mental health and psychiatry Somatofrom disorders.pptx

somatosensory disorder

1. Somatoform Disorders A  Somatic Symptom Disorder , formerly known as a  somatoform disorder , is any  mental disorder  that manifests as physical symptoms that suggest  illness  or injury, but cannot be explained fully by a general medical condition or by the direct effect of a substance, and are not attributable to another mental disorder. 1

2. SD Somatic symptom disorders are a group of disorders, all of which fit the definition of physical symptoms similar to those observed in physical disease or injury for which there is no identifiable physical cause. As such, they are a diagnosis of exclusion. 2

3. SD Somatic symptoms may be generalized in four major medical categories: neurological, cardiac, pain, gastrointestinal somatic symptoms. 3

4. SD In people who have been diagnosed with a somatic symptom disorder, medical test results are either normal or do not explain the person's symptoms 4

5. SD history and physical examination do not indicate the presence of a known medical condition that could cause them, 5

6. SD DSM-5 The patient must be excessively worried about their symptoms, and this worry must be judged to be out of proportion to the severity of the physical complaints themselves. A diagnosis of somatic symptom disorder requires that the subject have recurring somatic complaints for at least six months. 6

7. Presentation Symptoms are sometimes similar to those of other illnesses and may last for years. Usually, the symptoms begin appearing during adolescence, and patients are diagnosed before the age of 30 years. 7

8. Presentation Symptoms may occur across cultures and gender. Other common symptoms include anxiety and depression. 8

9. Presentation However, since anxiety and depression are also very common in persons with confirmed medical illnesses, it remains possible that such symptoms are a consequence of the physical impairment, rather than a cause. 9

10. Presentation Somatic symptom disorders are not the result of conscious malingering (fabricating or exaggerating symptoms for secondary motives) or factitious disorders (deliberately producing, feigning, or exaggerating symptoms). 10

11. Presentation Somatic symptom disorder is difficult to diagnose and treat. Some advocates of the diagnosis believe this is because proper diagnosis and treatment requires psychiatrists to work with neurologists on patients with this disorder. 11

12. Classification DSM IV old classification Somatic symptom disorders used to be recognized as Somatoform disorders The following were conditions under the term Somatoform Disorders: 12

13. Classification Conversion disorder: A somatic symptom disorder involving the actual loss of bodily function such as blindness, paralysis, and numbness due to excessive anxiety 13

14. Classification Somatization disorder 14

15. Classification Hypochondriasis 15

16. Classification Body dysmorphic disorder: wherein the afflicted individual is concerned with body image, and is manifested as excessive concern about and preoccupation with a perceived defect of their physical appearance. 16

17. Classification Pain disorder 17

18. Classification Undifferentiated somatic symptom disorder – only one unexplained symptom is required for at least six months. 18

19. New Classification DSM-5 (2013) somatic symptom disorders are recognized under the term Somatic Symptom and Related Disorders: 19

20. NC Somatic symptom disorder: Will take over many of what was formerly known as somatization disorders and hypochondriasis 20

21. NC Factitious disorder: Can be either imposed on oneself, or to someone else (formally known as factitious disorder by proxy). 21

22. NC Illness anxiety disorder: A somatic symptom disorder involving persistent and excessive worry about developing a serious illness. 22

23. NC Somatoform disorder not otherwise specified (NOS) 23

24. NC Included among these disorders are false pregnancy, psychogenic urinary retention, and mass psychogenic illness (so-called mass hysteria). 24

25. Epidemiology Somatization disorder – 1% Abridged somatization disorder – 6% Multisomatoform disorder – 24% Undifferentiated somatoform disorder – 69% 25

26. Diagnosis Each of the specific somatic symptom disorders has its own diagnostic criteria. 26

27. Management Psychotherapy, more specifically, cognitive behavioural therapy (CBT), is the most widely used form of treatment for Somatic symptom disorder 27

28. CBT Learn to reduce stress Learn to cope with physical symptoms Learn to deal with depression and other psychological issues Improve quality of life Reduce preoccupation with symptom 28

29. mgt psychodynamic interpersonal psychotherapy (PIT) for patients with Multisomatoform disorder has shown its long-term efficacy for improving the physical quality of life in patients with multiple, difficult-to-treat, medically unexplained symptoms. 29

