6.6 Somatization in Psychiatry Flashcards
What is a somatoform disorder?
- A constellation of physical symptoms with no organic cause, distressing to the individual.
- The patient is convinced the cause is medical rather than psychiatric.
Compared primary and secondary gain.
- Primary gain
- Expression of unacceptable feelings as physical symptoms in order to avoid facing them and to assume the sick role.
- The benefit: The sick role
- Secondary gain
- Use of symptoms to benefit the patient through obvious external incentives
- The benefit: Money, avoidance of law, recreation, etc.
Explain how somatoform disorders cause a breakdown in the therapeutic relationship.
All somatoform disorders share the feature of overimportance of certain physical symptoms and illnesses in a patient’s life.
This can cause misunderstanding between the patients and doctors, leading to a breakdown in the therapeutic relationship, such as when a doctor tries to explain that the symptoms are psychiatric rather than medical.
List 6 common types of somatoform disorders.
- Somatization
- Conversion
- Hypochondriasis
- Pain
- Body dysmorphic disorder
- Malingering
Describe the difference between somatoform, facticious and malingering disorders.
- Somatoform: Patients do not intentionally create symptoms.
- Factitious disorders: Patients intentionally create their illness or symptoms to assume the sick role. (Primary Gain)
- Malingering: Patients intentionally create their illness for secondary gain. (Secondary Gain)
Describe the epidemiology of somatoform disorders.
- Females are affected more than males.
- Half of affected patients have co-morbid disorders, such as anxiety and depression.
That females are affected more than males is controversial, as some studies have shown only a very slight difference. (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0032490)
How are somatic symptoms classified in the different diagnostic manuals?
- ICD-10 recognises somatoform disorders and its subsets.
- DSM-IV-TR previously described somatoform disorders.
- DSM-V has eliminated the category of somatoform disorders.
How does the DSM-V classify somatic symptoms?
The DSM-V has replaced the category of somatoform disorders with a category called somatic symptom and related disorders for patients with prominent somatic symptoms that cause distress and impair psychosocial functioning.
What is your first step when suspecting a somatoform disorder?
- Rule out an organic cause, by doing full Hx, examination, laboratory and imaging investigations.
- Key systems: CNS, endocrine, connective tissue disorders.
Basic Laboratory Investigations
- FBC, UEC, LFT, TFT
- Urinalysis, UDS
- CT head
What is a somatization disorder?
- Disorder characterised by:
- Experiencing somatic distress in response to psychosocial distress.
- Absence of organic cause.
- Somatic symptoms are attributed to a medical illness.
- It is a disturbance in the way that a person perceives, organises and expresses physical experiences.
- Often involves frequent visits to the doctor with multiple vague complaints in many organ systems.
Describe the healthcare utilisation associated with somatization.
Somatization is associated with increased healthcare costs and utilisation.
Why is there controversy over the diagnosis of somatization?
Because it is unclear whether somatization is a purely psychiatric disorder (i.e., a learned pattern of behaviour), or if it should be viewed as a syndrome of multiple unexplained symptoms that complicate the presentation of a general medical condition.
Can you name 10 different theories for how somatization disorder develops?
- Genetics
- Wandering womb
- Defense mechanism
- Social communication
- Learning theory
- Cultural stigma
- Biological
- Interpersonal model
- Childhood abuse/trauma
- Benefits
The majority of patients presenting to outpatient clinics have a medical condition.
True or false?
False.
More than 50% of patients presenting to outpatient clinics with a physical complaint do not have a medical condition!
Describe the epidemiology of somatization disorder.
Somatization disorder is more common in:
- Females (incidence is 5-20x of males)
- 10-20% incidence in 1st degree female relatives
- Genetics
- 30% concordance in monozygotic twins
- Lower education
- Minority ethnic status
- Low socioeconomic status
- 50% of those with this disorder also have a comorbid mental health condition
What is the link between antisocial personality disorder and somatization disorder?
- Male relatives of female patients with somatization disorder are more likely to have antisocial personality disorder.
List 6 common co-morbidities with somatization disorder.
- Mood disorders
- Anxiety disorders
- Substance abuse
- PTSD
- Personality disorders
- Childhood abuse and neglect
Describe which systems (are especially important) and should be considered in a systematic review of the manifestation of somatization disorder.
- Pain symptoms
- Gastrointestinal symptoms
- Cardiopulmonary symptoms
- Reproductive symptoms
- Neurologic symptoms
List the pain symptoms that should be explored when looking for a manifestations of a somatization disorder.
- Headache
- Back/joint pain
- Extremity pain
List the gastrointestinal symptoms that should be explored when looking for a manifestations of a somatization disorder.
- Upper GIT: N&V
- Anywhere in GIT: Bloating, gas, abdominal pain
- Lower GIT: Diarrhoea
List the cardiopulmonary symptoms that should be explored when looking for a manifestations of a somatization disorder.
- Chest pain
- SOB
- Palpitations
- Dizziness
List the reproductive symptoms that should be explored when looking for a manifestations of a somatization disorder.
- Dyspareunia
- Dysmenorrhea
- Burning in sex organs
List the neurologic symptoms that should be explored when looking for a manifestations of a somatization disorder.
- Fainting
- Pseudoseizures
- Amnesia
- Muscle weakness
- Dysphagia
- Vision changes
- Deafness
- Difficulty urinating
- Gait instability
- Hoarseness
- Aphonia
