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Somatization disorder

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Somatization disorder

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Somatization disorder

  1. 1. PRESENTED BY: M. RAZIA KHATOON Reg. NO: 11Y01T0011 PHARM.D; INTERN.
  2. 2. DEFINITION EPIDEMOLOGY ETIOLOGY AND PATHOPHYSIOLOGY CLINICAL PRESENTATION DIAGNOSTIC CRITERIA TREATMENT CONTENTS
  3. 3.  As defined in DSM-IV, somatization disorder is a polysymptomatic somatoform disorder characterized by multiple recurring pains and gastrointestinal, sexual and pseudoneurological symptoms occurring for a period of years with onset before age 30 years. DEFINITION
  4. 4.  In the USA, somatization disorder is found predominantly in women, with a female/male ratio of approximately 10 : 1.  Somatization disorder seems to be more common in less educated and lower socioeconomic groups.  The disorder is observed in 10% to 20% of female first- degree relatives of women with the disorder.  An estimated 25% to 75% of patients presenting with somatization disorder to primary care providers may have this disorder resulting from psychological distress. EPIDEMOLOGY
  5. 5.  The exact cause of somatic symptom disorder isn't clear, but any of these factors may play a role:  Genetic and biological factors, such as an increased sensitivity to pain  Family influence, which may be genetic or environmental, or both  Personality trait of negativity, which can impact how you identify and perceive illness and bodily symptoms  Decreased awareness of or problems processing emotions, causing physical symptoms to become the focus rather than the emotional issues  Learned behavior — for example, the attention or other benefits gained from having an illness; or "pain behaviors" in response to symptoms, such as excessive avoidance of activity, which can increase your level of disability ETIOLOGY AND PATHOPHYSIOLOGY
  6. 6. DEFENSE AGAINST PSYCHOLOGICAL DISTRESS:  According to this model, somatization disorder is a defense against psychological pain that allows some people to avoid the stigma of a psychiatric diagnosis.  Many patients described by Sigmund Freud would be diagnosed today with somatization disorder. His patients were usually young women who complained of numerous physical symptoms.  Although this theory offers a plausible explanation for somatization disorder, research indicates that people with multiple physical symptoms are actually more likely to report psychiatric symptoms than those with few physical problems.  These findings appear to support a connection between psychological and physical distress, but are inconsistent with the idea that physical symptoms offer a defense against overt psychiatric symptoms. HEIGHTENED SENSITIVITY TO PHYSICAL SENSATIONS.  An alternative theory suggests that somatization disorder arises from a heightened sensitivity to internal sensations.  People with somatization disorder may be keenly aware of the minor pains and discomforts that most people simply ignore. A similar theory has been offered to account for panic disorder.  The physiological or psychological origins of this hypersensitivity to internal sensations and their relevance to somatization disorder are still not well understood.
  7. 7. CATASTROPHIC THINKING ABOUT PHYSICAL SENSATIONS.  According to these thoughts, somatization disorder results from negative beliefs and exaggerated fears about the significance of physical sensations.  Individuals with somatization disorder are thus more likely to believe that vague physical symptoms are indicators of serious disease and to seek treatment for them.  Many people with somatization disorder reduce or eliminate many activities out of fear that exertion will worsen their symptoms. With fewer activities to distract them from their symptoms, they spend more time worrying about physical problems, resulting in greater distress and disability.
  8. 8. CLINICAL PRESENTATIONS
  9. 9. Mnemonic for Use as a Screening Test for Somatization
  10. 10. A. A history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning. B. Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance: 1. Four pain symptoms: a history of pain related to at least four different sites or functions (e.g., head, abdomen, back, joints, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination) 2. Two gastrointestinal symptoms: a history of at least two gastrointestinal symptoms other than pain (e.g., nausea, bloating, vomiting other than during pregnancy, diarrhea, or intolerance of several different foods) 3. One sexual symptom: a history of at least one sexual or reproductive symptom other than pain (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy) 4. One pseudoneurologic symptom: a history of at least one symptom or deficit suggesting a neurologic condition not limited to pain (conversion symptoms such as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures; dissociative symptoms such as amnesia; or loss of consciousness other than fainting) Diagnostic Criteria for Somatization Disorder
  11. 11. C. Either of the following: 1. After appropriate investigation, each of the symptoms in criteria B 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) 2. When there is a related general medical condition, the physical complaints or resulting social or occupational impairment are in excess of what would be expected from the history, physical examination, or laboratory findings D. The symptoms are not intentionally produced or feigned (as in factitious disorder or malingering).
  12. 12. Treatment Goals Psychotherapy and Psychosocial Strategies and Techniques Pharmacological and Physical Strategies and Techniques 1. Prevent adoption of the sick role and chronic invalidism. 2. Minimize unnecessary costs and complications by avoiding unwarranted hospitalizations, diagnostic and treatment procedures, and medications. 3. Pharmacological control of comorbid syndromes. 4. Instill, whenever possible, insight regarding temporal association between symptoms and personal, interpersonal, and situational problems. 1.Consistent treatment, generally by same physician, coordinated if multiple. 2. Supportive office visits, scheduled at regular intervals. 3. Focus gradually shifted from symptoms to personal and social Problems. 4. Establish firm therapeutic alliance. 5. Educate patient regarding manifestations of somatization disorder (psychoeducative approach). 6. Consistent reassurance. 1. Only as clearly indicated, or as time- limited empirical trial. 2. Avoid drugs with abuse or addictive potential. 3. Antianxiety and antidepressant drugs for comorbid anxiety or depressive disorders; if diagnosis unclear, consider empirical trial. Treatment of DSM-IV-TR Somatization Disorder
  13. 13.  No effective somatic treatments for somatization disorder itself have been identified.  Patients with somatization disorder may complain of anxiety and depression, suggesting readily treatable comorbid psychiatric disorders.  Use of antidepressants may be required for comorbid depression and anxiety, with tricyclics being useful in aiding chronic tension headaches and fibromyalgia. PHARMACOLOGICAL TREATMENT
  14. 14.  Fluvoxamine: 50 to 300 mg/day orally.  Amitriptyline: 50 to 100 mg orally.  Alprazolam: 0.25 to 0.5 mg orally 3 times a day.  Nefazodone: 200 mg/day, administered in two divided doses.  Lorazepam: Initial, 2 to 3 mg/day orally divided into 2 to 3 daily doses. Maintenance, 2 to 6 mg/day orally divided into 2 to 3 daily doses; dose may vary from 1 to 10 mg/day. MEDICATIONS USED
  15. 15.  Identifying and restructuring cognitions  Altering illness behavior/Behavioral activation  Relaxation training  Involvement of spouse or family member  Elicitation and expression of emotion Others are exercise therapy, bibliotherapy, short-term psychodynamic supportive psychotherapy, and interpersonal psychotherapy. COGNITIVE BEHAVIORAL THERAPY
  16. 16.  Jerald Kay and Allan Tasman. Essentials of psychiatry. england: John Wiley & Sons, 2006.  Oliver Oyama et al. Somatoform Disorders. American Family Physician. 2002 Nov; 76:1334-1338.  Hani Raoul Khouzam et al. Somatization Disorder: Clinical Presentation and Treatment in Primary Care. Hospital Physician. 1991 Apr; 45: 20-25. REFERNCE

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