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Somatization Dz
Somatization and Somatoform Disorders
| Question | Answer |
|---|---|
| What percentage of primary care visits are somatization cases? | 20-35% |
| ________ is the response of the individual to sx | Illness |
| Disease is associated wtih | pathophsiological processes, documentable lesions, tissue damage |
| Hypertensive pts who do not see themselves as ill, and somatoform pts who view themselves as very ill are examples of mismatches between | illness and disease |
| Causes of somatization | masked presentation of psych dx, due to amplifying perceptual style, due to tendency to seek care for common sxs, a response to inceentives of the health care system |
| Hypervigilence to bodily sensations followed by over-generalizations and catastrophizing is caused by | somatosensory amplification |
| Developmental factors of somatic sxs | families who don't discuss emotions, childhood exposure to parental chronic illness, people who have poor attachment abilities who are seeking love and care, trauma (physical and sexual abuse, PTSD), Stigmatization of psychiatric distress |
| Somatization key | must be an absence of explanation for symptoms. |
| A dx is more likely to be psychiatric if: | Many different organ systems involved,Coexistence of anxiety or depressive sxs or diagnosis,Sxs lead to psychological secondary gain,Chronicity |
| Somatization Disorder Characteristics | multiple and recurring physical complaints before age 30, four pain sx, two non-pain GI sx, one sexual sx, one pseudoneurologic sx, appropriate medical investigation, neither intentionally produced or feigned |
| Undifferentiated Somatoform | return |
| Conversion Disorder | Involves the presence of sx or deficits that affect voluntary motor or sensory function that suggests neurological problems but is not explained by the medical findings |
| Conversions Disorder Features | Initiation preceded by psychological conflict or stress, no appropriate medical explanation, significant distress and not feigned, not limited to pain or sexual dysfunction |
| "La belle indifference" is seen in | Conversion Disorder |
| ____________ is the most common somatoform disorder | Conversion disorder. Up to 25-30% hospitalized veterans. F:M (2-10:1) |
| Preoccupation with fears of having, or the that one has, a serious dz bsed on one's misinterpretation of bodily sx | Hypochondriasis. Key is fear. Preoccupation causes significant distress or impairment |
| Hypochondriasis must last at least | 6 months |
| Preoccupation with "imagined" defect in appearance | Body Dysmorphic disorder. 5-7% of pts seeking plastic surgery. Likely in the OCD spectrum |
| Disorder in which the individual's goal is to produce or feign signs of medical or mental disorder, and to assume the patient role, motivation unconscious. (not seeking financial or legal gain like malingering) | Factitious Disorder. Counter transference is often severe |
| Schizophrenia | >25% have >=5 unexplained medical sxs at admission and at 12 months |
| Principles of Management: | Acknowledge suffering and disability, don't suggest "it's all in your head" or trivialize. Reassure pt you are enagaged, focused on care, not cure. Ensure Regular Follow up |
| Principles of Managment Continued | Screen or physical and sexual abuse, tx mood or anxiety sx, encourage behavioral & lifestyle approaches (exerices, stress management, biofeedback), Minimize polypharmacy, change social dynamics that reinforce sxs, control negative rxns/countertransference |
| Experiential treatment of somatization | Decrease somatic sensations: biofeedback, pharmacology |
| Cognitive treatment of somatization | Reattribution of sensation-Distraction |
| Behavioral Treatment of somatization | Operant techniques to reduce medication consumption-Contract to save sxs for regular visit with PCP rather than visit ER |
Created by:
ltm12