* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download SOMATOFORM DISORDERS 1. Define Somatoform Disorder
Eating disorder wikipedia , lookup
Rumination syndrome wikipedia , lookup
Spectrum disorder wikipedia , lookup
Comorbidity wikipedia , lookup
Munchausen by Internet wikipedia , lookup
Eating disorders and memory wikipedia , lookup
Bipolar II disorder wikipedia , lookup
Treatments for combat-related PTSD wikipedia , lookup
Generalized anxiety disorder wikipedia , lookup
Causes of mental disorders wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Child psychopathology wikipedia , lookup
Treatment of bipolar disorder wikipedia , lookup
Glossary of psychiatry wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
History of mental disorders wikipedia , lookup
SOMATOFORM DISORDERS 1. Define Somatoform Disorder: Formerly, “hysteria.” Patients unconsciously convert psychological or emotional distress into physical symptoms. Intermediate between “real” disease and clear simulation, a process of magnification and elaboration of physical responses to emotion. Psychological factors affecting medical condition. Runs in families, more common in women. 2. List and Describe the major clinical features of somatoform disorders, including: Somatization disorder: Characterized by a history of at least 8 physical symptoms, including pain, GI, sexual, and neurological symptoms, usually chronic, without discernible cause. Often, patients are Alexithemic, or unable to articulate their feelings, and demonstrate a low emotional awareness. Varies by culture, social factors, and learning. The primary gain of the somatization is to express unacceptable emotions as physical symptoms to avoid dealing with them. Secondary gain results from the attention gained by the patient’s symptoms, and the resulting abdication of responsibility. Conversion disorder: Symptoms replace conflict. The sudden, dramatic loss of motor or sensory function. For example, non-anatomic paralysis. Patients appear unconcerned about their serious physical symptoms: la belle indifference. Many have antecedent brain disorders. Symptoms occur in site of previous trauma in self or close other (i.e. where dad broke his arm). Common in unsophisticated patients. Example: “I woke up this morning blind, but I’m cool with it. I feel basically fine. By the way, I saw my husband with another woman last night. But like I said, no worries.” Hypochondriasis: Fear of having a serious illness. Similar etiology to other disorders characterized by recurrent unwanted thoughts and behaviors (like OCD). SSRI’s help. Equally occurs in men and women. Patients are hyperaware and hyper responsive to physiologic events. Ideational more than symptomatic. Patients often able to give an “organ recital,” listing their every bodily process. Body Dysmorphic Disorder: Imagined ugliness. Not to be confused with Anorexia Nervosa or transsexualism. Patients are preoccupied with minor or imagined physical defects in physical appearance, usually face or head. Plastic Surgeons’ worst nightmare, because they are rarely happy with results, and often find more physical reasons to be unhappy. Shares features of OCD, Depression. SSRI’s help, as does support and cognition and exposure therapy. Patients may specifically suffer from Muscle Dysmorphia: “I’m chronically scrawny,” or Body Integrity Identity Disorder: “I want my hand amputated.” Example of general BDD: “My nose is too big for my head, and my nostrils are shaped funny, and my first five surgeries didn’t do the trick, so I’m going back for more.” Somatoform Pain Disorders: Psychogenic pain, in the absence of tissue pathology. More frequently in women (onset 30s and 40s), associated with depression. May be chronic. Characterized by protracted, intense pain without physical explanations, may accompany a real but minor medical condition. Patients are at risk for pain medication dependency. 3. Discuss three clinical approaches to the management of somatoform disorders: Listen attentively to patient’s complaints, and review the symptoms with the patient. Make sure they know that their distress is real to you, the physician. Collect past medical records. Share with the patient how you are diagnosing him, what you are looking for, and establish are shared set of expectations. Schedule regular visits, at first weekly, then more spread apart, with one physician, not multiple specialists for every complaint. Listen to the patient’s complaints and discuss them, then move the discussion to more general topics, like current emotional and psychosocial stressors. Make functional goals, like in the management of pain disorders to minimize the impact of the pain on daily life, but not to increase pain medication or resolve pain. Also helpful may be a multidisciplinary approach, where all of the patient’s care takers are in communication, in order to prevent the patient from playing one against the other, or trying to get more meds. SSRI’s are also helpful for many of the subsets of somatoform disorders. Individual and group therapy help, as does hypnosis, behavioral and cognitive therapy. Relational therapy is based on the idea that somatoform disorders develop within the setting of the family, and should be treated in this environment. However, because most of these patients show up most frequently in the primary care setting, this is a good place to treat somatoform disorders. There is no cure, and symptoms often return in time.