Flashcards in Somatic Symptoms and Related Disorders Deck (86):
What is somatization?
The experiencing and communicating of emotional distress, as physical distress
What are the reasons for somatization?
-A physical symptom may be perceived as a necessary ticket of admission to receive care from a clinician
-Emotional disturbance have physical effects on the body
What are the characteristics of somatization symptoms? (3)
-Impairment in functioning is disproportionately high relative actual pathology
What is the effect of varying levels of awareness of bodily sensations?
Higher level of awareness usually means seek more care
True or false: pts with somatizations disorders often overtly deny that symptoms might relate to psychological factors
What is the usual medical h/o pts with somatization disorder? (3)
-long h/o vague symptoms
-Complementary medicine use
-Sensivity to medication
True or false: patient with somatization disorders are generally more sensitive to the side effects of the drug, but also to the main effect of the drug
False--More sensitive to the side effects, but less sensitive to the actual effect of the drug
What are the criteria for somatic symptoms disorder? (3)
-One or more somatic symptoms that are distressing, or result in disruption in daily life
-Excessive thoughts or behaviors related to the symptoms
-Symptoms may vary, but state of being symptomatic persists
True or false: psychiatric problems comorbidities are common with somatic symptom disorder
What are the three signs that a patient may have excessive thoughts or behavior related to somatic symptom disorder?
-Disproportionate and persistent thoughts about symptoms' seriousness
-persistent high levels of anxiety about health or symptoms
-Excessive time and energy devoted to symptoms
What are the criteria for illness anxiety disorder (hypochondriasis)? (4)
-Preoccupation with health to the exclusion of everything else
-Somatic symptoms are not present or mild
-High level of anxiety
-Individual performs excessive health-related behaviors
What is the major difference between somatic symptom disorder, vs illness anxiety disorder?
IAD do not have a major symptom, or it is mild--it is more a general dis-ease about their health, whereas somatic symptom disorder is much more specific and distressing
What is the duration needed to diagnose illness anxiety disorder?
What is conversion disorder? (3 criteria)
-One or more symptoms of altered voluntary motor or sensory function
-Clinical findings show incompatibility between the symptom and recognized neurological or medical conditions
What is the approach to conversion disorder?
Rather than telling the patient their symptoms are not real, can reassure that there are no serious neurological causes
True or false: conversion disorder commonly occurs in individuals who actually have related pathology
What is factitious disorder?
-Intentional production of symptoms
-Goal is to assume the sick role
How is factitious disorder different from conversion disorder?
Conversion disorder is unconscious etiology, and the patient is not knowingly portraying false symptoms, whereas factitious disorder is conscious
Is malingering a psychological disorder?
No--lying for external reward
True or false: malingering is uncommon
What is the goal behind malingering?
To obtain some other desired benefit or outcome, not the sick role itself
What is the major issue with telling a patient with somatization disorder etc that their symptoms are all in their head?
-Decreases care seeking
-Further dismisses mental disorders
What is the best way to handle pts with somatization disorder? (2)
-Have them followed by one physician, and develop a trusting relationship
-Have regular visits
True or false: you should avoid promising a cure with a pt
What is the drug category of choice for somatic symptom disorders?
Diagnostic and treatment efforts should focus on what part of the H and P with somatic symptom disorder?
Physical exam signs
What are the general features of impulse control disorders?
Problem controlling own emotions and actions, in a way that creates problems with others
What major personality trait is usually seen in impulse control disorders?
Are impulse disorders usually considered externalizing or internalizing?
What is the biological cause of impulse control disorders?
What are the life consequences of impulse control disorders? (3)
What is oppositional defiance disorder?
Angry/irritable mood OR argumentative/defiant behavior OR vindictiveness in interactions with one non-sibling
What are the 3 angry/irritable symptoms in the criteria for oppositional defiant disorder?
-Frequent loss of temper
-Touchy or annoyed easily
-Often angry and resentful
What are the 4 argumentative/defiant symptoms in the criteria for oppositional defiant disorder?
-Often argues with authority figures
-Actively defies requests to comply with rules
-Deliberately annoys others
-Blames others for own mistakes
True or false: the s/sx of oppositional defiant disorder are always abnormal
False--normal if not consistent and/or significantly impacting functioning
Which gender more commonly has oppositional defiant disorder? When?
