Medically Unexplained Symptoms

Question 1

Common age group for “Medically unexplained symptoms” ?

Answer 1

Pediatric population

Question 2

Criteria of Somatoform disorder?

Answer 2

1. Sex > women
2. Age < 30
3. Frequent medical consultations
4. Don’t accept medical advice
5. Multiple different persistent physical symptoms
6. No physical explanation
7. Severe
8. 5% of Egyptians
9. Duration: at least 2 years
10. Disrupted life (social, family)
11. Depression & Anxiety are common associations

Question 3

Predisposing factors of Somatisation

Answer 3

1. Stigma of having psychological distress
2. Hx of parental illness
3. In childhood: Hx of parents trying to somatise
4. In childhood: “sick role” (+ve reinforcement)
5. In childhood: serious physical illness
6. In childhood: Abuse (physical, mental, sexual)

Question 4

Precipitating factors of “Chronic Somatisation”?

Answer 4

1. Stress
2. Illness
3. Problems with (family, friends or patient himself)

Question 5

Maintaining factors of “Chronic Somatisation “?

Answer 5

1. Failure to address underlying problems by doctors
2. Renforcement by family
3. Family discord
4. Social / occupational difficulties
5. Patient has psychiatric illness
6. Personality difficulties

Question 6

Assessment principles for Somatisation?

Answer 6

A. Explore:
1. Patient’s belief systems
2. Their expectations about Investigations & ttt
3. Impact of symptoms on life
4. Why seek help now?

B. Screen for “psychological illnesses “ (e.g. symptoms of depression & Anxiety )