30. mgt Antidepressant medication has also been used to treat some of the symptoms of depression and anxiety that are common among people who have somatic symptom disorder. Medications will not cure somatic symptom disorder, but can help the treatment process when combined with CBT. 30

31. History Somatisation disorder was first described by Paul Briquet in 1859 and was subsequently known as Briquette's syndrome. He described patients who had been sickly most of their lives and complained of multiple symptoms from different organ systems. Symptoms persist despite multiple consultations, hospitalisations and investigations. 31

32. Hypochondriasis Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. 32

33. HYP Hypochondria is often characterized by fears that minor bodily or mental symptoms may indicate a serious illness, constant self-examination and self-diagnosis, and a preoccupation with one's body. 33

34. HYP Many individuals with hypochondriasis express doubt and disbelief in the doctors' diagnosis, and report that doctors’ reassurance about an absence of a serious medical condition is unconvincing, or short-lasting. 34

35. HYP Additionally, many hypochondriacs experience elevated blood pressure, stress, and anxiety in the presence of doctors or while occupying a medical facility, a condition known as "white coat syndrome". 35

36. HYP Many hypochondriacs require constant reassurance, either from doctors, family, or friends, and the disorder can become a debilitating challenge for the individual with hypochondriasis, as well as their family and friends. 36

37. HYP Some hypochondriacal individuals completely avoid any reminder of illness, whereas others frequently visit medical facilities, sometimes obsessively. Some sufferers may never speak about it. 37

38. HYP It has been claimed that this debilitating condition results from an inaccurate perception of the condition of body or mind despite the absence of an actual medical diagnosis. An individual with hypochondriasis is known as a hypochondriac. 38

39. HYP Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they or others have, or are about to be diagnosed with, a serious illness. 39

40. HYP Often, hypochondria persists even after a physician has evaluated a person and reassured them that their concerns about symptoms do not have an underlying medical basis 40

41. HYP or, if there is a medical illness, their concerns are far in excess of what is appropriate for the level of disease. It is also referred to hypochondriaism which is the act of being in an hypochondriatic state; 41

42. HYP acute hypochondriaism. Many hypochondriacs focus on a particular symptom as the catalyst of their worrying, such as gastro-intestinal problems, palpitations, or muscle fatigue. To qualify for the diagnosis of hypochondria the symptoms must have been experienced for at least 6 months. 42

43. HYP The DSM-IV-TR defines this disorder, "Hypochondriasis", as a somatoform disorder and one study has shown it to affect about 3% of the visitors to primary care settings. The 2013 DSM-5 replaced the diagnosis of hypochondriasis with the diagnoses of somatic symptom disorder and illness anxiety disorder. 43

44. Signs and symptoms Hypochondriasis is categorized as a somatic amplification disorder a disorder of "perception and cognition“ that involves a hyper-vigilance of situation of the body or mind and a tendency to react to the initial perceptions in a negative manner that is further debilitating. 44

45. Signs and symptoms Hypochondriasis manifests in many ways. Some people have numerous intrusive thoughts and physical sensations that push them to check with family, friends, and physicians. For example, a person who has a minor cough may think that they have tuberculosis. Or sounds produced by organs in the body, such as those made by the intestines, might be seen as a sign of a very serious illness to patients dealing with hypochondriasis. 45

46. Signs and symptoms Other people are so afraid of any reminder of illness that they will avoid medical professionals for a seemingly minor problem, sometimes to the point of becoming neglectful of their health when a serious condition may exist and go undiagnosed. Yet others live in despair and depression, certain that they have a life-threatening disease and no physician can help them. Some consider the disease as a punishment for past misdeeds. 46

47. Signs and symptoms Hypochondriasis is often accompanied by other psychological disorders. Bipolar disorder clinical depression obsessive-compulsive disorder (OCD), phobias, and somatization disorder are the most common accompanying conditions in people with hypochondriasis as well as a generalized anxiety disorder diagnosis at some point in their life. 47

48. Signs and symptoms Many people with hypochondriasis experience a cycle of intrusive thoughts followed by compulsive checking, which is very similar to the symptoms of obsessive-compulsive disorder. However, while people with hypochondriasis are afraid of having an illness, patients with OCD worry about getting an illness or of transmitting an illness to others. Although some people might have both, these are distinct conditions. 48

