Psychosomatic Medicine Functional Neurological Symptom Disorder
How the mind affects the body Conversion Disorder
Psychosomatic medicine has evolved into a subspecialty Symptoms or deficits that affect voluntary motor or sensory functions Research has helped demonstrate the relationship suggesting another medical condition (sometimes pathological) between chronic medical Illness is preceded by psychological stressors conditions and psychiatric disorders Common symptoms: Treatments Involuntary movements, seizures, falling, weakness, Psychotherapy paralysis*, mutism*, anesthesia of the extremities, tunnel Psychopharmacologic vision, blindness*, deafness, urinary retention, diarrhea, vomiting Diagnosis Somatic Symptom Disorder Requires finding the association between the cause of the neurologic Hypochondriasis symptoms and the psychological factors >6m of a general and non-delusional preoccupation with fears of Cannot be due to malingering or factitious disorder having a serious disease based on a misinterpretation of symptoms Excludes symptoms of sexual dysfunction and pain Despite absence of pathological findings Only occur in somatization disorder (+) somatic symptoms Course: Low tolerance for physical discomfort 95% of acute (hospitalized) cases spontaneously remit within 2 wks Typically episodic disorder Common in pts >60y/o MC in pt 20-30 y/o Factitious Disorder Munchausen Syndrome DSM-5 Criteria Simulate or induce illness to receive medical attention A. 1 somatic symptom that is distressing Themselves B. Thoughts, feelings behaviors related to symptoms + 1 of the following By proxy on their children, other dependents 1. Persistent thoughts about severity of symptoms History: the patient or close relative was hospitalized when pt was a 2. Persistent high level of anxiety about health symptoms child for a real illness 3. Excessive time/energy devoted to symptoms or health concerns DDx: C.The state of being symptomatic is persistent, >6m Conversion disorder, personality disorders, schizophrenia, malingering, substance abuse Specifiers Suspicious Clues Predominant pain Dramatic presentation of symptoms abnormal Persistent (>6mo) Sx do not respond to tx Severity: New sx arise when others resolve Mild (one criterea in B) Eagerness to have a procedure Moderate (2) Refusal to sign releases/family contact info Severe (2 + multiple severe somatic symptoms) Extensive medical history/multiple surgeries Good prognosis is associated with Multiple drug allergies high SES Medical professionals tx responsive anxiety or depression Few visitors Sudden onset of symptoms Ability to forecast unusual progression/response Absence of personality disorder Absence of related non-psych medical condition Pain Disorder DSM-5, pain disorder is a variant of somatic symptom disorder Pain in the form of: Illness Anxiety Disorder LBP, HA, atypical facial pain, chronic pelvic pain, etc New diagnosis to the DSM-5 Generally chronic, distressing and disabling Preoccupation with being sick or developing a disease >6m Improved prognosis in pts who resume regular activities Variant of hypochondriasis Substance abuse/dependence common However few or no somatic symptoms are Tx: present antidepressants, Anxiety is incapacitating psychotherapy, biofeedback, pain control clinics DSM-5 Criteria A. Preoccupied with having/getting serious illness 6mo B. No/mild somatic SSx but preoccupied with getting illness dt other illness or FHx C. High anxiety about health status D. Excessive healthrelated behaviors (checking) or avoids dr appointments Specifiers E. Care seeking type F. Care avoidant type