1. Somatic symptom disorders
21st Nov. 2015
Dr. SAMI ADIL

2. MUPS = SAD
Stress
Defined negatively rather than positively
with or without medical dx
No FDA approved drug

3. DSM-5 Somatic Symptom Disorders
2. Illness anxiety disorder
3. Conversion disorder (Funcitonal Neurological Symptom)
psychological factors affecting medical condition
Factitious disorder
Other

4. The prevalence rates differ across countries and times
The prevalence rates differ across countries and times. It is generally believed that their prevalence is decreasing in developed countries.
Mosul 5 yrs UK before 1950 (1).

5. In a study about the use of traditional and spiritual healers is was found that 35.1% of the cases who go to those healers were complaining of somatoform disorders, while 24.8% of the cases were having schizophrenic disorders (2).

6. There is no FDA approved drug for any of the somatic symptom disorders

7. Somatic Symptom Disorder
One or more symptoms Distress and functional impairment Disproportionate ABC With or without medical dx

8. epidemiology
intro

9. Etiology: unknown Low threshold … cognitive
Sick role in face of problems
Variant of mental illness
Aggression turned inward (repression and displacement)

10. Diagnosis:
A false belief, not to the degree of delusion, that they have serious illness based on misinterpretation of physical signs or sensations. The belief must last at least 6 months despite the absence of pathological findings. This should not be restricted to distress about appearance.
Specify if: with predominant pain.

11. Ddx.:
1. Medical illnesses that are difficult to diagnose (e.g. endocrinopathies, MD, occult neoplastic disorders) 2. Illness anxiety disorder in which there is no symptom, but only the fear. 3. Conversion disorder is acute and neurological, and the patient is not concerned about being ill (la belle indifference). 4. Body dysmorphic disorder. 5. Mood disorders (depression). 6. Anxiety disorders (panic). 7. Psychotic disorders. 8. Malingering and factitious disorders.

12. Treatment One physician …. scheduled visits
Patients can develop real physical illnesses
Psychotherapy: insight-oriented, cognitive behavioral, and group psychotherapy all can be helpful. Hypnosis is also helpful sometimes. See the note in the introduction about spiritual healers.
Medication can lead to abuse

13. 2. Illness Anxiety Disorder
Persistent, excessive thoughts and feelings about having a serious physical illness; not reassured. Few or no somatic symptoms. Essential feature is preoccupation with being ill. It may be present with or without medical diagnoses.

14. Epidemiology: mostly unknown.
Etiology: similar to etiology of somatic symptom disorder.

15. Dx. the belief must last at least 6 months. No physical findings
Dx. the belief must last at least 6 months. No physical findings. Not delusional, not body dysmorphic disorder. Causes distress and/or dysfunction.

16. Ddx:
(i) Other somatic symptom disorder (ii) Mood disorders (iii) Anxiety disorder (iv) Psychotic disorder (v) OCD

17. 3. Functional Neurological Symptom Disorder (Conversion Disorder)
Hysteria

18. مسمر Franz Anton Mesmer 1734-1815

21. تختفي الأعراض حين نتذكر أول نشأتها
تختفي الأعراض حين نفهم سبب نشأتها

23. Funct. Neuro. (conversion)
Usually occurs acutely after stress, then resolves within 2 weeks. The sx resemble neurological symptoms (either sensory, motor, seizure, or mixed )

24. Epidemiology:
paragraph in the introduction above taken from reference no. 1.
More in left side
Two to 10 times more common in females.
The onset is rare before 10 years of age or after 35 years of age.
Rural, little education, low IQ, those in low SES, and military personnel who have been exposed to combat situations.

25. Etiology:
Previous experience (such as childhood abuse) is a predisposing factor, psychological or physical trauma is a precipitating factor, and special rewards for disability a perpetuating factor.

26. Brain-imaging studies have found hypometabolism of the dominant hemisphere and hypermetabolism of the nondominant hemisphere and have implicated impaired hemispheric communication in the cause of conversion disorder.

27. Clinical features Paralysis, blindness, and mutism
Neurological exam (-ve)
Pseudoseizures
Primary and seconday gain
La belle indifference

28. Paralysis --- hoover test
Aphonia – ask to cough
Patient’s dignity

29. ddx
Neurological disorders (25-50%)
Other somatoform disorders
Malingering and factitious

30. Slater BJP

31. Course and prognosis
Acute, spontaneuous

32. Treatment
Spontaneous
Abreaction
Spiritual healers

33. In my opinion, sometimes the conversion cases are met with negative attitude by the medical staff and receive some punitive treatments like the painful I.M. normal saline injection, or injections of furosemide (Lasix) and this is unethical.
What is Evidence Based Medicine??? Can we write in our lectures things like (in my opinion….)??

34. End of part one