Psychological factors affecting other medicial conditions
Dr Sami Adil 22nd nov. 2015Cartesian dichotomy
Holistic medicineStress
MUS
• Patients with MUS may receive a medical dx of a so-called functional somatic syndrome, such as IBS, and may also merit a psychiatric dx on the basis of the same symptoms.
• The most frequent psychiatric dx associated with MUS are anxiety or depressive disorders. When these are absent, a dx of somatic symptom disorders may be appropriate.
Psychiatry and functional somatic syndromes:
IBS: TCAs (amitriptyline or imipramine) 2 choice IBS with diarrhea. Duloxetine, relaxation therapy, biofeedback, and hypnotherapy are all the last choice for all the 3 subtypes of IBS.Coronary disease type A behavior … role of stress
white coat hypertension.
Respiratory: panic disorder, and hyperventilation syndrome.
Skin disorders: excoriation, trichotillomania, and delusions of infestationsEndocrine: mood disturbance, and psychotic symptoms.
Rheumatology: for the dx. of fibromyalgia, antidepressants, especially sertraline, have shown encouraging results.
Most headache are not associated with significant organic disease. SSRI useful for prophylaxis of migraine. Tension headache antianxiety measures.
Factitious disorder
This describes the repeated and deliberate production of the signs or symptoms of disease to obtain medical care. It is uncommon. An example is the dipping of thermometers into hot drinks to fake a fever. The disorder feigned is usually medical but can be a psychiatric illness, with false reports of hallucinations or symptoms of depression.Münchausen’s syndrome
severe chronic form of factitious disorder.older and male, sometimes visiting several hospitals in one day.
The history can be convincing enough to persuade doctors to undertake investigations or initiate treatment, including exploratory surgery.
Some emergency departments hold lists of such patients.
Management is by gentle but firm confrontation with clear evidence of the fabrication of illness, together with an offer of psychological support. Treatment is usually declined but recognition of the condition may help to avoid further iatrogenic harm.
Malingering
Malingering is a description of behaviour, not a psychiatric diagnosis. It refers to the deliberate and conscious simulation of signs of diseasePatients have motives that are clear to them but which they conceal from doctors.