What is the most common unifying characteristic of Somatoform Disorders?
Medically Unexplained Physical Symptoms
What are problems that can arise with Somatoform Disorders?
- Physician Frustration at the patient
- Patient dissatisfaction at diagnosis and psychological distressors
- Increased rates of depression/anxiety due to unknown condition
- Increased visits to office/hospital and untilization
What is the condition in which there are physical somatic complaints that have been persistent for more than 6 months and the patient constantly thinks about them increasing anxiety over the symptoms, which have been unable to be explained.
Somatic Symptom Disorder
What are common features of Somatization Disorder patients?
- very dramatic when describing their symptoms
- medical history is inconsistent and disorganized throughout their PMHx with many diagnoses/meds without any specific etiologies for any of them
- increased hospitalizations/outpatient visits
- very long allergy list
What is most important when you are suspicious a patient has a somatoform disorder?
Make sure to rule out any/all other primary disorders that could be responsible for the symptoms, other than psychiatric FIRST.
What are the key factors that can tip a physician off that a disorder may be somatoform disorder?
- Involvement of Multiple Organ Systems
- Younger Age of onset without development of physical signs or structural abnormalities
- Absence of laboratory abnormalities
- Adamant they do not have a psychiatric disorder
What is the best treatment for patients with Somatization Disorder?
Cognitive-Behavioral Therapy
- Schedule frequent visits to the office and limit contacts outside of the office and ED visits
- Look for objective signs of disease, rather than believing the patient at face value
- No unnecessary testing
- Explain to patient stress can cause physical symptoms
Is Psychotherapy or Psychopharmacology useful in treating Somatiform Disorders? Why?
- Psychotherapy = NO, only behavioral
- Meds – They don’t believe its a psych disorder, so low complaince rate and discontinuation rate
How is conversion disorder different from Somatoform Symptom disorder?
– Conversion Disorder most typically has neurologic symptoms/sensory that is proceeded by an ACUTE STRESSOR
What are key findings that a patient might be experiencing Conversion Disorder?
- Acute Stressor
- La Belle Indifference – they are not concerned
- Symptoms are not consistent with anatomic knowledge and patients have inconsistent physical exam
What is the best treatment for Conversion disorder?
- Conservative Treatment with reassurance/PT
- Psychotherapy (talk through stressor)
- Amytal Interview - hypnosis
If a patient has had constant abuse and traumatic upbringing eventually developed weakness and resting tremor and doesn’t think anything of it. When he finally goes to get evaluated his is thought to have Conversion Disorder, what might be his prognosis?
Poor
- No clear stressor
- Delayed Treatment
- Tremor / Seizure Symptoms
When the best prognosis of Conversion Disorder?
- Clear Stressor
- Prompt Treatment
- Commonly - Paralysis, Aphonia, Blindness
If you see an older female patient in the office frequently due to her believing she has a disease she read about on the internet and is insistent she be tested and has the disease. She may or may not have any symptoms at the time, but she is very anxious over the potential disease, what might be going on?
Hypochondriasis
- Illness Anxiety Disorder
What are common characteristics of Hypochondriasis patients?
- Very attuned to their bodies and symptomology
- Starts having these delusions early adulthood
- chronically have the symptoms in mild intensities
- Does not respond to reassurance after appropriate medical work up
What are the best kinds of treatment for Hypochondriasis?
- Establish Trust, Identify Stessors, Educate Patient
- Behavioral Therapy
- SSRIs
If a patient constantly applies make-up to her nose, repeatedly checks in the bathroom throughout the day, but her husband does not understand what the problem is and hasnt’ for many years. What might be going on?
Body Dysmorphic Disorder
- A person has a markedly excessive feeling of ugliness of some aspect of their appearance despite normal appearance
What are the most common associations with Body Dysmorphic Syndrome?
- Major Depression
- Social Phobias
- Personality Disorder – Avoidant Disorder
How is the best way to treat Body Dysmorphic Syndrome?
- Do not cause harm by surgery
- SSRI
- Cognitive-Behavioral Therapy
What are the types of Deception Syndromes and how are they similar?
- Factious Disorder
- Malingering
Symptoms are INTENTIONALLY Produced by the patient
- Exaggerations / Lies
- Tampering with Tests to produce positive results
What are the major difference between Factious Disorder and Malingering?
- Factious Disorder has no external reward or tangible rewards for being the “sick patient” when Malingering has some kind of external goal the patient is working towards.
What is the key characteristc of Factious Disorder?
- The patients like the attention of playing the “sick” role and induce symptoms or behavior in order to get themselves hospitalized.
What are the subtypes of Factious Disorder?
- Munchausen Syndrome = most severe form
- Factitious Disorder by Proxy = produces symptoms in another person who is under their care.
- Ganser’s Syndrome = uses approximate answers
What do you need in order to diagnose Factious Disorder?
To rule out all other causes and true illnesses AND direct evidence of the patient causing the symptoms.
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Depression / Bipolar Disorders63
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Defense Mechanisms22
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Sleep Disorders32
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Somatic Disorders29
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Anxiety and Sleep Pharm41
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Pyschosis Drugs53
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Eating Disorders22
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Personality Disorders28
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Substance Abuse45
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Traumatic Brain Injuries17
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Neurodevelopmental Disorders34
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PTSD12
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Sexual Assault and Domestic Abuse26
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Schizophrenia and Bipolar17
