Somatoform Disorders Flashcards
What are somatoform disorders?
Disorders in which patients present with physical symptoms that have no organic cause
What is the difference between primary and secondary gain in somatoform disorders?
Primary: expression of unacceptable feelings as physical symptoms in order to avoid facing them
Secondary: Use of symptoms to benefit the patient (increased attention, decreased responsibilities…)
Which somatoform disorder is not more common in women?
Hypochondriasis
What is somatization disorder?
Patients present with multiple vague complalints involving many organ systems; symptoms cannot be explained by a medical disorder
What is the DSM-IV criteria for somatization disorder?
- At least two GI symptoms
- At least one sexual or reproductive symptoms
- At least one neurological symptom
- At least four pain symptoms
- Onset before age 30
- Cannot be explained by general medical condition or substance use
The is a greater prevalence of somatization disorder in ____ socioeconomic groups
Low
What is the course of somatization disorder?
Usually chronic and debilitating
How is somatization disorder managed?
Regularly scheduled frequent visits to a primary care practicioner (these patients will usually not agree to see a psychiatrist)
What are the DSM-IV criteria for conversion disorder? (7)
- At least one neurological symptom
- Psychological factors associated with initiation or exacerbation of symptoms
- Symptom not intentionally produced
- Cannot be explained by medical condition or substance abuse
- Causes significant distress or impairment in social or occupational functioning
- Not accoutned for by somatization disorder or other mental disorder
- Not limited to pain or sexual symptom
What is la belle indifference in terms of conversion disorder?
Patients are often surprisingly calm and unconcerned when describing their symptoms (which may include blindness or paralysis)
What are some common symptoms of conversion disorder?
What is Globus Hystericus
- Shifting paralysis
- Blindness
- Mutism
- Paresthesias
- Seizures
- Globus Hystericus - sensation of lump in throat
What is the incidence of conversion disorder in general medical settings?
20-25%
There is increased incidence of conversion disorder in _____ socioeconomic groups
low
What percentage of patients with conversion disorder eventually receive medical diagnoses?
50%
Symptoms of conversion disorder usually resolve in ______
1 month
What is the role of sodium amobarbitol in conversion disorder?
Symptoms may spontaneously resolve after hypnosis or sodium amobarbital interview if the psychological trigger can be uncovered during the interview
Although most patients spontaneously recover, what treatment options are available for conversion disorder?
Insight-oriented psychotherapy, hypnosis, or relaxation therapy if needed
What are the DSM-IV criteria for Hypochondriasis?
- Patients fear that they have serious medical condition based on misinterpretation of normal body symptoms
- Fear persists despite appropriate medical evaluation
- Fears present for at least 6 months
What is the average age of onset of hypochondriasis?
20-30 years old
80% of patients with hypochondriasis have coexisting… (2)
Major depression or anxiety disorder
What clinical features distinguish between somatization disorder and hypochondriasis?
Hypochondriacs are worred about disease whereas patients with somatization disorder are concerned about their symptoms
What is the course of hypochondriasis?
What percentage of patients improve significantly?
Episodic - symptoms may wax and wane periodically
50% of patients improve significantly
What is the management of hypochondriasis?
Management involves frequently scheduled visits to one primary care doctor who oversees the patient’s care
What are some characteristics of patients with body dysmorphic disorder?
They are extremely self-conscious about their appearance
Spend significant time trying to correct perceived flaws with makeup, dermatological procedures or plastic surgery
