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01a Somatoform & Dissociative Dis
 

01a Somatoform & Dissociative Dis

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    01a Somatoform & Dissociative Dis 01a Somatoform & Dissociative Dis Presentation Transcript

    • Behavioral Sciences Juan Héctor M. Meléndez-Romero. MD Ciencias de la Salud
    • Behavioral Sciences Somatoform & Dissociative Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
    • Somatoform Disorders
      • Broad group of illnesses that have bodily signs and symptoms.
        • Soma = body
      • Encopass mind-body interactions
      Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
    • Somatoform Disorders
      • DSM-IV-TR recognizes five specific disorders:
      Modified from Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660 1. Somatization Disorder Physical complaints 2. Conversion Neurological complaints 3. Hypochondriasis “ Patient beliefs” 4. Body dismorphic Sx. “ Body is defective” 5. Pain Symptoms of pain Undeterminated Not otherwise specified
    • Somatoform Disorders
      • Somatization
      • Characterized by many somatic
      • symptoms
      • The symptoms can not be explained on basis of the physical and laboratory examinations.
      Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
    • Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
      • Somatization
      • Recognized by Pain, Gastrointestinal, Sexual and pseudoneurological symptoms.
      • Differs of other somotoform disorders because of the multiplicity of the complaints and the multiple organs symptoms.
    • Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
      • Somatization synonimous
      • Hysteria
      • Briquet’s syndrome
      • Somatization Disorder
    • Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
      • Somatization
      • Lifetime prevalence:
      • women 0.2 to 2.0 %
      • men 0.2 %
      • Begins before 30-year-old
      • Inversely related with social status
    • Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
      • Somatization
      • Coexist with other mental disorders.
        • 2/3 patients has mental disorders:
            • avoidant
            • paranoid
            • self defeating
            • obssesive – compulsive symptoms
    • Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
      • Somatization etiology:
        • Psychosocial Factors:
            • avoid obligations
            • express emotions
            • symbolized a feeling or belief
        • Biological Factors:
          • Attention and cognitive impairments
          • Cytokines theory: IL, TNF, IF.
    • Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
      • Somatization Disorder Diagnosis:
      • History of many physical complaints before age 30 years over a period of several years results in impairment of social and occupational functioning.
      • Individual symptoms:
          • Four pain symptoms (sites)
          • Two gastrointestinal symptoms
          • One sexual symptom
          • One pseudoneurological symptom
      • Either 1) and 2): 1) Each symptom cannot be fully explained 2) In case of medical condition, there are excessive impairment that would be explained.
      • The symptoms are not intentionally produced.
    • Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
      • Differential Diagnosis:
          • Multiple sclerosis
          • Myasthenia gravis
          • Systemic lupus erythematosus
          • AIDS
          • Hyperparathyroidism
          • Hyperthyroidism
          • Chronic Systemic Infections
    • Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
      • Somatization Treatment:
      • Primary Care:
      • Regularly scheduled visits
      • Listen to the somatic complaints and emotional expressions
      • Psychiatry evaluation:
      • Individual or group psychotherapy
      • Medication: AINEs and Placebo ?
    • Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
      • Conversion
      • Disturbance of bodily functioning
      • Occurrs in a setting of stress
      • Produces considerable dysfunction
    • Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
      • Conversion Disorder Definition:
      • Conversion disorder is characterized by the presence of one or more neurological symptoms that cannot be explain by a known neurological or medical disorder
    • Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
      • Commmon symptoms :
      • Motor symptoms : Sensory deficits :
      • Involuntary movements Anesthesia
      • Tics Blindness
      • Blepharospasm Tunnel vision
      • Torticolis Deafness
      • Seizures
      • Aphonia Visceral symptoms :
      • Paralysis Psychogenic vomiting
      • Weakness Pseudocyesis
      • Urinary retention
      • Diarrhea
    • Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
      • Conversion Disorder Comorbidity:
            • Depressive disorder
            • Anxiety disorder
            • Somatization disorder
            • Schizopherina
    • Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
      • Conversion Disorder Etiology:
      • Psychoanalytic factors : conversion of anxiety into a medical symptom.
      • Learning theory: conditioned learning behavior.
      • Biological factors: impaired hemispheric communication.
    • Somatoform Disorders Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
    • Tema XX
      • Concepto XX
      Kaplan & sadock`s (Ninth Edition ) Chapter 17 Page 643-660
    • Somatoform Disorders
      • Conversion Disorder Diagnosis:
      • One or more symptoms or deficitis affecting voluntary motor or sensory function.
      • Psychological factors are jugded to be associated with the symptoms or deficit because iniciation or exacerbation of symptoms is preceded by conflicts or other stressors.
      • Symptoms are not intentionally produces.
      • Symptoms cannot be explained by a general medical condition.
      • The symptoms causes clinically significant distress or impairment of social, occupational functioning.
      • The symtoms are no limited to pain or sexual dysfuntion.
    • Somatoform Disorders
      • Conversion Disorder Treatment:
      • Psychological therapy:
          • Insight-oriented supportive or behavior therapy.
