PSYCHIATRY AND MEDICAL UNEXPLAINED SYMPTOMS
PSYCHIATRY AND MEDICAL UNEXPLAINED SYMPTOMS • 12.1 Definitions and prevalence • 12.2 Aetiology and consequences somatization • 12.3 Somatoform disorders and functional somatic syndromes • 12.4 Management
DEFINITIONS AND PREVALENCE • Definitions • Somatization • Illness behaviour • Hypochondriasis
DEFINITIONS AND PREVALENCE •Prevalence of somatization • Community • Primary care • General hospital
AETIOLOGY AND CONSEQUENCES SOMATIZATION •Aetiology • Cognitive attribution • Family re-inforcment • Iatrogenic causes • Lack of social support and confiding relationships
AETIOLOGY AND CONSEQUENCES SOMATIZATION • Long-term consequences of somatization • unnecessary and expensive investigations • repeated admissions to hospital • prescribed drug misuse with dependence • untreated psychiatric illness • iatrogenic illness, e.g. polysurgery • disability and loss of earnings • social disability payments • poor quality of life • secondary impact on family and social network
SOMATOFORM DISORDERS AND FUNCTIONAL SOMATIC SYNDROMES •Somatoform disorders • Somatization disorder • Psychogenic pain disorder • Body dysmorphic disorder • Hypochondriasis
SOMATOFORM DISORDERS AND FUNCTIONAL SOMATIC SYNDROMES • Functional somatic syndromes
MANAGEMENT • Mild-to-moderate symptom severity • 1. Taking a clear history of the patient's symptoms • 2. Taking a history of psychological symptoms and enquiring about social stressors • 3. Picking up cues of emotional distress during the interview • 4. Carrying out a physical examination with appropriate investigations • 5. Summarizing the patient's physical and social problems • 6. Helping the patient to understand links between physical symptoms and psychological state • 7. Providing a coherent explanation for this link, which makes sense to the patient • 8. Being able to treat the patient's psychological symptoms or give advice about social stressors
MANAGEMENT • Moderate-severe-to-symptom severity • Cognitive therapy • Psychodynamic-interpersonal therapy