Neurological Presentations of Psychiatric illness Flashcards
(39 cards)
Disease vs Illness
Disease: objectively measurable pathophysiological state
Illness: experience, behaviours and functional changes associated with disease ( patient’s perception of disease , their personal suffering , alienation and debilitation
Can you have illness behaviour with a disease ?
Yes
What are Somatoform Disorders
Mental health condition causing individuals to experience somatic physical symptoms in response to psychological distress
Clues to Somatoform Spectrum Illness
1- Prominent emphasis on somatic symptoms in developmental years
2- family uses somatoform language
3- Parental attitudes towards child when ill
4- Caregiver suffered significant illness : child hears caregiver complaining about physical health symptoms
5- Illness behaviour as a main coping mechanism
6- Somatic complaints allows avoidance of difficult emotions or usual responsibilities
What is Somatization disorder
1- History of 2 year complaints of multiple and variable physical symptoms - not explained by a physical disorder
2- Preoccupation with symptoms causes persistent distress , seeking out several medical consultations
3- persistent refusal to accept no physical reason for symptoms , will go to multiple doctors
4- 6 or more symptoms form 2 or more different symptoms
Common complaints with Somatization disorders ( common systems )
GI symptoms: abdominal pain , nausea , bloated , vomiting , Bowel motions , funny taste
CVS : SOB wo exertion , chest pain
Genito-urinary: dysuria/frequency , unusual vaginal discharge , unpleasant genital sensations
Skin and pain : blotchiness, discolouration , pain in joints , unpleasant numbness/tingling
Where is Somatization disorder more prevalent
1- Females
2- lower social class
3- increased rate of anxiety and depression with SD patients
What is the treatment for Somatization disorders
1- Empowerment
- Explain the mechanism of SD to patients “ know your symptoms are real but this is why there’s no underlying physical disorder “
- not blaming patient , and gives patient opportunity for patient to self manage & work with doctor
2- Comprehensive clinical assessment
3- Regular, structured review : Ex: once a month : to stop link patient has made between physical symptoms and getting care/ attention
4- Minimize invasive and diagnostic procedures : due to risk of iatrogenic harm , might reinforce to patient that there is something physical wrong
5- Recognize reality of symptoms , link to stressful events in life
6- Identify and manage secondary reinforcers : minimize the care and attention they get when complaining of symptoms ( acts as a secondary reinforcer to their belief that something is wrong physically )
7- Treat comorbid psychiatric and medical conditions ( anxiety , depression )
8- CBT
- effective for physical and functional impairment , not psychological symptoms ( anxiety/depression )
9- Medications : SSRIs
- more sensitive to side effects and withdrawal syndromes which might complicate things further ( look up side effects online and start experiencing them )
Explain how CBT is done for Somatization Disorder
1- Limited number of sessions : if condition worsens due to sessions coming to an end , make it clear that that’s not a reason to continue with CBT
2- realistic short and long term goals
3- practical ways of coping with symptoms
4- Keep log of thoughts , feeling , coping behaviours
5- Promote social , recreational, occupational activities and relaxation
What is Hypochondriacal disorder , How does it present
1- Persistent belief ( over 6 months ) of the presence of a maximum of 2 serious diseases , 1 of which named by patient
OR
2- Persistent preoccupation with presumed disfigurement or deformity : body dysmorphic disorder
- Symptoms cause persistent distress or interfere with personal functioning in daily living, and leads patient to seek medical treatment
- persistent refusal to accept medical advice that there is no physical cause for symptoms except for short periods ( up to few weeks ) immediately after or during medical investigations
- not caused by schizophrenia
- overlaps with somatization , anxiety and OCD
- heterogeneous presentation
Treatment for Hypochondriacal disorder
- CBT : good response
- SSRIs
What is Pain disorder
1- Paint that’s not intentionally produced nor contrived
2- maybe an underlying medical disorder but pain patient is describing and dysfunction they’re getting form it is amplified beyond what you would expect based on the underlying cause of the pain
What does Pain disorder cause ( Ds + Associated features )
1- Disability
2- Disuse/reduced functioning
3- Drug misuse
4- doctor shopping
5- emotional dependency
6- demoralization
7- depression / anxiety disorder
8- Dramatic accounts of illness ( people don’t believe how much pain the patient is actually in )
9- CNS plasticity : heightened pain sensitivity & reduced pain threshold
10- Iatrogenic complication : opiate/benzodiazepine dependence , results in unnecessary surgical interventions
If the site of the pain is abdominal in a patient with pain disorder there is an increased risk of ?
Suicide
If the side of the pain is neuropathic in a patient with pain disorder, is the risk of suicide increased or decreased
Decreased
What is the management of Pain disorder
1- identify and create comorbid conditions ( ex: depression )
2- Anti-depressants : SNRI or TCA
3- Avoid opiates if possible
4- early referral to multidisciplinary- behaviourally based treatment program
37 yr man working as emergency service call handler presents with sudden onset mutism
- both patient and partner described no significant psychosocial stressors
- recent work promotion
- wife recently became pregnant & looking forward to child
- no history of mental illness
- no sign of neurological deficit
- no underlying physical problem
What is going on ?
Increase responsibility with work promotion and child but might feel like can’t voice these emotions because supposed to be happy.
Can’t talk = can’t work and can’t tell wife that he is stressed
Psychological problem not physical
What are the conditions to classify something as Dissociative disorder
1- No evidence of physical disorder explain symptoms
2- Convincing association in time between symptoms of disorder and stressful events, problems or needs
Explain the presentation of Dissociative disorder
Neurological Symptoms 1- Amnesia 2- Fuge 3- Stupor 4- Trance/possession 5- motor disorders: ataxia , loss of coordination , loss of control 6- Convulsions 7- Anaesthesia/ sensory loss 8- Ganser's syndrome 9- Multiple Personality disorder
What is Ganser’s syndrome
Prisoners psychosis , first found in prisoners awaiting trial. ( way to get out )
Presents with : loss of consciousness , hallucinations, answering questions with weird answers that showed they understood the question but gave bizarre answers ( ex: how many legs does cow have , A: 5 )
What is Multiple personality disorders
Patient develops another personality, they switch between personalities and once back they claim no memory of what they had done since it wasn’t them
- Usually patient has a background of significant trauma
- often seen with childhood abuse/neglect
Ganser’s syndrome and Multiple personality disorder is a type of which disorder ?
Dissociative disorders
15 yr girl , sudden onset of lower limb paralysis
- high parental expectations , upcoming exams , parental divorce ( stressors )
- No physical conditions causing this
- Physical health became primary concern for parents
- Muscle atrophy and contractors developed = patient in wheelchair for 3 years
What happened ?
This brought parents attention away from divorce and having perfect expectations from their daughter to each other. A way to change the situation.
Dissociative Disorder
Where are Dissociative Disorders present
- Prevalent in neurology clinics : FND , symptoms that aren’t explained bye disease
- 60-75% will be female
