IA Somatoform + Factitious Disorders

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Questions and Answers

What is the primary concern of the patient described in the scenario?

Seeking attention for psychological distress

Desire to manipulate medical professionals

Preoccupation with having multiple serious illnesses (correct)

Fear of dying due to old age

Which disorder is best characterized by the preoccupation with having a serious illness without significant somatic symptoms?

Somatic symptom disorder

Factitious disorder imposed on self

Malingering

Illness anxiety disorder (correct)

What response did the patient have after receiving normal ECG results?

She cried and remained convinced she had heart disease. (correct)

She felt relieved and confident in her health.

She dismissed it as unimportant.

She refused to believe the physician's assessment.

Which of the following distinguishes illness anxiety disorder from factitious disorders?

Factitious disorder involves medical attention-seeking behavior. (A) Signup and view all the answers

Which of the following describes a possible trigger for the patient's anxiety about death?

The death of multiple family members (A) Signup and view all the answers

What symptom does NOT correlate with illness anxiety disorder?

Intentional falsification of symptoms (B) Signup and view all the answers

Which response is likely from a patient with somatic symptom disorder compared to the described patient?

Continuously seeking reassurance from healthcare providers. (B) Signup and view all the answers

Which of the following statements best summarizes the distinction between illness anxiety disorder and malingering?

Illness anxiety is characterized by genuine distress over health fears. (A) Signup and view all the answers

What must be prioritized if a mother is found to be giving a toxin to her child?

Report to local authorities (D) Signup and view all the answers

What condition describes the mother's behavior of producing symptoms in her child to gain medical attention?

Factitious disorder imposed on other (D) Signup and view all the answers

Which disorder is characterized by an intentional feigning of symptoms for secondary gain?

Malingering (B) Signup and view all the answers

Which of the following disorders involves symptoms that are not intentionally produced by the individual?

Somatic symptom disorder (B) Signup and view all the answers

What does the presence of emetine in a patient indicate?

Exogenous toxin exposure (A) Signup and view all the answers

Why is repeat toxicology screening unnecessary in the presence of confirmed evidence of emetine?

Liquid chromatography already confirmed the toxin (B) Signup and view all the answers

What is a likely consequence of discharging the patient to home care when abuse is suspected?

Increased risk of continued child abuse (C) Signup and view all the answers

Which disorder does not involve intent to feign symptoms for healthcare access?

Somatic symptom disorder (C) Signup and view all the answers

What is the primary management strategy for patients with somatic symptom disorder?

Regular visits with the same physician (D) Signup and view all the answers

Which of the following best describes the symptoms experienced by the 31-year-old woman?

Somatic symptom disorder (B) Signup and view all the answers

What explains the child's abnormal body movements in the given scenario?

Malingering (B) Signup and view all the answers

What is an effective approach to explain symptoms related to psychological stress in patients?

Use the term ‘functional’ to describe the symptoms (C) Signup and view all the answers

What would be an unnecessary step for a patient with unexplained medical conditions?

Extensive diagnostic testing including CT scans (D) Signup and view all the answers

In managing a patient with somatic symptoms, why is assurance important?

It is likely to validate the patient's feelings (D) Signup and view all the answers

How is malingering distinguished from somatic symptom disorder?

Malingering involves conscious simulation for external gain (D) Signup and view all the answers

What is an example of a factor that may lead to misunderstanding of symptoms in patients?

Describing symptoms as merely psychological (B) Signup and view all the answers

Which of the following is NOT a characteristic of factitious disorder?

External motivation for feigning symptoms (B) Signup and view all the answers

What should be avoided to reduce demoralization in managing somatic symptom disorder?

Changing primary care providers frequently (A) Signup and view all the answers

What type of disorder might cause a patient to exhibit symptoms influenced by their environment, such as religious practices?

Conversion disorder (A) Signup and view all the answers

Why is it unhelpful to state that symptoms are purely psychological?

It may lead to misunderstanding of the symptoms (A) Signup and view all the answers

What best defines the objective of managing somatic symptom disorders?

To validate and manage both physical and psychological concerns (C) Signup and view all the answers

In the context of somatic symptoms, what role does a family physician play?

To provide emotional support and ongoing care (A) Signup and view all the answers

What is the primary intention of a patient with factitious disorder imposed on self?

To assume a sick role for internal emotional gain (C) Signup and view all the answers

Which of the following distinguishes factitious disorder from malingering?

Factitious disorder is associated with unconscious motivations. (A) Signup and view all the answers

Which symptom presentation is most indicative of somatic symptom disorder?

Significant distress with unconscious motivation (D) Signup and view all the answers

What is the appropriate communication style when addressing a patient with factitious disorder?

Gentle but firm with clear evidence (B) Signup and view all the answers

What common misconception do patients with conversion disorder have regarding their symptoms?

They believe their symptoms are real and not fabricated. (B) Signup and view all the answers

What laboratory result was significant in indicating that the patient was intentionally inducing diarrhea?

Positive thin-layer chromatography for bisacodyl (B) Signup and view all the answers

In the case of the 41-year-old male, what psychiatric symptom was reported?

Auditory hallucinations (D) Signup and view all the answers

How should the physician approach the conversation about the patient’s laxative use?

Clearly communicate the evidence found for laxative use (A) Signup and view all the answers

What is the most suitable diagnostic study for evaluating seizure disorders?

