NY Psyk-diagn: Blir dette innført er vi dødsdømt!

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NY Psyk-diagn: Blir dette innført er vi dødsdømt!

Post by mhj » Fri Jun 10, 2011 23:28

II. Complex Somatic symptom disorder (CSSD)

This disorder is characterized by a combination of distressing (often multiple) symptoms and an excessive or maladaptive response to these symptoms or associated health concerns.

The patient‟s suffering is authentic, whether or not it is medically explained. Patients typically experience distress and a high level of functional impairment. The symptoms may or may not accompany diagnosed general medical disorders or psychiatric disorders. There may be a high level of medical care utilization, which rarely alleviates the patient‟s concerns.

From the clinician‟s point of view, many of these patients seem unresponsive to therapies, and new interventions or therapies may only exacerbate the presenting symptoms or lead to new side effects and complications. Some patients feel that their medical assessment and treatment have been inadequate.

Patients with this diagnosis typically have multiple, current, somatic symptoms that are distressing; sometimes, they may have only one severe symptom. The symptoms may or may not be associated with a known medical condition. Symptoms may be specific (such as localized pain) or relatively non-specific (e.g. fatigue). The symptoms sometimes represent normal bodily sensations (e.g., orthostatic dizziness), or discomfort that does not generally signify serious disease (e.g., bad taste in one's mouth). Health-related quality of life is frequently severely impaired.

Patients with this diagnosis tend to have very high levels of health-related anxiety. They appraise their bodily symptoms as unduly threatening, harmful, or troublesome and often fear the worst about their health. Even when there is evidence to the contrary, they still fear the medical seriousness of their symptoms. Health concerns may assume a central role in the individual‟s life, becoming a feature of his/her identity and dominating interpersonal relationships.

If all of the somatic symptoms are consistent with another psychiatric disorder (e.g. panic disorder), and the diagnostic criteria for that disorder are fulfilled, then that psychiatric disorder should be considered as an alternative or additional diagnosis. If the patient has worries about health but no somatic symptoms, he/she may be more appropriately considered for an anxiety disorder diagnosis.

In the elderly somatic symptoms and comorbid medical illnesses are more common, and thus a focus on criteria B becomes more important. In the young child, the “B criteria” may be principally expressed by the parent.

CSSD is a disorder characterized by chronicity, symptom burden, and excessive or maladaptive response to symptoms. When patients do not meet criteria for these domains, other diagnoses should be considered such as Simple Somatic Symptom Disorder (SSSD).

Complex somatic symptom disorder (includes previous diagnoses of somatization disorder DSM IV code 300.81, undifferentiated somatoform disorder DSM IV code 300.81, hypochondriasis DSM IV code 300.7, as well as some presentations of pain disorder DSM IV code 307). To meet criteria for CSSD, criteria A, B, and C are necessary.

A. Somatic symptoms:
One or more somatic symptoms that are distressing and/or result in significant disruption of daily life.

B. Excessive thoughts, feelings, and behaviors related to these somatic symptoms or associated health concerns: At least two of the following are required to meet this criterion:
(1) Disproportionate and persistent concerns about the medical seriousness of one’s symptoms.
(2) High level of health-related anxiety
(3) Excessive time and energy devoted to these symptoms or health concerns

C. Chronicity: Although any one symptom may not be continuously present, the state of being symptomatic is chronic (at least 6 months).
For patients who fulfill the CSSD criteria, the following optional specifiers may be applied to a diagnosis of CSSD where one of the following dominates the clinical presentation:

XXX.1 Predominant somatic complaints (previously, somatization disorder)

XXX.2 Predominant health anxiety (previously, hypochondriasis) If patients present solely with health-related anxiety with minimal somatic symptoms, they may be more appropriately diagnosed as having Illness Anxiety Disorder (see V.B below).

XXX.3 Predominant Pain (previously pain disorder). This classification is reserved for individuals presenting predominantly with pain complaints who also have many of the features described under criterion B. Patients with other presentations of pain may better fit other psychiatric diagnoses such as adjustment disorder or psychological factors affecting a medical condition.

For assessing severity of CSSD, metrics are available for rating the presence and severity of somatic symptoms (see for instance PHQ, Kroenke et al, 2002). Scales are also available for assessing severity of the patient‟s misattributions, excessive concerns and preoccupations (see for instance Whiteley inventory, Pilowsky , 1967).

