SOMATOFORM�DISORDERS

GROUP MEMBERS

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OUTLINE

• INTRODUCTION
• EPIDEMIOLOGY
• AETIOLOGY
• CLASSIFICATION
• CONCLUSION
• REFERENCES

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INTRODUCTION

INTRODUCTION

• The word somatoform derives from a Greek word "Soma" meaning body and mind.

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• Somatoform disorders are group of mental illnesses characterized by the presentation of physical symptoms with no medical explanations.

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• The symptoms are severe enough to interfere with patients ability to function in social Or occupational activities.

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INTRODUCTION

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• Somatoform disorders are a group of disorder that include physical signs and symptoms for which an adequate medical explanation cannot be found.

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• A group of disorders In which people experience significant physical symptoms for which there's no organic cause.

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EPIDEMIOLOGY

EPIDEMIOLOGY

• Prevalence rate in general population ranges from:
• 11 to 21% in Younger age group
• 10 to 20% in middle aged group
• 1.5 to 13% in Older aged group
• 0.2-2% in females and <0.2% in males.
• Most common in low socioeconomic class and rural areas.
• Male relatives of women with somatization disorder have an increased risk of antisocial personality, substance abuse disorders, and somatization disorder.

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AETIOLOGY

AETIOLOGY

• No definitive causes have been established. Genetic and environmental influences appear to contribute.
• Environmental risk factors include
• Children raised in homes with parents with somatization
• Sexual abuse
• Poor ability to express emotions
• Reduced threshold for tactile and pain perception
• Genetic risk factors include:
• Mental disorder e.g. eating disorder
• Characteristic attention and cognitive impairments
• Decreased metabolism in the frontal lobes and non-dominant hemisphere

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CLASSIFICATION

CLASSIFICATION

• Somatization Disorder: history of complaints about physical symptoms, affecting many different areas of the body, for which medical attention has been sought but no physical cause found

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• Psychosomatic Disorders: actual physical illness present and psychological factors seem to be contributing to the illness

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• Pain Disorder: history of complaints about pain, for which medical attention has been sought but that appears to have no physical cause

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• Hypochondriasis: chronic worry that one has a physical disease in the absence of evidence that one does; frequently seeking medical attention

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• Body dysmorphic Disorder: excessive preoccupation with some part of the body the person believes is defective

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• Conversion Disorder: loss of functioning in some parts of the body for psychological rather physical reasons

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• Malingering: deliberate faking of physical symptoms to avoid an unpleasant situation, such as military duty

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• Factitious Disorder: deliberate faking of physical illness to gain medical attention

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SOMATIZATION DISORDER

History of complaints about physical symptoms, affecting many different areas of the body, for which medical attention has been sought but no physical cause found

CLINICAL FEATURES

• Headaches
• Backpain
• Persistent lack of sleep
• Have a persistent conviction of being ill, despite repeated negative results on laboratory tests, consultations with specialists and recurrent hospitalization
• Physical examination is normal
• May reveal some skin lesions or scars that resulted from previously performed surgeries

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DIAGNOSTIC CRITERIA

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria

1. History of physical complaints lasting for several years and beginning before age 30yrs, resulting in the request for treatment or leading to a significant impairment in social, occupational, and other types of functioning.

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B. The following four criteria must be met, with individual symptoms occurring at any time

1. History of pain related to at least four sites of function

2. History of at least 2 GI symptoms other than pain

3. History of at least 1 sexual or reproductive symptom other than pain

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C. One of the following criteria must be met

1. Symptoms in B cannot be explained by a medical condition, the effects of medication, or substance abuse

2. In the case of the presence of a medical condition, the physical complaint or the resulting social or occupational impairment is in excess of what would be expected from the history, physical examination, or laboratory findings.

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D. Somatization symptoms are not intentionally produced or feigned

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TREATMENT

• Explain to the patient and family relationship between psych and somatic
• Empathic attitude
• Avoid more diagnostic tests, laboratory evaluations and operative procedures unless clearly indicated
• Treatment of underlying depression and anxiety.
• Potentially addicting medications should be avoided

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• Psychotherapy, both individual and group
• decreases personal health care expenditures(50%)
• decreasing their rates of hospitalization.
• helped to cope with their symptoms
• to express underlying emotions
• to develop alternative strategies for expressing their feelings
• Behavioral Techniques
• Increased Activity Involvement
• Combats stress
• Improves overall mood
• Provides Distraction from somatic symptoms
• Pain perception has a subjective component-improved mood and distraction reduce the experience of pain
• Exercise has physiological effects that combat somatization and stress

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• Sleep Strategies
• Establish consistent sleep patterns (same bedtime and waketime everyday)
• Go to bed only when sleepy (stimulus control)
• If not asleep within 20-30 minutes leave bed and return when sleep again (stimulus control)
• Comfortable sleep environment
• Avoid alcohol/caffeine during 6 hours before bedtime
• Exercise regularly, but not within 4 hours of bedtime

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• Relaxation Techniques
• Directly acts on physical symptoms, given its effects on breathing, heart rate, muscle tension, etc.
• Patients report benefit soon upon learning the technique
• Helps with stress management
• Includes Diaphragmatic Breathing Progressive Muscle Relaxation, Biofeedback

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PAIN DISORDER

History of complaints about pain, for which medical attention has been sought but that appears to have no physical cause

CAUSES

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PSYCHODYNAMIC FACTORS: Patients who experience pain without identifiable and adequate physical causes may be symbolically expressing an intra-psychic conflict through the body.

