Somatisation Disorders (incomplete)
Definition
Multiple
Characterised by repeated presentation of medically unexplained symptoms affecting multiple organ systems (at least 2) - presenting before the age of 40
Usually chronic in adults
Children: involves 1 or a few organ systems for shorter period
Full blown disorder = Briket's disorder
Clinical Features
Non-specific, atypical symptoms
Discrepancy between subjective and objective findings
Symptoms are usually concentrated on one system at a time but may move to another
Multiple, atypical and inconsistent medically unexplained symptoms in patient under 40
Aetiology
- Observable clinical association with childhood illnesses in the patient
- History of parental anxiety towards illness
- Increased frequency of somatisation disorder in 1st degree relatives
- Association with sexual abuse in childhood
Epidemiology
Lifetime prevalence of 0.2%
F > M
Diagnosis
ICD-10 F.45
A) History of at least 2 years complaints of multiple and variable physical symptoms that cant be explained by any detectable physical disorder
B) Preoccupation with the symptoms causes epristent distress and leads to seeking >6 consultations/investigations from doctors
C) Peristent refusal to accept medical advice that there is no apparent physical cause for the physical symptoms
D) Total of >6 symptoms from multiple body systems with symptoms occuring in at least 2 seperate groups
Management
Initial Management
- Communicate the diagnosis
- Acknowledge severity and experience of distress
- Emphasise negative investigations
- Assess and treat psychiatric comorbidity as necessary
- reduce and stop unnecessary drugs
Ongoing Management
Psychotherapy
Use of eclectic psychotherapy gives insight into psychological disorders