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that would be furthered bythe intentional
production of symptoms.
D. Factitious Disorder. In factitious
disorder symptoms are intentionally
produced to assume the sick role
to meet a psychological need.
V. Treatment of Somatization Disorder
A. The physical complaints that occur
insomatization disorder are an expression
of emotional issues. Psychotherapy
is beneficial to help the patient find
more appropriate and direct ways
of expressing their emotional needs.
Behaviorally oriented group therapy
is also helpful.
B. The patient should have a primary
care physician and should be seen
at regular intervals tominimizeinappropriate
use of medical services.
Conversion Disorder
I. DSM-IV Criteria for Conversion Disorder
A. The patient complains of symptoms
or deficits affecting voluntary muscles,
or deficits of sensory function that
suggest a neurological or medical
condition.
B. The temporal relation of symptoms
to a stressful event suggests association
of psychological factors.
C. Symptoms are notintentionallyproduced.
D. Symptoms are not explained by an
organic etiology.
E. Symptoms result in significant functional
impairment.
F. Symptoms are not limited to pain
or sexual dysfunction, and are not
explained by another mental disorder.
II. ClinicalFeatures of Conversion Disorder
A. The most common symptoms are
sensory (blindness, numbness) and
motor deficits (paralysis, mutism),
and pseudoseizures. Other symptoms
include pseudocyesis (pregnancy),
urinaryretention, torticollis and voluntary
motor paralysis (astasia-abasia).
B. Abnormalities usually do not have
a normal anatomical distribution and
the neurological exam is normal.
Deficits tend to change over time.
C. Patients often lack the characteristic
normal concern about the deficit.
This characteristic lack of concern
has been termed  la belle indifference.
Conversion disorder can coexist with
depression, anxiety disorders, and
schizophrenia.
D. Conversion symptoms often will temporarily
remit after the disorder has been
suggested by the physician.
III. Epidemiologyof Conversion Disorder
A. Conversion disorder occursin1-30/10,000
in the general population and in up
to 3% of outpatient psychiatric patients.
B. The disorder is more common in lower
socioeconomic groups.
IV.Differential Diagnosis of Conversion
Disorder
A. Medical conditions must be excluded.
B. Somatization Disorder begins in
early life and involves multi-organ
symptoms. Patients tend to be very
concerned about symptoms.
C. Factitious Disorder. Symptoms are
under conscious voluntary control,
and they are intentionally created
to assume a sick role. In conversion
disorder, symptoms are not consciously
produced.
D. Malingering is characterized by the
presence of external motivations
behind fabrication of symptoms.
V. Treatment of Conversion Disorder
A. Symptoms typically last for days to
weeks and typicallyremit spontaneously.
Supportive,insight-oriented orbehavioral
therapy can facilitate recovery.
B. Anxiolytics and relaxation may also
be helpful in some cases. The physician
should avoid confrontation or focusing
on the symptoms. The focus should
be on psychological issues and any
secondary gain. Benzodiazepines
can be useful when anxiety symptoms
are prominent.
Hypochondriasis
I. DSM-IV Criteria for Hypochondriasis
A. Preoccupation with fear of having
a serious disease,based on misinterpretation
of symptoms.
B. The patient is not reassured by a
negative medical evaluation.
C. Symptoms are not related to delusions
or restricted to specific concern about
appearance.
D. The disorder results in significant
functional impairment.
E. Duration is greater than six months.
F. Symptoms are not accounted for
by another mental disorder.
II. Clinical Features of Hypochondriasis
A. Despite clinical, diagnostic or laboratory
evaluation, the patient is not reassured.
Doctor shopping is common, and
complaintsare often vague and ambiguous.
B. Repeated diagnostic procedures
mayresultin unrelated medical complications.
III. Epidemiology and Classification of
Hypochondriasis
A. The prevalence ranges from 4-9%.
Hypochondriasis is most frequent
between age 20 to 30 years, and
there is no sex predominance.
B. Hypochondriasis  with poor insight
is present if the patient fails to recognize
that his concern abouthealth is excessive
or unreasonable.
IV.DifferentialDiagnosis of Hypochondriasis
A. Major depression,obsessive-compulsive
disorder, generalized anxiety disorder,
and panic disorder can often cause
prominent somatic complaints with
no organic basis.
B. Medical conditions that can produce
varied symptoms, such as AIDS,
multiple sclerosis, and systemic lupus
erythematosus, must be excluded.
C. BodyDysmorphic Disorder.Concerns
are limited onlyto physical appearance,
in contrast to the fear of having an
illness that occurs in hypochondriasis.
D. Factitious Disorder and Malingering.
Hypochondriacal patients realistically
experience the symptoms and do
not fabricate them.
E. Conversion Disorder. This disorder
tends to cause only one symptom,
and the patient has less concern
about the symptom.
F. Somatization Disorder. The focus
of the patient is on the symptoms,
as opposed to fear of having a disease
in hypochondriasis.
V. Treatment of Hypochondriasis
A. Improvement usually results from
reassurance through regular physician
visits. Cognitive-behavioral group
therapy, rather than individual therapy,
is most helpful.
B. Coexisting psychiatric conditions
should be treated. Hypochondriasis
is sometimes episodic, and it may
be related to stressful life events.
There is preliminary evidence that
SSRI medications are beneficial.
Body Dysmorphic Disorder
I. DSM-IV Criteria for Body Dysmorphic
Disorder
A. A preoccupation with imagined defect
in appearance.
B. The preoccupation causes significant
functional impairment.
C. Preoccupation is not caused for by
another mental disorder.
II. ClinicalFeatures of Dysmorphic Disorder
A. Facial features, hair, and body build
are the most frequently  defective
features. Concerns about the imagined
defect mayreach delusional proportions
without meeting criteria for a psychotic
disorder. Multiple visits to surgeons
and dermatologists are common.
B. Major depressive disorder and anxiety
disorders frequently coexist with body
dysmorphic disorder.
III. Epidemiologyof Dysmorphic Disorder
A. The disorder is most common between
the ages of 15 and 20 years, with
women affected as frequently as men. [ Pobierz całość w formacie PDF ]