gain?
funtion of the system to relieve the patient of some obligation or activity, or to receive care which otherwise might not be offered.
when are conversion disorders common?
in the course of chronic illness, esp in individuals with conflict about dependency.
pain disorder: definition?
a conversion disorder in which pain is the only symptom. psychological factors are presumed to play a role in the onset, severity, exacerbation of the pain
-may also be a medical condition, but pain is exacerbated by psych factors
pain disorder: treatment?
most effective treatment is prevention. many cases of somatoform disorder start with acute painful conditions (ie disc disease). effective pain management can help reduce pain behaviors.
body dysmorphic disorder: definition
continuing preoccupation with a defect in appearance. becomes dominant in daily life, affects functioning.
Factitious Disorders v. Malingering: general difference?
both imply voluntary production of symptoms. FD: motivation is an unconscious need to be a patient. Malingering: motivation is need to achieve a clear secondary gain (narcotics, compensation for PTSD).
Factitious Disorders v. Malingering: which is more voluntary?
FD is thought to be more voluntary. Best viewed as a form of compulsive behavior. Ex: pt swallowed open safety pins.
Factitious Disorder by Proxy: definition?
FD by proxy = rare, the patient describes or produces sx in a child who is brought in for treatment.
Factitious Disorders: treatment
difficult, unlikely to be cured. can be terminal. psych referral. may use CBT, group therapy.
is malingering a psych dx?
NO, it is not a psychiatric disorder, it is lying/manipulating; intentional production for secondary gain.
commonalities among somatoform disorders?
-physical sx or concern about physical sx
-not fully explained by medical illness or other psych d/o
-symptoms NOT intentionally produced or feigned
-symptoms cause distress/impairment
what is La belle indifference? in what disorder does it present?
indifference to symptom - pt may not be anxious about being blind, for ex
presents in conversion disorder
in what disorder can pts have pseudoseizures?
10-60% of pts with pseudoseizures also have epilepsy
conversion d/o? recovery rates?
usually 90% even without treatment. blindness/paralysis just get better on their own
pain disorder is associated with what other psych disorders?
mood disorder, anxiety disorder
pain disorder: tx?
maintain activity (PT/OT)
regular visits, reassurance.
body dysmorphic disorder: what else could it be, particularly if there is low insight?
delusional disorder, somatic type
classic case: female nurse with hypoglycemia. insulin has been self-administered.
Factitious disorder, physical type
how has the classification of Factitious disorder changed from DSM4 to DSM5?
in DSM5 it is in the somatoform chapter. DSM4: not considered a somatoform disease.
what is the primary driver in factitious disorder?
to be a patient/under medical care. sx may be psychological or physical or both.