SlideShare a Scribd company logo

Diagnosis and Treatment of Psychosomatic Disorder (Educational Slides)

Andri Andri
Andri Andri
Andri AndriPsychiatrist, Psychosomatic Medicine Specialist,Fellow of The Academy of Psychosomatic Medicine

This is a standard presentation for teaching medical students and colleagues about psychosomatic disorder, its diagnosis and therapy. We hope by reading this slides, you will understand the nature of psychosomatic disorder and its current approach in therapy

Diagnosis and Treatment of Psychosomatic Disorder (Educational Slides)

1 of 29
Download to read offline
Curriculum Vitae
• Dr. Andri,SpKJ,FAPM
• Lulus Dokter dari FKUI tahun 2003
• Lulus Psikiater dari FKUI tahun 2008
• Fellow of Academy of Psychosomatic Medicine, USA (2013)
• Jabatan :
– Dosen FK UKRIDA (2008 – sekarang)
– Ketua Sub Kredensial Komite Medik Omni Hospitals Alam Sutera
(2014 – sekarang)
– Kepala Klinik Psikosomatik OMNI Hospitals (2008 – sekarang)
• Organisasi :
– Ikatan Dokter Indonesia (IDI)
– Perhimpunan Dokter Spesialis Kedokteran Jiwa Indonesia
(PDSKJI)
– American Psychosomatic Society (Faculty Leader of
Psychosomatic Medicine Interest Group in Indonesia)
– Academy of Psychosomatic Medicine (Fellow Member)
PSYCHOSOMATIC DISORDER
IN DAILY PRACTICE :
DIAGNOSIS AND THERAPY
dr.Andri,SpKJ,FAPM
Psychiatrist, Fellow of Academy of Psychosomatic Medicine
Faculty of Medicine, UKRIDA
Psychosomatic Clinic Omni Hospitals Alam Sutera, Tangerang Selatan
• What is Psychosomatic?
• Somatic complaints in clinical practice
• Somatic complaints in psychiatric disorder
• Treatment strategy (Using Pharmacology and
Non-Pharmacology approach)
• Conclusion
Outline for today’s talk
WHAT IS PSYCHOSOMATIC ?
• The term psychosomatic has been known for more
than 50 years in the field of psychiatry
• Mind and Body Connection
• George Engel : Biopsychosocial concept (1977)
• Since it was misunderstood by lay people as a disorder
“Only in Your Head”, since 1980, psychosomatic was
not a diagnosis terminology in DSM anymore
• Psychosomatic  Somatic symptoms
• The use of the term Psychosomatic for organization and
journal until now
• Psychosomatic Medicine is a subspecialist in Psychiatry
(APA,ABPN)
Kaplan and Saddock, Synopsis of Psychiatry,
Psychosomatic Medicine, Chapter 13,
American Psychiatric Publishing 2015
Historical Background and Changes
from DSM III
to DSM 5 (Dimsdale, J. E., et al. 2013)
• Somatoform Disorder Somatic Symptom Disorder
- First introduced 30 yrs ago in DSM-III as Somatoform Disorder.
Somatoform didn’t translate to another language well
- DSM-IV – concept of medically unexplained symptoms were introduced.
Is it unexplained or unexamined medical condition?
- DSM-5 replaced Somatoform Disorder with Somatic Symptom Disorder and
Related Disorders
The symptoms may or may not be medically unexplained. If the patient
primarily had anxiety but not somatic complaints, the diagnosis would be
Illness Anxiety Disorder.
Case Illustration
• A 29 years old man complaint discomfort feeling
in his left chest. He often felt palpitation that
made him visit ER more than once.
• He also felt bloating and fear of losing control at
the same time. Physical examination and
laboratory workup found nothing was wrong. He
had already done ECG, Echo and Stress Test
(Treadmil)
• What was wrong with this patient?
Ad

Recommended

Psychosomatic and somatization disorder
Psychosomatic and somatization disorderPsychosomatic and somatization disorder
Psychosomatic and somatization disorderHala Sayyah
 
GENERALISED ANXIETY DISORDER
GENERALISED ANXIETY DISORDERGENERALISED ANXIETY DISORDER
GENERALISED ANXIETY DISORDERSunil Hero
 
Somatoform disorders (psychophysical problems)
Somatoform disorders (psychophysical problems)Somatoform disorders (psychophysical problems)
Somatoform disorders (psychophysical problems)Richard Asare
 
PHENOMENOLOGY OF DELUSION
PHENOMENOLOGY OF DELUSIONPHENOMENOLOGY OF DELUSION
PHENOMENOLOGY OF DELUSIONFaisal Shaan
 

More Related Content

What's hot

psychiatry.Somatoform disorders animation part i.(dr.nzar)
psychiatry.Somatoform disorders animation part i.(dr.nzar)psychiatry.Somatoform disorders animation part i.(dr.nzar)
psychiatry.Somatoform disorders animation part i.(dr.nzar)student
 
Delusional Disorders
Delusional DisordersDelusional Disorders
Delusional DisordersTosca Torres
 
Somatic symptom and dissociative disorders
Somatic symptom and dissociative disordersSomatic symptom and dissociative disorders
Somatic symptom and dissociative disordersMuhammad Musawar Ali
 
Psychosomatic disorder
Psychosomatic disorderPsychosomatic disorder
Psychosomatic disordernabina paneru
 
Paranoid personality disorder
Paranoid personality disorderParanoid personality disorder
Paranoid personality disorderMilen Ramos
 
ACUTE AND TRANSIENT PSYCHOTIC DISORDER, REACTIVE PSYCHOSIS, ACUTE PSYCHOSIS, ...
ACUTE AND TRANSIENT PSYCHOTIC DISORDER, REACTIVE PSYCHOSIS, ACUTE PSYCHOSIS, ...ACUTE AND TRANSIENT PSYCHOTIC DISORDER, REACTIVE PSYCHOSIS, ACUTE PSYCHOSIS, ...
ACUTE AND TRANSIENT PSYCHOTIC DISORDER, REACTIVE PSYCHOSIS, ACUTE PSYCHOSIS, ...Dr. Amit Chougule
 
Mood disorders DSM 5 and ICD 11
Mood disorders DSM 5 and ICD 11 Mood disorders DSM 5 and ICD 11
Mood disorders DSM 5 and ICD 11 Simmi Waraich
 
