Download Somatoform Disorders Objectives By the end of lecture, students

Somatoform Disorders
Objectives
By the end of lecture, students would be able to,
 Identify the diagnostic features of the most common somatoform disorders
 List characteristics differentiating somatoform disorders from malingering and factitious
disorders
 List some of the common causes of somatoform disorder
 Outline management strategies for patients with somatoform disorders.
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Ahmed 35 years old came to hospital complaining of dizziness, backache and
indigestion.
His file show: for the last 7 month, he presented with the following: abdominal pain,
nausea, intolerance to 13 different foods, backache, shortness of breath at rest, chest
pain, dizziness, difficulty swallowing, palpitation.
Investigation: Blood test 5 times
chest x-ray 3 times, ECG ( 6 times), ultrasound abdomen (2 times), CT scan abdomen( 2
times), upper GI endoscopy (2 times), colonoscopy once
ALL investigations were NORMAL
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HOW YOU WILL MANAGE AHMED ?
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No explanatory organic cause can be found in 20-84% of patients presenting with bodily
symptoms.
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Bodily or physical symptoms (hence the term somatoform) without any organic,
physical cause (general medical condition or effect of substance)
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Increased bodily sensitivity
Physical symptoms perceived are normal for most individuals
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Need to be sick
Becoming physically sick is less stressfull than being unsuccessfull
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Central features of Somatoform Disorders
Physical complaints without organic basis
Psychological factors and conflicts seem important in initiating, exacerbating, and
maintaining the symptoms
Symptoms or magnified health concerns are not under conscious
control(Guggenheim2000)
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Symptoms must cause clinically significant distress or impairment in social, occupational
or other important areas of functioning
Classification
Somatization disorder
Undifferentiated somatoform disorder
Conversion disorder
Pain disorder
Hypochondriasis
Body dysmorphic disorder
Somatoform disorder not otherwise specified
Somatization Disorder
multiple recurrent physical complaints over many years
4 pain symptoms
2 gastrointestinal symptoms
1 sexual symptom
1 pseudoneurologic symptom
No organic etiology for these complaints
Begins by age 30
Undifferentiated Somatoform Disorder
One or more physical complaints (e.g. fatigue, loss of appetite, GI or urinary complaints)
Present for 6 months or longer
Conversion Disorder
Unexplained symptoms or deficits affecting voluntary motor or sensory function
suggesting neurological or other general medical condition
Types:
With motor symptoms or deficits
With sensory symptoms or deficits
With seizures or convulsions
With mixed presentation
Pain Disorder
symptoms of pain that are either solely related to or significantly initiated, exacerbated
or maintained by psychological factors.
Hypochondriasis
Preoccupation with fear of having or idea that one has a serious disease based on
person’s misinterpretation of bodily symptoms or functions despite medical evaluations
and reassurance
Body Dysmorphic Disorder
Preoccupation with imagined or exaggerated defects in physical appearance
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somatoform Disorder Not Otherwise Specified
somatoform symptoms that do not meet any of the previously mentioned somatoform
disorder diagnoses.
Differential Diagnosis
Factitious disorder and malingering
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Factitious disorder and malingering are different names for the same condition.
Factitious disorder attempts to achieve psychological benefit, malingering attempts to
achieve external benefit.
Factitious disorder is conscious, malingering is primarily unconscious.
Malingering is a much more chronic condition than factitious disorder.
Malingering patients complain of a wider variety of symptoms.
Etiology
Psychosocial Factors
 interpretations of the symptoms as social communication
 avoid obligations
 express emotions
 symbolize a feeling or a belief
 the symptoms substitute for repressed instinctual impulses
Biological Factors
 decreased metabolism in the frontal lobes and in the nondominant hemisphere
 genetic components
Management – Discuss the diagnosis
We counldn’t find anything serious after the exam or investigations. But htere is something
bothering you. Although the reason is not clear, this is a situation we face frequently…”
Management – Discuss the diagnosis
Better we should discuss how we can help you instead of the name. However, although there
are a lot of names given, we frequently call this situation as “Somatoform disorder”
 Primary physician should see patients usually at monthly interval.
 Additional laboratory and diagnostic procedures should generally be avoided.
 Long- range strategy for patient with somatoform disorder is to increase the patient's
awareness of the possibility that psychological factors are involved in the symptoms
until the patient is willing to see a mental health clinician.
Management - Pharmacological
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No specific medicine
Treat concomittant psychiatric problem
Deal with domiant symptom
Pain  Amitriptilline
Fatigue  Bupropion
Anxiety, sleep dist  SSRI, TCA
Medication must be monitored, because patients with somatoform disorder tend to use
drugs erratically and unreliably
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Management - Psychotherapy
In psychotherapy, patients are helped;
to cope with their symptoms
to express underlying emotions
to develop alternative strategies for expressing their feelings.
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In psychotherapy stress-somatic symptom relationship is explained
Focus is on anxiety, not physical symptoms
Minimize secondary gain (I.e. increased attention and decreased responsibilities)
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Management – Life style changes
Exercise
Yoga, meditation, walks
Socialization
Thank you