Term
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Definition
| the process by which a person consciously or unconsciously uses the body or bodily symptoms for psychological purposes or personal gain |
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Term
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Definition
-patient intentionally produces symptoms for secondary gain
-patient knows they are producing the symptoms and knows why they are doing it |
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Term
| malingering: diagnostic features |
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Definition
-feigned or simulated illness with physical or psychological symptoms
-frequently leaves against medical advice |
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Term
| malingering: epidemiology |
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Definition
-?M>F
-antisocial tendencies |
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Term
| malingering: patient awareness |
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Definition
| -CONSCIOUS mechanism of illness production AND motivation for illness behavior |
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Term
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Definition
Somatization Disorder
Conversion Disorder
Hypochondriasis
Body Dysmorphic Disorder
Pain Disorder |
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Term
| somatization disorder: diagnostic features |
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Definition
-multiple symptoms/complaints which are recurrent and chronic
-diffusely + ROS
-sickly by history
-multiple clinical contacts
-multiple surgeries and tests |
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Term
| somatization disorder: epidemiology |
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Definition
-onset at young age
-F:M = 20:1
-F prevalence: 1-2%
-familiar pattern
-5-10% incidence in primary care settings
-9x higher medical expenses that ave pt
-lower SES |
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Term
| somatization disorder: etiology |
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Definition
-unknown
-adoption studies suggest both genetic and environmental factors |
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Term
| somatization disorder: clinical features |
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Definition
-psychological distress
-interpersonal problems
-alcohol or substance abuse often coexists
-depression, anxiety, personality disorders often present
-dramatic presentations
-poor historians |
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Term
| somatization disorder: differential diagnosis |
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Definition
-medical disorders
-factitious disorder
-other psychiatric disorders
-need to be distinguished from a real medical condition that may be causing diffuse symptoms |
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Term
| somatization disorder: course and prognosis |
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Definition
-chronic
-increased complaints at times of stress
-poor prognosis
-cure unlikely
-goal of treatment is to decreased medical procedures |
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Term
| conversion disorder: diagnostic features |
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Definition
-single symptoms, incompatible with a known neurologic or medical disorder
-psychological factors muct be associated with the initiation or exacerbation of the sypmtom(s)
-mostly acute |
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Term
| conversion disorder: epidemiology |
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Definition
-onset yong age
-F>M
-more common among: low SES, rural, less educated, medically unsophisticated
-often associated with: MD, anxiety disorders, schizo, personality disorders |
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Term
| conversion disorder: etiology |
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Definition
-psychoanalytic theory or trying to avoid unconscious conflict
-biological factors |
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Term
| conversion disorder: patient awareness |
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Definition
| -completely UNCONSCIOUS mechanism of illness production and motivation for illness behavior |
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Term
| conversion disorder: clinical features |
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Definition
-symptoms can be: sensory, motor, special, seizures, mixed
-symptoms may be unconsciously modeled
-symptoms are often not medically accurate |
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Term
| conversion disorder: differential diagnosis |
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Definition
-medical or neurological disease (in 25-50% of pt's initially thought to have CD)
-other somatoform disorders
-factitious disorder, malingering |
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Term
| conversion disorder: course and prognosis |
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Definition
-excellent, except if chronic
-90% of cases resolve symptoms in days - 1 month
-25% have recurrence at some point (not necessarily with the same symptom)
-the longer the symptoms last, the poorer the prognosis for ever recovering |
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Term
| pain disorder: diagnostic features |
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Definition
-pain simulation or pain intensity incompatible with know physiology/anatomy
-chronic somatoform disorder in which pain in one ore more anatomical sites is the focus
-pain must be severe enough to impair function
-psychological factors likely have role in onset, exacerbation, maintenance of the pain
-frequent co-morbid substance abuse |
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Term
| pain disorder: epidemiology |
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Definition
-F>M
-older (40-50's)
-familial pattern
-up to 40% of pain patients |
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Term
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Definition
-guarded/variable
-treatment is multidisciplinary, multi-modality |
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Term
| hypochondriasis: diagnostic features |
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Definition
-patient's INACCURATE INTERPRETATION of physical symptoms or sensations leads to PREOCCUPATION and FEAR that they have a serious illness
-no medical evidence of illness can be found
-convinced of a specific disorder
-80% dependent or anxious
-often complain about care
-seek multiple medical opinions |
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Term
| hypochondriasis: epidemiology |
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Definition
