Usmle Step 2 Psychiatry Somatoform Disorders Chp. 8

Front 1

What is the key to somatoform disorder?

Back 1

think they have something wrong

present physical symptoms with no medical explanations

Front 2

What problems do the somatoform patients have?

Back 2

Always complaining

so problems in social and occupational activites

Front 3

What is somatization disorder?

Back 3

very easy
8 or more symptoms
4 pains (GI, pseudoneurological, shortness of breat, ringing in my ear, heart racing, pain during sex)
more women than men

Front 4

Classic somatoform patient?

Back 4

Young female from Low SES

begins by age 30

Front 5

What is it associated with?

Back 5

Personality Disorder
Long complicated medical histories

Front 6

Never choose answer?

Back 6

There is nothing wrong with you

never refer patient to another doctor

Front 7

What do you need to do with somatoform disorder?

Back 7

regular check-ups
single physician

Tx: Psychotherapy
need to fix their head
get their trust

Front 8

Differential for Somatoform?
medical

Back 8

MS
Myasthemia Gravias
SLE
AIDS
Thyroid
Chronic Systemic Infection

Front 9

What is the differential for somatoform (psychiatric)?

Back 9

depression
anxiety
schizophrenia

Front 10

What is conversion disorder?

Back 10

Pat. experience a stressor
and then has symptoms

voluntary muscle

or sensory control

Front 11

Classical conversion disorder?

Back 11

Patient hears something bad and can't hear

patient sees something terrible and can't see

Pat. wants to hit somebody in the head and becomes paralized

Front 12

What personalities are associated with conversion disorder?

Back 12

dependent personality
passive-agressive
antisocial
histrionic

young female low SES

Front 13

Psychiatric and physical symptoms?

Back 13

neurological voluntary or sensory

usually paralisis (parestesia)
sensory mutism, blindess

Pseudoseizures

Front 14

What is a real clue for conversion disorder?

Back 14

la belle indeference,
the beautiful indiference

the patient doesn't share
unconcerned about disorder

Front 15

What does identification or model?

Back 15

knew someone that was paralized or blind

but patient doesn't hurt themselves
they don't hit themselves on walls

Front 16

Tx of conversion?

Back 16

Psychotherapy

ALso Amotal interview
Amobarbital
tells the truth
truth serum

Front 17

What is associated w/conversion?

Back 17

Malingering

Front 18

What is the difference of somatization vs. hypochondriasis patient?

Back 18

the hypochondriasis says they have a headache and you do a MRI or CT scan normal
but they still believe they have a brain tumor

Front 19

What are the characteristics of hypochondriasis?

Back 19

young patients
equal male/fem

Front 20

What is the age of onset of hypochondriasis?

Back 20

20-30 year old

Front 21

Tx of Pat. w/ hypochondriasis?

Back 21

Psychotherapy

Front 22

Somatoform pain disorder involves?

Back 22

Pain

Front 23

Risk Factors/Etiology?

Back 23

Late in life

At least in 1 or more anatomic sites

pain is very distressing

Front 24

Etiology of pain?

Back 24

psychological factors
often submitted to surgery

Front 25

Best Tx for Pain Somatoform?

Back 25

BEST: Psychotherapy

Anti-depressants since patient have mood disorder

hypnosis, etc

Front 26

Differential Diagnosis for Pain Somatoform?

Back 26

Muscle contraction
Headaches

Front 27

What is body dysmorphic disorder?

Back 27

Patient who believes a part of his body is miss-shapen

defective, abnormal

Front 28

What do the body dysmorphic disorder search for professionally?

Back 28

Plastic Surgeons

Michael Jackson

patients cover/hide their "deformities"

Usually young women

Front 29

What Neurotransmitter is linked to Bodydysmorphic Ds?

Back 29

Serotonin

Front 30

What is the TX for bodydysmorphic ds?

Back 30

SSRIs

plus psychotherapy (individualized)

Front 31

Symptom production?

