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22 Cards in this Set

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Zimbardo Prison study
Mock prison/guard scenerio
Stopped early due to extreme distress
Some patients took on a "sick role"
Asch study on Opinions & Social Pressure
When faced with the choice to act independently (trusting one’s own perceptions) or go against the group, in nearly 40% of the cases, people went with the group consensus, giving the wrong answer
Index Patient
the identified person in the family to bear/carry the symptoms
-Case of Anorexia
-Drugs, alcohol, co-dependency
-Family secrets
Human Perception
(Gestalt Psychology Model)
Drive towards closure/Resolution
1) concious of need
2)pressure for resolution
3)search for solution in enviornment
4)Try on solutions
5)determine best fit
6)Action
7)CLOSURE
Somatoform Disorders
presence of physical symptoms that suggest a general medical condition, and are not fully explained by a general medical condition or if a medical condition is present, the symptoms are in excess of what would be expected

Symptoms are not intentionally produced or feigned
5 Main Types of Somatoform Disorders
1)Somatization Disorder(Classically “Hysteria”)
2)Conversion Disorder
3)Pain Disorder
4)Hypochondriasis
5)Body Dysmorphic Disorder
Somatization Disorder
-Chronic - occurs over many years, onset before 30
-Distress is significant enough to seek treatment – in fact, life seems to revolve around symptoms and relationships with medical professionals
- At least 4 pain symptoms (head, back, abs…)
- At least 2 GI symptoms (Nausea, bloating, vomiting…)
- At least 2 sexual/reproductive symptom (Irregular menses…)
- At least 1 pseudo-neurological symptom (Balance, double vision, coordination…)
Somatization Disorder
-Up to 2% of the population
-Co-morbidity with anxiety & mood disorders
-Sick role runs chronic course into old age
-More common in females
- Unmarried
- Lower SES
-Familial pattern – genetic or learned?
- Male relatives may have Anti-social Personality Disorder
Somatization Disorder :Treatment
Treatment is difficult

Usually involves reassurance, reducing or finding more productive ways to deal with stress, and reducing unnecessary help-seeking behavior
Conversion Disorder
-Symptoms tend to be neurological in nature
- Motor deficit: coordination, balance, paralysis
- Sensory deficit: loss of touch sensation, blindness
3% general population; 1-14% medical settings
-Mainly female
-Will typically seek help from a neurologist
-La Belle Indifference
Conversion Disorder:Treatment
Difficult to treat

Approaches are similar to Somatization Disorder

Need to address the underlying trauma or issue
Pain Disorder
Pain in a specific anatomical area is the predominant focus – the pain is real
Large portion of the general population suffers from chronic pain issue (ie., headaches, backaches)
Difficult to decipher this from pain that has an actual physical basis; therefore difficult to know prevalence
Psychological factors are strongly suspected; therefore psychotherapy is indicated
Hypochondriasis
Preoccupation with fears of having a serious disease based on misinterpretation of one’s bodily signs/symptoms”
Hypochondriasis
1-7% of the population (statistics vary)
More common among the elderly
Sex ratio is 50/50
Runs in families
- Genetic contribution
- Learned behavior
-External locus of control?
-Tendency to awful-ize?
Actual experience?
Hypochondriasis: Treatment
Treatment may involve psychotherapy or medication; similar to the treatment for an anxiety disorder
Body Dysmorphic Disorder
Preoccupation with an imagined
defect in one’s physical
appearance in a normal
looking person

Co-morbidity with Anxiety & Depression, as well as OCD
Malingering
Faking a disorder for an EXTERNAL gain
e.g.,Medication, Physician note, Insurance issues
Factitious Disorders
give examples
Factitious Disorder=Munchausen’s

Factitious Disorder By Proxy=Munchausen’s By Proxy
Factitious Disorder
Intentional production of physical or psychological signs/symptoms for the purpose of assuming the sick role. The individual has perceived a need for attention, affection, or other secondary gain, that can be attained through use of the sick role
Be suspicious of Factitious disorder when you note the following red flags:
Atypical/dramatic presentation that is inconsistent with the medical condition
Symptoms present only when under observation
Pathological lying
Disruptive behavior on the ward, such as non-compliance
Excessively argumentative with medical professionals
Extensive knowledge of medical terminology & hospital routines
Covert use of substances
Evidence of multiple treatment interventions (i.e., scar tissue from multiple surgeries)
Extensive history of traveling
Few (if any) visitors
Fluctuating clinical course with rapid developments and complications
Be suspicious of Factitious disorder by proxy when you note the following red flags:
Child who has 1 or more medical problems that do not respond to treatment or that follow a puzzling, atypical and persistent course
Lab findings that are highly unusual, discrepant with history, or physically/clinically impossible
Parent who appears medically knowledgeable and/or fascinated with medical details, hospital gossip, seems to enjoy the hospital environment, and is interested in other patients’ problems
Devalues and argues with staff, demands additional procedures
Child’s illness does not occur when parent is absent
Parent is not particularly interested in child when left alone
Parents seems to require excessive adulation for self-sacrifice
Child Abuse Reporting Laws
As a physician, you are a mandated reporter if you have a “reasonable suspicion” of child abuse

If in doubt, you can always have an anonymous phone consultation

Reporters have immunity from prosecution