Prior to adolescence
What are the risk factors for oppositional defiant disorder?
-Frequent changes of caregivers
-Parenting is harsh or neglectful
True or false: oppositional defiant disorders that are consistent across settings are more severe
What is the general progression of oppositional defiant disorder if kids are:
-Argumentative / vindictive = Conduct disorder
-Angry, irritable = emotional disorders
True or false: moderate levels of ODD are developmentally abnormal
True or false: most kids with ODD will progress to conduct disorder?
False--most do not progress, but most kids with conduct disorder have ODD first
What are the risks of untreated ODD?
Elevated risk for developing MDD or anxiety disorder d/t seeing self as "bad"
What is the treatment for ODD?
Parent management training:
-Increase positive reinforcement
True or false: aggressive discipline tends to make more aggressive kids
What is the pharmacologic treatment for ODD? (2)
-Stimulants if comorbid ADHD
What is conduct disorder?
(Like antisocial PD in kids)
-*Repetitive* behavior *violating the basic rights of others* or violation of age appropriate social norms
What are the four major areas in the diagnostic criteria for conduct disorder?
-Aggression toward people / animals
-Destruction of property
-Deceitfulness or theft
-Serious violation of rules
There is a worse prognosis if conduct disorder is early or late?
What defines childhood onset of conduct disorder?
At least one symptom before age 10
What defines adolescent onset of conduct disorder?
no symptoms before age 10
What are the characteristics that kids with CD must have to be diagnosed as such? (5)
-Lack of remorse or guilt
-Callous lack of empathy
-Unconcerned about performance
-Shallow or deficient affect
Are males or females more likely to get CD?
What is the prognosis for CD?
Most of the time, the disorder remits by adulthood
What is the major comorbidity of CD?
What is the major difference between ODD and CD?
CD has *repetitive* violation of the rights of others, without remorse
True or false: there is an increased risk of suicide with CD
What is intermittent explosive disorder (IED)?
Recurrent outbursts related to failure to control aggressive impulses, and aggression out of proportion to the provocation
What is the major difference between IED and CD?
IED pts have remorse
What are the two symptoms of IED?
Verbal or physical aggression
-Behavior outbursts that DO result in damage/destruction of property and/or physical injury to people
What is the age that IED can be diagnosed at?
What is the major risk of somatic symptom disorder?
Crying wolf label, and missing actual pathology
In whom is factitious disorder common in?
Healthcare workers or their adult children
Can you diagnose ODD if the behaviors are only seen between siblings
What is the major comorbidity with ODD?
What are the two major temperamental risk factors for CD?
-Below average IQ
What are the three major environmental risk factors for CD?
-Poor school performance
What are the genetic risk factors for CD?
-family h/o CD, ADHD, or substance use
-Reduced autonomic fear conditioning
Do IED pts seek reward for their actions?
No--just a blown out of proportion to stimulus
What is the usual onset and duration of IED?
Impulses arise quickly, and subside within 30 minutes
True or false: IED pts generally have regret with their actions
What is the common past history of pts with IED?
What age does IED usually start?
late childhood, adolescence
What happen to the prevalence of IED as people age?
How long does IED tend to last?
years, but can have long periods episode free
What is the psychotherapy treatment for IED? (2)
What is the pharmacological therapy for IED?
What is kleptomania, and what are the four diagnostic criteria?
-Recurrent failure to resist stealing objects
-Increasing tension before committing theft
-Pleasure, gratification at time of theft
-Stealing is NOT an expression of anger, vengeance, or in response to a delusion/hallucination
True or false: kleptomaniacs generally feel no remorse with stealing
Which gender is more commonly afflicted with kleptomania?
What is the major difference between kleptomania and normal stealing?
kleptomania is not about want or desire, more about the act itself
What is the treatment for Kleptomania?
What is pyromania, and what are the 5 diagnostic criteria?
-repeated, deliberate fire setting
-Tension before the act
-Fascination with fire
-Pleasure when setting fires
-Not done for gain
Which gender is more commonly afflicted with pyromania?
true or false: there is often little or no remorse with pyromania
What is the treatment of pyromania?
unknown, but CBT