psychiatry.somatoform disorders.(dr.nzar)

853 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
853
On SlideShare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
37
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

psychiatry.somatoform disorders.(dr.nzar)

  1. 1. Hypochondriasis <ul><li>Is a condition were the patient misinterprets trivial symptoms as having a serious disease and the idea is nondelusional and usually lasts for at. least 6 months </li></ul><ul><li>The belief is not fixed and could be removed transiently by explanation and reasoning to have another belief about another organ of the body ( doctor shopping ). </li></ul><ul><li>The condition interferes with the patient’s daily life and causes him distress . It causes disability and physical dysfunction. </li></ul><ul><li>Hypochondriacal symptoms could occur in most of the psychiatric disorders. </li></ul>
  2. 2. Hypochondriasis <ul><li>The attention of those patients is narrowly focused on bodily functions. </li></ul><ul><li>The patients have great concerns about their health. </li></ul><ul><li>The patients usually attend primary health care centers, nevertheless, they are rarely diagnosed by primary care physcians. </li></ul><ul><li>The patients have either disease phobia or disease conviction. </li></ul><ul><li>It is more common in medical patients than the general population. </li></ul>
  3. 3. Hypochondriasis <ul><li>The disorder affects 2-7% of patients attending general medical clinics. </li></ul><ul><li>The disorder most commonly appears in persons 20 to 30 years of age. </li></ul><ul><li>social position, education level, and marital status do not appear to affect the diagnosis. </li></ul><ul><li>There may be co morbid depression or other anxiety disorder </li></ul>
  4. 4. Hypochondriasis <ul><li>Etiological factors: </li></ul><ul><li>People with serious illness in childhood and history of traumatic sexual contact and physical violence and major parental illness early in the life of the patient are more likely to develop hypochondriasis. </li></ul><ul><li>Patients have faulty cognitive appraisal of bodily sensations. Patients might find illness as solution for some social and relationship conflicts. </li></ul><ul><li>In third world countries, somatisation is common because of stigma attached to mental illness. </li></ul>
  5. 5. Hypochondriasis <ul><li>Differential diagnosis: </li></ul><ul><li>Other psychiatric disorders </li></ul><ul><li>Delusional disorders </li></ul><ul><li>Physical disorders such as multiple sclerosis, Myasthenia Gravis, thyroid and parathyroid disorders. </li></ul>
  6. 6. Hypochondriasis <ul><li>Treatment </li></ul><ul><li>Patients with hypochondriasis usually resist psychiatric treatment, although some accept this treatment if it takes place in a medical setting and focuses on stress reduction and education in coping with chronic illness. </li></ul><ul><li>You might not be able to treat the symptoms but you can teach the patients to cope with the symptoms. </li></ul><ul><li>psychotherapy, such as individual insight-oriented psychotherapy, behavior therapy, cognitive therapy, and hypnosis may be useful. </li></ul><ul><li>Pharmacological treatment with antidepressants might be useful. </li></ul><ul><li>When hypochondriasis is secondary to another primary mental disorder, that disorder must be treated in its own right </li></ul>
  7. 7. Hypochondriasis <ul><li>Am J Psychiatry 164:91-99, January 2007 doi: 10.1176/appi.ajp.164.1.91 © 2007  American Psychiatric Association </li></ul><ul><li>Cognitive Behavior Therapy and Paroxetine in the Treatment of Hypochondriasis: A Randomized Controlled Trial </li></ul><ul><li>Anja Greeven, M.Sc., Anton J.L.M. van Balkom, M.D., Ph.D., Sako Visser, Ph.D., Jille W. Merkelbach, M.D., Yanda R. van Rood, Ph.D., Richard van Dyck, M.D., Ph.D., A.J. Willem Van der Does, Ph.D., Frans G. Zitman, M.D., Ph.D., and Philip Spinhoven, Ph.D. </li></ul><ul><li>CONCLUSIONS:   CBT or paroxetine are effective short-term treatment options   for subjects with  hypochondriasis . </li></ul>
  8. 8. Pain Disorders <ul><li>Pain has been derfined by the International Association for the Study of Pain ( IASP ) as ‘ an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage'. </li></ul><ul><li>Mental health workers face patients with pain in many ways: </li></ul><ul><li>Patients with terminal illness suffer from intractable pain that will make the patient depressed and adds to the patient’s distress. </li></ul><ul><li>Patients with chronic pain might affect his relationships with family members and other people making his management more difficult. </li></ul>
