Somatic Symptoms & Related Disorders

Question 1

What is the etiology of Somatization?

Answer 1

unclear

Question 2

T/F Somatic disorder is a benign disorder

Answer 2

FALSE

Question 3

What two things does somatic disorder lead to?

Answer 3

disability and iatrogenic harm

Question 4

What is the diagnosis of somatic symptom disorder?

Answer 4

basis of positive symptoms and signs RATHER THAN the absence of a medical explanation for somatic symptom

Question 5

How long does a somatic symptom need to be present

Answer 5

6 mo

Question 6

What is the screening tool for Somatic Symptom?

Answer 6

Patient Health Questionnaire (15 item)

Question 7

What is disorder is a diagnosis of exclusion?

Answer 7

Somatic Symptom disorder

Question 8

What things must be excluded in somatic symptom?

Answer 8

lack of physical or lab findings and factious disorder and malingering

Question 9

What is the goal of treatment for somatic symptom?

Answer 9

is management not cure

Question 10

When should appts be done for somatic symptom?

Answer 10

regular outpatient visits (4-8wks) NOT contingent upon SX

Question 11

What is the treatment for somatic disorder?

Answer 11

SSRI, SNRI, TCAs

Question 12

What is the dosing for meds for somatic disorder?

Answer 12

start lowest possible dose and increase slowly

Question 13

What therapy works best for somatic disorder?

Answer 13

Cognitive Behavior therapy

Question 14

What is conversion disorder?

Answer 14

abnormal nervous system functioning in the absence of structural pathology

Question 15

What are symptoms seen in conversion disorder?

Answer 15

weakness, abnormal movements, non-epileptic seizures

Question 16

What is the difference between conversion and malingering disorder?

Answer 16

symptoms are genuine and cause distress and/or psychosocial impairment

Question 17

What are the ABCD of conversion disorder?

Answer 17

A. 1 or more symp of altered voluntary motor or sensory function
B. findings provide evidence of incompatibility between symptom and recognized medical conditions
C. symptom not better explained by other disorders
D. causes distress in social, work etc.

Question 18

What is the 1st line txt for conversion disorder?

Answer 18

pt education about the syndrome

Question 19

What may be all that necessary for recovery in minority of pts?

Answer 19

explanation of the diagnosis

Question 20

What is the 2nd line txt for conversion disorder?

Answer 20

Cognitive Behavioral Therapy and PT

Question 21

What is the 3rd line txt for conversion disorder?

Answer 21

Antidepressants, Hypnosis, Family therapy, group therapy

Question 22

What is body dysmorphic disorder?

Answer 22

preoccupation w/ non-existent or slight defects in physical appearance, that the pt believe they look abnormal

Question 23

Appearance in mirrors, exercising, starving self, staying home

Answer 23

body dysmorphic disorder

Question 24

Causes distress, impaired functioning, and often associated w/ suicidal ideation and behaviors

Answer 24

Body dysmorphic disorder

Question 25

When does body dysmorphic usually start?

Answer 25

around 17 yo

Question 26

What do most pts w/ body dysmorphic seek for care?

Answer 26

dermatologic and surgical procedures

Question 27

T/F Effective treatment is available for body dysmorphic?

Answer 27

TRUE

Question 28

What are two symptoms of body dysmorphic disorder?

Answer 28

preoccupations and compulsions

Question 29

What percentage of ppl report no change in appearance after cosmetic treatment?

Answer 29

91%

Question 30

What is the most common comorbidity found with body dysmorphic?

Answer 30

depression

Question 31

What percentage of pts have a history of SI and SA in body dysmorphic?

Answer 31

80% and 25%

Question 32

What are 3 risk factors for Body dysmorphic disorder?

Answer 32

age on onset <17y severe symp comorbid substance use or PTSD

Question 33

What is the med txt of body dysmorphic disorder?

Answer 33

SSRI antidepressants

Question 34

What is the treatment of body dysmorphic disorder

Answer 34

Cognitive behavioral therapy | Patient and Family Education

Question 35

T/F With successful txt, pt will often have relapses?

Answer 35

TRUE

Question 36

What is malingering?

Answer 36

illness falsification to obtain external benefits

Question 37

How is malingering described?

Answer 37

Not a psychiatric illness and no longer in DSM 5, but added a v-code (descriptor)

Question 38

What 4 things should malingering be suspected in?

Answer 38

medicolegal context of presentation marked discrepancy between the person's claimed stress or disability and findings Lack of cooperation during the dx and complying w/ prescribed txt Presence in the pt of antisocial personality disorder

Question 39

What is the test for malingering?

Answer 39

NO SINGLE TEST

Question 40

How should malingering be managed?

Answer 40

referral to specialists as needed to r/o disease

Question 41

What is factitious Disorder?

Answer 41

a factitious disorder imposed on self or others

Question 42

What is the goal of those with factitious disorder?

Answer 42

NONE, achieving the patient role or sympathy towards the perpetrator

Question 43

What are some symptoms that a patient might induce on themselves?

Answer 43

self-mutilation, fever, hemorrhage, hypoglycemia, seizures

Question 44

How are symptoms usually presented in factitious disorder?

Answer 44

exaggerated and dramatic fashion

Question 45

What is factitious disorder imposed on another?

Answer 45

someone creates illness for another person based on psychological benefit of the first person, such as sympathy or a relationship w/ clinicians

Question 46

What is Medical Child Abuse

Answer 46

requires the provider to recognize the caregiver is exaggerating, fabricating, or inducing illness in a child

Question 47

What should a medical provider do in medical child abuse?

Answer 47

review all of the child's medical records

Question 48

What should a medical provider do in factitious disorder?

Answer 48

obtain a comprehensive history and physical exam confirm the history with other clinicians Identify whether symptoms depend upon perpetrator's presence

Question 49

What is the treatment for factitious disorder?

Answer 49

``` contact CPS cancel scheduled but unnecessary surgeries Stop meds Correct iatrogenic damage Take out vascular access ```