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  • The mothers present their children to the doctor with a mulititude of signs and sxs in virtually every bodily system such as the CNS, GI, Pulm. Bleeding from various parts of the body is one of the most common sxs. It is not unusual for mothers to describe/create sxs in more than one system and to create signs and sxs that make no biochemical or physiological sense , I.e. biochemical chaos as one author put it.
  • Undiagnosed, occult (rare) Can usually identify the secondary gain hypo - Preoccupation w disease Conv - monosypmtomatic Somat - polysymptomatic, sickly Schiz - psychotic sxs

Transcript

  • 1. Psyche & SomaPsyche & Soma Brain, Mind & BodyBrain, Mind & Body
  • 2. Relationship BetweenRelationship Between Psyche & SomaPsyche & Soma A-A- Medical conditions have psychiatricMedical conditions have psychiatric symptomatology.symptomatology. B-B- Psychological factors affectingPsychological factors affecting medical condition (Psychosomaticmedical condition (Psychosomatic Disorders).Disorders). C-C- Psychiatric disorders presentedPsychiatric disorders presented
  • 3. A- Medical Conditions HaveA- Medical Conditions Have Psychiatric SymptomatologyPsychiatric Symptomatology 1- Neurological diseases:1- Neurological diseases: Brain tumors, Epilepsy, MS,Brain tumors, Epilepsy, MS, Parkinsonism, Meningitis and encephalitis, etc.,.Parkinsonism, Meningitis and encephalitis, etc.,. 2- Endocrine syndromes:2- Endocrine syndromes: Thyroid, Suprarenal, Ovaries,Thyroid, Suprarenal, Ovaries, Testes, Pancreas.Testes, Pancreas. 3- Infectious diseases and autoimmune syndromes.3- Infectious diseases and autoimmune syndromes. 4- System failures:4- System failures: Renal. Hepatic, Cardiac,Renal. Hepatic, Cardiac, Respiratory, etc.,.Respiratory, etc.,. 5- Chronic disability:5- Chronic disability: Blindness, Deafness, Muteness,Blindness, Deafness, Muteness, Loss of limb.Loss of limb. 6- Blood diseases:6- Blood diseases: Anemia, Leukemia, HemolyticAnemia, Leukemia, Hemolytic diseases.diseases.
  • 4. B- Psychological Factors AffectingB- Psychological Factors Affecting Medical ConditionMedical Condition (Psychosomatic Disorders)(Psychosomatic Disorders) However, psychological factors seem to play aHowever, psychological factors seem to play a particularly important part.particularly important part. They can influence not only theThey can influence not only the causecause of theof the illness but can worsenillness but can worsen symptomssymptoms & affect the& affect the coursecourse of the disorder.of the disorder. The physical condition must show eitherThe physical condition must show either demonstrable organic pathology:demonstrable organic pathology: rheumatoidrheumatoid arthritis or a knownarthritis or a known pathophysiologic process:pathophysiologic process: migraine headache.migraine headache.
  • 5. Examples of PsychosomaticExamples of Psychosomatic DisorderDisorder 1- Cardiopulmonary:1- Cardiopulmonary: Angina, Hypertension &Angina, Hypertension & Bronchial Asthma.Bronchial Asthma. 2- Connective Tissue Diseases:2- Connective Tissue Diseases: SLE &SLE & Rheumatoid Arthritis.Rheumatoid Arthritis. 3- Inflammatory Bowel Diseases:3- Inflammatory Bowel Diseases: DuodenalDuodenal Ulcers, Ulcerative Colitis & Irritable BowelUlcers, Ulcerative Colitis & Irritable Bowel Syndrome.Syndrome. 4- Skin Diseases:4- Skin Diseases: Eczema, Psoriasis, Urticaria &Eczema, Psoriasis, Urticaria & Neurodermatitis.Neurodermatitis.
  • 6. C- Psychiatric Disorders Marked byC- Psychiatric Disorders Marked by Physical SymptomatologyPhysical Symptomatology Sometimes psychological factors can cause illSometimes psychological factors can cause ill health without actually causing a disease.health without actually causing a disease. As a result of unhappiness, anxiety or stressAs a result of unhappiness, anxiety or stress due to personal problems, physical symptomsdue to personal problems, physical symptoms may develop.may develop. A- Somatoform disorders.A- Somatoform disorders. B- Factitious disorders.B- Factitious disorders. C- Malingering.C- Malingering.
  • 7.  Common Features:  Lots of Physical Complaints.  Appear to be Medical Conditions.  No Identifiable Medical Cause.  Pathological Concern About: – Physical Appearance. – Functioning of Their Bodies.  Common Features:  Lots of Physical Complaints.  Appear to be Medical Conditions.  No Identifiable Medical Cause.  Pathological Concern About: – Physical Appearance. – Functioning of Their Bodies.
