1 / 49

SOMATOFORM DISORDERS

SOMATOFORM DISORDERS. Group of disorders that includes physical symptoms for which an adequate medical explanation cannot be found Psychological factors --> symptom’s onset, severity, duration Not malingering or factitious disorder. 5 Specific somatoform disorders: Somatization DO

andrew
Download Presentation

SOMATOFORM DISORDERS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. SOMATOFORM DISORDERS

  2. Group of disorders that includes physical symptoms for which an adequate medical explanation cannot be found • Psychological factors --> symptom’s onset, severity, duration • Not malingering or factitious disorder

  3. 5 Specific somatoform disorders: • Somatization DO • Conversion DO • Hypochondriasis • Body Dysmorphic DO • Pain DO

  4. SOMATIZATION DISORDER • Hysteria, Briquet’s Syndrome • Many somatic symptoms • Multiple complaints and organ systems affected • Chronic

  5. Epidemiology • Lifetime prevalence = 0.1-0.2% • F > M (5-20X) = 5:1

  6. Etiology • Psychosocial factors - social communication • Biological factors - attention and cognitive impairments

  7. Diagnosis • Onset before the age of 30 years • Complain of at least 4 pain sxs, 2 GI sxs, 1 sexual sx, 1 pseudoneurological sx • No physical or laboratory explanation

  8. Clinical Features • Many somatic complaints; long complicated medical history • Psychological distress: anxiety, depression • Common suicidal threats • Medical history is circumstantial, vague, imprecise, inconsistent, disorganized

  9. Patients are dependent, self-centered, hungry for admiration or praise • Common associated mental DO - MDD, PD, SRD, GAD, phobias

  10. Differential Diagnosis • Non-psychiatric medical condition • Mental DO - MDD, GAD, schizophrenia • Other somatization DO

  11. Course and Prognosis • Chronic, debilitating • Onset before age 30 years

  12. Treatment • Single identified MD • Visits: regular, avoid additional lab/diagnostic procedures • Somatic symptoms - emotional expressions • Psychotherapy: individual, group

  13. CONVERSION DISORDER • One or more neurological symptoms (paralysis, blindness, paresthesias) • Psychological factors --> onset, exacerbation

  14. Epidemiology • F:M = 2:1 - 5:1 • Onset is any age (common during adolescence and young adults) • Rural population, little educated, low IQ, low SE group, military personel • Comorbid with MDD, anxiety, schizophrenia

  15. Etiology • Psychoanalytic - repression of unconscious conflict/anxiety --> physical sx Nonverbal means of controlling and manipulating • Biological factors - hypomentabolism of dominant hemisphere impaired hemispheric communication

  16. Diagnosis • Symptoms or deficits affecting neurological functions • Psychological factors --> onset, exacerbations • Not intentionally feigned or produced

  17. Clinical Features • Most common symptoms: paralysis, blindness, mutism • Most commonly associated with passive-aggressive, dependent, antisocial and histrionic PDs

  18. Sensory Sxs: anesthesia and paresthesia, esp extremities distribution usually inconsistent with central or peripheral neuro dse characteristic stocking and glove anesthesia or hemianesthesia (along the midline) organs of special senses - deafness, blindness, tunnel vision --> N neuro exam

  19. 2. Motor Sxs: abnormal movements, gait disturbance, weakness, paralysis generally worsen by attention 3. Seizure Sxs: pseudoseizure 4. Mixed presentation

  20. Other associated features: • Primary gain: represent an unconscious psychological conflict • Secondary gain: accrue tangible advantages & benefits • Le belle indifference: unconcerned about what appears to be a major impairment • Identification: unconsciously model their sxs on those someone important to them

  21. Differential Diagnosis • Rule out medical disorder: thorough medical and neuro work-up • 25-50% diagnosed with conversion DO --> neuro or non-psychiatric medical DO • Neuro DO - dementia, brain tumors, degenerative dse, basal ganglia dse • Psychiatric DO - schiz, deprssive DO, other somatoform, malingering, factitious DO

  22. Course and Prognosis • 90-100% resolve in few days to less than a month • Good prognosis: sudden onset, easily identifiable stressor, good premorbid adjustment, no comorbid psychiatric or medical DO • 25-50% --> neuro or non-psychiatric DO

  23. Treatment • Spontaneously resolve • Insight-oriented supportive or behavioral therapy

  24. HYPOCHONDRIASIS • Unrealistic or inaccurate interpretations of physical symptoms or sensations --> preoccupation and fear that they have serious disease • Significant distress; impaired function

