Somatic Sxs Flashcards
(57 cards)
1
Q
- Group of psychological illnesses in which bodily sxs are a major focus
- Originate from faulty mind-body interactions
- Pts CONVINCED that their suffering comes from undetected/untreated bodily derangement
- ______ is an outlier
A
Somatic Symptom Disorder
Factitious Disorder
2
Q
3 types of somatic sxs associated w/ significant distress and impairment
A
- Affective
- Cognitive
- Behavioral
3
Q
Are somatic sxs due to recognized medical condition?
A
May or may not be explained by recognized medical condition
4
Q
Somatic Sx Disorder
- Are concurrent medical illnesses common or uncommon?
- Absence of medical explanation for sxs is required or not required?
- How is the dx made?
A
- common
- not required
- Dx based on abnormal response to sxs
5
Q
Somatic Sx Disorder
- Sxs are not under ____ or ____ control.
A
- Voluntary
- Conscious
6
Q
Somatic Sx Disorder
- Do males or females tend to report more somatic sxs?
- Usually onsets at what age?
A
- Females
- Teenage years, but may not become “pathologic” until later in life
7
Q
Somatic Sx Disorder
- Commonly encountered in PCP setting
- 5-10% of primary care pts have __ or more unexplained sxs
- Common or rare for pts to seek mental health consult at initial sx onset?
A
- 4
- Rare
8
Q
Higher prevalence of Somatic Sx Disorder in which 3 functional disorders?
A
- Fibromyalgia
- Irritable bowel syndrome
- Chronic fatigue syndrome
(FIC)
9
Q
4 “dimensions” of Somatic Sx Disorder
A
- Bioligical Dimension
- Psychological Dimension
- Social Dimension
- Sociocultural Dimension
10
Q
“Heightened Attention”
A
Biological Dimension
11
Q
“attention obtained from illness / learning”
A
Social Dimension
12
Q
“Inversely related to social position”
A
Sociocultural Dimension
13
Q
3 risk factors for Somatic Sx Disorder
A
- Early traumatic experiences
- Childhood chronic illness
- Depressive / Anxiety disorders
14
Q
Somatic Sx Disoder DSM criteria
- ___ or more somatic sxs distressing / result in disruption of daily life
- What is the MC sx?
- “high level of worry”
- “thinks the worst”
A
- 1
- Pain
15
Q
Somatic Sx Disorder - DSM Criteria
- Somatic sx or associated health concerns manifested by at least one of what 3 things?
A
- Disproportionate / persistent thoughts about seriousness of sxs
- Persistently high level of anxiety about health or sxs
- Excessive time / energy devoted to these sxs or health concerns
16
Q
Which patients w/ Somatic Sx Disorder rarely worry about the “illness?”
A
Young children, they are influenced by parental response.
17
Q
Somatic Sx Disorder
- State of being symptomatic is persistent, typically lasting more than __ months
- (one sx may not be continuously present
A
6
18
Q
4 common sxs in children w/ Somatic Sx Disorder
A
- Abd pain
- HA
- fatigue
- nausea
19
Q
Specifiers of Somatic Sx Disorder:
- Sxs predominantly involve ____
- Persistent: characterized by ____ sxs, marked impairment, long duration of more than __ months
A
- Pain
- Severe
- 6
20
Q
Severity of Somatic Sx Disorder:
Mild, moderate, or severe?
- Only 1 of sxs specified in Criterion B fulfilled
A
Mild
21
Q
Severity of Somatic Sx Disorder:
Mild, moderate, or severe?
- 2 or more sxs specified in Criterion B
A
Moderate
22
Q
Severity of Somatic Sx Disorder:
Mild, moderate, or severe?
- 2 or more of sxs specified in Criterion B fulfilled
- PLUS, multiple somatic complaints
- OR, 1 very severe somatic sx
A
Severe
23
Q
- What questionaire is used for Somatic Sx Disorder?
- Higher scores associated w/ what 3 things?
A
PHQ-15
- Poorer functioning
- Increased health care utilization
- More sxs of depression / anxiety
24
Q
PHQ scores
Minimal, low, moderate, or high?
- 0-4
A
Minimal
25
**PHQ scores**
_Minimal, low, moderate, or high?_
* 5-9
low
26
**PHQ scores**
_Minimal, low, moderate, or high?_
* 10-14
Moderate
27
**PHQ scores**
_Minimal, low, moderate, or high?_
* 15-30
High
28
**Type of Somatic Sx Disorder?**
* Attention focused on somatic sxs
* Attribution of normal bodily sensations to physical illness (degree of interpretation ranges, worry)
* Related general medical condition
* Fear that any physical activity will damage body (avoidance of physical activity)
Cognitive
29
**Type of Somatic Sx Disorder?**
* Repeated bodily checking for abnormalities
* Frequent medical consults
Behavioral
30
Severe cases of Somatic Sx Disorder assume a central role and lead to \_\_\_\_.
