Somatoform disorders and physical health

Question 1

Psychiatric presentation of multiple sclerosis

Answer 1

25% mood disturbance: bland euphoria/depression

25% cognitive deficits

Question 2

Psychiatric presentations of Parkinson’s

Answer 2

Depression

Dementia

DAergic therapy –> psychosis/disinhibition

Question 3

Prevalence of psychiatric presentations of SLE

Answer 3

5% at presentation

50% lifetime prevalence

Question 4

Psychiatric presentations in SLE

Answer 4

Delirium

Mood disorder

Psychosis

Seizures

Question 5

Psychiatric presentation of HIV

Answer 5

10-20% of AIDS patients will get dementia

Insidious memory loss, attention, concentration

Myoclonus/seizures

Apathy/social withdrawal

Depression psychosis

Question 6

Psychiatric presentation of Cushing’s disease

Answer 6

severe depression

Question 7

Psychiatric presentation of hyperthyroidism

Answer 7

Anxiety

Mania, psychosis, delirium

Question 8

Psychiatric presentation of hypothyroidism

Answer 8

Mental slowing, depressive symptoms

May persist despite thyroxine replacement

Question 9

Psychiatric presentations of hypercalcaemia

Answer 9

25% cognitive impairment

50% Psychosis, delirium, mood disorder

Question 10

Subcategories of somatoform disorder

Answer 10

Hypochondriasis

Dysmorphophobia

Somatization disorder

Persistent somatoform pain disorder

Dissociative/conversion disorder

Question 11

Main feature of condition is concern with having a disease

Answer 11

Hypochondriasis

Question 12

Main feature of condition is innappropriate concern with size/shape/deformity of body part

Answer 12

Dysmorphophobia

Question 13

Main feature of conditions is concern with somatic symptoms

Answer 13

Somatization disorder

Persistent somatoform pain disorder

Undifferentiated somatoform disorder

Question 14

Important to exclude in assessment of somatoform disorder

Answer 14

• Physical cause of symptoms
• Depression/anxiety (insufficient to explain symptoms)
• Psychosis w/ somatic hallucinations
• Malingering
• Dissociative/conversion disorder

Question 15

Time criterion for somatization disorder

Answer 15

>= 2 years of symptoms

Question 16

Consultation criteria for somatization disorder

Answer 16

>3 consultations w/ refusal to accept medical advice that there is no physical cause

Question 17

Symptom criteria for somatization disorder

Answer 17

>=6 symptoms from >=2 systems

Question 18

Criteria for somatization disorder

Answer 18

Time

Consultations

Symptoms

Question 19

Undifferentiated somatoform disorder vs somatization disorder

Answer 19

Shorter duration, fewer symptoms

Question 20

Loss of specific physical function

Answer 20

Conversion/dissociative disorder

Question 21

Time criterion for all somatoform disorders apart from somatization disorder

Answer 21

6 months

Question 22

Treatment of hypochondriasis

Answer 22

Avoid unnecessary treatment (biggest cause of harm)

CBT, behavioural activation therapy, formulations

Antidepressants (even in absence of depression)

Question 23

Pharmacological treatment of persistent somatoform pain disorder

Answer 23

SNRIs

Tricyclic antidepressants

Question 24

Psychiatric associations with somatoform disorders

Answer 24

Depression

Anxiety

Personality disorder

(May overlap or coexist with somatoform disorder)

Question 25

Distinction between factitious disorder and malingering

Answer 25

Absence of external motivation in factitious disorder (c.f. malingering) Factitious disorder is a psychiatric disorder

Question 26

Thoughts to elicit in MSE of suspected somatoform disorder

Answer 26

* Preoccupation with health/specific illness: how is your health? * Expectation from consultation: what do you think is causing it? What would help?

Question 27

Perceptions to elicit in somatoform disorder

Answer 27

* Many aches and pains? * Symptoms your doctor can't explain? * What do you think about your appearance?

Question 28

Prevalence of psychiatric disorder in medical/surgical outpatients

Answer 28

1/3 of attendees

Question 29

Important psychiatric cause of chest pain, dizziness, tingling

Answer 29

Panic disorder

Question 30

Important psychiatric cause of deterioration of medical/surgical conditions

Answer 30

depression

Question 31

Diagnostic algorithm for unexplained medical complaints

Answer 31

Question 32

Presentation of psychiatric disorders in medical settings

Answer 32

Unexplained medical symptoms Behavioural management problem Deterioration of preexisting medical disease

Question 33

Factitious illness vs hypochondriasis

Answer 33

Hypochondriasis: Anxiety disorder, fear of having a disease, vague symptoms Factitious illness: Pretending to have ysmptoms to get medical attention (2ry gain)

Question 34

Clinical features of hypochondriasis

Answer 34

Persistent anxiety about having a specific disease(s) in spite of medical reassurance

Question 35

Conversion/dissociative disorder features

Answer 35

Partial/complete loss of normal integration between memories/awareness of identity and immediate sensations/movement Physical illness in absence of pathology produced through unconscious mechanisms (psychological --\> physical stress)