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SOMATOFORM DISORDERS

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SOMATOFORM DISORDERS Group of disorders that includes physical symptoms for which an adequate medical explanation cannot be found Psychological factors -- symptom ... – PowerPoint PPT presentation

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Title: SOMATOFORM DISORDERS


1
SOMATOFORM DISORDERS
2
  • Group of disorders that includes physical
    symptoms for which an adequate medical
    explanation cannot be found
  • Psychological factors --gt symptoms onset,
    severity, duration
  • Not malingering or factitious disorder

3
  • 5 Specific somatoform disorders
  • Somatization DO
  • Conversion DO
  • Hypochondriasis
  • Body Dysmorphic DO
  • Pain DO

4
SOMATIZATION DISORDER
  • Hysteria, Briquets Syndrome
  • Many somatic symptoms
  • Multiple complaints and organ systems affected
  • Chronic

5
Epidemiology
  • Lifetime prevalence 0.1-0.2
  • F gt M (5-20X) 51

6
Etiology
  1. Psychosocial factors - social communication
  2. Biological factors - attention and cognitive
    impairments

7
Diagnosis
  • Onset before the age of 30 years
  • Complain of at least 4 pain sxs, 2 GI sxs, 1
    sexual sx, 1 pseudoneurological sx
  • No physical or laboratory explanation

8
Clinical Features
  • Many somatic complaints long complicated medical
    history
  • Psychological distress anxiety, depression
  • Common suicidal threats
  • Medical history is circumstantial, vague,
    imprecise, inconsistent, disorganized

9
  • Patients are dependent, self-centered, hungry for
    admiration or praise
  • Common associated mental DO - MDD, PD, SRD, GAD,
    phobias

10
Differential Diagnosis
  1. Non-psychiatric medical condition
  2. Mental DO - MDD, GAD, schizophrenia
  3. Other somatization DO

11
Course and Prognosis
  • Chronic, debilitating
  • Onset before age 30 years

12
Treatment
  • Single identified MD
  • Visits regular, avoid additional lab/diagnostic
    procedures
  • Somatic symptoms - emotional expressions
  • Psychotherapy individual, group

13
CONVERSION DISORDER
  • One or more neurological symptoms (paralysis,
    blindness, paresthesias)
  • Psychological factors --gt onset, exacerbation

14
Epidemiology
  • FM 21 - 51
  • Onset is any age (common during adolescence and
    young adults)
  • Rural population, little educated, low IQ, low SE
    group, military personel
  • Comorbid with MDD, anxiety, schizophrenia

15
Etiology
  • Psychoanalytic - repression of unconscious
    conflict/anxiety --gt physical sx
  • Nonverbal means of controlling and manipulating
  • Biological factors - hypomentabolism of dominant
    hemisphere
  • impaired hemispheric communication

16
Diagnosis
  • Symptoms or deficits affecting neurological
    functions
  • Psychological factors --gt onset, exacerbations
  • Not intentionally feigned or produced

17
Clinical Features
  • Most common symptoms paralysis, blindness,
    mutism
  • Most commonly associated with passive-aggressive,
    dependent, antisocial and histrionic PDs

18
  • Sensory Sxs anesthesia and paresthesia, esp
    extremities
  • distribution usually inconsistent with central
    or peripheral neuro dse
  • characteristic stocking and glove anesthesia or
    hemianesthesia (along the midline)
  • organs of special senses - deafness, blindness,
    tunnel vision --gt N neuro exam

19
  • 2. Motor Sxs abnormal movements, gait
    disturbance, weakness, paralysis
  • generally worsen by attention
  • 3. Seizure Sxs pseudoseizure
  • 4. Mixed presentation

20
  • Other associated features
  • Primary gain represent an unconscious
    psychological conflict
  • Secondary gain accrue tangible advantages
    benefits
  • Le belle indifference unconcerned about what
    appears to be a major impairment
  • Identification unconsciously model their sxs on
    those someone important to them

21
Differential Diagnosis
  • Rule out medical disorder thorough medical and
    neuro work-up
  • 25-50 diagnosed with conversion DO --gt neuro or
    non-psychiatric medical DO
  • Neuro DO - dementia, brain tumors, degenerative
    dse, basal ganglia dse
  • Psychiatric DO - schiz, deprssive DO, other
    somatoform, malingering, factitious DO

22
Course and Prognosis
  • 90-100 resolve in few days to less than a month
  • Good prognosis sudden onset, easily identifiable
    stressor, good premorbid adjustment, no comorbid
    psychiatric or medical DO
  • 25-50 --gt neuro or non-psychiatric DO

23
Treatment
  • Spontaneously resolve
  • Insight-oriented supportive or behavioral therapy

24
HYPOCHONDRIASIS
  • Unrealistic or inaccurate interpretations of
    physical symptoms or sensations --gt preoccupation
    and fear that they have serious disease
  • Significant distress impaired function

