Chapter 12 Somatic Symptom and - PowerPoint Presentation

Slide1

Chapter 12

Somatic Symptom and

Related

DisordersSlide2

Somatic Symptom Disorder:

DSM-5

Cornerstone diagnosis of this category

Main feature is the presence of one or more somatic symptoms that cause distress or impairment in daily living

Excessive thoughts, feelings, or behaviors related to the somatic symptoms

Disproportionate thoughts about the seriousness of the

symptoms

Persistent high levels of anxiety related to symptoms or health

Devotes excessive amount of time to healthSlide3

Somatic Symptom

Disorder:

DSM-5

cont.

Excessive somatic concerns must persist for at least 6 months

Diagnostic specifiers:

With predominant pain (replaces pain disorder)

Persistent (severe symptoms, marked impairment, and long

duration)

Severity: mild, moderate, severeSlide4

Illness Anxiety

Disorder:

DSM-5

Preoccupation with having or acquiring a serious illness

Somatic symptoms are not present (or minor)

High level of anxiety about health and easily alarmed about health-related matters

Performs excessive health-related behaviors (checking body) or exhibits maladaptive avoidance (avoids doctors/hospitals)Slide5

Conversion Disorder:

DSM-5

One

or more

symptoms

of altered voluntary

motor or sensory

function

Motor symptoms can include paralysis, paresthesia, tremors, convulsions

Sensory symptoms can include blindness, unusual skin sensations, altered speech

Hallmark is a lack of correspondence between signs and symptoms and medical understanding of the possible neurological conditionSlide6

Conversion Disorder:

DSM-5

cont

.

People with conversion disorder are often unaware of the psychological

factors

associated with their condition, and many report an inability to control their symptoms

Lack of worry or concern (

la belle indifference

) is not a criterion for diagnosis but is mentioned in the

DSM-5

list of associated featuresSlide7

Psychological Factors Affecting Other Medical Conditions

A medical symptom or condition is present

Psychological or behavioral factors affect the medical condition by

way of:

Close temporal relationship between psychological factors and the development or exacerbation of symptoms

Interference

with treatment (poor adherence)

Additional health risks

Influence underlying

pathophysiology,

precipitating or exacerbating symptoms or need for medical treatmentSlide8

Factitious Disorder: DSM-5

Falsification of physical or psychological symptoms, or induction of injury or

disease;

associated with deception

Presentation to others as ill, impaired, or injured

Deceptive behavior is evident even in the absence of obvious external rewards, such as monetary compensation or reduced workSlide9

Epidemiology

Given the substantial changes in diagnostic criteria (

DSM-III

to

DSM-5

), precise epidemiological data are challenging

Somatic

symptom disorder

:

5% to

7%

Anxiety

illness disorder

:

1.3% to

10%

Conversion disorder:

Low

prevalence rates (less than 0.1%)

Medically unexplained neurological symptoms are present in

11% to

35% of neurology patientsSlide10

Assessment

Patients believe their condition is organic, thus might refuse mental health referral and psychological testing

Ruling out organic pathology is not needed for diagnosis according to

DSM-5

criteria (change from

DSM-IV-TR

)

Structured/semistructured interviews

Structured Clinical Interview for the

DSM-

IV

Composite International Diagnostic Interview

Somatoform Disorders Schedule

Schedules

for Clinical Assessment in Neuropsychiatry

Slide11

Assessment

cont.)

Self-report measures

Screening for Somatoform Symptoms

Symptom

Checklist–90 ,

Revised

Patient Health

Questionnaire–15

Health Attitude Survey

Health Anxiety Questionnaire

Whiteley Index

M

edical service utilization and visual analogue scales pertaining to distressing thoughts and maladaptive behaviors can also be used

Measures of depression and anxietySlide12

Etiology: Behavioral

and

Molecular

Genetics

Somatic

symptom concordance rates between monozygotic twins are higher than between dizygotic twins, even when controlling for co-occurring psychiatric

symptoms

The

role of specific genetic markers in the development of somatoform symptoms remains

unclear

Genetic

factors are now being considered within the context of psychological models of various somatoform

disordersSlide13

Etiology: Neuroanatomy

and Neurobiology

The hypothalamic-pituitary-adrenal (HPA) axis has been a focus of research in this

area

Cortisol deregulation

HPA

axis controls glandular

and

hormonal responses to

stress; this may

lead to

hypocortisolism,

which induces greater stress and enhances experiences of pain and

fatigue

The second somatosensory area (SII) of the cerebral cortex has also been implicated

Slide14

Etiology: Learning

, Modeling,

and

Life Events

Childhood physical and sexual abuse and neglect have been associated with physician visits during adulthood and hypochondriasis

Early

childhood experiences of illness

and perceptions of

significant illness in others are associated with the experience of medically unexplained symptoms in

adulthood

Parents

who fear disease, who are preoccupied with their bodies, and who overreact to minor ailments experienced by their children are more likely to have children with the same

tendenciesSlide15

Etiology: Cognitive Influences

When attention is directed to the body, the intensity of perceived sensations

increases

People with somatoform disorders spend a considerable amount of time focusing on their bodies, thereby increasing

their chances

of noticing somatic sensations and

changes

Tendency to believe that somatic sensations and changes are indicative of disease or are harmful in some waySlide16

Sex and Racial/Ethnic

Considerations

More

prevalent in women than

men

Cultural factors, such as socially transmitted values, beliefs, and expectations, can influence how a person interprets somatic sensations and

changes

and whether treatment seeking is

initiated

Those

of Chinese,

African

American, Puerto Rican, and other Latin American descent

present

with more medically unexplained somatic symptoms than those from other

groupsSlide17

Treatment

Cognitive-behavioral

therapy (CBT)

has been shown to be superior

to standard medical care

in:

I

mproving

somatic complaints/

somatization

R

educing

health-related

anxiety

Psychiatric consultation letters to primary care physicians describing somatization and providing recommendations have been shown to improve physical functioning and reduce

costs

of medical care