Medical Archive

C13.1 Introduction and Overview

??: ?? medical condition? ??? ?? ??? factors
?? ?? ??? Alexithymia: ???, ?? ??? ? ????, ????

??	?????: ??? ??
??	??: ??? ??, ???, ??, ??, ?? ???
??	ACS: A? ?? (???, ??, ??? ??, ???)
??	???: ???, ??, ?????, ???, ??? ?????: A? ??, ??/??/??/?? ? Diazepam

??? ?? ?? ?? ?? ? ??? ?? ??
????? ???, ???? ??. BIOFEEDBACK

???? ? ????	?? ?? ??? ??
?????? ?????? (?? ??) ???? ?????? ?? ??? ??? ??? ?? ???? ?? ????? ??? ??? ?? ???? ??? ??? ?? ?? ???, ?? ???? ??…	?? ??? ?? ???? ?? ?? ???? ??

?? ???, ?? ???? ??…
????: ? m/c. 6?? ?? ???? ???? ??x
????(pseudocyesis), 6?? ? ????

?? ??/??? conversion, somatization??.
??? ??: ??, ???? ???
??? ??: ??? ?? ? ?? ?? ??

C13.2 Somatic Symptom Disorder ??????

Pathology

?? ?? >6??. ?????? ??? ??.
????? ?? 30? ?? ???? ?? ?
Doctor shopping ??? 2/3? ?? ???? ?? ??

Clinical presentation

Anxiety revolves around a patient’s symptoms.

Treatment

• General measures
  • ?? ???? ? ??? ??, ????? X
  • ?? ? ??? ???? ?????.
  • ?????? ?????? ?? ?????.
• Cognitive-behavioral therapy (CBT)
• Trial of antidepressant medication
  • SSRI – 1st line
  • TCA can also be used.

C13.3 Illness Anxiety Disorder ??????

1. ???? ?? ?? ??. ?? ??? ???. >6??
2. Guilt? ?? ???? ?? ??
3. ??? ? ???? ??? ??? ??, ??? ?T, ??? ?? ?

C13.4 Functional Neurological Symptom Disorder (Conversion Disorder)

??? Motor/Sensory function ? deficit. 
??, ?? ?, IQ ?, ? ??
1°, 2° ??? ??
????: ??, ??, ???, ??
Etiology: ??? ??, ???. Excessive cortical arousal (??<?????)
La belle indifference (?? ?? ???)
Identification: ?????? ???? ??? ??? ??? ??? ? ? ??.

# Psychogenic nonepileptic seizure (PNES)

• Inconsistent with seizures or other known neurological conditions.
• Forceful eye closure, side-to-side head or body movements, rapid alerting and reorienting, and memory recall of the event.
• Diagnosis: video-EEG
• Psychiatric assessment is crucial as many patients with PNES have comorbid psychiatric disorders and/or history of trauma.

Treatment and prognosis

??? ????; ??, ??, ????(??)
??? acute??. Stressor? ????(??) ??? ?? ?? ? 
??, ????, ?? ?? ?? ? (Cf. tremor, seizures)

C13.5 Psychological Factors Affecting Other Medical Conditions

C13.6 Factitious Disorder

??? ??, ???? ?? – ???? ?? ???? ??
Eg, self-inflicted trauma, manipulating laboratory tests, injecting fecal matter

Usually demanding and typically become upset when confronted, often leaving against medical advice and seeking care at another facility, where the cycle continues.

Cf) malingering(??): ??? ??, ??? ????. NOT a mental illness.

C13.7 Pain Disorder

C13.8 Consultation-Liaison Psychiatry