Somatisation

Question 1

ESSENCE

Answer 1

Experience of physical symptoms with no physical cause, with presumed psychological causation

Question 2

4 ways somatisation can occur

Answer 2

1. Normal accompaniment of physical illness
2. Common presentation of depressive illness
3. Core component of illness (functional somatic syndromes)
4. Part of long standing pattern behaviour

Question 3

Examples of functional somatic syndromes

Answer 3

• Suggestive of underlying organic cause
  
  • Cardiology - atypical chest pain
  • Rest - hyperventilation syndrome
  • GI - IBS
  • Infection - chronic fatigue syndrome
  • Rheumatology - fibromyalgia
  • Neuro - tension headache
  • ENT - globus syndrome
  • Surgery - abdominal pain
  • Gyncaecology - chronic pelvic pain
  • Dentistry - atypical facial pain

Question 4

3 types of somatisation disorder

Answer 4

1. Hypochondriasis
2. Conversion/dissociation
3. Factitious symptoms

Question 5

What is hypochondriasis

Answer 5

Belief that has illnesss despite evidence to contrary, usualy over-valued idea

Question 6

What is conversion/dossication

Answer 6

Process by which thoughts or memories unacceptable to conscious mind are repressed, and are converted into physical symptoms or disrupt normal functioning of the mind

Question 7

What are factitious symptoms

Answer 7

Those that are intentionally made up

Question 8

CLINICAL FEATURES

Answer 8

• Long complex medical histories
• Symptoms can occur in systems are to some extent are suggestible
• Discrepancy between subjective and objective findings
• Patients life revolves around illness
• Key diagnostic features - multiple atypical and inconsistent medically unexplained symptoms in patient under age of 40

Question 9

INVESTIGATIONS

Answer 9

• Lab testing
• EEG
• Personality testing (IDQ-10)

Question 10

MANAGEMENT

First line without co-morbid anxiety or depressive disorder

Answer 10

• 1st - eclectic phychotherapy
  
  • Plus regular psychiatric appointments
  • Adjunct graded physical exercise
  • Adjunct biofeedback training

Question 11

MANAGEMENT

First line with co-morbid anxiety or depressive disorder

Answer 11

• 1st - eclectic phychotherapy
  
  • Plus regular psychiatric appointments
  • Plus antidepressant
  • Adjunct graded physical exercise
  • Adjunct biofeedback training