Somatic Sx D/o

Question 1

What are somatic sx d/o characterized by? (basically, what are they?)

Answer 1

Physical sx for which no underlying medical workup can identify a cause

Question 2

__% of primary care pts exhibit medically unexplained sxs

Answer 2

30%

Question 3

Somatic sx d/o are more common in (men/women), with a typical age of onset in the _____ but also in the ______

Answer 3

women; 20s; elderly

Question 4

Somatic sx d/o are more common for lower _____ and lower ______

Answer 4

income; education level

Question 5

What is the etiology of somatic sx d/o?

Answer 5

Unknown, likely genetic component as can run in families

Question 6

Somatic sx must be presents for how long for official dx of somatic sx d/o? Must this be the same sx or many?

Answer 6

at least 6 mo

one single sx does not have to persist that entire time “sx migration

Question 7

T/F Somatic sx d/o can affect multiple organ systems

Answer 7

true

Question 8

In pts with somatic sx d/o, when does the preoccupation w/ their sx usually begin? How long can their sx last for?

Answer 8

usually begins early in life

months, years, or even decades

Question 9

What general type of sx do pts with somatic sx d/o usually present with? Examples?

Answer 9

Sxs are often those which cannot be measured, pain, GI upset, malaise, blurry vision

Question 10

What are some clues that a pt might have a somatic sx d/o?

Answer 10

Frequent clinical visits and “doctor shopping”
Frequent/multiple admissions (ED, inpt)
Unnecessary medical procedures

Question 11

What aspect of illness/anxiety d/o interferes w/ a pt’s normal social functioning?

Answer 11

Incessant worry

Question 12

Are pts with illness/anxiety d/o sx d/o reassured by negative medical tests?

Answer 12

No

Question 13

Pts with illness/anxiety d/o may amplify/misinterpret normal _________

Answer 13

physiological experiences/sensations

Question 14

What is the distress that pts with illness/anxiety d/o suffer from caused by? What is it NOT caused by?

Answer 14

NOT from the sxs, but what they feel the sxs mean, and the resulting anxiety and concern

Question 15

Do men have a(n) higher/lower/equal prevalence of illness/anxiety d/o as women? In what population is illness/anxiety d/o rarely seen in?

Answer 15

men and women have similar prevalence; rarely found in children

Question 16

What are some characteristics/actions of a pt w/ illness/anxiety d/o?

Answer 16

Pts are often hypervigilant about their health, monitor their bodies frequently for dz, may insist on multiple standard screening exams

Question 17

When illness/anxiety d/o is seen in the elderly, what is often the focus of their d/o?

Answer 17

memory-related

Question 18

Are Conversion D/o and Functional Neurological Sx D/o the same d/o?

Answer 18

Yes

Question 19

Pts with conversion d/o usually have 1+ sx where (involuntary/voluntary) motor/sensory fxn is lost, and suggests an underlying _______ condition

Answer 19

voluntary; neuro/medical

Question 20

In pts with conversion d/o, sx that are described (are not/are) consistent w/ a known neuro/medical illness

Answer 20

are not

Question 21

T/F A precipitating psychological factor is not usually associated with onset of sx of a conversion d/o

Answer 21

False, it usually is, but is not required for dx

Question 22

If the pt’s main complaint is limited to pain, then they are dx w/ ________

Answer 22

Somatic Sx D/o

Question 23

In regards to conversion d/o, acute is ____ mos of sx, and chronic is _____ mos of sx

Answer 23

<6; >6

Question 24

___-___% of pts admitted to neuro service have conversion d/o

Answer 24

20-25%

Question 25

Conversion d/o is more frequent in _____, lower income/educational level, and ____ areas

Answer 25

women; rural

Question 26

When is the typical age of onset of conversion d/o?

Answer 26

onset can be anywhere from childhood to adulthood

Question 27

Many pts w/ conversion d/o have additional dx of....

Answer 27

other mental illnesses (mood or psychotic d/o)

Question 28

Are sx of conversion d/o more permanent or more come-and-go?

Answer 28

Sx are transient

Question 29

The best outcome of pts with conversion d/o is associated w/ what type of onset? In the absence of what?

Answer 29

acute onset with a clear precipitating stressor | in the absence of other comorbid neuro/medical conditions

Question 30

What are some common complaints coming from a pt with conversion d/o? (x7)

Answer 30

Paralysis, abnml movements (twitching), aphonia, blindness, deafness, pseudoseizures, loss of sensation/anesthesia over part of body

Question 31

How often are psychotropic medications needed in the tx of somatic sx d/o, illness/anxiety d/o, and conversion d/o?

Answer 31

Rarely are psychotropic meds needed, unless there is a clear co-morbid condition

Question 32

Individual psychotherapy, cognitive behavioral therapy (has not/has) shown value in tx pts with somatic sx d/o, illness/anxiety d/o, and conversion d/o

Answer 32

has

Question 33

SSRIs have been shown to improve_______ in the past in pts with somatic sx d/o, illness/anxiety d/o, and conversion d/o

Answer 33

hypochondriasis (DMS-IV dx)

Question 34

If a pt with somatic sx d/o, illness/anxiety d/o, or conversion d/o presents with c/o ______, they may need inpatient tx

Answer 34

Dramatic sx (i.e. blindness, paralysis)

Question 35

What is factitious d/o?

Answer 35

A d/o characterized by the intentional production or feigning of physical or psychological sx

Question 36

Are there any clear external factors/incentives for faking sx in a pt with factitious d/o?

Answer 36

No

Question 37

What is factitious d/o thought to be motivated by?

Answer 37

unconscious desires

Question 38

Once factitious d/o is suspected/likely, what should be immediately obtained?

Answer 38

Psych consult

Question 39

If you feel as though you have sufficient evidence to dx a pt with factitious d/o, how should you confront the pt?

Answer 39

in a non-threatening manner | Once evidence is obtained, their belongings and room can be searched (drugs, sharp objects)

Question 40

Patients with factitious d/o often have a (short and uncomplicated/lengthy and complex) medical Hx

Answer 40

lengthy and complex

Question 41

In a pt with factitious d/o, self reported signs and sx are usually described as...

Answer 41

Self-reported s/s are “textbook”

Question 42

Pts with factitious d/o usually have an extensive hx of what?

Answer 42

Hx of excessive surgeries

Question 43

Once you believe that a pt has factitious d/o, what should be done?

Answer 43

Obtain previous medical records, if possible, and speak w/ previous providers

Question 44

What is the one condition that is not technically a somatic d/o that I am lumping into this section, and is actually characterized as an "Other Conditions" d/o?

Answer 44

Malingering!

Question 45

Is malingering considered a mental d/o?

Answer 45

No

Question 46

What is malingering?

Answer 46

The act of intentionally reproduction of sx/feigning illness for specific gain

Question 47

Might might be considered "external incentives" for pts presenting with malingering?

Answer 47

missing work, monetary compensation, avoiding military obligation, obtaining drugs…

Question 48

How should pts with malingering be handled?

Answer 48

Not really sure, no consensus on this matter -- good luck!