MEDI7301 Study Guide - Final Guide: Patient Health Questionnaire, Doctor Shopping, Body Dysmorphic Disorder
Somatic symptom and related disorders
Introduction
Overview All somatic sx and related disorders share a common characteristic - the prominence
of somatic sx associated with significant distress and impairment but lacking a known medical
basis in the presence of psychological factors
Patient attributes them to physical illness and seeks medical help for them
It is postulated to manifest in response to psychological stress or personality
style
It creates patient distress and can be incapacitating to daily functioning
Types of disorders
Somatic sx disorder
Illness anxiety disorder
Conversion disorder (functional neurological sx disorder)
Factitious disorder
Psychological factors affecting other medical conditions
Other specific somatic sx and related disorder
Unspecified somatic sx and related disorder
Most commonly encountered in primary care and other medical settings; less
commonly encountered in psychiatric and other mental health settings
Somatic vs illness anxiety
Both have similar presentation - excessive thoughts/ fears/ behaviours
related to somatic concerns, distress and impaired functioning, frequently checking
bodies to reassure themselves
Somatic (prominent physical complaints)
oYoung F with headaches, abdominal pain, diarrhoea etc presents to
ED with abdominal pain but all tests come back normal
oPatient continues to have sx from different organ systems
Illness (minimal/ non-existent physical complaints)
oYoung F with headaches comes in ruminating about possibly having
a brain tumour that causes her significant stress
oPhysical symptoms are usually minimal, and patient is more
preoccupied with idea they are sick
oSignificant worry over health and fear for illness/ death
Do you worry about your physical health more than most people
oDo you worry about specific symptoms (somatic)
OR
Do you worry about your general health and wellbeing (illness anxiety)?
CBT is consistently effective across a spectrum of somatoform disorders
Unexplained somatic sx are associated with a higher risk of suicidality
Suicidal ideation ranges from 1-10%, passive death wishes rate higher than
active suicidal ideation
Somatic sx
disorder
Somatic sx disorder is characterised predominantly by a collection of unrelated
bodily somatic sx that are excessive for any medical disorder that may be present
Number of sx refers to the number that the patient actively complains
about without prompt, not the number elicited by the clinician asking sx by sx
Larger amount of symptoms (6+) are more likely to have the disorder, have
poorer outcomes (eg physical functioning)
Epidemiology
Onset before age 30
4-6% general population; 17% primary care patients
Risk factors - female preponderance, fewer years of education, lower SES,
fam hx of chronic illness, personal hx of childhood chronic illness/ sexual abuse/ trauma,
childhood neglect (inadequate food, clothing, interest), concurrent GMC, concurrent
psychiatric condition (esp depressive or anxiety)
Pathophysiology
Currently unknown
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Postulated to involve heightened awareness of normal bodily sensations
paired with cognitive bias to interpret any physical sx as indicative of medical disease
DSM-5 criteria
One or more somatic sx that are distressing or result in significant disruption
of daily life (eg back pain)
Excessive thoughts, feelings or behaviours related to somatic sx or
associated health concerns as manifested by at least one of the following
oDisproportionate and persistent thoughts about the seriousness of
one's sx
oPersistently high level of anxiety about health or sx
oExcessive time and energy devoted to these sx or health concerns
Although any one somatic sx may not be continuously present, the state of
being symptomatic is persistent (typically 6+mths)
Specifiers
oWith predominant pain - somatic sx predominantly involve pain
oPersistent - severe sx, marked impairment and long duration 6+mths
oSeverity (mild, moderate, severe)
Clinical diagnosis is based off presence of +ve sx and signs (distressing somatic sx +
abnormal thoughts/ feelings/ behaviours in response to these sx) rather than the absence of a
medical explanation for somatic sx
Common somatic sx
Pain - joint pain, leg/ arm pain, back pain, headache, chest pain, abdominal
pain, dysuria, diffuse pain
Non-specific - fatigue, syncope, dizziness
GI - nausea, vomiting, abdominal pain, bloating, gas, diarrhoea
Cardiorespiratory - chest pain, SOB, palpitations
Neurological - movement disorders, sensory loss, weakness, paralysis
Reproductive - dyspareunia, dysmenorrhea, erectile dysfunction
Screening
Suspect
disorder
History of present illness is vague and inconsistent
Health care concerns rarely alleviated despite high
utilization of medical care
Multiple courses of standard treatment fail to mitigate sx
Repeatedly checking boy for abnormalities
Seeking care from multiple doctors for same somatic sx
History taking Presenting complaint
oWhat somatic sx is the patient most concerned
about
oDoes the patient spend excessive time and
energy towards somatic sx?
oDegree of insight (eg do they think their concern
is excessive?)
oIs the initiation, maintenance or exacerbation of
somatic sx related to psychosocial factors/ stressors (eg marriage, loss,
finances)?
oWhat exacerbates or alleviates the somatic sx
oWhat does the patient believe is wrong?
oWhat is their quality of relationship with current
and past primary care clinicians?
oWhat is their current treatment/ medications?
Other
oPast and current illnesses, medical conditions
and surgeries
oDevelopmental history - abuse, neglect, trauma,
illness
Screen
somatic
Patient health questionnaire (PHQ-15)
oMost widely used instrument to screen physical
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
All somatic sx and related disorders share a common characteristic - the prominence of somatic sx associated with significant distress and impairment but lacking a known medical basis in the presence of psychological factors style. Patient attributes them to physical illness and seeks medical help for them. It is postulated to manifest in response to psychological stress or personality. It creates patient distress and can be incapacitating to daily functioning. Most commonly encountered in primary care and other medical settings; less commonly encountered in psychiatric and other mental health settings. Both have similar presentation - excessive thoughts/ fears/ behaviours related to somatic concerns, distress and impaired functioning, frequently checking bodies to reassure themselves. Young f with headaches, abdominal pain, diarrhoea etc presents to. Ed with abdominal pain but all tests come back normal o o. Patient continues to have sx from different organ systems.
