5. Somatoform Disorders - Cd, Pain, Hypo, Bds

Front 1

What does a Conversion disorder consist of?

Back 1

An acute stressor followed by a voluntary motor or sensory movement.

Front 2

Why do conversion symptoms arise?

Back 2

As an attempt to resolve an unsconscious conflict from memories and to keep it in the unconscious.

Front 3

What are 5 common MOTOR conversion symptoms?

Back 3

WPITS
Weakness
Paralysis
Involuntary movements
Tics
Seizures

Front 4

What are 3 common SENSORY conversion symptoms?

Back 4

BAD
-Blindness
-Anesthesia
-Deafness

Front 5

How can you detect a motor conversion disorder?

Back 5

The patient says they can't write, but they can scratch just fine.

Front 6

How can you detect a sensory conversion disorder?

Back 6

Glove/stocking distributions or Hemianesthesias - a genuine neurologic disorder would track dermatomes

Front 7

What is La belle indifference?

Back 7

The way that patients with conversion disorder don't appear concerned with their symptoms; they are casual about it.

Front 8

What are 3 good clues to conversion disorder?

Back 8

-Symptoms follow stress
-Symptoms conform to patient understanding of neurology
-Inconsistent physical symptoms

Front 9

Is conversion disorder very often a misdiagnosis of an actual organic disease?

Back 9

no

Front 10

What does functional neuroimagin show in hysterical paralysis?

Back 10

Decreased activity in frontal and subcortical circuits (motor control)

Front 11

What does functional neuroimagin show in hysterical anesthesia?

Back 11

Decreased activity in somatosensory cortices

Front 12

What does functional neuroimagin show in hysterical blindness?

Back 12

Decreased activity in the visual cortex

Front 13

Is neuro dysfunction a cause or result of conversion disorder?

Back 13

We don't know

Front 14

What type of approach should you take for treating conversion disorder?

Back 14

General and conservative; Reassure the patient and give physical/occupational therapy.

Front 15

What are 3 specific treatments for CD?

Back 15

-Psychotherapy
-Amytal interview
-Hypnosis

Front 16

What is the prognosis for CD?

Back 16

Good

Front 17

Which conversion disorders have a good prognosis? Which have a bad prognosis?

Back 17

Good: paralysis, aphonia, blindness

Bad: seizures/tremors

Front 18

Why do symptoms of seizures and tremors develop?

Back 18

Because of delayed treatment.

Front 19

What is the basis of the CC and physical exam of a patient with pain disorder?

Back 19

PAIN PAIN PAIN

Front 20

What 3 things are psychological factors the cause of in pain disorder?

Back 20

-Pain genesis
-Pain severity
-Pain maintenance

Front 21

What is the differential diagnosis for pain disorder?

Back 21

-Purely pain
-Depression
-Other somatoform disorders
-Malingering
-Factitious

Front 22

How can you rule out purely physical pain?

Back 22

Patients can distract themselves from the pain, or take med to relieve it

Front 23

How should you treat pain disorder in general?

Back 23

-Stress that you understand
-Try to improve functioning and realize pain won't ever go away

Front 24

What are 3 specific treatments for Pain disorder?

Back 24

-CBT
-Hypnosis
-Pharmacotherapy

Front 25

When do we often see pain disorder?

Back 25

When there's a lawsuit involved

Front 26

What gives pain disorder a good prognosis?

Back 26

-resolution of litigation
-prompt treatment

Front 27

What is "Preoccupation with fears of having a serious illness that doesn't respond to reassurance after appropriate medical workup?"

Back 27

Hypchondriasism

Front 28

What are some etiologies of hypochondriasism?

Back 28

-Defense against guilt

Front 29

How can you differentiate hypochondriasis from somatic delusional disorder?

Back 29

The delusional patient can't be convinced that they don't actually have a disease; the hypochondriac can (even if only for a short time).

Front 30

What commonly causes an increase in symptoms in hypochondriacs?

Back 30

Stress

Front 31

What does the CBT model say the etiology of hypochondriasis is?

Back 31

Misinterpretation of harmless bodily symptoms

Front 32

What is a 'hardwiring' physiologic model for the etiology of hypochondriasis?

Back 32

Patients have lower thresholds and lower tolerance of physical symptoms

Front 33

Other than establishing trust, doing CBT and supportive therapy, what drug appears to be beneficial for hypochondriasis?

Back 33

Serotonergic meds

Front 34

What is "Pervasive feeling of ugliness of some aspect of the appearance despite it being normal or nearly normal?"

Back 34

Body dysmorphic disorder

Front 35

In what settings is BDD more common?

Back 35

-Dermatology
-Cosmetic surgery

Front 36

What is the of BDD?

Back 36

15-30 yo

Front 37

How long do patients perseverate on the body parts they are preoccupied with sometimes?

Back 37

3-8 hrs/day

Front 38

What are 5 comorbidities often seen with BDD?

Back 38

-Major depression
-Social phobia
-Substance use
-OCD
-Personality disorder

Front 39

What personality disorder is most commonly seen in BDD?

Back 39

Avoidant

Front 40

What are the 2 main treatments for BDD?

Back 40

-SSRIs
-Prevention of iatrogenic harm

Front 41

If SSRIs are used to treat Body dysmorphic disorder, what do you have to do with them?

Back 41

-Give higher doses than normal for depression
-Delayed response is seen so give for longer periods of time