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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