Term
| refers to the experience and reporting of physical symptoms that cause distress, but lack a corresponding level of tissue damage or pathology and are linked to psychosocial stress. |
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Definition
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Term
| means by which the unconscious mental conflicts could be manifested in the form of physical symptoms. |
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Definition
| Psychogenesis – somatization |
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Term
Abuse or emotional deprivation in childhood
Adult acute personal turmoil often involving abandonment and/or increased responsibilities
Societal roles
Learned behavior (people who are passive)
Secondary gain
Cultural factors
Seeking redress for a perceived wrong
Personality factors (particularly histrionic, narcissistic, and borderline personality traits) |
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Definition
| Contributing Factors for Somatization |
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Term
Defective or deficient processing of sensory and emotional information
Consequence of deficient central inhibition of incoming sensory information or impaired right to left hemispheric communication |
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Definition
Neurobiological
Etiology of somatization |
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Term
Somatoform arises solely from the mind, representing the outward expression of underlying, internal psychological conflicts
Higher rates of prior emotional and physical abuse, depression, and anxiety than non-affected populations
Have a need for nurturing and support in which they often receive from the medical community |
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Definition
Psychodynamic
Etiology of somatization |
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Term
Reinforced by individual environment such as other’s response to patient’s experience
Desirable responses by family, disability payments, or medical care which are brought about by and reinforce patient’s medical complaints |
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Definition
Cognitive-Behavioral
Etiology of somatization |
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Term
Individuals learn to express disease and distress in accordance with what their culture or environment accepts
Cultural interaction between clinician and patient is very important, often determines how the patient’s somatic complaints represent cultural language of emotional distress
Mistakes in this interpretation can lead to misdiagnosis and unnecessary treatment and testing.
Learn from their culture the “correct” behavior for dealing with emotions |
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Definition
Sociocultural
Etiology of somatization |
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Term
Undifferentiated somatoform disorder
Conversion disorder (person goes blind when they see something they don’t want to see)
Pain disorder with psychological factors
Hypochondriasis
Body Dysmorphic Disorder
Somatoform Disorder Not Otherwise Specified |
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Definition
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Term
| disorder that begins before age 30 years, extends over a period of years, and is characterized by a combination of pain, gastrointestinal, sexual and pseudoneurologic symptoms |
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Definition
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Term
| Unexplained physical complaints, lasting at least 6 months, that are below the threshold for a diagnosis of somatization disrder |
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Definition
| Undifferentiated Somatoform Disorder |
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Term
| Unexplained symptoms of deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition. Psychological factors are considered to associated with the symptoms or deficits |
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Definition
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Term
| Pain as the predominant focus of clinical attention. In addition, psychological factors are considered to have an important role in its onset, severity, exacerbation, or maintenance |
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Definition
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Term
| Preoccupation with the fear of having, or the idea that one has, a serious disease, based on the person’s misinterpretation of bodily symptoms or bodily functions |
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Definition
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Term
| Preoccupation with an imagined or exaggerated defect in physical appearance |
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Definition
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Term
Feigning or grossly exaggerating illness or disability to derive benefit or secondary gain
e.g., to escape work, gain compensation, or obtain drugs |
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Definition
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Term
| a liar who is trying to cheat the system. |
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Definition
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Term
Ongoing litigation
Significant discrepancy between subjective disability and objective findings
Lack of cooperation with the evaluation and with treatment
The presence of antisocial personality disorder
Behavior is commonly marked by a history of unlawful behavior, aggressive behavior, deceitful behavior, consistent irresponsibility, and lack of remorse for wrongdoing |
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Definition
| Risk Factors for Malingering |
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Term
| Patients who want to occupy the sick role consciously fabricate symptoms to attract the attention of the doctor |
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Definition
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Term
| Most persistent and severe form of factitious disorder: |
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Definition
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Term
Tenderness (Superficial and Non-anatomic)
Simulation (axial loading and simulated rotation)
Distraction (Distracted straight leg raise)
Regional disturbances (Regional sensory & Regional weakness)
Overreaction |
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Definition
Waddell Behavior Signs
(3 or more is positive finding) |
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Term
| Physical back pain does not |
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Definition
| make the skin tender to light touch |
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Term
| Pressure on the top of the head (axial loading) or a standing patient should not |
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Definition
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Term
