Kk&s Ch.17 Somatoform Disorders

Front 1

List all of the Somatoform disorders and key features of each:

Back 1

HUBCAPS
Hypochondiaris: worry of disease
Undifferentiated somatoform ds: 6months of multiple soma with no etiology
Body Dysmorphic ds: preoccupation with body defect
Conversion Ds: conflict expressed somatically in voluntary system
Pain Disorders
Somatization Disorder: 4 pain, 2 gi, 1 sexual, 1 pseudoneurog; onset <30; excess of expected or after investigations.

Front 2

Somatization and gender?

Back 2

> in women 5:1

Front 3

Somatization and brain imaging?

Back 3

brain-imaging studies have reported decreased metabolism in the frontal lobes and the nondominant hemisphere.

Front 4

Does somatization have a familial pattern?

Back 4

yes

Front 5

key features suggesting somatization ds?

Back 5

1. multiple organs
2. early onset and chronic course
3. no lab abn

Front 6

DDx of Somatization Ds?

Back 6

thyroid disease, hyperparathyroidism, intermittent porphyria, multiple sclerosis (MS), and systemic lupus erythematosus.

Front 7

Tx somatization ds?

Back 7

single provider
regular monthly appointments
view somatization as expression of emotion
continue to consider physical problem
regular psychotherapy

Front 8

Conversion disorder more common in gender? side of body?

Back 8

Symptoms are more common on the left than on the right side of the body in wome
> in women, even more so in children

Front 9

An association exists between conversion disorder and ? in men

Back 9

antisocial personality disorder

Front 10

conversion rare onset ages?

Back 10

<10 or >35

Front 11

conversion disorder and associated with brain activity?

Back 11

hypo on dominant
hyper on non-dominant
excess cortical arousal inhibits awareness of sensation

Front 12

Most common conversion ds sx?

Back 12

Paralysis, blindness, and mutism

Front 13

Conversion disorder may be most commonly associated with????personality disorders.

Back 13

passive-aggressive, dependent, antisocial, and histrionic

Front 14

Give example of neuro presentation inconsistent with true neuro disease?

Back 14

stocking-and-glove anesthesia of the hands or feet
or the hemianesthesia of the body beginning precisely along the midline.

Front 15

One gait disturbance seen in conversion disorder is , which is a wildly ataxic, staggering gait accompanied by gross, irregular, jerky truncal movements and thrashing and waving arm movements

Back 15

astasia-abasia

Front 16

How differentiate pseudo from actual seizure?

Back 16

Pupillary and gag reflexes are retained after pseudoseizure, and patients have no postseizure increase in prolactin concentrations
Moreover, about one third of the patient's pseudoseizures also have a coexisting epileptic disorder. Tongue-biting, urinary incontinence, and injuries after falling can occur in pseudoseizures, although these symptoms are generally not present

Front 17

What is primary gain? secondary gain?

Back 17

Patients achieve primary gain by keeping internal conflicts outside their awareness. Symptoms have symbolic value; they represent an unconscious psychological conflict.

Patients accrue tangible advantages and benefits as a result of being sick; for example, being excused from obligations and difficult life situations, receiving support and assistance that might not otherwise be forthcoming, and controlling other persons' behavior.

Front 18

What is la belle indifference?

Back 18

La belle indifférence is a patient's inappropriately cavalier attitude toward serious symptoms; that is, the patient seems to be unconcerned about what appears to be a major impairment. That bland indifference is also seen in some seriously ill medical patients who develop a stoic attitude. The presence or absence of la belle indifférence is not pathnognomonic of conversion disorder, but it is often associated with the condition.

Front 19

How does identifaction relate to conversion disorder?

Back 19

Patients with conversion disorder may unconsciously model their symptoms on those of someone important to them. For example, a parent or a person who has recently died may serve as a model for conversion disorder. During pathological grief reaction, bereaved persons commonly have symptoms of the deceased.

Front 20

Conversion ds prognosis?

Back 20

Symptoms or deficits are usually of short duration, and approximately 95 percent of acute cases remit spontaneously, usually within 2 weeks in hospitalized patients

Front 21

Good prognosis factors in conversion ds?

