Somatic Symptom

Question 1

What is a somatoform disorder?

Answer 1

The somatoform disorders are a group of problems characterized by persistent bodily symptoms or concerns that cannot be fully accounted for by a diagnosable disease

Question 2

What are the major criteria for somatic symptom disorder?

Answer 2

• Distressing symptom(s)
• Excessive thoughts/feelings/behaviors in response
  
  • Lasts at least 6 MONTHS
• Whether the symptoms are medically unexplained symptoms is irrelevant

Question 3

What are the characteristics of illness anxiety disorder (hypochondriasis)?

Answer 3

• Patient is preoccupied with having/getting an illness
• High level of anxiety about the illness, excessive behaviors or maladaptive avoidance
  
  • Lasts at least 6 MONTHS
• Not better explained by another disorder

Question 4

What are the characteristics of conversion disorder?

[ Functional neurological symptom disorder]

Answer 4

• Requires a medically unexplained symptom
• One or more symptoms of altered voluntary motor or sensory function
  
  • ie non-epileptic seizures, conversion blindness, paralysis
• Evidence of INCOMPATABILITY between the symptom and recognized conditions.
  
  • Splitting the midline, Hoover’s sign, arm drop, vEEG

Question 5

What is the impact of psychological factors and pre-existing medical conditions?

Answer 5

Psychological factors cause/exacerbate/prolong the condition, or interfere with treatment, or are well-established risks

Question 6

What are the characteristics of factitious disorder?

Answer 6

1) Falsifying or causing symptoms, and lying about it (intentional)
2) Presents for medical attention.
3) No obvious external rewards (i.e. court date, disability $$).
4) Can also be “by proxy” (i.e. mother for child)

Question 7

What are the characteristics of Malingering?

Answer 7

• Not a psychiatric diagnosis
• Intentional production of signs or symptoms FOR EXTERNAL REWARD
• Antisocial Personality Disorder a risk factor

Question 8

Define pseudo-malingering.

Answer 8

Pretending to have a disease that one eventually discovers one has

Question 9

What are treatments are available for somatic symptom disorder/ illness anxiety disorder?

Answer 9

1) Comorbid disorders
2) Consistent care with single physician
- Regular, brief, supportive visits; perhaps education; minimize unnecessary testing
3) Consultation letter from psychiatrist to physician reduced health care costs
4) Psychoeducational group
5) 5-10% recovery rate for psychodynamic psychotherapy
6) CBT

Question 10

What are pharmacologic treatments for somatic symptom disorder/illness anxiety disorder?

Answer 10

1) Nefazodone
2) St. John’s Wort
3) Gabapentin

Question 11

What are the treatments for conversion disorder?

Answer 11

1) Appropriate medical work up (to rule out)
2) Confrontation
3) Suggestion
4) Hypnosis
5) Amytal (truth serum) interview
* Naturally recovers in 90%

Question 12

What treatment is available for factitious disorder?

Answer 12

No good treatment

• Can provide face-saving alternative
  
  • Oone interesting approach is to double-bind the patient: “You may have physical illness or factitious illness; if the former it will improve with this treatment.”