| When the shoulders and pelvis are rotated in unison (simulated rotation) the structures in the back |
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Definition
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Term
Regional, sudden, or uneven weakness
Cog wheeling, giving way, breakaway |
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Definition
| Nonorganic behavioral signs |
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Term
| Patient is hypersensitive to light touch at one point during examination but later gives no response to touching of the same area |
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Definition
| Positive sign of overreaction |
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Term
Aid clinical assessment by separation of the organic and nonorganic elements of the presentation
Direct appropriate resources toward the physical pathology
Identify illness behavior
Reduce or eliminate unnecessary procedures, diagnostic studies and therapies |
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Definition
| Original Purpose of Waddell behavioral signs |
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Term
| The presence of these behavior signs does not contradict organic findings |
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Definition
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Term
| Behavior signs can occur in the presence of organic pathology |
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Definition
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Term
Multiple false positives were found in the elderly patients
It was recommended that such patients should be fully evaluated |
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Definition
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Term
| suggest that the patient does not have a straightforward physical problem and that psychological factors need to be considered |
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Definition
| Multiple behavioral signs |
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Term
Man Kopf's test
O’Donoghue’s maneuver
Flexed – hip test
Hoover’s test
Burn’s bench test |
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Definition
| Physical Exams for Nonorganic Back Pain |
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Term
Based on the fact that pain raises the pulse rate
Palpation of a painful area should increase the pulse rate by 5% or more
Absence of this finding is a positive behavioral sign |
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Definition
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Term
In patients with true physiologic pain, passive range of motion is greater than active range
If the patient’s active range of motion is greater, it is a positive behavioral sign |
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Definition
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Term
On a supine patient, place one hand under the lumbar spine
Palpate L5-S1 spinous processes
Maintain contact with L5-S1 while passively flexing the knee to 90° |
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Definition
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Term
Ask the patient to kneel on a chair and touch the floor
Because the knees are bent, patients with true back pain or sciatica should be able to do the test without much difficulty
Those with nonorganic back pain usually cannot |
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Definition
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Term
Cognitive-behavioral treatment
Relaxation training
Psychotherapy (both group and family) |
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Definition
| Psychological treatment approaches used to treat somatization |
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Term
Chronic Fatigue Syndrome (CFS)
Fibromyalgia (FM)
Irritable Bowel Syndrome (IBS)
Chronic Pelvic Pain (CPP) |
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Definition
| conditions are found to be more common in women and often times exacerbated by psychosocial stressors |
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Term
Worsening of symptoms
Increase in the number of symptoms
Lower threshold for pain
Increased utilization of health care
Increased degree of disability |
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Definition
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Term
| Higher likelihood of having current and lifetime episodes of psychiatric disorders – particularly anxiety, panic, and depression |
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Definition
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Term
| is a common complaint among women (~21-33%) |
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Definition
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Term
| occurs in young to middle-aged women and is characterized by persistent or relapsing fatigue |
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Definition
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Term
Self-reported impairment in short-term memory or concentration
Sore throat
Tender cervical or axillary nodes
Muscle pain
Multijoint pain without redness or swelling
Headaches of a new pattern or severity
Unrefreshing sleep
Postexertional malaise lasting 24 or more hours |
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Definition
| CDC criteria for chronic fatigue syndrome |
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Term
Characterized by chronic and diffuse pain
Between ages of 30 and 55
Exact cause and pathology unknown
Precipitating illness or exposure to certain stressors such as trauma and emotional distress is know to trigger FM
Usually not diagnosed until 5-7 years after onset of symptoms |
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Definition
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Term
Symptoms
Widespread chronic pain with absence of inflammation
Fatigue
Disturbances in sleep
Stiffness
Dizziness
Palpitations
Paresthesias
Vulvodynia
Night sweats
Weakness
“Allergy” symptoms |
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Definition
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Term
Exertion
Stress
Inadequate sleep
Weather changes
Psychosocial stressors |
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Definition
| Factors that trigger Fibromyalgia |
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Term
Systemic lupus erythematous (SLE)
Rheumatoid arthritis
Osteoarthritis
Raynaud’s phenomenon
CFS
Migraine headaches
IBS
CPP
Premenstrual disorders |
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Definition
| Coexistence of Fibromyalgia with other medical disorders |
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Term
Polymyalgia rheumatica
SLE
Lyme’s disease
Autoimmune disorders
Hypothyroidism |
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Definition
| Disorders most likely to be confused with FM |
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Term
Occiput
Trapezius
Supraspinatus
Gluteal
Greater trochanter
Low cervical
Second rib
Lateral epicondyle
Knee |
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Definition
