SOMATOFORM DISORDERS
FND vs conversion disorders. FND can fit a lesion hypothesis but conversion need not??? not sure tho
Illness anxiety disorder = hypochondriasis
NON-neurological symptom ^
vs illness anxiety disorder - actual physical symptom
Factitious disorder imposed on another (FDIA) formerly Munchausen syndrome by proxy (MSP) is a mental illness in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick
vs complex partial epilepsy (esp frontal lobe) so EEG
vs dementia and delirium
PCP is illegal and violence
they know hallucinations are not real
sodium thiopental truth portion lu
page 291 - DSm 5
ICD F44
Dissociative and Conversion Disorder
- Also known as “Hysteria”.
- Conversion disorder refers to unexplained sensory and motor symptoms.
- Dissociative disorder refers to unexplained amnesia, fugue (amnesic wandering), stupor, or identity disorder.
Classification
- The conditions are classified differently in DSM-IV and ICD-10, reflecting uncertainty in this field.
- In DSM-IV, conversion disorder is listed among somatoform disorders and there is a separate category for dissociative disorder.
- In ICD-10 both conditions are grouped together in a single category- Dissociative disorder.
Conversion and Dissociative Symptoms
- Occur in many psychiatric disorders other than conversion and dissociative disorders.
E.g.: Anxiety
Depressive disorder
Organic mental disorders
A conversion (or dissociative) symptom is one that suggests physical illness but occurs in the absence of relevant physical pathology and is produced through unconscious psychological mechanisms
- Practical difficulties in applying this concept:
üDifficult to exclude physical pathology completely at the initial presentation.
üDifficult to be certain that the symptoms are produced by unconscious mechanisms rather than consciously and deliberately.
Prevalence
- Reported more often in less industrialized societies.
- In Western societies: 3-6 per 1000 for women, less for men.
- Those of recent onset, usually recover quickly.
- Those that persist for more than a year are likely to continue longer.
- Occasionally, organic disease may be present.
Therefore, patients should receive a thorough physical assessment, and careful follow up
Clinical Features
- Although conversion and dissociative symptoms are not produced deliberately, they are shaped by the patient’s concepts of illness.
E.g.:
üMight resemble those of a relative or friend who has been ill.
üOriginate in the patient’s previous experience of ill health (Dissociative memory loss may appear some years after head injury).
- Motor symptoms
üParalysis of voluntary muscles
üTremors
üTics
üAbnormalities of gait
- Sensory symptoms
üAnaesthesiae
üParaesthesiae
üHyperaesthesiae
üPain
üDeafness
üBlindness
- Sensory changes are distinguished from those in organic disease by,
a)Distribution does not conform to the known innervation.
b)Varying intensity.
c)Responsiveness to suggestion.
- Dissociative symptoms
üThese are less common.
üDissociative amnesia
a)Sudden onset.
b)Patients are unable to recall long periods of their life and sometimes deny any knowledge of their previous life or personal identity.
üDissociative fugue
a)Patient loses his memory and wanders away from his usual surroundings.
üDissociative stupor
a)Patient is motionless and mute and does not respond to stimulation, but he is aware of his surroundings.
üMultiple personality
a)Rare condition of uncertain diagnostic validity.
b)There are sudden alterations between the patient’s normal state and another complex pattern of behaviour, which constitutes a ‘second personality’.
Management
- Diagnosis depends on,
üExclusion of physical causes.
üPsychological assessment to identify psychological reasons for the onset and course of the symptoms.
- Physical disease is a vital differential diagnosis.
- Thus, careful physical assessment is important.
- Conversion symptoms are common accompaniments to physical disorder.
- Therefore it is not necessarily an ‘either/or’ diagnosis.
Acute Conversion Disorder
- Acute disorders often respond to simple measures.
- Treatment:
üMedical and psychiatric history from patient and informants
üFull examination and appropriate investigation to exclude physical causes
üSympathetic but positive reassurance
üDiscussion of the expected rapid recovery
üAvoidance of reinforcement of disability or symptoms
üOffer continuing assessment and treatment of related psychiatric or social problems
Persistent Conversion Disorder
- General approach is similar.
- Attention is directed away from the symptoms and towards problems that have provoked the disorder.
- Staff should show sympathetic concern while encouraging self-help and avoid reinforcing the disability. (E.g.: A patient who complains of paralysis of the legs should be encouraged to return to walking, not offered a wheelchair)
- Main emphasis should be to try and concentrate the patient’s attention on understanding problems and methods of solving them.
test
test
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Somatoform disorders
