PSYCHIATRYANDMEDICALUNEXPLAINEDSYMPTOMS
PSYCHIATRY AND MEDICAL UNEXPLAINED SYMPTOMS
12.1Definitions andprevalence。12.2AetiologyandconsequencesPSYCHIATRYsomatizationANDMEDICALUNEXPLAINED12.3SomatoformdisordersandSYMPTOMSfunctional somatic syndromes12.4Management
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
DEFINITIONSANDPREVALENCEDefinitionsSomatizationlllnessbehaviourHypochondriasis
DEFINITIONS AND PREVALENCE • Definitions • Somatization • Illness behaviour • Hypochondriasis
DEFINITIONSANDPREVALENCE·Prevalenceof somatization·Community·PrimarycareGeneralhospital
DEFINITIONS AND PREVALENCE •Prevalence of somatization • Community • Primary care • General hospital
AETIOLOGYAND CONSEQUENCESSOMATIZATION·AetiologyCognitiveattributionFamilyre-inforcmentlatrogeniccauses·Lack of social support and confiding relationships
AETIOLOGY AND CONSEQUENCES SOMATIZATION •Aetiology • Cognitive attribution • Family re-inforcment • Iatrogenic causes • Lack of social support and confiding relationships
AETIOLOGYANDCONSEQUENCESSOMATIZATION·Long-termconsequencesof somatizationunnecessaryandexpensiveinvestigationsrepeatedadmissionstohospitalprescribed drug misusewith dependenceuntreated psychiatric illnessiatrogenic illness, e.g.polysurgerydisability and loss of earningssocialdisabilitypaymentspoorqualityof lifesecondary impact on family and social network
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
SOMATOFORMDISORDERSANDFUNCTIONALSOMATIC SYNDROMESSomatoformdisordersSomatizationdisorder·PsychogenicpaindisorderBodydysmorphicdisorderHypochondriasis
SOMATOFORM DISORDERS AND FUNCTIONAL SOMATIC SYNDROMES •Somatoform disorders • Somatization disorder • Psychogenic pain disorder • Body dysmorphic disorder • Hypochondriasis
SOMATOFORMDISORDERSsystemSyndromesANDFUNCTIONALSOMATICSYNDROMESitrritablebowelgastroenterologysyndromefunctionaldyspepsiaFunctional somatic syndromescardiologyAtypical chestpainNeurologyChronic fatiguesyndrome,commonheadacheRheumatologyFibromyalgiaGynaecologyChronic pelvic painorthopaedicsChronicback pain
SOMATOFORM DISORDERS AND FUNCTIONAL SOMATIC SYNDROMES • Functional somatic syndromes
MANAGEMENTMild-to-moderate symptom severity1.Takingaclearhistoryofthepatient'ssymptoms2.Takinga historyof psychological symptomsand enquiringaboutsocial stressors3.Picking up cues of emotional distress during the interview4.Carryingoutaphysicalexaminationwithappropriate investigations5.Summarizing thepatient's physicaland social problems6.Helping thepatienttounderstand links between physicalsymptoms and psychologicalstate7.Providinga coherentexplanationforthis link,whichmakes senseto thepatient8.Being ableto treatthe patient'spsychological symptoms orgive advice about socialstressors
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
MANAGEMENTModerate-severe-to-symptom severity·Cognitivetherapy?Psychodynamic-interpersonal therapy
MANAGEMENT • Moderate-severe-to-symptom severity • Cognitive therapy • Psychodynamic-interpersonal therapy