Lectures 86, 87: Somatic Syndromes Flashcards Preview

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Flashcards in Lectures 86, 87: Somatic Syndromes Deck (43):
1

Somatic symptoms are associated with significant...

Distress and impairment

2

In malingering disorder, what is conscious/unconscious?

Production of symptoms AND motivation are conscious

3

In somatic symptom conversion, what is conscious/unconscious?

Production of symptoms AND motivation are unconscious

4

In factitious disorder, what is conscious/unconscious?

Production of symptoms is conscious BUT motivation is unconscious

5

Somatic symptom disorder requires...(3)

1. Symptom; 2. Disproportion concern related to symptom; 3. 6 months "symptomatic"

6

What disorder is associated with the following statement: health concerns may assume a central role in the individual’s life

Somatic symptom disorder

7

How might someone with somatic symptom disorder feel about medical care they receive?

Often feel that treatment is inadequate

8

Describe presentation and course of somatic symptom disorder

Begins during adolescence, worsen into mid-20s, females > males, chronic, lives dominated by medical procedures which WORSEN course

9

Describe etiology of somatic symptom disorder (3)

Hx abuse, learned behavior, belief that problems are physical and can be cured by doctor

10

Key in treatment of somatic symptom disorder

Recognize disorder and treat with sensitivity

11

Conversion disorders primary characteristic. Some examples?

One or more symptoms of altered voluntary motor/sensory function; weakness, altered senses, tremor

12

What are two opposite responses to symptoms a person with conversion disorder might have?

La belle indifference (indifference to symptoms) or dramatic/histrionic presentation

13

In conversion disorder, symptoms are voluntary/involuntary

Involuntary

14

Conversion disorder symptoms often respond to...

Suggestion

15

Describe gender preference and another association with conversion disorder

Female > male; lower education achievement/psychological sophistication

16

Onset of conversion disorder is ________ and course is generally _______-___________

Acute; self-limited

17

Onset of conversion disorder precipitated by...Cultural relevance of this?

Stress: conversion of psychological conflict --> physical symptom; some cultures it is more acceptable to have physical rather than psychological complaints

18

Factitious disorder and malingering both involve...What distinguishes them?

Feigning symptoms without underlying pathology; motivation for symptom production

19

Describe factitious disorder

Falsification of symptoms or induction of injury, associated with identified deception

20

What might someone with factitious disorder do? (3)

Manipulate diagnostic instruments to give false readings, tamper with lab specimens, cause actual tissue damage

21

Munchausen's is diagnosed more often in (gender) characterized by...

Men; simulation of disease

22

Is factitious disorder serious?

Yes: often unrecognized with significant morbidity

23

How to recognize factitious disorder (4)

Discrepancies b/t findings and history, atypical illness course, failure to respond to therapies, resistance to releasing medical records

24

Etiology of factitious disorder is related to the desires to...

Be the sick person: receive empathy, often related to early abuse or a recent stressor

25

If a person is falsifying disease in another, it is called...

Factitious disorder imposed on another

26

Managing factious disorder requires both _____ and ______ management, both involve

Acute and chronic; psych consultation

27

Malingering is not...why?

A psychiatric diagnosis; for some gain

28

Management of malingering first involves recognizing...

The motivation behind it

29

Red flags for medically unexplained syndromes

Many somatic complaints + anxiety/depression + past history of "poorly defined medical disorders"

30

Describe arm drop test findings

Non-organic illness, arm will miss face

31

What tends to be normal in non-medical illnesses? This is associated with what non-medical gait?

Reflexes/Babinski; Dragging monoparetic gait

32

Hoover's sign

Involuntary extension of the "paralyzed" leg occurs when flexing the contralateral (normal) leg against resistance

33

How can the sternum or forehead be used to detect sensory psychogenic?

Sternum/skull vibrates as a unit --> sensory loss should NOT stop at midline

34

How to test to see if a tremor is psychogenic?

Have them do tremor on other side voluntarily with different frequency --> will entrain the frequency on the other side

35

Psychogenic gaits tend to...(3)

Rapid onset, show significant variability, and demonstrate improvement with distraction

36

Describe Astasia-Abasia

Dramatic gait: patient lurches wildly and falls only when there is someone or something nearby to catch them

37

How to test to see if something is pyschogenic blindness (tasks [1] and exam [3])

Ask patient to do something that you don't need to see to do just fine (sign name, touch fingers together); normal pupils, normal fundoscopic exam, nystagmus to OKN drum

38

Psychogenic seizures are usually NOT...name some other hallmarks (6)

Stereotyped (all different); slow down at end, asynchronous body movements, side-to-side head throwing, eyes closed, crying/moaning, clenched mouth

39

Are psychogenic seizures common?

Yes! Maybe up to 50% of those presenting with seizures in hospital

40

Important other seizure on differential for psychogenic seizures?

Frontal lobe seizure

41

In a psychogenic seizure, tongue biting is where (as opposed to where in non-psych seizures)

Tip; lateral

42

Psychogenic coma: eyes/vestibular (4)

Eye lid fluttering, pupils small/reactive, nystagmus to OKN drum, calorics intact

43

Psychogenic coma: sternal rub

They will withdraw

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