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Somatoform & Factitious Disorders. Factitious Disorder. Physical or psychological Sx that are intentionally feigned for the purpose of fulfilling an intrapsychic need to adopt a sick role. Presents history very dramatically with vague & inconsistent details

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Factitious Disorder

  • Physical or psychological Sx that are intentionally feigned for the purpose of fulfilling an intrapsychic need to adopt a sick role.
  • Presents history very dramatically with vague & inconsistent details
  • When confronted with evidence of inconsistencies, will deny allegations and often avoid further evaluation
  • These individuals have frequently had numerous surgeries or other invasive medical procedures.
factitious disorder
Factitious Disorder
  • Primarily physical
  • Primarily psychological
somatoform disorders
Somatoform Disorders
  • Presentation of physical symptoms that suggest a physical disorder
    • Symptoms not fully explained by:
      • The medical condition
      • Substance use
      • Another mental disorder
  • Must judge the onset, severity, and duration of symptoms for proper diagnosis
somatoform disorders6
Somatoform Disorders
  • Somatization disorder
  • Conversion disorder
  • Hypochondriasis
  • Body dysmorphic disorder
  • Pain disorder
  • Two other residual categories
somatization disorder
Somatization Disorder
  • History of many physical complaints beginning before 30. Very chronic course and result in tx being sought or significant role impairment.
  • During a episode, the following must occur
    • 4 pain sx
    • 2 GI sx
    • one sexual sx
    • and 1 psuedoneurological sx
somatization continued
Somatization continued
  • Not due to GMC or
  • When related to GMC, the resulting social or occupational impairment are ins excess of what would be expected from physical exam, history, or labs
somatization d o epidemiology
Somatization D/O-Epidemiology
  • Rare in men; much more common in psychiatric patients
  • More among low SES groups and EMs
  • 20% of 1st degree female relatives of these pts. will have a somatization d/o.
  • Differentials
first aid for somatizers
First Aid for Somatizers
  • Recent study found that a brief psychiatric consultation followed by a letter to the doctor greatly reduced cost and somaticizing tendencies.
  • Schedule brief appointments and Phx. Exams every 4 to 6 weeks; only at set times and NOT on demand; avoid lab tests, surgery and hospitalization unless absolutely necessary and avoid suggesting that the problems are all in his/her mind
  • Charges fell 25 to 33% as did subjective pain Smith, Rost & Kashner (1995). Archives of General Psychiatry, 52.
case example
Case Example
  • 44 year-old African American pt. With reported history of recent TBI in which he was kicked in the back of the head and everything went black.
  • NP Testing: MMSE=13, poor memory and exec. functioning. Language intact
  • Presentation and follow-up
conversion disorder
Conversion Disorder
  • Usually a single motor or neurological symptom with symbolic meaning that affects voluntary motor or sensory function.
  • Frequently primary (protects) or secondary gain (gratifies).
  • Sudden onset of symptoms (usually a temporal relationship)
conversion d o etiology prevalence
Conversion D/O Etiology & Prevalence
  • Equal in men and women
  • More common in lower SES groups and in subcultures that consider these symptoms as being expectable
  • Often medical impossibilitythat confirms their conceptualization of CNS function
conversion d o treatment
Conversion D/O Treatment
  • Important to rule out GMC such as Multiple Sclerosis and Lupus
  • Remove from situation, reinforce alternative coping strategies and occasionally hypnosis
pain disorder presentation
Pain Disorder-Presentation
  • Symptoms are usually initiated by an acute stressor, erupt suddenly, intensify over the next several days or weeks and subside when the acute stressor is gone.
  • Patients frequently have secondary gain (“doctor shop”) and have symptoms that worsen under stress.
pain d o epidemiology prevalence
Pain D/O Epidemiology & Prevalence
  • Initially afflict women more, but sex differences fall out after major depression is eliminated.
  • More common in relative with pain problems and patients with physically demanding jobs.
pain d o treatment
Pain D/O Treatment
  • Acute management- giving insufficient narcotics leads to moderate and severe distress in 3/4 of the patients. Drs. fear addiction. Don’t give narcotics PRN!!
  • Chronic management- Cognitive behavioral therapy, pharmacotherapy and “team” tx.
hypochondriac
Hypochondriac
  • Overwhelming, persistent preoccupation with physical sxs. based on unrealistically ominous interpretation of physical signs or sx
  • Ex. Felix Unger
  • Affects both sexes equally; begins 20-30
  • La belle indifference
body dysmorphic disorder
Body Dysmorphic Disorder
  • Focus on obsession with perceived fault in physical appearance or imagined image
  • Greater in women (3:1)
  • Mood disorders usually come AFTER not before the sx of BDD
  • Treatment
    • Behavior therapy and serotonergic antidepressants (OCD variant?)