Transcript Somatization

Somatization
Jameel Adnan, MD.
Community & Primary Health Care
KAAU-RABEG BRANCH
Round Map
Introduction
Somatoform disorders categories
Epidemiology
Clinical presentation
Screening
Treatment
Introduction
Introduction
 Somatization refers to the tendency to experience
psychological distress in the form of somatic
symptoms and to seek medical help for these
symptoms
Introduction
 Emotional responses such as anxiety and
depression can initiate symptoms.
 Somatization can be conscious or unconscious and
may be influenced by psychological distress or a
desire for personal gain
Introduction
 One study identified somatization,
Patients with somatization generated twice the
costs for medical care and utilized medical services
(outpatient and inpatient) twice as often as nonsomatizing patients.
Introduction
 Somatization disorder, which was called hysteria or
Briquet's syndrome in the past, is one of the
somatoform disorders. It is diagnosed when the
patient has requested help for numerous medically
unexplained symptoms in various different organ
systems.
o Less than 1% of patients who present with
unexplained somatic symptoms meet the criteria
for somatization disorder
Somatoform disorder categories
Somatoform disorder categories
 The DSM-IV divides the somatoform disorders into a
spectrum of disorders that include the following
categories
 Somatization disorder
 Undifferentiated somatoform disorder
 Conversion disorder
 Somatoform pain disorder
 Hypochondriasis
 Factitious disorder
 Malingering
Somatoform disorder categories
Somatization disorder
o Refers to patients with a history of many physical
complaints beginning before age 30 years that occur
over a period of several years and result in treatment
being sought or significant impairment in social,
occupational, or other important areas of functioning.
o All of the following are present at any time during the
course of illness: four pain symptoms; two
gastrointestinal tract symptoms; one sexual symptom;
and one pseudoneurologic symptom.
Somatoform disorder categories
Undifferentiated somatoform disorder
o Refers to one or more physical symptoms that
cause significant distress or impairment in
functioning lasting at least six months.
Somatoform disorder categories
Conversion disorder
o Refers to symptoms or deficits of voluntary or sensory
function suggesting a neurologic or general medical
condition and associated with psychological factors.
o Typically there is a sudden onset of a dramatic but
physiologically impossible condition like paralysis,
aphonia, blindness, deafness, or pseudoseizures. The
presentation fits the patient's view of the disorder
rather than physiology.
o Unlike somatization disorder, patients with conversion
disorder focus upon only one symptom.
Somatoform disorder categories
Somatoform pain disorder
o Refers to pain in one or more sites of significant
focus or severity, causing significant distress or
impairment and associated with psychological
factors.
Somatoform disorder categories
Hypochondriasis
o Refers to preoccupation with the fear of having a
serious disease based on a misattribution of bodily
symptoms or normal functions
o often seen in generalized anxiety disorder,
obsessive compulsive disorder, panic disorder,
major depressive disorder, and separation anxiety.
Somatoform disorder categories
Body dysmorphic disorder
o Refers to preoccupation with an imagined or
exaggerated defect in physical appearance.
Somatoform disorder categories
Factitious disorder
o Tends to occur in patients who have some medical
knowledge.
o Wound healing difficulty, infection, bleeding,
hypoglycemia, and gastrointestinal ailments are
common presentations.
o Munchausen syndrome,
occurs in a subgroup of patients who feign disease,
move from hospital to hospital, and submit to repeated
procedures for illness they have voluntarily
manufactured
Somatoform disorder categories
Malingering
o Malingering (ie, purposely faking symptoms) occurs
in the setting of substance abuse, antisocial
personality disorder, and legal battles over
disability, criminal prosecution, or financial
compensation. Patients will not cooperate with
diagnostic evaluation; a discrepancy between
findings and symptoms is evident.
Epidemiology
Epidemiology
 True somatization disorder as defined by DSM-IV is
relatively uncommon (0.3 % one year prevalence in
the population)
 The process of somatization is very common in the
general population. Over one-half of people
presenting to clinicians in an outpatient setting have
no organic disease ,and less than one-third of new
complaints have an organic disease basis
Clinical Presentation
Clinical Presentation
almost any symptom that occurs in patients with
organic pathology
 Pain
 Gastrointestinal symptoms
 Cardiopulmonary symptoms
 Pseudoneurologic symptoms
 Reproductive organ symptoms
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Even Syndromes
Atypical chest pain,
Fibromyalgia,
Chronic fatigue syndrome,
Premenstrual syndrome,
Temporomandibular joint syndrome.
Screening
Screening tests
 Amnesia, Burning in sex organs, Dysmenorrhea,
Lump in throat, Painful extremities, Shortness of
breath, and Vomiting.
 In one study, the presence of three of these seven
symptoms was highly accurate for diagnosing
somatization disorder
Treatment
General Principles of treatment
 There is no specific therapy for somatization.
 Communication among physicians is key.
General Principles of treatment
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Basic principles of care include
Taking a thorough history
Performing a physical examination
Arranging good communication
Treating associated depression and anxiety
Encouraging and facilitating psychotherapy (CBT)
 Naming the illness
o Patients often feel better if they can have a name to
describe his multiple symptoms
o Avoid the debate of whether this is an organic or
psychiatric illness.
o more reasonable to explain that there is no evidence of
a life-threatening illness results in the set of symptoms
Psychotropic medication
 Major depressive disorder and anxiety disorder are
commonly comorbid in patients with somatization.
Thus, treatment with antidepressant medications
should be considered. Somatization symptoms
frequently resolve when clinical depression and
anxiety disorder are treated appropriately
Psychosocial intervention
• In a review of randomized trials, cognitive
behavioral treatments were the most effective
intervention