Download hypochondriasis

 A middle-aged man is chronically preoccupied with his
health. For many years he feared that his irregular bowel
functions meant he had cancer. Now he is very
preoccupied about having a serious heart disease, despite
his physician’s assurance that the occasional “extra
beats” he detects when he checks his pulse are
completely benign.
 What is his most likely diagnosis?
A. Somatization disorder
B. Hypochondriasis
C. Delusional disorder
D. Conversion disorder
Hypochondriasis
(Illness Anxiety Disorder)
PSYCHIATRY
FATIMAH ALMUHANNA
ID:131220197
Objectives :
 Definition
 Associated Features
 Associated Psychiatric Disorders
 Epidemiology
 Aetiology
 Differential Diagnosis
 Comorbidity
 Course and Prognosis
 Management
Hypochondriasis
Hypochondriasis is the preoccupation (
) with the fear of having a serious disease
(e.g. cancer, organ failure, AIDS, etc.) which
persists despite negative medical investigations and
appropriate reassurance with subsequent distress
and impaired function.
Associated Features:
 Doctor – shopping and deterioration in doctor-
patient relationships, with frustration and anger on
both sides.
 The patient often believes that he is not getting a
proper medical care and may resist referral to
psychiatry.
 Physical complications may result from repeated
diagnostic procedures.
 Family and social relationships may become
disturbed because the patient expects special
consideration.
Associated Psychiatric Disorders:
 major depression
 dysthymic disorder
 generalized anxiety disorder or adjustment
disorders
 Most of such patients have obsessional and anxiety
personality traits.
Epidemiology:
 Age: it can begin at any age. However, onset is
thought to be most common between 25 – 45 years.
 It is thought to be more common in men, and those
closely associated with the disease (e.g. relatives of a
patient with cancer).
 The true prevalence is uncertain, but it is common
amongst patients attending general medical
clinics.?????
Aetiology
 No specific cause has been detected, however, there are
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some etiological theories:
There may be a history of childhood illness, parental
illness, or excess medical attention-seeking in the
parents.
Childhood sexual abuse and other emotional abuse or
neglect are associated.
In one etiological model, individuals with a combination
of anxiety symptoms and predisposition to misattribute
physical symptoms, seek medical advice.
The resulting medical reassurance provides temporary
relief of anxiety which acts as a ‘reward’ and makes
further medical attention-seeking more likely.
Differential Diagnosis:
 1. Physical diseases (e.g. endocrinopathy).
 Somatization disorder (the focus is on the symptoms
and not on the over concern with a disease).
 Underlying other psychiatric disorders (depression –
anxiety).
 Monosymptomatic hypochondrical delusion : e.g.
delusion of internal parasitosis or disturbance of
body image.
This delusion can be part of any psychotic disorder,
e.g. schizophrenia.
Comorbidity
 High (>50%) incidence of generalized anxiety
disorder.
 Also coexist with major depressive illness, OCD, and
panic disorder.
Course and Prognosis
 Usually chronic course with waxing and waning
symptoms.
 Complete recovery occurs in some cases specially if
there is underlying depressed or anxious mood.
 Presence of personality problems are unfavorable
prognostic factors.
Management
 1-Exclude a possible organic pathology.
 Search for and teat any underlying depression or anxiety.
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(Hypochondriasis often will improve when these conditions are
treated), exclude substance abuse or thyroid problem (TSH).
2-A cognitive-educational approach:
provide a more realistic interpretation of complaints.
explain the role of psychological factors in symptoms origin
and fluctuation.
3-Pharmacological treatment :
From their clinical experience some psychiatrists suggest trial
of tricyclic antidepressant in all patients (even if no underlying
depressive features).
Try fluoxetine 20mg, increasing to 60mg, or imipramine up to
150mg.
Summary
References
Dr- mohammed
Al-sughyir
PreTest SelfAssessment and
Review – Ninth
Edition
Oxford Handbook of
Psychiatry 3rd Ed