Page 610 - First Aid for the USMLE Step 1 2020, Thirtieth edition [MedicalBooksVN.com]_Neat

566 sEctiON iii Psychiatry ` Psychiatry—Pathology Psychiatry ` Psychiatry—Pathology

Cluster C personality Anxious or fearful; genetic association with Cluster C: Cowardly, obsessive-Compulsive,
disorders anxiety disorders. Clingy. “Worried.”
Avoidant Hypersensitive to rejection and criticism, socially Cowardly.
inhibited, timid, feelings of inadequacy, desires
relationships with others (vs schizoid).
Obsessive- Preoccupation with order, perfectionism, and
Compulsive control; ego-syntonic: behavior consistent with
one’s own beliefs and attitudes (vs OCD).
Dependent Excessive need for support, low self-confidence. Submissive and Clingy.
Patients often get stuck in abusive relationships.

Malingering Symptoms are intentional, motivation is intentional. Patient consciously fakes, profoundly
exaggerates, or claims to have a disorder in order to attain a specific 2° (external) gain (eg,
avoiding work, obtaining compensation). Poor compliance with treatment or follow-up of
diagnostic tests. Complaints cease after gain (vs factitious disorder).

Factitious disorders Symptoms are intentional, motivation is unconscious. Patient consciously creates physical and/or
psychological symptoms in order to assume “sick role” and to get medical attention and sympathy
(1° [internal] gain).
Factitious disorder Formerly called Munchausen syndrome. Chronic factitious disorder with predominantly physical
imposed on self signs and symptoms. Characterized by a history of multiple hospital admissions and willingness to
undergo invasive procedures. More common in women and healthcare workers.
Factitious disorder Formerly called Munchausen syndrome by proxy. Illness in a child or elderly patient is caused or
imposed on another fabricated by the caregiver. Motivation is to assume a sick role by proxy. Form of child/elder abuse.

Somatic symptom and Symptoms are unconscious, motivation is unconscious. Category of disorders characterized by
related disorders physical symptoms causing significant distress and impairment. Symptoms not intentionally
produced or feigned.
Somatic symptom ≥ 1 bodily complaints (eg, abdominal pain, fatigue) lasting months to years. Associated with excessive,
disorder persistent thoughts and anxiety about symptoms. May co-occur with medical illness. Treatment:
regular office visits with the same physician in combination with psychotherapy.
Conversion disorder Also called functional neurologic symptom disorder. Loss of sensory or motor function (eg, paralysis,
blindness, mutism), often following an acute stressor; patient may be aware of but indifferent
toward symptoms (la belle indifférence); more common in females, adolescents, and young adults.
Illness anxiety Preoccupation with acquiring or having a serious illness, often despite medical evaluation and
disorder reassurance; minimal to no somatic symptoms.

FAS1_2019_13-Psych.indd 566 11/7/19 5:28 PM