MH&W exam 2 - Somatic sxs and related d/o

pt disproportionally frustrates providers taking care of them bc they dont recognize that the pt is

what dz is where a person feels extreme exaggerated anxiety about a physical sx wrong with them that affects their daily life. one or more sx that results in significant disruption of daily life. can be constant thoughts about how serious their sx is, persistent anxiety about health or sx, a lot of time and energy used for these concerns. sx are fluid where they might have one illness at a time

somatic sx d/o

used to be called conversion disorder. causes neuro sx w/o a real problem in the NS, usually caused by stress. pt has altered voluntary motor or sensory function, sxs not better explained by another medical/mental d/o, causes significant distress in social and job life. usually in women. follows trauma and can be used to cope w stress. learned behavior. instead of pts saying they’re stressed they have pseudo seizures instead.

functional neurologic sx d/o

pt has a dysfunction of voluntary motor or sensory sx, causing problems like pseudo seizures, vocal cord dysfunction, blindness, tunnel vision, deaf anesthesia/paralysis. these pts are depressed or anxious about their sx. their sx usually go away after some time. pseudoneurologic.

functional neurologic sx d/o

pt comes in complaining of having seizures when they never had a hx of it. they’re worried about it and it bothers theri social and job life. you hook them up to and EEG and when they seize you notice that the EEG remains normal. you also observe that most of the sx are on the pts non dominant side. their sx eventually remit spontaneously. this is suggestive of what dz

functional neurologic sx d/o

how to tx functional neurologic sx d/o

spontaneous relief of sx. if chronic is being reinforced by environmental factors. insight oriented psychotherapy can be good but not as good for chronic sx.. those need behavioral mods like behavioral therapy. can also do hypnosis or amobarbital or lorazepam interview that creates altered state of consciousness which is good to look at underlying cause of dz. environmental manipulation can produce sx relief, represents underlying physical/sexual abuse

pt thinks that they have a serious/life threatening illness with few or no sx. sx mild or not present. pt is really preoccupied with the potential of having a fhx condition. pt has excessive health related behaviors like constantly checking for signs of illness, or maladaptive avoidance where they avoid appts. they’re preoccupied with illness for >/= 6mo, where the illness feared can change over time. onset young adulthood. transient hypochondriasis after an acute illness. can be learned from fam.

Illness anxiety disorder

criteria to dx illness anxiety disorder

excessive health related d/o, maladaptive avoidance, worried about these things for >6mo.

pt has fear and concern about disease instead of dramatic sx. misinterprets bodily sensations. relates sx in obsessively detailed manner, pts keep their won medical records, books they reference. sx come and go, usually apparent around job or personal stress. 

illness anxiety disorder

how to tx illness anxiety disorder

work up each complaint appropriately. some pts take referral to psychiatry, some don’t and destroy the rapport with their PCP. some say SSRIs help. CBT, group therapy works.

is insight oriented psychotherapy good for illness anxiety d/o

no bc they are alexithymic (can’t express feelings in words).

if i have illness anxiety d/o and depression, anxiety, ro OCD how do i tx pt

using low dosages bc pts are prone to side effects.

complications of illness anxiety d/o

needless expenses from taking a bunch of meds. iatrogenic complications can happen from invasive procedures. most pts won’t be cured

pt has unexplained physical sx accompanied with urgency. nonspecific complaints like pain, weak, SOB that cause inc distress and functional problems. these pts aren’t properly diagnosed bc they go “doctor shopping”. pts come from unstable homes and use this dz as a way to cope. numerous invasive diagnostic or tx procedures. multisystemic sx like chronic pelvic pain, atypical facial pain, or nonspecific like dizziness.

somatic sx d/o

how to dx somatic sx d/o

fashionable dx like fibromyalgia, dysautonomia, chronic fatigue syndrome, total allergy syndrome. have one or more axis I psych diagnoses and meet criteria for one personality d/o

how to tx somatic sx d/o

unlikely to seek psych care. management falls on PCP. group experiences, supportive insight.

how to manage somatic sx d/o

schedule freq appointments, don’t say its in their head, do tx procedures if objective signs are present. prescribe meds and give medical care

complications of somatic sx do

iatrogenic complications like peritoneal adhesions from multiple abdominal operations. be cautious when giving lethal meds bc these pts can lash out and have suicidal tendencies. no evidence of dec longevity, seems like a mental d/o rather than physical

pt can’t top thinking about defects in their appearance pt feels anxious about social interactions bc of it. these flaws aren’t visible of are slight to others. they have repetitive behaviors like constantly check their appearance and seek confirmation from others. also do mental acts like comparing themselves to others

body dysmorphic disorder

pt visits doctors multiple times seeking tx, esp surgical intervention to correct defects that normal people can’t see. spend a lot of time in repetitive behaviors to improve or hide defects. includes attempts to camouflage defect like in excessive grooming. little insight into their condition. extreme situations = complete social withdrawal and hi suicide risk. many consults from derms and plastic surgeons to fix this non existent problem. this d/o is

body dysmorphic

how to tx bdd

SSRI first choice. off label use tho. pts sx improve if they have delusional intensity. CBT does cognitive restructuring and exposure and response prevention. do NOT tx w surgery makes d/o worse.

complications of bdd

inc of suicide and psychosis. pts usually unhappy with their results and want more