Lecture 4B: Somatic Stress Disorders - Pete

Front 1

What are Somatic Stress
Disorders?

Back 1

They are a related set of syndromes characterized
more by disability, symptoms, and suffering, than
by objective pathology

Front 2

functional somatic syndromes, somatic stress disorders, illnesses of unknown origin; medically unexplained symptoms are other names for....

Back 2

Somatic stress disorders

Front 3

Somatic stress disorders include

Back 3

1. Fibromyalgia
2. Chronic Fatigue Syndrome
3. Pseudoseizure in epilepsy
4. Silicone breast implant illness
5. Gulf War Unexplained illness
6. Toxic mould and Sick Building Syndrome
7. Idiopathic Environmental Intolerance (IEI) (Multiple chemical sensitivity)
8. Psychologically-based aspects of the post concussion syndrome

Front 4

How do Individuals with Somatic Stress Disorders tend to view themselves?

Back 4

These patients tend to view themselves as
severely disabled

Front 5

What do individuals with Somatic Stress
Disorders tend to do (hint: Centrelink)?

Back 5

They often apply for disability payments

Front 6

In somatic stress disorders:

Demonstrable pathology vs. degree of disability?

Back 6

The degree of disability is often out of proportion to that seen with patients with demonstrable pathology e.g. patients with heart disease, amputations, cancer or
rheumatoid arthritis.

Front 7

The reported frequency of neurological symptoms in healthy
Controls:

Fatigue?


(Paniak et al, 2002) _ Fatigue 33%; headaches 58%; forgetfulness 58%; poor concentration 35%

Back 7

Fatigue 33%

Front 8

The reported frequency of neurological symptoms in healthy Controls:

Headaches and forgetfulness?

Back 8

58%

Front 9

The reported frequency of neurological symptoms in healthy
Controls:

Poor concentration?

Back 9

Poor concentration 35%

Front 10

Reported frequency of pain in community dwellers?

Back 10

Common!!

Pain 37%, back pain 32%; headache 25%; chest pain 25%; arm or leg pain 24%; abdominal pain 24%

Front 11

People who view themselves as able bodied do not allow pain and neurological symptoms to...

Back 11

Disable them.

Front 12

Some people see common symptoms as signs of _______ ______.

Back 12

Some people see common symptoms as signs of serious illness;

Situation is made worse by the oft noted social isolation of these folk which means they do not get significant other feedback on the complaint

Front 13

What are “fashionable diseases”?

Who coined the Term?

What are they characterized by? (8)

Back 13

Ford coined the term. (Think Ford models = fashionable)

1. Vague,
2. subjective,
3. multisystem complaints
4. a lack of objective laboratory findings
5. quasi-scientific explanations,
6. overlap of one fashionable diagnosis with
another,
7. symptoms which are consistent with depression
or anxiety or both
8. denial of psychosocial distress or attribution of it to the illness

Front 14

What do patients with “fashionable diseases” tend to do? (3)

Back 14

1. Rejects psychological explanations for their
symptoms
2. Prefers biomedical and somatic explanations
3. They seek out healthcare professionals who share their belief systems and who are likely to recommend alternative medical treatments or explanations

Front 15

MILLER noted:

If damage in structure X is known to produce a
decline on test T it is tempting to argue that any
new subject, or group of subjects, having a
relatively poor performance on T must have a lesion at X. In fact the logical status of this argument is
the same as reasoning that because a horse meets
the test of being a large animal with four legs then
any newly encountered large animal with four legs
must be a horse. The newly encountered specimen
could of course be a cow or a hippopotamus and still meet the same test. Similarly new subjects who do badly on T may do so for reasons other than having a lesion at X (p 131).

Back 15

If damage in structure X is known to produce a
decline on test T it is tempting to argue that any
new subject, or group of subjects, having a
relatively poor performance on T must have a lesion at X. In fact the logical status of this argument is
the same as reasoning that because a horse meets
the test of being a large animal with four legs then
any newly encountered large animal with four legs
must be a horse. The newly encountered specimen
could of course be a cow or a hippopotamus and still meet the same test. Similarly new subjects who do badly on T may do so for reasons other than having a lesion at X (p 131).

Miller = Damage to structure X person.

Front 16

What is the key feature of factitious disorder?

Back 16

Physical or psychological symptoms are intentionally produced to assume sick role; conscious/voluntary symptom production

Front 17

What are the three types of factitious disorder?

