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Somatoform Disorders

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Title: Somatoform Disorders


1
Somatoform Disorders
  • ?"? ??? ????,
  • ??"? "??????".

2
????
3
  • ?? 30, ????? ??? ?????, ????? ???????. ?????? ??
    ??? ???? ?????. ??? ?- 10 ???? ????? ?
  • -???? ???
  • -??? ?? ?????
  • - ????? ??? ???? ???? ???
  • -???? ??????
  • - ??????? ???????
  • - ?????? ??????
  • - ???? ?????.

4
???????
  • MRI ???- ????.
  • ????????????- ?????? ??????? ?? ??????. ??? ????
    ????.
  • ???????????- small hiatal hernia.
  • CT ??"?- scoliosis.
  • ?????? ??????- ??????.
  • ?????? ????? ?????? ???? ????? ??????????
    ???????? - mild iron deficiency anemia, Hb-11.3.

5
?????? ??????????
  • ????? ??? ????, ???? ???? ??, ????? ??????. ?????
    ????? ????? ???. ????? ?? ??? ???. ??-???
    ?????-?????? ?? (???? ?????? ?? ????). ????
    ?????, ?? ?????? ????? ???? ????? ??????. ???
    ????? ????? ?????? ?????? ??????. ???? ?????
    ??? ???? ??????? ????. ????? ?????? ?????????
    ??????? ?????? ???? ??? "??? ?? ????? ??? ????
    ???? ?????????, ?? ????? ???? ????? ?? ???????".
    ??? ??? "???-???, ???? ????? ???? ???". ?????
    ?????? ??????? ????????. ????? ?????? ???????.
    ???????? ????. ?????? ????. ???? ?????? ????.
    ????? ????? ????.

6
?????
7
  • ?? 60, ???? ????? ??? ?-4. ???? ?????? ????.
  • ??? ???? ??? ????? ????? ??? ?????? ???????.
  • ??? ????? ????? ?????? ?????.
  • ??? ????? ?????, ???????? ????????? ????.

8
  • ????? ??? CT ???, MRI ???, EEG, ?????? ?? ????
    ????? ?????.
  • ?? ??????? -???????.
  • ??? ???? ??? ????? ???? ?????? ???????, ???
    ?????? ????? ?????? ??. ???? ?????? ??? ??? ??
    ????? ????? ????? ?????? ?????? ????.
  • ????? ??? ???????????? ????? ????? ??? ????? ????
    ???? ???? ?????? ?????????.

9
?????? ??????? ??????
  • ???? ?????, ???????.
  • "??? ???? ??? ??????? ??? ??????, ??? ??? ?? ????
    ?????? ????? ????? ??? ??? ???? ????? ?? ?????
    ????- ??? ???? ????? ?????? ????? ?????? ???????,
    ????? ?? ?? ??? ????? ????...??? ????? ?????? ???
    ??? ????, ???? ?? ????? ??? ???, ??? ???? ?????
    ????? ?? ??? MRI".

10
????
11
  • ?? 50,??? ??-?????? ???????. ????.
  • ???? 17 ??? ????? ??? ????? ????? ???
  • ?? ???? ??? ??? ???, ?????? ??? "????", ????????
    ??? ???? ???.
  • ??????? ???? ???? ????? ??? ???? ??????.
  • ??? 3 ???????? ??????? ?? ??????.
  • ????? ??????- ????? ???? ????, ????? ???? ??????
    ????.

12
  • ???? 30 ??? ????? ??????? ??????? (??- 3 ?????,
    ?????? ??????, ????, ????? ????).
  • ???????? ????? ????? ????? ????.
  • "?? ???????? ?? ????, ??? ???? ??? ?????, ??? ???
    ?? ???? ?? ?????".

13
???
14
  • ?? 23, ????, ???? ????? ???????.
  • ??? ?-3 ?????? ???? ???? ???-?????. ???? ?"? ????
    ?????, ??? ?????? ?????? PR. ??? ??????? ??????
    ????? ?????? ?????, ??? ?????. ????? ?????
    ??????? ?? ???? ?????.
  • ????? ?????????? ??? ?????? ???????? ?? ????
    ??????.

15
  • ??????? ???????? ???? ?????? ???????? ???????
    ????????? ?????, ??? ???? ???????? ????.
  • ????? ???? ???? ???? ???? ???????? ???????? ????
    ????? ?????? ????? ?? ?????? ????? ???? ?????.

