Somatoform Disorder: physical symptoms w/o physical findings and physiological mechanisms that may account for the

e symptoms 5 subtypes i. ii. iii. iv. v. Somatization disorder Hypochondriasis Conversion disorder Pain disorder Body dismorphic disorder Hypochondriasis Fear of having a serious physical ds Due to misinterpretation of normal body symptoms Fear persists even with medical reassurance Interfere with social & occupational fx May interpret normal fx / minor abN (tension h/a etc) as evidence of serious ds Fear of serious ds may involve -multiple organ systems OR -organ systems in succession OR -some will center on single organ system Clinical features 1) pt has seen many physicians, sometimes simultaneously 2) anxious and distressed 1) patient strongly believe and cant be reassured to the contrary, despite negative lab result 2) commonly association: 1) Most common conversion symptoms *paresis: incomplete paralysis *paralysis *aphonia-loss of voice *seizures 1) Symptom: is limited to physical pain 2) Dx: pain with at least 6 m duration + absence of physical findings 3) onset: may begin at any Conversion disorder Presence of neurological symptoms that cant be explained by a known neurological and medical disorder Pain disorder Prolonged severe discomfort w/o adequate medical explanation Body dysmorphic disorder Preoccupation with imagined defect of appearance OR exaggerated distortion of minimal/minor defect in physical app. Typically focus on Skin wrinkle/blemishes Facial hair shape of nose,mouth,jaw

Somatization disorder Multiple physical symptoms involving multiple organ systems Is a chronic disorder -Recur over period of several years Unrelated to identifiable physical findings Can be grossly in excess of physical finding (more that whats expected)

3) onset: usually before 30 y.o 4) symptoms are multiple and recurrent 5) majority are women 6) strong familial tendency

anxiety, depression, compulsive personality trait 3) onset: usually begins in adolescent but may not begin until 4th decade(man) and 5th decade (woman) 4) usually chronic 5) Women=men

*blindness *numbness 2) Dx of conversion isnt made when -physical symptom is limited to pain OR disturb. in sexual fx -when physical symptoms occur as components of somatization d/o -need evidence of psyco.factor to dx 3) onset: often abrupt; may begin at any age but often in adolescent or early adulthood 4) may occur as 1 episode, Or may recur over lifetime 5) duration: most often short 6) resolution: rapid 7) symptoms extremely disruptive, pt tend to spend unnecessary cost 8) may develop actual physical problem Eg: conversion paralysis disuse atrophy 9) la belle indifference:

age but often in adolescent or early adulthood May begin suddenly and severity over days/weeks May resolve spontaneously / with tx/ become chronic despite tx

Pt seem to be unconcerned about major impairment Eg; not worry about blindness that happened instead, worry about house payment after bf left DSM-IV criteria A) Many physical complaints before 30 y.o; over period of yrs sought of Tx + fx impairment B) 4 pain symptoms + 2 GIT +1 sexual + 1 pseudoneurological symptoms C) Either i) symptoms cant be explained by known medical cond. after appropriate Ix ii) physical complaints are in excess of what would be expected from history, PE, and lab findings D) Symptoms are not intentionally feigned (pretended)/ produced factitious disorder or malingering where symptoms are made up Treatment Objective: To limit unnecessary medical procedures and facilitate Treatment 1) usually resistance to psychotherapy ; should only be Analgesic can cause substanceabuse/dependence Often misuse: sedative & Serotonin specific drugs: clomopromine & fluoxetine reduce symptoms in 50% pts DSM-IV criteria A) fear of having a serious ds B) idea persists despite appro. medical evaluation and reassurance C) not delusional and as in body dysmorphic d/o D) cause clinically significant social/occupational fxs E) 6 months F) 1) pt knows its exaggerating 2) will often seek tx/surgical correction for the perceived anomaly

pts acceptance of psychiatric Tx 1) Dr should listen carefully for the psychosocial cues from pt 2) Dr should provide clear feedback to pt about lack of physical finding in PE 3) Limit Ix to those deemed medically necessary only 4) Reassure pt that theres no organic basis for the symptoms, as reassurance with negative result is often impossible 5) Consolidate pts care under a single drhelp to limit unnecessary consultations/tests

2)

offered to highly motivated, insightful pt frequent , regularly scheduled PE reassurance to pts

anti-anxiety Useful: anti-depressant eg TCA , SSRI