-6 month prevalence of 4-6% in general medical patients
-M=F
-onset in 20-40's
-previous medical diagnosis |
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Term
| hypochondriasis: etiology |
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Definition
theories:
-symptom amplification
-learned behavior
-symptoms of another psychiatric disorder (esp. depression)
-psychodynamic theory: deserved punishment |
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Term
| hypochondriasis: clinical features |
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Definition
-specific diseases are feared
-fear can shift one one disease to another over time
-multiple medical opinions are sought
-complaints about care received are common (doctors can't find the "real" problem)
-high risk of complications, from diagnostic, or possibly, therapeutic procedures
-depression or anxiety disorders often coexist |
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Term
| hypochondriasis: patient awareness |
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Definition
| -completely UNCONSCIOUS mechanism of illness production and motivation for illness behavior |
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Term
| hypochondriasis: differential diagnosis |
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Definition
-true medical illness
-other somatoform disorder
-factitious disorder, malingering
-other psychiatric disorders (of hypoch develops for the first time in an elderly patient, suspect depression) |
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Term
| hypochondriasis: course and prognosis |
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Definition
-fair to good
-episodic, with episodes occurring at times of stress
-1/3 t0 1/2 of patients improve with time |
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Term
| body dysmorphic disorder: diagnostic features |
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Definition
-rare disorder
-patient becomes preoccupied with a bodily defect that is either imagines entirely or is a greatly exaggerated distortion of a true, but minor, defect
-subjective feelings of ugliness or concern with body defect |
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Term
| body dysmorphic disorder: epidemiology |
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Definition
| adolescent or young adult |
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Term
| body dysmorphic disorder: patient awareness |
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Definition
| -completely UNCONSCIOUS mechanism of illness production and motivation for illness behavior |
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Term
| body dysmorphic disorder: prognosis |
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Definition
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Term
| management of somatoform disorders |
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Definition
-provide CARE rather than aiming for cure
-focus on the psychosocial problems not the physical ones
-establish ONE physician to manage care and schedule regular, brief, frequent meetings
-establish empathetic relationship to minimize doctor-shopping
-minimize use of psychotropic drugs
-minimize medical diagnostic tests and procedures to reduce expense and iatrogenic complications |
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Term
| managing psychosocial problems of somatoform disorders |
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Definition
| focus on COPING and FUNCTIONING strategies instead of trying to completely eliminate symptoms |
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Term
| medications and somatoform disorders |
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Definition
-no medication has been shown to be useful in somatoform disorders
-patients may tend to become dependent upon drugs easily, esp sedative-hypnotics
-DO provide psychotherapy instead |
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Term
| factitious disorder: diagnostic features |
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Definition
-feigned or simulated illness with no obvious external goal or gains
-multiple hospitalizations
-patient intentionally produces signs of illness and misrepresents their history to assume the patient role |
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Term
| factitious disorder: patient awareness |
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Definition
| the patient is aware that the behavior is intentional (conscious), but the motivation for the behavior in unconscious and not easily controlled |
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Term
| factitious disorder: epidemiology |
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Definition
-prevalence unknown
-F>M
-frequently have medical background
-younger
-Munchhausen's variant: may travel from place to place, assuming different names, and simulating different illnesses |
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Term
| factitious disorder: etiology |
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Definition
Psychodynamic theories:
-hospital seeking
-difficulty recognizing self-boundaries, thus taking on patient role
-seeking painful procedures for self-punishment |
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Term
| factitious disorder: clinical features |
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Definition
-symptoms can be physical, psychological, or both
-may occur by proxy (parent simulating illness in a child) |
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Term
| factitious disorder: differential diagnosis |
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Definition
-medical illness
-somatoform disorders
-malingering |
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Term
| factitious disorder: course and prognosis |
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Definition
-chronic with poor prognosis
-onset in early childhood, often after an illness or loss
-increasing frequency of episodes
-incapacitation results from the patient's own illness behavior as well as from untoward reactions to treatments |
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Term
| factitious disorder: management |
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Definition
-recognition
-verification of past medical history
-minimize procedures
-one primary physician
(?-confronting the patient)
-psych consultant's main role may be in helping medical staff deal with their own counter-transference to these patients |
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Term
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Definition
-the mind and body are connected
-some people feel their psychic pain physically
-some people have physical symptoms for primary (psych) or secondary (tangible) gain |
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