16
  • ?????? ??? ?? ????? ???? ???? ?????, ??-???
    ??????????? ?? (???? ???? ????? ????).
  • ???? ?????, ???? ?????? ????? ??? ???? ??????
    ????? ?????? ?? ???, ??? ???? ??? ?????. ???? ???
    ?????? ????? ???, ?? ???? ????? ?? ???? ?????
    ?????? (???? ?? ???? ??? ????? ??? ???? ???? ????
    ???) "??? ?? ?? ?????".

17
?????
18
  • ?? 18, ??????? ???? ??????.
  • ????? ???? ???? ???????? ???? ???? ???? ??????
    ??????? ?? ?? ????, ?????? ???? ?-15 ????, ????
    ??? ????? ???????, ????? ?????? ????? ?-4 ?????
    ???? ?-5 ????.

19
?????? ???? ????
  • ??????, ??????, ?????? ????????, ??? ????? ????
    ???????.
  • ?? ??? ????? ????? ?? ?????? ?? ????? ????.
  • ?????? cpk- ???? ????????- ??????? ??????.
  • ???? ?????, ?? ?????? ?? ????? ?????? "??? ??
    ?????? ????".
  • ?????? ????? ?????, ???? ???????.

20
????????
  • ?????? ???? ???? ?????, ????? ???????.
  • ??- ??? ???? ??- ???? ???.
  • ??? ????? ????? ??"?. 2 ??????? ?? febrile
    convulsions ???????, ?????? ??? ??? ?? ??????.
  • ??? ????????? ??"?.

21
  • ????? ?"? ????????? ???? ???? ??????.
  • ???? ???? ??????? ????? ???? ?? ???? ?? 21 ????
    ????.
  • ????? ?????? ???? ?? ???? ???? ?????? ?????,
    ?????? ???? ?????? ?? ?? ????, ??"? ???? ?????
    ????.

22
?? ???????
23
  • ?????? ?? ?????? ????
  • Medically unexplained symptoms (MUS)
  • Mind?body, "?????-??????"
  • ???? ???? ?????? ?????? ????? ?? ??????/?????
    ????.

24
??? ?? ??????
  • ?????? ?????? ??????!
  • ??? ???? ??? ?????
  • Context- ?????? ?????? ???? ????.
  • Expectation
  • Suggestion
  • Placebo

25
(No Transcript)
26
(No Transcript)
27
  • ???? ?- Malingering -?????? ????? ??? ???? ????
    ??????.
  • ???? ?-Factitious- ?????? ????? ??? ????? ????
    ????????? (????? ????? ????).

28
Somatoform history
  • ???????? ????? ???? ???? ??????
    (????????????).
  • ???????- ???? ????- ????? ????? ?? ????
  • Thomas willis (17th cen.)- ??????????? ????????
    ????? ??????- ?????? ???? ??? ????.
  • Charcot (19th cen.)- ????? ??????.

29
Somatoform history II
  • Freud and co.- 20th century-
  • ???? MUS ????????? (?????? ?????? ???
    ????????).
  • 1980- ????? ?????? ?? ??? ??????? ??????? ((DSM
    III.

30
???? ????? ?????-????????
  • ?????? ??????? (???????? ?????????) ???????
    ??????.
  • ???? ?(??????)? ????? ????? ??????? ????????
    (freeze-fight-flight).
  • ?????? ?????, ???? ????- ????? ??????? ???????
    ???????? ??????, ?????? ????? ??????.

31
?????? ??????? ??????? ?? ????
  • ??????? ????? ??????? ??????? ???????- ??????
    ????.
  • ????? ????? ?? ????? ?????? ?????.
  • ?????? ????? ????? ?? ?????? ???????.
  • ??????? ???? ?????? ??????? ??????????? ??????
    (????/???????????????)- ????? ?????? ???????-
    ????? ?? ?????.
  • ??? ??????? ???????- ????? PET.

32
??????? ?????????
  • ?? ???? ???? ??????? ???????????.
  • ????? ??????????? ?????, ???? ????? ??????? ??
    ?????.
  • ????? ???? ???? ?????? ??? ?????? ?? ???????.
  • ??? ???? somatosensory amplification ?????
    ?????? ?????? ????? ?? ?????? ???????.

33
???? ??????? ??????
  • 85-95 ?????????? ???????/????- ????? ?????? ???
    ?????? ???????.
  • ??????? ???????? ???? ???????/????.
  • ?????? ??????? ???? ?????? ????? ????.
  • ????? ????????????? ???????? ?????????.

34
??????
  • ??? ?????? ??????
  • ????? ?????? ???????- ??? ???? ????????.
  • ??? ?????- ??? ??? ??????? ?????????? ????
    ???????.

