Somatoform disorders and physical health Flashcards Preview

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Flashcards in Somatoform disorders and physical health Deck (35):
1

Psychiatric presentation of multiple sclerosis

25% mood disturbance: bland euphoria/depression

25% cognitive deficits

2

Psychiatric presentations of Parkinson's

Depression

Dementia

DAergic therapy --> psychosis/disinhibition

3

Prevalence of psychiatric presentations of SLE

5% at presentation

50% lifetime prevalence

4

Psychiatric presentations in SLE

Delirium

Mood disorder

Psychosis

Seizures

5

Psychiatric presentation of HIV

10-20% of AIDS patients will get dementia

Insidious memory loss, attention, concentration

Myoclonus/seizures

Apathy/social withdrawal

Depression psychosis

6

Psychiatric presentation of Cushing's disease

severe depression

7

Psychiatric presentation of hyperthyroidism

Anxiety

Mania, psychosis, delirium

8

Psychiatric presentation of hypothyroidism

Mental slowing, depressive symptoms

May persist despite thyroxine replacement

9

Psychiatric presentations of hypercalcaemia

25% cognitive impairment

50% Psychosis, delirium, mood disorder

10

Subcategories of somatoform disorder

Hypochondriasis

Dysmorphophobia

Somatization disorder

Persistent somatoform pain disorder

Dissociative/conversion disorder

11

Main feature of condition is concern with having a disease

Hypochondriasis

12

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

Dysmorphophobia

13

Main feature of conditions is concern with somatic symptoms

Somatization disorder

Persistent somatoform pain disorder

Undifferentiated somatoform disorder

14

Important to exclude in assessment of somatoform disorder

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

15

Time criterion for somatization disorder

>= 2 years of symptoms

16

Consultation criteria for somatization disorder

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

17

Symptom criteria for somatization disorder

>=6 symptoms from >=2 systems

18

Criteria for somatization disorder

Time

Consultations

Symptoms

19

Undifferentiated somatoform disorder vs somatization disorder

Shorter duration, fewer symptoms

20

Loss of specific physical function

Conversion/dissociative disorder

21

Time criterion for all somatoform disorders apart from somatization disorder

6 months

22

Treatment of hypochondriasis

Avoid unnecessary treatment (biggest cause of harm)

CBT, behavioural activation therapy, formulations

Antidepressants (even in absence of depression)

23

Pharmacological treatment of persistent somatoform pain disorder

SNRIs

Tricyclic antidepressants

24

Psychiatric associations with somatoform disorders

Depression

Anxiety

Personality disorder

(May overlap or coexist with somatoform disorder)

25

Distinction between factitious disorder and malingering

Absence of external motivation in factitious disorder (c.f. malingering)

Factitious disorder is a psychiatric disorder

26

Thoughts to elicit in MSE of suspected somatoform disorder

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

27

Perceptions to elicit in somatoform disorder

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

28

Prevalence of psychiatric disorder in medical/surgical outpatients

1/3 of attendees

29

Important psychiatric cause of chest pain, dizziness, tingling

Panic disorder

30

Important psychiatric cause of deterioration of medical/surgical conditions

depression

31

Diagnostic algorithm for unexplained medical complaints

32

Presentation of psychiatric disorders in medical settings

Unexplained medical symptoms

Behavioural management problem

Deterioration of preexisting medical disease

33

Factitious illness vs hypochondriasis

Hypochondriasis: Anxiety disorder, fear of having a disease, vague symptoms

Factitious illness: Pretending to have ysmptoms to get medical attention (2ry gain)

34

Clinical features of hypochondriasis

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

35

Conversion/dissociative disorder features

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)