Mental Health Book

http://www.fpnotebook.com/

Somatoform DisorderAka: Somatization, Somatizing Patient, Multiple Somatic Complaints, Hysteria

Advertisement

  1. Background
    1. Somatizers generate 9 times the average medical cost
    2. Despite medical attention, somatizers highly disabled
    3. Physicians report frustration in treating somatizers
      1. Lack sense of effectiveness
      2. Patient does not fit into standard diagnoses
      3. Patient does not fit into standard office schedule
  2. Pathophysiology
    1. Sensory amplification
      1. Preoccupation with disease focuses on body sensations
      2. Normal variations in senses interpreted as abnormal
      3. Exacerbates anxiety and panic, as well as discomfort
    2. Identified patient within a dysfunctional family
      1. Family dysfunction transferred to the patient
      2. Patient's "illness" stabilizes family
      3. Other family member's anxiety relieved
    3. Need to be sick
      1. Patient pursues sick role to relieve stressors
      2. Not the same as Malingering or faking symptoms
        1. Somatizing patient unaware of symptom generation
    4. Dissociation
      1. Activation of Pain Sensation without physical pain
  3. Types: Somatoform Disorders
    1. Somatization Disorder
    2. Undifferentiated Somatoform Disorder
    3. Hypochondriasis
    4. Conversion Disorder
    5. Body Dysmorphic Disorder
    6. Pain Disorder
  4. Differential Diagnosis
    1. Organic disease (exclude completely before making somatization diagnosis)
    2. Reported symptoms adopted by patient for Secondary Gain
      1. Factitious Disorder (Adoption of physical symptoms for unconscious internal gain)
      2. Malingering (Purposeful feigning of physical symptoms for external gain)
  5. Risk Factors
    1. See Somatization Risk Factors
    2. Underlying mental health condition
    3. History of physical abuse or sexual abuse
  6. Definition
    1. Emotional distress experienced as physical symptoms
  7. Symptoms
    1. See Somatization Symptoms
  8. Associated Conditions: Syndromes
    1. Vague Food Allergy
    2. Vague Vitamin Deficiency
    3. Multiple chemical sensitivity
    4. Atypical Chest Pain
    5. Temporomandibular Joint Syndrome (TMJ)
    6. Hypoglycemia
    7. Chronic Fatigue Syndrome
    8. Fibromyalgia
    9. Premenstrual Syndrome
  9. Associated Conditions: Psychiatric
    1. Major Depression (60%)
    2. Anxiety Disorder (50%)
      1. Panic Disorder
      2. Obsessive Compulsive Disorder
    3. Personality Disorder (60%)
    4. Substance Abuse
  10. Precautions
    1. Reassess for underlying medical condition
  11. Management
    1. See Somatization Management
  12. References
    1. McCahill (1995) Am Fam Physician 52(1):193
    2. Oyama (2007) Am Fam Physician 76(9):1333
    3. Ringel (April 1998) Patient Care :
    4. Schwer (March 1999) Hosp Med :
    5. Servan-Schreiber (2000) Am Fam Physician 61(4):1073
    6. Servan-Schreiber (2000) Am Fam Physician 61(5):1423

Hysteria (C0020701)

Definition (MSH)Historical term for a chronic, but fluctuating, disorder beginning in early life and characterized by recurrent and multiple somatic complaints not apparently due to physical illness. This diagnosis is not used in contemporary practice.
Definition (CSP)behavior exhibiting excessive or uncontrollable emotion, such as fear or panic; mental disorder characterized by emotional excitability and sometimes by amnesia or a physical deficit, such as paralysis, or a sensory deficit, without an organic cause.
ConceptsMental or Behavioral Dysfunction (T048)
ICD9300.10
MSHD007046
EnglishHysteria, Hysteria unspecified, Hysterical disorder, SOMATIZATION DISORDER <HYSTERIA>, SOMATIZATION DISORDER HYSTERIA
Spanishhisteria, histeria no especificada, trastorno histerico
Parent ConceptsNeurotic Disorders (C0027932), Mental disorders (C0004936), Brain Diseases (C0006111), Dissociative, conversion and factitious disorders (C1456314), Histrionic Personality Disorder (C0019681), Symptoms (C1457887), Dissociative disorder (C0012746), Duplicate concept (C1274013)
SourcesAOD, CSP, CST, DXP, ICD9CM, LCH, MSH, MTH, NCI, NDFRT, QMR, RAM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Psychophysiologic Disorders (C0033931)

Definition (MSH)A group of disorders characterized by physical symptoms that are affected by emotional factors and involve a single organ system, usually under AUTONOMIC NERVOUS SYSTEM control. (American Psychiatric Glossary, 1988)
Definition (CSP)characterized by physical symptoms and demonstrable structural or physiological changes in which emotional factors are believed to play a major etiologic role.
ConceptsMental or Behavioral Dysfunction (T048)
ICD9306.9
MSHD011602
EnglishPSYCHOPHYSIOL DIS, Psychophysiologic disorder, Psychophysiologic Disorders, Psychophysiological Disorder, Psychophysiological Disorders, psychophysiological dysfunction, PSYCHOSOMATIC DIS, Psychosomatic disorder, Psychosomatic Disorders, psychosomatic illness
Spanishtrastorno psicofisiologico, trastorno psicosomatico
Parent Concepts[X]Mental and behavioral disorders (C0556006), Mental disorders (C0004936), Neurologic Manifestations (C0027854), Psychosomatic factor in physical condition (C0033899), Somatoform Disorder (C0037650)
SourcesAOD, COSTAR, CSP, MSH, MTHICD9, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree