Psychiatry- First Aid and Class note combination (somatic disorders) – Flashcards

Malingering Disorder Factitious Disorder

Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder Pyschological factors affecting other conditions (not inFA)

patient consciously fakes/ exaggerates/ claims to have a disorder in order to get a secondary (external gain) i.e. avoiding work, obtaining compensation patient knows that he is producing the symptoms (conscious mechanism for symptoms) and knows why he is doing it (conscious motivation) complaints stop after you get what you want/ gain something (unlike factitious disorder)

A disorder in which the patient consciously creates the signs/ symptoms of an illness and misrepresents the history to assume the patient role and get medical attention (primary gain- internal) Patient is aware that their behavior is intentional (mechanism for the symptoms is clear/conscious) but the motivation behind the symptoms is unclear/ unconscious. may be for itself or by proxy may show physical or psychological symptoms or both

a real medical illness (causing the symptoms) a somatic symptom disorder causing the symptoms malingering disorder causing symptoms munchausen disorder causing symptoms

chronic factitious disorder with predominantly physical signs and symptoms there would be a history of multiple hospital admissions and a willingness to receive invasive procedures

a parent usually the mother simulates illness in a child or elderly patient in order to assume the sick role by proxy form of child abuse or elder abuse Also called "factitious disorder imposed on another"

occurs more in women than men patients have medical backgrounds (i.e. nurse practitioner, etc) patients can travel from place to place and assume medical roles/ simulate different illnesses

psychoDYNAMIC 1) Hospital seeking 2) Difficulty recognizing self boundaries to take on the patient role 3) seeking painful procedures for self punishment

1) recognize it (watch them with a video) 2) verify their past medical history 3) minimize the procedures performed on them 4) one primary physician only; their main role might be to help the medical staff deal with their own counter-transferrance/ anger towards their patient ***confronting the patient is debated

it's a chronic condition with a poor prognosis because the episodes increase in frequency the patient may get incapacitated because of their own illness behavior and adverse reactions to the treatment that docs give them.

early adulthood, often after an illness or loss

category of disorders characterized by physical symptoms with no identifiable physical cause, but they're NOT feigned mechanism for symptoms is unconscious motivation for producing the symptoms is unconscious / unintentional Types Somatic symptom disorder Illness Anxiety Disorder Conversion disorder Psychological factors affecting conditions

1. Medical disorder (real disease) 2. Other disorders in the same family (illness anxiety, conversion, somatic symptom, psychological factors) 3. Factitious disorder / malingering disorder 4. Psychiatric disorders (panic- episodic; OCD, Generalized anxiety disorder, Delusional disorder, depression)

chronic disorder (more than 6 months) associated with excessive thoughts/ anxiety about symptoms as well as functional impairment *could be pain* they usually are poor "historians" i.e. give a poor history which can be frustrating and present dramatically they often coexist with other psychological illnesses (depression, anxiety, personality disorder) and alcoholism/ substance abuse if pain is the symptom that predominates associated with psychological distress or interpersonal problems ***increased symptoms / complaints during times of stress

1) highly prevalent in women; more common in women than men by a lot 2) familial pattern 3) causes higher medical expenses and occurs a lot in primary care patients 4) common in low SES

unknown cause but could have both genetic and environmental causes 1) psychoSOCIAL theory- avoid obligations 2) behavioral- learned from parents / care givers 3) biologic- their brains look different from others

1) chronic disease 2) worsened during times of stress 3) prognosis is poor, cure is unlikely 4) goal is to decrease medical procedures

preoccupation with and fear of having a serious illness despite no medical evidence of illness on evaluation/ reassurance from physician *symptoms are absent, or if they're absent they are mild compared to the patient's level of concern Characteristics of patients 1) specific diseases are feared, but fear can shift from one disease to another 2) multiple medical opinions are sought and complaints about care are common 3) could lead to excessive health related behavior (going to doctor frequently) or avoidance of health related behavior (avoiding doctor)

somatic symptom: Women > men illness anxiety disorder: women= men conversion disorder: women > men

20-40

1. amplification of symptoms 2. learned behavior 3. symptom of another psychiatric disorder 4. psychoDYNAMIC theory- deserved punishment for something they did bad

1) episodic, with anxiety occurring during times of stress 2) 1/3-1/2 of patients improve with time

a disorder of a real neurological symptoms (i.e. sudden loss of sensory or motor function- paralysis, blindness, mutism, seizures, mixed) but findings aren't associated with a neurological disorder **symptoms are unconsciously modeled after someone they've seen and are sometimes not medically accurate also known as functional (not organic!) neurological symptom disorder **you may or may not find a psychological cause of it, but usually you do and it's an acute stressor "la belle indifference"- patient aware but indifferent towards symptoms

1) women > men 2) onset throughout life, but non epileptic seizures occur in 20s, and motor symptoms occur in 30s 3) stupid/ poor people- low SES, rural population, medically unsophisticated 4) psychopathology coexists- major depression, anxiety, personality disorder, dissociative disorder)

1) PsychoANALYTIC- easier to develop symptoms to deal with the underlying stressor than deal with it 2) biological changes (neuropsych testing diffs)

1) mostly resolves but sometimes can recur 2) longer the symptoms last, the poorer the prognosis *chronic symptoms can lead to disability 3) receipt of disability benefits worsens the prognosis 4) young children do better than adolescents/ adults

1) medical condition present but psych factors worsen it Example: inconsistent adherence to a med, anxiety leading to worsened asthma symptoms, ignoring MI symptoms to worsen your life expectancy

1) care not cure (psychosocial problems not physical symptoms) **don't try to eliminate symptoms, focus on coping 2) one physician to manage care and schedule brief but regular visits; be empathetic to minimize doctor shopping 3) minimize use of psychotropic drugs (no meds work and patients become dependent especially to sedatives and hypnotics) 4) provide psychotherapy i.e. talk therapy 5) minimize procedures and diagnostic tests (reduce $$, iatrogenic complications, review records before ordering tests, consider benign remedies that are free) 6) for pain somatic symptoms: use multidisciplinary, multi modality treatment

the process by which a person consciously or unconsciously uses body or bodily symptoms for psychologic purposes or gain (both the somatic symptom disorders and the gain disorders)

medical not mental health clinics; outpatient.