Lecture 25 - Somatization D/o and Malingering Flashcards
what is the concept of somatization?
Concept: Somatization is the expression of psychological distress through bodily complaints
Somatic Symptom Disorder
Criteria for dx
how long does it have to latsed for?
Distressing somatic sx(s) that disrupt daily life ( symptoms that cannot be explained fully by a general medical condition or by the direct effect of a substance, and are not attributable to another mental disorder)
patient has persistent thoughts, anxiety, or devote excessive time to the symptoms or health concerns
6 months+
what may be associated with somatic symptom d/o?
An actual medical disorder - eg a patient had a low scale MI, and is now exhibiting symptoms and health concerns related to MI, but not caused by the MI,
Illness Anxiety disorder –
how is it different that somatic symptom disorder?
two specifier tpyes?
Patient has Preoccupation of having or acquiring serious illness
But Somatic symptoms are mild or absent
Excessive health behaviors
Not better explained by another disorder
> 6 months
care seekers vs care avoiders
Management of Somatic Symptom D/o and Illness Anxiety D/o
One primary physician Regularly scheduled appts Keep meds to a minimum Reassurance Address Co-morbidity No cure, but can improve functioning --
• Conversion disorder (aka Functional Neurologic Symptom D/o)
Criteria –
symptoms of altered voluntary motor or sensory function
but…incompatibility between sxs and recognized neuro or medical d/o
not better explained by anothre medical disorder
significant distress or impairment
what are some manifestations that persons with conversion d/o might complain of?
seizures paralysis, weakness Speech BLindlness Sensory loss
Explain some Dx clues that could help rule our neurological or other medical process and lead towards dx of conversion d/o?
EEG of a non epileptic sz would be totally normal
Aphonia – but the pt can cough
Paraplegic with intact reflexes
Comatose, but doesn’t allow hand to fall on face
Hoover’s sign
Some psycholical factors that might contribute to conversion d/o
Emotional stressor prior to onset
Model for symptoms (eg an epileptic patient who develops psuedoseizures)
h/o sexual abuse
Treatment of Conversion D/o
is the d/o conscious vs unconcious?
NON CONFRONTATIONAL reassurance, optimism, suggestion of stepwise improvement,
Resolve the psychosocial stressors; remove the secondary gain
Conversion – unconsciously produce the symptoms; ; not faking it; unconsciously driven
Factitious Disorder –
General definition -
Patient is consciously faking the disorder (eg purposeful infection, or injection of feces to become septic) in order to assume the sick role
but they don’t have an objective rewards
Eg - conciously creating symptoms but unconsciously driven
Criteria for Facticious D/o
Falsification of physical or psychological signs or symptoms (self injury, surreptitious medication, eg injecting themselves with insulin)
* Trying to gratify dependency, masochism, * A/w substance use, depression
what are the two subtypes of facticious and what are the difference?
Munchausen’s syndrome – “Hostpital Addicts, the wanderer” — usually male, lots of hospital visits, vague and evasive histories, Leave AMA when found out
Non munchausen’s type –
Females; non wandering; works in the health field
Leave AMA when found out
Making the dx of facticious d/o
Treatment?
○ The Diagnosis – Gather collateral, room search, cross check hospital records
○ Management – Establish rapport; present evidence; supportive confrontation; suggest psych eval
what is malingering ?
Conscious feigning of signs and symptoms for clearly identifiable external incentive or reward (avoid work, money, avoid prosecution, drugs)
consciously produced and consciously driven
