Psychiatry and Behavioral Health Rotation

Psychiatry EOR: Somatic Symptom and Related Disorders; Nonadherence to Medical Treatment (Pearls)

SOMATIC SYMPTOM AND RELATED DISORDERS; NONADHERENCE TO MEDICAL TREATMENT
Factitious disorder Patient consciously reports false symptoms, or induces symptoms, with the goal of playing the "sick role

A condition in which a person, without a motive for reward, acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms, purely to attain (for themselves or for another) a patient's role.

Factitious disorder imposed on self (Munchausen syndrome)

  • The patient falsifies physical or psychological symptoms or induces injury or disease to themselves
  • When in another person (e.g., a child) it is termed factitious disorder imposed on another (Munchausen syndrome by proxy)

Treatment:

  • Conjoint confrontation by the PCP and the psychiatrist
  • In factitious disorder imposed on another (e.g., in a child)
    • Children must be removed by child protective services
Illness anxiety disorder (Hypochondriasis) Obsession with the idea of having a serious but undiagnosed medical condition

  • Patient's are worried about having or developing a serious illness and
  • This preoccupation is present for at least 6 months and
  • Is not better explained by another mental disorder (e.g., obsessive-compulsive disorder and somatic symptom disorder)

Treatment:

  • Group/insight-oriented therapy
  • Regular appts with a provider for reassurance
  • Medications: (SSRIs) if concurrent/underlying anxiety or major depressive disorder
Somatic symptom disorder Preoccupation with having a serious illness

  • More than 1 somatic symptom(s) which are distressing to the patient or leads to a significant amount of disruption in the patient's life.
  • The patient experiences excessive thoughts, feelings, and behaviors in relation to their somatic symptoms or their health concerns.
  • The somatic symptom must be persistent for ≥ 6 months although these symptoms don't have to always be present

Treatment

  • Have a single clinician as the designated primary caretaker
    • Schedule monthly visits and psychotherapy
    • Avoid unnecessary diagnostic testing unless indicated
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