USMLE Step 2 Psychiatry Somatoform Disorders Chp. 8

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What is the key to somatoform disorder?: think they have something wrong

present physical symptoms with no medical explanations
What problems do the somatoform patients have?: Always complaining

so problems in social and occupational activites
What is somatization disorder?: very easy
8 or more symptoms
4 pains (GI, pseudoneurological, shortness of breat, ringing in my ear, heart racing, pain during sex)
more women than men
Classic somatoform patient?: Young female from Low SES

begins by age 30
What is it associated with?: Personality Disorder
Long complicated medical histories
Never choose answer?: There is nothing wrong with you

never refer patient to another doctor
What do you need to do with somatoform disorder?: regular check-ups
single physician

Tx: Psychotherapy
need to fix their head
get their trust
Differential for Somatoform? medical: MS
Myasthemia Gravias
SLE
AIDS
Thyroid
Chronic Systemic Infection
What is the differential for somatoform (psychiatric)?: depression
anxiety
schizophrenia
What is conversion disorder?: Pat. experience a stressor
and then has symptoms

voluntary muscle

or sensory control
Classical conversion disorder?: Patient hears something bad and can't hear

patient sees something terrible and can't see

Pat. wants to hit somebody in the head and becomes paralized
What personalities are associated with conversion disorder?: dependent personality
passive-agressive
antisocial
histrionic

young female low SES
Psychiatric and physical symptoms?: neurological voluntary or sensory

usually paralisis (parestesia)
sensory mutism, blindess

Pseudoseizures
What is a real clue for conversion disorder?: la belle indeference,
the beautiful indiference

the patient doesn't share
unconcerned about disorder
What does identification or model?: knew someone that was paralized or blind

but patient doesn't hurt themselves
they don't hit themselves on walls
Tx of conversion?: Psychotherapy

ALso Amotal interview
Amobarbital
tells the truth
truth serum
What is associated w/conversion?: Malingering
What is the difference of somatization vs. hypochondriasis patient?: the hypochondriasis says they have a headache and you do a MRI or CT scan normal
but they still believe they have a brain tumor
What are the characteristics of hypochondriasis?: young patients
equal male/fem
What is the age of onset of hypochondriasis?: 20-30 year old
Tx of Pat. w/ hypochondriasis?: Psychotherapy
Somatoform pain disorder involves?: Pain
Risk Factors/Etiology?: Late in life

At least in 1 or more anatomic sites

pain is very distressing
Etiology of pain?: psychological factors
often submitted to surgery
Best Tx for Pain Somatoform?: BEST: Psychotherapy

Anti-depressants since patient have mood disorder

hypnosis, etc
Differential Diagnosis for Pain Somatoform?: Muscle contraction
Headaches
What is body dysmorphic disorder?: Patient who believes a part of his body is miss-shapen

defective, abnormal
What do the body dysmorphic disorder search for professionally?: Plastic Surgeons

Michael Jackson

patients cover/hide their "deformities"

Usually young women
What Neurotransmitter is linked to Bodydysmorphic Ds?: Serotonin
What is the TX for bodydysmorphic ds?: SSRIs

plus psychotherapy (individualized)
Symptom production?: Do you know as a patient where the symptoms are coming from
What is symptom motivation?: What do you know/drives these symptoms forward
Symptom production of somatoform?: Unconscious

No...
Symptom motivation for somatoform?: No

Unconscious

not trying to lie or be deceitful
Factitious Disorder?: Patients who have conscious productions of symptoms

medical or mental

faking both

fever, chills, pain, patient says it had blood in urine

(they will prick their finger when given pee cup)
What is another factitious disorder case? mental: Patient says they hear voices

they want to be admited to hospital and get treated

swallow glass, spoon, forks
Factitious Disorder person?: Physician Assitant
Nurse
or Pharmacist
Cardiologist (even if results are negative)
Psychiatrists
Patient history includes what?: Child abuse

Pat. was sick a lot in childhood
What is a common physical finding of factitious ds?: typically dridiron abdomen from multiple surgeries
What is a characteristic after being diagnosed?: they leave to another hospital
enraged

they will move to another state, city
Doctor must be aware of what condition?: countertransference

since it is a patient nobody wants
What personality is associated with factitious disorder?: Antisocial (they lie a lot)

histrionic(need for attention)
schizophrenia(bizarre behavior)
malingering
Ganser Sx
What is Ganser Syndrome involved in factitous disorder?: usually prison inmates

nearmissed answer to questions

what is the color of the sky? red

How many feet does a cat have? 8
What is malingering characterized?: Usually mother that fakes all symptoms of the child

notice blood in urine
mother places blood (from prick on finger) in the urine cup to get admitted

Child Abuse
REPORT TO AUTHORITIES
What is characteristic of malingering?: Disability cases (gain money)

Cold (homeless)
get something to eat

I'm hearing voices (shelter)

I hear voices to kill someone

Wearing women clothing (to get kicked out of army)
Is malingering conscious?: Yes
they don't know why

symptom production conscious
symptom motivation unsconscious
Risk Factors for malingering?: Malingering seen in prison
in order to get out of prison

factory and military settings also

to get out
What are the physical and psychiatric symptoms?: complain a lot
exaggerate

they are preocuppied with gain rather than alleviation of symptoms
Is malingering a mental disorder?: no
it is not a mental disorder
Tx of Malingering?: not a mental disorder

so must avoid confronting the patient

anger the patient

establish patient-relation
Malingering? Production? Motivation?: Production conscious
Motivation conscious

intentional

pat. wants to deceive you
What do you look in the question for somatoform dis.?: no alteration of physical
work-up tests negative
What must be present in malingering?: lawsuit
avoiding prison
trying to get out of military

look for a gain
What must be present in factitious dis.?: Physical findings

or Pscyhological Findings

will find glucose
edema or blood in urine
If the question says lost of symptoms?: Somatization
If it is just pain?: pain disorder
if you complain of only one part of your body?: body dysmorphic
if pat. has some traumatic experience and then develops symptoms?: conversion disorder
if pat. thinks he's got an illness and still not conviced even after surgical/tests done?: hypochondriasis

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