Today will be our first review quiz for the psychosomatic disorders theme. Take a few minutes and check your learning.
1) Which of the following disorders occur equally in men and women?
a) Functional neurologic disorder
b) Somatic symptom disorder
c) Illness anxiety disorder
d) Conversion disorder
2) Which of the following is the most common physical symptom reported by patients with somatic symptom disorder?
3) Which of the following treatment should be considered in patients with conversion disorder?
a) Cognitive behavioral therapy
b) Physical therapy
c) Selective serotonin reuptake inhibitors (SSRIs)
d) Emphasized that the patients symptoms are real
e) All of the above
From day #118
Illness anxiety disorder
Epidemiology of Illness Anxiety Disorder
Epidemiology is largely unknown due to limited studies since the disorder was first introduced in 2013 in the DSM-5.
Prevalence is estimated based on prevalence of the DSM-3 and DSM-4 diagnosis of hypochondriasis (now an obsolete diagnosis) for which about 25% of patients meet criteria for illness anxiety disorder.
Prevalence estimated to be about 0.75% in the medical outpatient environment and about 0.1% in the general population.
Thought to occur equally between men and women. It is the only somatic symptom-related disorder that does not likely have a higher frequency in women.
Average age of onset 20-30 years old. Symptoms typically worsen with age.
May be associated with fewer years of education, unemployment, and depressive disorders.
Somatic Symptom Disorder
Higher female representation (female-to-male ratio about 10:1).
Functional Neurologic Disorder (aka Conversion Disorder)
Higher female representation (female-to-male ratio about 3:1).
From day #119
People with somatic symptom disorder (SSD) often seek initial care from their primary care provider as opposed to a mental health care provider.
Common somatic symptoms reported by patients with SSD include pain (most common), headaches, weakness, dizziness, fainting, diarrhea, constipation, bowel or bladder incontinence, painful menstrual periods, or pain during sexual activity.
A diagnosis may first be suggested by a vague and often inconsistent history of present illness, symptoms that are rarely alleviated with medical interventions, patient attribution of normal sensations as medical illness, avoidance of physical activity, high sensitivity to medication adverse effects, and/or medical care from multiple providers for the same complaints.
From day #120
All of the above
Treatment of FNDs is a process that starts with explaining the diagnosis in a way that helps the patient understand and gain confidence in it. This in turn enhances the odds of adherence to and success from therapeutic strategies.
Education: The primary treatment is education about the illness. It should be emphasized that the patients symptoms are real while emphasizing which medical and neurologic conditions have been considered and rule out. The diagnosis of "functional neurologic disorder" should be clearly shared. Explain how the diagnosis was made by demonstrating relevant clinical findings. Consider providing written materials explaining the diagnosis or referring the patient to neurosymptoms.org.
General approach: Team-based approach with primary care, neurology, behavioral health, and physical therapy. There should be regularly scheduled visits to one primary care physician with a focus on reassurance, acknowledging health fears, education about coping, and limiting unnecessary tests/referrals. Educate and empathically acknowledge that real symptoms can be present even in the absence of other disease. It is often best to address psychological issues slowly, and patients may initially resist referral to a mental health professional. The main goal of treatment is to improve patients functional status and coping rather than elimination of symptoms.
Although randomized clinical trial evidence is limited, promising data are emerging from cohort and pilot randomized studies to support specific treatments.
Psychotherapy: Cognitive behavioral therapy (CBT) is first-line psychological treatment. CBT and other psychotherapies designed for FNDs include components such as education, skills in gaining control of symptoms, recognizing triggers, cognitive restructuring of dysfunctional beliefs, modification of maladaptive behaviors associated with symptoms, and widening therapy to other aspects of interpersonal functioning. Other psychological treatments with emerging evidence includes hypnotherapy, relaxation techniques, psychodynamic psychotherapy, family therapy, and group therapy.
Physical therapy: Recently, a greater role for physical therapy has been recognized when motor symptoms predominate. Motor rehabilitation strategies aim to help the patient to establish normal control of movement through physical therapy, occupational therapy or speech therapy, informed by an understanding of FNDs.
Pharmacotherapy: Comorbid anxiety and depressive disorders should be treated with selective serotonin reuptake inhibitors (SSRIs) or other appropriate psychotropic medications (see treatment of depression; treatment of anxiety). Improvement of FNDs to any pharmacological treatment can occur because of positive effects on mood, coexisting disease, or placebo response. Medications directed at FND symptoms (eg, antitremor medications) are not appropriate.
Nice work. If you want to see all of the weekly quizzes you can see them here. Next up we will discuss psychogenic non-epileptiform seizures (PNES).
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