          • Hypnosis
          • Behavioral relaxation therapy
      • Medical Treatment:
          • Anxiolytic drugs
    • Somatoform Disorders
      • Hypochondriasis
      • Defined as a person’s preoccupation with the fear of contracting, or belief of heaving a serious disease.
      • The person misinterpreat bodily symptoms or functions.
    • Somatoform Disorders
      • Hypochondriasis
      • Etiology.
      • Low tolerance of, low threshold for physical discomfort
      • Understandable in terms of a social learning model
      • Variant of depressive or anxiety disorder.
    • Somatoform Disorders
      • Diagnosis of Hypochondriasis
      • Preoccupation with fear of having, or the idea that one has a serious disease.
      • Preoccupation persist despite appropiated medical evaluation and reassurance.
      • The belief in Criterion A is not of delusional intensity.
      • The preocupation causes clinical distress or impariment of social or functioning areas.
      • Duration at least six months.
      • The preoccupation is not better accounted for by generalized anxiety disorder, separation anxiety,etc.
    • Somatoform Disorders
      • Treatment of Hypochondriasis
      • Stress reduction
      • Medical education in chronic illness
      • Treatment of depressive or mental disorder.
    • Somatoform Disorders
      • Body dhysmophic
      • Patient’s have a pervasive subjective feeling of ugliness of some aspecto of their appearance despite a normal or nearly normal appearance.
      • The person’s strong belief or fear that he or she is unattractive or even repulsive.
    • Somatoform Disorders
      • Body dhysmophic
      • Location of Imagined Defects:
      • Hair Lips
      • Nose Chin
      • Skin Ears
      • Eyes Pennis
      • Head or face Buttocks
      • Body build Breast, etc.
    • Somatoform Disorders
      • Diagnostic Criteria for Body dhysmophic
      • Preoccupation with an imagined defect in appearance.
      • The preoccupation causes clinically significant distress or impairment of social or functioning.
      • The preoccupation is not betteraccounted for by another mental disorder.
    • Somatoform Disorders
      • Diagnostic Criteria for Body dhysmophic
      • Relation to plastic surgery
      • Medical treatment: Tryciclics
      • SSRIs
      • IMAO.
    • Somatoform Disorders
      • 5. Pain disorder
      • Presence of pain that is “the focus of clinical attention”.
      • Pain is not fully accounted for by a medical or neurological condition.
      • Synonimous: Somatoform pain disorder
      • Psychogenic pain
      • Atypical pain disorder
      • Idiopathic pain disorder
    • Somatoform Disorders
      • 5. Etiology of Pain disorder
      • Psychodynamic factors.
          • Intrapsychic conflic: unable to express their feelings
          • Displacing the problems to the body
          • Convinced that they have to suffer
      • Behavioral factors.
      • Interpersonal factors.
          • Means of manipulation.
      • Biological factors.
          • Endorphin deficiency.
    • Somatoform Disorders
      • 5. Diagnostic Criteria for Pain disorder
      • Pain in one or more anatomical sites is the predominant focus in clinical presentation.
      • Pain causes significat distress or clinical impairment.
      • Psychological factors are jugde to have an important role in onset, severity, exacerbation and maintenance of pain.
      • The symptom is not intentionally produced or feigned.
      • The pain is not better accounted for by a mood, anxiety or psychotic disorder.
    • Somatoform Disorders
      • Diagnostic Criteria for Pain disorder
      • Medical Treatment:
          • Tryciclics
          • SSRI’s
      • Psychoterapy
      • Biofeedback
      • Pain Control Programs.
    • Dissociative Disorders Dissociative Disorders
    • Characteristics
      • Contradictory representation of the self.
      • Produces conflicts with each other.
      • They feel that they have not identity
      • Can develops sevral identities
    • Classification
      • There are four different types:
      • Dissociative amnesia
      • Dissociative Fugue
      • Dissociative Identity dissorder
      • Depersonalization dissorder
      • Not otherwise specified
    • 1. Dissociative amnesia
      • Amnesia is the Key symptom in this type
      • Reffers to the inability to recall information, usually about stressful o traumatic events.
      • Affects the recall of general information
    • 1. Dissociative amnesia
      • Appears in war time or natural disasters.
      • Also is related with domestic settings and emergency situations.
      • Most patients can not retrive stressful memories.
      • DSM-IV diagnostic criteria
    • 2. Dissociative Fugue
      • The behavior of the patient with dissociative fugue is unusual and dramatic.
      • Fugue = The patient travel away his from their customary home and work situations.
      • Fails to remember personal data.
    • 2. Dissociative Fugue
      • Its rare.
      • Associated to alcohol abuse
      • Desire to withdraw from emotionally painful experiences
      • DSM-IV diagnostic criteria
    • 3. Dissociative Identity disorder
      • Sinonimous: Multiple personality disorder
      • Chronic disease
      • Associated to traumatic events:
        • Child abuse
        • Child physical trauma
      • There are two or more personalities
    • 3. Dissociative Identity disorder
      • In 1800 Benjamin Rush building earlier clinical report of this problem
      • Freud relates with psychodynamic mechanism
      • Bleuler relates with schizophrenia.
      • The cause is unknown
    • 3. Dissociative Identity disorder
      • Signs of multiplicity:
      • Time distorsion Change in name
      • Change behavior Use word “we”
      • Do not recognize personal objetcs
      • Auditive hallucinations
    • 4. Depersonalization disorder
      • Depersonalization disorder symptoms
      • Persistent or recurrent alteration in the perseption of the self.
      • His personality is temporally lost.
    • 4. Deprsonalization disorder
      • Causes: Neurological disorders
            • Toxic - metabolic Disorders
            • Mental dissease
      • DSM-IV diagnostic criteria
      • Course & Prognosis