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Flashcards in Somatoform Disorders Deck (60):
1

What is the common feature of somatoform disorders?

the presence of physical symptoms that suggest a general medical condition and are not fully explained by a general medical condition, by the direct effects of a substance, or by another mental disorder

2

What is the essential feature of somatization disorder?

a pattern of recurring, multiple, clinically significant somatic complaints

3

What makes a somatic complaint clinically significant?

  • if it results in medical treatments
  • if it causes significant impairment in social, occupational, or other important areas of functioning

4

What are the requirements for somatic complaints to fit into criterion A of somatization disorder?

  • beginning before age 30
  • occur over a period of several years
  • result in treatemnt being sought or significant impairment in social, occupational, or other important areas of functioning

5

What is the B criteria for somatization disorder?

B. Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance:

  1. four pain symptoms
  2. two gastrointestinal symptoms
  3. one sexual symptom
  4. one pseudoneruological symptom

6

What qualifies the pain symptoms in somatization disorder?

a history of pain related to at least four different sites or functions (head, abdomen, back, joints, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination)

7

What qualifies the gastrointestinal symptoms for somatization disorder?

a history of at least two gastrointestinal symptoms other than pain (nausea, bloating, vomiting other than during pregnancy, diarrhea, or intolerance of several foods)

8

What qualifies the sexual symptom of somatization disorder?

a history of at least one secual or reproductive symptom other than pain (sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy)

9

What qualifies as a pseudoneurological symptom for somatization disorder?

a symptom or deficit suggesting a neurological condition not limited to pain (conversion symptoms such as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures; dissociative symptoms such as amnesia, or loss of consciousness other than fainting)

10

What is the C criterion for somatization disorder?

Either 1 or 2:

  1. after appropriate investigation, each of the symptoms in criterion B cannot be fully explained by a known general medical condition or the direct effect of a substance
  2. when there is a related general medical condition, the physical complaints or resulting social/occupational impairment are in excess of what would be expected from the history, physical examination, or laboratory findings

11

What is criterion D for somatization disorder?

D. The symptoms are not intentionally produced or feigned (as in factitious disorder or malingering).

12

What are characteristic attributes of people with somatization disorder?

  • describe complaints ini colorful, exaggerated terms, lacking specific factual information
  • inconsistent historians
  • often seek treatment from several physicians concurrently
  • prominent anxiety symptoms and depressed mood common

13

What differentiates somatization disorder from a general medical condition?

  1. involvement of multiple organ systems
  2. early onset and chronic course without development of physical signs or structural abnormalities
  3. absence of laboratory abnormalities that are characteristic of the suggested general medical condition

14

How can somatization disorder be differentiated from schizophrenia?

schizophrenia may include multiple somatic delusions, but somatization disorder features somatic complaints that are nondelusional

15

How can somatization disorder be differentiated from panic disorder?

in panic disorder, somatic symptoms are generally contained within a panic attack

16

How can somatization disorder be differentiated from generalized anxiety disorder?

the focus of anxiety in generalized anxiety disorder is not limited to physical complaints

17

How can somatization disorder be differentiated from mood disorders (especially depressive disorders)?

in somatization disorder, symptoms persist regardless of mood, while in depressive disorders, the somatic symptoms are generally only experienced during depressive episodes

18

How can somatization disorder be differentiated from hypochondriasis?

hypochondriasis can not be diagnosed if preoccupation with fears of having a serious illness occurs exclusively during the course of somatization disorder

19

What is the essential feature of undifferentiated somatoform disorder?

one or more physical complaints (like fatigue, loss of appetite, gastrointestinal, or urinary complaints) that persist for six months or longer

20

What is the B criterion for undifferentiated somatoform disorder?

Either 1 or 2:

  1. after appropriate investigation, the symptoms cannot be fully explained by a known general medical condition or the direct effects of a substance
  2. when there is a related general medical condition, the physical complaints or resulting social or occupational impairment is in excess of what would be experienced from the history, physical examination, or laborotory findings

21

What are the C and D criteria for undifferentiated somatoform disorder?

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

D. The duration of the disturbance is at least six months

22

What are the E and F criteria for undifferentiated somatoform disorder?

E. Not better accounted for by another mental disorder (like another somatoform disorder, sexual dysfunction, mood disorder, anxiety disorder, sleep disorder, or psychotic disorder)

F. The symptom is not intentionally produced or feigned (like factitious disorder or malingering)

23

If symptoms do not meet the full criteria for somatization disorder and have not persisted for six months, what must be diagnosed?

somatoform disorder not otherwise specified

24

What is the essential feature of conversion disorder?

the presence of symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition

25

What is criterion B for conversion disorder?

B. Psychological factors are judged to be associated with the symptom or deficit because the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors.

26

What are criterion C and D for conversion disorder?

C. The symptom or deficit is not intentionally produced (factitious/malingering)

D. Not gen med/substance or a culturally sanctioned behavior or experience

27

What are criteria E and F for conversion disorder?

E. causes clinically significant distress/impairment (social, occupational, other) or warrants medical evaluation

F. Not limited to pain or sexual dysfunction, does not occur exclusively during course of somatization disorder, and not better accounted for by another mental disorder

28

What are the subtypes of conversion disorder?

  1. with motor symptom or deficit
  2. with sensory symptom or deficit
  3. with seizures or convulsions
  4. with mixed presentation

29

When would the subtype "with motor symptom or deficit" be applied to conversion disorder?

This subtype includes such symptoms as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or "lump in throat," aphonia, and urinary retention.

30

When would the "with sensory symptom or deficit" subtype to conversion disorder be used?

This subtype includes such symptoms as loss of touch or pain sensation, double vision, blindness, deafness, and hallucinations.

