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Somatoform Disorder

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Somatoform Disorder ... anti-anxiety and anti-depressant Other specified Neurotic Disorders/Cultural Bound Syndromes Dhat Syndrome- whitish discharge in the ... – PowerPoint PPT presentation

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Title: Somatoform Disorder


1
Somatoform Disorder
2
  • Soma Meaning Body
  • Experiencing physical distress/symptoms in
    response to mental/emotional conflict
  • Seeking medical attention for that physical
    distress
  • wandering uterus
  • Types of DSM-IV Somatoform Disorders
  • Hypochondriasis
  • Somatization disorder
  • Conversion disorder
  • Pain disorder
  • Body dysmorphic disorder

3
Somatization Disorder
  • Seeking treatment for many physical complaints,
    with onset before age 30
  • Four pain symptoms
  • Two gastrointestinal symptoms
  • One sexual symptom
  • One pseudoneurological symptom

4
Associated Features
  • Stories are often vague, inconsistent, colorful
    and dramatic
  • Frequently seek care from multiple providers with
    repeated work-ups
  • High comorbidity with personality disorders
    (especially histrionic)
  • More common in women
  • Chronic and fluctuating course
  • One or more symptoms affecting voluntary motor or
    sensory function
  • Resembles neurological or medical disease
  • Psychological factors must be involved
  • The symptoms are NOT intentionally produced

5
  • Causes-
  • Familial history of illness
  • Relation with antisocial personality disorder
  • Weak behavioral inhibition system
  • Treatment-
  • No treatment exists with demonstrated
    effectiveness
  • Reduce tendency to visit numerous medical
    specialists
  • Assign gatekeeper physician
  • Reduce supportive consequences of talk about
    symptoms

6
Hypochondriasis
  • Preoccupation with fears of having a serious
    disease based on misinterpretation of bodily
    sensations
  • Preoccupation goes on despite medical evaluation
    and reassurance (poor insight)
  • Duration is at least six months
  • Serious childhood illnesses and past experience
    with illness in a family member are common
  • Doctor-shopping and costly medical work-ups are
    common
  • Appears equally common in men and women

7
  • Causes
  • Cognitive perceptual distortions
  • Familial history of illness
  • Treatment
  • Challenge illness-related misinterpretations
  • Provide more substantial and sensitive
  • reassurance

8
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9
Body Dysmorphic Disorder
  • Preoccupation with an imagined defect in
    appearance
  • If the individual already has a mild physical
    flaw the concern surrounding it is excessive
  • Frequent inspection of the defect can consume
    many hours a day, lead to suicidal thoughts
  • Insight is often poor- can become delusional
  • Medical and surgical treatments are often pursued
  • High prevalence in cosmetic surgery and
    dermatology clinics

10
Common Locations of Defects
  • Hair
  • Nose
  • Skin
  • Eyes
  • Head / Face
  • Lips

11
Factitious Disorder
  • I know Im producing my symptoms, but I dont
    understand why
  • Intentional production of physical or
    psychological signs and symptoms
  • The motivation for the behavior is to assume the
    sick role (primary gain)
  • External incentives (such as economic gain, or
    avoiding responsibilities) are absent (i.e., no
    secondary gain)

12
Associated features
  • Often involves multiple hospitalizations at
    multiple sites
  • Invasive procedures and surgery
  • Usually have few visitors while in the hospital
  • Patients often have extensive knowledge of
    medical terminology (health care workers, etc.)

13
Munchausen Syndrome?
  • Another term for Factitious Disorder
  • Baron Von Munchausen was a fictional
    eighteenth-century character known for
    story-telling, exaggeration and frequent travel

14
Munchausen by Proxy
  • Parent induces illness in a child
  • The child is repeatedly hospitalized as a result

15
Malingering
  • Intentional production of false or exaggerated
    physical or psychological symptoms
  • The malingerer is aware that he is producing the
    symptoms for gain (secondary gain)

16
  • Causes-
  • Little is known
  • Shares similarities with obsessive-compulsive
    disorder
  • Treatment-
  • Parallels that for obsessive-compulsive disorder
  • Medications (i.e., SSRIs) provide some relief
  • Exposure and response prevention is also helpful
  • Plastic surgery is often unhelpful

17
Neurasthenia- increased fatigue , body weakness,
muscular pain, dizziness, dyspepsia , functional
impairment, soft physical signs, sleep
disturbance, headache,irritability gtgtgt
distressing complaints after mental complaints
18
Depersonalization Disorder
  • Feeling detached from and outside of ones body
    (like youre in a dream)
  • During the experience reality testing is still
    intact (not a psychotic episode)
  • Prevalence is unknown, but appears common in mild
    form
  • Many people without psychiatric pathology have
    had this experience

19
Derealization
  • A feeling or experience that the external world
    is strange or unreal
  • May occur during Depersonalization Disorder
  • Other people may seem unfamiliar or mechanical
  • Size or shape of objects in external world may
    seem altered

20
RX
  • Rule out medical causes
  • Medications not helpful with Dissociation, but
    may help with comorbid anxiety or depression
  • Depersonalization Disorder may respond to SSRIs

21
Hyperventilation Syndrome
  • Excessive fatigue, chest pain, headache,
    palpitation, sweating and feeling of
    lightheadedness
  • In severe hyperventillation- carpopedal spasm,
    paresthesias and LOC

