Somatoform Disorders

Front 1

are somatoform disorders EXPLAINABLE by a general medical condition, by the direct effects of a substance, or by another mental disorder (such as the physical symptoms occurring during a panic attack?)

Back 1

NO- if present, the symptoms are far from what would normally be expected

Front 2

What are Factitious Disorders or Malingering disorders characterized by?

Back 2

INTENTIONAL production or feigning of symptoms

Front 3

Factitious or Malingering Disorder?:
symptoms produced or feigned in order to appear ill, w/ NO perceivable BENEFIT to patient

Back 3

Factitious disorder

Front 4

Factitious or Malingering Disorder?:
-symptoms produced or feigned in response to external INCENTIVE(ie, avoid military service; obtain a settlement in a lawsuit, etc.)

Back 4

Malingering disorder

Front 5

How is the dx of Psychological Factors Affecting Physical Condition made?

Back 5

Medical disorder is precipitated or exacerbated by psychologically meaningful enviro. stimuli (ie: asthma attack precipitated by family argument)

Front 6

What disorder?
1. Medically unexplained physical symptoms or complaints which cause significant stress of impairment of functioning
2. Symptoms that are not willfully produced or feigned (as they are in factitious disorders or malingering)
3. symptoms that are not due to physiologic effects of substance abuse, dependence, or w/drawal

Back 6

Somatoform disorder
-NOT explained medically
-NOT being faked
-NOT due to substance

Front 7

7 types of Somatoform disorders include:

Back 7

1. Somatization Disorder
2. Undifferentiated Somatoform disorder
3. Conversion disorder
4. Pain disorder
5. Hypochondriasis
6. Body dysmorphic disorder
7. Somatoform disorder NOS

Front 8

Which Somatoform disorder?:
hx of multiple physical complaints, involving multiple organ systems, beginning b/4 age 30, and seeking medical attention

Back 8

somatization disorder

Front 9

Which Somatoform disorder?:
characterized by unexplained physical complaints lasting at lleast 6 mos but does not meet the full symptom picture of a somatization disorder

Back 9

undifferentiated somatoform disorder

Front 10

one or more symptoms or deficits affecting Voluntatry motor or sensory function that suggest a neurological or other condition, psychological factors are judged to be associated w/ the symptom or deficit, the symptoms can not be explained by a general medical condition, physiologcal effects of a substance, or a culturally sactioned behavior or experience

Back 10

Conversion disorder

Front 11

Which Somatoform disorder?:
pain in one or more anatomical sites is the predominant presentation; the pain cuases significant distress and impairment, and psychological factors are judged to be etiologically significant

Back 11

Pain disorder

Front 12

Preoccupation w/ fear of having or the belief that one has a dz, based on bodily symptoms

Back 12

Hypochondriasis

Front 13

Which Somatoform disorder?:
Preoccupation w/ a slight or imagined defect in appearance (e.g. "the pores on my face are getting bigger", causing clinically sig. distress and/or impairment

Back 13

Body Dysmorphic disorder

Front 14

Which Somatoform disorder?:
Disorders w/ somatoform symptoms that do not fit one of the categories above

Back 14

Somatoform disorder NOS

Front 15

When must symptoms begin for a Somatization disorder?

Back 15

Before the age of 30 and occur over a period of several years

Front 16

How many symptoms must a patient have for a somatization disorder?

Back 16

-4 pain symptoms
-2 GI symptoms
-one sexual symptom
-one pseudoneurologic symptom

Front 17

In addition to having the 4, 2, 1,1 symptoms w/ somatization disorder, what must be determined about symptoms?

Back 17

Symptoms must have no known medical etiology or be in excess of what would be expected if an underlying condition exists

Front 18

Somatization Disorder:
associated features?

Back 18

-complaints presented in dramatic, vague or exaggerated way.
-anxiety and depression common
-suicide threats are not infrequent
-Personality disorder often present
-marital and occupational difficulties are common

Front 19

Somatization Disorder:
course and prognosis

Back 19

-Chronic, fluctuating course; patients are rarely entirely asymptomatic. There is a risk of complications due to unnecessary medical procedures and surgery.

Front 20

Somatization Disorder:
-Prevalence?

Back 20

Estimates of lifetime prevalence in f/ms range from 0.2-2%. This disorder israrely dxd in males

Front 21

Somatization Disorder:
Etiology?

Back 21

environmental and genetic factors suggested
-observed in 10-20% of first-degree f/m relatives of somatization disorder patients
-w/in these families, male relatives show an increased risk of Antisocial Personality Disorder and Alcohol Abuse

Front 22

Somatization Disorder:
-Management?

Back 22

Establish docto-patient relationship w/ ONE physician
-tx co-morbid anxiety or depression, if present.
-maintain regular appointments, even if doing well.

Front 23

Somatization Disorder:
how should you deal with somatic complaints?

Back 23

don't pursue needless work-ups, refererrals unless objective evidence of dz is present
-shift emphasis from physical complaints to talking about psychosocial stressors

Front 24

How is Undifferentiated Somatoform Disorder related to a Somatoform disorder?

