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Psych/BSci > Somatoform Disorders > Flashcards

Somatoform Disorders Flashcards

1
Q

What are the 5 somatoform disorders?

A
  1. Somatization disorder
  2. Conversion disorder
  3. Hypochondriasis
  4. Body dysmorphic disorder
  5. Pain disorder
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2
Q

What are the 2 diagnostic categories for somatoform disorders?

A
  1. Undifferentiated somatoform disorder

2. Somatoform disorder NOS

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3
Q

What are characteristics of Somatization disorder?

A
  • Starts before age 30
  • Combination of Pain, GI, Sexual, and Pseudo-neurological symptoms
  • It is chronic and associated w/:
    • psychological distress
    • impaired social/occupational functioning
    • excessive medical help seeking behavior
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4
Q

What are the associated personality traits of Somatization disorder?

A
  • Avoidant
  • Paranoid
  • Self-defeating
  • Obsessive-compulsive
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5
Q

How do you Dx Somatization disorder?

A
  • Onset of symptoms before age 30
  • Complaints of at least:
    • 4 pain symptoms
    • 2 GI symptoms
    • 1 sexual symptom
    • 1 pseudo-neurological symptom
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6
Q

What are common clinical features of Somatization disorder?

A
  • Nausea and vomiting
  • Pain in the arms and legs
  • Shortness of breath unrelated to exertion
  • Amnesia
  • Difficulty swallowing
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7
Q

What are the pseudo-neurological symptoms associated with Somatization disorder?

A
  • Impaired coordination or balance
  • Paralysis or weakness
  • Difficulty swallowing
  • Aphonia
  • Urinary retention
  • Hallucinations
  • Loss of touch or pain sensation
  • Double vision
  • Blindness
  • Deafness
  • Seizures
  • Loss of consciousness
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8
Q

What are the 3 features that suggest Somatization disorder?

A
  1. Involvement of multiple organ systems
  2. Early onset and chronic course w/o physical signs or structural abnormalities
  3. Absence of lab abnormalitites
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9
Q

What is the prognosis of Somatization disorder?

A

Rarely remits and a patient is unlikely to be symptom free for > 1 year

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10
Q

What is the Tx for Somatization disorder?

A

Have only 1 physician, brief regular visits at monthly intervals, avoid lab/diagnostic procedures for somatic complaints, group psychotherapy

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11
Q

What is Conversion disorder?

A

An illness caused by psychological factors and is preceded by conflicts or stressors resulting in deficits that affect voluntary motor or sensory functions

*There is no social, financial or legal gain

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12
Q

How is Conversion disorder diagnosed?

A
  • 1 or more symptoms or deficits affecting voluntary motor of sensory function
  • The symptom or deficit is not intentionally produced or feigned
  • The symptom or deficit cannot be explained by a medical condition
  • The symptoms or deficits cause clinically significant distress or impairment in social/occupational areas
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13
Q

What is required for the Dx of Conversion disorder?

A

An association between the cause of the neurological symptom and psychological factors

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14
Q

What must be excluded in the Dx of Conversion disorder?

A

Pain and sexual dysfunction symptoms

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15
Q

What are the most common clinical features of Conversion disorder?

A
  • Paralysis
  • Blindness
  • Mutism
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16
Q

What are the MOTOR symptoms of Conversion disorder?

A
  • Involuntary movements
  • Tics
  • Blepharospasm
  • Torticollis
  • Opisthotonos
  • Seizures
  • Abnormal gait
  • Falling
  • Inability to stand or walk in a normal manner
  • Paralysis
  • Weakness
  • Aphonia
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17
Q

What are the SENSORY symptoms of Conversion disorder?

A
  • Anesthesia of the extremities
  • Midline anesthesia
  • Blindness
  • Tunnel vision
  • Deafness
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18
Q

What are the VISCERAL symptoms of Conversion disorder?

A
  • Psychogenic vomiting
  • Pseudocyesis
  • Globus hystericus (sensation of lump in throat)
  • Swooning or syncope
  • Urinary retention
  • Diarrhea
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19
Q

What personality disorders may be associated with Conversion disorder?

A
  • Dependent
  • Passive-aggressive
  • Antisocial
  • Histrionic
20
Q

Patients with Conversion disorder have what associated features?

A
  • Primary gain
  • Secondary gain
  • La Belle Indifference
  • Identification
21
Q

What is Primary gain?

A

Keeping internal conflicts outside of their awareness

22
Q

What is Secondary gain?

A

What the patient receives as a result of being sick (e.g. receiving support)

23
Q

What is La Belle Indifference?

A

When the patient seems to be unconcerned about what appears to be a major impairment

24
Q

What is Identification

A

When the patient may unconsciously model their symptoms on those of someone important to them

25
Q

What are neurological differential diagnoses of Conversion disorder?

