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🌱 來自: Huppert’s Notes
Somatic Symptom and Related Disorders🚧 施工中
Somatic Symptom and Related Disorders
• Somatic symptom disorder: Somatic symptoms with excessive thoughts, anxieties, or behaviors causing significant disruption to social, occupational, and/or other areas of functioning lasting >6 months. Treatment: Regularly-scheduled visits with providers (i.e., not PRN when symptoms and/or related anxiety spikes), CBT, limited evidence for SSRIs but should be considered in patients with comorbid psychiatric illnesses.
• Conversion disorder (functional neurological symptom disorder): 1+ “real” (i.e., not intentionally feigned) neurologic symptom (e.g., blindness, deafness, mutism, paralysis) not otherwise explained by a medical disorder (think “converts” a psychiatric disorder into a neurologic disorder). Typically patient is calm/unconcerned about symptom(s) (“la belle indifference”). Diagnosis of exclusion. Treatment: Patient education, CBT, physical therapy (i.e., for motor deficits); antidepressants may be helpful.
• Illness anxiety disorder: Preoccupation and anxiety of having an undiagnosed serious disease to the point where the concern interferes with functioning. May have mild or no symptoms. Treatment: Goal is to improve tolerance/ability to cope with anxieties. Regularly scheduled visits with providers (i.e., not PRN when anxieties spike), reassurance, CBT, SSRIs may be helpful.
• Factitious disorder: Consciously feigning/producing symptoms in the absence of external reward to assume the role of the sick patient (i.e., primary gain is assuming the sick role without external reward). Treatment: 1) Use only objective signs/data to decide on diagnostics/procedures (i.e., do NOT rely on subjective reporting); 2) Communicate frequently with the patient as a “united front” with all members of the care team to prevent splitting; 3) Supportive confrontation once rapport is established (or, if admitted inpatient, pursue a therapeutic discharge).
- Munchhausen syndrome: Repeated episodes of simulated/feigned illness, peregrination (i.e., visiting multiple medical settings), and pseudologia fantastica (i.e., patient provides detailed, colorful/fantastical stories associated with feigned illness)
- Factitious disorder imposed on another (“Munchhausen syndrome by proxy”): Typically the caregiver is causing harm to another and/or giving false report of symptoms to providers; victims are typically <4 yr, but adults can also be victimized
• Malingering: Consciously feigning/producing symptoms for external reward (e.g., to avoid jail, to gain disability, to acquire pain medications). Symptoms stop when reward is obtained.