Somatoform disorder & psychosomatic disorder
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Transcript of Somatoform disorder & psychosomatic disorder
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Case example
• D, a ten-year-old, arrived in the eye clinic complaining his vision was deteriorating. He was a bright boy and his family looked worried. He had thorough medical assessments, and was found to have reduced distance vision (6/18 in both eyes). No medical cause for this sight loss was found.
• He attended the eye clinic with his mother and father. It transpired his parents were divorced and had remarried. D lived with the stepfather he did not care for, and a new baby half-sister. Towards the end of the consultation, the mother volunteered that her father had a neurological disease. On airing these difficult emotional issues, D then said “I see better”. He left the clinic with his vision normal and age-appropriate.
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By: Ismah Haron
• Somatoform disorder- Pain disorder- Undifferentiated somatoform disorder- Somatoform disorder not otherwise
specific (NOS)
• Psychosomatic disorder
OUTLINE
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PAIN DISORDER
• Definition:Preoccupation with pain in the absence of physical disease. The pain doesn’t follow a neuroanatomic distribution. [1]
• Epidemiology:1 month prevalence is 0.15-1.26%, >Female [2]
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Etiology
behavioral
interpersonal
biological
psychodynamics
Pain can escape from dislike activity
Pain stabilize relationship
Pain threshold
Emotional pain body pain
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DSM IV diagnostic criteria for pain disorder
A. Pain in one or more anatomical sites is the predominant focus of the clinical presentation and is of sufficient severity to warrant clinical attention
B. The pain causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. Psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance of the pain.
D. The symptom or deficit is not intentionally produced or feigned.
E. 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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• Antidepressant• Analgesia
Biological
• Psychoeducation• Cognitive
behavioral therapy
• Massage
Psychosocial
Treatment:
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UNDIFFERENTIATED SOMATOFORM DISORDER
DSM IV
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SOMATOFORM DISORDER NOS
• Cannot be classified in any category
• Duration is <6 months
• Examples:- Pseudocyesis- Fatigue or body weakness in less than 6 months
and not due to other mental illness
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PSYCHOSOMATIC DISORDER
Definition
Prevalence
Classification
Diagnosis
Etiology
Treatment
1. Psychological factor medical condition
2. Physical illness emotional/ mental disorder
Psyche (mind) & Soma (body)
12.5% [3]
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Physical condition affected by psychological factors
• Hypertension- Psychological theories: inhibit anger, guilt
over hostile impulse, need to gain approval from authority
- Acute stress, chronic stress- Hormonal changes
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Medical problems that present with psychiatric symptoms
Disease Psychiatric symptoms
Impaired performance and
behavior
AIDS • Depression• Anxiety
Dementia
Hypothyroidism • Thought disorder• Somatic delusion• Hallucinations
Myxedema madness;• Delusional• Paranoid• Aggressive
behavior
Pheochromocytoma • Anxiety• Panic• Trembling
Inability to function during attack
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Diagnosis
DSM IV criteria for psychological factor affecting medical condition:
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• Examples:- MDD delaying recovery from MI- Anxiety exacerbating asthma- Pathological denial of the need of surgery
in cancer patient- Stress related exacerbation of ulcer
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Etiology
A. Stress factors
Prolonged stress + organ that genetically vulnerable to stress
B. Neurotransmitt
er response Catecolamines,
serotonin, dopamine
C. Endocrine response
Cortisol
D. Immune response
Cytokines increase glucocorticoids
E. Physiological
factors General
adaption syndrome; stress affect HPA axis
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Treatment
• Collaborative approach• Biological• Psychosocial - Supportive psychotherapy- Dynamic insight oriented psychotherapy- Group therapy- Family therapy- Cognitive behavioral therapy
?
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Case example
• D, a ten-year-old, arrived in the eye clinic complaining his vision was deteriorating. He was a bright boy and his family looked worried. He had thorough medical assessments, and was found to have reduced distance vision (6/18 in both eyes). No medical cause for this sight loss was found.
• He attended the eye clinic with his mother and father. It transpired his parents were divorced and had remarried. D lived with the stepfather he did not care for, and a new baby half-sister. Towards the end of the consultation, the mother volunteered that her father had a neurological disease. On airing these difficult emotional issues, D then said “I see better”. He left the clinic with his vision normal and age-appropriate.
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SUMMARY
• Pain disorder - Preoccupation with pain in the absence of
physical disease.- Treatment
• Undifferentiated somatoform disorder (≥6 months) vs. somatoform disorder NOS (<6 months)
• Psychosomatic disorder- Mind & body
Biological
Psychosocial
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THANK YOU
References:1. KAPLAN & SADOCK; Pocket Handbook of Clinical Psychiatry 5th Edition
2. LIU, L., BI, B., QIN, X., WEI, S., WANG, W., LI, Y., JIN, Q., AI, L., PHILLIPS, M. R. & DONG, G. 2012. The prevalence of somatoform disorders in internal medicine outpatient departments of 23 general hospitals in Shenyang, China. General Hospital Psychiatry
3. HIDAYAT, D., INGKIRIWANG, E., ANDRI, A., ASNAWI, E., WIDYA, R. S. & SUSANTO, D. H. 2011. The Usage of Two Minutes Method (M2M) to Determine Mental Disorder Prevalence in Primary Care. Journal of the Indonesian Medical Association, 60.
4. DSM IV TR