Carlson: Somatic Disorders

Question 1

Presence of physical symptoms
suggesting a medical condition
absence of explanatory physical findings
not caused by a substance
not caused by another medical condition
causes significant clinical distress or impairment in social/occupational areas

Answer 1

somatic symptom disorders

Question 2

Psychological factors usu present in somatic disorders

Answer 2

stress-related
dependency is a core issue
limited insight

Question 3

There is a suggestion that increased (blank) activity might be involved in somatic symptom disorders

Answer 3

limbic system

Question 4

T/F: Somatic symptom complaints will be present commonly in primary care settings

Answer 4

true

Question 5

T/F: Over-treatment of unexplained somatic complaints is common

Answer 5

true

**invasive work-ups, high costs of care, usual medical problems

Question 6

If a patient comes in and has symptoms that don’t seem explained, what should you do regardless?

Answer 6

you still have to rule out medical disorders and psychiatric disorders, like MS, SLE, ALS, etc

Question 7

What kinds of emotions might you feel toward pts with somatic symptom disorders?

Answer 7

fear of a missed diagnosis
frustrations
disgust
anger

Question 8

What is hypochondriasis now called?

Answer 8

Illness Anxiety Disorder

**anxiety associated w having an illness

Question 9

A. One or more somatic symptoms that are distressing or result in significant disruption of daily life
B. Excessive thoughts, feelings, or behaviors
C. Persistence of sx for 6 months
High level of anxiety about symtoms, and
Excessive time and energy spent
Disproportionate thoughts re seriousness of sx

Answer 9

Somatic Symptom Disorder

**also called Briquette’s Syndrome and Hysteria

Question 10

Somatic symptom disorder has been around for awhile… it used to be thought of as a result of…?

Answer 10

hysteria: misplacement of the uterus
or

related to demon possession in middle ages

Question 11

Who is more likely to get somatic symptom disorder?

Answer 11

females

Question 12

Associated w somatic symptom disorder…

Answer 12

depression
GAD
physical/sexual abuse
childhood illness

Question 13

When is the usu onset of somatic symptom disorder? How does it present?

Answer 13

teens; presentation dramatic, vague, complicated, manipulative, emotional

**chronic course, symptoms fluctuate with stress

Question 14

How to manage pts with somatic symptom disorder?

Answer 14

establish a relationship w empathy
see them at regular intervals
be careful about invasive procedures and addictive drug rx's
treat co-morbid psych illness
support from colleagues

Question 15

Symptoms or deficits affecting voluntary motor or sensory system
Blindness, paralysis, dysphonia, seizures
Onset often related to stress
Not intentionally induced
Can’t be explained by a medical condition, substance, or a culturally sanctioned behavior or experience

Answer 15

Conversion Disorder

**can be acute (6 months)

Question 16

Things that can occur w conversion disorder

Answer 16

weakness, paralysis
abnormal movements
swallowing problems
speech problems

Question 17

How does conversion disorder present?

Answer 17

onset following recent stress
symptom or deficit in voluntary motor system or sensory system
brief in duration
deficit makes little neurological sense
MSE: symptom indifference

Question 18

Conversion disorder may develop into (blank) in females; it is associated with (blank) in men

Answer 18

somatic symptom disorder; antisocial personality disorder

Question 19

What conditions make the prognosis of conversion disorder better? Which conditions make it worse?

Answer 19

paralysis, aphonia, blindness; worse with tremor and seizures

Question 20

How to treat conversion disorder?

Answer 20

supportive psychotherapy
determine stressors
help patient problem solve
positive expectations

Question 21

Preoccupation with fears of having a serious disease based on misinterpretation of bodily symptoms
Not of delusional intensity
Preoccupation persists after workup and reassurance
Duration at least 6 months
Care-avoidant type less frequent

Answer 21

Illness anxiety disorder

Question 22

When does illness anxiety disorder typically begin? Does it affect males or females more?

Answer 22

adulthood; both sexes equally

Question 23

This factor makes prognosis of illness anxiety disorder better

Answer 23

higher socioeconomic status

Question 24

What is this?

Fears having a serious illness related to a single body sensation
History of doctor shopping
Brings problem lists
Doubts physician competence
Creates insecurity in physician
Accepts extensive workups
MSE: excessive concern about illness and narrowed existential focus
Increased concern with negative workup

Answer 24

illness anxiety disorder

Question 25

How to manage illness anxiety disorder?

Answer 25

Develop a trusting relationship with one primary caregiver Reassure continued regular care R/O medical illness Treat any concurrent medical or psychiatric illness Do partial physical exam with each brief visit Avoid over-prescribing and excessive lab and diagnostic procedures Encourage health-related activities Eventually establish a stress-illness connection Consider SSRI Cognitive Behavioral Therapy Supportive Psychotherapy

Question 26

One thing you can ask patients to do is track their symptoms. What might you ask your pt to do?

Answer 26

track primary symptom four times daily at specific times; track other hypothesized symptoms as well like anxiety and pain; try to find a causal relationship b/w the symptoms

Question 27

What is factitious disorder?

Answer 27

Intentional production of symptoms with some level of conscious awareness to play a sick role

Question 28

What is the motivation behind factitious disorder?

Answer 28

sick role

Question 29

What are some false symptoms a patient with factitious disorder may present with?

Answer 29

``` report of symptoms: headaches, voices generating false evidence of illness (ex: manipulating thermometer) faking evidence (ex: taking warfarin to change blood clotting times) ```

Question 30

It's important to understand that factitious disorder is a disorder. What implications does this have?

Answer 30

it can be life threatening it can be due to underlying personality disorder pts may respond to treatment

Question 31

T/F: In patients with factitious disorder, their motivation for faking their illness is often unclear

Answer 31

True

Question 32

A type of factitious disorder Patient travels from hospital to hospital for treatment of factitious problems; seen often in children and other dependents

Answer 32

Munchaushen syndrome

Question 33

``` More conscious motivation Intentional production of signs and symptoms Clear external incentives Avoid military, jail Obtain drugs for abuse/ resale Obtain food and shelter ```

Answer 33

Malingering

Question 34

Who is more likely to malinger, males or females?

Answer 34

males

Question 35

Reasons to suspect malingering?

Answer 35

medicolegal case discrepancy in findings vs report lack of cooperation/compliance clear external incentive

Question 36

Common psychiatric presentations of malingering?

Answer 36

psychosis memory deficits suicidality

Question 37

Decreased progress while in questionwith improvement after settlement Largely unconscious Estimated 40% malingering in civil damage actions

Answer 37

malingering with claim/ligation association

Question 38

What are some clues that a patient might be malingering?

Answer 38

Demanding medications Divulging symptoms too eagerly or dramatically Dependent or conditional threats of self-harm, violence, or litigation

Question 39

Differentiate between factitious disorder and malingering.

Answer 39

Factitious disorder more likely to have borderline personality traits, more likely to pursue painful tests, have more varied symptoms; malingering more likely to be temporary and present with a history of antisocial personality traits

Question 40

How are somatic symptom disorders different from factitious and malingering?

Answer 40

somatic symptom disorders have an unconscious motivation and an unconscious production of symptoms - not deliberately trying to obtain some goal

Question 41

T/F: It is important to remember that these are disorders! Symptoms may improve or the patient may abruptly leave treatment.

Answer 41

True