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46 Cards in this Set
- Front
- Back
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Physical or somatic complaints unexplained by a medical condition
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Somatoform Disorder
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Symptoms are NOT intentionally produced
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Somatoform Disorder
(vs factitious or lingering) |
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Why do pts with somatoform disorders mostly come to primary care docs?
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PHYSICAL symptom presentation.
-At least 30% of the physical complaints of primary care patients cannot be explained a by medical illness -About half of these have a somatoform disorder |
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What is the job of the clinician in somatoform disorders?
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Clinician must rule out occult physical illness, other psychiatric disorders, and substance abuse
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Conscious Production of symptom with Unconcious Motivation.
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Facitious Disorder
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Concious production of symptom + concious motivation
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Malingering.
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Multiple UNEXPLAINED physical complaints in multiple organ systems
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Somatization Disorder DSM-IV-TR Criteria
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During course of Somatization disorder must have had:
P_________ (4 symptoms from different body regions) -G____ (2 symptoms) -S__________ (1 symptom) -Pseudo______________(1 symptom) |
Pain
GI Sexual Neurologic |
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SD:
Onset must be before age? |
30!
Symptoms occurring over several years and resulting in treatment being sought |
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Symptoms NOT intentionally produced
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Somatization Disorder
DSM-IV-TR Criteria |
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Often these patients are seen by several specialists, undergo frequent diagnostic tests, and have multiple hospitalizations and surgeries
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Clinical features of SD
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Psychological distress and interpersonal problems are PROMINENT
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Clinical features of SD
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Patients often seek disability because of their genuine concern that they are seriously ill
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SD
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-unknown but thought related to unconscious psychological factors
-Unlike conversion disorder, no clear psychological precipitants |
Etiology of SD
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Management of SD
-Identify _____physician who will be the primary caretaker -Have frequent, regularly scheduled visits (monthly) -Keep visits brief with ___________physical exam as needed |
one
limited |
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-Preoccupation with fears of having a serious disease based on misinterpretation of bodily symptoms
-Persists DESPITE appropriate medical evaluation and reassurance -Causes clinically significant distress or impairment -Duration at least 6 months |
Hypochondriasis: DSM-IV-TR Criteria
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Men and women equally effected
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Hypochondriasis
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Occurs in 3% of med students in first 2 years
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Hypochondriasis
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Patient misinterprets / amplifies bodily sensations due to faulty cognitive scheme
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Cognitive Theory to explain hypochondriasis.
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Best treatment for hypochondriasis
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-Cognitive Behavioral Psychotherapy focusing on their coping skills has proven helpful
-Pharmacotherapy RARELY useful unless underlying condition such as depression or anxiety is present |
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The presence of one or more NEUROLOGIC symptoms that are unexplained by any medical or neurologic disorder
(i.e., non-anatomic distributions of numbness or paralysis) |
Conversion disorder
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Is pain, numbess, and etc intentially produced with conversion disorder?
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NO.
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The onset of conversion disorder is associated with?
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a stressor. (Car accident)
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Tics, torticollis, seizures, abnormal gait
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Motor symptoms in Conversion Disorder
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Anestheisa, midline anesethia, blindess
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Sensory Deficiets in Conversion Disorder
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Psychogenic vomiting
Pseudocyesis Globus hystericus Swooning or syncope Urinary retention Diarrhea |
Visceral symptoms in Conversion Disorder
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Contrary to popular belief, indifference toward symptoms is typically NOT characteristic of patients with conversion disorder
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La Belle Indifférence”
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-More frequent in rural areas
-Less education or poor |
Conversion Disorders
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Management of conversion disorder
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Place emphasis on REHABILITATION.
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Significant pain complaints NOT fully explained by a medical condition
Psychological factors play a major role in the onset, severity, or maintenance of the pain |
Pain Disorder
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Are symptoms intentionally produced in Pain Disorders?
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NO!
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Low back pain, pelvic pain, headace
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common sites of pain disorder
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-Psychological factors play the major role
-Medical condition is absent or if present, does not contribute significantly |
Pain disorder associated with psychological factors
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-Medical condition is present and plays significant role
-Psychological factors also play significant role |
Pain disorder associated with psychological factors and a general medical condition
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PD managemnt
-d______________from analgesic and other drugs if necessary -Referral for pain management education -R_____________of normal activities -P_______________directed at resolving underlying psychological conflicts |
detoxification
resumption psychotherapy |
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-These patients believe that some part of their body is malformed or ugly
-They are preoccupied with imagined or greatly exaggerated abnormalities in their appearance -This disorder is more common in young, often single, women |
Body Dysmorphic Disorder
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-Board exams will often present a single woman in her 20s who presents to the plastic surgeon asking for a revision on a rhinoplasty previously performed (and often already revised)
-She will be obsessed (frequently check the mirror) with the perceived defect -She will be extremely self conscious about it (staying home, covering up) and this will significantly interfere with functioning |
Body Dysmorphic Disorder
Clnical Presentation |
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Management of BDD
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-COGNITIVE BEHAVORIAL PSYCHOTHERAPY and reality testing have been shown to be helpful
-Antidepressants are also frequently used |
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However, they differ from the somatoform disorders in that the symptoms here are willingly and knowingly induced by the patient
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Factitious Disorder and Malingering
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-Often the motivation is to assume the “sick role” (i.e. be admitted to the hospital and have people care for you)
-If the signs are induced in another person, the disorder is called “factitious disorder by proxy” -They know they are doing it but don’t know why they are doing it |
Factitious Disorder
(Munchausen Syndrome) |
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Management of Facitious Disorder
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-Treatment is not usually very successful, in part because patients often terminate treatment relationships when confronted with the diagnosis
-Patients frequently move to different hospitals or clinics where they can satisfy their need to be sick -A caring, non-judgment approach is critical, and the recognition that the person is suffering from a disorder (psychiatric rather than physical) may help |
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A disorder in which signs and symptoms of physical and mental disorders are intentionally produced by the patient
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Malingering
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How does malingering differ from faciitious disorder?
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-Malingering differs from factitious disorder in that the motivation is some form of secondary gain
-(qualify for disability, free pain medications, money from a lawsuit, get out of work, etc) -They KNOW they are doing it and they know why they are doing it -Malingering is NOT considered a mental illness |
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Management of Malingering
-It is suggested that you not confront patients with this disorder in hopes that you can maintain their trust and be enabled to treat them for any actual disorder -Mention to the patient how the objective evidence (x-rays, blood work, etc) do not correlate with his/her story – allow them to save face |
-Be sure to document thoroughly your interactions to protect yourself from any repercussions
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-A REAL medical condition is present
-One or more psychological or behavioral problems adversely and significantly affect the course or outcome of the medical condition in one of the following ways |
Psychological Factors Affecting a Medical Condition
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-common in medical setting
-requires team approach for management |
Psychological Factors Affecting a Medical Condition
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