MY DEAR COLLEAGUES HERE IS MY LITTLE INITIATIVE TO HELP U ALL PRESENTING INFRONT OF YOU THE TOPIC SOMATOFORM DISORDER, IT IS VERY ESSENTIAL IN THE FIELD OF PSYCHIATRY........

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3. These disorders are characterized by repeated presentation
with physical symptom which do not have any physical basis,
and a persistent request for investigations and treatment
despite repeated assurance by treating doctors.
They are divided in to following.
 Somatization disorder.
 Hypochondriasis.
 Somatoform autonomic dysfunction.
 Persistent somatoform pain disorder.

4. Somatization disorder is characterized by chronic
multiple somatic symptoms in the absence of physical
disorder.
The symptoms are vague, presented in a dramatic
manner.

5. Hypochondriasis is defined as a persistent preoccupation
with fear or belief of having a serious disease despite
repeated medical reassurance.

6.  COMMON SIGNS AND SYMPTOMS
OF SOMATIZATION DISORDER
 Multiple somatic complaints, unexplained by medical
findings.
 Complaints of pain in at least four different locations.
 Two gastrointestinal; one sexual or reproductive and
one neurologic symptom
 Moderate to severe anxiety
 Inability to voluntarily control
the symptoms

7.  Dependency with demanding, attention getting
behaviors.
 Secondary gain
 Significant distress or impairment in social or
occupational areas.
 Fear or preoccupation with body functioning
misperceived as major illness

8.  Repeated healthcare visits seeking verification of fear
(doctor shoping).
 Symptoms reported in specific detail.
 Involvement of one or more body symptoms.
 impaired social and family relationships.

9.  In this disorder, the symptoms are predominantly
under autonomic control, as if they were due to a
physical disorder. Some of them include palpitations,
hiccoughs, hyperventilation, irritable bowel, dysuria etc
.

10. The main feature of this disorder is severe, persistent
pain without any physical basis.
It may be of sufficient severity so as to cause social or
occupational impairment preoccupation with the pain is
common.

11.  Physical workup to rule out medical and neurologic
conditions.
 Complete patient history with emphasis on current psy
chological stressors.
 Test to rule out underlying organic disease.

12. DRUG THERAPY:-
 Antidepressants
 Benzodiazepines
PSYCHOLOGICAL TREATMENT:-
 Supportive psychotherapy
 Relaxation therapy

13.  Before a somatoform determination, a physical
examination and diagnostic testing are necessary to
rule out any underlying pathology.
 Create an accepting safe and supportive atmosphere
that allows open communication with the patient
 Should focus on the whole person, including
psychological, social and family factors in addition to
the physical symptoms.

14.  It must be remembered that they are not consciously
trying to be sick or avoid responsibilities.
 Respond to the patient with understanding and
patience.
 Identify the types of primary and secondary gain
achieved by symptoms.
 Minimize time and attention given to physical
symptoms

15.  Encourage patient to keep a diary of daily happenings
and feelings, along with physical symptoms.
 Encourage the patient to make decisions and take res
ponsibility for situations related to them.
 Help the patient to identify more effective coping
mechanisms rather than the somatic symptoms.

16. NEURASTHENIA is characterized by persisting and
distressing complaints of increased fatigue after mental
or physical effort.
DEPERSONALIZATION is characterized by an alteration
in the perception or experience of self, so that the feeli
ng of one’s own reality is temporarily changed or lost.

17.  DHAT SYNDROME is a culture-bound syndrome, whic
h is prevalent in the Indian subcontinent characterize
d by complaint of passage of whitish discharge (dhat)
in urine, multiple somatic symptoms, physical and men
tal exhaustion, anxiety or depression, and sexual
dysfunction.
TREATMENT:-
 Supportive psychotherapy
 Counselling
 Antidepressants

18.  FOLLOW UP CARE &
REHABILITATION:-
 These people are often treated in community, clinics,
physician office and psychiatric OPDs. Issues to be
considered during outpatient therapy include,
locating community resources.
 For people with anxiety disorders, the goal is effective
management of stress and anxiety, not the total
elimination of anxiety.

19.  Follow up interventions are especially helpful for
anxiety disorder patients.
 Teach the patient stress management techniques such
as relaxation, guided imagery and meditation,
encourage him to practice regularly
 Teach the patient about medications and lifestyle cha
nges like exercise regularly, eat a well balanced meals
get enough rest and sleep, limit intake of caffeine and
alcohol

20.  Encourage the patient to express his feeling through la
ughing, crying, etc.
 It is important for the nurse to educate the patient and
family members about the physiology of anxiety, early
symptoms of anxiety.
 Educate the patient and family
about medications
(therapeutic dose, frequency)

21.  Teach the patient and family to identify stressors and
situations that promote and exacerbate anxiety and to
avoid them as much as possible.
 Teach the patient and family how to access community
resources and support groups