A
  • Brian tumors
  • Basal ganglia disease
  • Dementia
  • Myasthenia gravis
  • Polymyositis
  • Acquired myopathies
  • MS
  • Guillan-Barre syndrome
  • Creutzfeldt-Jakob disease
  • Periodic paralysis
26
Q

What is the prognosis of Conversion disorder?

A
  • Deficits are usually short duration
  • 95% remit spontaneously
  • Those with duration longer than 6 months have < 50% chance of symptom resolution
27
Q

What is Hypochondriasis?

A

When a person has a general and non-delusional preoccupation with fears of having a serious disease

  • Misinterpretation of bodily symptoms for > 6 months
  • They misinterpret and amplify their bodily symptoms
  • They have a low threshold for physical discomfort
28
Q

What is the most common age for Hypochondriasis to appear

A

20 to 30 years old

29
Q

What is the DSM IV criteria for Dx of Hypochondriasis?

A

A. Preoccupation with fears that one has a serious disease
B. Preoccupation persists despite appropriate medical reassurance
C. The belief in criterion ‘A’ is not delusional or about appearance
D. The preoccupation causes clinically significant distress/impairment in social/occupational
E. The duration is at least 6 months
F. The preoccupation is not better accounted for by other anxiety disorders

30
Q

What are some clinical features of Hyponchondriasis?

A
  • Often accompanied by depression or anxiety disorder

- Hypochondrial responses may remit when the external stress resolves

31
Q

What is the differential Dx of Hypochondriasis?

A
  • Somatization has concern about MANY symptoms, whereas hypochondriacs have a fear of having a disease
  • Conversion disorder is acute and involves a symptom, whereas hypochondriasis involves a disease
32
Q

What is the prognosis of Hypochondriasis?

A

Episodes last from months to years

33
Q

What is Body dysmorphic disorder?

A

A person who is preoccupied with an imagined defect in appearance that can lead to significant distress/impairment in important areas of functioning

34
Q

What is the most common age of onset of Body dysmorphic disorder?

A

15 to 30 years old

35
Q

What are the DSM IV criteria for Dx of Body dysmorphic disorder?

A

A. Preoccupation with an imagined defect in appearance
B. The preoccupation causes clinically significant distress/impairment in social/occupational
C. The preoccupation is not better accounted for by another mental disorder

36
Q

What are the clinical features of Body dysmorphic disorder?

A
  • Concern with facial flaws, hair, breasts, genitalia
  • (Men) concern is to develop large muscle mass
  • Excessive mirror checking or avoiding reflective surfaces
  • Avoidance of social and occupational exposure
37
Q

What is the Tx for Body dysmorphic disorder?

A
  • Tricyclic drugs
  • MOA inhibitors
  • Pimozide
  • Serotonin specific drugs
38
Q

What is Pain disorder?

A

Characterized by the presence of pain in one or more body sites and is sufficiently severe to come to clinical attention

39
Q

What are the psychodynamic factors of Pain disorder?

A
  • Pain w/o an identifiable physical cause
  • Displacement of emotional pain to the body
  • Pain is a way of obtaining love, a punishment, and a way to expiate guilt
40
Q

What are the behavioral factors of Pain disorder?

A

Pain behaviors are reinforced when rewarded and inhibited when ignored

41
Q

What are the interpersonal factors of Pain disorder?

A

Intractable pain is a way to ensure the devotion from family members or to stabilize a fragile marriage

42
Q

What are the biological factors of Pain disorder?

A
  • Deficiency of endorphins correlate with augmentation of incoming sensory stimuli
  • Limbic structural or chemical abnormalities may be the cause of pain
43
Q

What is the DSM IV criteria for Dx of Pain disorder?

A

A. Pain in one or more anatomical sites sufficient in severity to warrant clinical attention
B. Pain causes clinically significant distress/impairment in social/occupational
C. Psychological factors have an important role
D. The deficit is not intentionally produced
E. The pain is not better accounted for by a mood, anxiety, or psychotic disorder

44
Q

What are clinical features of Pain disorder?

A
  • Low back pain, headache, atypical facial pain, chronic pelvic pain
  • Can be post-traumatic, neuropathic, neurological, iatrogenic or musculoskeletal
  • There should be a psychological factor associated with the pain
  • Patients with Pain disorder visit many physicians and request many medications
  • 60-100% of patients have persistent mild depression (dysthymia)
45
Q

What is the differential Dx of Pain disorder?

A

Physical pain can be distinguished from psychogenic pain by its FLUCTUATION in intensity and its sensitivity to emotional, cognitive, and situational influences

46
Q

What is the Tx for Pain disorder?

A
  • Rehabilitation
  • Antidepressants (tricyclics & SSRIs)
  • Amphetamines
  • Psychotherapy

Psych/BSci (3 decks)

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