Somatic Symptom Disorders +Obsessive compulsive Flashcards
(40 cards)
1
Q
Disorders
A
- somatic Sx disorder (mild, moderate, severe)
- Illness Anxiety Disorder
- Conversion disorder (funcitonal Neuro symptom disorder
- Factitious disorder
2
Q
General elements
A
- no organ pathology to s/s
- Patients not reassured by negative findings
- Preoccupation w/ illness
- sick role w/o professional confirmation
3
Q
Difficult Differential
A
- masked depression, anxiety
- adjustment disorder, PTSD
- Somatic Sx disorder
- childhood somatic sx
4
Q
Somatic Sx Disorder
Criteria
A
6 months
*1+ somatic s/s not explained by condition
*1 cognitive behavioral (severity):
overconcern, anxiety, time devoted to seeking explanation, reduced quality of life
REPLACED SOMATIZATION Disorder
5
Q
Somatic symptom disorder
A
- illness in the home when growing up
- doctor shopping
- s/s = pain, nausea, position sense, autonomic instability
- female, reproductive age
- influenced by media
- early personal experience of illness/sick role
- current stress/impairment
- alienates providers, patient feels isolated/misunderstood
6
Q
Problems with current dagnosis
A
- depends of PROVIDER”s assessment of legitimacy (bias)
* notes but deflects attention from stressors + context
7
Q
Language
A
- structural= promote search for solutions (sugery)
* functional/ non structural can lead to dismissiveness
8
Q
Why these symptoms and not other?
A
- pain fibers unequally distributed
- most autonomic activity
- boundary with outside world is monitored w/ pain fibers
9
Q
Rapid/delayed responses
A
- sensory info goes to amygdala, trigger HPA maybe
- Thalamus to cingulate Cortex + prefrontal
- cortex applies contex (memory), interpretation (language), regulates thalamus to connect to HPA
10
Q
Beyond neuroanatomy
A
- immune factors
- homronal interactions w/ monamine neuro-transmitters (pain)
- other metabolic/endocrine factors (gluten sensitivity)
- role of poor sleep (FBM)
11
Q
Female>male:
A
*ssds, depression, anxiety (age 14-45)
*”Chronic Episodic Disorders” (CEDs)
=Migraines, IBS, FBM/CFS, Pelvic pain, depression,
=highly co-morbid
=Females!
12
Q
Sex influences
A
- testosterone
- female reproductive organs (endometriosis)
- E2/P regulate MOA transmiters (depression/pain often)
13
Q
Gender influence
Stressors
A
- subordinate status
- social support need
- abuse / interpersonal trauma
14
Q
Male variant psychosomatic disorder
A
*low back pain
15
Q
Reaction to Stress?
A
MUPS
- ID in combat veterans (Gulf wars)
- low grade, persistent stress
- chronic civilian stress
- dissociation
16
Q
Utility of SSD Dx
A
- includes real world complexity
- DON’T have to rule out everything medical for this
- tx: CBT, psychotherapy, some s/s respond to Rx (SNRI, tricyclics = low dose), exercise + restoration of sleep
17
Q
Somatic symptom disorder =
A
Their RESPONSE to disease is part of the problem
18
Q
Conversion symptoms
A
- non-epileptic seizure
- tunnel vision
- choking
- month after completing tx for injured finger, numbness in digits after
19
Q
Non-epileptic seizure dx
A
- EEG monitoring
- no incontinence, tongue biting, injury
- prolactin levels high in post ictal
- Pseudosz in actual seizure people
20
Q
Functional Neuro Sx disorder
A
- common in kids (visual complaints, dizziness, HA, not GI)
- not anatomical deficit distribution
- inexpressible dilemma/sudden stress
- respond to hypnosis, behavioral intervention, physical therapy
21
Q
Illness Anxiety Disorder
A
- ”hypochdriasis”
* Believes they have a CONDITION, not symptoms
22
Q
Factitious disorder
S/s
A
- want medical attention, not treatment
- seen in ER
- often seen w/ personality disorder
- can induce illness in child
- dangerous possibly
23
Q
Factitious disorder
Tx
A
- investigate, observe
- check EHR
- confront empathically
- no exploratory surgery, tx
24
Q
Malingering
A
Faking for gain
Antisocial
25
OCD vs OCPD (obsessive compulsive personality disorder)
OCD =
* ritual to undo worry
* stereotypic, elemental (basic instincts, drive : sex, aggression, danger, blasphemy)
* Anxiety (OCPD = irritability)
* professional/intelligence irrelevant
26
DSM 5
OCD
*Obsessions
*Compulsions (not realistic threat)
EXCLUDE = food obsessions, drug seeking, paraphilia, depressive rumination
27
Stereotypic Obsessions
* contamination
* symmetry
* Sin: offending, blaspheming
* Sin: aggression
* doubt
28
Obsessions
Subcortical/limbic
elemental, hardwired, overactive stress response
Change slowly with age
29
Types of compulsion
* 2ndary to obsession
* behavioral/mental
* Yielding: counting, checking, ordering, washing
* resisting = repeating thoughs/actions
* motor: tapping
30
Importance of compulsions
* simple/operant conditioning
* consume attention/time
* embarrassment
31
OCD scale
YBOCS
32
OCD
Epidemiology
* Boys more
* adult same
* relation : Tourette’s
* Female onset = postpartum (estrogen going away)
33
OCD
Path
CorticoThalamicStriatal (CTS) (learning), “hyperfrontality”
34
OCD
DDx
* depression
* schizophrenic
* heavy metals (lead)
* PANDAS (strep autoimmune reaction)
* tics (tourette’s)
* Head injury, other neuro
* meds, drugs
35
OCD
Tx
* avoid shaming
* explanation, education
* behavioral Tx (exposure/response VERY EFFECTIVE)
* Rx = SSRI fluvoxamine, chlorimipramine
* stereotactic surgery
36
OCD
Hoarding
* anxiety, fear of loss
* deprivation, isolation
* no known Tx
37
OCD
Trichotillomania
* hair pulling
* disfiguring
* causes embarrassment
* women more likely to be treated
* tension relieved by pullng
* Tx: SSRI maybe, CBT, WIgs
38
OCD
Body dysmorphic disorder
* EXCLUDE weight/shape preoccupation
| * TX: SSRI, CBT
39
Excoriation disorder
* skin picking
| * may cause infection
40
OC Spectrum
* great distress
* Pediatrics, obstetrics, derm, plastic surgery, psyc, neuro
* OC disorders = treatable, but not recognized by generalists