Back 17

1. With predominantly psychological signs and
symptoms
2. With predominantly physical signs and
symptoms
3. With combined psychological and physical
signs and symptoms

Front 18

What is the key feature of Somatoform Disorders?

Back 18

Key Feature: Presenting complaint cannot
be explained by any known medical
condition; unconscious/involuntary
symptom production

Front 19

What are the types of somatoform disorders? (6)

Back 19

1 Conversion Disorder
2. Somatoform Pain Disorder
3. Hypochondriasis
4. Somatization Disorder
5. Body Dysmorphic Syndrome
6. Undifferentiated Somatoform Disorder

Front 20

What is the key feature of conversion disorder?

Back 20

Key Feature: Patient complains of isolated
symptoms that seem to have no physical
cause, e.g., blindness, deafness, stocking
anaesthesia

Front 21

What are the criteria for conversion disorder? (4)

Back 21

Criteria
1. Symptoms are preceded by stressors
2. Symptoms are not intentionally feigned or produced
3. No neurological, medical, substance abuse or cultural
explanation
4. Must cause marked distress

Front 22

What is the key feature of hypochondriasis?

Back 22

Key feature: Excessive preoccupation with
fear of disease or strong belief in having
disease due to false interpretation of a
trivial symptom

Front 23

What are the key criteria for hypochondriasis?

Back 23

1. Unwarranted fear or idea persists despite reassurance
2. Clinically significant distress
3. Not restricted to appearance
4. Not of delusional intensity

Front 24

What is the key features of pan disorder?

Back 24

1. Chronic, unexplained pain in one or more anatomical
sites of sufficient severity to warrant clinical
attention.

2. The pain causes clinically significant distress or
impairment in social, occupational, or other important
areas of functioning.

3. Psychological factors play an important role in onset,
exacerbation, or maintenance of the pain.

4. Symptom or deficit is not intentionally produced.

5. The pain is not better accounted for by a Mood,
Anxiety, or Psychotic Disorder

Front 25

What is malingering?

Back 25

The intentional production of false or grossly
exaggerated physical and/or psychological symptoms for external incentives such as obtaining monetary compensation or avoiding criminal prosecution (American Psychiatric Association, DSM-IV-TR, 2000; Rogers, 1997).

Front 26

The notion of malingering occurs with a view to presenting oneself as ________ than one is with the view to a demonstrable and predictable ____.

Back 26

The notion of malingering occurs with a view to
presenting oneself as worse than one is with a view to
a demonstrable and predictable gain.

Front 27

What are the two types of gain?

Back 27

Gain has generally been divided into primary versus
secondary gain in the psychoanalytic tradition.

Front 28

What is primary gain?

Back 28

Primary gain is considered to represent the reduction
in anxiety and relief generated by the unconscious
emotional conflict.

Front 29

What is secondary gain?

Back 29

Secondary gain describes the psychosocial benefit of
the sick role including such things as release from
unpleasant responsibility, increased personal
attention and sympathy and financial reward?

Front 30

The distinction between primary and secondary gain has been described as somewhat _________.

Back 30

Cullum, Heaton and Grant (1991) propose that
the distinction between primary and secondary
gain is somewhat artificial and prefer the
notion of merely gain irrespective of whether
the benefit is conscious or unconscious

Front 31

SSDs are not due to ___________.

Back 31

SSDs are due to malingering

Front 32

What percentage of the patients seen by neurologists have co morbid psychiatric disorders?

Back 32

Half of the patients seen by neurologists have co morbid psychiatric disorders.

Fink et al (2003) questioned 198 consecutive patients referred to a neurologist for the first time and found that 61% had at least one medically unexplained symptom and 33.8% met criteria for one of the somatoform disorders

Front 33

What percentage of new patients referred to neurologists fulfil criteria for somatoform disorder?

Back 33

33% (up to 1/3!)

Worse, 70% of neurologists do not recognize common psychiatric conditions such as somatoform disorders (Bridges & Goldberg, 1984; Fink et al, 2005)

Front 34

Which disorder results in more disability and unemployment than any other psychiatric diagnosis? (Thomassen et al, 2003)

Back 34

Somatotization disorder

Front 35

Somatization disorder is ____ times more common in women.