III. Simple (or abridged) somatic symptom disorder [xxxxxxxx] e.g. pain (# XXX)
This diagnosis requires the following 3 criteria:

A. Somatic symptoms: One or more somatic symptoms that are distressing and/or result in significant disruption of daily life.

B. Excessive thoughts, feelings, and behaviors related to these somatic symptoms or associated health concerns:

This diagnosis requires one of the following:
(1) Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
(2) High level of anxiety about health or symptoms
(3) Excessive time and energy devoted to these symptoms or health concerns
C. Symptom duration >1 month.

IV. Illness Anxiety Disorder (hypochondriasis without somatic symptoms)

This disorder is characterized by high illness anxiety that is distressing and/or disruptive to daily life with minimal somatic symptoms. Most patients previously diagnosed with hypochondriasis have somatic symptoms and will now be included in CSSD. However, some patients previously diagnosed with hypochondriasis have minimal somatic distress and instead are concerned primarily with the idea that they are sick. They are now diagnosed with illness anxiety disorder.

The following 6 criteria must be met.
A. Somatic symptoms are not present or, if present, are only mild in intensity.

B. Preoccupation with having or acquiring a serious illness. If a general medical condition or high risk for developing a general medical condition is present, the illness concerns are clearly excessive or disproportionate. The individual‟s concern is focused not on any physical distress per se, but rather on a suspected, underlying medical diagnosis.

C. High level of anxiety about health or having or acquiring a serious illness. These individuals have a low threshold for considering themselves to be sick and a low threshold for becoming alarmed about their health.

D. The person performs related excessive behaviors (e.g. checking one‟s body for signs of disease, repeatedly seeking information and reassurance from the internet or other sources), or exhibits maladaptive avoidance (e.g. avoiding doctor‟s appointments and hospitals, avoiding visiting sick friends or relatives, avoiding triggers of illness fears such as exercise). E. Although the preoccupation may not be continuously present, the state of being preoccupied is chronic (at least 6 months)

F. The illness-related preoccupation is not better accounted for by the symptoms of another mental disorder such as complex somatic symptom disorder, panic disorder, generalized anxiety disorder, or obsessive compulsive disorder.

V. Functional Neurological Disorder (previously, Conversion disorder (#300.11)

The essential feature of this disorder is neurological symptoms that are found, after appropriate medical assessment, to be incompatible with a neurological condition.

The symptoms might include weakness or paralysis, events resembling epilepsy or syncope, abnormal movements, sensory symptoms (including loss of vision and hearing), or speech and swallowing difficulties.

In addition, the diagnosis will usually be supported by evidence of internal inconsistency or incongruity with neurological disease. This evidence may include physical signs (such as, Hoover‟s sign of functional weakness) or diagnostic investigations (such as seizure-like behaviour in the absence of simultaneous convulsive activity on EEG). The symptoms may be acute or chronic.

Psychological stressors or personally meaningful life events may often be associated with onset of symptoms, but their identification is not necessary for the diagnosis. Co-morbid neurological disease may also be present and does not exclude the diagnosis.

If there is evidence that the symptoms are intentionally feigned, the condition is not conversion disorder but rather either factitious disorder or malingering. Cognitive complaints that are incompatible with objective findings may be coded as a variant of functional neurological symptoms, dissociative disorder, factitious disorder, malingering, illness anxiety disorder, or CSSD, depending on the clinician‟s overall assessment of the clinical situation.

Given the increased prevalence of neurological disorders in the elderly, special care should be taken in diagnosing functional neurological disorder in older patients who have not previously had such symptoms.

Criteria A, B, C and D must all be fulfilled to make the diagnosis:
A. One or more neurologic symptoms such as altered voluntary motor, sensory function, or seizure-like episodes

B. The symptom, after appropriate medical assessment, is not found to be due to a general medical condition, the direct effects of a substance, or a culturally sanctioned behavior.

C. The physical signs or diagnostic findings are internally inconsistent or incongruent with recognized neurological disorder.

D. The symptom causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

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Bakgrunn:

Home / Proposed Revisions / Somatic Symptom Disorders
Somatic Symptom Disorders


Please find below a list of disorders that are currently proposed for the diagnostic category, Somatic Symptom Disorders.

This category contains diagnoses that were listed in DSM-IV under the chapter of Somatoform Disorders.