49. Signs and symptoms Patients with hypochondriasis often are not aware that depression and anxiety produce their own physical symptoms, and mistake these symptoms for manifestations of another mental or physical disorder or disease. For example, people with depression often experience changes in appetite and weight fluctuation, fatigue, decreased interest in sex and motivation in life overall Intense anxiety is associated with rapid heartbeat, palpitations, sweating, muscle tension, stomach discomfort, dizziness, shortness of breath, and numbness or tingling in certain parts of the body (hands, forehead, etc.). 49

50. Signs and symptoms If a person is ill with a medical disease such as diabetes or arthritis, there will often be psychological consequences, such as depression. Some even report being suicidal. In the same way, someone with psychological issues such as depression or anxiety will sometimes experience physical manifestations of these affective fluctuations, often in the form of medically unexplained symptoms. Common symptoms include headaches; abdominal, back, joint, rectal, or urinary pain; nausea; fever and/or night sweats; itching; diarrhoea; dizziness; or balance problems. 50

51. Signs and symptoms Many people with hypochondriasis accompanied by medically unexplained symptoms feel they are not understood by their physicians, and are frustrated by their doctors’ repeated failure to provide symptom relief. 51

52. Causes The genetic contribution to hypochondriasis is probably moderate, with heritability estimates around 10-37%. 52

53. Causes exposure to illness-related information are widely believed to lead to short-term increases in health anxiety and to have contributed to hypochondriasis in individual cases. Overly protective caregivers and an excessive focus on minor health concerns have also been implicated as potential causes of hypochondriasis. 53

54. Causes In the media and on the Internet, articles, TV shows and advertisements regarding serious illnesses such as cancer and multiple sclerosis often portray these diseases as being random, obscure and somewhat inevitable. In the short term, inaccurate portrayal of risk and the identification of non-specific symptoms as signs of serious illness may contribute to exacerbating a fear of illness. Major disease outbreaks or predicted pandemics can have similar effects. 54

55. Causes There is anecdotal evidence that it is common for serious illnesses or deaths of family members or friends to trigger hypochondria in certain individuals. Similarly, when approaching the age of a parent's premature death from disease, many otherwise healthy, happy individuals fall prey to hypochondria. These individuals believe they are suffering from the same disease that caused their parent's death, sometimes causing panic attacks with corresponding symptoms. 55

56. Diagnosis The ICD-10 defines hypochondriasis as follows: A. Either one of the following: A persistent belief, of at least six months' duration, of the presence of a minimum of two serious physical diseases (of which at least one must be specifically named by the patient). A persistent preoccupation with a presumed deformity or disfigurement (body dysmorphic disorder). 56

57. Diagnosis B. Preoccupation with the belief and the symptoms causes persistent distress or interference with personal functioning in daily living, and leads the patient to seek medical treatment or investigations (or equivalent help from local healers). 57

58. Diagnosis C. Persistent refusal to accept medical advice that there is no adequate physical cause for the symptoms or physical abnormality, except for short periods of up to a few weeks at a time immediately after or during medical investigations. 58

59. Diagnosis D. Most commonly used exclusion criteria: not occurring only during any of the schizophrenia and related disorders (F20–F29, particularly F22) or any of the mood disorders (F30–F39). 59

60. Diagnosis The DSM-IV defines hypochondriasis according to the following criteria: A. Preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms. 60

61. Diagnosis B. The preoccupation persists despite appropriate medical evaluation and reassurance. 61

62. Diagnosis C. The belief in Criterion A is not of delusional intensity (as in Delusional Disorder, Somatic Type) and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder). 62

63. Diagnosis D. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. 63

64. Diagnosis E. The duration of the disturbance is at least 6 months. 64

65. Diagnosis F. The preoccupation is not better accounted for by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive Episode, Separation Anxiety, or another Somatoform Disorder. 65

66. Mgt cognitive behavioural therapy (CBT) is an effective treatment for hypochondriasis. selective serotonin reuptake inhibitors can also reduce symptoms, hypochondriasis responds well to antipsychotics, particularly the newer atypical antipsychotic medications. 66

