Somatoform+Disorders

=Reading= Andreason, 25pp =Goals=

1. Define somatization
A chronic syndrome in which thepatient has frequent medical complaints

2. Recgnize, compare and contrast: Somatization disorder, conversiond isorder, hypochondirasis, pain disorder, and body dysmorphi disorder; recognize each from a vignette
Somatization disorder: many clinical visits Conversion Disorder: Psychological problem turns into hysterical paralysis, etc hypochondriasis: lengthy worrying about some disease, such as HIV, AIDs, etc etc Body Dysmorphic Disorder: Incorrect belief that body is flawed

5. Know the difference between factitious disorder and malingering
Define term: conscious or unconscious process by which person uses body or body symptoms for psych purposes or personal gain go to specialist for system

5 somatoform disorders, facittious, malingering

Somatization Disorder
diffusely positive review of symptoms often women formerly caused 'hysteria' prevalence 1-2% women 20:1 female to male 5-10% of all ambulatory primary care pts familial pattern low socioeconomic factors medical expenses 9x higher than average pt etiology unknown genetic and environmental facotrs suggested theories; psychosocial, behavioral, biological--attentive, cognitive differences

DSM-IV criteria somatoform disorder, lots of symptoms, young women

psychological distress interpersonal problems alchohol or substance abuse often coexists 'good actresses' depresion,a nxiety, personality disorders dramatic presentation, poor hisotrians

diff diagnosis: real medical disorders > SLE, Multiple Sclerosis factitious disorder > patient knows symptoms are faked other psychiatric disorder > schizophernia

course, prognosis: chornic increased in times of stress prognosis is poor, cure unlikely goal is to minimize damage

Conversion Disorder a disorder characterized by neurlogical symptoms that cannot be explained by jknown neurologic or medical disorder psycholgoical factors must be associated with the symptoms

anuyal incidence 22/100000

more common in rural populations those with little education lower soceoeconomic groups medically unsophisticated

example: spousal abuse starts right before kids get home when husband gets home, has to lie down dealt with by getting dizzy

example: low functioning adult move in with boyfriend against parents will didn't want to lose face to move in with parents became paralyzed from legs down strength testing, reflexes

etiology: psychoanalytic theory biological factors

Symptoms: sensory, motor, special senses, seizures,mixed

primary or secondary gain secondary gain--get out of jail--physical difference primary gain--psychological gain

syumptoms may be unconsciously modeled symptoms often not meidcally accurate

Diff Diagnosis Medical with neurological disease...25-50& intilallayy thougth to have conversion disorder are eventually found to have real disease--MS, SLE other somatoform disrodres factitous disorder, malingering

in 90% of cases suymptoms resolve ina few days or less than a month ofte with suggestion

25% have a recurrence at some point sometimes can, sometimes can't

longer last, worse prognosis pt...hysterical or conversion blindness lots of psych issues chronically unable to see nothing wrong with eyes walks around object in path seeing eye dog went blind

Pain Disorder pain is very subjective sy drome in which pt has pain in one or many places not fully explained disruptive, causes to seek care very similar to somatization,etc

fibromyalgia may also be connected best handled in multidisc pt

hypochondriasis pt inaccurate interpretation of phys suymptoms or sensatiosn lead sto preoccupation and fear that hhe or she ahs a serious illness, even thogh no medical evidence of illness can be found

4-6% general pts men: women 1 to 1 usual age of onset is 20s to 40s

onset 20s-40s,50s amplify sumptoms learned behavior symptom of another psych disorder sychodymnamic theory: deserved punishment/guilt response

specific disease are feared--cancer disease can shif tfrom one fear to another multiple medical opinions sought, hate MDs

high risk of complications, form diagnosit cor therapeutic procedures often comorbid with depression and anxiety disorders

diff diag other somatoform disroders medical illness facittious disorder or malingering if for the first time, after 50, suspect depression

Body dysmophic disorder preoccupied with a body defect that is either totally imagined or is a greatly exaggerated sitortion of a true, but minor effect or belief body has funny smell

NEED TO KNOW:: NEED TO KNOW HANDOUT what to do to manage disorders? care rather than cure don't eliminatesymptoms focus on coping strategies establish one physician establish regular brief but frequent visits establish an empathetic relationship to minimize doctor-shopping 'whydon't you come in every 2 weeks'

no medication may treat comorbidities don't overmeidcate minimize all tests...reduce expense, complications review old records before ordering tests consider benign remedies

minimize medical diagnostic tests, but realize can really get sick

Factitious Disorder Do bizarre things to self...need to be a patient put something so always have blood in urine inject feces in joints woman got admitted said she ahd barter's syndrome...low potassium K 1.9 put in ICU couldn't get potassium up brother says, horrible lyers look at lasix taking lasix to make K low... intentionally produces illness motivateion is unconsicous, not easily controlled unknow prevalence prequent medical background occurs in women more than men psychodynamic theors hosptial seeking difficultiy reognizing self-boundaries seeking painful procedures symptoms physical, ppsychological, both may occur by proxy: a aparent simulates illness in child usually parent to child
 * are aware they are doing it**

Diff Diagnosis: medical isllness somatoform disoder malingering onset in early adulthood, often after loss increase frequency of epsidodse opoor prognosis incapacitation results from own illness, complications

Treatment: reognicze verify past medical history minimize procedures one primary physician deal with own anger...'coutnertransference'

Malingering know why doing it, what doing watch guy take tylenol problem with blood pressure pops nitroglycerin...chest pain....gets admission...rule out from MI...keep cold got a job at salvation army....

somatoform disorders mechanism is conscious doing something for secondary gain
 * Diagnosis || Diagnostic Features || Epidemiology || Prognosis || Mechanism of Illness Production || Motivation for Illness Behavior ||
 * Somatization Disorder || *multiple symptoms/complaints which are recurrent and chronic * Diffusely positive Review of Systems * Sickly by histry * multiple clinical contacts * ultiple surgeries and tests || * Onset at young age * 20x more females * Familial Pattern * 5-10% incidence in family care settings || Poor to fair || Unconcious || Unconscious ||
 * Conversion Disorder || * Single symptom, incompatible with known disease *mostly acute * Neurological Disease * Sensory * motor * seizures * mxed || * Young onset * Female > ale * rural, lower S-E class * less educated and sophisticated || Excellent, except if chronic || Unconscious || Unconscious ||
 * Hypochondriasis || * innacurate interpretation of physical symptoms, sensations * disease concern or preoccupation * 80% dependent or anxious * often complain about care * seek multiple opinions || * Middl to old age * Equal males & Females * Previous physical dz * 4-6% prevalence || Fair to good; Waxes & wanes 50-65% recover || Unconscious || Unconscious ||
 * Body Dysmorphic Disorder || * Subjective feelings of ugliness or concern with body defect || Adolecence or young adult || Unknown || Unconscious || Unconscious ||
 * Pain Disorder || * Pain simulation or pain intensity incompatalie with known physiology/anaotomy * Co-morbid substance abuse || Females 2:1 leas Older onset: 40s, 50s, famillial pattern up to 40% chronci pain pts || Guarded/variable || Unconscious || Unconscious ||
 * Factitious Disorder || * feigned illness with no obvious external goal or gaines * Multiple hospitalizations || Fenale > male * yonger * socially conforming * employed in medicalfield || Poor prognosis; chronic || Conscious || Unconscious ||
 * Malingering || * Feigned or simulated illness with physicalor psychologcal symtpoms * frequently leavea against medical advice || ?Males>Females * Antisocial tendencies || N/A || Conscious || Conscious ||