Flashcards in Somatoform Disorders Deck (46):
1
What are the 5 somatoform disorders?
1. Somatization disorder
2.Conversion disorder
3. Hypochondriasis
4. Body dysmorphic disorder
5. Pain disorder
2
What are the 2 diagnostic categories for somatoform disorders?
1. Undifferentiated somatoform disorder
2. Somatoform disorder NOS
3
What are characteristics of Somatization disorder?
- 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
4
What are the associated personality traits of Somatization disorder?
- Avoidant
- Paranoid
- Self-defeating
- Obsessive-compulsive
5
How do you Dx Somatization disorder?
- Onset of symptoms before age 30
- Complaints of at least:
*4 pain symptoms
*2 GI symptoms
*1 sexual symptom
*1 pseudo-neurological symptom
6
What are common clinical features of Somatization disorder?
- Nausea and vomiting
- Pain in the arms and legs
- Shortness of breath unrelated to exertion
- Amnesia
- Difficulty swallowing
7
What are the pseudo-neurological symptoms associated with Somatization disorder?
- 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
8
What are the 3 features that suggest Somatization disorder?
1. Involvement of multiple organ systems
2. Early onset and chronic course w/o physical signs or structural abnormalities
3. Absence of lab abnormalitites
9
What is the prognosis of Somatization disorder?
Rarely remits and a patient is unlikely to be symptom free for > 1 year
10
What is the Tx for Somatization disorder?
Have only 1 physician, brief regular visits at monthly intervals, avoid lab/diagnostic procedures for somatic complaints, group psychotherapy
11
What is Conversion disorder?
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
12
How is Conversion disorder diagnosed?
- 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
13
What is required for the Dx of Conversion disorder?
An association between the cause of the neurological symptom and psychological factors
14
What must be excluded in the Dx of Conversion disorder?
Pain and sexual dysfunction symptoms
15
What are the most common clinical features of Conversion disorder?
- Paralysis
- Blindness
- Mutism
16
What are the MOTOR symptoms of Conversion disorder?
- Involuntary movements
- Tics
- Blepharospasm
- Torticollis
- Opisthotonos
- Seizures
- Abnormal gait
- Falling
- Inability to stand or walk in a normal manner
- Paralysis
- Weakness
- Aphonia
17
What are the SENSORY symptoms of Conversion disorder?
- Anesthesia of the extremities
- Midline anesthesia
- Blindness
- Tunnel vision
- Deafness
18
What are the VISCERAL symptoms of Conversion disorder?
- Psychogenic vomiting
- Pseudocyesis
- Globus hystericus (sensation of lump in throat)
- Swooning or syncope
- Urinary retention
- Diarrhea
19
What personality disorders may be associated with Conversion disorder?
- Dependent
- Passive-aggressive
- Antisocial
- Histrionic
20
Patients with Conversion disorder have what associated features?
- Primary gain
- Secondary gain
- La Belle Indifference
- Identification
21
What is Primary gain?
Keeping internal conflicts outside of their awareness
22
What is Secondary gain?
What the patient receives as a result of being sick (e.g. receiving support)
23
What is La Belle Indifference?
When the patient seems to be unconcerned about what appears to be a major impairment
24
What is Identification
When the patient may unconsciously model their symptoms on those of someone important to them
25
What are neurological differential diagnoses of Conversion disorder?
- Brian tumors
- Basal ganglia disease
- Dementia
- Myasthenia gravis
- Polymyositis
- Acquired myopathies
- MS
- Guillan-Barre syndrome
- Creutzfeldt-Jakob disease
- Periodic paralysis
26
What is the prognosis of Conversion disorder?
- Deficits are usually short duration
- 95% remit spontaneously
- Those with duration longer than 6 months have < 50% chance of symptom resolution
27
What is Hypochondriasis?
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
What is the most common age for Hypochondriasis to appear
20 to 30 years old
29
What is the DSM IV criteria for Dx of Hypochondriasis?
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
What are some clinical features of Hyponchondriasis?
- Often accompanied by depression or anxiety disorder
- Hypochondrial responses may remit when the external stress resolves
31
What is the differential Dx of Hypochondriasis?
- 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
What is the prognosis of Hypochondriasis?
Episodes last from months to years
33
What is Body dysmorphic disorder?
A person who is preoccupied with an imagined defect in appearance that can lead to significant distress/impairment in important areas of functioning
34
What is the most common age of onset of Body dysmorphic disorder?
15 to 30 years old
35
What are the DSM IV criteria for Dx of Body dysmorphic disorder?
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
What are the clinical features of Body dysmorphic disorder?
- 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
What is the Tx for Body dysmorphic disorder?
- Tricyclic drugs
- MOA inhibitors
- Pimozide
- Serotonin specific drugs
38
What is Pain disorder?
Characterized by the presence of pain in one or more body sites and is sufficiently severe to come to clinical attention
39
What are the psychodynamic factors of Pain disorder?
- 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
What are the behavioral factors of Pain disorder?
Pain behaviors are reinforced when rewarded and inhibited when ignored
41
What are the interpersonal factors of Pain disorder?
Intractable pain is a way to ensure the devotion from family members or to stabilize a fragile marriage
42
What are the biological factors of Pain disorder?
- Deficiency of endorphins correlate with augmentation of incoming sensory stimuli
- Limbic structural or chemical abnormalities may be the cause of pain
43
What is the DSM IV criteria for Dx of Pain disorder?
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
What are clinical features of Pain disorder?
- 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
What is the differential Dx of Pain disorder?
Physical pain can be distinguished from psychogenic pain by its FLUCTUATION in intensity and its sensitivity to emotional, cognitive, and situational influences
46