Hypochondriasis

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Hypochondriasis 






      Hypochondriasis is characterized by a preoccupation with fear of having or developing a serious physical illness
      The fear is often a result of unrealistic interpretation of physical signs or sensations as evidence of disease
      The disorder is often chronic, with symptoms present for months or years

Epidemiology
      The prevalence in general medical setting is known to be 49%
      Slightly predominant in men
      The peak age of onset is 20-30 
Etiology
1. Psycho-Dynamic Theory :
      It describes hypochondriasis as an alternative channel to deflect sexual, aggressive or oral drives or an ego- defense against guilt and low esteem or as sign of excessive self concern
      The aggressive and hostile wishes towards others are transformed into physical complaints through repression or displacement
      The hypochondriacal symptoms have also been viewed as an expression of wishes for caring, attention, and sympathy
2. Socio cultural theory :
      It is visualized as a learned social behavior
      The behavior was learned because of its success in past in eliciting caretaking and in securing the other secondary gains of the sick role
      They may have assumed the sick role initially as a result of an accident, injury or medical illness or by modeling themselves after someone, who successfully used the sick role
3. Neuropsychological theory
      According to this theory, hypochondriasis is the result of an underlying perceptual or cognitive abnormality

Diagnostic guidelines (
ICD-10)
      For a definite diagnosis, both of the following should be present:
a. Persistent belief in the presence of at least one serious physical illness underlying the presenting symptom or symptoms, even though repeated investigations and examinations have identified no adequate physical explanation, or a persistent preoccupation with a presumed deformity
b. Persistent refusal to accept the advice and reassurance of several different doctors that there is no physical illness or abnormality underlying the symptoms

Differential diagnosis:
      Somatization disorder
      Depressive disorders
      Delusional disorders
      Anxiety and panic disorders
Clinical presentations:
      Full file of medical records
      Consulted a number of doctors
      Undergone a variety of diagnostic procedures
      The patient believes that he has serious disease
      They keep on scrutinizing their body functioning
      Always preoccupied with their body appearance
      Often complain abnormal body sensations, disturbed body functions or anatomical deviations suggesting disease
Management
       Basic principle of treatment can be outlined as :
      Treatment by a single physician, with whom the patient feels confident
      Supportive approach and regularly scheduled visits
      Avoidance of hospitalizations, diagnostic procedures and medications as possible
      Focusing on symptoms and gradually concentrating on social or interpersonal problems
      Supportive psychotherapy
      Treatment of associated or underlying depression and anxiety, if present
Treatment Modalities
      Drug therapy
ü  Antidepressants
ü  Benzodiazepines
      Psychological treatment
ü  Supportive psychotherapy
ü  Relaxation therapy
Undifferentiated somatoform disorder

      When physical symptoms are multiple, varying and persistent, but the complete and typical picture of somatization disorder is not fulfilled, this category is to be considered

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Hypochondriasis
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