67. Etymology Among the regions of the abdomen, the hypochondrium is the uppermost part. The word derives from the Greek term hypokhondrios, meaning "of the soft parts between the ribs and navel" from ὑπό hypo ("under") and khondros, or cartilage (of the sternum). Hypochondria in Late Latin meant "the abdomen". 67

68. Etymology The term hypochondriasis for a state of disease without real cause reflected the ancient belief that the viscera of the hypochondria were the seat of melancholy and sources of the vapour that caused morbid feelings. Until the early 18th century, the term referred to a "physical disease caused by imbalances in the region that was below your rib cage" (i.e., of the stomach or digestive system). For example, Robert Burton's The Anatomy of Melancholy (1621) blamed it "for everything from 'too much spittle' to 'rumbling in the guts'". 68

69. Hysteria Hysteria colloquially means ungovernable emotional excess and can refer to a temporary state of mind or emotion; however, beginning in 1900 B.C., hysteria was considered a diagnosable physical illness in females and then in the 1500s shifted to a mental illness 69

70. Hysteria Many influential psychiatrists such as Sigmund Freud and Jean-Martin Charcot dedicated research to hysteria patients. currently, most doctors practicing Western medicine do not accept hysteria as a medical diagnosis 70

71. Hysteria The blanket diagnosis of hysteria has been fragmented into myriad medical categories such as epilepsy, histrionic personality disorder, conversion disorders, dissociative disorders, or other medical conditions Furthermore, social deviances, such as deciding not to wed, are no longer considered psychological disorders 71

72. History The word hysteria originates from the Greek word “uterus,”  hystera.   The oldest record of hysteria dates back to 1900 B.C. when Egyptians recorded behavioural abnormalities in adult women on medical papyrus 72

73. History The Egyptians attributed the behavioural disturbance to a wondering uterus- Thus later dubbing the condition hysteria 73

74. History To treat hysteria Egyptian doctors prescribed various medications For example, doctors put strong smelling substances on the patients’ vulvas to encourage the uterus to return to its proper position 74

75. History Another tactic was to smell or swallow unsavoury herbs to encourage the uterus to flee back to the lower part of the female’s stomach 75

76. History The ancient Greeks accepted the ancient Egyptians’ explanation for hysteria; however, they included in their definition of hysteria the inability to bear children or the failure to marry Ancient Romans also attributed hysteria to an abnormality in the womb; however, discarded the traditional explanation of a wandering uterus  76

77. History Instead, the ancient Romans credited hysteria to a disease of the womb or a disruption in reproduction (i.e. a miscarriage, menopause, etc.) Hysteria theories from the ancient Egyptians, ancient Greeks, and ancient Romans were the basis of the Western understanding of hysteria 77

78. History Between the fifth and thirteenth centuries, however, the increasing influence of Christianity in the Latin West altered medical and public understanding of hysteria  St. Augustine's writings suggested that human suffering resulted from sin, and thus, hysteria became perceived as satanic possession With the shift in perception of hysteria came a shift in treatment options  78

79. History Instead of admitting patients to a hospital, the church began treating patients through prayers, amulets, and exorcisms  Furthermore, during the medieval and Renaissance periods many patients of hysteria were prosecuted as witches and underwent interrogations, torture, and execution 79

80. History However, during the sixteenth and seventeenth centuries activists and scholars worked to change the perception of hysteria back to a medical condition  Particularly, French physician Charles Lepois insisted that hysteria was a malady of the brain  In addition, in 1697, English physician Thomas Sydenham theorized that hysteria was an emotional condition, instead of a physical condition 80

81. History Many physicians followed Lepois and Sydenham's lead and hysteria became disassociated with the soul and the womb  During this time period science started to focalize hysteria in the central nervous system  As doctors developed a greater understanding of the human nervous system, the neurological model of hysteria was created, which further propelled the conception of hysteria as a mental disorder  81

82. History In 1859 Paul Briquet defined hysteria as a chronic syndrome manifesting in many unexplained symptoms throughout the body's organ systems 82

83. History French psychologist, who studied five of hysteria's symptoms (anaesthesia, amnesia, abulia, motor control diseases, and character change) in depth and proposed that hysteria symptoms occurred due to a lapse in consciousness 83

