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psychiatric conditions where pts experience distressing physical symptoms that are not fully explained by other medical,

neurologic, or psychiatric disorders. abnormal thoughts, feelings, and behaviors in response to these symptoms. may result from psychological stress that is unconsciously (without awareness) expressed somatically.

Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder Psychological factors affecting other Medical conditions Other specified somatic symptom and related disorder.

charac. by somatic symptoms that are either very distressing or result in significant disruption of functioning, as well as excessive & disproportionate thoughts, feelings & behaviors regarding those symptoms. To be diagnosed with SSD, the pt must be persistently symptomatic (typically at least for 6 months).

One or more somatic symptoms that are distressing or result in significant disruption of daily life. B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns manifested by following: 1. Persistent thoughts abt seriousness of symptoms 2. Persistently high level of anxiety 3. Excessive time & energy devoted to symptoms and health concerns.
A.

C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months). Specify if - Predominant pain (previously Pain Disorder)

multiple, current, somatic symptoms that are distressing or result in disruption of daily life Symptoms may or may not be associated with medical illness. high levels of worry abt illness. Assumption of bodily symptoms as unduly threatening, harmful, or troublesome & often think the worst abt their health. high level of medical care utilization, which rarely alleviates the individual's concerns. Attention focused on somatic symptoms. Worry about illness & fear that any physical activity may damage the body.

SSD is common in older population & Focus on Criteria B is crucial for Dx. Underdiagnosed in old since symptoms (pain, fatigue) are normal part of ageing & illness worry is considered understandable in old. In children, the most common symptoms are recurrent abdominal pain, headache, fatigue,and nausea. SSD is frequent in individuals with few yrs of education and low socioeconomic status.

Panic Disorder - somatic symptoms & anxiety abt health tend to occur in acute episodes. Generalized anxiety disorder Individuals worry abt multiple events, situations, or activities, only one of which may involve their health. Main focus is not usually somatic symptoms or fear of illness as it is in SSD. Illness anxiety disorder - If the individual has extensive worries about health but no or minimal somatic symptoms, it may be more appropriate to consider illness anxiety disorder.

Conversion disorder - presenting symptom is loss of function (e.g of a limb). In SSD focus is on the distress that particular symptoms cause. Criterion B of SSD can differentiate the 2 disorders. Delusional Disorder (somatic type)- the somatic symptom beliefs & behavior are stronger than those found in SSD. Body Dysmorphic Disorder - the individual is excessively concerned abt & preoccupied by, a perceived defect in his physical features. In SSD there is fear of underlying illness, but not of defect in appearance.

A. Preoccupation with having or acquiring a serious illness. B. Somatic symptoms are not present or, if present, are only mild in intensity. C. There is a high level of anxiety abt health & the individual is easily alarmed abt personal health status. D. The individual performs excessive health-related behaviors (e.g., repeatedly checks his body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments & hospitals).

E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time. Specify whether: Care-seeking type: Medical care, including physician visits or undergoing tests & procedures, is frequently used. Care-avoidant type: Medical care is rarely used.

Preoccupation with diseases, despite constant reassurance by physicians Belief is not delusional Daily functioning is affected. Individuals often examine themselves repeatedly. Excessive research abt their suspected disease. Frequently seek reassurance from family, friends & physicians. Thorough evaluation fails to identify a serious medical condition Duration of at least 6 months.

Both sexes equally affected. Common age of onset is 20-30 yrs. May be precipitated by a major life stress or a serious but ultimately benign threat to the individual's health. A Hx of childhood abuse or illness may be a predisposing factor.

SSD - is diagnosed when significant somatic symptoms are present. In contrast, individuals with illness anxiety disorder have minimal somatic symptoms & are primarily concerned with the idea they are ill. Anxiety disorders - In generalized anxiety disorder, individuals worry abt multiple events, situations, or activities, only one of which may involve health. In panic disorder, the anxiety is episodic and acute.

Major depressive disorder - Some individuals with a major depressive episode ruminate about their health & worry excessively abt illness. Dx of illness anxiety disorder is not made if these concerns occur only during major depressive episodes. Psychotic disorders - Individuals with illness anxiety disorder are not delusional. Their ideas do not attain the rigidity & intensity seen in the somatic delusions. (e.g an organ is rotting or dead)

A disorder in which an individual experiences one or more neurological symptoms that cannot be explained by a medical or neurological condition. Usually a Hx of sexual/physical abuse, unstable childhood, Hx of trauma-related disorders.

A. B.

C. D.

One or more symptoms of altered voluntary motor or sensory function. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions. The symptom or deficit is not better explained by another medical or mental disorder. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

Specify symptom type With weakness or paralysis With abnormal movement (tremor, gait disorder) With swallowing symptoms With speech symptoms (slurred) With attacks or seizures With sensory loss

One or two neurologic symptoms affecting volountary function. May have paralysis, gait disturbance, weakness, tics, jerks. Give way weakness - When testing motor strength, sudden collapse after several seconds of full resistance can indicate psychogenic aetiologies. False sensory findings blindness, tunnel vision, paresthesias, deafness.

Distractable symptoms - Symptoms abate during the exam when attention is drawn elsewhere. E.g a tremor that stops when pt is asked to perform a cognitive task. Psychogenic non-epileptic seizures : back arching & side to side head movements. Gait disorders - inability to use legs, unstable gait. Bizarre movements. Cognitive complaints unintentional use of wrong words, forget whole conversations.

Neurological disease Factitious disorder - Patients feign, deliberately produce, or exaggerate their physical symptoms. Deceptive behaviou is usually eveident. Panic disorder - the neurological symptoms are typically transient and acutely episodic with characteristic cardiorespiratory symptoms. SSD - The excessive thoughts, feelings, and behaviors characterizing somatic symptom disorder are often absent in conversion disorder.

establish rapport with patients by showing genuine interest & concern. Throrough physical exam looking for evidence of pseudoneurological signs. Lab and other investigations normal. Psychotherapy is the mainstay of treatment for most patients.

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