Back 24

dx made when clinical picture does not meet the full dx criteriorn for somatization disorder (4,2,1,1)

Front 25

What is the dx criteria for Undifferentiated Somatoform Disorder?

Back 25

At least ONE unexplained somatic symptom must be present for at least 6 mos.

Front 26

What are some of the disorders/problems that must be ruled out w/ somatoform disorder?

Back 26

Somatoform, Sexual Dysfunction, Mood, Anxiety, Sleep, and Psychotic Disorders must be ruled out

Front 27

This disorder is characterized by the UNEXPLAINED LOSS or alteration in VOLUNTARY motor functioning or sensory function that is apparently an expression of psychological conflict or need. the person is NOT conscious of INTENTIONALLY porducing the symptom.

Back 27

Conversion Disorder
-unexplained loss function
-apparently expression of psychological conflict or need
-not conscious intentionally producing it

Front 28

How do you establish dx for conversion disorder?

Back 28

Temporal relationship found between a relevant psychosocial stressor and the conversion syndrome

Front 29

Conversion Disorder:
-associated features?

Back 29

-"classic" presentations of Conversion disorder are those that suggest neurologic DZ, eg blindness, paralysis

Front 30

Conversion Disorder:
course and prognosis

Back 30

onset usually SUDDEN and associated w/ settings of extreme psychological distress
-Duration usually SHORT, with abrupt resolution
-Recurrence predicts a more chronic course w/ marked impairment of function

Front 31

Conversion Disorder:
Prevalence?

Back 31

Rare, more common in women

Front 32

Conversion Disorder:
Etiology:
-the conversion symptom keeps an internal conflict out of awareness (symoblic representation of an unconscious conflict)

Back 32

Primary gain

Front 33

Conversion Disorder:
-Etiology
-the conversion symptom mediates AVOIDANCE of Noxious activity or getting support from the environment

Back 33

Secondary gain

Front 34

Characterized by a preoccupation w/ unexplained severe and continuous pain that cuases signfiicant distress and impairment in functioning. Psychological factors are felt to be significant

Back 34

Pain Disorder

Front 35

Pain Disorder:
-associated features

Back 35

-frequent visits to doctors to obtain relief and excessive use of analgesics are common
-patients typically refuse to consider the contribtuion of psychological factors to their pain
-Depressive symptoms prevalent, in many cases warranting an associated dx of MDD (major depressive disorder)

Front 36

Pain Disorder:
course and prognosis

Back 36

generally CHRONIC and DISABLING
-iatrogenic complications include substance dependence and unnecessary or dangerous interventions
-in about 50% of cases, pain develops immediately folling a physical trauma

Front 37

preoccupation w/ the fear of having a serious dz and the misinterpretation of physical symptoms and sensations as evidence of physical illness. The preoccupation persists despite reassurance. It is NOT DELUSIONAL in intensity but causes significant distress and interference in functinoing

Back 37

Hypochondriasis

Front 38

Hypochondriasis:
Associated features?

Back 38

Anxiety and depressed mood are common. Bodily preoccupation is also common (increased vigilance over bodily sensations)

Front 39

Hypochondriasis:
-Prevalence/Epidemiolgoy

Back 39

3-14% of patients in general medical practice
-onset most commonly early adulthood
-equally common men/women

Front 40

Hypochondriasis:
-Course and Prognosis?

Back 40

-usually Chronic and Fluctuating, but recovery occurs in many cases. Usually some impairmaent in social and occupational functioning b/c the person is preoccupied w/ the dz. complications include missed medical diagnoses and unnecessary medical procedures

Front 41

Hypochondriasis:
Differential Diagnosis

Back 41

Hypochondriacal symptoms are common in depression, Generalized Anxiety Disorder and Panic Disorder. Some obsessions and phobias can resemble Hypochondriasis, but in these cases, the patients know that their symptoms are IRRATIONAL, EXCESSIVE, or Unrealistic

Front 42

Preoccupation w/ a slight or imagined defect in appearance in a normal appearing person. If a slight anomaly is present, the person's concern is markedly excessive

Back 42

Body Dysmorphic Disorder

Front 43

Body Dysmorphic Disorder:
-Associated features?

Back 43

complaints of facial flaws: excessive facial hair, shape of features and swelling of face. A hx of repeated visits to plastic surgeons or dermatologists to correct the "defect" is common

Front 44

somatoform symptoms that do not meet criteria for any of the other specific somatoform disorder above

Back 44

Somatoform Disorder not otherwise specified

Front 45

Is psychotherapy helpful for someone w/ a somatoform disorder?

Back 45

when accepted, is usually helpful, but should take place in the medical setting

Front 46

What is the tx goal for somatoform disorders?

