2406308
Description
Flashcards by Anna Walker, updated more than 1 year ago
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Created by Anna Walker
about 9 years ago
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| Question | Answer |
| What is meant by the terms "somatoform", "medically unexplained symptoms" and "functional symptoms"? | These terms all refer to symptoms that patients present with that remain unexplained by identifiable disease even after extensive medical assessment. By assuming that a physical symptom is the result of a physical disease/pathology, we may be subjecting the patient to unnecessary tests and hospital visits, adding to patient distress, and failing to deliver the kind of integrated management that is needed. NB: this is quite different to the manufacture or exaggeration of symptoms seen in some patients. |
| List some common symptoms that are often functional. | Pain syndromes: abdo, non-cardiac chest pain, headache, atypical facial pain, muscular pain, low back pain, pelvic pain. Chronic fatigue. Non-ulcer dyspepsia. Irritable bowel. Palpitations. Dizziness. Tinnitus. Dysphonia. Premenstrual tension. Food intolerance. |
| What are the three classifications of medically unexplained symptoms? | Descriptive physical syndromes, psychiatric syndromes that are a primary cause of the functional syndromes, Psychiatric syndromes comprising health concern and functional symptoms. |
| Describe what is meant by "Descriptive physical syndromes". | These include fibromyalgia, chronic fatigue syndrome, non-cardiac chest pain, chronic pain syndrome and IBS. Although the specific terms are used in everyday medical practice, there is substantial overlap, and many patients with eg fibromyalgia will also have IBS. |
| Describe what is meant by "Psychiatric syndromes that are a primary cause of the functional syndromes". | Well-recognised psychiatric syndromes, such as depression, anxiety and adjustment disorder and common primary causes of functional symptoms, and commonly present via them, sometimes via the general hospital's A&E department or cardiology outpatient clinic. Eg, a patient with GAD has multiple autonomic symptoms of anxiety, including palpitations; the palpitations are themselves alarming, and trigger negative automatic thoughts about possible cardiac illness and its outcomes, thereby maintaining anxiety, autonomic arousal and physical symptoms. The physical symptoms may resolve with effective treatment of these psychiatric disorders. Psychiatric disorders such as anxiety may also be secondary to the functional symptoms, which then are exacerbated and maintained by the anxiety. |
| Describe what is meant by "Psychiatric syndromes comprising health concern and functional symptoms". | The appropriate psychiatric diagnosis is a somatoform disorder. These are conditions characterised by A) Persistent abnormal concern about physical health, and B) One or more symptoms unexplained by physical pathology. Within the somatoform disorders, there are several specific disorders. |
| Name the 6 somatoform disorders (NB these classifications are controversial and not universally recognised). | Somatoform autonomic dysfunction, Somatisation disorder, Hypochondriasis, Body dysmorphic disorder, Persistent somatoform pain disorder, Dissociative (conversion) disorder. |
| THE SOMATOFORM DISORDERS - Describe the features of somatoform autonomic dysfunction. | Common. A large, ill-defined category of patients who present repeatedly with one or more unexplained physical symptom(s), attributable to a system under autonomic control (CV, GI, Resp, Urogenital), which persists in spite of negative investigation and reassurance. |
| THE SOMATOFORM DISORDERS - Describe the features of somatisation disorder. | Uncommon. Multiple, recurrent and changing unexplained physical symptoms, with multiple presentations to medical care, often over many years. Usually begins in early life. Chronic and often fluctuating course. |
| THE SOMATOFORM DISORDERS - Describe the features of hypochondriasis. | Severe persistent anxiety about ill health and conviction of disease, with repeated presentation of concern about the possibility of one or more specific diseases (eg cancer, heart disease), despite negative medical investigations and appropriate reassurance. |
| THE SOMATOFORM DISORDERS - Describe the features of body dysmorphic disorder. | Persistent, inappropriate concern about the appearance of the body (eg about the size and shape of the nose or breasts), despite reassurance. Some patients demand cosmetic procedures, which is helpful only in those with clear and reasonable expectations. |
| THE SOMATOFORM DISORDERS - Describe the features of persistent somatoform pain disorder. | The intensity and duration of pain cannot be accounted for by any primary physical or mental disorder. |
| THE SOMATOFORM DISORDERS - Describe the features of dissociative (conversion) disorder. | Partial or complete loss of the normal integration between i) memories of the past, ii) awareness of identity and immediate sensations and iii) control of movements, in the absence of a medical explanation. Examples of symptoms include amnesia, aphonia, paralysis and anaesthesia. A conversion symptom occurs in the absence of relevant physical pathology and is produced through unconscious psychological mechanisms. Thus, although the symptoms are not produced deliberately, they are shaped by the patient's concept of illness. |
| What is the aetiology of functional symptoms? | One idea is that the bio/psycho/social factors all contribute to the symptoms. This approach suggests that the functional symptoms arise initially from minor physiological or pathological body sensations, triggered by a multitude of usually benign causes, such as a hangover, autonomic effects of anxiety, lack of sleep, prolonged inactivity, overeating, fatigue, sinus tachycardia, or minor arrhythmias. Next, importantly, attribution happens; that is, the process of assigning a putative cause to the symptom. Attributions may be normalising (assigning benign causes), psychologising (assigning causes such as stress or depression), or somatising (assigning more serious physical causes such as tumour, endocrine disease or cardiac disease). Which way they attribute depends on their personality and their personal situation at that time . Other factors include their family history, their own personal medical history, their knowledge of illnesses of relevance, their family and friends' responses and their doctor's response. |
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