DSA24 - Somatic Symptom Disorders

Sensation or production of symptoms that are unexplained after medical work up

Define Somatization

Somatic Symptom Disorder

Define Condition:

1 or more somatic Sx that are distressing or result in significant disruption of daily life > 6 mo:

-Disproportionate and persistent thoughts about the seriousness of one's Sx

-Persistently high level of anxiety about health or Sx

-Excessive time and energy devoted to these Sx or health concerns

-Hx:

> More in FEMALES

> Lower SES

> Lower educational level

> Unemployment

-Tx: Utilize brief scheduled visits

> Teach pt better coping skills

> Establish baseline in case true issue arises later

•Panic disorder

•Depression

•Anxiety disorders

What are the DDx for Somatic Symptom Disorder?

Illness Anxiety Disorder

Define Condition:

Preoccupation with having or acquiring a serious illness for > 6 mo (but illness fear may change over time) - cannot be explained by another mental disorder

-Hx:

> Environmental STRESSORS

> Transient

-Sx: Somatic Sx either not present OR only mildly present

> Excessive health-related behaviors OR Maladaptive avoidance (HELP SEEKING VS HELP AVOIDING)

> If another condition present/high risk of developing --> Preoccupation EXCESSIVE or DISPROPORTIONATE

-Prog: If there is more psychiatric comorbidity and more medical comorbidity --> longer course of illness

-Adjustment Disorder

-Anxiety Disorders

-OCD

-Depression

-Psychotic Disorders

What are the DDx for Illness Anxiety Disorder?

Functional Neurological Symptom Disorder(Conversion disorder)

Define Condition:

1 or more Sx of altered voluntary motor or sensory function - not better explained by another medical or mental disorder

-Sx (Examples):

> Paralysis or weakness

> Abnormal movement (like tremors or gait issues)

> Loss of sensation (like numbness)

> Vision or hearing disturbances

> Non-epileptic seizures

-Hx:

> A/w Stress (esp Environmental) or Trauma

> Any stage of life

> Maladaptive personality traits

> x2-3 MC in FEMALES

-Dx: Incompatibility btwn the Sx and the recognition of neurological or medical conditions

-Tx: NEUROLEPTICS (Controversial, as 50% ALSO have neurological illness)

-Prog:

> RARE to recover from this

> Significant distress or impairment

•Neurological illness

•Dissociative disorders

•Depressive disorders

•Factious disorders

•Malingering

What are the DDx for Functional Neurological Symptom Disorder?

Psychological factors affecting other medical conditions (PFAMC)

Define Condition:

Medical Sx or Condition (other than mental disorder) present + Psych/behavior factors in Criterion B NOT better explained by another mental disorder

Affect in following ways:

•Factors interfere with the treatment of the medical condition

•The factors constitute addition of well-established health risks for the individual

•Factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention

•Factors have influenced the course of the medical condition as shown

> Close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the medical condition

Examples:

1. Asthma worsened by anxiety

A child with asthma has panic attacks, which trigger bronchospasm.

2. Poor diabetes control due to depression

Teen with Type 1 diabetes skips insulin due to low motivation and hopelessness.

3. Hypertension exacerbated by chronic stress

Family conflict or trauma leads to sustained high blood pressure.

4. Chronic pain worsened by catastrophic thinking

Pain becomes more disabling because of fear, rumination, or avoidance.

5. Nonadherence in epilepsy due to denial

Refusal to take anticonvulsants leads to recurrent seizures.

•Adjustment disorder

•Illness anxiety disorder

What are the DDx for PFAMC?

Factitious disorder imposed on SELF (fka Munchasen Syndrome)

Define Condition:

Falsification of physical or psychological signs and symptoms, or induction of injury or disease, associated with identified deception in which Individual presents himself, or herself to others as ill, impaired, or injured; NOT better explained by another mental disorder (i.e. delusional)

-Hx:

> Course of one of intermittent episodes

> EARLY Adulthood

-Signs/Sx: Deceptive behavior is evident even in the absence of obvious external rewards

-Tx:

> Psych Consultation

> NON-Threatening confrontation by primary physician/psychiatrist

Factitious Disorder Imposed on ANOTHER (fka Munchasen by Proxy Syndrome)

Define Condition:

Falsification of physical or psychological signs and symptoms, or induction of injury or disease, associated with identified deception in which Individual presents ANOTHER INDIVIDUAL (VICTIM) to others as ill, impaired, or injured; NOT better explained by another mental disorder (i.e. delusional)

-Hx:

> Course of one of intermittent episodes

> EARLY Adulthood

-Signs/Sx: Deceptive behavior is evident even in the absence of obvious external rewards

-Tx:

> LEGAL LIAISON (Victim Involved)

> Psych Consultation

> NON-Threatening confrontation by primary physician/psychiatrist

•Conversions disorder

•Borderline personality disorder

•Somatic symptom disorder

What are the DDx for Factitious Disorder?

Malingering

Define Condition:

Intentional CONSCIOUS MECHANISM of production of illness w/ CONSCIOUS MOTIVATION (by obvious external goal)

-Hx: (External Goals) Need for...

> Financial help

> Avoiding military

> Avoiding prosecution

> Obtaining Drugs

> Shelter

-Hx/Path:

> Antisocial PD

> Hx/records of multiple past episodes of injury

-Dx: MMPI (Minnesota Multiphasic Personality Inventory) or Clinical Multiaxial Inventory (MCMI) to evaluate validity of claims