Substance related disorders
Substance related disordersSubstance related disorders
Substance related disordersNursing Path
 
Classification of Psychiatric disorders
Classification of Psychiatric disordersClassification of Psychiatric disorders
Classification of Psychiatric disordersdonthuraj
 
Generalized anxiety disorder
Generalized anxiety disorderGeneralized anxiety disorder
Generalized anxiety disorderUttam Vaishnav
 
Somatization disorder
Somatization disorderSomatization disorder
Somatization disorderNeurologyKota
 
Psychosomatic disorders
Psychosomatic disordersPsychosomatic disorders
Psychosomatic disordersShimla
 
Bipolar disorder
Bipolar disorderBipolar disorder
Bipolar disorderChandan N
 

What's hot (20)

psychiatry.Somatoform disorders animation part i.(dr.nzar)
psychiatry.Somatoform disorders animation part i.(dr.nzar)psychiatry.Somatoform disorders animation part i.(dr.nzar)
psychiatry.Somatoform disorders animation part i.(dr.nzar)
 
Delusional Disorders
Delusional DisordersDelusional Disorders
Delusional Disorders
 
Somatic symptom and dissociative disorders
Somatic symptom and dissociative disordersSomatic symptom and dissociative disorders
Somatic symptom and dissociative disorders
 
Dementia PRESENTATION
Dementia PRESENTATIONDementia PRESENTATION
Dementia PRESENTATION
 
Psychosomatic disorder
Psychosomatic disorderPsychosomatic disorder
Psychosomatic disorder
 
Paranoid personality disorder
Paranoid personality disorderParanoid personality disorder
Paranoid personality disorder
 
ACUTE AND TRANSIENT PSYCHOTIC DISORDER, REACTIVE PSYCHOSIS, ACUTE PSYCHOSIS, ...
ACUTE AND TRANSIENT PSYCHOTIC DISORDER, REACTIVE PSYCHOSIS, ACUTE PSYCHOSIS, ...ACUTE AND TRANSIENT PSYCHOTIC DISORDER, REACTIVE PSYCHOSIS, ACUTE PSYCHOSIS, ...
ACUTE AND TRANSIENT PSYCHOTIC DISORDER, REACTIVE PSYCHOSIS, ACUTE PSYCHOSIS, ...
 
Mood disorders DSM 5 and ICD 11
Mood disorders DSM 5 and ICD 11 Mood disorders DSM 5 and ICD 11
Mood disorders DSM 5 and ICD 11
 
Substance related disorders
Substance related disordersSubstance related disorders
Substance related disorders
 
Neurotic disorder
Neurotic disorderNeurotic disorder
Neurotic disorder
 
Bipolar Disorders I & II
Bipolar Disorders I & IIBipolar Disorders I & II
Bipolar Disorders I & II
 
Classification of Psychiatric disorders
Classification of Psychiatric disordersClassification of Psychiatric disorders
Classification of Psychiatric disorders
 
Generalized anxiety disorder
Generalized anxiety disorderGeneralized anxiety disorder
Generalized anxiety disorder
 
Cognitive disorders
Cognitive disordersCognitive disorders
Cognitive disorders
 
Pain Disorder
Pain DisorderPain Disorder
Pain Disorder
 
Somatization disorder
Somatization disorderSomatization disorder
Somatization disorder
 
Substance use disorder
Substance use disorderSubstance use disorder
Substance use disorder
 
Psychosomatic disorders
Psychosomatic disordersPsychosomatic disorders
Psychosomatic disorders
 
Anxiety Disorders
Anxiety DisordersAnxiety Disorders
Anxiety Disorders
 
Bipolar disorder
Bipolar disorderBipolar disorder
Bipolar disorder
 

Viewers also liked

Viewers also liked (8)

Fibromyalgia powerpoint completed
Fibromyalgia powerpoint completedFibromyalgia powerpoint completed
Fibromyalgia powerpoint completed
 
Fibromyalgia
FibromyalgiaFibromyalgia
Fibromyalgia
 
Updates in Fibromyalgia: Diagnosis and Management
Updates in Fibromyalgia: Diagnosis and ManagementUpdates in Fibromyalgia: Diagnosis and Management
Updates in Fibromyalgia: Diagnosis and Management
 
Fibromyalgia
FibromyalgiaFibromyalgia
Fibromyalgia
 
Fibromyalgia and Chronic Fatigue Syndrome
Fibromyalgia and Chronic Fatigue SyndromeFibromyalgia and Chronic Fatigue Syndrome
Fibromyalgia and Chronic Fatigue Syndrome
 
Fibromyalgia
FibromyalgiaFibromyalgia
Fibromyalgia
 
Fibromyalgia
FibromyalgiaFibromyalgia
Fibromyalgia
 
Fibromyalgia lecture2010
Fibromyalgia lecture2010Fibromyalgia lecture2010
Fibromyalgia lecture2010
 

Similar to Diagnosis and Treatment of Psychosomatic Disorder (Educational Slides)

medically unexplained physical symptoms
medically unexplained physical symptoms medically unexplained physical symptoms
medically unexplained physical symptoms MohammedAlHinai18
 
SOMATOFORM AND DISSOCIATIVE DISORDERS
SOMATOFORM AND DISSOCIATIVE DISORDERSSOMATOFORM AND DISSOCIATIVE DISORDERS
SOMATOFORM AND DISSOCIATIVE DISORDERSANCYBS
 
Anxiety and Psychosomatic
Anxiety and PsychosomaticAnxiety and Psychosomatic
Anxiety and PsychosomaticAndri Andri
 
5 Somatic symptom disorder.pptx
5 Somatic symptom disorder.pptx5 Somatic symptom disorder.pptx
5 Somatic symptom disorder.pptxashenafigezahegn2
 
Spiritual approach to psychosomatic cases
Spiritual approach to psychosomatic casesSpiritual approach to psychosomatic cases
Spiritual approach to psychosomatic casesAndri Andri
 
Differential diagnosis
Differential diagnosis Differential diagnosis
Differential diagnosis Nasar Khan
 
somatic symptom disorder.ppt
somatic symptom disorder.pptsomatic symptom disorder.ppt
somatic symptom disorder.pptDrMOHITBANSAL2
 
Somatic symptom and related disorder
Somatic symptom and related disorderSomatic symptom and related disorder
Somatic symptom and related disorderhiba iman
 
