Download Somatoform disorders (part 1)

Somatic symptom disorders
21st Nov. 2015
Dr. SAMI ADIL
•MUPS = SAD
•Stress
•Defined negatively rather than positively
•with or without medical dx
•No FDA approved drug
DSM-5 Somatic Symptom Disorders
1. Somatic symptom disorder
2. Illness anxiety disorder
3. Conversion disorder (Funcitonal Neurological Symptom)
- psychological factors affecting medical condition
- Factitious disorder
- Other
• The prevalence rates differ across countries and times.
It is generally believed that their prevalence is
decreasing in developed countries.
• Mosul 5 yrs UK before 1950 (1).
• In a study about the use of traditional and
spiritual healers is was found that 35.1% of the
cases who go to those healers were complaining
of somatoform disorders, while 24.8% of the
cases were having schizophrenic disorders (2).
• There is no FDA approved drug for any of the somatic
symptom disorders
Somatic Symptom Disorder
One or more symptoms
Distress and functional impairment
Disproportionate ABC
With or without medical dx
epidemiology
• intro
Etiology: unknown
• Low threshold … cognitive
• Sick role in face of problems
• Variant of mental illness
• Aggression turned inward (repression and displacement)
Diagnosis:
• A false belief, not to the degree of delusion, that they
have serious illness based on misinterpretation of
physical signs or sensations. The belief must last at
least 6 months despite the absence of pathological
findings. This should not be restricted to distress
about appearance.
• Specify if: with predominant pain.
Ddx.:
1.
Medical illnesses that are difficult to diagnose (e.g. endocrinopathies, MD,
occult neoplastic disorders)
2.
Illness anxiety disorder in which there is no symptom, but only the fear.
3.
Conversion disorder is acute and neurological, and the patient is not
concerned about being ill (la belle indifference).
4.
Body dysmorphic disorder.
5.
Mood disorders (depression).
6.
Anxiety disorders (panic).
7.
Psychotic disorders.
8.
Malingering and factitious disorders.
Treatment
• One physician …. scheduled visits
• Patients can develop real physical illnesses
• Psychotherapy: insight-oriented, cognitive behavioral, and
group psychotherapy all can be helpful. Hypnosis is also
helpful sometimes. See the note in the introduction about
spiritual healers.
• Medication can lead to abuse
2. Illness Anxiety Disorder
• Persistent, excessive thoughts and feelings about
having a serious physical illness; not reassured. Few or
no somatic symptoms. Essential feature is
preoccupation with being ill. It may be present with or
without medical diagnoses.
• Epidemiology: mostly unknown.
• Etiology: similar to etiology of somatic symptom
disorder.
• Dx. the belief must last at least 6 months. No
physical findings. Not delusional, not body
dysmorphic disorder. Causes distress and/or
dysfunction.
Ddx:
(i)
(ii)
(iii)
(iv)
(v)
Other somatic symptom disorder
Mood disorders
Anxiety disorder
Psychotic disorder
OCD
3. Functional Neurological Symptom
Disorder (Conversion Disorder)
•Hysteria
‫مسمر‬
Franz Anton Mesmer
1815-1734
‫تختفي األعراض حين نتذكر أول نشأتها‬
‫تختفي األعراض حين نفهم سبب نشأتها •‬
Funct. Neuro. (conversion)
•Usually occurs acutely after stress, then
resolves within 2 weeks. The sx
resemble neurological symptoms (either
sensory, motor, seizure, or mixed )
Epidemiology:
• paragraph in the introduction above taken from reference
no. 1.
• More in left side
• Two to 10 times more common in females.
• The onset is rare before 10 years of age or after 35 years of
age.
• Rural, little education, low IQ, those in low SES, and military
personnel who have been exposed to combat situations.
Etiology:
• Previous experience (such as childhood abuse) is
a predisposing factor, psychological or physical
trauma is a precipitating factor, and special
rewards for disability a perpetuating factor.
• Brain-imaging studies have found hypometabolism of
the dominant hemisphere and hypermetabolism of
the nondominant hemisphere and have implicated
impaired hemispheric communication in the cause of
conversion disorder.
Clinical features
• Paralysis, blindness, and mutism
• Neurological exam (-ve)
• Pseudoseizures
• Primary and seconday gain
• La belle indifference
• Paralysis --- hoover test
• Aphonia – ask to cough
• Patient’s dignity
ddx
•Neurological disorders (25-50%)
•Other somatoform disorders
•Malingering and factitious
Slater BJP
Course and prognosis
•Acute, spontaneuous
Treatment
•Spontaneous
•Abreaction
•Spiritual healers
• In my opinion, sometimes the conversion cases are
met with negative attitude by the medical staff and
receive some punitive treatments like the painful I.M.
normal saline injection, or injections of furosemide
(Lasix) and this is unethical.
What is Evidence Based Medicine??? Can we write in our
lectures things like (in my opinion….)??
• End of part one