Term
| what are somatoform disorders? |
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Definition
| a group of disorders w/physical symptoms, but have an underlying aspect of psychological issues or distress. 25% of pts may have this and all of these disorders have a sense of over-importance of somatic complaints in a pt's life. |
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Term
| what are "benefits" to being sick or pretending to be? |
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Definition
| pts can get attention and care through manipulation. pts may also have depression but be uncomfortable naming it so they complain of something else. |
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Term
| how do emotional issues affect chronic pain? |
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Definition
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Term
| can some conditions become fashionable to the point of pts thinking they have something they might actually not? |
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Definition
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Term
| what is somatization disorder? |
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Definition
| a chronic disorder characterized by *multisystem somatic complaints that produce some *level of impaired function = become frequent fliers in medical services. the physical complaints do involve some occupational, social and academic impairment. these pts are not "faking it", they truly are experiencing these symptoms. this often starts before age 30. |
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Term
| what are the 4 requirements for somatization disorder dx? |
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Definition
| 1) 4 areas have to involve simultaneous pain (back/head/joints/abdominal). 2) 2 non-painful GI complaints (constipation, diarrhea, flatulence, etc). 3) some area of sexual dysfunction other than pain (decreased libido, ED, menorrhagia, etc). 4) pseudoneurological (amnesia, syncope, visual disturbance, diplopia, aphasia, claim ataxia etc) |
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Term
| what characterizes the co-morbidity between somatization disorder and psychiatric illness? |
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Definition
| 50% of pts w/somatization disorder also have a recognizable diagnosable psychiatric disorder (anxiety/mood disorder, PTSD) and 72% have a personality disorder, starting w/histrionic followed by borderline and antisocial. substance abuse is also involved - but there is the chicken/egg conundrum. |
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Term
| does somatization disorder run in families? |
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Definition
| yes often if a pt has it a first degree relative will. |
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Term
| what are possible organic causes for the multisystem symptoms associated w/somatization disorder? |
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Definition
| chronic multisystem infection, adrenal problem, carcinoid, tertiary syphilis, MS, **porphyria**, and lupus. usually somatization disorder is considered b/c it affects younger pts. |
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Term
| what is tx for somatization disorder? |
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Definition
| this requires a long term relationship w/the physician who will not blow it off as a "psychological" issue, the pt needs to be in the sick role, visits will require a very structured agenda, iatrogenic issues need to be avoided (SSRIs can cause GI symptoms, TCAs can cause constipation, BZDs can cause sleepiness - prescribe medications sub-therapeutically initially), acknowledgment of the symptoms - but recognition of the fact that the etiology is emotional, remind the pt that it will get better, and attempt group therapy. |
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Term
| what is undifferentiated somatoform disorder? |
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Definition
| this involves more subtle/sub-threshold complaints than in classic somatoform disorder - including *chronic fatigue and *environmental allergies. |
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Term
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Definition
| a somatic disorder often associated w/chronic fatigue. there is not yet an etiology or objective disorder, but the clinical presentation is very similar to somatization disorder - but not as easy to pin down (sub threshold). no specific age and treated the same way as somatization disorder. |
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Term
| what is chronic fatigue syndrome? |
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Definition
| likely related to a deficiency of delta sleep - sodium oxybate is being investigated for tx. |
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Term
| what is conversion disorder? |
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Definition
| somatic symptoms w/o an organic substrate which affect voluntary motor or sensory function (looks neurologic, but isn't). possible symptoms: loss of vision, diplopia, complete hemianesthesia, paralyzed limb, etc. this is not a willful disorder, but is usually due to psychological trauma (something that occurs intrapsychically that is being converted into a somatic symptom) and prior to onset of the symptoms there was some psychological conflict or stress. this is usually seen in female adults, and sometimes this is the *start of what will become major depression or an anxiety disorder. tx: use combinations of therapy (insight directed psychotherapy) to disclose and identify the underlying issue and treat it. MS, myasthenia gravis, seizures - should be in ddx. |
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Term
| what is the difference between the stress level in somatization disorder and conversion disorder pts? |
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Definition
| pts w/somatization disorder are distressed by their condition while conversion disorder pts have "la belle" indifference (casual detachment). |
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Term
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Definition
| the fear that the pt will get something |
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Term
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Definition
| aka psychogenic pain, in this the predominant complaint is pain occurring in multiple parts of the body simultaneously (not multisystem like w/somatization and the focus is on the pain). the pain is severe, constant, disproportionately high (out of proportion w/physical findings) and commonly seen in the head, face, neck, pelvis, and low back (but nonsexual). the pain is not intentionally produced or conceived and is not due to depression, psychosis, anxiety disorders. this causes problems w/daytime function, occupational function and social relationships and psychological issues play a role in the development of this disorder. tx: multifactorial, may involve family/group therapy, but cognitive behavioral therapy is the most effective. |
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Term
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Definition
| this pts are preoccupied w/health issues and have fears of developing an illness. these pts believe that innocuous symptoms underlie something more severe - like GAD, but only within the health context. they are not easily reassured about their condition - however they are able to function personally w/family and occupationally, just w/a higher level of distress. |
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Term
| what is body dysmorphic disorder? |
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Definition
| a condition where people have imagined ugliness and are preoccupied w/a sense of an imagined defect in their appearance - commonly a facial deformity. these pts become obsessive but are often too embarrassed to seek medical care. these pts constantly look at themselves in mirrors and are constantly grooming/checking their appearance. they are constantly distressed as a result, no matter how much they are reassured. these pts will employ compensatory behaviors to conceal their imagined deficit (wearing a hat, glasses, etc) and some pts will become isolated socially. they may go through a lot of cosmetic sx and incidence is equal between M/F. there may be an underlying psychiatric comorbidity such as anxiety issues, depression, social phobia, or OCD. |
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Term
| what is tx for body dysmorphic disorder? |
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Definition
| get to the underlying cause and deal w/it |
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Term
| what characterizes the factious disorders? |
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Definition
| the goal of the individual to to become a pt and they deliberately lie and fake symptoms in order to attain that. these people will have very pronounced physical or psychological symptoms, but which are all under voluntary control (not caused by a disorder). these pts are not doing it for profit or fake an insurance claim. |
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Term
| what is munchausen syndrome? |
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Definition
| when symptoms are present in a factitious disorder. these pts will complain about very accurate symptoms b/c they are knowledgeable and like to go to teaching facilities. they will give good histories and will often infect themselves. if the symptoms are only psychologic, it is harder to determine, but usually symptoms end up being inconsistent. |
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Term
| how is a factitious disorder different than a malingerer? |
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Definition
| malingerers have secondary gain, factitious disorder pts are just trying to become a pt. |
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Term
| what is factitious disorder by proxy? |
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Definition
| parent will produce physical symptoms in their child so the child becomes the object of care |
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Term
| what is tx for factitious disorder/malingering? |
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Definition
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Term
Study Guide for Somatoform Disorders
1. How do the complaints of Somatoform Disorder resemble and yet differ from Conversion Disorder?
2. Which medical illnesses resemble Somatization Disorder?
3. How does Hypochondriasis differ from Conversion Disorder, Somatization Disorder, and Factitious Disorder?
4. What are the underlying motives (drives) in Factitious Disorder, Conversion Disorder, and Malingering? |
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Definition
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