  9. 9. Pain Disorders <ul><li>the pain could be localized as backache or generalized as in fibromyalgia. </li></ul><ul><li>The pain causes distress and impairment in social occupational and other areas of functioning. </li></ul><ul><li>Pain occurs in psychotic disorders such as schizophrenia and psychotic depression. </li></ul><ul><li>Mood and anxiety disorders are commonly associated with pain. </li></ul><ul><li>Pain could be a feature of any of the somatoform disorders however, Pain Disorder will not be diagnosed if the requirements for the diagnosis of somatization disorder is satisfied. </li></ul>
  10. 10. Pain Disorders <ul><li>Diagnosis : </li></ul><ul><li>The patient must have a pain that is persistent, severe and distressing. The pain can not be explained by a psychological process or physical disorder and occurs in association with emotional conflicts or psychosocial problems. </li></ul><ul><li>The patient consults many doctors, undergoes many investigations and receive many kinds of treatments. </li></ul>
  11. 11. Pain Disorders <ul><li>Comorbidity : </li></ul><ul><li>Include anxiety ,depression, substance abuse and personality disorders. </li></ul><ul><li>Assessment </li></ul><ul><li>Should include patient’s attitude to pain, family history of pain and disability. </li></ul><ul><li>Patient’s premorbid personality traits must be assessed. </li></ul>
  12. 12. Pain Disorders <ul><li>Treatment </li></ul><ul><li>Reassurance does not work well on those patients. However psychological treatments include cognitive, behavioural, cognitive and psychodynamic treatments. </li></ul><ul><li>Relaxation, hypnosis and biofeedback techniques </li></ul><ul><li>Avoid anxiolytics especially benzodiazepines. </li></ul><ul><li>Antidepressants are effective in many cases. </li></ul>
  13. 13. Body Dysmorphic Disorder <ul><li>distressing and/or impairing preoccupation with a non-existent or slight defect in appearance. </li></ul><ul><li>The patient does not usually declare the condition although it causes him distress and might lead to suicide. </li></ul><ul><li>Face and head are commonly mentioned by patients. </li></ul><ul><li>Many patients have no insight and might have delusions of reference. </li></ul>
  14. 14. Body Dysmorphic Disorder <ul><li>Patients usually spend time trying to hide their defect and keep looking in the mirror and compare themselves with others. </li></ul><ul><li>It affects the patients functioning socially and occupationally. </li></ul><ul><li>It is sometimes difficult to separate from Delusional Disorder or previously called Monosymptomatic hypochondriacal Psychosis. </li></ul>
  15. 15. Body Dysmorphic Disorder <ul><li>Treatment: </li></ul><ul><li>Cognitive Behaviour therapy </li></ul><ul><li>SSRIs </li></ul>
  16. 16. Paranormal healing: What is the way forward? Journal of Psychosomatic Research ,  Volume 71, Issue 2 ,  August 2011 ,  Pages 86-89 ,  Alison Easter, Caroline Watt It's good to know: How treatment knowledge and belief affect the outcome of distant healing intentionality for arthritis sufferers <ul><li>In the August 2011 of  Journal of Psychosomatic Research  Easter and Watt report their findings from an elegant, albeit small study of paranormal healing on pain of arthritis patients  [1] . Such studies may be relevant, not least because this population uses alternative treatments for symptom control more frequently than any other patient group  [2] . Easter and Watt show that healing is ineffective, i.e., it is no better than no intervention in terms of improving general health or reducing pain. Belief in healing also did not affect the outcome. Yet a medium to large effect was noted for participants who were aware of receiving the verum treatment. This suggests that patients’ awareness of being treated maximises the placebo effect. </li></ul>
  17. 17. Paranormal healing: What is the way forward? Journal of Psychosomatic Research ,  Volume 71, Issue 2 ,  August 2011 ,  Pages 86-89 ,  Alison Easter, Caroline Watt It's good to know: How treatment knowledge and belief affect the outcome of distant healing intentionality for arthritis sufferers <ul><li>Many different forms of paranormal healing exist and are popular in the United Kingdom, United States, and other countries. Some have religious connotations while others do not. All rely on some form of paranormal “energy” which allegedly enables the body to heal itself [3] . Numerous studies have tested whether healing is effective. Even though some have produced encouraging answers (and several investigations were suspected to be fraudulent and therefore false-positive  [4] ), the overall picture is far from convincing. The most recent review of these data concluded that “the weight of the evidence [is] against the notion that distant healing is more than a placebo” [5] . </li></ul>