  • 8.  Six Somatoform Disorders (ICD 10): 1- Body dysmorphic disorder (Dysmorphophobia). 2- Dissociative & conversion disorders. 3- Hypochondriasis. 4- Somatization disorder. 5- Somatoform pain disorder. 6- Undifferentiated somatoform disorder.  Six Somatoform Disorders (ICD 10): 1- Body dysmorphic disorder (Dysmorphophobia). 2- Dissociative & conversion disorders. 3- Hypochondriasis. 4- Somatization disorder. 5- Somatoform pain disorder. 6- Undifferentiated somatoform disorder.
  • 9.  Clinical Description:  Preoccupation With Appearance: – Imagined Defect.  “Imagined” Ugliness.  Mirrors (Fixation or Avoidance).  Ideas of Reference.  Suicidal Ideation and Tendencies.  Clinical Description:  Preoccupation With Appearance: – Imagined Defect.  “Imagined” Ugliness.  Mirrors (Fixation or Avoidance).  Ideas of Reference.  Suicidal Ideation and Tendencies.
  • 10.  Common Locations of Defects  Hair  Nose  Skin  Eyes  Head / Face  Lips  Common Locations of Defects  Hair  Nose  Skin  Eyes  Head / Face  Lips
  • 11.  The Plastic Surgery Solution?  Quite Popular but Expensive.  Most are Disappointed With Results.  The Plastic Surgery Solution?  Quite Popular but Expensive.  Most are Disappointed With Results. BEFORE AFTER
  • 12. 2- Dissociative Disorders2- Dissociative Disorders Core Symptoms:Core Symptoms: - Loss of access to certain thoughts, feelings,- Loss of access to certain thoughts, feelings, memories.memories. - Splitting current awareness from certain- Splitting current awareness from certain aspects of past awarenessaspects of past awareness Types:Types: – Depersonalization and or derealization.Depersonalization and or derealization. – Psychogenic amnesia.Psychogenic amnesia. – Psychogenic fugue.Psychogenic fugue. – Dissociative identity disorder (MPD).Dissociative identity disorder (MPD).
  • 13. A) Depersonalization DisorderA) Depersonalization Disorder A dissociative disorder whose main feature isA dissociative disorder whose main feature is that the person suddenly feelsthat the person suddenly feels strange orstrange or differentdifferent.. Some describe it as an “Some describe it as an “out of bodyout of body”” experience.experience. Because depersonalization is also a symptom ofBecause depersonalization is also a symptom of Panic DisorderPanic Disorder (which is much more common),(which is much more common), that disorder should be ruled out beforethat disorder should be ruled out before making this diagnosis.making this diagnosis.
  • 14. B) Dissociative AmnesiaB) Dissociative Amnesia There is a loss of memory for pastThere is a loss of memory for past events (events (days, weeks or yearsdays, weeks or years) without) without organic cause.organic cause. Dissociative amnesia may result fromDissociative amnesia may result from a painful experience such asa painful experience such as physicalphysical or sexual abuseor sexual abuse..
  • 15. C) Dissociative FugueC) Dissociative Fugue ““FugueFugue”: means to take flight.”: means to take flight. A person suddenly leaves home andA person suddenly leaves home and assumes a new identity, with amnesiaassumes a new identity, with amnesia for past identity and events.for past identity and events. The person may emerge from the fugueThe person may emerge from the fugue weeks or months later in a strange cityweeks or months later in a strange city not knowing how did he/she got there.not knowing how did he/she got there.
  • 16. D) Dissociative Identity DisorderD) Dissociative Identity Disorder Formerly called “Formerly called “Multiple PersonalityMultiple Personality DisorderDisorder” (MPD) or “” (MPD) or “Split PersonalitySplit Personality”.”. A person has several distinctA person has several distinct personalities that emerge at differentpersonalities that emerge at different times.times. A history of physical or sexual abuse inA history of physical or sexual abuse in childhood is common.childhood is common. Borderline personality and eatingBorderline personality and eating disorders often co-occur.disorders often co-occur. This isThis is NOTNOT the same as schizophrenia.the same as schizophrenia.
  • 17.  Clinical Description:  Physical Malfunctioning: Paralysis, Blindness, Aphonia or Lost Sense of Touch.  No Organic Pathology.  Looks Like Neurological Disease.  Clinical Description:  Physical Malfunctioning: Paralysis, Blindness, Aphonia or Lost Sense of Touch.  No Organic Pathology.  Looks Like Neurological Disease.