**Invalidism:** state of being abnormally preoccupied w/ one's prolonged ill health
31
**Somatic Sx Disorder**
* High level of medical care utilization. Does this usually alleviate concerns?
* What do these patients tend to do?
* Are they responsive to medical interventions?
* Common to have side effects from meds?
* Rarely
* Tend to seek care from multiple providers
* Often unresponsive
* Unusually sensitive to medication side effects
32
2 comorbidities of Somatic Sx Disorder
* Anxiety
* Depression
33
If a pt meets criteria for somatic sx disorder and another mental disorder, which is documented?
Both
34
1st line tx for Somatic Sx Disorder
CBT
* reduce physical sxs
* reduce psychological distress
* reduce disability
35
* Off label drug for Somatic Sx Disorder
* What is it used for?
**Fluoxetine**
* Improve functional status
* Global well being
* Morning stiffness
* Pain
* Sleep
* Tender points
36
Illness Anxiety Disorder was previously classified as \_\_\_\_\_.
Hypochondriasis
37
* Distress arises from unfound fear of having the disease rather than physical sxs
* Concern and distress persist despite appropriate physical examination & diagnostic testing that are negative
Illness Anxiety Disorder
38
Illness Anxiety Disorder more common in males or females?
Equal
39
Pts w/ Illness Anxiety Disorder rarely seek a _____ consult at initial symptom onset.
Mental Health Consult
40
What are the risk factors for Illness Anxiety Disorder?
No clear risk factors
41
**Illness Anxiety Disorder**
* Somatic sxs are not present, but if they are presents are \_\_\_\_.
* Pt sometimes worry bc/ strong family hx for developing condition
* Performs excessive health related behaviors
* Exibits what?
* Mild intensity
* Exhibit maladaptive avoidance, avoids doctor appts and hospitals
42
**Illness Anxiety Disorder**
* Illness preocupation has been present for at least __ months, but the specific illness that is feared may change over that period of time.
6
43
2 types of Illness Anxiety Disorder
* **Care-seeking type:** medical care, including physician visits or undergoing tests & procedures, is frequently used
* **Care-avoidant type:** Medical care rarely used
44
**Illness Anxiety Disorder**
* Normal physiological sensation: \_\_\_\_
* Benign and self limited dysfunction: \_\_\_\_\_
* Bodily discomfort not generally considered indicative of disease: \_\_\_\_\_
* Orthostatic dizziness
* Transient tinnitus
* Belching
45
3 ways in which Illness Anxiety Disorder affects daily activities
* Repeatedly examines themselves
* Spend excessive amts of time researching disease
* Repeatedly seeks reassurance from family, friends, or medical providers
46
Comorbidities of Illness Anxiety Disorder
* "New DSM V diagnostic category so exact comorbidities are unknown"
* Anxiety disorders
* Depressive disorders
47
**Tx for Illness Anxiety Disorder (3 non-pharm)**
* What is the goal of tx?
* Collaborate w/ mental health providers
* Establish therapeutic alliance w/ pt
* Schedule regular office visits NOT contingent upon active health concerns
* **Goal:** functional improvement
48
Steps of pharm tx for Illness Anxiety Disorder (3)
* **1st line:** CBT
* **CBT non-responders / declines CBT:** off label SSRIs
* If present, tx comorbidities
49
Functional neurologic sx disorder
Conversion Disorder
50
* Neurologic sxs inconsistent w/ neurological disease, but cause distress/impairment
* Sxs do not conform to known anatomical pathways and physiological mechanisms
**Conversion Disorder** (Functional Neurologic Sx Disorder)
51
Postulated that presenting sxs tend to reflect pts own understanding of anatomy... (lower knowledge --\> higher implausibility)
Conversion Disorder
52
**Conversion Disorder**
* Sxs produced/feigned intentionally?
* Sxs thought to be an attempt to resolve conflict that \_\_\_\_\_.
* Not intentional
* patient feels inside
53
Conversion Disorder more common in males or females?
**Females**
F:M 2-3 : 1
54
3 risk factors of Conversion Disorder
* Hx of **childhood abuse/neglect**
* **Stressful life events**
* Presence of **neuro disease that causes similar sxs**
55
Etiology of Conversion Disorder
Poorly understood
56
**Conversion Disorder**
* 1 or more sxs of \_\_\_\_\_\_\_\_\_\_\_\_\_\_
* Can or cannot be turned on / off at will
* altered **voluntary motor** or **sensory function**
* **Cannot**
57
