Chap 12
Conversion disorder also called Functional Neurobiological Symptom Disorder – Presents
with one or more symptoms of impaired motor or sensory function. S/S: Weakness, paralysis,
abnormal movement, swallowing or speak difficulties, seizures, or attacks, sensory loss or
anesthesia, or symptoms involving the senses such as (blindness, loss of smell). Nerve system is
affected.
• La belle indifference - Lack of emotions
Somatic symptom disorder formerly Somatization Disorder: ppl are extremely and
persistently preoccupied w/ and distressed by their perceived health issues. “dr shopping”
• Interventions: presenses of one or more syptoms accompained by abnormal thoughts,
feelings, & behvioral reactions, often in the absnces of known physical finsings or
medical illnesses that would expolain them.
• Somatic sysmptoms: pain, gastric or intestional distress, palpatations, dizziness, SOB,
sexual dysfunction, neurological symoptoms, & fatigue.
Dissociative Diorders: A distrubance in normally well intergreted contiunum of conciuosness,
memory, identity, & perception. Dissociation is an unconciuos defenese mechanism to protect
the indivudual aganist overwhelming anxiety related to past trauma, & ranges from minor ro
severe.
Depersonalization disorder: aka derealization disorder-deciding not to think about it. Unreal,
detached, outside of the body.
Dissociative amnesia - related to a traumatic incident and may be accompanied by fugue- pt
flees life and go to another location and starts a new life. Pt becomes embarrassed when amnesia
subsides and memory returns.
Dissociative identity disorder DID formerly Multiple Personality Disorder: pts lose time,
sexual abuse was reported by 83% of sufferers, physical abuse 81% and trauma 94%, 90% are
female, each alter has its own memories, even different handwriting, exists in 1% of the
population, a rate to schizophrenia, self-harm may occur, 70% have attempted suicide.
Alternative personality (Alter) has its own pattern of personality, perception and memories. EX:
Person develops a different handwriting.
Interpersonal model: Children raised in homes where there is a high degree of parental
somatization may model somatization. Like Imitate
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,Illness anxiety disorder/ formerly Hypochondriasis: Individuals are preoccupied w/ having or
eventually developing a serious illness & they are alarmed with any new bodily sensations.
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, Factitious disorder formerly Munchausen Syndrome: Fabrication of symptoms or self-
injury, to seek attention.
• Malingering: Attempt to receive an obvious gain. EX: Continued visits to
chiropractor when neck strain has been solved in order to inflate an insurance claim.
• These people are often intelligent, resourceful regarding medical practice.
• Factitious disorder imposed on another: Fabrication of symptoms or injury imposed
on person often a child or dependent victim (caregiver). Perpetrator is the one who has
the diagnosis of the disorder.
Chap 15
Depression: Is the most common mental illness in the medical/psychiatric ages between 14-44.
Women are 70% more likely than men to experience depression.
Major depressive disorder-MDD: pts experience substantial pain and suffering, as well as
psychological, social and occupational disability. Individuals are unable to function normally
• Melancholic depression- Sadness/Severe complete loss of pleasure (Anhedonia)
and ability to feel better.
• Atypical depression: rejection sensitivity (pathological sensitivity to perceived
interpersonal rejection) that is present throughout the life and results in functional
impairment; depressed mood can brighten in response to a positive event, atypical
depression can be tx w/ MAOIs.
• Persistent depressive disorder PDD: less severe commonly known as dysthymia
or chronic depression. Pts have difficulty w/ sleeping, in PDD there is often
difficulty getting to sleep and once asleep excessive sleep (hypersomnia)
Primary neurotransmitters involved in depression are: Serotonin (stored in GI tract), NE,
Dopamine.
SSRI’s may help ZOLOFT< PAXIL< ELAVIL< PAMELOR
White males complete 78% of attempts, 3rd leading cause of death ages 15-24 2nd leading cause
of death in college students.
Areas to assess: Mood
• Assess Anergia (lack of energy)
• Anxiety common symptom in depression 60-90% of patients
• Worthlessness unrealistic evaluation of self-worth
• Low self-esteem, painful partner to depression
• Guilt is a common accompanied to depression
• Helplessness believing that everything is to diff to accomplish.
• Hopelessness core characteristics of depression & suicide, schizophrenia, alcoholism, &
physical illnesses.
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