  • 18.  Clinical Description:  Essential Problem is Anxiety  Preoccupied With Bodily Symptoms  Misinterpretation of Symptoms  Strong Disease Conviction  Many Medical Visits and Tests  Clinical Description:  Essential Problem is Anxiety  Preoccupied With Bodily Symptoms  Misinterpretation of Symptoms  Strong Disease Conviction  Many Medical Visits and Tests
  • 19.  Clinical Description:  Many Physical Complaints  No Known Medical Cause  Little Concern About Symptoms “La Belle Indifference”  Clinical Description:  Many Physical Complaints  No Known Medical Cause  Little Concern About Symptoms “La Belle Indifference”
  • 20.  Clinical Description:  Pain is Real.  Pain May Have Organic Cause.  Psychological Factors Maintain Pain.  Clinical Description:  Pain is Real.  Pain May Have Organic Cause.  Psychological Factors Maintain Pain.
  • 21. B- Factitious DisordersB- Factitious Disorders Core Symptoms:Core Symptoms: self-inflicted injury orself-inflicted injury or disease; motivated by unconscious,disease; motivated by unconscious, dissociated desire to be cared fordissociated desire to be cared for ““Playing The Patient RolePlaying The Patient Role”.”. Subtypes:Subtypes: Physical, Psychological or Both.Physical, Psychological or Both. 1- Munchausen's syndrome1- Munchausen's syndrome 2- Munchausen's by proxy syndrome2- Munchausen's by proxy syndrome
  • 22. Common Presentations (F D)Common Presentations (F D) Dizziness, Seizures.Dizziness, Seizures. Severe Pain, Hematemesis, Hemoptysis.Severe Pain, Hematemesis, Hemoptysis. Fever, Malaise, Weakness.Fever, Malaise, Weakness. Biochemical Chaos.Biochemical Chaos. Depression, Amnesia, Hallucinations.Depression, Amnesia, Hallucinations.
  • 23. Occupation of Patients (F D)Occupation of Patients (F D) – Nurses.Nurses. – Medical Technicians.Medical Technicians. – Medical Secretary.Medical Secretary. – Student Nurse.Student Nurse. – Hospital Administrator.Hospital Administrator. – Students.Students. – Housewives.Housewives.
  • 24. Differential Diagnosis (F D)Differential Diagnosis (F D) General medical or mental illness.General medical or mental illness. Malingering.Malingering. Somatoform disorders.Somatoform disorders. – Hypochondriasis.Hypochondriasis. – Conversion disorder.Conversion disorder. – Somatization.Somatization. Schizophrenia & other psychosis.Schizophrenia & other psychosis.
  • 25. C- MalingeringC- Malingering Core Symptoms:Core Symptoms:  Intentional production of entirely falseIntentional production of entirely false symptoms (Physical or psychological).symptoms (Physical or psychological).  Motivated by desire for secondary gainMotivated by desire for secondary gain or avoidance of responsibility.or avoidance of responsibility. Examples:Examples: – Insurance Gains.Insurance Gains. – Avoid Military.Avoid Military. – School Truancy.School Truancy.
  • 26. For Differential DiagnosisFor Differential Diagnosis 1-1- 1ry Gain1ry Gain to avoid psychological stress:to avoid psychological stress: (Dissociation, Conversion or Factitious).(Dissociation, Conversion or Factitious). 2-2- 2ry Gain2ry Gain or avoidance of responsibility:or avoidance of responsibility: (Malingering).(Malingering). 3-3- VoluntaryVoluntary production of symptoms:production of symptoms: (Factitious or malingering).(Factitious or malingering). 4-4- Tertiary GainTertiary Gain..
  • 27. Biopsychosocial FormulationBiopsychosocial Formulation Biological (Brain-body) Psychological (Mind) Social (Environment) What can we see? Sleep. Appetite. Concentration. Fatigue. Poor self-image. Negativity. Isolation. What might be the cause? Diabetes. Acute Major Depression. Childhood abuse & neglect. Domestic violence. What we might do? Medication Psychotherapy. Social support.
  • 28. Brain Environment Endocrine Glands Immune System Physiology & Behavior Nerves Hormones Action Biological Basis of Psychiatric Disorders
  • 29. The Biological Basis ofThe Biological Basis of Psychiatric DisordersPsychiatric Disorders MindBrain Body Psychoneuro- Immunology Medically Unexplained Physical Symptoms Biopsychosocial Model
  • 30. Diathesis-Stress ModelDiathesis-Stress Model Diathesis “Predisposing Causes” (Hereditary Predisposition) Stress “Precipitating Causes” (Situational Factors) Disorder Recovery “Maintaining Causes” Physical Conditions Bio-Psycho-Social Approach • Emphasizes Interaction of Biological and Social Factors
  • 31. ConclusionsConclusions Brain, Mind and Body:Brain, Mind and Body: 1- All for one and one for all.1- All for one and one for all. 2- It is more important to know what kind2- It is more important to know what kind of a patient has a disease than what kindof a patient has a disease than what kind of a disease a patient has.of a disease a patient has. 3- The good physician will treat the3- The good physician will treat the disease, but the great physician will treatdisease, but the great physician will treat the patient.the patient.