Review of DSM5 Mental Disorders for NCMHCE Study

1. Somatic Symptom Disorder2. Illness Anxiety Disorder3. Conversion Disorder (Functional Neurological

Symptom Disorder)4. Factitious Disorder5. Psychological Factors Affecting Other Medical

Conditions6. Other Specified Somatic Symptom &

Related Disorders7. Unspecified Somatic Symptom &

Related Disorders

Find Out MoreMedical and treatment historyWork historyFamily and social historyAffective functioning

Assess & ReferMedical evaluationEEG testNutritional and exercise counselingTestsHistory & Severity of Traumatic Events & 12 Theme Assessement of Post Traumatic Symptoms (HSTE-12)Prime-MDSomatic Symptom Scale (PHQ-12)Mental status exam

S4. TreatmentsMedicationAnti-depressants

TherapiesCognitive Behavioral TherapyGroup counselingPsychoeducationStress Management TrainingExercise

Somatic SymptomMultiple symptoms, including pain, gastrointestinal, sexual problemsDoctor shoppingPossible early abuse

Illness AnxietyMay not have symptomsPreoccupation with what sensations may meanMay seek care or strongly avoid care

Factious Faking

symptoms Seeks sick role

Diagnosis IA. Somatic symptom(s) causing distress (not simultaneous)Pain in 4+ placesGastrointestinal problems, like diarrhea or vomitingFalse fainting or blindnessA sexual symptom

B. Excessive thoughts, feelings or behaviors related to the symptoms or associated health condition, shown by 1 of these:

Disproportionate thoughts about the seriousness of the symptoms

High anxiety about symptoms Excessive time and energy

devoted to health concernsC. Symptom persistent over 6

months

Diagnosis IIContributing Factors:Commonly appears in late adolescence or young adulthoodOften associated with childhood abuse and represents buried feelings manifesting as physical conditionsOften associated with complex, vague medical histories and “doctor shopping”More likely female

Diagnosis IIIComorbidity:AnxietyDepressionBody DysmorphiaHypochondriatis

Rule OutsMalingeringConversion Disorders: Detached, less concernedBody Dysmorphia: Embarrassed, delusionalHypochondriatis: Concerned with dying

S1. Find Out MoreMedical and treatment historyWork historyFamily and social historyAffective functioning

S2. Assess & ReferMedical evaluationEEG testNutritional and exercise counselingTestsHistory & Severity of Traumatic Events & 12 Theme Assessement of Post Traumatic Symptoms (HSTE-12)Prime-MDSomatic Symptom Scale (PHQ-12)Mental status exam

S4. TreatmentsMedicationAnti-depressants

TherapiesCognitive Behavioral TherapyGroup counselingPsychoeducationStress Management TrainingExercisePsychotherapy

S5. Monitoring ProgressPhysical symptomsAffective functioningUnderstanding and controlling anxietyTaking responsibility for emotions and behaviorReceptivity to psychological intervention

S6. TerminationKeep contact with one physician who will monitor their physical conditionRelaxation exercises

Diagnosis1. Preoccupied with idea of being ill 2. May or may not have physical symptoms3. Concern is more about implications of the symptoms than the symptoms themselvesExamine themselves repeatedly Easily alarmed by new sensations 4. Persistent refusal to accept medical advice 5. For 6 months

TypesCare-seeking typeCare-avoidant type

Diagnosis IIRule OutSomatic Symptom

S1. Find Out MoreMedical and treatment historyWork historyFamily and social historyAffective functioning

S2. Assess & ReferMedical evaluationTestsHistory & Severity of Traumatic Events & 12 Theme Assessement of Post Traumatic Symptoms (HSTE-12)Prime-MDSomatic Symptom Scale (PHQ-12)Mental status exam

S4. TreatmentsMedicationAnti-depressants (SSRIs)

TherapiesCognitive Behavioral Therapy

Diagnosis IFalsifying physical or psychological signs or symptoms, or self injury With identified deceptionWithout obvious external rewards, only to assume the sick role and be cared forNo delusionsWilling to receive invasive medical care

Factitious Disorder Imposed on SelfPresenting oneself with symptomsFactitious Disorder Imposed on AnotherPresenting someone else with symptomsDisorder attributed to abuser

Diagnosis II

ComorbidityPersonality disorders

Rule OutsMalingering: Seeks external gain Munchausen Syndrome: Chronic, has real induced symptoms

S1. To Find Out S2. Assess & ReferTestHSTE-12 History & Severity of Traumatic Events & 12 Theme Assessment of Post Traumatic Symptoms Prime-MD

S4. Treatments If confronted, the patient will often leave or find another doctorIndividual therapy, with empathy and gentle confrontationStress Management

Diagnosis IUnexplained altered voluntary motor or sensory functionWith no neurological disease

Specifiers:Weakness or paralysisSpeech symptomsAttacks or seizuresAnesthesia or sensory lossSpecial sensory disturbanceSwallowing symptomsAbnormal movementWith or without psychological stressorAcute or persistent (6 months or more)

Diagnosis IIRule OutMyasthenia gravisGuillain-Barre syndromeNeurological disorders (Parkinson’s, epilepsy)StrokeLupusSpinal cord injury

S1. Find Out MoreMedical and treatment historyNeurological evaluationWork historyAffective functioningCognitive functioningFamily and social history

S2. Assess or ReferMedical evaluationEEG testPsychological testing

S4. Treatments HypnosisStress Management TrainingPhysical therapyNutrition and exercise counseling

MedicationAntianxietyAntidepressants