Neuro 2 - Ryan - Somatoform And Related Disorders

Front 1

List the 5 Somatoform disorders

Back 1

Somatization disorder, Hypochondriasis, Conversion disorder, Pain disorder, Body Dysmorphic disorder

Front 2

Whats the KEY to somatoform disorders?

Back 2

Symptoms are NOT intentionally produced

Front 3

What percent of somatoform symptoms cannot be explained by a medical illness?

Back 3

30%

Front 4

T/F: 50% of pts with a somatoform disorder also have another mental symptom (ex = depression, anxiety)

Back 4

TRUE

Front 5

Pt has a physical symptom, they are producing it UNCONSCIOUSLY. What are our differential Dxs?

Back 5

Somatoform Disorder

Depression

Anxiety

Front 6

Pt has a symptom they are producing consciously to fulfill emotional need. Dx?

Back 6

Facticious disorder

Front 7

Pt has a symptom they are consciously producing for secondary gain. Dx?

Back 7

Malingering

Front 8

In last year, Pt has had 4 symptoms of pain in each extremity, upset stomach and constipation, they can't ejaculate, and they can't feel sensory perception in their leg. Symptoms unexplained. Dx?

Back 8

Somatization disorder:

4 pain symptoms from dif body regions
2 GI symptoms
1 sexual symptom
1 Pseudoneurological symptom

Front 9

What is prominent in pts with somatization disorder?

Back 9

psychological distress and interpersonal problems prominent

Front 10

Is somatization disorder chronic and debilitating

Back 10

Yep

Front 11

Management of this pt: In last year, Pt has had 4 symptoms of pain in each extremity, upset stomach and constipation, they can't ejaculate, and they can't feel sensory perception in their leg. Symptoms unexplained.

Back 11

Think somatization disorder - ID ONE Dr. to be primary caretaker

frequent, regular visits, visits brief, limited physical exam, avoid unecessary labs/procedures

Ensure you're not over-looking a medical Dx

Front 12

T/F: Its important to help pts come up with a way to express feelings with somatization disorder

Back 12

TRUE

Front 13

Pt has been pre-occupied with fears that they have Tay-Sachs for 6 months. Many specialists have concluded this is not the case. Dx?

Back 13

Hypochondriasis

Front 14

T/F: 70-80% medical students display Hypochondriasis symptoms in first two years, but only 1% meet criteria

Back 14

TRUE

Front 15

What are the theories of Hypochondriasis?

Back 15

Cognitive, social learning model, Variant form of another mental disorder, Psychodynamic model

With hypochondriasis, theres a maladaptive train of thought leading to anxiety and uncertainty

Front 16

How do we manage this pt: Pt has been pre-occupied with fears that they have Tay-Sachs for 6 months. Many specialists have concluded this is not the case.

Back 16

think hypochondriasis

Schedule brief/frequent checkups to reassure pt, cognitive behavioral therapy

Front 17

T/F: Drugs are helpful for hypochondriacs

Back 17

FALSE

(shocker i made a false t/f)

Front 18

Pt has sensory loss in leg and on right abdominal area with no explanation that came on abruptly after the loss of her dog. Dx?

Back 18

Conversion Disorder.

Front 19

Are the neurologic symptoms seen in conversion disorder intentional?

Back 19

no

Front 20

Pts leg doesn't respond to patellar tendon reflex. No known cause, pt is not intentionally producing symptoms. Dx?

Back 20

Conversion disorder

Front 21

List common motor symptoms of conversion disorder

Back 21

Involuntary movements, tics, torticollis, seizures, falling, astasia-abasia (can't stand/walk), Blepharospasms (abnoromal eye lid twitch - Lilly!!!), paralysis, weakness, aphonia = can't talk

Front 22

List some of the sensory deficits of conversion disorder

Back 22

Anesthesia (esp limbs), blindness, tunnel vision, deafness

Front 23

List some of the visceral symptoms of Conversion disorder

Back 23

Psychogenic vomiting, pseudocyesis (false pregnancy), globus hystericus (Lump in throat), swooning/syncope, urinary retention, D

Front 24

Pt has sensory loss to tongue with no cause. This disorder is most often associated with what personality disorders?

Back 24

Think conversion disorder: associated with Histrionic and Dependent

Front 25

Histrionic and dependent personality disorders will be seen most commonly in a pt with what somatization disorder?

Back 25

Conversion disorder

Front 26

Whats the MOST IMPORTANT thing to do when managing Conversion disorder?

Back 26

Establish relationship of TRUST between dr. and pt.

Front 27

T/F: Conversion disorder usually resolves spontaneously?

Back 27

TRUE

Front 28

Pt with conversion disorder usually have stress so how do you manage that cray?

Back 28

refer to counseling/psychotherapy

Hypnois/anxiolytics/relaxations exercises effective sometimes

Front 29

Pt has a painful bum knee that you've been unable to pinpoint the cause for. Dx? and what are the associated factors?

Back 29

Pain disorder

Associated factors = psychological factors = play major role in onset, severity, maintenance of pain

Front 30

Are symptoms intentionally produced in pain disorder?

Back 30

Nay

Front 31

What are the pain disorder subtypes?

Back 31

Pain disorder associated with psychological factors

Pain disorder associated with psychological factors AND a general medical condition

Subtypes can be acute or Chronic (greater than 6 months)

Front 32

Pt has low back pain for last 8 months with no cause and psychological symptoms tha the sustained from the fact he's a drunkard and fell of a bar stool. Dx?

Back 32

CHRONIC pain disorder with psycholocial factors AND general medical condition

Front 33

How do we manage this pt: Pt has low back pain for last 8 months with no cause and psychological symptoms tha the sustained from the fact he's a drunkard and fell of a bar stool.

Back 33

CHRONIC pain disorder with psycholocial factors AND general medical condition

Tx = referral for pain management education, resume normal activities, psychotherapy to resolve underlying psychological conflict

Front 34

Katie is 25 and has had 3 facial plastic surgeries and her boobs done but still isn't happy. Dx? Tx?

Back 34

Body Dysmorphic disorder = preoccupation with imagined defect in appearance

Dif. DX = mood disorders, psychotic disorder, eating disorder, anxiety disorder

Tx = Cognitive behavioral psychotherapy and reality testing, anti-depressants

Front 35

T/F: Body dysmorphic disorder is equally common in men + women

Back 35

TRUF

Front 36

How do Facticious and Malingering disorder differ from the other somatoform disorders?

Back 36

Symptoms are willingly and knowingly induced by pt.

Front 37

Pt knows she is irritating her throat to produce a cough, but she doesn't know why. she has recurrent explainable symptoms despite close observation. Dx?

Back 37

Facticious disorder

Front 38

Pt is irritating his throat to get out of work for the day. He knows exactly why hes doing it. Dx?

Back 38

Malingering disorder

Front 39

T/F: Tx of Facticious disorder is not usually successful, and a caring, NON-JUDGMENTAL approach is best

Back 39

true dat. (understand they are suffering from a mental disorder)

Front 40

T/F: Malingering is considered a mental disorder

Back 40

FALSE, it is NOT considered a mental disorder, because the "patient" is just being a little biotch for secondary gain.

Pt will focus on the benefits they will gain from positive Dx

Front 41

How do you manage a malingering pt?

Back 41

Don't confront them with disorder to maintain trust and be able to treat their actual disorder

Mention to pt how Objective evidence doesn't support their claim.

Front 42

How do psychological factors affect medical conditions?

Back 42

Affect course of illness by exacerbating condition = delay recovery
Interfere with tx
create additional health risk
stress-related psysiological responses precipitate or exacerbate medical condition