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Somatoform, Conversion, and Factitious disorders
Terms in this set (25)
What are some somatoform disorders?
Body dysmorphic disorder
What is a somatization disorder?
Patient has recurring, multiple complaints of pain, GI, sexual symptoms that have no definitive cause. Pts. often are continually seeking treatment.
Somatization disorder epidi?
Almost exclusively a femal disorder.... (before age of 30 and present for years)
Males can have it but it is highly co-morbid with antisocial personality disorder and alcoholism.
What are the genetics and family hx of somatization disorder?
Familial disorder especially in women
Many pts. have 1st degree male relatives with increased rates of antisocial personality disorder and alcoholism.
Female relatives of women with somat. d/o have increased rates of somatization disorder and also antisoc. persona. d/o
Assortative mating - Women with somat. d/o tend to pair off with men who are antisocial and alcoholi.
What are the clinical features of somat. disorder?
Symptoms in 4 categories....
These symptoms are medically unexplained or is in excess of what expected
Onset by age 30
Not pathopgnomonic symptoms....
Histrionic behavior (act in a way to draw attn. to themselves)
"La belle indifference" (A naive, inappropriate lack of emotion or concern for the perceptions by others of one's disability)
Voluminous medical record
What are the DDx of somat. disorder?
General medical conditions.
Anxiety disorders and depression
What is teh common history of somat. disorder in pts?
Begins after puberty
WAXING and WANING course
BECOMES STABLE OVER TIME (no waxing or waning)
Prognosis & management of somat. disorder?
Prognosis - Full recovery is poor
Management - Education
Only ONE primary care doctore
Regulary scheduled visits
Discourage "prn" visits and calls
What are the SxS of conversion disorder?
Motor deficit - Weakness, paralysis, ataxia, balance problems, aphonia, urinary retention.
Sensory deficit - Numbness, blindness, tunnel vision, deafness and hallucinations
Seizures or convulsion
Symptoms are not intentionally produced but they cannot be fully explained by a medical condition
How to dx pt. with conversion disorder?
Presence of one or more symptoms or deficites relating to voluntary motor or sensory function
Symptoms by defin. medically unexpalined cause signif. social or occupational impairment or warrant medical attn.
What is the difference between conversion & Somatization disorders?
Somatizaiton disorder is teh manifestations of numerous physical complaints over the course of years (4 pain, 2 GI, 1 sexual, 1 pseudoneurological). Whereas conversion disorder is the unconscious manifestation of one neurological/medical condition (motor or sensory) symptoms for which no cause can be found. Symptoms are usually preceded by a stressor or conflict.
Both disorders lead to significant impact on social and ocupational functioning
What is the HPI for pts. with conversion disorder?
Onset - Any age
Most often - 10-35
Middle age/older - HIgher chance of gen med. condition.
20-30% of pts are later re-diagnosed with gen med condition or somatization disorder.
What is the prognosis for pts with conversion d/o?
Long term is poor
Two thirds or more remain sympotm. at follow up (avg 6 years later)
LESS long term impairment than SOMATIZATION d/o
Specific symptoms usually go away within 2 wks.
Recurrence is common within 1 yr.
PSEUDOSEIZURES and CONVERSION TREMORS have the WORST prognosis.
What is DDx for conversion d/o?
Tumors of CNS
Frontal lobe lesions
What is factitious disorder?
Intentional production or feigning of physical or psychological sxs WITHOUT an EXTERNAL INCENTIVE.
"assuming the sick role"
What are the clinical features of factitious disorder?
Febrile type (fever)
What are some diagnostic flags of factitious disorder?
Facility (knowing) medical jargon
Paucity (scarcity) of verifiable hx
Absence of close interpersonal relationships
Previous jobs in med. fields
Hx of abuse or relationship with a physician
Multiple scars (many unscesaary surgeries)
What are some management approaches to pts with factitious disorders?
Collateral (additional) information
Avoid early confrontation
Be aware of negative countertransferance (emotional reaction of the analyst to the subject contribution)
Dx early and avoid unnecessary interventions
Focus on management, rather than cure in a psychiatry
Legal intervention (Munchausen by proxi)
What is the difference between malingering and factitious d/o?
Pts who malinger due it for some sort of benefit. Pts who have factitious disorder also fake their symptoms but they dont have a reason that they do it.
What are most common psychiatric syndromes that are malingered?
SYMPTOMS rather than signs
What are some common medical conditions that are malingered?
What are some dx associated with malingering?
Antisocial perssonality d/o
NOT ASSOCIATED WITH SOMATIZATION D/O
What are some red flags of malingering?
CONTRADICTORY past medical records
REFUSAL to cooperate
Pt DEMANDING controlled substances
LEGAL/SOCIAL/ FINANACIAL severe problems
How to evaluate a malingering pt?
Obtain COLLATERAL INFO
REMOVE legal/social stressor (get pt. out of military)
Psychometric testing (test w/built in validity scales)
Managment approaches for malingerers
Removal of incentive for malingering (Get pt. out of military, rehab for drugs)
Behavior modification - aversive techniques ("someone can sit and watch you all day if you are sucidial - poop, sleep, eat")
Confrontation and education
THIS SET IS OFTEN IN FOLDERS WITH...
Substance abuse disorders
Neuro H & P
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