  18. 18. Paranormal healing: What is the way forward? Journal of Psychosomatic Research ,  Volume 71, Issue 2 ,  August 2011 ,  Pages 86-89 ,  Alison Easter, Caroline Watt It's good to know: How treatment knowledge and belief affect the outcome of distant healing intentionality for arthritis sufferers <ul><li>As clinicians, should we or should we not use healing or encourage patients to use this approach? On the one hand, through a placebo response, it has the potential to ease the suffering of many patients, particularly, as Easter and Watt have shown  [1] , if they are aware that they receive this therapy. On the other hand, doing so might violate important ethical principles of healthcare. Medical ethics require all clinicians to be truthful. If we informed our patients that they were about to receive a placebo, they would most likely not experience a placebo response. In a way, the emerging conundrum boils down to a choice between helping suffering individuals or behaving ethically correct. Many clinicians might find it difficult to choose between these two options. However, we should also consider the risks promoting irrational beliefs in the paranormal. These risks reach far beyond the realms of healthcare. Undermining rationality with mystical nonsense endangers progress and the fabric of society in general. </li></ul>
  19. 19. Paranormal healing: What is the way forward? Journal of Psychosomatic Research ,  Volume 71, Issue 2 ,  August 2011 ,  Pages 86-89 ,  Alison Easter, Caroline Watt It's good to know: How treatment knowledge and belief affect the outcome of distant healing intentionality for arthritis sufferers <ul><li>As researchers, we might ask ourselves whether more research into paranormal healing is justified. Easter and Watt seem convinced that “it is important that continued and varied approaches of research in this field be pursued…”  [1] . I am not entirely convinced that this is the case. Around 60 clinical trials of paranormal healing have collectively failed to demonstrate that this approach is more than a placebo  [5] . Given that resources are always limited, I believe that future research should focus on interventions that are solidly backed by biological plausibility. In my view, this strategy would increase our chances of improving healthcare for the benefit of our patients. </li></ul>
  20. 20. Journal of Psychosomatic Research Volume 71, Issue 5 , November 2011, Pages 357-363 doi:10.1016/j.jpsychores.2011.05.004  |  How to Cite or Link Using DOI    Permissions & Reprints Type D personality and metabolic syndrome in a 7-year prospective occupational cohort Paula M.C. Mommersteeg a ,  ,  ,  Raphael Herr b ,  c ,  Jos Bosch b ,  d ,  Joachim E. Fischer b ,  c ,  Adrian Loerbroks b ,  c ,  e <ul><li>Received 2 December 2010; revised 9 May 2011; Accepted 10 May 2011. Available online 1 July 2011. </li></ul><ul><li>Abstract </li></ul><ul><li>Objective </li></ul><ul><li>Type D personality is a combination of high negative affectivity (NA) and high social inhibition (SI). This trait is related to increased mortality and poor health outcomes in patients with cardiovascular diseases, although it is less well-established if Type D personality also poses an increased risk in healthy populations. A potential underlying pathway could include the metabolic syndrome and the combination of abdominal obesity, subnormal levels of triglycerides and HDL-cholesterol, elevated blood pressure, and increasedplasma glucose levels. We investigated if Type D personality shows a cross-sectional and longitudinal association with metabolic syndrome in a working population. </li></ul>
  21. 21. Journal of Psychosomatic Research Volume 71, Issue 5 , November 2011, Pages 357-363 doi:10.1016/j.jpsychores.2011.05.004  |  How to Cite or Link Using DOI    Permissions & Reprints Type D personality and metabolic syndrome in a 7-year prospective occupational cohort Paula M.C. Mommersteeg a ,  ,  ,  Raphael Herr b ,  c ,  Jos Bosch b ,  d ,  Joachim E. Fischer b ,  c ,  Adrian Loerbroks b ,  c ,  e <ul><li>Methods </li></ul><ul><li>Poisson regression and linear regression were used to estimate the association between Type D personality and its subscales (NA) and (SI) with objectively established metabolic syndrome markers in cross-sectional ( n  = 458) and prospective ( n  = 268, 6.3 years follow-up) analyses of data from an occupational cohort (mean age = 35.9 years, SD = 11.7; 80% male). </li></ul><ul><li>Results </li></ul><ul><li>Type D personality was neither associated with the metabolic syndrome nor with any of its subcomponents. </li></ul><ul><li>Conclusion </li></ul><ul><li>The present study does not support a role for metabolic syndrome as a mediating mechanism. More research is needed that examines potential pathways linking Type D personality with cardiovascular disease outcomes. </li></ul><ul><li>Keywords:  Type D personality; Metabolic syndrome; Longitudinal; Cohort; Life style; Occupational </li></ul>
  22. 22. <ul><li>Thank you for attendance and kind attention </li></ul>

×