The diagnosis of Somatic Symptom disorder is based on ....
Distressing somatic symptoms
Abnormal thoughts, feelings and/or behaviors in response to these symptoms
Somatic Symptom Disorder Criteria
Distressing Somatic symptoms that disrupt daily life and lasting > 6months
Symptoms include one of the following:
-persistent thoughts about the seriousness of symptoms
-persistent anxiety about the health or symptoms
-excessive time and energy devoted to symptoms or health concerns
Persistent somatic symptoms are more associated with these populations of people...
Older, Female, low SES, Little education, unemployed
Sexual abuse or other child adversity in history
concurrent medical illness
Comorbid psych illness - depression, anxiety, panic
What is illness anxiety disorder and how does it present?
Preoccupation of having or acquiring serious illnes sbut somatic symptoms are mild or absent
Have a high level of anxiety/alarm about health and exhibit either 1) excessive health behaviors or 2) maladaptive avoidance
What are characteristics of people who get IAD?
MEN AND WOMEN ARE EQUAL
Thick chart patient
relationship with health care providers tinged with hostility and frustration
Depression and Anxiety common with it
What is the best way to manage a patient with IAD or SSD?
1 primary physicial with regularly schedule appointments that are NOT contingent on symptoms
Regular physical exams
Invasive testing based on OBJECTIVE physical abnormalities
Keep meds to a minimum bc they get all of the negative side effects
Take them seriously!
ID comorbidity - depression, anxiety, pain
What is Conversion Disorder (aka Functional Neurological Symptom disorder)?
Rapid and sudden onset of loss of /one or more symptoms of altered voluntary motor or sensory function that is incompatible with neuro or medical diagnosis
Deficit/symptom causes significant distress or impairment and can not be better explained by another medical or mental disorder
[Generally occurs following a severe stressor]
THEY HAVE THE SYMPTOM BUT IT IS NOT DUE TO UNDERLYING PROBLEM
What are some diagnostic clues for Conversion disorder (aka Functional Neurological Symptom Disorder)?
Pseudo-seizures = Non-epileptic seizures on EEG during seizure
Aphonia but cough intact (meaning vocal cords can close)
Symptoms do NOT conform to known anatomical pathways - ex exact midline
Tubular visual fields
HOOVER's Sign - Surreptitious strength testing
Weak ankle plantar flexion in bed but can walk on tiptoes
Comatose pt does not allow hand to fall on face
What kinds of people develop conversion disorder?
More common in rural areas
Onset late childhood/early adulthood
What psychologic factors predispose for conversion disorder?
history of conversion symptoms or somatization disorder!
Model for symptom (people wtih non-epileptic seizures are ppl w epilepsy)
Emotional stress prior to onset!!!!
history of sexual abuse
youngest child of same sex
What is La Belle Indifference? When do you see that?
its when a person with conversion disorder doesn't care about their symptom
What should you NOT do in treatment of conversion disorder?
Confront the patient that the symptoms are psychological ...can be harmful
How can you treat conversion disorder/remove the symptom?
Suggestions - predict step-wise recovery
attitude of supportive optimism
resolve psychosocial stresses
What is "Psychological factors affecting other medical conditions?"
Pt has a medical condition or symptom and his/her psychological or behabioral factors adversely affect medication condition in one of these ways:
- the course of condition
-interfering wiht treatment (adherence)
-adding additional health risks
- influencing underlying pathophysiology
What are some examples of "psychological factors affecting other medical conditions?"
ex. Girls w/ diabetes want to lose weight and manipulate their insulin therapy
ex. angina precipitated by frequent bouts of rate
ex. poor coping to stressful life events and worsening migraines
What is Pseduocyesis?
False belief of being pregnant with objective signs and symptoms of prenancy
What is Factitious Disorder (imposed on self)?
Falsification of physical signs/symptoms or injury with deceptive behavior in the absence of obvious external rewards
the GOAL is to achieve the role of the patient
What is the classic presentation of Munchausen's Type Factitious Disorder?
history of multiple hospitalizations in wide range of geographic locations using aliases
PResents history in dramatic manner - Pseudologia Fantastica
unusually submissive to hospitalization / invasive procedures
history of either self-mutilation or AMA discharges
What is the presentation of Non-Munchausen's Type FActicitous Disorder?
History of medical or nursing training
how do you manage someone with factitious disorder?
non-punitive supportive confrontation
Present the evidence and stress patients strengths and long history of suffering
OR non-confrontation techniques
-inexact interpretations, therapuetic double blind or face-saving techniques like hypnosis or biofeedback
What is factitious disorder imposed on another?
Falsification of physical or psychological signs or symptoms in another (often mother child or caregiver position)
Deceptive behavior with absence of obvious external rewards
Diagnosis to the perpetrator
What is malingering?
Conscious feigning of signs and symptoms for clearly identifiable external incentive or reward ... like avoiding work, money, evading prosecution, or drug seeking
What is Body Dysmorphic Disorder and under what category is it classified?
Classified under OCD!!!
Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others and then repetitive behavirors or metnal acts
Significant distress and preoccupation with appearance even though they know its silly (or even if they are convinced beliefs are true)
When does Body Dysmorphic Disorder present and what is the course?
Age of onset around 12 or 13 and most cases before age 18 yo
high rates of suicide and comorbid major depression and social anxiety disorder
Can become housebound from it
Can lead to repetitive surgeries
Treatment for Body Dysmorphic behaviors?
SSRIs are good for treatment of OCD
CBT can be helpful
chronic disorder needing lifelong treatment
Compare and contrast conversion disorder, factitious disorder, and malingering
Conversion Disorder --> true symptom unconsciously produced
Factitious Disorder --> fake symptoms consciously produced for UNCONSCIOUS reasons
Malingering --> fake symptoms consciously produced for Conscious reasons
compare and contrast SSD with IAD
SSD - excessive thoughts/feelings about somatic symptoms that disrupt daily life
IAD - disease fear/conviction with minimal somatic symptoms