35
?????
  • ?????? ???? ???????? ?? ????? ?????? ?????
    ????????.
  • ????????? ?? ?????- "???????" ??????? ??????.
  • ????????- ??? ???????? ????? ?????? ?? ??????
    (????' ???????? ??? ?????).
  • ?????? ?????-?????? ?????? ?? ?????? ?? ?????
    (????' ??? ??? ??? ????? ???????).

36
???????? ?????-????????
  • ????? ???? ?? ??? ????? ???????? (????, ???).
  • ???????? ?????? ???? ????
  • ??????? ?? ???? ?????? ("???????")??????
    ?????????? ?????????? ?????? "?????" ???????
    ?????????? ?????? ?????, ??? ?????, ???? ?? ??
    "?????".

37
????? ??? ??????? ??????
  • ????? ????????? ??????? (?????????,
    ??????????)??????? ??????.
  • ???? ???????- ??????? ??????? ??? ??????
  • ?????????- ????? ???? ?? ????????? ????????
    ?????? ???????? ????????.

38
The somatoform disorders
  • Somatization disorder
  • Conversion disorder
  • Hypochondriasis
  • Body dysmorphic disorder
  • Pain disorder
  • Undifferentiated somatoform disorder
  • Somatoform disorder NOS

39
????
  • ?? 30, ??? ?- 10 ???? ????? ?
  • -???? ???
  • -??? ?? ?????
  • - ????? ??? ???? ???? ???
  • -???? ??????
  • - ??????? ???????
  • - ?????? ??????
  • - ???? ?????.

40
Somatization disorder
  • ?????? ??????? ????
  • ????? ???? ??? 30
  • ?????? ???? ????
  • ????? ??????? ?? ?????
  • 4 ?????? ???
  • 2 ?????? GI
  • 1 ????? ???.
  • 1 ????? ??????-?????????.
  • ?? ???????? ?? ??????? ?????? ?"? ?????? ???????.

41
????????????
  • Life-time prevalence 0.2-2 women 0.2 men.
  • Women x 5-20
  • Low education, low income
  • 2/3- psychiatric symptoms ½- other mental dis.
  • No higher prevalance BP I substance abuse.
  • Personality traits avoidant, paranoid,
    self-defeating, obsessive-compulsive.

42
DD!
  • Thyroid disorders
  • MS
  • SLE
  • Hyperparathyroid
  • porphyria

43
????
  • ?????
  • ????? ???????
  • ?????? ???? ?????
  • ???? 20 ???- ??? ?????? ??? ?? ????? ???????!

44
??????? ?????
  • ???? ??? (???? ???? ?????)
  • ?????? ??????? ??? ??????.
  • ????? ?? ??????? ?????- ?? ?? ?????.
  • ??????? ??????? ???????.
  • ???? ?? ?????? ?? ???? ???-???.
  • ?????????? (?????/???????) ?????? ???????
    ???????.
  • ??????- ????? ????? ????? ????? ?????.

45
?????
  • "??? ???? ??? ??????? ??? ??????, ??? ??? ?? ????
    ?????? ????? ????? ??? ??? ???? ????? ??
    ?????...??? ????? ?????? ??? ??? ????... ??? ????
    ????? ????? ?? ??? MRI".

46
Hypochondriasis
  • ????? ??? ?????? ?????? ????? ???, ?? ???? ???.
  • ????? ????? ????? ????? ?????.
  • ?? ???? ?? ????? ????.
  • ????? ?? ????? ??????.
  • ????? 6 ??????.
  • ?? ???? ? GAD, OCD, Panic Dis., MDE, seperation
    anxiety, other somatoform.
  • ?? ????? poor insight.

47
????????????
  • 4-6 gen. med. pop. 6 month prevalance.
  • menwomen!
  • Onset most common 20-30 yrs. any age possible.
  • No effect social, marital, economic.
  • 3 of medical students (usually first 2 yrs.).

48
DD
  • Depression
  • Panic disorder
  • Delusional disorder, somatic type.
  • Schizophrenia etc.
  • Factitious
  • malingering

49
????
  • ??????? (??????-????)
  • ??? ?????? ????
  • ???? ?? ??? ??????? ????
  • ???????? ???? ???????????? ? ??????/????
    ??????? ?????? ????? ??????? ????? ??' ??????
    ??????.

50
?????
  • ??"?- ??????? ?????? ?????????.
  • ??????????- CBT, , ???????, ???????, ???????.
  • ?????? ??????? ???????!
  • ????? ?????? ??????? ?????- ????? ?? ???? ??????
    ?????.