Electroencephalography (D) Signup and view all the answers

What aspect characterizes the diagnosis of malingering?

Deliberate fabrication of symptoms for an external reward (D) Signup and view all the answers

Which of the following conditions is associated with significant impairment but lacks intentional symptom fabrication?

Somatic symptom disorder (C) Signup and view all the answers

What type of disorder is characterized by a deliberate falsification of symptoms for personal gain?

Factitious disorder imposed on self (A) Signup and view all the answers

Which condition is characterized by a discrepancy between a patient's symptoms and neurological findings?

Conversion disorder (B) Signup and view all the answers

What is the gold standard diagnostic method for epilepsy?

EEG (C) Signup and view all the answers

Which imaging test is considered the gold standard for evaluating neurological disorders such as stroke?

MRI (D) Signup and view all the answers

Which condition is characterized by loss or distortion of neurological functioning not fully explained by organic disease?

Conversion disorder (D) Signup and view all the answers

What therapeutic approach is beneficial for patients diagnosed with conversion disorder?

Cognitive behavioral therapy (A) Signup and view all the answers

What is the underlying factor often associated with conversion disorder symptoms?

Recent stress or trauma (A) Signup and view all the answers

In a case of suspected conversion disorder, what would likely rule out the diagnosis of epilepsy?

Normal EEG findings (C) Signup and view all the answers

In the scenario where a patient presents with symptoms suggestive of intestinal pseudo-obstruction, what is the critical next step in management given the presence of emetine in urine and stool?

Report the case to local authorities (C) Signup and view all the answers

What is a potential indicator that a patient with neurological symptoms is not feigning their condition?

Relief at diagnosis (D) Signup and view all the answers

Why are antiepileptic drugs not appropriate for a patient with confirmed conversion disorder?

There is no evidence of epilepsy (C) Signup and view all the answers

What symptom combination in the 15-year-old male patient may indicate that he has not been intentionally causing his symptoms?

Intellectual disability and negative toxicology (B) Signup and view all the answers

What distinguishes a conversion disorder from malingering?

Malingering includes a secondary gain such as financial compensation (A) Signup and view all the answers

What could be a potential consequence of discharging a patient with conversion disorder without a treatment plan?

Increased risk of further neurological events (D) Signup and view all the answers

Which of the following is least likely to be a feature of conversion disorder?

Intentional feigning of symptoms (B) Signup and view all the answers

What differentiates factitious disorder from conversion disorder in patients?

Patients with factitious disorder seek to assume the sick role (C) Signup and view all the answers

Which of these would not typically feature in the evaluation of a patient suspected of having conversion disorder?

Immediate provision of antiepileptic medication (B) Signup and view all the answers

Study Notes

Patient Presentation

15-year-old male with intellectual disability
Presents with nausea, vomiting, diarrhea, and difficulty urinating
Initial diagnosis of intestinal pseudo-obstruction in the ER due to suspected motility issues in both the intestine and urinary system

Hospitalization and Treatment

Patient hospitalized and started on total parenteral nutrition
Requires bladder catheterization three times a day

Investigative Findings

X-rays do not show objective evidence of intestinal pseudo-obstruction or urinary system hypomotility
Laxative and toxicology screenings are negative
High-performance liquid chromatography reveals emetine (neuro and nephrotoxic agent from ipecac) in the patient's urine and stool

Patient's Mother

The patient's mother is described as "devoted" and stays with him almost constantly

Best Next Step in Management

Investigate the source of the ipecac: This is crucial as the presence of emetine indicates intentional ingestion, likely by the patient's mother.
Assess the patient's mother: This is necessary to understand her role in the situation and determine if she might be deliberately harming her son.
Consider reporting suspected abuse: The presence of ipecac in the patient's system suggests potential harm and could warrant reporting to the appropriate authorities.
Reassess the patient's condition: It's vital to carefully monitor the patient for any signs of toxicity or complications from ipecac.
Consult a child protection specialist: Their expertise can be invaluable in evaluating the situation and determining the best course of action.

Child Abuse and Emetine

Emetine poisoning is a form of child abuse, the mother is likely the one who gave the toxin.
It is important to report this case to local authorities.
Do not discharge the patient to home care as it will expose the child to further abuse.
Do not refer to surgery and nephrology services, as reporting to the authorities is the priority.
A DNA test for a congenital metabolic disorder is unnecessary because emetine is an exogenous toxin.
A liquid chromatography revealed the presence of emetine, so a repeat toxicology screening test is not needed.

Factitious Disorder Imposed on Others

Factitious disorder imposed on others (Munchausen syndrome by proxy) is the repeated and deliberate creation of signs or symptoms of illness in another person to obtain medical care.
In this case, the mother was diagnosed with factitious disorder imposed on others, and her son exhibited the symptoms.
Malingering is not a correct diagnosis because the mother's gain was an internal reward (attention and sympathy), not external (e.g., financial gain).
Somatic symptom disorder (SSD), illness anxiety disorder, conversion disorder are not relevant in this case, as patients with these disorders do not intentionally produce their symptoms.

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Description

Test your knowledge on managing pediatric cases of intestinal pseudo-obstruction, especially in patients with intellectual disabilities. This quiz covers presentation, diagnosis, treatment options, and next steps in management, emphasizing the importance of investigating toxic agents. Assess your understanding of this critical pediatric scenario.