Back 31

Do you know as a patient where the symptoms are coming from

Front 32

What is symptom motivation?

Back 32

What do you know/drives these symptoms forward

Front 33

Symptom production of somatoform?

Back 33

Unconscious

No...

Front 34

Symptom motivation for somatoform?

Back 34

No

Unconscious

not trying to lie or be deceitful

Front 35

Factitious Disorder?

Back 35

Patients who have conscious productions of symptoms

medical or mental

faking both

fever, chills, pain, patient says it had blood in urine

(they will prick their finger when given pee cup)

Front 36

What is another factitious disorder case? mental

Back 36

Patient says they hear voices

they want to be admited to hospital and get treated

swallow glass, spoon, forks

Front 37

Factitious Disorder person?

Back 37

Physician Assitant
Nurse
or Pharmacist
Cardiologist (even if results are negative)
Psychiatrists

Front 38

Patient history includes what?

Back 38

Child abuse

Pat. was sick a lot in childhood

Front 39

What is a common physical finding of factitious ds?

Back 39

typically dridiron abdomen from multiple surgeries

Front 40

What is a characteristic after being diagnosed?

Back 40

they leave to another hospital
enraged

they will move to another state, city

Front 41

Doctor must be aware of what condition?

Back 41

countertransference

since it is a patient nobody wants

Front 42

What personality is associated with factitious disorder?

Back 42

Antisocial (they lie a lot)

histrionic(need for attention)
schizophrenia(bizarre behavior)
malingering
Ganser Sx

Front 43

What is Ganser Syndrome involved in factitous disorder?

Back 43

usually prison inmates

nearmissed answer to questions

what is the color of the sky? red

How many feet does a cat have? 8

Front 44

What is malingering characterized?

Back 44

Usually mother that fakes all symptoms of the child

notice blood in urine
mother places blood (from prick on finger) in the urine cup to get admitted

Child Abuse
REPORT TO AUTHORITIES

Front 45

What is characteristic of malingering?

Back 45

Injecting fecal matter in I.V.

hitting children
suffocating them


place hidden cameras in patient room

Front 46

Is malingering conscious?

Back 46

Yes
they don't know why

symptom production conscious
symptom motivation unsconscious

Front 47

What is characteristic of malingering?

Back 47

Disability cases (gain money)

Cold (homeless)
get something to eat

I'm hearing voices (shelter)

I hear voices to kill someone

Wearing women clothing (to get kicked out of army)

Front 48

Risk Factors for malingering?

Back 48

Malingering seen in prison
in order to get out of prison

factory and military settings also

to get out

Front 49

What are the physical and psychiatric symptoms?

Back 49

complain a lot
exaggerate

they are preocuppied with gain rather than alleviation of symptoms

Front 50

Is malingering a mental disorder?

Back 50

no
it is not a mental disorder

Front 51

Tx of Malingering?

Back 51

not a mental disorder

so must avoid confronting the patient

anger the patient

establish patient-relation

Front 52

Malingering?

Production?
Motivation?

Back 52

Production conscious
Motivation conscious

intentional

pat. wants to deceive you

Front 53

What do you look in the question for somatoform dis.?

Back 53

no alteration of physical
work-up tests negative

Front 54

What must be present in malingering?

Back 54

lawsuit
avoiding prison
trying to get out of military

look for a gain

Front 55

What must be present in factitious dis.?

Back 55

Physical findings

or Pscyhological Findings

will find glucose
edema or blood in urine

Front 56

If the question says lost of symptoms?

Back 56

Somatization

Front 57

If it is just pain?

Back 57

pain disorder

Front 58

if you complain of only one part of your body?

Back 58

body dysmorphic

Front 59

if pat. has some traumatic experience and then develops symptoms?

Back 59

conversion disorder

Front 60

if pat. thinks he's got an illness and still not conviced even after surgical/tests done?

Back 60

hypochondriasis