Back 35

5 times more common

Front 36

Somatic Stress Disorders and
Neuropsychology:

ALL somatic stress disorders except X are associated with neuropsychological abnormalities.

Back 36

Idiopathic Environmental Intolerance (IEI)

Front 37

With SSD, Subjective cognitive impairment is _______;

Back 37

Subjective cognitive impairment is INVALID;
remember the hippopotamus

Front 38

Cognitive abnormalities do not of themselves signify
neurologic disease but ____ _________ and perhaps
_______ are altered by stress.

Back 38

Cognitive abnormalities do not of themselves signify
neurologic disease but brain chemistry and perhaps
structure are altered by stress

Front 39

Cognitive complaints are often an index of _______ __________ communicated in a different language from the complaints typically associated with depression and anxiety”

Back 39

Cognitive complaints are often an index of EMOTIONAL DISTRESS communicated in a different language from the complaints typically associated with depression and anxiety.

(i.e., masked anxiety and depression)

Front 40

Individuals with SSD tend to ____ diagnose.

Back 40

Self-diagnose.

Front 41

They tend to ______ their symptoms and turn to the internet to …….?

Back 41

They tend to AMPLIFY their symptoms and turn to the internet to research and complete questionnaires on their symptoms.

Front 42

They believe their illness is _____ but not _____.

Back 42

They believe their illness is serious by not fatal.

Front 43

What do they think about mainstream medicine?

Back 43

They have skepticism with mainstream medicine but this is not so surprising as experts mostly believe that these conditions are either of disputed origin or surrogates for psychological disorders.

Front 44

They tend to shop for doctors who ____

Back 44

They shop for doctors who BELIEVE.

Front 45

They reject _________ explanations and prefer _________ explanations for their difficulties.

Back 45

They reject psychological explanations and prefer biomedical explanations for their difficulties.

(secondary gain an issue)

Front 46

Individuals with SSD are so tuned into their bodes that they tend to view _______ as abnormal

Back 46

Individuals with SSD are so tuned into their bodes that they tend to view NORMAL as abnormal.

Front 47

Sick role and disability:

What % of cases of Fibromyalgia in the US are on disability payments?

Back 47

27.

Front 48

What is the stance of SSD’s on self-help groups?

Back 48

Self-help groups++

Front 49

What is the media’s role in SSD’s?

Back 49

Sensationalized media coverage, e.g., Gulf War, silicone breast implants.

Front 50

SSDs tend to be ___________ conditions:

Back 50

Overlapping.

Front 51

Healthcare professionals are often pressured by misguided patients to ____________ physical illness

Back 51

We can be pressured by misguided patients to
over diagnose physical illness.

Front 52

Advocacy groups often pressure name changes for disorders despite objective evidence. Give an example:

Back 52

The name change of CFS to chronic immune
dysfunction syndrome occurred due to the
intervention of advocacy groups, despite the
lack of evidence of immune dysfunction in the
condition.

We can be pressured by misguided patients to overdiagnose physical illness.

Front 53

Shorter’s historical view- 1

Historical eras and culture shape the ____ and
_______.

Back 53

Historical eras and culture shape the mind and
symptoms

Front 54

Shorter’s historical view- 1

The ________ considers some symptoms legitimate and
others illegitimate

Back 54

The CULTURE considers some symptoms legitimate and others illegitimate.

Front 55

Shorter’s historical view- 1

As symptom legitimacy changes, what happens?

Back 55

As symptom legitimacy changes, people produce
different symptoms

Front 56

Shorter’s historical view- 1
Pervasive _________ dictates the shape of symptoms

Back 56

Pervasive zeitgeist dictates the shape of symptoms

Front 57

Shorter’s historical view- 1

For example, If glove anaesthesia or paralysis will not produce the desired outcome (i.e. the secondary gain) then….

Back 57

If glove anaesthesia or paralysis will not produce the
desired outcome (i.e. the secondary gain) then more
intangible symptoms e.g. headache, pain or fatigue
may be more effective

Front 58

Shorter’s historical view- 2
_
What is happening to the Medical authority’s influence?

Back 58

It’s declining

Front 59

Shorter’s historical view- 2

What two things are increasing in influence?

Back 59

Media (including the internet) and support groups are increasing in influence

Front 60

Shorter’s historical view- 2

Social isolation is increasing and this may
increase idiosyncratic explanations of
__________

Back 60

Social isolation is increasing and this may increase idiosyncratic explanations of symptoms.

