Other Disorders

Question 1

What are the somatoform disorders?

Answer 1

The somatoform disorders are a group of psychiatric disorders that cause unexplained physical symptoms.

Question 2

What is somatisation?

Answer 2

The tendency to experience psychological distress in the form of somatic symptoms and to seek medical help for these symptom

Question 3

What are dissociative disorders?

Answer 3

Also known as conversion disorders.

Dissociative disorders are a range of conditions that can cause physical and psychological problems. Can occur following a traumatic life event.

This leads to the disruption of:
- Consciousness
- Memory
- Identity
- Perception

There is NO organic basis.

Question 4

Give some symptoms of dissociate disorders

Answer 4

Partial/complete loss between memories of past, awareness of identity and immediate sensations, and control of bodily movements:
- feeling disconnected from yourself and the world around you
- forgetting about certain time periods, events and personal information
- feeling uncertain about who you are
- having multiple distinct identities
- feeling little or no physical pain

Question 5

What is the theory behind dissociative/conversion disorders?

Answer 5

Conversion of anxiety symptoms into more
tolerable physical symptoms

Question 6

Clinical signs of dissociate disorders

Answer 6

• Paralysis – 1/more limbs, or side of face/body
• Aphonia (loss of speech)
• Sensory loss – not fitting with dermatomes
• Seizures – generalised shaking, no tongue
  biting/incontinence/injury
• Amnesia – memory loss, most often for recent events
• Fugue – all features of dissociative amnesia, plus purposeful travel beyond usual every day range

Question 7

How do dissociative disorders differ from factitious disorder or malingering?

Answer 7

unlike factitious disorders and malingering, the symptoms of somatoform disorders are not intentional or under conscious control of the patient

Question 8

Management of dissociative disorders?

Answer 8

• Exclude organic nature of disease
• Acceptance and support
• Physical rehabilitation
• Treatment of comorbid mental disorder
• Clear presentation of diagnosis
• Avoid interventions which maintain the sick role/prolong abnormal features
• CBT/IPT, supportive psychotherapy

Question 9

Which dissociative disorder is typically seen following traumatic or stressful events?

Answer 9

Dissociative amenesia (loss of memory)

Question 10

Give some other dissociative disorders

Answer 10

• dissociative fugue
• dissociative stupor
• dissociative motor disorders
• dissociative anaesthesia
• trance and possession disorders
• dissociative compulsions (i.e. seizures with no organic basis)
• Gander syndrome
• Multiple personality disorder

Question 11

What happens in dissociative fugue?

Answer 11

o Sudden, unexpected, memory loss and
confusion about identity or assumption of
another identity
o May last several months
o After fugue ends all memory of it is lost

Question 12

What happens in trance and possession disorders?

Answer 12

o Temporary replacement of identity with a ghost/ spirit/deity/other person/animal/object
o Not seen by patient’s culture as acceptable

Question 13

What happens in dissociative anaesthesia?

Answer 13

Loss of sensation

Question 14

What happens in dissociative motor disorders?

Answer 14

Paralysis of muscle groups
Ataxia–> inability to stand or walk

Question 15

What are somatoform disorders?

Answer 15

Medically unexplained symptoms

• Physical symptoms that cannot be accounted for by a physical disorder or other mental disorder
• Frequently accompanied by anxiety or depression
• Requests for medical investigations, in spite of repeated negative findings and reassurance

Question 16

Management of somatoform disorders?

Answer 16

• Acceptance
• Clear and consistent explanation for the symptoms
• Reassure patient of continuing care
• Reduce/stop unnecessary medication
• Keep investigations to a minimum
• CBT and treatment of comorbid mental health disorders

Question 16

Assessment of somatoform disorders?

Answer 16

• Look at previous medical records
• Full details of current symptoms
• Explore illness beliefs
• Explore psychiatric history

Question 17

What childhood event are somatoform disorders typically associated with?

Answer 17

• Often history of childhood illness or increased parental anxiety
• Associated with childhood sexual abuse

Question 18

Different somatoform disorders:

Answer 18

• Somatisation disorder
• Hypochondrial disorder
• Conversion disorder
• Persistent somatoform pain disorder
• Somatoform autonomic disorder

Question 19

What is somatisation disorder?

Answer 19

• A long history of multiple, severe, frequently changing physical symptoms that cannot be accounted for by a physical disorder or other mental disorder
• Course chronic and fluctuating, often associated with disruption of social, interpersonal and family behaviour

Question 20

Is somatisation disorder more common in males or females?

Answer 20

Females

Question 21

What is hypochondrial disorder?

Answer 21

Persistent preoccupation with possibility of
having one or more serious and progressive physical disorders – eg cancer

Manifest persistent somatic complaints despite medical reassurance to the contrary

Question 22

What population is at risk of hypochondrial disorder?

Answer 22

Med students (especially males)

Question 23

What is malingering?

Answer 23

Manufacturing or exaggerating psychological and physical symptoms for a purpose other than assuming the sick role

For financial or other gain such as:
* Evading the police
* Claiming compensation
* Obtaining drugs – eg exaggerating pain to obtain morphine
* Obtaining shelter for the night

N.B. this is NOT a mental disorder

Question 24

What is Munchausen Syndrome?

Answer 24

Factitious disorders are manufactured or exaggerated for the purpose of assuming the sick role Fabricating signs of physical/mental disorder with primary aim of obtaining medical attention and treatment

Question 25

What is an adjustment disorder?

Answer 25

A protracted response to a significant life event or life change characterised by significant emotional distress and disturbance that interferes with normal social functioning E.g. migration, change of job, divorce, bereavement

Question 26

Symptoms of adjustment disorder?

Answer 26

* Depressive symptoms * And/or anxiety symptoms * Inability to cope * Not severe enough to warrant a diagnosis of depressive or anxiety disorder * But impacts on social functioning

Question 27

When do symptoms of adjustment disorder occur after the stressor?

Answer 27

* Occurs within 1 month of particular stressor * Shouldn’t persist longer than 6 months after stressor is removed

Question 28

What are some risk factors for depression following bereavement?

Answer 28

* Previous history of depression * Intense grief/depressive symptoms early on * Few social supports * Little experience of death * Traumatic/unexpected death

Question 29

A differential diagosis for adjustment disorder is Acute Stress Reaction (ASR). What is this?

Answer 29

This is a transient disorder that develops in response to exceptional physical and/or mental stress

Question 30

How long does ASR typically last?

Answer 30

Typically subsides within hours or days. It should last no more than one month.