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what is the brief diagnostic criteria for somatisation disorder?
- 1. at least 2 years of multiple variable physical SYMPTOMS for which no adequate physical explanation has been found
- 2. persistent REFUSAL to accept advice/reassurance from several Drs that there is no physical explanation for the symptoms
- 3. impairment of social/family functioning attributable to symptoms and the resulting behaviour
what is undifferentiated somatoform disorder?
- the complete picture of somatisation disorder is not fulfilled eg not very forceful or dramatic or fewer complaints
- but must be no physical basis for symptoms
what is hypochondriacal disorder?
- need both 1 and 2
- 1. (can be a or b)
- a) persistent belief that theatre is at least one serious PHYSICAL ILLNESS underlying the presenting symptoms even though repeated investigations and examinations have identified no adequate physical explanation,
- b) a persistent preoccupation with a presumed deformity or disfigurement
- 2. persistent refusal to accept the advice and reassurance of several different doctors that there is no physical illness or abnormality underlying the symptoms
how can you differentiate between delusional disorder and hypochondriacal disorder?
- in hypochondriacal disorder - they do not have the same FIXITY as those in depressive and schizophrenic disorders with somatic delusions.
- A disorder in which the patient is CONVINCED that he or she has an unpleasant appearance or is physically misshapen should be classified under delusional disorder
what is persistent somatoform pain disorder?
- persistent severe and distressing pain
- not fully explained by a physiological process or physical disorder
- pain often assoc with emotional conflict or psychosocial problems of sufficient severity to suggest that they are the main causal factor
what is factitious disorder?
- conscious faking of symptoms to deceive doctors
- may do self inflicted cuts or injection of toxic substances or put blood in urine sample
- patient is aware of deception but little or no insight into motives
- motive is to stay in sick role
- usually assoc with marked abnormalities of personality or relationships
what is munchausen syndrome?
- form of factitious disorder 'hospital addiction'
- totally invented history
- usually present as emergency eg acute abdomen or haemetemesis
- may give false name
- aim to have intervention eg major surgery and often have multiple scars
what is munchausen by proxy?
- form of factitious disorder
- carer or parent fabricates illness symptom in a child or vulnerable adult
- form of child abuse
- can cause death of child!
what is malingering?
- faked illness where subject is conscious BOTH of making up symptoms and purpose or nature of potential gain
- eg benefits or medical discharge from work
what is dissociative (conversion) disorder?
- usually acute
- after major stress
- often dramatic eg fits, amnesia, blindness
- patients convert an unbearable emotion into a physical phenomenon eg really stressed and then claims she's paralysed but clearly isn't
- patients often not distressed by their symptoms - belle indifference
- the disorder may reduce initial psychological distress or also have secondary gains
how is factitious disorder different from dissociative (conversion) disorder?
- factitious: conscious
- dissociative: unconscious
in factitious disorder are patients conscious that symptoms are not of physical origin?
in factitious disorder are patients aware of motivation?
in malingering are patients conscious that symptoms are not of physical origin?
in malingering are patients aware of motivation?
in conversion disorder are patients conscious that symptoms are not of physical origin?
in conversion disorder are patients aware of motivation?
what is the definition of a medically unexplained symptoms?
person experiences a physical symptom for which NO CLEAR ORGANIC PATHOLOGY is found
what is somatisation?
person experiences and communicates psychological distress in the form of physical symptoms and seeks medical help for them
what are predisposing factors for somatisation?
- 1. stigma or unacceptability of presenting with or acknowledging psychological distress
- 2. history of parental illness or tendency to somatise during childhood
- 3. positive reinforcement of sick role during childhood
- 4. serious physical illness or physical/mental/sexual abuse in childhood
what are the 6 main principles of assessment in you suspect MUS?
- 1. explore pts belief systems about the symptoms
- 2. pts expectations for investigation or treatment
- 3. impact of symptoms on their life
- 4. why seeking help NOW in particular?
- 5. screen for psychological morbidity
- 6. screen for symptoms of depression (low mood, sleep, appetite, energy) and anxiety (as may indicate somatic presentation of psychological problems)
what is the way of assessing chronic MUS?
- 1. review past medical records esp if large look for recurring patterns
- 2. reassess psycho symptoms and treat
- 3. physical examination and investigation if new illness or symptoms
- remember few physical diagnoses result from further investigation more than 6/12 from 1st presentation
what are the various management strategies for chronic somatisation?
- 1. pt coping not curing
- 2. acknowledge reality of symptoms
- 3. empowering explanations (not rejecting)
- 4. aim to broaden the agenda with the pt
- 5. proactive not reactive eg arrange regular fixed interval appt
- 6. consistent approach amongst dr - eg have 1 dr
- 7. reduce drugs
- 8. avoid over ix
- 9. CBT, relaxation
- 10. realistic goals
- 11. support to return to normal life
what is the f:m ration in somatisation disorder?
what is the f:m ration in hypochondriacal disorder?