Dsm Iv - Somatoform Disorders

Front 1

What are the Diagnostic Criteria for Somatoform Disorder?

Back 1

A. A history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning.

B. Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance:

(1) four pain symptoms: a history of pain related to at least four different sites or functions (e.g., head, abdomen, back, joints, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination)

(2) two gastrointestinal symptoms: a history of at least two gastrointestinal symptoms other than pain (e.g., nausea, bloating, vomiting other than during pregnancy, diarrhea, or intolerance of several different foods)

(3) one sexual symptom: a history of at least one sexual or reproductive symptom other than pain (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy)

(4) one pseudoneurological symptom: a history of at least one symptom or deficit suggesting a neurological condition not limited to pain (conversion symptoms such as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures; dissociative symptoms such as amnesia; or loss of consciousness other than fainting)

C. Either (1) or (2):

(1) after appropriate investigation, each of the symptoms in Criterion B cannot be fully explained by a known general medical condition or the direct effects of a substance (e.g., a drug of abuse, a medication)

(2) when there is a related general medical condition, the physical complaints or resulting social or occupational impairment are in excess of what would be expected from the history, physical examination, or laboratory findings

D. The symptoms are not intentionally feigned or produced (as in Factitious Disorder or Malingering).

Front 2

What are the Diagnostic Criteria for Undifferentiated Somatoform Disorder?

Back 2

A. One or more physical complaints (e.g., fatigue, loss of appetite, gastrointestinal or urinary complaints).

B. Either (1) or (2):

(1) after appropriate investigation, the symptoms cannot be fully explained by a known general medical condition or the direct effects of a substance (e.g., a drug of abuse, a medication)

(2) when there is a related general medical condition, the physical complaints or resulting social or occupational impairment is in excess of what would be expected from the history, physical examination, or laboratory findings

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The duration of the disturbance is at least 6 months.

E. The disturbance is not better accounted for by another mental disorder (e.g., another Somatoform Disorder, Sexual Dysfunction, Mood Disorder, Anxiety Disorder, Sleep Disorder, or Psychotic Disorder).

F. The symptom is not intentionally produced or feigned (as in Factitious Disorder or Malingering).

Front 3

What are the Diagnostic Criteria for Conversion Disorder?

Back 3

A. One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition.

B. Psychological factors are judged to be associated with the symptom or deficit because the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors.

C. The symptom or deficit is not intentionally produced or feigned (as in Factitious Disorder or Malingering).

D. The symptom or deficit cannot, after appropriate investigation, be fully explained by a general medical condition, or by the direct effects of a substance, or as a culturally sanctioned behavior or experience.

E. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

F. The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of Somatization Disorder, and is not better accounted for by another mental disorder.

Specify type of symptom or deficit:
With Motor Symptom or Deficit
With Sensory Symptom or Deficit
With Seizures or Convulsions
With Mixed Presentation

Front 4

What are the Diagnostic Criteria for Pain Disorder?

Back 4

A. Pain in one or more anatomical sites is the predominant focus of the clinical presentation and is of sufficient severity to warrant clinical attention.

B. The pain causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. Psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance of the pain.

D. The symptom or deficit is not intentionally produced or feigned (as in Factitious Disorder or Malingering).

E. The pain is not better accounted for by a Mood, Anxiety, or Psychotic Disorder and does not meet criteria for Dyspareunia.

Front 5

What are the three types of Pain Disorder?

Back 5

307.80 Pain Disorder Associated With Psychological Factors:
Psychological factors are judged to have the major role in the onset, severity, exacerbation, or maintenance of the pain. (If a general medical condition is present, it does not have a major role in the onset, severity, exacerbation, or maintenance of the pain.) This type of Pain Disorder is not diagnosed if criteria are also met for Somatization Disorder.

Specify if:

- Acute: duration of less than 6 months
- Chronic: duration of 6 months or longer

307.89 Pain Disorder Associated With Both Psychological Factors and a General Medical Condition:
Both psychological factors and a general medical condition are judged to have important roles in the onset, severity, exacerbation, or maintenance of the pain. The associated general medical condition or anatomical site of the pain (see below) is coded on Axis III.

Specify if:

- Acute: duration of less than 6 months
- Chronic: duration of 6 months or longer

Note: The following is not considered to be a mental disorder and is included here to facilitate differential diagnosis.

Pain Disorder Associated With a General Medical Condition:
A general medical condition has a major role in the onset, severity, exacerbation, or maintenance of the pain. (If psychological factors are present, they are not judged to have a major role in the onset, severity, exacerbation, or maintenance of the pain.) The diagnostic code for the pain is selected based on the associated general medical condition if one has been established or on the anatomical location of the pain if the underlying general medical condition is not yet clearly established--for example, low back (724.2), sciatic (724.3), pelvic (625.9), headache (784.0), facial (784.0), chest (786.50), joint (719.4), bone (733.90), abdominal (789.0), breast (611.71), renal (788.0), ear (388.70), eye (379.91), throat (784.1), tooth (525.9), and urinary (788.0).

Front 6

What are the Diagnostic Criteria for Hypochondriasis?