84. History Both Charcot and Janet inspired Sigmund Freud's work . Freud theorized hysteria stemmed from childhood sexual abuse or repression, and was also one of the first to apply hysteria to men. 84

85. Factitious cases of feigned illness not driven by a psychiatric disorder Malingering. Factitious disorder imposed on self Munchausen syndrome 85

86. Factitious Factitious disorder imposed on self, also known as Munchausen syndrome, is a factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention, sympathy, or reassurance to themselves. Munchausen syndrome fits within the subclass of factitious disorder with predominantly physical signs and symptoms, but patients also have a history of recurrent hospitalization, travelling, and dramatic, extremely improbable tales of their past experiences. The condition derives its name from fictional character Baron Munchausen. 86

87. Factitious Factitious disorder imposed on self is related to factitious disorder imposed on another, which refers to the abuse of another person, typically a child, in order to seek attention or sympathy for the abuser. This drive to create symptoms for the victim can result in unnecessary and costly diagnostic or corrective procedures. 87

88. Signs and symptoms In factitious disorder imposed on self, the affected person exaggerates or creates symptoms of illnesses in themselves to gain examination, treatment, attention, sympathy, and/or comfort from medical personnel. In some extreme cases, people suffering from Munchausen syndrome are highly knowledgeable about the practice of medicine and are able to produce symptoms that result in lengthy and costly medical analysis, prolonged hospital stays, and unnecessary operations. 88

89. Signs and symptoms The role of "patient" is a familiar and comforting one, and it fills a psychological need in people with this syndrome. This disorder is distinct from hypochondriasis and other somatoform disorders in that those with the latter do not intentionally produce their somatic symptoms. 89

90. Signs and symptoms Factitious disorder is distinct from malingering in that people with factitious disorder imposed on self don't fabricate symptoms for material gain such as financial compensation, absence from work, or access to drugs. 90

91. Signs and symptoms The exact cause of factitious disorder is not known, but researchers believe both biological and psychological factors play a role in the development of this disorder. 91

92. Signs and symptoms Risk factors for developing factitious disorder may include childhood traumas, growing up with parents/caretakers who were emotionally unavailable due to illness or emotional problems, a serious illness as a child, failed aspirations to work in the medical field, personality disorders, and low self-esteem. 92

93. Signs and symptoms Arrhythmogenic Munchausen syndrome describes individuals who simulate or stimulate cardiac arrhythmias to gain medical attention. 93

94. Signs and symptoms A similar behaviour called factitious disorder imposed on another has been documented in the parent or guardian of a child. 94

95. Signs and symptoms The adult ensures that his or her child will experience some medical affliction, therefore compelling the child to suffer through treatments and spend a significant portion during youth in hospitals. Furthermore, a disease may actually be initiated in the child by the parent or guardian. This condition is considered distinct from Munchausen syndrome. 95

96. Signs and symptoms There is growing consensus in the paediatric community that this disorder should be renamed "medical abuse" to highlight the harm caused by the deception and to make it less likely that a perpetrator can use a psychiatric defence when harm is done. 96

97. Diagnosis Due to the deceptive behaviours involved, diagnosing factitious disorder is very difficult. If the healthcare provider finds no physical reason for the symptoms, he or she may refer the person to a psychiatrist or psychologist (mental health professionals who are specially trained to diagnose and treat mental illnesses). 97

98. Diagnosis Psychiatrists and psychologists use thorough history, physical examinations, laboratory tests, imagery, and psychological testing to evaluate a person for physical and mental conditions. 98

99. Diagnosis Once the person's history has been thoroughly evaluated, diagnosing factitious disorder imposed on self requires a clinical assessment. 99

100. Diagnosis Clinicians should be aware that those presenting with symptoms (or persons reporting for that person) may malinger, and caution should be taken to ensure there is evidence for a diagnosis. 100

101. Diagnosis Lab tests may be required, including complete blood count (CBC), urine toxicology, drug levels from blood, cultures, coagulation tests, assays for thyroid function, or DNA typing. 101

102. Diagnosis In some cases CT scan, magnetic resonance imaging, psychological testing, electroencephalography, or electrocardiography may also be employed. 102