Illness cognition and cognitive behavioral approches
Illness cognition and cognitive behavioral approchesIllness cognition and cognitive behavioral approches
Illness cognition and cognitive behavioral approchesMishaRiaz
 
Depression: What Is It and What Are My Treatment Options? (Community Lecture)
Depression: What Is It and What Are My Treatment Options? (Community Lecture)Depression: What Is It and What Are My Treatment Options? (Community Lecture)
Depression: What Is It and What Are My Treatment Options? (Community Lecture)Summit Health
 
Breakout 3.4 Asthma and psychological problems - Mike Thomas
Breakout 3.4 Asthma and psychological problems - Mike ThomasBreakout 3.4 Asthma and psychological problems - Mike Thomas
Breakout 3.4 Asthma and psychological problems - Mike ThomasNHS Improvement
 
Obsessive compulsive disorder : ocd treatment the balance
Obsessive compulsive disorder : ocd treatment   the balanceObsessive compulsive disorder : ocd treatment   the balance
Obsessive compulsive disorder : ocd treatment the balanceAbdullah Boulad
 
SOMATOFORM DISORDER (BY PRANAY)
SOMATOFORM DISORDER (BY PRANAY)SOMATOFORM DISORDER (BY PRANAY)
SOMATOFORM DISORDER (BY PRANAY)home
 
adjustment disorders and distress in Palliative care
adjustment disorders and distress in Palliative careadjustment disorders and distress in Palliative care
adjustment disorders and distress in Palliative careruparnakhurana
 
Somatoform disorders
Somatoform disorders Somatoform disorders
Somatoform disorders FemiOpadotun
 
Psychiatry and palliative care medicine
Psychiatry and palliative care medicinePsychiatry and palliative care medicine
Psychiatry and palliative care medicineSaleh Uddin
 
anxiety ppt.pptx
anxiety ppt.pptxanxiety ppt.pptx
anxiety ppt.pptxAquib Reza
 
Depression in Primary Care
Depression in Primary CareDepression in Primary Care
Depression in Primary CareNick Ashley
 

Similar to Diagnosis and Treatment of Psychosomatic Disorder (Educational Slides) (20)

medically unexplained physical symptoms
medically unexplained physical symptoms medically unexplained physical symptoms
medically unexplained physical symptoms
 
SOMATOFORM AND DISSOCIATIVE DISORDERS
SOMATOFORM AND DISSOCIATIVE DISORDERSSOMATOFORM AND DISSOCIATIVE DISORDERS
SOMATOFORM AND DISSOCIATIVE DISORDERS
 
Anxiety and Psychosomatic
Anxiety and PsychosomaticAnxiety and Psychosomatic
Anxiety and Psychosomatic
 
5 Somatic symptom disorder.pptx
5 Somatic symptom disorder.pptx5 Somatic symptom disorder.pptx
5 Somatic symptom disorder.pptx
 
Spiritual approach to psychosomatic cases
Spiritual approach to psychosomatic casesSpiritual approach to psychosomatic cases
Spiritual approach to psychosomatic cases
 
Differential diagnosis
Differential diagnosis Differential diagnosis
Differential diagnosis
 
somatic symptom disorder.ppt
somatic symptom disorder.pptsomatic symptom disorder.ppt
somatic symptom disorder.ppt
 
Somatic symptom and related disorder
Somatic symptom and related disorderSomatic symptom and related disorder
Somatic symptom and related disorder
 
Illness cognition and cognitive behavioral approches
Illness cognition and cognitive behavioral approchesIllness cognition and cognitive behavioral approches
Illness cognition and cognitive behavioral approches
 
Depression: What Is It and What Are My Treatment Options? (Community Lecture)
Depression: What Is It and What Are My Treatment Options? (Community Lecture)Depression: What Is It and What Are My Treatment Options? (Community Lecture)
Depression: What Is It and What Are My Treatment Options? (Community Lecture)
 
Psychiatry - Archer USMLE step 3
Psychiatry - Archer USMLE step 3Psychiatry - Archer USMLE step 3
Psychiatry - Archer USMLE step 3
 
Breakout 3.4 Asthma and psychological problems - Mike Thomas
Breakout 3.4 Asthma and psychological problems - Mike ThomasBreakout 3.4 Asthma and psychological problems - Mike Thomas
Breakout 3.4 Asthma and psychological problems - Mike Thomas
 
Obsessive compulsive disorder : ocd treatment the balance
Obsessive compulsive disorder : ocd treatment   the balanceObsessive compulsive disorder : ocd treatment   the balance
Obsessive compulsive disorder : ocd treatment the balance
 
SOMATOFORM DISORDER (BY PRANAY)
SOMATOFORM DISORDER (BY PRANAY)SOMATOFORM DISORDER (BY PRANAY)
SOMATOFORM DISORDER (BY PRANAY)
 
adjustment disorders and distress in Palliative care
adjustment disorders and distress in Palliative careadjustment disorders and distress in Palliative care
adjustment disorders and distress in Palliative care
 
Somatoform disorders
Somatoform disorders Somatoform disorders
Somatoform disorders
 
Psychiatry and palliative care medicine
Psychiatry and palliative care medicinePsychiatry and palliative care medicine
Psychiatry and palliative care medicine
 
Somatoform disorders
Somatoform disordersSomatoform disorders
Somatoform disorders
 
anxiety ppt.pptx
anxiety ppt.pptxanxiety ppt.pptx
anxiety ppt.pptx
 
Depression in Primary Care
Depression in Primary CareDepression in Primary Care
Depression in Primary Care
 

More from Andri Andri

Anxiety disorder and medical comorbidity
Anxiety disorder and medical comorbidityAnxiety disorder and medical comorbidity
Anxiety disorder and medical comorbidityAndri Andri
 
Psychogenic Pain : Psychosomatic Point of View
Psychogenic Pain : Psychosomatic Point of ViewPsychogenic Pain : Psychosomatic Point of View
Psychogenic Pain : Psychosomatic Point of ViewAndri Andri
 
Diagnosis and Treatment Insomnia for primary care physician
Diagnosis and Treatment  Insomnia for primary care physicianDiagnosis and Treatment  Insomnia for primary care physician
Diagnosis and Treatment Insomnia for primary care physicianAndri Andri
 
