Chapter 16. Somatic Disorders and Physiological Dysfunctions as Manifestations of Mental Pathology
6 topics with concise breakdowns: definitions, key facts, and class questions.
In this chapter, we examine the fine line between the physical and the mental. This section is dedicated to conditions in which patients complain of physical discomfort, sleep disturbances, appetite changes, or sexual dysfunction, but the true root cause lies in psychiatric pathology. General practitioners encounter such patients on a daily basis.
The material covers five key topics: classical psychosomatic and somatoform disorders, eating disorders, as well as sleep disturbances and non-organic sexual dysfunctions. You will learn to recognize hidden depression, anxiety, and neurotic conflicts behind somatic symptoms.
In practical classes and examinations, differential diagnosis is tested most rigorously: how to confidently distinguish a somatoform disorder from a true somatic disease. Other frequent exam topics include diagnostic criteria for anorexia nervosa and bulimia nervosa, management algorithms for patients with psychogenic insomnia, and principles of handling hypochondriacal complaints.
What is the difference between malingering and aggravation?
In malingering, a person fakes an illness they do not have. In aggravation, the patient has a real medical condition, but intentionally exaggerates the severity of its symptoms.
How to distinguish psychogenic cardiac pain from true angina pectoris?
Psychogenic pain (in neurosis or depression) is not relieved by taking nitroglycerin, but subsides after using sedatives or validol.
What is the characteristic feature of vomiting in elevated intracranial pressure?
It occurs suddenly, at the peak of the headache, and is not preceded by a feeling of nausea. This is an important marker to distinguish an organic lesion from other conditions.
Why do patients with masked depression frequently consult physicians of other specialties?
Because classical depressed mood recedes into the background and somatic complaints (pain, insomnia, blood pressure surges) become dominant, patients are treated by general practitioners and neurologists for years with erroneous diagnoses such as vegetative-vascular dystonia or osteochondrosis.
What is the main difference between hysterical disorder and simulation?
During simulation, the patient pursues a clear gain while avoiding real pain. In hysteria (and especially Munchausen syndrome), the fabrication is purposeless, the behavior is maladaptive, and the patient is willing to stoically endure painful invasive procedures.
How does Münchausen syndrome differ from ordinary malingering?
The main difference lies in the aimlessness of the fabrication and the patient's willingness to endure painful surgical and diagnostic procedures without any material benefit.
Master the entire topic in the "Psychiatry" course
This is a summary. The course covers everything tested in classes and exams.
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Assignments and quizzes after every topic — just like in a colloquium