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21 Cards in this Set
- Front
- Back
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deliberate fabrication of illness in the absence of external incentives.
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factitious disorder
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Multiple physical complaints a/w with distress and seeking medical help,
Persisting for several years Beginning before age 30 Symptoms often include pain, GI complaints, sexual dysfunction, and pseudoneurological problems Where there is a genuine physical condition, the symptoms go beyond what can be explained by objective findings |
Somatization Disorder
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Presentation is often dramatic, exaggerated, vague, circumstantial, and imprecise
Personality is often described as manipulative, dependent, self-centered, and eager for praise and affection Complications include risks from medical treatment and diagnostic procedures, substance abuse, disruption of family/interpersonal/ occupational life |
Somatization disorders
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1-2% of all females, uncommon among men
Occurs in 10-20% of first degree female relatives First degree male relatives prone to antisocial personality and substance abuse frequency is inversely related to education, income, and occupational status One study reports concordance of 29% in MZ twins and 10% in DZ twins |
Familial Characteristics of Somatization Disorder
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Distractibility
Failure to habituate Impressionistic grouping of cognitive constructs Partial and circumstantial associations |
neuropsychological basis in faulty perception and assessment of somatosensory stimuli in somatization disorder
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Relatively circumscribed loss or alteration of functioning resembling physical disorder
Temporally related to a precipitating psychosocial stressor and the patient is not conscious of producing the symptoms intentionally Symptoms often “neurological” in nature but physically implausible and objective exam reveals normal physiology |
Conversion Disorder
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Headaches
Paralysis Sensory impairments Seizures Vertigo |
Common Sx of Conversion Disorder
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2-5x more common among women than among men, and can occur at any age
Inversely related to education and socioeconomic status Fairly common among hospital inpatients for whom psychiatric consultation is requested (5-16% in some studies) |
Conversion Disorder
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25-70% of patients in various studies acquire a neurological diagnosis over the next 3-4 years
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Diagnostic progression of conversion disorder
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Persistent (more than 6 months)
Concern is over specific illness Concern persists despite the absence of confirmatory medical findings and a lack of normal disease progression Patient will link any symptom to the illness and react to benign events |
Hypochondriasis
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Equally prevalent among males and females.
Peak incidence in 30s and 40s Seen in 3-14% of patients in general medical practice Note that somatization disorder does not involve “disease fear” or the conviction that one has a specific disease, and usually begins before age 30 |
Hypochondriasis
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Psychodynamic terms: anxiety
Inhibition of unacceptable impulses Inability to cope with life stresses Learning related to experiences of physical illness in self or others Low thresholds or tolerance for somatosensory stimuli |
Explanatory ideas for Hypochondriasis
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What are the two kinds of pain disorders?
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Pain disorder associated with psychological factors
Pain disorder associated with psychological factors and a general medical condition |
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What can be said for the variablity of location of pain among those evealuated for pain disorder?
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Heterogenous
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Twice as common in women as in men
Peak ages of onset in 30s and 40s More common in blue-collar occupations, perhaps due to increased risk of job-related injuries Increased likelihood in first degree relatives |
Pain DIsorder
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Likely to present invariant complaints, and deny that pain is influenced by other factors (e.g., stress, emotions)
Atypical responses to interventional methods such as nerve blocks Often have long histories of medical and surgical care |
Pain Disorder
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changes in the brain as a function of experience
Related changes in the way somatosensory input is interpreted in the brain |
Neuroplasticity of Pain perception
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Involvement of brain structures important in emotional regulation, memory
Changes secondary to chronic exposure to negative stimuli, resulting in corticolimbic sensitization |
Limibically Augmented Pain Syndrome
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Preoccupation with imagined defect in appearance, or exaggerated reaction to minor physical anomaly
Does not involve delusional intensity, and is not associated with anorexia or transsexualism Average age 30, sex distribution unknown |
Body Dysmorphic Disorder
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One or more physical complaints over at least six months
No physiological findings, or complaints grossly out of line with what physical findings will justify |
Undifferentiated Somatorform Disorder
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Symptoms intentionally produced or feigned in the absence of external incentives
Goal usually seems to be admission to hospital and undergoing treatment Sometimes associated with “pseudologia fantastica” and impostorship Associated with poor social adjustment |
Factitious Disorders
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