Front 61

Shorter’s historical view- 2

What can normal symptoms such as fatigue be viewed as?

Back 61

Normal symptoms such as fatigue can
become viewed as disease

Front 62

Shorter’s historical view- 2

Who do individuals with SSDs pick as friends and treatment providers?

Back 62

They pick friends and clinicians that agree with them.

Front 63

Somatic stress disorders:
Are associated with neuropsychological with neuropsychological symptoms and findings?

Back 63

YES THEY ARE.

Front 64

Somatic stress disorders:

Are emotional abnormalities may be greater or lesser than cognitive ones?

Back 64

Emotional abnormalities may be greater than
cognitive ones!

Front 65

Somatic stress disorders:

Stress and psychiatric can cause what sort of abnormalities?

Back 65

Stress and psychiatric illness can cause NEUROCHEMICAL ABNORMALITIES, medical illness and unexplained illnesses

Front 66

Somatic stress disorders:

What may not be reported by patients with SSDs?

Back 66

Stressors

Front 67

Somatic stress disorders:

What is common with regard to reporting of symptoms?

Back 67

Amplification is common

Front 68

Somatic stress disorders:

“ Organic” vs. “Psychiatric” distinction is
_________.

Back 68

“Organic” vs. “Psychiatric” distinction is outdated.

NB: Many psychiatric disorders are increasingly looking more and more organic.

Front 69

Patients with SSDs may present with May present illusory mental health deny what two things?

Back 69

Deny emotional problems and history

Front 70

What does emotional suppression result in? (2)

Back 70

Adverse immune system effects.
Adverse cardiovascular effects.

Front 71

Are there are genetic differences in reactivity to stress?

Back 71

Yes

Front 72

Will everyone subjected to an intensely stressful life experience develop PTSD? What percentage will?

Back 72

No. Only 10% will.

Front 73

What is the nocebo effect?

Back 73

The nocebo effect occurs when a subject has a negative response to a treatment that is known to be inert.

Front 74

What two things play an important role in the nocebo effect?

Back 74

Conditioning and expectation play an important role in the nocebo response

Front 75

Most investigators agree that the size of the placebo effect is about how big?

Back 75

1/3 of any treatment effect

Front 76

In general…the more invasive the therapy….

Back 76

the stronger the placebo effect.

Front 77

What is pseudoneurologic disease? (hysteria)

Back 77

Neurologic symptoms without objective evidence of neurologic disease.

Front 78

Is pseudoneurologic disease often associated with cognitive deficits?

Back 78

Yes

Front 79

Did Slater show that hysteria often over diagnosed?

Back 79

Yes

Front 80

What is the best model of pseudoneurological illness?

Back 80

Nonepileptic seizures (NES)

Front 81

Nonepileptic seizures (NES) are diagnosed when:

Back 81

1. Neurological disease has been ruled out

Intensive EEG video telemetry monitoring is necessary because episodes usually not observed and NES and ES seizures often appear similar.

Psychological methods useful for description and to identify persons at risk, but cannot be used for
diagnosis

Front 82

Neuropsychological functioning in NON epileptic seizures. Do deficits persist?

Back 82

YES. Neuropsychological deficits persist

Front 83

What are non epileptic seizures commonly associated with?

Back 83

Associated with psychiatric illness- usually
psychogenic in origin

Front 84

What percentage of individuals with non epileptic seizures have a psychiatric history?

Back 84

30%

Front 85

How are individuals with non epileptic seizures in terms of providing history?

Back 85

They are BAD historians and deny verifiable stressors

Front 86

Can you you distinguish between actual seizure groups non epileptic seizure groups based on neuropsychological findings?

Back 86

NO. Cannot distinguish between the two seizures groups.

Front 87

The MMPI-2 is about ___% accurate in differentiating ES from NES

Back 87

MMPI-2 about 70% accurate in differentiating ES from NES

Front 88

MMPI: What subscales would we expect to be elevated in NES groups relative to ES?

DODRILL

Back 88

1. Conversion V profiles
2, hypochondriasis
3. hysteria

Actual Seizures groups consistently 10 points lower on hypochondriasis and hysteria scales (striking difference)

Front 89

Binder’s group found that epileptic and non
epileptic seizure patients did not differ on
most neurocognitive variables except the
______

Back 89

Portland Digit Recognition Test (a test of effort). But not in the range of malingering!!