Relationship between sleep disorder and gastrointestinal problem
Relationship between sleep disorder and gastrointestinal problemRelationship between sleep disorder and gastrointestinal problem
Relationship between sleep disorder and gastrointestinal problemAndri Andri
 
Pandangan Ilmu Kedokteran Jiwa pada KESURUPAN
Pandangan Ilmu Kedokteran Jiwa pada KESURUPAN Pandangan Ilmu Kedokteran Jiwa pada KESURUPAN
Pandangan Ilmu Kedokteran Jiwa pada KESURUPAN Andri Andri
 
Investigation of Cognitive Function in Geriatric Mood Disorder
Investigation of Cognitive Function in Geriatric Mood DisorderInvestigation of Cognitive Function in Geriatric Mood Disorder
Investigation of Cognitive Function in Geriatric Mood DisorderAndri Andri
 
Long Acting Antipsychotic
Long Acting AntipsychoticLong Acting Antipsychotic
Long Acting AntipsychoticAndri Andri
 
Bipolar Disorder in Primary Care
Bipolar Disorder in Primary CareBipolar Disorder in Primary Care
Bipolar Disorder in Primary CareAndri Andri
 
Panic Symptoms in Patients with non cardiac chest pain
Panic Symptoms in Patients with non cardiac chest painPanic Symptoms in Patients with non cardiac chest pain
Panic Symptoms in Patients with non cardiac chest painAndri Andri
 
Psychosocial aspect of bariatric surgery
Psychosocial aspect of bariatric surgeryPsychosocial aspect of bariatric surgery
Psychosocial aspect of bariatric surgeryAndri Andri
 
Outcomes of left ventricular assist device implantation stratifiedby psychoso...
Outcomes of left ventricular assist device implantation stratifiedby psychoso...Outcomes of left ventricular assist device implantation stratifiedby psychoso...
Outcomes of left ventricular assist device implantation stratifiedby psychoso...Andri Andri
 
Developing Leadership Skills: Lessons Learned from Our Teachers
Developing Leadership Skills: Lessons Learned from Our TeachersDeveloping Leadership Skills: Lessons Learned from Our Teachers
Developing Leadership Skills: Lessons Learned from Our TeachersAndri Andri
 
Transcranial direct current stimulation
Transcranial direct current stimulation Transcranial direct current stimulation
Transcranial direct current stimulation Andri Andri
 
Neurobiology and Treatment of Alcohol Withdrawal
Neurobiology and Treatment of Alcohol Withdrawal Neurobiology and Treatment of Alcohol Withdrawal
Neurobiology and Treatment of Alcohol Withdrawal Andri Andri
 
Are we doing the right kind of research to guide clinical care?
Are we doing the right kind of research to guide clinical care?Are we doing the right kind of research to guide clinical care?
Are we doing the right kind of research to guide clinical care?Andri Andri
 
Challenge of integration care of clp (acpm 2014)
Challenge of integration care of clp (acpm 2014)Challenge of integration care of clp (acpm 2014)
Challenge of integration care of clp (acpm 2014)Andri Andri
 
Challenge of Integration Care of Consultation Liaison Psychiatry (ACPM 2014)
Challenge of Integration Care of Consultation Liaison Psychiatry (ACPM 2014)Challenge of Integration Care of Consultation Liaison Psychiatry (ACPM 2014)
Challenge of Integration Care of Consultation Liaison Psychiatry (ACPM 2014)Andri Andri
 
Functional Gastrointestinal Disorder : Psychosomatic Review
Functional Gastrointestinal Disorder : Psychosomatic ReviewFunctional Gastrointestinal Disorder : Psychosomatic Review
Functional Gastrointestinal Disorder : Psychosomatic ReviewAndri Andri
 

More from Andri Andri (19)

Anxiety disorder and medical comorbidity
Anxiety disorder and medical comorbidityAnxiety disorder and medical comorbidity
Anxiety disorder and medical comorbidity
 
Psychogenic Pain : Psychosomatic Point of View
Psychogenic Pain : Psychosomatic Point of ViewPsychogenic Pain : Psychosomatic Point of View
Psychogenic Pain : Psychosomatic Point of View
 
Diagnosis and Treatment Insomnia for primary care physician
Diagnosis and Treatment  Insomnia for primary care physicianDiagnosis and Treatment  Insomnia for primary care physician
Diagnosis and Treatment Insomnia for primary care physician
 
Relationship between sleep disorder and gastrointestinal problem
Relationship between sleep disorder and gastrointestinal problemRelationship between sleep disorder and gastrointestinal problem
Relationship between sleep disorder and gastrointestinal problem
 
Pandangan Ilmu Kedokteran Jiwa pada KESURUPAN
Pandangan Ilmu Kedokteran Jiwa pada KESURUPAN Pandangan Ilmu Kedokteran Jiwa pada KESURUPAN
Pandangan Ilmu Kedokteran Jiwa pada KESURUPAN
 
Investigation of Cognitive Function in Geriatric Mood Disorder
Investigation of Cognitive Function in Geriatric Mood DisorderInvestigation of Cognitive Function in Geriatric Mood Disorder
Investigation of Cognitive Function in Geriatric Mood Disorder
 
Long Acting Antipsychotic
Long Acting AntipsychoticLong Acting Antipsychotic
Long Acting Antipsychotic
 
Bipolar Disorder in Primary Care
Bipolar Disorder in Primary CareBipolar Disorder in Primary Care
Bipolar Disorder in Primary Care
 
Panic Symptoms in Patients with non cardiac chest pain
Panic Symptoms in Patients with non cardiac chest painPanic Symptoms in Patients with non cardiac chest pain
Panic Symptoms in Patients with non cardiac chest pain
 
Psychosocial aspect of bariatric surgery
Psychosocial aspect of bariatric surgeryPsychosocial aspect of bariatric surgery
Psychosocial aspect of bariatric surgery
 
Outcomes of left ventricular assist device implantation stratifiedby psychoso...
Outcomes of left ventricular assist device implantation stratifiedby psychoso...Outcomes of left ventricular assist device implantation stratifiedby psychoso...
Outcomes of left ventricular assist device implantation stratifiedby psychoso...
 
