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Transcript
Somatoform disorders T. Omidvar,MD Definition • The key characteristic of somatoform disorders: • preoccupation with physical symptoms • without explanation of any medical conditions • leading to significant stress • not intentionally produced Somatoform disorders in DSMIV • Somatization disorder • Conversion disorder • Pain disorder • Hypochondriasis • Body dysmorphic disorder • Somatoform disorder nos • Undifferentiated somatoform disorder Epidemiology • very common in all countries and cultures • physical symptom the most common presentation • idiopathic physical symptoms: no organic cause • finding 20%-80% • co-occuring with psychiatric disorders Etiology • Using a biopsychosocial model • biological vulnerability • early traumatic experience • learning factors • Leading to focus on the somatic and difficulty expressing emotions (alexythymia) Course and prognosis • Chronic course associating with personality and cognitive style • Inconsistency in symptom presentation • With these symptoms psychiatric disorders becoming more severe Treatment • Establishing an alliance • Taking the history • Reassurance • Physical versus psychological focus • General therapeutic approach SOMATIZATION DISORDER Somatization disorder Definition: • a polysymptomatic syndrome • physical symptoms coming from several organs • causing significant stress • severe reluctancy to accept psychological etiology DSMIV criteria four pain sites or functions (back, chest,..) • two non pain GI symptoms(nausea, bloating) • one non pain sexual symptom(loss of libido) • one pseudoneurological symptom (aphonia, ..) Epidemiology • More common among females • Individuals from lower socioeconomic states • Having comorbidity with depression and anxiety Etiology • Some biological factors : – violence in biological fathers of the woman with somatization Treatment • General considerations • Pharmacotherapy • Reassurance and supportive therapy • psychotherapy PAIN DISORDER Pain disorder • Pain : one of the most complaints in medical practice • Associating with psychological stress • Deciding that the pain is psychogenic can be difficult Definition • Complaints of severe, persistent pain in one or more areas • Warrant clinical attention • Cause significant impairment in function • Relatedness of severity , exacerbation and maintenance of symptoms with psychological factors Treatment • Approaching the patient • Pharmacological management • Psychotherapy