The Somatic Symptom Disorders Work Group has been responsible for addressing these disorders. Among the work group’s recommendations is the proposal to rename this category Somatic Symptom Disorders.

Because the current terminology for somatoform disorders is confusing and because somatoform disorders, psychological factors affecting medical condition, and factitious disorders all involve presentation of physical symptoms and/or concern about medical illness, the work group suggests renaming this group of disorders Somatic Symptom Disorders.

In addition, because of the implicit mind-body dualism and the unreliability of assessments of “medically unexplained symptoms,” these symptoms are no longer emphasized as core features of many of these disorders.

Since Somatization Disorder, Hypochondriasis, Undifferentiated Somatoform Disorder, and Pain Disorder share certain common features, namely somatic symptoms and cognitive distortions, the work group is proposing that these disorders be grouped under a common rubric called Complex Somatic Symptom Disorder. Furthermore, the diagnosis of Factitious Disorder can now be found under the diagnostic chapter Other Disorders. We appreciate your review and comment on these disorders.

Kilde: http://www.dsm5.org/proposedrevision/Pa ... rders.aspx


J 00 Complex Somatic Symptom Disorder
J 01 Simple Somatic Symptom Disorder
J 02 Illness Anxiety Disorder
J 03 Functional Neurological Disorder (Conversion Disorder)
J 04 Psychological Factors Affecting Medical Condition
J 05 Other Specified Somatic Symptom Disorder
J 06 Unspecified Somatic Symptom Disorder

Hentet fra: http://www.dsm5.org/Documents/Somatic/S ... 202011.pdf
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Re: NY Psyk-diagn: Blir dette innført er vi dødsdømt!!!!

Post by Anastasia » Sat Jun 11, 2011 01:25

Hvorfor tror du det? Jeg kjenner meg ikke igjen i noe av dette.

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Re: NY Psyk-diagn: Blir dette innført er vi dødsdømt!!!!

Post by Anastasia » Sat Jun 11, 2011 01:27

Og somatoforme lidelser er da allerede godt kjent.

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Re: NY Psyk-diagn: Blir dette innført er vi dødsdømt!!!!

Post by Rasmus » Sat Jun 11, 2011 10:29

Det er sikkert noen som tror at ME-diagnosen (G 93.3) passer på deres tilstand som i stedet lider av en somatoform lidelse. Grundig medisinsk vurdering skal utelukke også dette før ME-diagnosen settes. At de som RETTMESSIG plasseres i gruppen somatoforme lidelser, ikke liker dette forstår jeg godt. Men det er viktig å få skilt ut det som IKKE er ME dersom aksepten av ME skal øke. Dermed vil forhåpentligvis også forskningsinnsatsen for å finne en løsning på årsaker og effektive behandlings- og kanskje forebyggingsmetoder øke.

Men det er nok et problem at kunnskapen om ME fortsatt er så dårlig blant legene at de oftere feildiagnostiseres andre vegen. Mange leger har også alvorlige fordommer i forhold til lidelser som ikke kan påvises helt objektivt via en blodprøve, sees med det blotte øye eller påvises via undersøkelser som EKG, EEG, MR etc. Disse har nok større tilbøyelighet til å tenke på somatoforme tilstander og ser kanskje helt bort fra ME som en mulighet.

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Re: NY Psyk-diagn: Blir dette innført er vi dødsdømt!

Post by mhj » Sun Jun 12, 2011 00:51

Norefall wrote:European ME Alliance(og Norges ME-forening) sitt svar på forslaget til DSM-V om Complex Somatic Symptom Disorders:
http://www.euro-me.org/news-Q22011-003.htm
Takker Norefall :wink:

jeg samler disse innsigelsene/protestene i ett innlegg i bloggen:

Reaksjon og innsigelse fra: IACFS/ ME med flere – Statement på DSM-5 Somatic Symptom Disorder

http://totoneimbehl.wordpress.com/2011/ ... -disorder/

:wink: viktig at dette avverges.

@ Anastasia: Det gjør resten av WWW og ikke uten grunn!!!
Læresetningen er: *3-2-1 STOPP* *Indre styrke og mot* *Tro, håp og kjærlighet* *Balanse, ro, harmoni og flyt*

Utredning ved LHK/SmedS http://www.strommenmedisinskesenter.no/ fra april 2009 :-)

Bloggen min kan du lese her: http://totoneimbehl.wordpress.com/

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