Developing Leadership Skills: Lessons Learned from Our Teachers
Developing Leadership Skills: Lessons Learned from Our TeachersDeveloping Leadership Skills: Lessons Learned from Our Teachers
Developing Leadership Skills: Lessons Learned from Our Teachers
 
Transcranial direct current stimulation
Transcranial direct current stimulation Transcranial direct current stimulation
Transcranial direct current stimulation
 
Neurobiology and Treatment of Alcohol Withdrawal
Neurobiology and Treatment of Alcohol Withdrawal Neurobiology and Treatment of Alcohol Withdrawal
Neurobiology and Treatment of Alcohol Withdrawal
 
Are we doing the right kind of research to guide clinical care?
Are we doing the right kind of research to guide clinical care?Are we doing the right kind of research to guide clinical care?
Are we doing the right kind of research to guide clinical care?
 
132609
132609132609
132609
 
Challenge of integration care of clp (acpm 2014)
Challenge of integration care of clp (acpm 2014)Challenge of integration care of clp (acpm 2014)
Challenge of integration care of clp (acpm 2014)
 
Challenge of Integration Care of Consultation Liaison Psychiatry (ACPM 2014)
Challenge of Integration Care of Consultation Liaison Psychiatry (ACPM 2014)Challenge of Integration Care of Consultation Liaison Psychiatry (ACPM 2014)
Challenge of Integration Care of Consultation Liaison Psychiatry (ACPM 2014)
 
Functional Gastrointestinal Disorder : Psychosomatic Review
Functional Gastrointestinal Disorder : Psychosomatic ReviewFunctional Gastrointestinal Disorder : Psychosomatic Review
Functional Gastrointestinal Disorder : Psychosomatic Review
 

Recently uploaded

Website Fixer-Upper Series to Boost your Online Presence
Website Fixer-Upper Series to Boost your Online PresenceWebsite Fixer-Upper Series to Boost your Online Presence
Website Fixer-Upper Series to Boost your Online PresenceSamantha Russell
 
Appendicular SkeletonSystem PPT.....pptx
Appendicular SkeletonSystem PPT.....pptxAppendicular SkeletonSystem PPT.....pptx
Appendicular SkeletonSystem PPT.....pptxRenuka N Sunagad
 
Exit Essay - Save the Filipino Language by Renz Perez.docx
Exit Essay - Save the Filipino Language by Renz Perez.docxExit Essay - Save the Filipino Language by Renz Perez.docx
Exit Essay - Save the Filipino Language by Renz Perez.docxMYDA ANGELICA SUAN
 
Practical Research 1: Nature of Inquiry and Research.pptx
Practical Research 1: Nature of Inquiry and Research.pptxPractical Research 1: Nature of Inquiry and Research.pptx
Practical Research 1: Nature of Inquiry and Research.pptxKatherine Villaluna
 
2.20.24 The March on Washington for Jobs and Freedom.pptx
2.20.24 The March on Washington for Jobs and Freedom.pptx2.20.24 The March on Washington for Jobs and Freedom.pptx
2.20.24 The March on Washington for Jobs and Freedom.pptxMaryPotorti1
 
BTKi in Treatment Of Chronic Lymphocytic Leukemia
BTKi in Treatment Of Chronic Lymphocytic LeukemiaBTKi in Treatment Of Chronic Lymphocytic Leukemia
BTKi in Treatment Of Chronic Lymphocytic LeukemiaFaheema Hasan
 
Writing Agony Letter & If type O+1 & Diphthongs + Text “Arab Science”.pdf
Writing Agony Letter & If type O+1 & Diphthongs + Text “Arab Science”.pdfWriting Agony Letter & If type O+1 & Diphthongs + Text “Arab Science”.pdf
Writing Agony Letter & If type O+1 & Diphthongs + Text “Arab Science”.pdfMr Bounab Samir
 
IR introduction Introduction, Principle & Theory
IR introduction Introduction, Principle & TheoryIR introduction Introduction, Principle & Theory
IR introduction Introduction, Principle & Theorynivedithag131
 
Shapley Tech Talk - SHAP and Shapley Discussion
Shapley Tech Talk - SHAP and Shapley DiscussionShapley Tech Talk - SHAP and Shapley Discussion
Shapley Tech Talk - SHAP and Shapley DiscussionTushar Tank
 
Evaluation and management of patients with Dyspepsia.pptx
Evaluation and management of patients with Dyspepsia.pptxEvaluation and management of patients with Dyspepsia.pptx
Evaluation and management of patients with Dyspepsia.pptxgarvitnanecha
 
Barrow Motor Ability Test - TEST, MEASUREMENT AND EVALUATION IN PHYSICAL EDUC...
Barrow Motor Ability Test - TEST, MEASUREMENT AND EVALUATION IN PHYSICAL EDUC...Barrow Motor Ability Test - TEST, MEASUREMENT AND EVALUATION IN PHYSICAL EDUC...
Barrow Motor Ability Test - TEST, MEASUREMENT AND EVALUATION IN PHYSICAL EDUC...Rabiya Husain
 
UniSC Sunshine Coast library self-guided tour
UniSC Sunshine Coast library self-guided tourUniSC Sunshine Coast library self-guided tour
UniSC Sunshine Coast library self-guided tourUSC_Library
 
D.pharmacy Pharmacology 4th unit notes.pdf
D.pharmacy Pharmacology 4th unit notes.pdfD.pharmacy Pharmacology 4th unit notes.pdf
D.pharmacy Pharmacology 4th unit notes.pdfSUMIT TIWARI
 
50 ĐỀ THI THỬ TỐT NGHIỆP THPT TIẾNG ANH 2024 CÓ GIẢI CHI TIẾT - GIỚI HẠN KHO...
50 ĐỀ THI THỬ TỐT NGHIỆP THPT TIẾNG ANH 2024 CÓ GIẢI CHI TIẾT - GIỚI HẠN KHO...50 ĐỀ THI THỬ TỐT NGHIỆP THPT TIẾNG ANH 2024 CÓ GIẢI CHI TIẾT - GIỚI HẠN KHO...
50 ĐỀ THI THỬ TỐT NGHIỆP THPT TIẾNG ANH 2024 CÓ GIẢI CHI TIẾT - GIỚI HẠN KHO...Nguyen Thanh Tu Collection
 
