Psychiatry (Dissociative Disorders)

Front 1

What are somatoform disorders?

Back 1

• a group of mental disorders characterized by physical symptoms
• do not have corresponding organic pathology
• pts truly believe they have a physical problem

Front 2

What are the 6 major classifications of somatoform disorder?

Back 2

• Somatization disorder
• Conversion disorder
• Hypochondriasis
• Body dysmorphic disorder
• Pain disorder
• Undifferentiated somatoform disorder (combo of other somatoform disorders)

Front 3

Differentiate between primary and secondary gain

Back 3

• Primary gain: patient unconsciously expresses an unacceptable emotion as a physical symptom so he does not have to deal with the emotion

• Secondary gain: symptoms allows the patient to get attention from others or avoid responsibility

Front 4

What are factors that can lead to a better prognosis of somatization disorders?

Back 4

• formation of a good doctor-patient relationship
• individual and group psychotherapy, hypnosis, and behavior relaxation therapy
• identification and reduction of patient's life that may exacerbate the symptoms
• reducing the secondary gain associated with the symptoms

Front 5

What are physical symptoms of somatization disorder?

Back 5

Multiple vague physical symptom:
• Nausea
• Dyspnea
• Tiredness
• Menstrual irregularities

Front 6

Somatization disorders tends to occur in what types of patients?

Back 6

• onset before 30 years of age
• more common in lower socioeconomic groups

Front 7

What is conversion disorder?

Back 7

• abrupt, dramatic loss of motor or sensory function or organ of special sense
• motor presentation (ex. paralysis, seizures, globus hystericus)
• sensory presentation (ex. paresthesias, anesthesias, visual problems)

Front 8

Conversion disorders tends to occur in what types of patients?

Back 8

• more common in adolescents and young adults
• patients from rural areas
• psychiatrically unsophisticated patients

Front 9

What is hypochondriasis?

Back 9

exaggerated concern with health and illness

Front 10

Hypochondriasis is more common in what age groups and gender?

Back 10

• more common in middle and old age
• equal in both sexes

Front 11

What is body dysmorphic disorder?

Back 11

• patient is preoccupied with a defect in appearance
• if defect is present, it is usually very minor
• most often complaint involves slight flaws of the face and head

Front 12

What is the usual onset of body dysmorphic disorder?

Back 12

late teens

Front 13

What are characteristics of pain disorder?

Back 13

• Patient experiences intense, prolonged pain with no physical cause or not explained completely by physical cause or not explained completely by physical disease

• Can be acute (lasting less than 6 months)

• Chronic is lasting more than 6 months

• often coexists with a general medical condition

Front 14

What is the usual onset of pain disorder?

Back 14

30s and 40s

Front 15

What class of drugs can be used to treat pain disorder?

Back 15

anti-depressants (SSRIs)

Front 16

What are common symptoms of patients with factitious disorder?

Back 16

• Abdominal pain
• Blood in urine
• Fever
• Induction of tachycardia
• Skin lesions
• Seizures

Front 17

What are characteristics of factitious disorder by proxy?

Back 17

• Induction of illness in another person
• Usually a child by parent
• Some patients report a history of childhood abuse or neglect

Front 18

What is malingering?

Back 18

• simulation of physical or mental illness for financial or other gain
• patients avoids medical treatment and "recovers" as soon as the gain is realized

Front 19

What are the 4 types of dissociative disorders?

Back 19

• Dissociative amnesia
• Dissociative fugue
• Dissociative identity disorder
• Depersonalization disorder

Front 20

What are other differentials in patients with dissociative disorder?

Back 20

• PTSD
• malingering

Front 21

What are characteristics of dissociative amnesia?

Back 21

• Patient is not able to remember important information about oneself
• used as defense mechanisms for denial and repression after an emotionally traumatic event

Front 22

Dissociative amnesia is more likely to occur in what type of patients?

Back 22

young adults and women

Front 23

What organic disorder can mimic dissociative amnesia?

Back 23

seizure disorder

Front 24

What can be used to help patients with dissociative amnesia to recover lost memories?

Back 24

• hypnosis
• sodium amorbarbital
• long-term psychotherapy (to deal with the recovered material)

Front 25

What are characteristics of dissociative fugue?

Back 25

• Sudden inability to remember important information about oneself with leaving home and assuming a different identity
• Patient is usually not aware that he has done this

Front 26

What are possible causes of dissociative fugue?

Back 26

• history of excessive alcohol use
• traumatic event in recent past

Front 27

What are characteristics of dissociative identity disorder?

Back 27

• aka Multiple Personality Disorder
• patients have at least two separate personalities

Front 28

Dissociative identity disorder is more commonly seen in which gender?

Back 28

women

Front 29

Mild forms of dissociative identity disorder may resemble which psychiatric conditions?

Back 29

• borderline personality disorder
• schizophrenia

Front 30

What must be ruled out when the patient presents with dissociative identity disorder in a forsenic/legal context?

Back 30

malingering

Front 31

What are possible causes of dissociative identity disorder?

Back 31

• early traumatic experience (usually abuse in childhood or adolescence)
• most commonly associated with incest

Front 32

What is depersonalization disorder?

Back 32

recurrent and persistent feeling of detachment from one’s own body or social situation

Front 33

What is the treatment for depersonalization disorder?

Back 33

• anti-anxiety meds
• SSRIs
• psychotherapy

Front 34

When does depersonalization disorder usually start?

Back 34

between 15-30 years of age

Front 35

A 20 y/o woman cannot remember any of the events of a car accident in which she was driving in which her sister was killed. What is the mostly likely diagnosis?

Back 35

dissociative amnesia

Front 36

A 44 y/o man has been living and working in a town 500 miles from his home for over 2 years. He has no memory of his life before this time. What is the most likely diagnosis?

Back 36

dissociative fugue

Front 37

A 32 y/o woman discovers clothes in her closet that she has no memory of buying and that are quite different from the clothes that she usually wears. What is the most likely diagnosis?

Back 37

dissociative identity disorder

Front 38

A 45 y/o woman tells you that she often feels like an observer rather than a participant in her life. What is the most likely diagnosis?

Back 38

depersonalization disorder