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36 Cards in this Set

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What term was first used in the DSM III for somaticdisorders? Why has it changed?

Somatoform disorders(medically unexplained symptoms)




Ancient Greece“Histeria”




DSM V acknowledgesthat there is uncertainty of causality




De-emphasis on whetherit’s medically explained

What is the focus of somatic disorders in the DSM V?

Abnormal reactions tosomatic symptoms




Combination ofprominent preoccupation, worry and excessive help seeking

What’s involved in dissociative disorders?

Loss of normalintegration of identity, memory, perception or consciousness

Explain the term dissociation (disconnection) which isthought to be a similar mechanism underlying somatic and dissociative disorders

Dissociation betweenmental awareness and normal mental system

What dissociation exists in somatic disorders anddissociative disorders?

Somatic - Spit offbetween sensory or motor system




Dissociative - Spitoff between “higher” mental functions (psychological dissociation)

Define Psychosomatic disorders

Patient presenting physicalillness contributed to by psychological factors (which some have physiologicallinks e.g. hormonal, stress…)

Define Hypochondriasis

Disorder entailingintense anxiety regarding the belief that one has a serious medical conditionthat one clearly does not have

What factors help identify somatic and related disorders asmental disorders rather than medical?

Number and persistenceof symptoms




Degree of bodilypreoccupation Intensity of illnessworry




Forceful seeking ofmedical/healthcare




Poor quality ofpatient-healthcare system relationship

What is the somatic symptom diagnosis criteria?

One or moredistressing or debilitating somatic symptoms accompanied by abnormal thoughts,feelings and behaviours in relation to these somatic symptoms.




Being symptomatic ispersistent or with predominant pain and any one somatic symptom may not beconsistently present




3 levels of severity

What are the 3 types of somatic symptoms?

1) Disproportionateand persistent thoughts about seriousness of symptoms




2) Persistently highlevels of anxiety about health or symptoms




3) Excessive time andenergy spent devoted to symptoms or health concerns (e.g. excessive health careutilisation)

What are the 5 types of somatic symptom and relateddisorders? Add prevalence rates

Somatic symptomdisorder (est. 5-7%)




Illness anxietydisorder (est. 1 – 10%)




Conversion disorder(functional neurological symptom disorder) 5% of neurology patients




Psychological factorsaffecting other medical conditions




Factitious disorder(1% of patients in hospital)

What disorder do most individuals with hypochondriasis(abnormal levels of anxiety regarding their health) meet?

Somatic symptomdisorder

What is the difference between somatic symptom disorder andillness anxiety disorder

Illness anxietydisorder patients preoccupied with having or acquiring illness – In the absenceof experiencing marked somatic symptoms

What are some of the elements in illness anxiety disorder?

Disturbances in:




Perception(hypersensitivity to bodily sensations)




Affect (anxiety)




Cognition (beliefsregarding threat or reality)




Behaviour (excessivehelp and reassurance seeking)

Define Conversion Disorder (functional neurological symptomdisorder)

Disorder marked by asudden loss of functioning in a sensory or motor part of the body (e.g.blindness) without an identifiable medical cause

Define factitious disorders

Characterized bydeliberately faking physical or mental illness in order to gain medicalattention




Another variant called“factitious disorder imposed on another” (e.g. child)




Patient producessymptoms to gain medical attentions (e.g. create an infection)m

How are factitious disorders different to malingering?

Malingering patientshave a recognisable external incentive such as financial compensation fordeliberately feigning symptoms

Which of the somatic disorders were added in the DSM V.Which is higher in females?

Somatic symptom(higher in females) and illness anxiety disorder

What happens as number of unexplained somatic symptomsincrease?

Proportion of patientswith depression and anxiety increases

What percentage of presenting symptoms to GP’s will remainunexplained even as they persist over time?

30%

Describe 2 factors contributing to the aetiology of somaticsymptom and related disorders

Hormonal StressResponse System – underactivity = fatigue




Neurobiological Models– Gate Control Theory (neural gates in spinal cord can be opened or closed tovarying degrees to control flow of impulses from peripheral receptors in bodyto CNS, determining amount of pain)

Explain the possible roles of Trauma and Personality insomatic symptom and related disorders

Trauma may benon-declarative (contained in emotions, reflex or bodily sensations) ratherthan declarative (conscious thought and facts)




Personality –Alexithymia (diminished capacity to consciously experience/describe emotions)causing misinterpretations of bodily sensations as sign of physical illness

Describe the 4 processes in Somatosensory amplification(Cognitive/Behavioural factors)

Perception of symptoms(attention directed towards body)




Attribution regardingsymptoms (physical rather than psychological)




Concerns/Anxiety aboutillness (hypochondriacal)




Illness behaviour (e.g.seeking medical attention and hypervigilance)




*the 3 later processesfeedback into the first, effectively “amplifying” perception of symptoms

Give examples of family, social and cultural factorsinvolved in somatic symptom and related disorders

Family – parentalmodelling




Healthcare – attentiongiven if diagnosis




Cultural – culturebound syndromes (occur only in certain cultures)

Outline important aspects to treatment in somatic symptomand related disorders

Comprehensive assessment(physical and psychological factors)




Minimizing # ofclinicians to maximize consistency




Identifying andminimizing reinforcers (maintenance factors)




Treating comorbidmedical or psychological disorders

What is the difference between acute or chonic somaticsymptom and related disorders?

Acute – Weaker illnessconviction




Chronic – Multiplesomatic symptoms and strong illness conviction

While common ground on medical diagnoses is unlikely somaticsymptom and related disorders are likely to agree with you eventually on?

Goals of minimizingsymptoms




Maximizing functioning




Finding enjoyment inlife




Working onrelationships




Treating co-morbidconditions

What are some useful treatment approached to somatic symptomand related disorders?

CBTSelf-monitoring (dailyactivity diary recording # beh. and circumstances in which beh. occurs)




Meds




SSRIs – (Illnessanxiety disorder)

What are the 5 primary experiences that might be associatedwith dissociative disorders?

Amnesia – absence ofmemory for sig. period of time




Depersonalisation –change in individuals sense of self




Derealisation – changein individuals sense of the world




Identity confusion –feelings of uncertainty/conflict regarding ones identity




Identity alteration –most extreme, objective behaviours during assumed alt. identities at differenttimes

Outline and describe the 3 primary dissociative disorders

Depersonalisation/derealisationdisorder – repeated episodes of depersonalisation and/or derealisation




Dissociative amnesia –loss of memory for important facts about one’s own life (usually stress/traumanature)




Dissociative identitydisorder – individual develops more than one distinct identity (multiple PD)

Which dissociative disorder is characterised by acting withoutvolition (automaton) or as if in a dream?

Depersonalisation/derealisationdisorder

Changed from multiple PD in DSM IV, Dissociative identitydisorder must not?

Be a part ofreligious/cultural practices




Related to imaginaryplaymates

Depersonalisation/derealisation not meeting criteria fordisorder in general population compared to those with lifetime prevalence of disorder?

26-74% compared to 0.8-2.4

30% of those who report childhood abuse also report whatdissociative disorder? What setting it also common in?

Dissociative amnesia, alsocommon in war

The vast majority of individuals with dissociative identitydisorder report what?

Experienced sometrauma, vast majority have PTSDSmall percentageiatrogentic (physician origin) by reinforcement via attention

Marijuana and hallucinogen use is tied to what dissociative disorder?

Depersonalisation/derealisationdisorder