Somatisation Flashcards
What is somatisation?
Repeated presentation for medical symptoms requesting investigation and diagnosis with no biological cause found, and continous resistance to discuss psychological basis.
What is the aetiology of somatisation?
Low threshold for consulting doctors. Often acquired attitudes in childhood when illness behavior is associated with positive reward. Some genetic component. High proportion also have personality disorder, anxiety or depression.
What is the epidemiology of somatisation?
Lifetime prevalence 0.1%. W>M and often <30yo.
What may you find in the history and exam of somatisation?
Multiple, recurrent and frequently changing physical symptoms (i.e. abdominal pain, fatigue, dizziness, pins and needles)
Symptoms may affect any system but usually GI, derm, sexual, menstrual.
No physical explanation found in symptoms. Symptoms often present for >2y and there is persistant refusal to accept advice even from >1 doctors. Social or occupation functioning often impaired as result of behavior.
What investigations would you do for somatisation?
Full physical examination and investigation for illnes
What is the management of somatisation?
Seen by same doctor each time if possible. Treat associated anxiety or depression. Clear about the negative investigations and findings. DO not conduct further investigations. Acknowledge phsychological distress and offer help.
Elicit childhood illness hx, ancourage coping strategies and leting go of sick role. Involve faimly who may be reinforcing the behavior.
What are the complications and prognosis of somatisation?
New symptoms may come on in times of stress.
Chronic and fluctuating, often resistant to tx.