Front 90

Somebody has NES and they complete an MMPI-2. What pattern of results would you expect to see as compared to someone who experiences actual seizures?

Back 90

NES score about 10 points higher on hypochondriasis and hysteria

Front 91

Non epileptic patients not typically in malingering range on ____.

Back 91

Non epileptic patients ARE NOT typically in
malingering range on PDRT.

Front 92

Classification of seizure type
with multiple predictors:

What are the best three predictors of NES?

Back 92

1. MMPI-2 hysteria
2. routine EEG
3. And brief chronicity

Front 93

MMPI-2 data and anecdotal evidence leads to the
conclusion that many of NES patients lack _______ and try to deny _________ problems, preferring physical explanations for their illness

Back 93

MMPI-2 data and anecdotal evidence leads to the
conclusion that many of these patients lack
insight and try to deny psychological problems,
preferring physical explanations for their illness.

Fortunately, some are willing to accept a
psychological explanation.

Front 94

How is fibromyalgia diagnosed?

Back 94

Diagnosis based on report of pain to at least 11
of 18 trigger points in response to 4 kg of pressure. Sites must be bilateral and both above and below the waist

Front 95

What are the two problems with diagnosing fibromyalgia? (2)

Back 95

Problems in diagnosis with examiner and
patient reliability

Front 96

Is fibromyalgia is associated with mild neuropsychological deficits?

Back 96

YES. Think CN (RAVLT poor and psychiatrically disturbed)

1. mild neuropsychological deficits
2. psychiatric illness

Front 97

Fibromyalgia aetiology is _____

What are the two hypotheses?

Back 97

Unproven.

1. ?Psychiatric
2. Abnormal illness behaviour

Various neuroendocrine and gate control theory
hypotheses have been advanced

Front 98

Pain and neuroendocrine findings in fibromyalgia are often associated with _______ _______.

Back 98

Pain and neuroendocrine findings in fibromyalgia are often associated with PSYCHIATRIC ILLNESS.

Front 99

People diagnosed with fibromyalgia often have a history of what? (think CN)

Back 99

Abuse.

Front 100

Read:

“The only relevant feature of the illness suffered
by these people is that they feel too wretched to
go to work…disability determination for
Fibromyalgia is nothing more than a testing of the
veracity of the claimant.” (Hadler, 1997)

What does this mean?

Back 100

Have to validity test.

Front 101

US criteria for chronic fatigue syndrome include chronic disabling fatigue and at least 4 of 8 other features. What are they?

Back 101

1. muscle ache
2. joint pains
3. subjective cognitive problems
4. sore throat,
5. new headache
6. non-restorative sleep
7. post exertion malaise
8. swollen lymph glands.

Front 102

Crowe’s CFS study found that medically confirmed CFS patients performed poorly on what test?

Back 102

The RAVLT.

The supports the notion that there is central nervous system compromise.

Front 103

CFS is associated with _______ cognitive deficits and what two types of disorders?

Back 103

Associated with acquired cognitive deficits and
affective and anxiety disorders.

Front 104

Subjective cognitive impairment is usually great than _______ impairments.

Back 104

Subjective cognitive impairment>objective.

Front 105

CFS and depression?

Back 105

Often different than depression (Jason)

Front 106

Neuropsychological Profile of CFS?

Where is the deficit (1) and what’s preserved (2)?

Back 106

1. Complex information processing deficit

2. Preservation of intellect and complex
problem solving


Subjective>objective findings (Tiersky et al; DiPino & Kane)

Front 107

Idiopathic Environmental
Intolerance (IEI) is otherwise known as?

What is it associated with?

Back 107

Also known as Multiple Chemical Sensitivity

It is associated with psychiatric disease

Front 108

What characterizes Idiopathic Environmental Intolerance (IEI)?

Back 108

Characterized by allergic like sensitivity to various
common chemical odours such as common cleansers,
gasoline and perfume (odours rather than
neurotoxins: Bolla, 2000)

Front 109

What are some of Idiopathic Environmental Intolerance (IEI) often reported symptoms (4)

Back 109

Symptoms include
1. fatigue
2. confusion
3. dizziness
4. respiratory problems

Front 110

IEI and cognitive function vs. controls? (SPARK)

Back 110

SAME.

