Clinical Medicine I: Somatic Symptom and Dissociative Disorders (somatoform disorders)

Cause of somatic symptom disorder

No organic cause

Somatic symptom disorder (somatization)

chronic condition of physical complaints involving at least 1 organ system (or many) that cannot be explained by general medical condition or substance abuse

What are common symptoms that present in Somatic symptom disorder?

2 GI symptoms, 1 sexual or reproductive function, 1 pseudoneurological symptom

Goal of somatic symptom disorder

improve function

Treatment for somatic symptom disorder

regular (monthly) scheduled visits with same provider, let objective signs or symptoms guide invasive testing, stress reduction, psychotherapy

________ reported in 1 or more areas in somatic symptom disorder

pain

Are pain symptoms intentionally produced?

No

What would a history look like in a patient with somatic symptom disorder?

long history severe pain out of proportion to findings, long history of medical and surgical interventions

Illness Anxiety Disorder (hypochondriasis)

preoccupation with belief of having or fear of contracting a serious illness

characteristics of illness anxiety disorder (hypochondriasis)

no somatic complaints, lasts 6 months or more and impair functioning

Illness Anxiety Disorder is exacerbated by ________

stress

Treatment for illness anxiety disorder

psychotherapy, regularly scheduled appointments, treat comorbid anxiety and depressive disorders

Functional Neurological Symptom Disorder (conversion disorder)

one or more neurologic complaints (voluntary motor or sensory) that cannot be explained clinically

Are symptoms in Functional Neurological Symptom Disorder (conversion disorder) intentionally produced

No

What is most common in Functional Neurological Symptom Disorder (conversion disorder)?

shifting paralysis, blindness, mutism

What motor effects in Functional Neurological Symptom Disorder (conversion disorder)?

paralysis, involuntary movements, tics, blepharospasm, weakness, mutism

What other symptoms in Functional Neurological Symptom Disorder (conversion disorder)?

pseudoseizures, psychogenic vomiting, syncope

Symptoms in Functional Neurological Symptom Disorder (conversion disorder) can cause significant distress/impairment in ______

function (ADL)

What criteria diagnoses Functional Neurological Symptom Disorder (conversion disorder)?

symptoms are inconsistent with known medical or neurologic conditions- incompatibility

Functional Neurological Symptom Disorder (conversion disorder) treatment

patient education, early referral (full, complete, detailed neurological exam necessary), psychotherapy

Factitious Disorder

faking of medical or psychiatric signs and symptoms to assume sick role (primary gain)

Characteristics of patients with factitious disorder

want to be seen as sick or injured, not looking for external rewards, use deception

Malingering

deliberate production of physical or psychological symptoms motivated by external gain (secondary gain)

Is malingering a mental illness?

No

History of patients with malingering

vague poorly defined complaints that cause great distress and impair function, often shows self-inflicted injuries, multiple undiagnosed illnesses, lab results tampered with

Dissociative disorders

loss or impaired sense of self

Treatment for dissociative disorders

psychotherapy

What are dissociative disorders often associated with?

previous experience of trauma (childhood)

Types of dissociative disorders

dissociative identity disorder, depersonalization/derealization disorder, dissociative amnesia

dissociative identity disorder (former multiple personality disorder)

alternation of two or more distinct personality states that take control of behavior

depersonalization/derealization disorder

periods of detachment from self or surrounding which may be experienced as "unreal" while retaining awareness that this is only a feeling and not a reality

dissociative amnesia

inability to recall personal information secondary to a traumatic event, dissociative fugue

dissociative fugue

change in geographical location with loss of identity and inability to recall past