Case Files Psychiatry, Fifth Edition (LANGE Case Files) by Eugene Toy & Debra Klamen

Case Files Psychiatry, Fifth Edition (LANGE Case Files) by Eugene Toy & Debra Klamen

Author:Eugene Toy & Debra Klamen [Toy, Eugene]
Language: eng
Format: azw3
Publisher: McGraw-Hill Education
Published: 2015-08-21T16:00:00+00:00


ANSWERS

28.1 D. The most likely diagnosis for this woman is somatic symptom disorder. She presents with numerous somatic complaints, related to several body areas, which are not fully explained by a medical cause. The focus is on the symptoms themselves, not on a perceived physical defect (as in body dysmorphic disorder), on the fear of having a specific disease (as in illness anxiety disorder), or on symptoms of pain (as in somatic symptom disorder with predominant pain).

28.2 B. The most likely diagnosis in this woman is conversion disorder (“pseudo-seizures”). Conversion disorder patients present with neurological symptoms (eg, sensory deficit, motor weakness, seizures) that are felt to be unconsciously produced and believed to be caused by a psychological conflict or stressor. It is unlikely a seizure disorder given her retention of consciousness and lack of incontinence or injury. Her focus is not on an imagined defect in appearance, on the fear of having a serious illness caused by misperceived body sensations, or on multiple physical complaints.

28.3 B. The most likely diagnosis for this man is illness anxiety disorder. His chief complaint is a concern that he has colon cancer. He remains focused on this illness despite prior evaluations with negative results and reassurance from his physician. Although he has several gastrointestinal symptoms (blood in stools due to hemorrhoids and abdominal cramps), he is probably misinterpreting them. His worry is caused by fears of having colon cancer, not about a distorted body image, pain sensations, or numerous physical symptoms.

28.4 D. The most effective strategy for treating individuals with illness anxiety disorder is to schedule regular appointments. In this way, any physical complaints are addressed, and reassurance is provided, albeit temporarily. This approach also minimizes both doctor shopping and unnecessary testing. Treatment with an antianxiety (or antidepressant) agent is not helpful in illness anxiety disorder, unless a comorbid anxiety (or depressive) disorder is present. Because individuals with this disorder are fearful of having a medical illness, they usually resist seeing a psychiatrist.



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