Somatic Symptoms and related disorders
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| these disorders are physicla or somatic complaints unexplained by a medical condition. symptoms are not intentionally produced. because o fphysical symptoms presentation they often come to the attention of primary care docs, most have add mental symptom | Somatoform disorders
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| what must docs rule out when diagnosing a somatoform disorder? | occult physical illenss, other psychiatric disorders, and substance abuse
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| this disorder is characterized by one or more somatic symptoms that are distressing or result in significant disruption of daily life. XS thoughts, feelings or behaviors related to the somatic symptoms or assoc health concerns, | somatic symptoms disorder
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| to diagnose somatic symptom disorder, you need one or more of the following... | disproportionalte and persistent thoughts about the seriousness of one's symptoms, persistently high level of anxiety about health or symptoms, excessive time and energy devoted to these symptoms or health concerns.
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| in a somatic symptom disorder, how long do you typically need to have symptoms. does one specific somatic symptoms have to be continually present? | more than six months. No, you do not need one symptom continuously present, different symptoms can be persistent
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| what do you need to specify with somatic symptoms disorder? | if with predominant pain, persistent, severity
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| this illness describes preoccupation with having or acquiring a serious illness. somatic symptoms are not present or, if present, are only mild in intensity. if another medical condition is present or high risk, there is preoccupation is clearly XSive. | illness anxiety disorder
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| what does a person with illness anxiety disorder typically do? | individual performs excessive health related behaviors (ex: repeated self breast exams) or exhibits maladaptive avoidance (ex: avoids doc appt. and hospitals)
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| in illness anxiety disorder, how long does the illness preoccupation need to be present? | at least six months, but the specific illnes that is feared may change over that period of time. it is not better explained by another medical disorder. think: high health anxiety without somatic symptoms.
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| in this illness, there are one or more symptoms of altered voluntary motor or sensory function. clinical findings provide evidence of incompatibility between the symptoms and recognized neurological or medical conditions. | conversion disorder
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| what are symptoms that may be present in conversion disorder | clinically significant distress with: weakness or paralysis, abnormal movement, swallowing symptoms, speech symptoms, attacks or seizures, anesthesia or sensory loss, special sensory symptoms, mixed symptoms
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| what are some ways to manage conversion disorder? | it usually resolves spontaneoyusly, place emphasis on rehabilitation (ex: physical therapy), refer for counseling/psychotherapy to help manage stress, hypnosis, anxiolytics, relaxation exercises effective in some cases
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| what is the most important thing in managing a conversion disorder? | establish a relationship of trust between physicians and patient
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| when managing conversion disorder, what is the most important thing? | establish a relationship of trust between physician and patient
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| in somatoform disorders, is a real medical illness present? | YES!
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| how do psychological or behavioral problems adversely affect the course or outcome of the medical condition in somatoform disorders? | they affect the course of the illness by exacerbating the condition or causing delay in recovery, interfere with treatment, create additional health risks, influence the underlying pathophysiology, precipitation or exacerbating symptoms
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| what are psycholgical factors affecting a medical condition? | very commmon in acute and chron medicla setting, but often unrecognized, often a source of psychiatric consults in hospital, requires collaborative approach between psych, other fields of medicine and health profs, may respond to a variety of trmts
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| what is the main difference between factitious disorders and somatoform disorders? | the patient willingly and knowingly induces the symptoms. in somatoform disorders, the patient is unaware of the source of the symptoms.
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| This is a factitious disorder in which there is falsification of physical or psychological signs or sympptoms, or induction of injury or disease, associated with identified deception. person presents to others as will, impaired, or injured. | Munchausen syndrome
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| in munchausen syndrome, is the deceptive behavior evident? | yes, even in the absence of obvious external rewards. behavior is not better explained by another medical disorder. the factitious disorder can be imposed on another person as well.
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| what is the gain for the patient with munchausen syndorme? | psychological
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| what are some characteristics of someone with factitious disorder/ | the patient is often assoc with health care industry (knows diseases are supposed to present and has access to medications that can bring about symptoms mimicking distress.
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| with factitious disorder, what do you need to watch out for? | somebody with recurrent, unexplainable symptoms often despite close observation (ex: recurrent hypoglycemia form surreptitious insulin injections). can sometimes demand to be hospitalized and can be difficult to manage when confronted
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| how do you manage someone with factitious disorder? | trmt not usually very successful, in part because patients often terminate trmt relationships when contronted with dx. pts frequently move to different hospitals or clinics where they can satisfy need to be sick. a caring, nonjudgemental approach is criti
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| this is a disorder in which S&S of mental disorders are intentionally produced by the patient, they know they are doing it and why they are doing it, and want some sort of secondary materialistic gain (ex: disability, pain meds, money from lawsuit) | malingering disorder
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| is malingering disorder considered a mental illness | NO!
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| when making a diagnosis of malingering disorders, what else do you need to evaluate for? | somatoform disorders
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| how do people with malingering disorder often present? | they will often be men (and frequently inmates or with a prison history) who present with subjective complaints and will focus on the beenfits they may gain from a positive diagnosis (money, drugs, etc)
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| how do you manage someone with malingering disorder | suggested that you not confront patients wth this disorder in hopes that you can maintain their trust and be enabled to treat them for any actual disorder. mention how the objective evidence (xrays, bloodwork) do not match with story, document interaction
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