Systematic studies indicate no differences from
controls in cognitive function (Sparks, 2000).

Front 111

Laboratory provocation in MCS with those chemicals
identified as incitants yielded extremely low
________ and __________(Staudenmayer et al, 1993)

Back 111

Laboratory provocation in MCS with those chemicals
identified as incitants yielded extremely low
sensitivity and specificity (Staudenmayer et al, 1993).

Front 112

There is a strong association between IEI and…

Back 112

Strong association between IEI and psychiatric illness.

Classical conditioning but can occur without history of a US causing UCR

Front 113

Individuals with IEI have what sort of belief system?

Back 113

An ILLNESS belief system

Front 114

It is possible that CFS, FM, IEI are all

Back 114

All one condition.

There is significant symptom and diagnostic overlap

It is said that the same patient will receive a FM
diagnosis from a rheumatologist and a CFS diagnosis from an internist, (and probably a diagnosis of depression or anxiety from a psychiatrist) and many patients carry 2-3 of these labels

Front 115

What may be the most objective finding regarding the differences between CFS, FM, IEI?

Back 115

Neuropsychological findings may be the most
objective abnormality, but NO EVIDENCE that there
is a neurologic disease in the classical sense.

Front 116

Subjective cognitive impairment is weakly _________ of objective findings and is more related to ________.

Back 116

Subjective cognitive impairment is WEAKLY predictive of objective findings and is more related to DISTRESS.

Front 117

Accuracy of self report-1
_

What is the “Good old days” phenomenon?

Back 117

Pre-morbid health is overestimated AFTER injury.

Lees-Haley et al (1997) gathered data on a total of 446 subjects (comprising 131 litigating and 315 non-litigating adults from five locations across the United States) and noted that the litigating clients consistently reported themselves to be hyper-normal before their injury.

These differences applied to areas as diverse as life in general, concentration, memory, level of depression, level of anxiety, level of alcohol abuse, work or school performance, level of irritability, level of headache, level of confusion, level of self esteem, fatigue, level of sexual functioning, quality of their marriage and the relationship to their children. Only level of drug abuse did not differ between the forensic group and the controls.

Front 118

Empirical evidence that adults who were sexually
abused or otherwise traumatized during
childhood or earlier in adulthood may ____ __ _______ abuse/trauma when directly asked

Back 118

Empirical evidence that adults who were sexually
abused or otherwise traumatized during
childhood or earlier in adulthood may FAIL TO REPORT abuse/trauma when directly asked

Front 119

Gulf War trauma reported more _________ at 2 years than 1 month after return in the same cohort (Southwick et al, 1997)

Back 119

Gulf War trauma reported more FREQUENTLY at 2
years than 1 month after return in the same
cohort (Southwick et al, 1997)

Front 120

30-40% ______ for physical and sexual abuse when
assessed 15 years later with file evidence from
childhood.

Back 120

30-40% denial for physical and sexual abuse when
assessed 15 years later with file evidence from
childhood

Front 121

Accuracy of self report-3

Post-encoding effects and events can influence the _________ of memory (i.e. reconsolidation)

Back 121

Post-encoding effects and events can
influence the ACCURACY of memory (i.e.
reconsolidation).

Academic, athletic, military achievements
distorted by some.

Well documented stressors, medical and
mental health history imperfectly recalled
(Harlow & Linet; 1989; Simon & Von Korff,
1995)

Front 122

What is the level of overlap between self report
of depression in structured interview and
in a self report instrument administered a
year later?

Back 122

NO SIGNIFICANT overlap between self report
of depression in structured interview and
in a self report instrument administered a
year later.

Results were “disheartening…wherever
possible, use of records of past depression
is to be strongly preferred over a reliance
on respondent recall” (Coyne et al, 2001)

1008 New Zealand 18 years olds who had
participated in a longitudinal study had
inaccurate recollections of items such as
family conflict at various ages as reported
earlier by mother, self report of hyperactivity, self report of depression.
(Henry et al., 1994)

Front 123

Given the unreliability of self-report, you should always….

Back 123

Seek to obtain comprehensive records.

- For some reason these folk may well have
suffered significant stressful life events and
for whatever reason may not recognize these
(repression/denial???)

- Disclosure is healthy
- Disclosure of trauma must be titrated –too
much disclosure can be traumatic for some
people

Front 124

Somatic Stress Disorders and Neuropsychology

SSD’s are associated with neuropsychological _________

Back 124

Associated with neuropsychological ABNORMALITIES.

