Psych- Somatic Symptom and Related Disorders Flashcards Preview

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Flashcards in Psych- Somatic Symptom and Related Disorders Deck (27)
1

The diagnosis of Somatic Symptom disorder is based on ....

Distressing somatic symptoms 

+

Abnormal thoughts, feelings and/or behaviors in response to these symptoms

2

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

3

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 

4

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 

5

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

6

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

7

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

8

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

Intact Reflexes

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

9

What kinds of people develop conversion disorder?

Women

More common in rural areas

Onset late childhood/early adulthood

Psychologic Factors

10

What psychologic factors predispose for conversion disorder?

history of conversion symptoms or somatization disorder!

Associate psychopathology

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

11

What is La Belle Indifference? When do you see that? 

its when a person with conversion disorder doesn't care about their symptom

12

What should you NOT do in treatment of conversion disorder?

Confront the patient that the symptoms are psychological ...can be harmful

13

How can you treat conversion disorder/remove the symptom? 

REassurance

Suggestions - predict step-wise recovery

attitude of supportive optimism

hypnosis 

resolve psychosocial stresses 

psychotherapy

 

14

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 

15

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

16

What is Pseduocyesis?

False belief of being pregnant with objective signs and symptoms of prenancy

17

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 

18

What is the classic presentation of Munchausen's Type Factitious Disorder? 

MEN PATIENTS!!!

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 

19

What is the presentation of Non-Munchausen's Type FActicitous Disorder? 

Female

Non-wandering

Unmarried

Young

History of medical or nursing training

20

how do you manage someone with factitious disorder? 

establish rapport

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

21

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 

22

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

23

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)

24

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

25

Treatment for Body Dysmorphic behaviors? 

NO SURGERY

 

SSRIs are good for treatment of OCD

CBT can be helpful

chronic disorder needing lifelong treatment 

26

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

27

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