Psychosomatic Disorders
what are common incentives for malingering?
financial compensation, avoiding criminal charges, obtaining meds, getting excused from work, admission to hospital
what is factitious disorder by proxy?
a caretaker will purposefully cause the dependent victim to become ill (must be reported to authorities)
conversion disorder usually clears on its own, unless the patient has been through severe abuse. what are prognostic indicators?
acute onset, identifiable stressor, immediate response to tx, higher IQ
when should you suspect malingering?
around pending legal action, exaggerated symptoms, patient performs well below expected capabilities, if they aren't cooperative with assessment or tx, if they have a history of antisocial personality disorder
what are examples of psychological factors affecting other medical conditions?
asthma, heart disease, diabetes, HTN, migraines (psychological stress can interfere with tx of these or add risk)
what are things to look for in factitious disorder by proxy?
child repeated admitted with vague/unusual complaints, in many cases the proxy will present as a guardian angel with a health care background
what happens with people who have illness anxiety disorder if the tests are negative?
constant online research, dissatisfaction with provider, may have comorbid anxiety disorders
how can you dx conversion disorder?
consultation with a neurologist, look for connection between physical symptoms and psychological factors, MMPI may be useful, information from collateral sources
what are pscyhosomatic disorders?
disorders related to the mind-body connection
what is the prevalence of somatic symptom disorder?
equal in men and women; 4-15% of people and usually onset before 30
what are contributing factors to pscyhosomatic disorders?
genetics (increased sensitivity to pain), trauma (abuse and violence), learned experiences (attention gained), cultural/social
what is illness anxiety disorder?
instead of focusing on symptoms, they focus on the fear of having a certain disorder; somatic symptoms are either mild or not present and they will seek care excessively for at least 6 months
what are conversion disorders associated with?
less education, females, chaotic or abusive relationships, maladaptive personalities, rural settings, SES
what is the tx for somatic symptom disorder?
may be resistant to mental health disorder, focus on stress reduction and coping, regularly scheduled visits with the PCP
what is body dysmorphic disorder?
negative feelings about one's appearance with respect to specific body parts; may often be depressed and may repeatedly seek out inappropriate plastic surgery
what are somatic symptom disorders?
one or more somatic symptoms for longer than 6 months that cause distress/interruption in their life: persistently high anxiety and disproportionate thoughts about the seriousness of their symptoms
what are conversion disorders?
one or more symptoms of altered voluntary motor or sensory function with no medical or physical reason for this; won't be worried about the symptoms they present
what is factitious disorder?
patient intentionally makes self ill or knowingly feigns illness without external incentives
malingering is not a psychiatric disorder. what is it?
people intentionally produce exaggerated physical or psychological symptoms for external incentives (patient is aware their symptoms are false)
what is the tx for conversion disorder?
psychotherapy if they are receptive to reduce stress and improve coping skills, change in environment to reduce reinforcement or gain, be supportive and suggestive
what patient is typical for non-epileptic seizure events? - how can you be sure they aren't epileptic activity
young disadvantaged female with multiple stressors and poor coping; quite a few patients actually are epileptic - hook them up to an EEG and monitor to confirm