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somatoform disorder

psychatry
by

mooshy mohd

on 23 December 2012

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Transcript of somatoform disorder

C) HYPOCHONDRIASIS: Body-Dysmorphic Disorder E) Factitious disorder: B ) CONVERSION DISORDER : somatoform disorders Definition:

These are a group of disorders in which physical symptoms are the main complaints and cannot be explained fully by a general medical condition. What elements of history are suggestive of somatoform disorder ? somatoform disorders What elements of examination and laboratory studies are suggestive of
somatoform disorders?

Inconsistent physical examination or lab findings . Several unconnected, exaggerated,often strange medical complaints
that have been worked up by numerous physicians in the past without clear cause. Types of the somatoform disorders:

• Somatization disorder
• Conversion disorder
• factitious disorder
• Hypochondriasis
• dysmorphic disorder A) somatization Disorder : criteria for diagnosis of somatization disorder.. -onset prior age 30.

- more common in female than male .

- History of illness in the family or history of abusive relationships .

-Repressed instincts is thought to be a cause of
somatization disorder 1- History of seeking treatment for several physical complaints beginning before age 30 and
occurring over several years

2- Functional impairment .

3- Presence of each of the following at any time during the course:

_ Pain symptoms (four or more)
_ Gastrointestinal symptoms other
than pain (two or more)
_ Sexual symptom (one or more)
other than pain
_ Pseudoneurologic symptom (one or
more) other than pain

4- None of these symptoms are intentionally produced or feigned.
What is the key to successful treatment of somatization disorder?

1.Arrange brief regularly scheduled appointments, e.g. every month
2. Formation of a therapeutic doctor patient relationship.
3. Encourage graded return to normal activities Course and Prognosis:

•Conversion symptoms usually remit in a short time (hours, days).

•Recurrence is common.

•Good prognosis is associated with:

•acute onset.

•an obvious stressful precipitant.

•good premorbid personality.

•a short interval between onset and treatment.

•absence of other forms of psychopathology.
* Sensony:

• Special: visual disturbances (e.g. partial blindness), deafness, loss of taste, loss of smell. Symptoms are related to the neurological system: What is conversion disorder?

It involves an unconscious conversion of a psychological conflict into an acute loss of physical functioning, which suggests a neurologic disease . (motor or sensory deficit). * Motor:

1.Paralysis and paresis
2.Gait disturbances (astasia – abasia).
3.Tremor & rigidity.
4.Aphonia.
5.General: paraesthesia, anesthesia. * Others:

• vomiting.
• Pseudoseizures.
• muteness.
• Histirical attacks >> more in young girls -age group Early childhood to elderly populations.

-5:1 female to male ratio .

- Acute onset . Treatment:

• rule out medical causes
• Relaxation techniques
• Psychotherapy
• Reassurance that it will improve What is hypochondriasis?

Intense overconcern and preoccupation with physical health and / or excessive worry about having a serious physical disease (e.g. cancer, organ failure, AIDS, etc). Affect Middle to late age.

Equal among males and females. •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. How long must symptoms exist for the diagnosis of hypochondriasis to be made?

At least 6 months. What two psychiatric conditions most frequently accompany the diagnosis of
hypochondriasis?

1) Major depressive disorder.

2) generalized anxiety disorder. Management:

1. Exclude a possible organic pathology.
2. Search for and treat any underlying depression or anxiety. (Hypochondriasis often will improve when these conditions are treated).
3. A cognitive-educational approach:
•provide a more realistic interpretation of complaints.
•explain the role of psychological factors in symptoms origin and fluctuation. Symptoms :


person with this disorder Having a lot of anxiety and stress about the perceived flaw and spending a lot of time focusing on it, such as frequently picking at skin, excessively checking appearance in a mirror,seeking reassurance from others about how they look, and getting cosmetic surgery.
• Epidemiology:

Its seen equally in males and females
With onset usually in early 20s

Cormorbidity

Do you think pt with this disorde have another psychatric futures?

Yes

No

Like what ? :) •Body dysmorphic disorder is a type of mental illness, a somatoform disorder, in which affected person is concerned with body image, person is preoccupid about perceived defect of their physical features. Most common comorbid
disorder:

Major depreesive disorder
Social phobia
Obsessive_compulsive disorder
Substance abuse
Personality disorders •Management in general?

•1-acceptance (not reinforcement).
•2-explanation.
•3-investigation (necessity only).
•4-cognitive-behavioral therapy
•5-treat comobidities.
•N.B: patient is likely to be reluctant to accept psychiatic treatment. FACTITIOUS DISORDERS:

Psychiatric disorders characterized by intentionally produced physical pathology or faking psychological or physical symptoms with the apparent objective of being diagnosed as ill to assume the role of a patient or to challenge doctors.

more common in females 3:1, and more severe in men :) TYPES:

1. Factitious disorder with physical features.
2. Factitious disorder with psychological features
3. Factitious disorder with both physical and psychological features
4- not otherwise specified (factitious disorder proxy or munchausen by proxy)
Munchausen’s Syndrome (Hospital Addiction):

It is a severe form of factitious disorder in which a patient gives dramatic plausible stories of severe illness.

Attending a series of hospitals giving different names to each, undergoing unnecessary medical procedures or surgeries Munchausen’s Syndrome by proxy:

It refers to a form of child abuse in which a parent fabricates an evidence to suggest, falsely, that the child is ill.

A parent gives false accounts of symptoms, and may fake or inflict signs in the child.

The parent is the ill person who should be evaluated and treated. • Aetiology:

No known causes but the following factors have been reported to play a role:

Lack of a support system at home (illness of parent, loss of parent )
Depression
Dependence
Poor sense of self
Suicidal tendencies
Sexual/physical abuse
Extreme poverty/homelessness
Chronic lying
Chronic illness •Management: (No specific treatment has been effective)

•early recognition and intervention.
•carefully planned confrontation .
•close collaboration between psychiatrist and medical treating physician or surgical staff.
•the patient is helped to face reality. DONE BY:

1) Amal alshahrani..
2) Arrej alqarni
3) fatima alshahrani
4) Jamila alqhatani
5) maryam alshahrani
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