Psychosomatic

Factitious Disorder (AKA Munchhausen)

Patients stimulate, induce, or aggravate illness to receive medical attention, regardless of whether or not they are ill. Inflict painful, deforming, or even life-threatening injury on themselves. Unusual, dramatic presentation of symptoms that defy conventional medical or psychiatric understanding. Symptoms do not respond appropriately to usual treatment or medications, emergence of new, unusual symptoms when other symptoms resolve, extensive medical hx or evidence of multiple surgeries. Primary motivation is not avoidance of duties, financial gain, or anything concrete but instead to receive medical care and to partake in the medical system.

Factitious Disorder by proxy

Person stimulate, induce, or aggravate illness to receive medical attention, regardless of whether or not they are ill. Inflict painful, deforming, or even life-threatening injury to others; their children, other dependents of people in their care. The deception may involve a false medical history, alteration in records, or induction of injury and illness in the child -Both the family and the child need to be treated -One apparent purpose of the behavior is for the caretaker to indirectly assume the sick role; another is to be relieved of the caretaking role by having the child hospitalized

Psychosomatic disorders and stress

Stress can lead to neurological symptoms of anxiety, delirium and dementia were added to this category b/c they have behaviors that are stress-related -Chronic fatigue syndrome and fibromyalgia are NO LONGER in this group

What does "psychosomatic" mean?

Psycho = "Soul" Somatic = "Body" MEANS: "The Mind-body connection" -How the mind effects the body

This once prevalent phenomenon has dropped significantly in prevalence since the now public knowledge of mothers doing this on purpose to their infants... And better knowledge of how to appropriately position your child...

SIDS

Factitious Disorder Prevalence

Seen in higher prevalence in healthcare workers and mothers. -There is now a databank of persons who feign illness to alert hospitals about such patients, many of whom travel from place to place, seek admission under different names, or simulate different illnesses

Factitious Disorder: Childhood

Case reports indicate that many of these patients suffered childhood abuse or deprivation, resulting in frequent hospitalizations during early development, an inpatient stay may have been regarded as an escape from traumatic home situations, and the patient may have found a series of caretakers (e.g. doctors, nurses, etc.) to be loving and caring -illness is thought to recreate the desired positive parent-child bond

Many people with factitious disorder have..

Comorbid psychiatric diagnoses EX: mood, personality, substance related disorders

*According to our in class notes, these patients simulate, induce, or aggravate an illness to receive medical attention for the purpose of being nurtured... NOT for financial gain...

Factitious Disorder

Proportion of the general population that have factitious disorder

1%

Major goal in the treatment of factitious disorder

1. Reduce risk of morbidity and mortality 2. Address underlying emotional needs or psychiatric diagnosis underlying factitious illness behavior 3. Mindful of legal and ethical issues **The SINGLE MOST IMPORTANT factor in successful management is the physician's early recognition of the disorder

Hypochondrias or Somatic symptom disorder

6 or more months of general and non delusional preoccupations with fears of having, idea that one has, a serious disease based on persons misinterpretation of body symptoms.

What percentage of SIDs cases were though to be by Proxy?

80% (8/10)

Proportion of people in the hospital that have factitious disorder at one time

9%

Stress related GI problem

Highly associated with psychiatric condition, link between psychiatric disorders and GI somatic symptoms Psychological and psychiatric factors commonly influence onset, severity and outcome of GI disorders.

Factitious Disorder: Treatment

Individuals do not respond well to cognitive behavioral treatment b/c they want to be loved and nurtured -OTs encourage these individuals to get a broader range of support -Small doses of antidepressants have been effective in treatment

Pain Syndrome

Is now a somatic symptom disorder, was in it's own diagnostic category in previous DSM. Characterized by presence of, and focus on, pain in one or more body sites and is sufficiently severe to come to clinical attention. Psychosocial factors are necessary in severity or maintenance of pain, which causes significant distress, impairment or both.

To be diagnosed with a psychosomatic disorder

Must rule out all other disorders to be diagnosed with this

Psychosomatic Disorders

NOT what public describes as "all in your head", APA deleted psychophysiological (psychosomatic) due to this and replaced it with psychological factors affecting physical conditions. But continues to be used. Relationship between chronic medical conditions and psychiatric disorders, better understanding pathophysiologic relationships. Fatigue, chronic pain. Psychiatric morbidity 20-67% Depressive disorder 2x as common Delirium 18% of Pts -Psychiatric illness worsens the condition

Fibromyalgia

Pain and stiffness to soft tissues such as muscles, ligaments, tendons but also have anxiety, depression and GI problems -any kind of pain syndrome -GI problems