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38 Cards in this Set

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What are somatoform disorders?
• a group of mental disorders characterized by physical symptoms
• do not have corresponding organic pathology
• pts truly believe they have a physical problem
What are the 6 major classifications of somatoform disorder?
• Somatization disorder
• Conversion disorder
• Hypochondriasis
• Body dysmorphic disorder
• Pain disorder
• Undifferentiated somatoform disorder (combo of other somatoform disorders)
Differentiate between primary and secondary gain
• 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
What are factors that can lead to a better prognosis of somatization disorders?
• 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
What are physical symptoms of somatization disorder?
Multiple vague physical symptom:
• Nausea
• Dyspnea
• Tiredness
• Menstrual irregularities
Somatization disorders tends to occur in what types of patients?
• onset before 30 years of age
• more common in lower socioeconomic groups
What is conversion disorder?
• 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)
Conversion disorders tends to occur in what types of patients?
• more common in adolescents and young adults
• patients from rural areas
• psychiatrically unsophisticated patients
What is hypochondriasis?
exaggerated concern with health and illness
Hypochondriasis is more common in what age groups and gender?
• more common in middle and old age
• equal in both sexes
What is body dysmorphic disorder?
• 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
What is the usual onset of body dysmorphic disorder?
late teens
What are characteristics of pain disorder?
• 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
What is the usual onset of pain disorder?
30s and 40s
What class of drugs can be used to treat pain disorder?
anti-depressants (SSRIs)
What are common symptoms of patients with factitious disorder?
• Abdominal pain
• Blood in urine
• Fever
• Induction of tachycardia
• Skin lesions
• Seizures
What are characteristics of factitious disorder by proxy?
• Induction of illness in another person
• Usually a child by parent
• Some patients report a history of childhood abuse or neglect
What is malingering?
• simulation of physical or mental illness for financial or other gain
• patients avoids medical treatment and "recovers" as soon as the gain is realized
What are the 4 types of dissociative disorders?
• Dissociative amnesia
• Dissociative fugue
• Dissociative identity disorder
• Depersonalization disorder
What are other differentials in patients with dissociative disorder?
• PTSD
• malingering
What are characteristics of dissociative amnesia?
• Patient is not able to remember important information about oneself
• used as defense mechanisms for denial and repression after an emotionally traumatic event
Dissociative amnesia is more likely to occur in what type of patients?
young adults and women
What organic disorder can mimic dissociative amnesia?
seizure disorder
What can be used to help patients with dissociative amnesia to recover lost memories?
• hypnosis
• sodium amorbarbital
• long-term psychotherapy (to deal with the recovered material)
What are characteristics of dissociative fugue?
• 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
What are possible causes of dissociative fugue?
• history of excessive alcohol use
• traumatic event in recent past
What are characteristics of dissociative identity disorder?
• aka Multiple Personality Disorder
• patients have at least two separate personalities
Dissociative identity disorder is more commonly seen in which gender?
women
Mild forms of dissociative identity disorder may resemble which psychiatric conditions?
• borderline personality disorder
• schizophrenia
What must be ruled out when the patient presents with dissociative identity disorder in a forsenic/legal context?
malingering
What are possible causes of dissociative identity disorder?
• early traumatic experience (usually abuse in childhood or adolescence)
• most commonly associated with incest
What is depersonalization disorder?
recurrent and persistent feeling of detachment from one’s own body or social situation
What is the treatment for depersonalization disorder?
• anti-anxiety meds
• SSRIs
• psychotherapy
When does depersonalization disorder usually start?
between 15-30 years of age
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?
dissociative amnesia
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?
dissociative fugue
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?
dissociative identity disorder
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?
depersonalization disorder