NRNP 6665-01 Final Exam Study Guide 2025

Overview "How the mind affects the body" -DSM5- "psychological factors affecting physical conditions" Known mind/body connection is seen with: -General hospital population: depressive disorders 2x as common -Depression is a risk factor and poor prognostic factor in CAD Current trends Chronic fatigue syndrome and fibromyalgia -Some still believe to represent somatization variants -Currently are established medical diagnoses Summary of clinical problems in psychosomatic medicine Psychosomatic disorder spectrum (4) -Hypochondriasis/ Somatic symptom disorder -Conversion disorder -Factitious Disorder -Pain Disorder Hypochondriasis AKA Somatic Sx Disorder -6 or more months of general and non-delusional preoccupation with fears of having or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms (despite negative findings) -causes significant distress in their life -Not accounted for by another psychiatric or medical disorder -Patient typically has poor insight; do not consistently recognize that their concerns about the disease are excessive Epidemiology of hypochondriasis -Ranges from 4-15% of general population -Affects men and women equally -Usually ages from 20-30's but can affect individuals of any age -Up to 3% of medical students reportedly have this disorder -Coexisting problems: 80% of patients may have depressive/anxiety disorders DSM-5 criteria for hypochondriasis 6 or more months Clinical features -Pts believe they have a serious disease even if they have negative findings -Stressors can cause exacerbation -Months-years -Must differentiate from non-psych medical conditions -Work up should include HIV, lupus, myasthenia graves, endocrinopathies, MS, nervous system diseases, occult neoplastic disorders (get family/social history) Tx of hypochondriasis -Psychotherapy, group therapy Helps to reduce anxiety -Scheduling frequent physical exams for reassurance (once a week even) -Avoided invasive testing unless medically necessary -Prescriptions only if has underlying anxiety or depressive disorder Illness anxiety disorder -Variant of hypochondriasis -Patients do not have a group of symptoms but are preoccupied with the fact that they are "ill" or "sick" or are developing a disease of some kind -Usually complain of fewer symptoms -May also be for pts who do have a medical illness but whose anxiety is out of proportion to their diagnosis, and assume the worst possible outcome These pts think more of a terminal illness, being ill, not severe sx Differentiated from somatic sx disorder Emphasis on fear of having a disease rather than a concern about many symptoms Conversion disorder overview AKA-Functional Neurological Sx Disorder -An illness of symptoms or deficits that affect voluntary motor or sensory functions that may appear as another medical condition but shown to be caused by psychological factors (paralysis, blindness, no medical cause) -Usually preceded by conflict or psychological "stressors" -Symptoms that are not intentionally produced and are not caused by substance use -They are not limited to pain or sexual symptoms and the gain is psychological, not social, monetary, or legal Epidemiology of conversion disorder -2:1 women to men 10:1 girls to boys in pediatric populations Men who are diagnosed have usually had military or occupational accidents -Usually seen in late childhood through early adulthood -Rare in patients 10 y/o age and 35 y/o age -Most common in lower SES, lower education levels -Seen with MDD, anxiety disorders, and schizophrenia Clinical features of conversion disorder -typically abrupt, but may be chronic -Paralysis of arm/leg, mutism (aphonia), and blindness are the most common symptoms Other common sx with conversion disorder -Impaired coordination of balance -Abnormal limb posturing --Generally worsen when attention is called to them -Sensation of lump in throat or difficulty swallowing -Weakness, abnormal movements or gait -Shaking movements and impaired consciousness, suggesting Seizures --May be difficult to differentiate from actual seizure by observation alone Sensory sx of conversion disorder -Anesthesia and paresthesia are common, especially of the extremities -Distribution of the disturbance is usually inconsistent with either central or peripheral neuro disease --Map dermatomes (test) and suspect conversion findings: do not conform to recognized pattern of distribution May involve organs of special senses and can produce deafness, blindness, and tunnel vision -Unilateral of bilateral, however neuro evaluation reveals intact sensory pathways -Visual fields (test peripheral vision) and suspect conversion findings: changing patterns on multiple exams -Sudden flash of bright light (to test blindness) and suspect conversion findings: patient flinches (or loud noise behind pt) Motor sx-weakness and paralysis (1,2,or all 4 limbs) -Drop paralyzed hand onto face (test) and suspect conversion disorder: hand falls next to face, not on it -However reflexes remain normal, no fasciculations or muscles atrophy and electromyography (EMG) findings are normal Gait disturbance seen in conversion disorder is astersia-abasia, what is this? Wildly ataxic, staggering gait accompanied by gross, irregular, jerky truncal movements and thrashing and waving arm movements. Seizure Symptoms: Pseudoseizures, or Psychogenic nonepileptic seizures (PNES) are difficult to differentiate from an actual seizure from clinical observation alone -About 1/3 of pseudoseizures also have a coexisting epileptic disorder -Tongue biting, urinary incontinence and injuries after falling can occur in pseudoseizures, although generally not present -Pupillary and gag reflexes are retained after pseudoseizures -Patients have no post seizure increase in prolactin concentrations in pseudoseizures DSM-5 criteria of conversion disorder -have at least one neurological symptom that is not being intentionally produced -have distress caused by the impairment that impairs their function -not be limited to pain or a sexual symptom -not be explained by an actual medical condition -be subsequent to a psychological stressor or trigger