Practical Research 1: Qualitative Research and Its Importance in Daily Life.pptx
Practical Research 1: Qualitative Research and Its Importance in Daily Life.pptxPractical Research 1: Qualitative Research and Its Importance in Daily Life.pptx
Practical Research 1: Qualitative Research and Its Importance in Daily Life.pptxKatherine Villaluna
 
Intuition behind Monte Carlo Markov Chains
Intuition behind Monte Carlo Markov ChainsIntuition behind Monte Carlo Markov Chains
Intuition behind Monte Carlo Markov ChainsTushar Tank
 
skeletal system details with joints and its types
skeletal system details with joints and its typesskeletal system details with joints and its types
skeletal system details with joints and its typesMinaxi patil. CATALLYST
 
mean stack mean stack mean stack mean stack
mean stack mean stack  mean stack  mean stackmean stack mean stack  mean stack  mean stack
mean stack mean stack mean stack mean stackNuttavutThongjor1
 

Recently uploaded (20)

Website Fixer-Upper Series to Boost your Online Presence
Website Fixer-Upper Series to Boost your Online PresenceWebsite Fixer-Upper Series to Boost your Online Presence
Website Fixer-Upper Series to Boost your Online Presence
 
Appendicular SkeletonSystem PPT.....pptx
Appendicular SkeletonSystem PPT.....pptxAppendicular SkeletonSystem PPT.....pptx
Appendicular SkeletonSystem PPT.....pptx
 
Exit Essay - Save the Filipino Language by Renz Perez.docx
Exit Essay - Save the Filipino Language by Renz Perez.docxExit Essay - Save the Filipino Language by Renz Perez.docx
Exit Essay - Save the Filipino Language by Renz Perez.docx
 
Practical Research 1: Nature of Inquiry and Research.pptx
Practical Research 1: Nature of Inquiry and Research.pptxPractical Research 1: Nature of Inquiry and Research.pptx
Practical Research 1: Nature of Inquiry and Research.pptx
 
2.20.24 The March on Washington for Jobs and Freedom.pptx
2.20.24 The March on Washington for Jobs and Freedom.pptx2.20.24 The March on Washington for Jobs and Freedom.pptx
2.20.24 The March on Washington for Jobs and Freedom.pptx
 
BTKi in Treatment Of Chronic Lymphocytic Leukemia
BTKi in Treatment Of Chronic Lymphocytic LeukemiaBTKi in Treatment Of Chronic Lymphocytic Leukemia
BTKi in Treatment Of Chronic Lymphocytic Leukemia
 
Writing Agony Letter & If type O+1 & Diphthongs + Text “Arab Science”.pdf
Writing Agony Letter & If type O+1 & Diphthongs + Text “Arab Science”.pdfWriting Agony Letter & If type O+1 & Diphthongs + Text “Arab Science”.pdf
Writing Agony Letter & If type O+1 & Diphthongs + Text “Arab Science”.pdf
 
IR introduction Introduction, Principle & Theory
IR introduction Introduction, Principle & TheoryIR introduction Introduction, Principle & Theory
IR introduction Introduction, Principle & Theory
 
Shapley Tech Talk - SHAP and Shapley Discussion
Shapley Tech Talk - SHAP and Shapley DiscussionShapley Tech Talk - SHAP and Shapley Discussion
Shapley Tech Talk - SHAP and Shapley Discussion
 
Caldecott Medal Book Winners and Media Used
Caldecott Medal Book Winners and Media UsedCaldecott Medal Book Winners and Media Used
Caldecott Medal Book Winners and Media Used
 
Evaluation and management of patients with Dyspepsia.pptx
Evaluation and management of patients with Dyspepsia.pptxEvaluation and management of patients with Dyspepsia.pptx
Evaluation and management of patients with Dyspepsia.pptx
 
Barrow Motor Ability Test - TEST, MEASUREMENT AND EVALUATION IN PHYSICAL EDUC...
Barrow Motor Ability Test - TEST, MEASUREMENT AND EVALUATION IN PHYSICAL EDUC...Barrow Motor Ability Test - TEST, MEASUREMENT AND EVALUATION IN PHYSICAL EDUC...
Barrow Motor Ability Test - TEST, MEASUREMENT AND EVALUATION IN PHYSICAL EDUC...
 
UniSC Sunshine Coast library self-guided tour
UniSC Sunshine Coast library self-guided tourUniSC Sunshine Coast library self-guided tour
UniSC Sunshine Coast library self-guided tour
 
D.pharmacy Pharmacology 4th unit notes.pdf
D.pharmacy Pharmacology 4th unit notes.pdfD.pharmacy Pharmacology 4th unit notes.pdf
D.pharmacy Pharmacology 4th unit notes.pdf
 
50 ĐỀ THI THỬ TỐT NGHIỆP THPT TIẾNG ANH 2024 CÓ GIẢI CHI TIẾT - GIỚI HẠN KHO...
50 ĐỀ THI THỬ TỐT NGHIỆP THPT TIẾNG ANH 2024 CÓ GIẢI CHI TIẾT - GIỚI HẠN KHO...50 ĐỀ THI THỬ TỐT NGHIỆP THPT TIẾNG ANH 2024 CÓ GIẢI CHI TIẾT - GIỚI HẠN KHO...
50 ĐỀ THI THỬ TỐT NGHIỆP THPT TIẾNG ANH 2024 CÓ GIẢI CHI TIẾT - GIỚI HẠN KHO...
 
Time-Honored Wisdom: African Teachings for VUCA Leaders
Time-Honored Wisdom: African Teachings for VUCA LeadersTime-Honored Wisdom: African Teachings for VUCA Leaders
Time-Honored Wisdom: African Teachings for VUCA Leaders
 
Practical Research 1: Qualitative Research and Its Importance in Daily Life.pptx
Practical Research 1: Qualitative Research and Its Importance in Daily Life.pptxPractical Research 1: Qualitative Research and Its Importance in Daily Life.pptx
Practical Research 1: Qualitative Research and Its Importance in Daily Life.pptx
 
Intuition behind Monte Carlo Markov Chains
Intuition behind Monte Carlo Markov ChainsIntuition behind Monte Carlo Markov Chains
Intuition behind Monte Carlo Markov Chains
 
skeletal system details with joints and its types
skeletal system details with joints and its typesskeletal system details with joints and its types
skeletal system details with joints and its types
 
mean stack mean stack mean stack mean stack
mean stack mean stack  mean stack  mean stackmean stack mean stack  mean stack  mean stack
mean stack mean stack mean stack mean stack
 