25
Epidemiology
  • F M
  • Onset at any age

26
Etiology
  1. Misinterpretation of bodily symptoms
  2. Social learning model
  3. Variant form of other mental disorder -
    depression and anxiety DO (80)
  4. Aggressive and hostile wishes

27
Diagnosis
  • Preoccupied with false belief based
    misinterpretation of physical s/sxs
  • At least 6 months
  • Not a delusion or restricted to distress of
    appearance

28
Clinical Features
  • Believe that they have a serious disease not yet
    detected
  • Conviction persist despite negative lab results,
    benign course, reassurances
  • Usually with depression and anxiety

29
Differential Diagnosis
  1. Non-psychiatric medical condition
  2. Other somatoform disorders
  3. MDD, anxiety DO, schiz, other psychotic DO

30
Course and Prognosis
  • Episodic, months to years
  • Good prognosis high SE class, treatment-responsiv
    e anxiety or depression, sudden onset, (-) PD,
    (-) related non-psychiatric medical condition

31
Treatment
  • Usually resistant to psychiatric treatment
  • Focus on stress reduction and education in coping
    with chronic illness
  • Group psychotherapy
  • Regular scheduled PE

32
BODY DYSMORPHIC DO
  • Preoccupation with an imagined bodily defect or
    an exaggerated distortion of a minimal or minor
    defect
  • Causes significant distress impaired function

33
Epidemiology
  • Rare poorly studied
  • Most common age of onset 15-30 yo
  • F gt M, unmarried
  • Commonly coexists with other mental DO (MDD,
    anxiety, psychotic DOs)

34
Etiology
  • Serotonin
  • Cultural and social effects
  • Psychodynamic models

35
Diagnosis
  • Preoccupied with an imagined defect in appearance
    or an overemphasis of a slight defect
  • Significant emotional distress impaired
    functioning

36
Clinical Features
  • Most common concerns facial flaws
  • Common associated symptoms ideas of reference,
    attempts to hide deformity, excessive mirror
    checking or avoidance
  • Avoid social or occupational exposure
  • Housebound attempt suicide
  • Traits O-C, schizoid, narcissistic PD
  • Comorbid depression, anxiety DO

37
Differential Diagnosis
  • Anorexia nervosa, gender identity DO, brain
    damage
  • Delusional DO, somatic type
  • Narcissistic PD, depressive DO, OCD, schizophrenia

38
Course and Prognosis
  • Gradual onset
  • Usually chronic

39
Treatment
  • Serotonin-specific drugs - clomipramine,
    fluoxetine
  • Treat coexisting mental DO

40
PAIN DISORDER
  • Psychogenic pain DO
  • Pain in one or more sites --gt no non-psychiatric
    medical or neurological condition
  • Emotional distress functional impairment

41
Epidemiology
  • F gt M
  • Peak onset on 4th to 5th decades
  • Blue-collar occupation, 1st degree relatives

42
Etiology
  • Psychodynamic expression of intrapsychic
    conflict
  • defense mechanism-displacement, substitution,
    repression
  • Behavioral reinforced with reward and inhibited
    when ignored/punished
  • Interpersonal manipulation and gaining
    advantages
  • Biological 5HT and endorphins

43
Diagnosis
  • Significant complaints of pain
  • Emotional distress and functional impairment

44
Clinical Features
  • Collection of different histories of various
    pains
  • Pain maybe post-traumatic, neuropathic,
    neurological, iatrogenic, musculoskeletal
  • () psychological factor
  • Long history of medical and surgical care, visits
    many MDs, requests many meds
  • Complicated by SRD
  • MDD 25-50 of patients
  • Dysthymic or depressive DO sxs - 60-100

45
Differential Diagnosis
  1. Physical pain VS Psychogenic pain
  2. Physical Pain fluctuates in intensity, highly
    sensitive to emotional, cognitive, attentional
    and situational influence
  3. Psychogenic Pain does not vary, insensitive to
    any of above factors, does not wax or wane, not
    temporarily relieved by distraction
  4. Other somatoform DO

46
Course and Prognosis
  • Abrupt onset and increases in severity

47
Treatment
  • Address rehabilitation
  • PAIN IS REAL
  • Pharmacotherapy - antidepressant
  • Behavioral therapy
  • Psychotherapy
  • Pain control program

48
UNDIFFERENTIATED SOMATOFORM DO
  • One or more physical complaints that cant be
    explained by known medical condition
  • Doesnt meet the diagnostic criteria for any
    somatoform DO
  • At least 6 months
  • Significant emotional distress and impaired
    functioning

49
  • 2 types of somatoform pattern
  • Involving ANS CV, GI, urogenital, derma sxs
  • Involving sensations of fatigue or weakness
    (neurasthenia) mental or physical fatigue,
    physical weakness and exhaustion
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