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30 Cards in this Set

  • Front
  • Back
1. Presentation of pts w/somatoforms disorders (overview)?
a. They present w/enduring physical sx w/out an identifiable organic cause, which causes significant distress or impairment in social, occupational or other areas of functioning.
b. Although the symptoms expressed in these disorders result in primary and secondary gains, these pts truly believe that their sx are due to medical problems.
c. THEY ARE NOT CONSCIOUSLY FEINGING SYMPTOMS.
d. Malingering, on the other hand, is when one consciously feigns sx in order to get something.
2. Primary gain?
a. Symptoms as an unconscious defence against unacceptable internal conflicts (self-justification for various actions or lack of actions).
3. Secondary gain?
a. Symptoms that provide unconscious external benefits (↑ attention from others, ↓ responsibilities, avoidance of the law, etc).
4. Examples of somatoform disorders (just to prep) [these pts have a true belief in their sx]?
1. Somatization disorder
2. Conversion disorder
3. Hypochondriasis
4. Pain disorder
5. Body dysmorphic disorder
6. Undifferentiated somatoform disorder
7. Somatoform disorder NOS.
b. Somatoform disorders are generally more common in women.
c. Half of pts have comorbid mental disorders, especially anxiety and depression.
5. If external benefits are reached through conscious feigning of symptoms, this would be?
a. Malingering, not secondary gain.
6. Somatization Disorder?
a. Pts w/somatization disorder present with multiple, often nonspecific, physical ex involving many organ systems.
b. They seek tx from many doctors, often resulting in extensive lab work, diagnostic procedures, hospitalizations, and/or surgeries.
7. DSM criteria for Somatization Disorder?
a. Onset before age 30!!!
b. At leat 4 pain symptoms
c. At leat 2 GI symptoms
d. At least one sexual or reproductive sx.
e. At least one pseudoneurological symptom, not limited to pain.
f. Cannot be explained by a general medical condition or substance use.
g. When a general medical condition is present, physical complaints are in excess of what would be expected.
h. Symptoms must not be intentionally produced.
8. When must the onset be to be considered somatization disorder?
a. Onset before age 30.
9. Tx and prognosis of Somatization disorder?
a. The course is usually chronic and debilitating. Symptoms may periodically improve and then worsen under stress.
b. The pt should have regularly scheduled visits w/a single primary care physician, who limits, but does not eliminate, medical workups.
c. Address psychological issues slowly. Pts will likely resist referral to a mental health professional.
10. What percent of pts presenting in primary care have a somatization disorder?
a. 5-10%.
11. How much concern to pts w/somatization disorder have with their condition?
a. They typically express lots of concern over their condition and chronically perseverate over this, whereas conversion disorder pts often have an abrupt onset of their disability (blindness, etc) and the pt usually appears apathetic.
12. Somatization memory key?
a. SO MAny physical complaints.
13. DSM criteria for Conversion Disorder?
a. At least 1 Neurologic sx.
b. Psychological factors associated w/initiation or exacerbation of symptoms.
c. Not intentionally feigned or produced!
d. Cannot be explained by medical condition or substance use.
e. Causes significant distress or impairment in social or occupational functioning or warrants medical evaluation.
f. Not limited to pain or sexual dysfunction, and not better accounted for by a different mental disorder.
14. Common symptoms of Conversion Disorder?!?
a. Shifting paralysis
b. Blindness
c. Mutism
d. Paresthesias
e. Globus hystericus (sensation of lump in throat).
15. Tx of Conversion Disorder?
a. Insight-oriented psychotherapy, hypnosis, or relaxation therapy if needed.
b. Most pts spontaneously recover.
c. Symptoms may be brief or last for several weeks or longer.
d. 25% will eventually have future episodes, especially during times of stress.
16. Hypochondriasis DSM?
a. Preoccupation w/fear of having or contracting a serious disease, based on misinterpreting bodily symptoms.
b. Persists despite medical evaluation and reassurance.
c. Not a delusional intensity and not restricted to a circumscribed concern about appearance.
d. Significant impairment in functioning.
e. Persists for at least 6 months.
f. Not better accounted for by another mental disorder.
17. Is Hypochondriasis more prevalent in men or women?
a. Equal. Average age of onset: 20-30.
18. Comorbidity w/ Hypochondriasis?
a. 80% have coexisting major depression or anxiety disorder.
19. Tx of Hypochondriasis?
a. Regularly scheduled visits to one primary care physician.
b. Comorbid anxiety and depression should be treated w/SSRIs or other psychotropics.
c. CBT seems to be the most useful of psychotherapies.
20. Prognosis of Hypochondriasis?
a. Episodic- symptoms may wax and wane periodically.
b. Exacerbations occur commonly under stress.
c. Up to 50% of pts improve significantly.
d. Better prognostic factors include higher socioeconomic status, treatment-responsive anxiety or depression, and absence of comorbid medical conditions and personality disorders.
21. Body dysmorphic disorder DSM?
a. Preoccupation w/an imagined defect in appearance or excessive concern about a slight physical anomaly.
b. Must cause significant distress in the pt’s life.
c. Not better accounted for by another mental disorder.
22. In whom is Body dysmorphic disorder most common?
a. FM>M.
b. Unmarried> Married
c. Avg age of onset: 15-20
23. What is Body dysmorphic disorder often comorbid with?
a. Depression, anxiety, and psychotic disorders.
24. Tx of Body dysmorphic disorder?
a. Surgical or dermatologic procedures are routinely unsuccessful in pleasing the pt.
b. SSRIs may reduce sx in 50% of pts.
c. The onset is usually gradual. Sx may be chronic, or they may wax and wane in intensity.
25. Only somatoform disorder that doesn’t have a higher frequency in women?
a. Hypochondriasis.
26. Pain Disorder DSM?
a. The patient’s main complain is pain at one or more anatomic sites, of sufficient severity to warrant clinical attention.
b. The pain causes significant distress or impairment in the pt’s life.
c. Psychological factors play an important role in the pain.
d. Not intentionally produced
e. Not better accounted for by a mental disorder or meet criteria for dyspareunia.
27. Can Pt’s w/pain disorder have a real condition?
a. Yes, pts w/pain disorder may have a real medical condition (MS, back injury, etc) but w/pain symptoms that are far in excess of the disease pathology.
28. What can exacerbate the symptoms of Pain Disorder?
a. Major depression.
29. Epidemiology of Pain Disorder?
a. FM 2x as likely as Men.
b. Avg onset 30-50.
c. ↑ incidence in first-degree relatives.
d. ↑ incidence in blue-collar workers.
e. Pts have a higher incidence of major depression, anxiety disorders, and substance abuse.
30. Tx and prognosis of Pain Disorder?
a. SSRIs, biofeedback, hypnosis, and psychotherapy.
b. Analgesics are not helpful, and pts often become dependent on them.
c. Pain disorder usually ↑ in intensity for the first several months and often becomes chronic and disabling.