Psychosomatic Illness

Mind-Body Interaction

The mind is the action and consists of conscious and unconscious -Demonstrated by behaviour, cognitions and reported emotions and perceptions

Psychosomatics

This is the study of the influence of the mind on bodily functions -reference to clinical symptoms that are psychological in origin Most common complaints: -fatigued -insomnia -nausea/vomiting -back pain Most common systems -Endocrine, immunological, neurological and CV

Secondary Gain

To fulfill the wants and desires of a person. Money, Drugs, Time off Work!!!

Symptom Defined Syndromes

! Chronic fatigue syndrome ! Fibromyalgia ! Irritable bowel syndrome ! Multiple chemical sensitivities ! Gulf-war syndrome ! Cancer-related Fatigue syndrome ! Adjustment disorders

Hypochondriasis

- May have many questions and concern about all sorts of physical complaints - Looks very much like Somatoform Illness - Preoccupation is on having an illness, not on the symptoms as it is in somatoform (I am going to die.. not sure exactly how!!)

Treatment

1) lifestyle modification (diet, sleep, time management) 2) Stress management techniques (meditation, light and progressive exercise, social support groups) 3) Rehabilitation 4) Encourage taking responsibility for health 5) adjunctive therapies (spiritual, complementary therapies, treat comorbidities)

Body Dysmorphic Disorder

Imagined defect in appearance (my nose, face or bit on my body is ugly) -Preoccupation causes concern that impacts the social and occupational functioning -Can't be accounted for by another illness like anorexia nervosa -Kind of like OCD for that part of the body

Illness Behaviour

This is a broader term than just disease -encompasses all behaviours that are determined by illness (care seeking, treatment adherence, tolerating side effects) Psychological Factors ! Anxiety ! Need for explanation ! Need for control ! Personality ! Primary vs Secondary Gain ! Experience/Sick role ! Culture

Pain Disorder

This is really rare!! -Pain in various locations is the presenting complaint -Severe enough to warrant physical attention -Impairing social or occupational functioning

Primary Gain

This is the needs of the psyche that are being met when a person adopts the sick role to deal with the stressors of the outside world

Factitious Disorder

This is when you are all about taking on the sick role (Primary Gain) -Descriminated from conversion disorder by intentionally produced symptoms Keys -Not in complete control of symptoms -Aware that they are feigning symptoms somewhat -Usually experience a compulsion or irresistible need to assume sick role Features -Argue with staff over special treatment -Evidence of tampering with lab results -Self-inflicted injuries Treatment -Promote adaptive skills (psychotherapy?) -If you kick them out they will get anxious and depressed (let it happen then deal with it)

Conversion Disorder

This is when you have a stress response that goes out of control and produces something physcial -Can be positive or negative symptoms -Most commonly a neurological symptom Possible Responses: -Blindness -Hemiparesis -Sensory inhibition -Motor inhibition -Parkinsons Symptoms -You can often (play where is the lesion) Features -You can't find any anatomical reason for them -Not pain or sexual dysfunction -Patients are often highly suggestable Treatment -No point in confrontation -Reinforce positive aspects -Discuss the role of stress and look at therapies that accommodate and deal with it -Promote a coping focus -Diagnose and treat anything else

Somatization Disorder

This is when you have multiple system involvement Must Have: - 4 pain symptoms - 2 GI symptoms - 1 sexual symptom - 1 pseudo-neurological symptom

False Symptom Disorders

Unconsciously produced (Somatoform) - Somatization disorder, Conversion disorder, Pain disorder - Hypochondriasis - Body dysmorphic disorder Intentional production or exaggeration -Mental health days - Factitious disorder. - Malingering.

Maligering

• The essential feature of Malingering is that it is motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs. Common Features -Medico-legal -Discrepancy between subjective pains -Lack of cooperation -Antisocial personality disorder -Family history -Don't accept good prognosis -Self-inflicted injuries Treatment -Gentle confrontation -Can't endorse anything evidence dosen't allow you to do -Little point in getting angry -Explore alternative courses of action