Back 46

rehabilitation, not cure of pain

Front 47

Characterized by symptoms that ARE INTENTIONALLY PRODUCED OR FEIGNED (ie: a patient might claim to have pain when they do not, or might inject themselves w/ insulin, or drip blood from a figer-stick into a urine sample

Back 47

Factitious and Malingering Disorders

Front 48

The goal for such behaviors IS NOT OBVIOUS, and the patient seems unable to refrain even if its dangers are known. There is a psychological need to assume a sick role, as evidenced by an absence of external incentives for the behavior, such as economic gain

Back 48

Factitious disorders

Front 49

There is evidence that the GOALS for such behavior are MOTIVATED BY EXTERNAL INCENTIVES, such as avoiding work, obtaining financial compensation, evading criminal prosecution, obtaining drugs, securing better living conditions, etc.

Back 49

Malingering disorder

Front 50

Is Malingering Disorder considered to be a Psychiatric Ilness?

Back 50

No

Front 51

This category can apply to any physical condition to which psychological factors have been judged to be contributory. The dx is established when a temporal relationship is found between the relevant stress and the onset or worsening of a medical condition. Diagnostic certainty is improved w/ repeated occurrences

Back 51

Psychological factor affecting medical condition
-Gi probs, tension, angina, back pain, asthma, etc.

Front 52

Psychological factor affecting medical condition:
-Etiology

Back 52

Chronic, severe, and perceived stress probably contributes to the development of certain medical disorders. The stress may be external, or may also be internal, based on private conflicts.

Front 53

Do some people respond to stress w/ physiologic dysfunction?

Back 53

yes- if stressed, might get sick, etc.
-ie: people w/ Type A personality may predispose to coronary dz
Psychological factor affecting medical condition

Front 54

Psychological factor affecting medical condition
Pathophysiolgy

Back 54

Physioligc variables which may mediate stress and medical disorders may be
-hormonal
-mediated by autonomic nervous system
-most ten to have genetic predisposition, predisposing behavior pattern, and a certain enviro. settig

Front 55

Psychological factor affecting medical condition
-Tx:?

Back 55

a hierarchy or treatments may be used. Simply eliminating a stress is the first choice. However, if a person must continue to live w/ stress, then relaxation training, lifestyle changes, or judicious use of medicaitons will often help.

Front 56

Is psychotherapy helpful for Psychological factor affecting medical condition

Back 56

Usually not, unless to help get someone out of a stressful situation

Front 57

What are two big separations in disorders?

Back 57

Somatoform Disorder vs
Factitious Disorder

Front 58

Of Factitious Disorders, what do you have to differentiate between?

Back 58

Malingering
vs
Psychological Factor affecting a medical condiation

Front 59

How is Illness different from dz?

Back 59

Illness = a response of an individual, or his or her family, to symptoms
Disease=a PATHOPHYSIOLOGIC process associated w/ domumentable physical lesions

Front 60

How is somatization different from somatoform illness?

Back 60

Somatization is the tendency to expereince and communicate psychological or emotional distress as bodily complaints or somatic (physical) symptoms
--Somatoform illness goes beyond this to produce significant DYSFUNCTION in patient's life

Front 61

FOOT acromym for Somatization disorder?

Back 61

*begin b/4 age of 30

F=Four gastrointestinal
O=One pseudoneurologic
O=One sexual
T=Two pain symptoms

Front 62

Course of Somatization Disorder?

Back 62

Chronic, fluctuating

Front 63

How long does undifferentiated somatoform disorder need to last?

Back 63

at least 6 mos.

Front 64

Is conversion disorder characterized by a symptom or deficit that is intentionally feigned or produced?

Back 64

No- not intentionaly produced
"a psychologic "bind" --> conflict is converted by unconscious to a physical symptom

Front 65

Subtypes of conversions disorders? (how might it be manifested)?

Back 65

-motor symtom
-sensory symptom or deficit
-Seizures
-mixed

Front 66

Are conversion disorders more prevalent in men or women/

Back 66

Women: men
2:1 to 10:1

Front 67

acute vs chronic pain disorders

Back 67

acute: less than 6 mos
chronic: greater than 6 mos.

Front 68

4 D's of Hypochondriasis?

Back 68

Disease fear
Disease preoccuption
Disease conviction
Disabilty results

Front 69

Two types of people with body Dysmorphic Disorder/

Back 69

Checkers and Hiders

Front 70

Are factitious and malingering disorders factitiously produced?

Back 70

yes

Front 71

Munchausen's Syndrome - desire to be tx'd like sick person is example of?

Back 71

Factitious disorder

Front 72

Are patients entitled to thorough medical work-up, even if have hx of factitiosu disorder/

Back 72

Yes

Front 73

What is a "Factitious disorder by proxy"

Back 73

induce DZ in other people
-think of the 6th sense

Front 74

Grossly exaggerating, lying or faking symptoms for concrete, recognizable gain

Back 74

Malingering disorder
-considered a legal, rather than a psychiatric or medical dx

Front 75

What is disorder?:
-production symptom:involuntary
-Motivation: unconscious

Back 75

Somatoform Disorders

Front 76

What is disorder?:
-production symptom:Voluntary
-Motivation:unconscious

Back 76

Factitious disorder

Front 77

What is disorder?:
-production symptom:Voluntary
-Motivation: conscious

Back 77

malingering