Somatic Symptoms and Related Disorders, Dissociative Disorders and Psychotic Disorder

Neurosis - produce by stress, depression and anxiety

Psychosis - lost of contact to reality

I. Somatic Symptoms and Related Disorder

- illness anxiety that cause significant distress
Somatic
- concern with physical symptoms
- usual seen in medical settings
- usually evaulated for physical illness only
- patients believe that they have physical pain

1. Somatic Symptom Disorder

DSM-4: Somatoform, Somatization, and Pain Disorde
- the individual shall experience one or more physical symptoms that are distressing
- when pain has no cause
- has pain
- pain is subjective
- at least one of the three:
a. excessive thought (cognitive level)
b. feelings (affective)
c. behavioral
Duration: at least 6 months
- can be chronic or acute
Nature: Psychodynamic view: stress became body pain

2. Illness Anxiety Disorder

Hypochondriasis- overreaction/ excessie worrying
- pain could only be mild or none
- experience or feeling of terribly worry of having serious life threatening illnesses
- ordinary symptoms that are magnified or exaggerated (papitation became heart disease)
- anxiety persist despite medical evidences to the contrary and reassurance by health care
professional.
- check all critera: cognitive, affective, and behavioral
Duration: at least 6 months

Two Types
1. Care seeking
- doctor hopping
- unsatisfied with diagnosis
2. Care avoidant
- don't want to know the severity of their pain
- only imagines pain without assurance
Difference between Somatic and Illness Anxiety
Cause of distress
Somatic - from symptoms/ pain
Illness Anxiety Disorder - from the interpretation of symptoms

Illness Phobia: Avoid suseptivility

Illness Anxiety Disorder: Convincing themselves that they have illnesses

3. Conversion Disorder
Functional Neurological Symptom Disorder
- a change in sensory or voluntary of motor functioning that seems clinically inconsistent with
any know clinical illness
- cannot explain by medical views
Two convesion symptoms
1. Alteration of body function
2. Alteration of body function without physical cause (Psuedoneurological)
- psychological damage that converted into physical dysfunction
Alteration on:
1. change in motor functioning
2. sensory changes
- brain is normal but not functioning corretly
- reversible
- can be treated through therapy'
- can be explain by psychodynamic theory (repression)

4. Factitious Disorder
- there's fabrication to appear sick or impaired
- someone deceives others by appearing sick
- gawa gawang sakit
- conscious that are faking their illnesses
- unconsious: their motive
- not scared of surgery or psychiatric disorders

Types:
Impose in self: want to be part of the lifestyle/ want to be ill
Impose on others: want to inflict illness to other people/ want to take care of others

Malingering - faking symptoms because of external reward

- scared as they are aware of consequences

II. Dissociative Disorders

DSM-5 TR: after trauma and stressor related disorder
- individual experience trauma which develop dissociative disorders

Difference:
Trauma disorders dissociation - only connected to the traumatic event
Dissociative Disorder - dissociates on the general lifestyle
- intrusion of awareness and behavior
- lost of contact with reality
- can be normal if mild

Dissociations
- disruption of normally integrated fuctions
A. conciousness
B. Memory
C. Identity
D. perception
E. motor control

1. Dissociative Identity Disorder

former known as: Multiple Personality Disorder
- fragmentation of personality states and identities
- 1 personality with many identities
- disruption of identity characterized by two or more idenitity
- mutliple way of thinking, feeling, and behaving
- reccurent episodes of amnesia
- blackouts - not attributed to any substance
- do something without awareness
- still debatable/ under debate
- rare disorder

Types of Identity
1. Host - original identity
2. Alters - other identities

if you are aware = good pragnosis = good recovery rate

Recovery: connect host to alters

Identity - an individual’s sense of self defined by (a) a set of physical, psychological, and
interpersonal characteristics that is not wholly shared with any other person and (b) a range of
affiliations (e.g., ethnicity) and social roles.

Hallucination = psychosis

2. Dissociative Amnesia
- inability to recall important autobiographical information
- no underlying organic/ medical condition
Autobiographical - informations about yourself

Types of Amnesia
1. Psychogenic - reversable

NOT PART OF THE LECTURE

1. Localized. This is where you cannot remember events from a specific time period.
2. Generalized. This is a complete loss of memory, including things like identity and life history.
It’s very rare.
3. Fugue. In dissociative fugue you forget most or all of your personal information and may
wander or travel to places you wouldn’t usually go. In longer-lasting cases, you may even take
on a whole new identity.

Specifier:
Dissociative fugue: forget past self then create new identity
- only psychological problem

Retrograde Amnesia - loss of information that was acquired before

Anterograde Amnesia - impaired capacity for new learning

3. Depersonalization/ Derealization
- one's sense of reality is lost/ detachment from environmeent - strange people, unfamiliar
environment, etc.
- one's sense of self became detachment from own body
- unrecognized reflection
- loss of sensation
- spectator
- recurring and impairing

Derealization
- external
- where you are is perceive as confusing
- feeling of being detached from one's surroundings (derealization).

Depersonalization
- internal
- watching yourself
- outside observer of one's life (depersonalization)

III. Schizophrenia Spectrum and Psychotic Disorder

Psychosis - significant loss of contact with reality
Psychotic symptoms
+ positive psychotic symptoms
- presence of odd, unusual feelings, thoughs, and behavior
Hallucinations - false sensory perception/ distorted perception
A. Auditory
B. Tactile
C. Visual
Delusion - strongly held false belief
Disorganzied speech/behavior - word salad, neologism (invent new words), purposeless
movements

- negative psychotic symptoms

- absence or lack of functioning
Catalepsy - loss of sensation and consciousness with body rigidity
Alogia - loss of speech
Avolition - absence of self-directed movements
Flat effect

1. Brief Psychotic Disorder

- patient develops, then recover completely from an episode of psychosis
Duration: at least 1 day but less than 1 month

2. Schizophreniform Disorder
- two or more psychotic symptoms
- at least one positive psychotic symptoms
- may or may not exhibit negative psychotic symptoms
Duration: at least 30 days to 6 months

3. Schizophrenia
- two or more psychotic symptoms
- at least one positive
- may or may not exhibit negative
Duration: at least 6 months

1-3 Difference: Duration

4. Schizoaffective Disorder
- major mood episodes (depression or mania) that concurrent with or following a psychotic
episode
- psychotic episode ->two or more weeks -> major mood episode
- psychotic episode create major mood episodes
- psychotic episode (delusion or hallucination) in the absence of mood episode for 2 or more
weeks
- treatment of psychosis (antipsychotics) stabilizes the mood
Mood Disorder with Psychotic Features
- mood disorder followed by psychotic episode
- kabaliktaran ng nasa taas

Psychosis and Mood Disorder can be separated by 2 weeks span of time

5. Delusional Disorder
- the patient has had delusions but on other psychotic symptoms, and any mood symptoms are
relatively brief
Duration: at least 1 month

Specified whether:
A. Erotomanic type - believe that someone is in love with them
B. Grandiose type - patient is a person of exalted statute (god or movie star)
C. Guilt type - has done something unrecoverable/ feeling of doing something unforgivable
D. Jealous Type - believing that partner is constantly cheating or unfaithful
E. Passivity type - being controlled by outside forces (radio waves)
D. Persecutory type - feeling pinakakaisahan/ feeling victim
E. Somatic type -
F. Mixed type
G. Unspecified type