  25. Epidemiology • F = M • Onset at any age

  26. Etiology • Misinterpretation of bodily symptoms • Social learning model • Variant form of other mental disorder - depression and anxiety DO (80%) • Aggressive and hostile wishes

  27. Diagnosis • Preoccupied with false belief based misinterpretation of physical s/sxs • At least 6 months • Not a delusion or restricted to distress of appearance

  28. Clinical Features • Believe that they have a serious disease not yet detected • Conviction persist despite negative lab results, benign course, reassurances • Usually with depression and anxiety

  29. Differential Diagnosis • Non-psychiatric medical condition • Other somatoform disorders • MDD, anxiety DO, schiz, other psychotic DO

  30. Course and Prognosis • Episodic, months to years • Good prognosis: high SE class, treatment-responsive anxiety or depression, sudden onset, (-) PD, (-) related non-psychiatric medical condition

  31. Treatment • Usually resistant to psychiatric treatment • Focus on stress reduction and education in coping with chronic illness • Group psychotherapy • Regular scheduled PE

  32. BODY DYSMORPHIC DO • Preoccupation with an imagined bodily defect or an exaggerated distortion of a minimal or minor defect • Causes significant distress; impaired function

  33. Epidemiology • Rare; poorly studied • Most common age of onset: 15-30 yo • F > M, unmarried • Commonly coexists with other mental DO (MDD, anxiety, psychotic DOs)

  34. Etiology • Serotonin • Cultural and social effects • Psychodynamic models

  35. Diagnosis • Preoccupied with an imagined defect in appearance or an overemphasis of a slight defect • Significant emotional distress; impaired functioning

  36. Clinical Features • Most common concerns: facial flaws • Common associated symptoms: ideas of reference, attempts to hide deformity, excessive mirror checking or avoidance • Avoid social or occupational exposure • Housebound; attempt suicide • Traits: O-C, schizoid, narcissistic PD • Comorbid: depression, anxiety DO

  37. Differential Diagnosis • Anorexia nervosa, gender identity DO, brain damage • Delusional DO, somatic type • Narcissistic PD, depressive DO, OCD, schizophrenia

  38. Course and Prognosis • Gradual onset • Usually chronic

  39. Treatment • Serotonin-specific drugs - clomipramine, fluoxetine • Treat coexisting mental DO

  40. PAIN DISORDER • Psychogenic pain DO • Pain in one or more sites --> no non-psychiatric medical or neurological condition • Emotional distress; functional impairment

  41. Epidemiology • F > M • Peak onset on 4th to 5th decades • Blue-collar occupation, 1st degree relatives

  42. Etiology • Psychodynamic: expression of intrapsychic conflict defense mechanism-displacement, substitution, repression • Behavioral: reinforced with reward and inhibited when ignored/punished • Interpersonal: manipulation and gaining advantages • Biological: 5HT and endorphins

  43. Diagnosis • Significant complaints of pain • Emotional distress and functional impairment

  44. Clinical Features • Collection of different histories of various pains • Pain maybe post-traumatic, neuropathic, neurological, iatrogenic, musculoskeletal • (+) psychological factor • Long history of medical and surgical care, visits many MDs, requests many meds • Complicated by SRD • MDD: 25-50% of patients • Dysthymic or depressive DO sxs - 60-100%

  45. Differential Diagnosis • Physical pain VS Psychogenic pain • Physical Pain: fluctuates in intensity, highly sensitive to emotional, cognitive, attentional and situational influence • Psychogenic Pain: does not vary, insensitive to any of above factors, does not wax or wane, not temporarily relieved by distraction • Other somatoform DO

  46. Course and Prognosis • Abrupt onset and increases in severity

  47. Treatment • Address rehabilitation • PAIN IS REAL • Pharmacotherapy - antidepressant • Behavioral therapy • Psychotherapy • Pain control program

  48. UNDIFFERENTIATED SOMATOFORM DO • One or more physical complaints that can’t be explained by known medical condition • Doesn’t meet the diagnostic criteria for any somatoform DO • At least 6 months • Significant emotional distress and impaired functioning

  49. 2 types of somatoform pattern: • Involving ANS: CV, GI, urogenital, derma sxs • Involving sensations of fatigue or weakness (neurasthenia): mental or physical fatigue, physical weakness and exhaustion

More Related