What is the definition/diagnostic criteria for hypochondriasis?
Pts believe that they have some specific disease despite constant reassurance.
What is the definition/diagnostic criteria for conversion disorder?
Typically affects voluntary motor or sensory functions that are indicative of a medical condition but are usually caused by psychological factors. Can be associated with “la belle indifference,” where the pt is unconcerned about his or her impairment.
What is the definition/diagnostic criteria for body dysmorphic disorder?
Pts believe that some part of the body is abnormal, defective, or misshapen.
What is the definition/diagnostic criteria for pain disorder?
The presence of pain is the main complaint, and must have psychological factors associated with the pain.
What is the definition/diagnostic criteria for factitious disorder?
An individual fakes an illness in order to get attention and emotional support in the pt role. This can either be a psychological or physical illness.
What are the symptoms of factitious disorder?
- Psych Sx: hallucinations, delusions, depression, and bizarre behavior
- Physical Sx: abdominal pain, fever, nausea, vomiting, or hematomas
At times, they may inflict life-threatening injuries on themselves in order to get attention.
Who are typical pts in factitious disorder?
Typically, Pts are women who may have a Hx of being employed in healthcare. Men more often have physical Sx. The pt’s ultimate goal is to gain admission to the hospital. You must always exclude any medical disorder with similar Sx.
What is the treatment of factitious disorder?
No specific therapy is been proven effective. When a child is involved in factitious disorder by proxy, child protective services should be contacted to ensure the child’s safety.
What is the definition of malingering? How is it diagnosed?
Malingering is the conscious production of signs and symptoms for an obvious gain, such as avoiding work, evading criminal prosecution, or achieving financial gain. Malingering is not a mental illness. A lack of cooperation from pts is characteristic.
It is typically diagnosed when there is a discrepancy between the pt’s complaints and the actual physical or laboratory findings.
What is the definition/diagnostic criteria for adjustment disorder? What are the symptoms? What is the treatment?
Adjustment disorder is characterized by a maladaptive reaction to an identifiable stressor, such as loss of a job, divorce, or failure in school. The symptoms usually occur within 3 months of the stressor and must remit within 6 months of removal of the stressor.
Symptoms include anxiety, depression, or disturbances of conduct. They are severe enough to cause impairment in functioning.
Psychotherapy is the treatment of choice. Both individual and group therapy may be effective.
What are the common features of somatiform disorders? What is the treatment?
Pts experience physical symptoms with no medical explanation. Typically the symptoms are severe enough to affect the level of functioning. They are more common in women and usually have some psychological component of which the pt is usually unaware.
Psychotherapy is the treatment of choice.
What are the features of anorexia?
Anorexia is characterized by:
- Failure to maintain a normal body weight
- Fear and preoccupation of gaining weight
- Body image disturbance (unrealistic self-evaluation as overweight; pts deny their emaciated condition)
- Typically lose weight by maintaining strict caloric diet, excessive exercise, purging, fasting, and laxative and diuretic use
- Amenorrhea is common from low body weight
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How is anorexia diagnosed?
- Anorexia is seen more frequently in teenage girls between the ages of 14 and 18
- There is evidence of severe weight loss
- Hypotension, bradycardia, lanugo hair, and edema may be present
- EKG changes such as Arrhythmias occur due to hypokalemia (arrhythmia is the MCC of death)
How is anorexia treated?
- Hospitalization to prevent dehydration, starvation, electrolyte imbalances, and death
- Psychotherapy
- Behavioral therapy
- SSRIs have been used to promote weight gain
What are the features of bulimia?
Bulimia is characterized by:
- Frequent binge eating
- Lack of control of overeating episodes
- Compensatory behavior to prevent weight gain in the form of purging, misuse of laxatives and diuretics, fasting, and excessive exercise
- The pt’s self-evaluation is unduly influenced by body shape and weight
How is bulimia diagnosed?
Bulimia is more frequently seen in women and occurs later in adolescence than anorexia. Most of these women are of normal weight but do have a history of obesity.
How is bulimia treated?
- Psychotherapy
- SSRIs
- Does not require hospitalization unless severe electrolyte abnormality is present
What is the definition/diagnostic criteria for somatization disorder?
Patients must have at least 4 pain, 2 GI, 1 sexual, and 1 pseudoneurological symptom.
What are the physical signs of vomiting that may be seen on physical exam in anorexic and bulimic pts?
Dorsal hand callouses (Russell’s sign), enamel erosion, and enlarged parotids
How is narcolepsy defined? When does it occur?
Narcolepsy is characterized by excessive daytime sleepiness and abnormalities of REM sleep. It typically occurs in young adulthood.
Define the following symptoms of narcolepsy:
- Sleep attacks
- Cataplexy
- Hypnogogic and hypnopompic hallucinations
- Sleep paralysis
- Sleep attacks: episodes of irresistible sleepiness and feeling refreshed upon awakening
- Cataplexy: sudden loss of muscle tone; may be precipitated by loud noise and emotions
- Hypnogogic and hypnopompic hallucinations: occur as the pt is going to sleep or waking up, respectively
- Sleep paralysis: pt awake and unable to move; this typically occurs upon awakening
How is narcolepsy diagnosed? How is it treated?
Dx: Sleep study
Rx:
- No therapy is curative
- The pt is managed with forced naps during the day
- Modafinil is used to maintain alertness
- Methylphenidate or dextroamphetamine GHB at bedtime to induce symptoms of narcolepsy and contain them at night
How is insomnia defined? What are the causes? What are the symptoms?
Insomnia is characterized by inability to initiate or maintain sleep. It may be due to depression or anxiety. It typically occurs in women who complain of feeling tired or have increased appetite or yawning.
What is the treatment of insomnia?
- Sleep hygiene techniques
- Zolpidem, eszopiclone, or zaleplon