Back 6

A. Preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms.

B. The preoccupation persists despite appropriate medical evaluation and reassurance.

C. The belief in Criterion A is not of delusional intensity (as in Delusional Disorder, Somatic Type) and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder).

D. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The duration of the disturbance is at least 6 months.

F. The preoccupation is not better accounted for by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive Episode, Separation Anxiety, or another Somatoform Disorder.

Specify if:
With Poor Insight: if, for most of the time during the current episode, the person does not recognize that the concern about having a serious illness is excessive or unreasonable

Front 7

What are the Diagnostic Criteria for Body Dysmorphic Disorder?

Back 7

A. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.

B. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).

Front 8

What percentage of patients diagnosed with conversion disorder are later diagnosed with a medical cause?

Back 8

20%

Front 9

What features increase the probability of a conversion disorder?

Back 9

History of Sexual abuse (1/3)
Recent significant stressor
Histrionic personality traits (1/5)
Low medical sophistication
Alexithymia
La Belle Indifférence
Youngest sibling

Front 10

Per definition, a somatoform disorder is one in which....

Back 10

Symptoms, signs, or history suggest a medical disorder.
No physical evidence for a pathophysiologic cause.

Front 11

Per definition a psychosomatic disorder is one in which.....

Back 11

Pathophysiology is directly effected by cognitive, emotional, or behavioral factors.

Front 12

DSM IV criteria for conversion disorder are....

Back 12

Pseudoneurological symptoms
Preceded by stressor or conflict
Not intentionally produced
No medical condition or substance related cause
Significant distress or impairment
Not limited to pain or sexual dysfunction

Front 13

4 pain, 2 GI, 1 sexual or 1 neurological symptom before age 30 not intentionally produced but not explained by medical condition could be...

Back 13

Somatization disorder
More common in women.(10:1)

Front 14

Preoccupation with fear of having a serious medical illness based on misinterpretation of symptoms for > 6 months is called...

Back 14

Hypochondriasis
May respond to SSRIs or Clomipramine

Front 15

Conscious production of fake history in which the motive is attaining the patient role is called...

Back 15

Factitious disorder or Munchhausens disese
More refractory in males.

Front 16

Feigning illness to avoid an undesired circumstance or obtain a desired circumstance is called...

Back 16

Malingering
NOT a psychiatric diagnosis

Front 17

Primary gain from a symptom has to do with....

Back 17

Satisfying an internal conflict

Front 18

Somatoform disorders happen in the....

Back 18

Unconscious
eg.
Conversion disorder
Somatization disorder

Front 19

Factitious or Malingering Disorder?:
symptoms produced or feigned in order to appear ill, w/ NO perceivable BENEFIT to patient

Back 19

Factitious disorder

Front 20

Factitious or Malingering Disorder?:
-symptoms produced or feigned in response to external INCENTIVE(ie, avoid military service; obtain a settlement in a lawsuit, etc.)

Back 20

Malingering disorder

Front 21

Name the facticious disorders




























Meets criteria for general factitious disorder and signs are present but neither predominates

Back 21

Factitious disorder with predominately signs and symptons

Fictitious disorder with predominently physical signs and symptoms

Factitous disorder with combined psychological and physical signs and symptoms

Fictitous disorder NOS

Front 22

Name the general diagnostic criteria for general factitous disorder

Back 22

A. Purposeful creation or feigning of signs or symptoms (physical or psychological)

B. Assuming the sick role is motivation

C. External incentives are not present

Front 23

Name the diagnostic criteria for fictious disorder with predominantly psychological signs & symptoms

Back 23

A. Meets criterial for general factitous disorder

B. Psychological signs and symptoms predomniate

Front 24

Name the diagnostic criteria for facticious disorder with predominantly physical signs and symptoms

Back 24

A.Meets criteria for general facticious disorder

B. Physical signs and symptoms predominate

Front 25

Name the diagnostic criteria for factitious disorder w/ combined psychological and physical symptoms

Back 25

Meets criteria for general factitious disorder and signs are present but neither predominates

Front 26

Name the Diagnostic Criteria for Dissociative Amnesia

Back 26

At least 1 instance, going beyond ordinary forgetfullness, or not recalling important info

Not soley occuring during dissociative identity disorder, dissociative fugue, PTSD, accute stress disorder, or somatization disorder.

Not due to subtance use or general medical condition

Causes distress or impairment in social, occupational or other functioning

Front 27

Name the diagnostic criteria for dissociative fugue

Back 27

Unexpected travel from home or work with inabillity to recall personal history

Confused about identity or assumption of new identity

Does not occur soley during dissociative identity disorder and not due to substance use or general medical condition

Causes significant distress is social, occupational or other functioning

Front 28

Name the diagnostic criteria for dissociative identity disorder

Back 28

At least 2 distinct personalitues or identities

At least 1 personality takes control

Cannot remember to an extent beyond usual forgetfullness personal info

Not due to substance or general medical condition

Front 29

Name the diagnostic criteria for depersonalization disorder

Back 29

Persisting or repeated feelings of being detached from one's self.

Reality testing is intact

Distress or impairment in social, occupational, or other important functioning.

Not occuring soley during another mental disorder. Also not due to substance abuse or general medical condition