51
????
  • "?? ???????? ?? ????, ??? ???? ??? ?????, ??? ???
    ?? ???? ?? ?????".

52
Body Dysmorphic disorder
  • ????? ??? ???? ??????? ??????, ?? ????? ???????
    ????????? ???? ??????.
  • ????? ?? ????? ??????.
  • ???? ????? ?"? ????? ???? (????' AN).

53
????????????
  • ????? ?????? (????? ??????????)
  • ???-????? ???? ????
  • ????gt?????
  • ??? ????? ???? 15-30
  • ???? ??????
  • 90 ??????? ?????? 70 ????? ???? 30 ?????
    ???????? (?"? ???? ????).

54
?????????
  • ????? ???? ???? ????????????
  • ??? ?-OCD
  • ??? ??????? ???????? ????????.
  • ????? ???????? ???????????.

55
???????
  • ??? ???? ????? ?????? ????? ????? (??, ??????)
  • ????? ????, ?????, ???????.
  • ?????? ?????? ??? (????? ???????)!
  • ????? ??????? ????????
  • ??????? ???????- ???? ???? ?? ??????
  • 20 ?????? ??????!
  • ??????MDD, anxiety, OCD

56
?????
  • ??????? ???????????
  • SSRI
  • Clomipramine(tricyclic)
  • MAOi
  • ???????? ?????????? ?????????????, ??????.
  • ?????????? CBT ?????? ????? ??????.

57
???
  • ??? ???????? ??? 3 ??????, ???? ??? ???? ????? ??
    ???.

58
Pain disorder
  • ???- ???????? ??????
  • ?????/????? ???????
  • ?????? ??????????? ???? ????? ???????
    ??????/?????/?????/???.
  • ?? ????? (factitious/malingering).
  • ?? ????? ?"? ??' ????????, ????, ???????? ??
    dyspareunia.

59
????? ?-3 ?????
  • Associated with psychological factors
  • Both psychological and general medical factors
  • Only general medical factors ???? ???? ?????
    ??????????!
  • ???? ????
  • Acuteless than 6 months
  • Chronic 6 months or longer

60
????????????
  • Lifetime prevalence 12
  • 3 of GP patients
  • Onset any age
  • Gender ratio unknown
  • Association with affective and anxiety dis.
  • Family pain dis., depressive dis., alcohol dep.
  • Depression or terminal illness suicide risk.

61
?????????
  • ????? ???? ?? ???????? ???? (????, ??????).
  • ??????????- alexithymia
  • ???? ??? ?????
  • ????????? ???? ????? ??, ??????? ?????? (??
    ???? ???? ?????!).
  • ????????- ??? ?????? ??????????, descending
    inhibitory pathway- serotonin.

62
????
  • ??"? ????? ?????, ????? ??????? ????
    ??????/??????.
  • ?????- ???????? ???? ????
  • ????? ?????? ???? ??????? (????? ?????, ????)
  • ????? ??????? ???????
  • ??????? ?????????- ???? ??????

63
DD
  • ??? ????/????????- ?? ???? ???? ??????. ???
    ??????? ?????- ???? ???? ?????????.
  • ??' ???????????? ?????
  • Tension headache (not pain disorder)
  • Factitious malingering

64
?????
  • ?????-?????? ???? ??? ?????? ??????????? ????.
  • ?????????? ???????, ??????????, ?????????,
    ???????.
  • Biofeedback, hypnosis, exercise
  • SSRI , tricyclics (anti-depressive or anti-pain?)
  • ?????? ?????? ??? ????????? ?????????.

65
?????
  • ?? 18, ????? (?) ??????? (aphonia) ??? ??? ??????.

66
Conversion disorder
  • ?????/??? ??? ?? ???? ?? ???' ????????? ??
    ????????? ????????, ?????? ?????? ??????????.
  • ???? ????????? ???? ???????? ?? ??? ???? ??????.
  • ???? ????? (???? factitious ?? malingering).
  • ???? ????? ?"? ?????? ???????????/ ??????? ?????
    ????? ??????? ?????? (????' ??? ????? ???????).
  • ?????/????? ???????
  • ???? ????? ???? ?? ?????? ????? ???? ???? ???
    ?-somatization disorder.

67
?????
  • With motor symptom or deficit
  • With sensory symptom or deficit
  • With seizures or convulsions
  • With mixed presentation

68
????????
  • Hysteria dissociative reaction- ???? ??????.
  • Charcot- ????? ?? ?????? ????? ????????.
  • Freud- ???? ?? ???????? ?? ???? ?????? ?????
    conversion ?????- ???? ????????? ????? ?"?
    ???????????.