22
Rx
  • Jacobsons progressive muscular relaxation,
    hypnosis, yoga, transcendental meditation
  • Breathing-in-bag technique
  • Rx. If anxiety, depression

23
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24
Irritable Bowel Syndrome
  • Spastic colitis, irritable colon syndrome,
    nervous diarrhea, mucus colitis, colon neurosis
  • Abdominal pain, cramps
  • Alteration of bowel habits
  • Sensation of incomplete evacuation
  • 40 in all pt. attending gastroenterology clinics
  • Psychological stressors leads to hypo-motility
    and hyper-motility

25
Rx
  • Supportive psychotherapy
  • Identification of stressors
  • Anti-anxiety and Anti-depressants
  • Prokinetic agents and fibre rich diet

26
Premenstrual Syndrome
  • Premenstrual tension is characterized by feelings
    of irritability, depression, crying spells,
    restlessness and anxiety
  • Swelling of breasts, pedal edema, wt. gain,
    gastrointestinal manifestations
  • Starts after few days of ovulation, 4-5 days
    before menstruation
  • Due to excess estrogen, progesterone deficiency

27
Rx
  • Diuretics, restriction of excess fluid intake
  • Psychotherapy
  • Hormonal therapy
  • Bromocriptine,
  • anti-anxiety and
  • anti-depressant

28
Other specified Neurotic Disorders/Cultural Bound
Syndromes
  • Dhat Syndrome-
  • whitish discharge in the urine (semen)
  • Its a masturbatory anxiety and over concern with
    noctural emission
  • Amok- sudden unprovoked episode of rage which may
    kill or injure (Malaysia)

29
  • Koro- a belief that penis is shrinking and may
    disappear (shrinking of breasts and vulva in
    females)
  • Wihtigo (windigo)-a belief that one has
    transformed into a cannibal monster during
    starvation
  • Piblokto (Arctic Hysteria)- screaming and
    tearning of clothes, may imitate birds and
    animals, followed by transient amnesia
  • Latah(Startle Reaction)-automatic obedience,
    echo-lalia, echo-praxia due to sudden stimulus

30
Post Traumatic Stress Disorder
  • Exposed to traumatic event
  • The persons response involved intense fear,
    helplessness or horror
  • witnessed, or was confronted with an event
    involving actual or threatened death, serious
    injury
  • The traumatic event is re-experienced in one or
    more of the following ways
  • Recurrent images, thoughts, recurrent distressing
    dreams of the event
  • Persistent avoidance of stimuli associated with
    trauma and numbing as indicated by 3 or more
  • Avoiding thoughts, feelings, or discussion,
    activities, places or people that bring back
    recollections sense of foreshortened future,
    feeling detached
  • Persistent symptoms of increased arousal by 2 or
    more
  • Difficulty falling or staying asleep,
    Irritability or outbursts of anger
  • Difficulty concentrating
  • Duration for more than 1 month

31
  • 1-14 community, 3-58 in at-risk populations
  • 25-30 lifetime prevalence in Vietnam veterans
  • 85 in concentration camp survivors
  • 30 recover completely
  • 40 continue with mild symptoms
  • 20 moderate symptoms
  • 10 unchanged or worsen

32
Examples of Traumatic Events
  • Complicated or unexpected bereavements
  • Accidents
  • Captivity
  • Violent crime
  • Sexual trauma
  • Chronic physical abuse
  • Military combat
  • Natural disasters
  • Manufactured disasters

33
Treatment
  • Talking about the trauma allowing
  • Individual or group therapy, hypnosis , followed
    by support
  • Pharmacotherapy
  • Psychotherapy
  • Relaxation Training

34
DREAMS
Detachment Re-experiencing the event Emotional
effects Avoidance Month in Duration Sympathetic
hyperactivity or hypervigilance
35
PTSD Questionnaire
36
  • A 22 year old woman presents to the doctor
    convinced that there is something wrong with
    her. She reports frequent headaches that are not
    relieved with aspirin. She has been to numerous
    physicians and all have told her that there is
    nothing wrong with her. She expects that you can
    help her bcoz she knows that there is something
    wrong and that you can adequately treat her
    condition.
  • what is your diagnosis?
  • Generalized Anxiety Disorder
  • Mood Disorder
  • Hypochondriasis
  • Factitious Disorder

37
  • A 40 year old homeless man presents to the
    hospital on a cold night complaining of auditory
    hallucinations telling him to kill himself. When
    asked about the past psychiatric history, he is
    unable to give any detailed information. He seems
    concerned about being admitted immediately and
    refuses all medications, when offered.
  • What is your diagnosis?
  • Factious Disorder
  • Malingering Disorder
  • Schizophrenia
  • Panic Disorder

38
  • The mother of a 20 year old man presents to your
    office in tears. She insists that you come to her
    house and see her son, who has been homebound for
    several years. She tells you that her son refuses
    to leave the house bcoz he believes that he is
    ugly and people will laugh at him. He feels
    deformed and refuses to let others see him. When
    you arrived at the house , you find an attractive
    young man with no observable deformities.
  • What is your diagnosis?
  • Mental retardation
  • Psychosis
  • Body Dysmorphic Disorder
  • Munchausen by Proxy
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