Somatoform disorders presentation

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Items should be fullfilled:1 .Definition of somatoform disorders.

2 .Classification of somatoform disorders in DSM-4-TR.3 .Somatization disorder.

4 .Conversion disorder.5 .Pain disorder.

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DefinitionDisorders involve appearance of symptoms of disease or belief one has a disease or deformity ,despite

the absence of one.

Characterized by :Physical symptoms not fully explained by medical illness.

Severe enough to cause patient significant impairment or functional distress.

Tend to be chronic &respond to psychotherapy.

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Somatoform disorder in DSM-4-TR

5 Specific disorders

Somatization disorder

Conversion disorder

Pain

disorder

Hypochondrias

is

Body

dysmorphic

disorde

r

2 Residual

Undiferentiated NOS

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Somatization disorder

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Somatization disorderIt is disorder that characterized by reporting and experience of range of physical symptoms not medically well explained & cause significant impairment &\or result in multiple attempts at medical intervention.

Epidemiology Life time prevalence 0.1-0.5%

F:M ratio 5:1Usual onset: adolescence&young adulthood

EtiologyPsychological Genetic

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DSM-4-TR diagnostic criteriaA. multiple physical complaints result in

<30 yrs TTT being sought Several yr period significant impairment in functioning

B. 4 pain symptoms &2 GIT symptoms &1sexual symptom &1 pseudo neurologic symptom at any time during the course of disturbance .

C. either:

1 )Not fully explained by medical condition or direct effect of substance2 )If related medical condition , complaints or impairment

are in excess of what expected.

D.Not intentinoally produced .

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Differential diagnosis:

-Medical conditions(multiple sclerosis,porphyria).-schizophrenia .-panic attacks .

-conversion,pain disorder .-facticious disorder .

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Course & prognosis

-chronic course with few remissions.- complications due to:

adverse effects of unnecessary prescribed drugs & substance dependence.

repeated medical workups upto surgery. depression.

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TTT1)Pharmacological

Avoid psychotropics.

2)PsychotherapyLong term supportive psychotherapy.

-Importance of follow up.

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Conversion disorder

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Definition:

Involuntary alteration or limitation of voluntary motor or sensory functioning that result s from psychological conflict or need .

Other terms that are sometimes used for conversion disorder include pseudoneurologic syndrome, hysterical neurosis, and psychogenic disorder.

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DSM-IV-TR (2000) specifies six criteria for the diagnosis of conversion disorder. They are:

The patient has one or more symptoms or deficits affecting the senses or voluntary movement that suggest a neurological or general medical disorder.

The onset or worsening of the symptoms was preceded by conflicts or stressors in the patient's life.

The symptom is not faked or produced intentionally. The symptom cannot be fully explained as the result of a

general medical disorder, substance intake, or a behavior related to the patient's culture.

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The symptom is severe enough to interfere with the patient's schooling, employment, or social relationships, or is serious enough to require a medical evaluation.

The symptom is not limited to pain or sexual dysfunction, does not occur only in the context, of somatization disorder and is not better accounted for by another mental disorder.

DSM-IV lists four subtypes of conversion disorder: conversion disorder with motor symptom or deficit; with sensory symptom or deficit; with seizures or convulsions; and with mixed presentation.

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Causes:1.The immediate cause of conversion disorder is a stressful event or

situation that leads the patient to develop bodily symptoms as symbolic expressions of a long-standing psychological conflict or problem.

2.Two terms that are used in connection with the causes of conversion disorder are primary gain and secondary gain. Primary gain refers to the lessening of the anxiety and communication of the unconscious wish that the patient derives from the symptom(s). Secondary gain refers to the interference with daily tasks, removal from the uncomfortable situation, or increased attention from significant others that the patient obtains as a result of the symptom(s) .

3.Physical, emotional, or sexual abuse can be a contributing cause of conversion disorder in both adults and children.

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Symptoms:Motor abnormalities – paralysis ,

ataxia , dysphagia , vomting , aphonia.

Seizure symptoms – peudo seizures , unconsciousness .

Sensory disturbances – blindness , deafness, anesthesia , analgesia , diplopia.

Close temporal relationship between symptom and stress or intense emotion.

The patient is not conscious of intentionally producing the symptoms.

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Differential diagnosis: 1-paralysis 2- ataxia 3- deafness 4- sensory 5- pseudoseizures 6- schizophrenia 7- mood disorder 8- malingering and factitious disorder with physical

symptom

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:Treatment

:Counseling and psychotherapy* Discussing the stressful event with a counselor may help

you cope with the underlying cause of the physical symptoms .

* Continued work to learn how to deal with stressors throughout life will also be important, as about 25% of patients with these disorders often have future episodes.

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Pharmacological therapy:* Benzodiazepines for anxiety and muscular tension.* Antidepressant or serotonergic agents for obsessive

rumination about symptoms.Physical or occupational therapy :* Physical therapy may prevent complications of conversion

disorder, such as muscle stiffness due to conversion paralysis.

* Identifying and removing environmental triggers is also an important part of treatment.

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Pain disorder

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Pain disorderDefinition:

The patient experiences chronic pain in one or more areas, and is thought to be caused by psychological stress. The pain is often so severe that it disables the patient from proper functioning. It can last as short as a few days, to as long as many years. The disorder may begin at any age, and more women than men

seem to experience it . 

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Diagnostic criteria DSM-IV-TR Pain in one or more anatomical sites is the

predominant focus of the clinical presentation and is of sufficient severity to warrant clinical attention.

The pain causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance of the pain.

The symptom or deficit is not intentionally produced or feigned (as in Factitious Disorder or Malingering).

The pain is not better accounted for by a Mood, Anxiety or Psychotic Disorder and does not meet criteria for Dyspareunia. 22

  Code as follows:*Pain Disorder Associated With Psychological Factors:

psychological factors are judged to have the major role in the onset, severity, exacerbation, or maintenance of the pain. (If a general medical condition is present, it does not have a major role in the onset, severity, exacerbation, or maintenance of the pain.) This type of Pain Disorder is not diagnosed if criteria are also met for Somatization

Disorder .

Specify if :Acute: duration of less than 6 months. Chronic: duration of 6 months or longer.

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*Pain Disorder Associated With Both Psychological Factors and a General Medical Condition:

Both psychological factors and a general medical condition are judged to have important roles in the onset, severity,

exacerbation, or maintenance of the pain ..

Specify if :Acute: duration of less than 6 months.

Chronic: duration of 6 months or longer. 

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Diagnosis: Diagnosis is based on history after excluding a physical disorder that would adequately explain the pain and its onset, severity, duration, and maintenance and the degree of disability. Detection of mental or social stressors may help explain the disorder.

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Differential diagnosis:

* Physical pain due to general medical condition. * Hypochondriasis: have more symptoms than patient with

pain disorder. *Conversion disorder :more motor and sensory disturbance

than pain disorder. *Malingering or factitious disorder.

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Course and prognosis:

variable course but tend to be chronic. patients with comorbid depression have poor prognosis .

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Treatment:Pharmacotherapy:

-antidepressants : particularly SSRIs are useful . -avoid opoids for analgesia because of risk of abuse .

Psychotherapy: -cognitive therapy has proved beneficial in altering

negative life attitudes. -insight oriented psychotherapy.

 

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Some patients may not believe that their pain is connected to emotional factors and may refuse these treatments.

Supportive measures that also can be helpful include:-Hypnosis-Massage-Physical therapy

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Lamia2 3bdelbasitSomya EldesokyRana SamyNourhan 3ezatLubna NagyNahla TarekMarwa ElzeinyHeba Shawky

Thank

You

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