somatoform disorders by : dr seddigh hums dr seddigh

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Somatoform Disorders By : Dr Seddigh HUMS Dr Seddigh

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Somatoform Disorders

By : Dr Seddigh

HUMS

Dr Seddigh

An Overview of Somatoform Disorders

Somatoform Disorders

Somatization disorder Conversion disorder Hypochondriasis Body dysmorphic disorder Pain disorder

Hypochondriasis

Hypochondriasis: An Overview

Clinical Description Anxiety or fear be or having a seriuos

disease

bodily symptoms

Hypochondrium

Hypochondriasis: An Overview

Statistics 4% to 6% of medical patients

15% rate Female : Male = 1:1 Onset at any age

Peaks: age (20-30)

Medical students

Hypochondriasis

Causes Familial history

Genetics Modeling/learning

Other factors Stressful life events “Benefits”

Hypochondriasis

Causes Disorder of cognition or perception

Physical signs and sensations

Hypochondriasis in DSM IV

A. Preoccupation with fears of having, or the idea that one has, a serious disease based on the person’s misinterpretation of bodily symptoms

B. The preoccupation persists despite apprpriate medical evaluation and reassurance

C. The belief in Criterion A is not of delusional intensity

Hypochondriasis

D. The preoccupation causes significant distress or impairment in functioning

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

rumination about illness, suggestibility

unrealistic fear of infection, fascination with medical information

fear of prescribed medication. rumination about illness plus at least one of five other symptoms form a distinct diagnostic entity

performing better than the current DSM-IV hypochondriasis diagnosisAm J Psychiatry 161:1680-1691, September 2004

Hypochondriasis

Somatoform Disorder or Anxiety Disorder???

Hypochondriasis

Differ phobia

Hypochondriasis: already have

Reassurance temporary

Better prognosis 1- good socioeconomic 2- anxiety or depression (sensitive) 3-acute onset 4-no personality dx 5- no medical problem

accidents and criminal victimization develop various diseases.

Am J Psychiatry 163:907-912, May 2006

Hypochondriasis - Treatment

Group therapy Insight oriented and HX Cognitive-Behavioral

Identify and challenge misinterpretations “Symptom creation” Stress-reduction

Physical exammedications (SSRI)

Body Dsmorphic Disorder

Body Dysmorphic Disorder

Clinical Description Imagined defect in appearance Impaired function

Social Occupational

Not attracted Dysmorphophobia

Body Dysmorphic Disorder

Statistics 1% to 15% (unknown) Female >: Male = ~1:1

Onset = 15 – 30 y/o Most remain single Lifelong, chronic course With MDD, Anxiety & Psychosis

Body Dysmorphic Disorder: Causes

Little scientific knowledge

Cultural imperatives Body size Skin color

Serotonin ( OCD )

Body Dysmorphic Disorder in DSM IV

A. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive.

B. The preoccupation causes clinically significant distress or impairment in functioning

C. The preoccupation is not better accounted for by another mental disorder

Body Dysmorphic Disorder

Comorbidity with depression Some believe it is similar to OCD

Obsessions Compulsions

5 most common locations for perceived deficits: Skin – 73% Hair – 56% Nose – 37% Stomach – 22% Breasts/chest/nipples – 21%

partial remission 0.21 Gender and ethnicity did not significantly predict remission

Am J Psychiatry 163:907-912, May 2006

Body Dysmorphic Disorder

Clinical Description mirrors Suicidal ideation and behavior Unusual behaviors

Ideas of reference Checking/compensating rituals

Delusional disorder: somatic type?

Suicidal ideation mean of 57.8% per year attempted suicide mean of 2.6% per year. completed suicide (0.3% per year).

Am J Psychiatry 163:1280-1282, July 2006

Treatment

The Plastic Surgery Solution?Popular but ExpensiveMost are Disappointed with Results

CBT: Exposure and Response Prevention – very effectivePimozide,TCA,MAO INHClomipramine, SSRI’s – moderately effective

Treatment

The Plastic Surgery Solution?Popular but ExpensiveMost are Disappointed with Results

CBT: Exposure and Response Prevention – very effectivePimozide,TCA,MAO INHClomipramine, SSRI’s – moderately effective

Body Dysmorphic Disorder

With olanzapine treatment, body dysmorphic disorder symptoms minimally improved Pimozide augmentation of fluoxetine treatment for body dysmorphic disorder was not more effective than placebo,

Am J Psychiatry 162:377-379, February 2005

Pain Disorder

Clinical Description Pain is Real Pain May Have Organic Cause Psychological Factors Have an Important Role in:

onset severity exacerbation OR maintenance of the pain

Clinical Description Pain is Real Pain May Have Organic Cause Psychological Factors Have an Important Role in:

onset severity exacerbation OR maintenance of the pain

Pain Disorder

Pain Disorder

Clinical Description Pain in one or more areas Significant impairment Etiology may be physical Maintained by psychological factors

Pain Disorder

Statistics Fairly common 5% - 12%

Sex female 2 times Age from 30 & 40 y/o

Pain Disorder in DSM IV

A. Pain in one or more anatomical sites that is of sufficient severity to warrant clinical attention

B. The pain causes clinically significant distress or impairment in functioning

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

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

E. The pain is not better accounted for by another mental disorder

Treatment Behavioural Management,CBT& Insight oriented

Medication

not effective : analgesic ,antianxiety & sedative

effctive :TCA,SSRI & AMPHETAMINE

Others

BIOFEEDBACK

HYPNOSIS

Treatment Behavioural Management,CBT& Insight oriented

Medication

not effective : analgesic ,antianxiety & sedative

effctive :TCA,SSRI & AMPHETAMINE

Others

BIOFEEDBACK

HYPNOSIS

Pain Disorder

THANKS FOR

YOUR KIND ATTENTION