| Trigger point diagnosis for Fibromyalgia (Increase in number of tender points has been associated with worsening depression, fatigue, and anxiety, and a higher number of somatic complaints) |
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Term
Tricyclic antidepressants
Low dose amitriptyline and cyclobenzaprine at bedtime improve pain, global well being and sleep related problems
Some improvement with used of cardiovascular fitness training, cognitive-behavioral therapy, biofeedback, hypnotherapy, and acupuncture |
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Definition
| Treatment for Fibromyalgia |
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Term
Chronic abdominal pain and altered bowel habits in the absence of an organic cause
Female to male 2:1 predominance
Cause unknown
Disorder of gastrointestinal motility and increased visceral sensitivity of the gut |
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Definition
| Irritable Bowel Syndrome (IBS) |
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Term
| Patients usually experience more stressful life experiences and psychosocial stressors have been shown to both precipitate and exacerbate symptoms. |
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Definition
| Irritable Bowel Syndrome (IBS) |
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Term
| Patients with more severe forms report history of sexual physical abuse, major loss of a loved one or divorce, or exposure to major trauma |
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Definition
| Irritable Bowel Syndrome (IBS) |
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Term
Alternate between constipation and diarrhea
Abdominal pain – cramping sensation varying in intensity and frequency and is often precipitated by meals and relieved with defecation
Dysphagia
Dyspepsia
Nausea
Vomiting
Acid reflux
Sexual dysfunction
Dyspareunia
Dysmenorrhea
Urinary frequency
Urinary urgency |
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Definition
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Term
FM
CFS
Chronic pain syndromes
Depression
Anxiety
Panic attacks |
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Definition
Coexistence other medical disorders
and IBS |
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Term
| Diagnosis made through patient’s history and normal physical examination |
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Definition
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Term
| Gastrointestinal bleeding, fever, anorexia, weight loss, malnutrition, progressive pain, and pain that awakens the patient or interferes with the patient’s sleep |
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Definition
| Symptoms requiring further evaluation in IBS |
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Term
| Mild disease – requires education and reassurance and over the counter medications occasionally |
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Definition
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Term
| Psychological treatment including dynamic psychotherapy, cognitive-behavioral treatment, hypnosis, relaxation and biofeedback have been show to be effective for diarrhea and abdominal pain but not constipation |
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Definition
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Term
Persistent pain in the pelvis for greater than 6 months.
Other symptoms:
Headache, low back pain, dizziness, shortness of breath, fatigue and weakness |
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Definition
| Chronic Pelvic Pain (CPP) |
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Term
| depression, anxiety, somatization disorders, sexual dysfunction and substance abuse |
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Definition
| Coexisting disorders with Chronic Pelvic Pain |
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Term
Do you make yourself Sick because you feel uncomfortably full
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone (fourteen pounds) in a three month period?
Do you believe yourself to be Fat when others say you are too thin?
Would you say Food dominates your life? |
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Definition
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Term
| Yes to any answer on the SCOFF = 1 and score of 2 is highly predictive of |
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Definition
| anorexia nervosa or bulimia nervosa |
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Term
| Sick, Control, One (stone), Fat, & Food |
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Definition
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Term
| Cyclic occurrences of a variety of somatic, affective and behavioral symptoms |
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Definition
| Premenstrual Syndrome and Premenstrual Dysphoric Disorder |
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Term
| Symptoms: fatigue, irritability, bloating, anxiety or tension, breast tenderness, moodiness, depression and food cravings |
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Definition
| Premenstrual Syndrome and Premenstrual Dysphoric Disorder |
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Term
| SX usually appear 7-10 day prior to menstruation and usually resolves a few day after the onset of menses |
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Definition
| Premenstrual Syndrome and Premenstrual Dysphoric Disorder |
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Term
| Neurotransmitter implicated is serotonin for |
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Definition
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Term
Birth control – if symptoms mostly physical, not effective if mood liability is primary sx
Evening primrose oil – relieves breast discomfort
1200 mg Calcium – reducing depression, water retention, pain, food cravings, fatigue, insomnia
Vitamin B6, Vitamin E and magnesium – also found to have some positive effects |
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Definition
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Term
| Hot flashes disruption of sleep and sleep disturbances psychological symptoms |
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Definition
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Term
| bladder retraining in cognitively intact women can decrease episodes of incontinence by 50%; biofeedback |
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Definition
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Term
| avoid overfilling of the bladder and regular muscle contraction exercises (Kegel exercises) |
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Definition
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Term
| Smoking associated with increase risk of |
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Definition
| cervical cancer, osteoporosis, early menopause, depression and infertility |
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Term
| Two – Five drinks per day increases risk of |
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