Diagnosis and Treatment of Psychosomatic Disorder (Educational Slides)

  • 1. Curriculum Vitae • Dr. Andri,SpKJ,FAPM • Lulus Dokter dari FKUI tahun 2003 • Lulus Psikiater dari FKUI tahun 2008 • Fellow of Academy of Psychosomatic Medicine, USA (2013) • Jabatan : – Dosen FK UKRIDA (2008 – sekarang) – Ketua Sub Kredensial Komite Medik Omni Hospitals Alam Sutera (2014 – sekarang) – Kepala Klinik Psikosomatik OMNI Hospitals (2008 – sekarang) • Organisasi : – Ikatan Dokter Indonesia (IDI) – Perhimpunan Dokter Spesialis Kedokteran Jiwa Indonesia (PDSKJI) – American Psychosomatic Society (Faculty Leader of Psychosomatic Medicine Interest Group in Indonesia) – Academy of Psychosomatic Medicine (Fellow Member)
  • 2. PSYCHOSOMATIC DISORDER IN DAILY PRACTICE : DIAGNOSIS AND THERAPY dr.Andri,SpKJ,FAPM Psychiatrist, Fellow of Academy of Psychosomatic Medicine Faculty of Medicine, UKRIDA Psychosomatic Clinic Omni Hospitals Alam Sutera, Tangerang Selatan
  • 3. • What is Psychosomatic? • Somatic complaints in clinical practice • Somatic complaints in psychiatric disorder • Treatment strategy (Using Pharmacology and Non-Pharmacology approach) • Conclusion Outline for today’s talk
  • 4. WHAT IS PSYCHOSOMATIC ? • The term psychosomatic has been known for more than 50 years in the field of psychiatry • Mind and Body Connection • George Engel : Biopsychosocial concept (1977) • Since it was misunderstood by lay people as a disorder “Only in Your Head”, since 1980, psychosomatic was not a diagnosis terminology in DSM anymore • Psychosomatic  Somatic symptoms • The use of the term Psychosomatic for organization and journal until now • Psychosomatic Medicine is a subspecialist in Psychiatry (APA,ABPN) Kaplan and Saddock, Synopsis of Psychiatry, Psychosomatic Medicine, Chapter 13, American Psychiatric Publishing 2015
  • 5. Historical Background and Changes from DSM III to DSM 5 (Dimsdale, J. E., et al. 2013) • Somatoform Disorder Somatic Symptom Disorder - First introduced 30 yrs ago in DSM-III as Somatoform Disorder. Somatoform didn’t translate to another language well - DSM-IV – concept of medically unexplained symptoms were introduced. Is it unexplained or unexamined medical condition? - DSM-5 replaced Somatoform Disorder with Somatic Symptom Disorder and Related Disorders The symptoms may or may not be medically unexplained. If the patient primarily had anxiety but not somatic complaints, the diagnosis would be Illness Anxiety Disorder.
  • 6. Case Illustration • A 29 years old man complaint discomfort feeling in his left chest. He often felt palpitation that made him visit ER more than once. • He also felt bloating and fear of losing control at the same time. Physical examination and laboratory workup found nothing was wrong. He had already done ECG, Echo and Stress Test (Treadmil) • What was wrong with this patient?
  • 7. Somatic symptoms in Clinical Practice • 25-50% No serious medical cause found • 30-75% Remain medically unexplained • 16-33% “bothered the patient a lot” but remain unexplained • Schneider R
  • 8. • A 39 years old woman complaint about her uneasy feeling in her stomach. She frequently felt bloating, sometimes accompanied by palpitation and feeling imbalance. • She had already visited her internist and had done regular examination and specific workup (gastroscopy). • All the findings were normal. She was afraid of her condition and still thinking about having severe disease related to her complaints. • She was a manager in one of the telecommunication company. A very strong and persistent woman. She thought about her stress in her work but she thought they were all regular stress until 6 months ago she started complaint about her stomach Case Illustration
  • 9. Somatic Complaints • Somatic complaint is a poorly understood “blind spot” of medicine • Somatic complaints and somatoform disorder (now is somatic symptoms disorder based on DSM 5 ) remain neglected by psychiatrist and also primary care physician • It can be conceptualized in a variety of different ways but fundamentally it appears to be a way of responding stress • Not all somatizing patients have a diagnosis of somatoform disorder, many have another Axis 1 disorder or transiently somatize in the context of significant life stress Abbey, Wulsin and Levenson in Somatization and Somatoform Disorder, Textbook of Psychosomatic Medicine, 2nd ed, 2011
  • 10. Somatic Complaints • Patients commonly present to their primary care physician complaining of physical symptoms. • More often than not, appropriate medical work-up fails to reveal a clear underlying physical etiology • The prevalence of somatic symptoms that are multiple, chronic, and associated with medical help- seeking—but do not meet full criteria for a DSM-IV somatization disorder :19.7% – 22% Psychosomatics 42:3, May-June 2001
  • 11. 1. palpitations (pounding heart) : 90.52%, 2. ache or discomfort in the abdomen : 84.94% 3. lack of energy (weakness) much of the time : 84.41%, 4. pain or tension in neck or shoulder : 82.86% 5. feeling giddy or dizzy : 81.88% 6. feeling tired even when are not working : 81.39% 7. suffered from excessive wind (gas) or belching : 73.6% 8. pain in the chest or heart : 73% 9. trembling or shaking : 72.7% 10. buzzing noise in ears or head : 71.34%. Top 10 Somatic Symptoms Unpublished data. Survey conducted by Andri from Psychosomatic Clinic Omni Hospital
  • 12. Data 2009 di Puskesmas di Jakarta Dan Hidayat, dkk. Majalah Kedokteran Indonesia, Vo. 60 No.10 Oktober 2010
  • 13. Common types of somatization seen in primary care 1. Acute somatization Temporary production of physical symptoms associated with transient stressors 2. Relapsing somatization Repeated episodes of physical symptoms associated with repetitive stressors & anxiety or depressive episodes 3. Chronic somatization Nearly continuous somatic focus, perception of ill health, development of disability (Croicu, C., et al. 2014)
  • 14. Assessing for Somatic Symptom Disorder Using the 3-Ps (Croicu C, et al. 2014) Predisposing Chronic childhood illnesses, childhood adversities, comorbid medical illness, lifetime psychiatric diagnosis, poor coping ability Precipitating Medical illness, psychiatric disorder, social & occupation stress, and changes in social support Perpetuating Chronic stressors, maladaptive coping skills, negative health habits, and disability payments Approach to the patient with multiple somatic symptoms.pdf
