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o Biological factors
Hypometabolism of the dominant
hemisphere
Excessive cortical arousal leading to
negative feedback HYPOCHONDRIASIS
Inc. corticofugal output = inhibit
patient awareness of bodily sensation Pre-occupation with fears of contracting or the
(observe sensory deficits) belief of having a serious disease significant
Clinical features stress impair ability to function in their
o Paralysis, blindness and mutism most personal, social and occupational roles
common Misinterpret body symptoms or functions
o Commonly associated with Common abdominal complaints hypochondrium
Passive-aggressive below the ribs
Dependent Unrealistic or inaccurate interpretation of
Anti-social physical symptoms or sensations
Historionic personality disorder Epidemiology
Depression and anxiety o Atleast 6 months
o Sensory symptoms o 4-6% in general population
anesthesia and paresthesia o 3% medical students in their 1st 2 years
stocking and glove anesthesia of the o M=F
hands and feet or hemianesthesis from o 20-30 yearsold
midline Etiology
Involve special senses (deafness, o Misinterpretation of bodily symptoms
blindness, tunnel vision) unilateral or o Augment and amplify somatic sensation
bilateral o Low threshold for pain
o Motor symptoms o Sick roles offer an escape (excused to
Abnormal movements usual duties, avoid noxious obligations)
Gait disturbance o Aggressive and hostile wishes towards
Weakness others are transferred through
Paralysis repression and displacements into
Movements worsen when you call their physical complaints
attention o Deserved punishment
Astasia-abasia wildly ataxic,
staggering gait, jerky Differential diagnosis
truncalmovements, thrashing and o AIDS, endocrinopathies, myasthenia gravis,
waving arms movements SLE, multiple schlerosis, degenerative
o Seizure symptoms disease or nervous system, occult neoplastic
Pseudoseizure (tongue biting and disorders
urinary incontinence) Course and prognosis
o Other associated features o Episodic months to years and are
Primary gain symptoms have separated with equally long quiescent
symbolic meaning period
Secondary gain accrue tangible o Fewer symptom compared to somatization
advantages and benefits as a resultof disorder
being sick (excused from obligations) o Good prognosis:
La belle indifference unconcerned Upper socioeconomic status
about what appears to be major Response to treatment
Identification model their symptoms Sudden onset
on those of someone important to them Absence of personality disorder
Course and prognosis Absence of related non psychiatric
o Later may have neurological disorder medical condition
o 90-100% resolve in a few days or less than Most children recover by late
a month adolescence and early adulthood
o Good prognosis: Treatment
Sudden onset o Psychotherapy
Easily identifiable stressor o Frequent regular scheduled PE
Good premorbid judgement Take complaints seriously
No comorbidity
No ongoing litigation
Treatment BODY DYSMORPHIC DISORDER
Manipulation and gaining advantage in
Preoccupation with an imaged defect in interpersonal relationships
appearance o Biological factors
Causes significant distress or impairment in Cerebral cortex can inhibit firing of
important areas of functioning afferent pain fibers
Epidemiology Serotonin is the main neurotransmitter
o 15-30 yearsold in the descending inhibitory pathways
o F>M Endorphins play a role in CNS
o Unmarried individual modulation of pain = dec. Endorphin
o 90% MDD augment incoming sensory stimuli
o 70% anxiety disorder Most prominent symptoms
o 30% psychotic disorder o Anergia, anhedonia, dec. Libido, insomnia,
Etiology irritability, diurnal variation, weight loss
o Unknown Course and prognosis
o Serotonin o Begin abruptly
o Stereotype concept of beauty family and o Inc. saeverity for a few weeks or months
culture Treatment
o Displacement of sexual and emotional o Nerve block 6-8 months repeat
conflict nonrelated body part o Psychotherapy
Clinical feature Biofeedback esp. Migraine, myofacial
o Concerns involve facial flaws (nose) pain and tension headache
o Commonly assoc. symptoms Develop solid therapeutic alliance by
Frank delusions of reference empathizing with patients suffering
Excessive mirror checking / avoidance Acknowledge reality of pain
of reflective surface (make up and Alter negative thoughts and foster a
clothing) positive attitude
Attempts to hide presumed deformity o Pharmacotherapy
o Avoid social and occupational exposure SSRI and TCA
Comorbidity Amphetamine adjunct to SSRI
o MDD
o Anxiety disorder
o OCD
o Narcisstic personality disorder
Differential diagnosis
o Anorexia nervosa, gender identity disorder,
brain damage neglect syndrome
Treatment
o Psychotherapy
o Pharmacotherapy
SSRI (Clomipramine and Fluoxetine)
PAIN DISORDER