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BEHAVIOURAL FACTORS Pain behaviours are reinforced when rewarded and are inhibited when ignored and punished

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BIOLOGICAL FACTORS: Serotonin and endorphins play a role in pain disorders

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TYPES

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PAIN DISORDER ASSOCIATED WITH PSYCHOLOGICAL FACTORS: Psychological factors are judged to have a major role in the onset, severity or maintenance of pain.

- Acute: duration of less than six months

- Chronic: Duration of 6 months or longer

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PAIN DISORDER ASSOCIATED WITH A GENERAL MEDICAL CONDITION

A general medical condition has a major role in the onset, severity, or maintenance of the pain

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PAIN DISORDERS ASSOCIATED WITH BOTH PSYCHOLOGICAL FACTORS AND GENERAL MEDICAL CONDITIONS

Both Psychological factors and general medical conditions are judged to have important roles in the onset, severity or maintenance of the pain.

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CLINICAL FEATURES

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Symptoms vary depending on the side of the pain and are treated medically. Symptoms are;

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• Negative or distorted cognition, such as feeling helpless or hopeless with respect to pain and its management.
• Inactivity, passivity, and /or disability
• Increased pain requiring clinical interventions
• Insomnia and fatigue
• Depression and anxiety
• Disrupted social relationship at home, work or school

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DIAGNOSTIC CRITERIA

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• Pain in one or more anatomical sites is the predominant focus of the clinical presentation and is of sufficient severity to warrant clinical attention.

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• The pain causes clinically significant distress or impairment in social in social, occupational, or other important areas of functioning.

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• Psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance of the pain.

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• The symptoms or deficit is a bit intentionally produced.

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• The pain is not better accounted for by a mood, anxiety, or psychotic disorder and does not meet criteria for dyspareunia.

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TREATMENT

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Treatment consists of:

-Supportive psychotherapy

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-Relaxation techniques

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-Pharmacotherapy

Hormonal Treatment: Hormonal therapy is given to the patients having premenstrual syndrome. Treatment with oral or parental progesterone has been recommended with good results

Benzodiazepines

Anti Depressants

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HYPOCHONDRIASIS

Chronic worry that one has a physical disease in the absence of evidence that one does; frequently seeking medical attention

CAUSES

• History of physical or sexual abuse
• History of having a serious illness as a child
• Poor ability to express emotions
• Parent or close relative with the disorder
• Inherited susceptibility for the disorder

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CLINICAL FEATURES

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• Having a long-term intense fear or anxiety about having a serious disease or health condition
• Worrying that minor symptoms or bodily sensations mean you have a serious illness
• Seeing doctors repeated times or having involved medical exams such as MRI, echocardiograms, or exploratory surgery
• Frequently switching doctors — if one doctor tells you that you aren't sick, you may not believe it and seek out other opinions

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CLINICAL FEATURES

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• Continuously talking about your symptoms or suspected diseases with family and friends
• Obsessively doing health research
• Frequently checking your body and vital signs
• Thinking you have a disease after reading or hearing about it

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TREATMENT

• Supportive care: In most cases, the best course of action is for the person to stay in regular contact with a trusted health care provider, who focuses on reassuring and supporting the person, and preventing unnecessary tests and treatments

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• Medications: Antidepressant or anti-anxiety drugs are sometimes used if a person with somatic symptom disorder also has a mood disorder or anxiety disorder

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• Psychotherapy: (a type of cognitive counseling) may help the thinking and behavior that contribute to the symptoms and help them learn better ways to deal with stress, and improve his or her social and work functioning
• Unfortunately, most people with somatic symptom disorder deny there are any mental or emotional problems, making them fairly resistant to psychotherapy.

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CONCLUSION

CONCLUSION

• Somatoform disorders are neurotic disorders.

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• They are characterized by Persistent requests for medical attention because of physical Complaints that cannot be Sufficiently explained by medical causes.

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REFERENCES

Somatization Disorders:Diagnosis, Treatment and Prognosis;Psychosocial: vol 32no2 Feb 2011

Somatisation in neurological practice;J Neurol Neurosurg Psychiatry. Oct 2004; 57(10):1161-1164.

Somatization A Debilitating Syndrome in Primary Care; Psychosomatics 42:1,January- February 2001

Kaplans and Sadocks textbook of psychiatry

http://www.mayoclinic.org/diseases-conditions/hypochondria/basics/symptoms/con-20028314

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THANK YOU

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