Front 125

In SSDs, subjective cognitive impairment is not ______

Back 125

Subjective cognitive impairment is NOT VALID.

Front 126

In SSDs, self-report may be ________.

Back 126

Self report history may be INACCURATE

Front 127

Cognitive abnormalities do not signify ______ ______ but brain chemistry and perhaps structure can be altered by stress.

Back 127

Cognitive abnormalities do not signify NEUROLOGIC DISEASE but brain chemistry and perhaps structure
can be altered by stress.

Front 128

The pattern of neuropsychological deficits does not
allow for classification as “_______” or “_______”

Back 128

Pattern of neuropsychological deficits does not
allow for classification as “organic” or “functional”

AVOID ENDORSING ORGANIC ACCOUNTS OF ILLNESS.

Front 129

Epstein et al’s model does not use labels such as _______ or medical labels that ________.

Back 129

1. Don’t use labels such as somatoform
2. Don’t use medical labels that pathologize

He prefers symptom descriptors as labels.

Employ the biopsychosocial model in case conceptualization as all illnesses involve
physical symptoms, social relationships,
emotions.

Front 130

Epstein argues that you need to empathize with the patient’s experience, validating the experience without ________ the diagnosis/pathology.

Back 130

Epstein argues that you need to empathize with the patient’s experience, validating the experience without endorsing the diagnosis/pathology.

Front 131

In terms of working with SSD patients, it’s best to have only ___ treating clinician.

Back 131

One treating clinician.

MINIMIZE LEVEL OF CLINICIAN INVOLVEMENT.

Front 132

After appropriate work up and diagnosis, further diagnostic testing __________ ______ ______,

Back 132

After appropriate work up and diagnosis, further diagnostic testing should be minimized

Front 133

Is it better to say “there is no neurological/neuropsychological
problem” or that “you condition is purely
psychiatric/psychological”?

Back 133

Say neither.

Front 134

In SSD, they symptoms are real but are associated with….?

Back 134

The symptoms are “real” but are associative with maladaptive coping patterns

Front 135

SSDs are common syndromes and you will see them.

Be sure to avoid endorsing organic accounts of these conditions.

What else should you recommend in terms of treatment?

Back 135

Recommend appropriate psychological
intervention minimizing the level of clinician
involvement

Front 136

What two factors can have a PROFOUND effect on functional outcome following mTBI? (2)

Back 136

1. Psychological factors
2. Subjective cognitive factors

Front 137

Neuroanatomical and neurochemical changes in SSD

What's altered? (2)

Back 137

1. Brain chemistry
2. Structure are altered by stress

Front 138

Cognitive abnormalities do not themselves signify neurological disease.... BUT.....

Back 138

but chemistry and perhaps structure due to stress.

Front 139

The danger of placing someone on the DSP is that they will become....

Back 139

Sick role dependent.

Front 140

Is intensive EEG monitoring monitoring necessary in NES diagnostic workup? If yes, why? (2)

Back 140

1. Intensive EEG video telemetry monitoring is necessary because episodes usually not observed and NES and ES seizures often appear similar.

2. Psychological methods useful for description and to identify persons at risk, but cannot be used for diagnosis.

Front 141

Do patients presented with NES have neuropsychological deficits?

Back 141

YES!!

Front 142

Scores above ____ on MMPI2 hypochondriasis and hysteria are associated with NES

Back 142

Scores about 79!

Actual seizure groups are 10 points lower than pseudoseizure groups.

Front 143

THREE BEST PREDICTORS OF PSEUDO SEIZURE?

Back 143

1. MMPI-2 Hysteria
2. ROUTINE EEG
3. BRIEF CHRONICITY.

Front 144

in terms of psychological interventions, the focus should be on ___________ the level of clinician involvement.

Back 144

in terms of psychological interventions, the focus should be on minimising the level of clinician involvement.

Front 145

Don't assume all cognitive change is due to neurological...

Back 145

injury (e.g., TBI).

Front 146

Key points to lecture (4)

Back 146

 Don’t assume that all cognitive change is due to neurological injury
 Do your best to corroborate the history if possible
 Avoid endorsing organic accounts of these conditions
 Recommend appropriate psychological intervention minimizing the level of clinician involvement