31

When would the subtype "with seizures or convulsions" be applied to conversion disorder?

When the individual experiences seizures or convulsions. If motor or sensory components are involved, the subtype would still be with seizures or convulsions.

32

When would the "with mixed presentation" subtype to conversion disorder be applied?

if symptoms of more than one category are evident

33

What is the difference between a primary gain and a secondary gain in conversion disorder?

  • a primary gain is thought to be keeping the underlying conflict that caused the onset of symptoms to remain out of the individual's awareness
  • a secondary gain is one that externally benefits the individual, like duties or responsivilities are avoided

34

How can conversion disorder be differentiated from factitious disorder or malingering?

in conversion disorder, the symptoms are not intentionally produced

35

What is the typical course for conversion disorder?

  • onset generally acute
  • generally of short duration
  • if hospitalized, symptoms will typically remit within two weeks
  • recurrence is common

36

What are factors associated with a good prognosis of conversion disorder?

  • acute onset
  • presence of clearly identifiable stress at time of onset
  • short interval between onset and treatment
  • above average intelligence
  • paralysis
  • aphonia
  • blindness

37

What symptoms are not associated with a good prognosis for conversion disorder?

  • tremors
  • seizures

38

How can conversion disorder be differentiated from hypochondriasis?

In hypochondriasis, the person is preoccupied with the "serious disease" underlying the pseudoneurological symptoms.

In conversion disorder, the focus is on the presenting symptom, and there may be la belle indifference.

39

How can the hallucinations in conversion disorder be differentiated from the hallucinations in psychotic disorders like schizophrenia?

Hallucinations in conversion disorder usually occur with intact insight, absence of other psychotic symptoms, often involve more than one sensory modality, and often have naive, fantastic, or childish content.

40

What is the essential feature of pain disorder?

pain that is the predominant focus of the clinical presentation and is of sufficient severity to warrant clinical attention

41

What is criterion B for pain disorder?

pain causes significant distress or impairment in social, occupational or other important areas of functioning

42

What is criterion C for pain disorder?

psychological factors are judged to play a significant role in the onset, severity, exacerbation, or maintenance of the pain

43

What are criteria D and E of pain disorder?

D. Not intentionally produced or feigned (malingering/factitious)

E. Not better accounted for by mood, anxiety, or psychotic disorder, and not diagnosed if the pain presentation meets criteria for dyspareunia.

44

What are the subtypes of pain disorder?

  1. associated with psychological factors
  2. associated with both psychological factors and a general medical condition
  3. associated with a general medical condition

45

What is pain disorder with psychological factors?

This subtype is used when psychological factors are judged to have the major role in the onset, severity, exacerbation, or maintenance of the pain. General medical conditions play a minimal or no role in the onset and maintenance of pain. Not diagnosed if criteria for somatization disorder are met.

46

What is pain disorder associated with both psychological factors and a general medical condition?

This subtype is used when both psychological factors and a general medical condition are judged to have  important roles in the onset, severity, exacerbation, or maintenance of the pain. The anatomical site of the pain or associated general medical condition is coded on axis III.

47

What is pain disorder associated with a general medical condition?

This subtype of pain disorder is NOT CONSIDERED A MENTAL DISORDER and is coded on axis III. Pain results from a general medical condition and psychological factors are judged to play little or no role in the onset or maintenance of the pain.

48

What are the specifiers for pain disorder?

  • acute: duration of pain is less than six months
  • chronic: duration of pain is six months or longer

49

How is pain disorder differentiated from conversion disorder?

conversion disorder does not necessarily include pain

50

What is the essential feature of hypochondriasis?

preoccupation with fears of having, or the idea that one has, a serious disease based on a misinterpretation of one or more bodily signs or symptoms

51

What are criteria B and C for hypochondriasis?

B. The preoccupation persists despite appropriate medical evaluation and reassurance.

C. The belief in criterion A is not of delusional intensity (delusional disorder, somatic type) and is not restricted to a circumscribed concern about appearance (body dysmorphic disorder).

52

What are criteria D, E, and F for hypochondriasis?

D. Clinically significant distress/impairment of social, occupational, other areas of functioning

E. At least six months

F. Not better accounted for by GAD, OCD, panic disorder, major depressive episode, separation anxiety, or another somatoform disorder.

53

What is the specifier for hypochondriasis?

with poor insight

This specifier is used if, for most of the time during the current episode, the individual does not recognize that the concern about having a serious illness is excessive or unreasonable.

54

What are good prognostic indicators for hypochondriasis?

  • acute onset
  • brief duration
  • mild symptoms
  • presence of gen med comorbidity
  • absence of mental disorder comorbidity
  • absence of secondary gain

55

How can hypochondriasis be differentiated from a specific (disease) phobia?

In the specific phobia, the individual is fearful of developing or being exposed to a disease. Hypochondriacs think they have the disease.

56

What is the essential feature of body dysmorphic disorder (BDD)?

A preoccupation with a defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.

57

What are criteria B and C for body dysmorphic disorder?

B. The preoccupation causes clinically significant distress or impairment to social, occupational, or other important areas of functioning.

C. Not better accounted for by another mental disorder (like anorexia nervosa)

58

how can body dysmorphic disorder be differentiated from delusional disorder, somatic type?

an additional diagnosis of delusional disorder, somatic type can be made if the individual's preoccupation is held with delusional intensity

59

How can body dysmorphic disorder be differentiated from anorexia nervosa?

anorexia nervosa is limited to concerns about "fatness," while body dysmorphic disorder can be related to any body part

60

How can body dysmorphic disorder be differentiated from OCD?

OCD can only be diagnosed when the obsessions or compulsions are not limited to concerns about appearance