  • 15. Somatic Symptoms in Psychiatry Disorder • Major Depression and Dysthymia • Panic Disorder • Generalized Anxiety Disorder (GAD) • OCD • Somatoform Disorders • Substance abuse • Delirium • Dementia • Schizophrenia and delusion disorder Brown 1990
  • 16. Relation Mind and Body : Physical and Behavior
  • 17. Somatic Comorbidities of Anxiety Disorders Inflammatory Bowel Disease DiabetesHypertension Cardiovascular Disease Anxiety Disorder s
  • 18. Pharmacotherapy and Cognitive-Behavioral Therapy Effective Treatment of Anxiety Disorders Both Removes Symptoms and Prevents Relapse Anxiety Disorder Treatment Bandelow B, et al. Int J Psychiatry Clin Pract. 2012;16(2):77-84. Goals of treatment:  Removal of symptoms  Prevention of relapse
  • 19. Essential Treatment Approaches for Patients with Somatic Symptom Disorder • Avoid the temptation to order unnecessary, repetitive, or invasive investigations • Educate the patient on how to cope with their symptoms instead of focusing on a cure • Evaluate somatic symptom burden • Collaborate with the patient in setting treatment goals • Screen for common psychiatric conditions associated with somatic complaints such as depression and anxiety • Treat identified comorbid psychiatric disorders (Croicu, C., et al. 2014)
  • 20. Essential Treatment Approaches for Patients with Somatic Complaints • Case management to minimize economic impact • Medications to treat anxiety and depression (SSRIs : Fluoxetine, Sertraline or SNRI : Venlafaxine ) : Need specific competencies • Short term use of anxiety medication (benzodiazepine, e.q : diazepam, clobazam, alprazolam,clonazepam) • Non-pharmacological treatments • *CBT – Shows promising evidence • Psychodynamic therapy • Integrative therapy (Croicu, C., et al. 2014)
  • 21. Treatment options for anxiety disorders Psychological treatment • Consider treatments that have been most thoroughly evaluated first • If response inadequate, adapt treatment to the individual Pharmacological treatment • Refer to section for diagnosed disorder for specific medication choices • Consider short-term benzodiazepines if severe anxiety or agitation or acute functional impairment Step 1: First-line agent Optimize dosage and duration Step 2: If inadequate response or side effects, switch to alternate first-line agent. If partial response, adding another agent may be preferred over switching Step 3: Consider referral to specialist, or consider combination treatment, or switch to second- or third-line agents Potential combinations • Psychological treatment + pharmacological treatment • SSRI-SNRI + benzodiazepines (short-term) • SSRI-SNRI + anticonvulsant or atypical antipsychotic • Refer to section for disorder for augmenting agents Contraindicated combinations • SSRI-SNRI-TCA + MAOI • Buspirone + MAOI Follow up • Response may take 8-12 weeks • Pharmacotherapy may be needed for 1-2 years or longer Can J Psychiatry, Vol 51, Suppl 2, July 2006
  • 22. http://www.psychiatrictimes.com/articles/achievin g-remission-generalized-anxiety-disorder By Laura A. Mandos, PharmD, Jennifer A. Reinhold, PharmD, BCPS, BCPP, and Karl Rickels, MD - See more at: http://www.psychiatrictimes.com/articles/achieving-remission-generalized- anxiety-disorder#sthash.pLl7TBKm.dpuf
  • 23. Clobazam is Effective • Clobazam has the same effectiveness compare to diazepam, lorazepam, chlordiazepoxide, bromazepam and alprazolam • Maximum anxiolytic response seen one to two weeks • Clobazam was generally well tolerated. • Drowsiness was reported less frequently with clobazam than with diazepam or lorazepam. • No objective evidence of any sedative or amnestic effects or impairment of psychomotor function with clobazam. • Clobazam is a useful agent in the treatment of outpatients and patients in general practice with anxiety disorders. Clobazam: Epilepsy, Anxiety and General Psychopharmacology . Human Psychopharmacology: Clinical and Experimental. Volume 10, Issue Supplement 1, pages S27–S41, July 1995
  • 24. Fluoxetine as the First Line Treatment • SSRIs are greatly preferred over the other classes of antidepressants. • Fluoxetine is the first SSRI Antidepressant • SSRIs do not have the cardiac arrhythmia risk associated with tricyclic antidepressants. • Level of Evidence A, Level of Recommendation 1 : Panic Disorder and Post traumatic stress disorder • A group of 9087 patients (87 different RCTs) confirms that fluoxetine is safe and effective in the treatment of depression from the first week of therapy.2 1. BORWIN BANDELOW. Guidelines for the pharmacological treatment of anxiety disorders, obsessive – compulsive disorder and posttraumatic stress disorder in primary care . International Journal of Psychiatry in Clinical Practice, 2012; 16: 77–84 2. . Rossi A. Fluoxetine: a review on evidence based medicine.. Ann Gen Hosp Psychiatry. 2004; 3: 2
  • 25. Essential Treatment Approaches for Patients with Somatic Symptom Disorder (Croicu, C., et al. 2014) • Schedule time-limited regular appointments (e.g. 4-6 weeks) to address complaints • Explain that although there may not be a reason for their symptoms, you will work together to improve their functioning as much as possible • Educate patients how psychosocial stressors and symptoms interact • Avoid comments like “Your symptoms are all psychological.” or “There is nothing wrong with you medically.” • Relief their symptoms with appropriate and effective drug. Consider to ask about drug history and alcohol use
  • 26. Summary • Acknowledge the patients symptoms • Non-pharmacological interventions such as CBT has shown evidence in decreasing somatic symptom disorder. • Initial treatment must be effective and relief patient’s symptoms • Therapeutic alliance with the patient with somatic complaints improves outcomes. • Know our competencies, refer the patients with somatic symptoms if you think they need further assessment and therapy
  • 27. “Healing” painting by Devin Sutanujaya (2016)
  • 29. Twitter : @mbahndi IG : andripsikosomatik