Somatoform Disorders and Eating Disorders Flashcards

(36 cards)

1
Q

what are somatization disorders

A

psychiatric disorders characterized by presence of somatic (physical) complaints
symptoms typically medically unexplainable and cause significant distress

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2
Q

what are types of somatization disorders

A

Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion Disorder
Factitious Disorder

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3
Q

what are clues to the presence of a somatization disorder?

A

vague history of present illness
inconsistent history
symptoms out of proportion to possible dx
symptoms rarely alleviated with tx
patient avoids physical exam
patient avoids providing previous records
frequent complaints of medication side effects
receiving care from multiple providers
extensive work-up with no diagnosis
multiple medial diagnosis on PMH

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4
Q

What is Somatic Symptom Disorder

A

aka Hypochondriasis
Females equal to or greater than males
avg age onset: 20-30 years
higher prevalence in pts with functional disorders (IBD, fibromyalgia, CFS)
many have co-occuring depression/anxiety

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5
Q

What are common symptoms of Somatic Symptom Disorder

A

Neuropsychiatric: memory impairment, numbness/tingling, impaired coordination
cardiopulmonary: dizziness, pleuritic chest pain, palpitations
Gastrointestinal: biliary colic, stomach cramps, IBD
Genitourinary: sexual dysfunction, pelvic cramps, urinary dysfunction
MSK: weakness pain, spasms
Sensory: blurred vision, tinnitus, hearing loss
Endocrine: hair loss, feeling hot or cold

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6
Q

what are screening tests for Somatic Symptom Disorders

A

PHQ-15 survey
Somatic Symptom Scale -8

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7
Q

What is conversion disorders

A

characterized by medically unexplained neurologic or motor symptoms
AKA functional Neurologic Symptom Disorders
- DOES NOT include pain
- symptoms more often evident on PE, but dont fit with known medical disorders

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8
Q

what are common symptoms of conversion disorders

A

weakness - paralysis, tics/tremors, other involuntary movements
tingling - numbness/ spasms
incoordiantion (falls) - ataxia, pesudoseizures, inability to ambulate
inability to speak (aphonia) - vision loss, hearing loss, slurred speech,
urinary retention - syncope, ‘lump in throat’, inability to swallow

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9
Q

when does conversion disorder typically begin

A

onset in late childhood to early adulthood
F> males (2:1)
higher incidence in: low SES, rural areas, Low education levels

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10
Q

what is the prognosis of conversion disorder

A

primary episodic with longer symptom free intervals
more transient that somatic episodic disorders
often spontaneous resolution of symptoms

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11
Q

what is illness anxiety disorder

A

characterized by excessive worry over having or getting an illness
+/- associated symptoms
epidemiology ill defined

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12
Q

what is the prognosis of Illness anxiety disorder

A

unclear
likely chronic with exacerbations

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13
Q

What is factitious disorder

A

aka munchausens syndrome
INTENTIONAL production or reigning of symptoms/illness
MAY appear medically explainable
not motivated by some secondary gain
can be induced in one’s self or another person (munchausen’s by proxy)

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14
Q

what is the presentation of factitious disorder

A

often presents in early adulthood - middle age
M>F
healthcare workers are at higher risk

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15
Q

what are ways patient may induce illness in factitious disorder

A

injection of a contaminated substance to induce infection
contaminating lab samples
secretive use of medications that aren’t indicated
self-inflicted wounds or worsening of surgical wounds

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16
Q

how are somatization disorders diagnosed

A

diagnosis of exclusion
undertake only LIMITED work-up
Schedule regular visits for reassurance

17
Q

what is the treatment of somatization disorders

A

cautiously discuss relationship to anxiety/emotional state: exception- factitious disorder - patient should be confronted, may end symptoms
avoid surgery, procedures and medications: SSRIs show to be somewhat helpful
consult psychiatry - initiate CBT

18
Q

what are types of eating disorders?

A

anorexia nervosa
bulimia nervosa
binge-eating disorder

19
Q

what is anorexia nervosa

A

most commonly diagnosed in adolescence (14-18)
F>M (10-20x)
associated with several other psychiatric diagnoses
higher prevalence with occuaptions/sports that require control of body weight

20
Q

what is anorexia nervosa associated with

A

NT, hormonal and brain changes

21
Q

what is a patients BMI with a severe anorexia nervosa

22
Q

if a patient with anorexia nervosa presents with a BMI of 12-18.5 what is the severity level of their disorder

A

mild anorexia

23
Q

what is the treatment of anorexia nervosa

A

mostly outpatient
no effective pharmacologic treatment - should treat comorbid psych disorders
CBT and MANTRA

24
Q

what is MANTRA

A

Maudsley Anorexia Nervosa Treatment for adults - 12 months, family based therapy

25
who gets inpatient treatment with anorexia nervosa
severe disease (BMI < 16) hypotension or hypothermia electrolyte imbalances suicidal ideation or psychosis failure of outpatient treatment
26
what is the prognosis of patients with anorexia nervosa
25-40% will achieve remission other proportion will remain symptomatic untreated anorexia - mortality rate 5/1,000
27
what is refeeding syndrome
if someone in starvation is fed too much, too quickly it may result in: - hypophosphatemia -hypomagnesemia -hypokalemia -thiamine deficiency -salt and water retention
28
what is bulimia nervosa
more common than anorexia F>M tends to develop later than anorexia (late adolescence to early adulthood) more likely to be normal weight
29
what are high risk groups for bulimia nervosa
high achievers, parental neglect, history of depression, SUD
30
what is the bulimia nervosa cycle
binge, interruptions or feelings of physical discomfort, guilt, depression, self-disgust, compensatory behaviors, symptom free interval, binge loop
31
when is bulimia nervosa considered extreme
14+ episodes of compensatory behaviors per week
32
what are subtypes of bulimia nervosa
purging: self-induced vomiting, laxatives, diuretics non-purging: dieting/fasting, exercise, common in higher BMI
33
what are less common medical complications of bulimia nervosa
electrolyte disturbances (hypokalemia) dehydration elevated amylase levels, pancreatitis menstrual irregularities or amenorrhea hypotension/bradycardia esophageal/gastric tears
34
what is the treatment of bulimia nervosa
most treated outpatient less likely to need hospitalization than anorexia
35
what is binge-eating disorders
most common F>M usually older age at onset more likely to be overweight significant overlap with bulimia
36
what are the goals of eating disorder treatments
restore normal body weight change restrictive/binging/purging behaviors therapy: CBT, behavior changes, group/individual psychotherapy, family therapy