Term
| What are the 6 somatoform disorders according to the DSM-IV? |
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Definition
All start in adolescence, with bias towards females (except hypochondriasis), with high psychiatric and GMC co-morbidity. They present in "waxing waning" form.
1) Conversion
2) Hypochondriasis
3) Body Dysmorphic Disorder
4) Pain Disorder
5) Somatization
6) Undifferentiated Somatoform |
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Term
A 20 year old female patient presents to your office exhibits sudden blindness, and inability to move their left arm. However, they don't seem to care.
Strangely, after 2 months her symptoms disappear, despite no changes in treatment.
What are the 6 main favorable prognostic signs associated with this disorder? |
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Definition
Conversion Disorder (unexplained motor/sensory symptoms with "la belle indifference" that spontaneously remits within 1 year)
1) Acute onset
2) Clear precipitant
3) Early treatment
4) Intelligence
5) Good social environment
6) Lack of co-morbidity |
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Term
A patient comes into your office 3 times per week complaining that she feels like she has a brain tumor. Despite reassurance from her family, she is always worried.
What is the prevalence of this condition? |
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Definition
Hypochondriasis
10% of primary care visits with MALE PREDOMINANCE |
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Term
A patient comes into your office frequently complaining adamantly that their cheek looks hideous and is unresponsive to any sort of reassurance.
What is going on, what is this condition related to and how could you treat? |
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Definition
Probably Body Dysmorphic Disorder
- Related to OCD (compulsive rituals to manage anxiety related to pre-occupation)
- Exposure and response prevention works well and/or SSRI |
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Term
A 25 year old women presents to your office complaining of pain in her hands, feet, neck and back. She is nauseous and has been having painless diarrhea. She also explains a lack of sexual drive and difficulty focusing on tasks during the day.
Despite your efforts, you cannot find medical evidence for these symptoms
What are the 2 major Etiological explanations of this condition? |
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Definition
This is Somatization Disorder
1) Amplification of bodily sensations with altered cognitive interpretation of physical sensations.
2) Need for Sick Role (cultural pressures)
**Also biological, psychological and social theories**
**Diagnostic Criteria**
1) Onset <30 with symptoms lasting years and decline in function.
2) Symptoms
- Pain (4 sites)
- GI (2 non-pain)
- Sexual (1 non-pain)
- Neuro (1 non-pain)
3) No adequate medical explanations |
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Term
A 25 year old women presents to your office complaining of pain in her hands, feet, neck and back. She is nauseous and has been having painless diarrhea. She also explains a lack of sexual drive and difficulty focusing on tasks during the day.
Despite your efforts, you cannot find medical evidence for these symptoms
what are the "Primary and Secondary Gain" associated with this condition and what significant co-morbidities should you be aware of? |
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Definition
"Gains" are reasons why patient might be presenting with the somatization.
1) Primary Gain has internal benefits by lowering awareness of or anxiety about a problem
2) Secondary Gain has external benefits by lowering responsibility and garnering care and support from others
- Histrionic Personality disorder is a common co-morbid condition |
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Term
| How can you distinguish Somatoform disorders from Factitious and Malingering conditions? |
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Definition
1) Somatoform will have an "unconscious mechanism" and an "unconscious motivation"
2) Factitious ( Münchausen syndrome ) folks will be conscious of the mechanism, but not of their motivation
3) Malingering folks will be conscious of both the mechanism and the motivation |
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Term
| What are the significant co-morbidities associated with Somatoform disorders? |
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Definition
"Somatoform" disease does NOT rule out presence of real disease.
1) PD
2) Depression
3) Anxiety
4) Addiction
5) GM/Neuro |
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Term
| What is a good way to approach treatment of Somatoform disorders? |
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Definition
1) Summarize presenting signs/sx
2) Good news ("nothing serious")
3) Bad news ("we can't tell you exactly")
4) Not crazy
5) Power of suggestion ("you may get better through your effort!")
**Shift focus from body to person!** |
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Term
| What are the 2 most common Somatoform disorders? |
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Definition
1) Hypochondriasis (bias in men) is 3-13%
2) Pain d/o is 10-15% |
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Term
Which statement accurately describes the difference between factitious disorder and malingering?
a) in malingering, symptoms are consciously produced and motivated, while in factitious disorder, symptoms are unconsciously produced and motivated
b) in malingering, symptoms are consciously produced and unconsciously motivated, while in factitious disorder, symptoms are unconsciously produced and consciously motivated
c) in malingering, symptoms are consciously produced and motivated, while in factitious disorder, symptoms are consciously produced and unconsciously motivated
d) in malingering, symptoms are unconsciously produced and consciously motivated, while in factitious disorder, symptoms are unconsciously produced and consciously motivated |
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Definition
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Term
A patient comes to your office after an argument with his wife, complaining of sudden onset paralysis of his right arm. His physical exam is unremarkable, including normal muscle tone, and nerve conduction studies are normal. The most likely diagnosis is:
a. conversion disorder
b. somatization disorder
c. body dysmorphic disorder
d. hypochondriasis |
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Definition
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Term
All of the following conditions are more likely to be seen in women EXCEPT:
a) Conversion
b) Somatization
c) Hypochondriasis
d) Pain disorder |
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Definition
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Term
Which statement would be the BEST way to tell a patient you think they have a somatoform disorder:
a) “There’s nothing physically wrong with you, so I think you should see a psychiatrist.”
b) “I’m pleased there’s nothing seriously wrong with you, but I know you’re experiencing considerable discomfort. So I want to follow you carefully and see you in two weeks.”
c) “At this point, I can’t tell if it’s all psychological or if the symptoms are real. But I want to help figure it out with you, so let’s just do a couple of more tests.”
d) “I think you have somatization disorder.” |
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Definition
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Term
Probably the most widely accepted theory to explain hypochondriasis and other somatoform disorders says that these patients have an alternative and dysfunctional cognitive schema which results in negative misinterpretations of physical sensations. The name of this theory is:
a) Amplification
b) Sick role need
c) Hysterical identification
d) Neurodevelopmental model |
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Definition
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Term
Your patient with pain disorder presents complaining of new-onset lower back pain. In general, your best response would be to:
a) Ask about personal or social problems that might be present, perform a brief physical exam and prescribe analgesics if needed.
b) Perform a full physical exam, order spine films, and send the patient for a course of physical therapy
c) Prescribe a non-steroidal anti-inflammatory and refer patient to an orthopedic surgeon for further management
d) Reassure the patient that ‘this will pass’ and schedule a follow-up appointment for next month. |
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Definition
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