69
????????????
  • ??????? ??-??????? -1/3 ??????????? ????? ?????.
  • ???? ??????? ???????? ????? (10/100,000-300/100,00
    0) .
  • ???? ????????? ?????, ????? ?, ?????????????,
    ?????-??????? ?.
  • ?????? ???? ????? ?????? ??????? ???? ?????.
  • ?????? ??? ??? ???????????? ??? ?? ???
    ??????????.
  • ???? ?? 2 ?? 10 ??????.
  • ??????? ???? ?????? ??? ???? (????? ????????
    ??????????? ?? neglect).
  • ??? ?????- ??? ???' ?????? ????-????????.
  • ??? ???? ??? ??????? ?? ??? 35.

70
comorbidity
  • ????? ??????????? ?????? ????? ????- ???????
    "?????" (pseudoseizures in epilepsy).
  • ??????, ????, ??????????.
  • ??' ?????? ??????????, ??????.

71
?????????
  • ??????????? ????? ?? ???????? ????-???? (???,
    ??????, ?? ??????? ???????) ????? ??????? ???????
    ?????? ?????.
  • ??? ???? ??? ?????? ????????? ????'- ?????????
    ??? ???? ????? ?????? ??????.
  • ????????? ??????? ???? ?????? ?????? ????? ????
    ???????? ?? ????? ??????? ????? ?????.
  • ???????? ??????? ??????? ???????????? ??
    ??????? ????????? ????????????? ?? ???
    ?????????. ?????? ??????? ????????????????
    ?????? (??????, ??????, ?????).

72
???????
  • ??? ?????? ?????, ???????, ?????? (??????).
  • ???????? ??????? ???????? "stocking and
    glove ?????????? ?????? ????? ??? ?????
    ?????? ??????? tunnel vision.
  • ???????? ?????? ????? (chorea, ticks, jerks)
    ????? ????? pseudoseizures.

73
???????? ?????? (?? ????????)
  • La belle indifference- ?????? ??????
  • Primary gain- ????? ?? ?????????? ?? ??????
  • Secondary gain- "????" ????????? ?? ?????, ?????
    ?? ?????.
  • Identification

74
DD
  • ???
  • 25-50- ???? ?????? ????? ??????????!
  • Brain tumor
  • Basal ganglia disease
  • Myasthenia
  • Myopathies
  • MS
  • Guillain-Barre
  • CJD
  • HIV
  • ?????? ?????.

75
????
  • Usually -acute
  • Usually- short duration (95 spontaneous
    remission after 2 weeks)
  • Long standing- bad prognosis.
  • Recurrence- 25 of patients within 1 year
  • Good prognosis acute onset clear stressor
    quick treatment high IQ paralysis, aphonia,
    blindness.
  • Bad prognosis tremor, seizure.

76
?????
  • ???? ?? ???? ???-??? ??????? ??????? ??????.
  • ????? ?? ????? ???/?????????? ?????? ?????.
  • ???????/?????? ??????/ ?????? ?????????? (IV
    amobarbital/diazepam/lorazepam).
  • ?????? ???????- ?????????? ?? ??? ?? ????? ??????
    ?? ???????????.

77
Undifferentiated somatoform disorder
  • ????? ?????? ??? ?? ???? (????' ??????, ????
    ??????, ?????? ????????? ?? GI).
  • ?? ??????? ????? ?"? ?????? ???????.
  • ?????/????? ???????
  • ????? 6 ??????
  • ???? ??? ?????? ??????????? ????
  • ???? ???????

78
Somatoform disorder not otherwise specified
  • Pseudocyesis -????? ?????.
  • ??????? ???????????? ???? ?-6 ??????.
  • ??????? ??????? (????' ????? ?? ??????) ???????
    ???? ?-6 ??????.

79
?????
  • ?????? ?????????.
  • ?????? ?????????? ???-??? ????? ?? ????????
    ?????? ?????? ????????-?????????.
  • ?????????? ???? ??????? ?? ???????. ???? ???????
    ???????.

80
??????? ??????
  • ???? ??????
  • ????? ???? ?????? ???????
  • ??? ???? ???? ????????
  • ??????? ??????? ??????????? ???????
  • ????? ?????? ????? ??????/????? ?????
  • ????? ??????? ??????
  • ???? ??????? ?? ????? ????? ?????? (????
    ????? ?????? ????? ???????????).

81
???? ???????
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