SOMATOFORM DISORDERS

A GROUP OF DISORDERS THAT CONVERT ANXIETY INTO PHYSICAL SYMPTOMS FOR WHICH THERE IS NO IDENTIFIABLE PHYSICAL DIAGNOSIS

TYPES
SOMATIZATION DISORDER CONVERSION DISORDER HYPOCHONDRIASIS BODY DYSMORPHIC DISORDER

PAIN DISORDER-

DEFINITION
Somatisation is a syndrome of multiple somatic symptoms that cannot be explained medically & are associated with psychological distress

ETIOLOGY
Genetic &familial factors Biological factorsLearning factorsPsychodynamic theory Behavioural theory Cognitive theory Interpersonal modelSociocultural factors

CLASSIFICATION
DSM IV
Somatisation disorder Conversion disorder

ICD-IO
Somatisation disorder Hypochondriacal disorder

Hypochondriasis

Somatoform autonomic dysfunction Pain disorder Persistant somatoform pain disorder Body dysmorphic disorder Other somatoform disorders Undifferentiated Somatoform disorder,unspecified Somatoform disorder

PAIN DISORDER

Predisposing Factors

Psychodynamic theory Theory of family dynamics Neurophysiological theory Transactional model of pain

PAIN DISORDER CLINICAL FEATURES

CLINICAL FEATURES
2. EXCESSIVE USE OF ANALGESICS 4. DEPRESSIVE FEATURES

1. FREQUENT VISIT TO PHYSICIANS

3. REQUEST FOR SURGERY

Diagnostic criteria according to ICD 10

The predominant complaint is of persistent, severe, and distressing pain, which cannot be explained fully by a physiological process or a physical disorder. Pain occurs in association with emotional conflict or psychosocial problems that are sufficient to allow the conclusion that they are the main causative influences. The result is usually a marked increase in support and attention, either personal or medical.

MANAGEMENT
Pharmacotherapy

Antidepressants, such as tricyclics and SSRIs

Amphetamine

Psychotherapy
Other Therapies Biofeedback

Management(cont..d)
Hypnosis Transcutaneous nerve stimulation Dorsal column stimulation Nerve blocks Pain Control Programs

HYPOCHONDRIASIS

DEFINITION

Unrealistic or inaccurate interpretation of physical symptoms or sensations, leading to preoccupation & fear of having a serious disease. The symptoms are excessive compared to their clinical pathology

ETIOLOGY
Psychodynamic theory Cognitive theory Social learning theory Past experience with physical illness Genetic influences Transactional model of stress

CLINICAL FEATURES
Preoccupation with specific organ, with bodily functions May feel that rapid heart rate is due to heart disease Totally aware of their body sensations Unrealistic & exaggerated response

 Doctor shopping Anxiety & depression Impaired social & occupational functioning Sudden alarm reactions

Diagnostic Criteria(ICD-10) A. Persistent belief in the presence of at least one serious physical illness underlying the presenting symptom or symptoms, even though repeated investigations and examinations have identified no adequate physical explanation, or a persistent preoccupation with a presumed deformity or disfigurement B. Persistent refusal to accept the advice and reassurance of several different doctors that there is no physical illness or abnormality underlying the symptoms.

CONVERSION DISORDER

CONVERSION DISORDER

It is a loss or change in body function resulting from psychological conflict; the physical symptoms have not features of a medical disorder

Predisposing factors
Psychoanalytical theory Familial factors

Neurophysiological theory
Behavioral theory Interpersonal theory-

CLINICAL FEATURES
Paralysis Aphonia ,seizures Coordination disturbance Swallowing difficulty, urination problems Blindness,deafness,loss of pain sensation Pseudocyesis

Diagnostic Criteria According To ICD 10

A. the clinical features as specified for the individual disorders in F44.-; B. no evidence of a physical disorder that might explain the symptoms; C.Evidence for psychological causation, in the form of clear association in time with stressful events and problems or disturbed relationships (even if denied by the individual).

Treatment Hypnosis Anxiolytics(parenteral amobarbital or lorazepam) Behavioral relaxation exercises . Insight-oriented psychotherapy

BODY DYSMORPHIC DISORDER

Definition
A disorder in which individuals have a pervasive subjective feeling of ugliness and are preoccupied with an imagined defect in physical appearance

ETIOLOGY
Unknown Stereotyped concepts of beauty Psychodynamic models

SIGNS & SYMPTOMS

SIGNS &SYMPTOMS

Slight flaws of face, thinning hair Acne, Wrinkles ,Scars, Asymmetry, Excessive facial hair ,or they think that their body parts are malformed.

 Depression &anxiety Inability to meet occupational, family, or social responsibilities Inability to participate in usual community activities Dependence on pain relievers

SIGNS &SYMPTOMS
Distortion of body functions &symptoms Presence of secondary gains by adoption of sick role. Inability to meet family role functions Feeling of inability to control symptoms Development of negative self image Lack of personal needs Social isolation Insomnia

Treatment
Tricyclic drugs, monoamine oxidase inhibitors (MAOIs) Pimozide (Orap). serotonin-specific drugs for example, clomipramine (Anafranil) and fluoxetine (Prozac)

UNDIFFERENTIATED SOMATOFORM DISORDER

DSM-IV-TR Diagnostic Criteria One or more physical complaints (e.g., fatigue, loss of appetite, gastrointestinal or urinary complaints). Either (1) or (2):
after appropriate investigation, the symptoms cannot be fully explained by a known general medical condition or the direct effects of a substance (e.g., a drug of abuse, a medication) when there is a related general medical condition, the physical complaints or resulting social or occupational impairment is in excess of what would be expected from the history, physical examination, or laboratory findings

 The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The duration of the disturbance is at least 6 months. The disturbance is not better accounted for by another mental disorder (e.g., another somatoform disorder, sexual dysfunction, mood disorder, anxiety disorder, sleep disorder, or psychotic disorder). The symptom is not intentionally produced or feigned (as in factitious disorder or malingering).

SOMATOFORM DISORDER NOT OTHERWISE SPECIFIED

Pseudocyesis A disorder involving nonpsychotic hypochondriacal symptoms of less than 6 months' duration. A disorder involving unexplained physical complaints (e.g., fatigue or body weakness) of less than 6 months' duration that are not due to another mental disorder

TREATMENT
Individual psychotherapy Group psychotherapy Behavior therapy Pharmacology

Tricyclic antidepressants amitryptilline SSRI-Paroxetine,Fluoxetine,Sertaline Anticonvulsants-Phenytoin,Clonazepam