0071643192.pdf

PSYCHOBEHAVIORAL DISORDERS

TABLE 16.7. Somatoform Disorders

DISORDER SYMPTOMS/EXAM DIFFERENTIAL DIAGNOSIS TREATMENT

Conversion Usually involves Rule out organic Clinical diagnosis; Reassurance; supportive

Disorder neurologic/orthopedic pathology first (MS, no physical findings care; refer for outpatient

(rare, F >M, manifestations(paralysis, SLE, Lyme disease, related to symptom medical and psychiatric

adolescence) seizures, blindness), polymyositis, toxins). found, and exam is follow-up

sudden onset of single Check labs or inconsistent with

symptom related to imaging if indicated. known anatomic or

severe stress pathophysiologic

states

Somatization Wide variety of complaints Rule out organic Clinical diagnosis. Reassurance, close

Disorder and long complicated causes if indicated. outpatient medical and

(F>M, history of medical psychiatric follow-up;

adolescent–30s) problems with no apparent minimize number of

medical cause; a pan- providers and ensure a

positive review of single one is taking the

systems, repeated visits lead on treatment plan

Hypochondriasis Patient is preoccupied Rule out organic Clinical diagnosis. Reassurance, close

with fears of serious causes. outpatient medical and

illness that persist psychiatric follow-up;

despite appropriate minimize number of

medical evaluation providers and ensure a

and reassurance. single one is taking the

lead on treatment plan

Fictitious Disorders

See Table 16.8.

TABLE 16.8. Factitious Disorders

DISORDER SYMPTOMS/EXAM/DIAGNOSIS DIFFERENTIAL TREATMENT

Drug-seeking Most common complaints are back pain, Rule out real medical Refuse drug, consider

behavior headache, extremity pain, and dental pain. illness. Strike a balance need for alternative

Common techniques include lost prescription, between sufficient medication/treatment,

impending surgery, factitious hematuria, workup and exhaustive refer for drug counseling.

self-mutilation, multiple drug allergies. unnecessary

Secondary gain is to obtain pain medication. tests/procedures.

Malingering This is strongly linked with antisocial Somatization disorder; Close outpatient

personality disorder.There is marked same as for follow-up.

discrepancy between patient’s complaints and drug-seeking behavior

objective findings, with poor cooperation during

exam or a history of poor compliance.