Somatic Symptom Disorders

Somatic Symptom Disorder

physical symptoms manifest in patient despite not having an underlying medical condition (out of proportion) and result in a disruption of daily life for more than 6 months
→pain related symptoms are the most common presentation
→symptoms cause excessive anxiety and stress to patient
→more common in females, comorbid depression, anxiety, fibromyalgia

Somatic Symptom Disorder

Psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause
- Always work-up new medical conditions as indicated but avoid unnecessary workups

Sx:
- Pain (joint aches, back pain)
- Constitutional Sx (fatigue, weakness)
- GI (nausea, diarrhea)
- GU (pelvic pain)
- Neuro sx (dizziness, weakenss)

Tx: Therapy (mainstay), antidepressants (TCA/SNRI), anti-anxiety meds

Illness Anxiety Disorder (Hypochondriasis)

Patients are worried about having a serious illness but have no symptoms or mild symptoms of disease
→ convinced that they have a serious medical condition

Subtypes:

1. Those that seek care frequently
2. Those that avoid medical care (scared of bad news)

Tx: Improve coping mechanisms
- Regular visits w/ same provider to give reassurance
- SSRIs + psychotherapy may help

Functional Neurological Symptom Disorder

A mental health condition in which symptoms manifest as neurological symptoms

Sx:
- Motor sx (muscle weakness, paralysis)
- Abnormal movement (tremors, jerk)
- Gait abnormalities
- Sensory sx (altered skin sensation, vision changes)
- Globus sensation (something stuck in throat feeling)
- Speech disturbances

Physical Exam:
- Look for inconsistencies in exam (change in gait, speech, phonation)

Dx:

1. One of more sx of altered voluntary motor or sensory function
2. Incompatibility between the sx and recognized neurologic finding
3. Deficit not better explained by another medical or mental disorder
4. Deficit causes clinically significant distress or impairment

Psychogenic Nonepileptic Seizures (PNES)

A sub-type of functional neurological symptom disorder specifically where symptoms manifest as seizures

PE:
- Persistent eye closure w/ resistance to opening
- Preserved awareness to world
- Lack of bowel/bladder incontinence
- Lack of post-ictal phase (no confusion after seizures)
- Duration of symptoms longer than 5 minutes

Tx:
- Education about illness
- Physical therapy/speech therapy/occupational therapy
- Psychotherapy (hypnosis)
- Tx underlying anxiety and depression

Factitious Disorder

patient manifests symptoms of an illness in the absence of an external reward

→ may enjoy the attention or sympathy from being sick and being the one who receives care

Dx: Deliberately faking symptoms for no additional external gain

When to suspect?
• Patient has an extensive, evasive, and changing medical history
• Symptoms rare, unusual, out of proportion to objective findings, or do not respond to expected treatment
• When one rare condition treated - another rare condition starts
• Patient has extensive evaluations with large number of consults, tests, procedures • Differentiate from illness anxiety disorder
• Patient is strongly opposed to seeing mental health provider

Malingering

patient manifests symptoms of an illness deliberately for external reward
→pain medicine, time off work, reduced jail time, money from a lawsuit, FMLA

abuse

Factitious disorder imposed on another person is ______
→PAs are mandatory reporters if someone is unable to advocate for themselves (children, elderly, disabled)