Back 21

Paralysis, aphonia, and blindness are associated with a good prognosis
A good prognosis is heralded by acute onset,
presence of clearly identifiable stressors at the time of onset, a

short interval between onset and the institution of treatment,
and above average intelligence

Front 22

Poor prognosis factors?

Back 22

recurrent episodes
tremor and seizures are poor prognostic factors.

Front 23

Tx conversion ds?

Back 23

1. know most resolve spontaneously
2. insight-oriented supportive or behavior therapy
3. Rx to help relax ... benzo's; amobarbital;

Front 24

Time factor in hypochondriasis?

Back 24

6 months or more with fear fo disease

Front 25

hypochondriasis and gender?

Back 25

men=female

Front 26

Name theories of hypochondriasis

Back 26

1. cog distortion of body sx
2. sick role
3. 80% have dep/anx
4. agression changed to physical complaints

Front 27

Tx of hypochondriasis?

Back 27

stress reduction
group psychotherapy
cbt, group, insight
regular visits
tx comorbid axis I

Front 28

Body Dysmorphic ds def?

Back 28

preoccupation of imagined or small real defect

Front 29

Body dysmorphic disorder commonly coexists with other mental disorders. One study found that more than ? percent of patients with body dysmorphic disorder had experienced a major depressive episode in their lifetimes; about ? percent had experienced an anxiety disorder; and about ? percent had experienced a psychotic disorder.

Back 29

Body dysmorphic disorder commonly coexists with other mental disorders. One study found that more than 90 percent of patients with body dysmorphic disorder had experienced a major depressive episode in their lifetimes; about 70 percent had experienced an anxiety disorder; and about 30 percent had experienced a psychotic disorder.

Front 30

Rank most common sites of imagined defects in pts with BDD?
Least?

Back 30

1. Hair
2. Nose
3. Skin
4. Eyes

Hips, Shoulders, Forehead, Neck, Arms, wrists

Front 31

Name drugs used for BDD?

Back 31

Although tricyclic drugs,
monoamine oxidase inhibitors (MAOIs), and
pimozide (Orap) have reportedly been useful in individual cases, other data indicate that

serotonin-specific drugs—for example,

clomipramine (Anafranil) and fluoxetine (Prozac)—reduce symptoms in at least
50 percent of patients

Front 32

What can improve response rate in BDD?

Back 32

Augmentation of the selective serotonin reuptake inhibitor (SSRI) with clomipramine (Anafranil), buspirone (BuSpar), lithium (Eskalith), methylphenidate (Ritalin), or antipsychotics may improve the response rate.

Front 33

Key psychological features in pain disorder?

Back 33

psychological factors are part of genesis, severity or maintence of pain

Front 34

? disorders, ? dependence, and ? pain may be more common in relatives of individuals with chronic pain disorder

Back 34

depressive
alcohol
chronic

Front 35

Theories on etiology of pain disorder?

Back 35

1. expression of intrapsychic conflict
2. behavioural reward for pain (i.e., avoidance of distateful activities; increased attention of others)
3. gaining advantage in interpersonal relationships
4. dysfxn of serotonin and or endorphins

Front 36

The most prominent depressive symptoms in patients with pain disorder are
least common?

Back 36

anergia, anhedonia, decreased libido, insomnia, and irritability;

diurnal variation, weight loss, and psychomotor retardation appear to be less common

Front 37

When > suspect psychogenic component to pain?

Back 37

When pain does not wax and wane and is not even temporarily relieved by distraction or analgesics, clinicians can suspect an important psychogenic component.

Front 38

Tx of pain ds?

Back 38

Psychoed: psychological factors are important in cause and consequences of pain
e.g. less pain if hit head while happy at work vs angry at work
Rx: tricyclics, SSRi's, and maybe amphetamines
Psychotherapy: start by looking at ramifications on life
Multidiscp team

Front 39

Undifferentiated somatoform disorder is characterized by one or more unexplained physical symptoms of at least ???months' duration, which are below the threshold for a diagnosis of somatization disorder

Back 39

6

Front 40

Two types of symptom patterns may be seen in patients with undifferentiated somatoform disorder:

Back 40

1.those involving the autonomic nervous system and those involving
2. sensations of fatigue or weakness