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.
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.
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
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..
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.
Editor's Notes
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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
