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
This powerpoint presentation represents definition of the Somatoform disorder, its subtypes, etiology in perspective of theories along differential diagnosis in an attempt to shed light on the disorder adequately
This powerpoint presentation represents definition of the Somatoform disorder, its subtypes, etiology in perspective of theories along differential diagnosis in an attempt to shed light on the disorder adequately
The somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition. Medically unexplained physical symptoms account for as many as 50% of new medical outpatient visits. [1] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [2] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms.
Somatization in children consists of the persistent experience and complaints of somatic distress that cannot be fully explained by a medical diagnosis. They can be represented by a wide spectrum of severity, ranging from mild self-limited symptoms, such as stomachache and headache, to chronic disabling symptoms, such as seizures and paralysis. These psychological disorders are often difficult to approach and complex to understand. It is important to note that these symptoms are not intentionally produced or under voluntary control.
In somatoform disorders, somatic symptoms become the focus of children and their families. They generally interfere with school, home life, and peer relationships. These youngsters are more likely to be considered sickly or health impaired by parents and caretakers, to be absent from school, and to perform poorly in academics. Somatization is often associated temporarily with psychosocial stress and can persist even after the acute stressor has resolved, resulting in the belief by the child and his or her family that the correct medical diagnosis has not yet been found. Thus, patients and families may continue to seek repeated medical treatment after being informed that no acute physical illness has been found and that the symptoms cannot be fully explained by a general medical condition. When somatization occurs in the context of a physical illness, it is identified by symptoms that go beyond the expected pathophysiology of the physical illness.
Recurrent complaints often present as diagnostic and treatment dilemmas to the primary care practitioner (PCP) who is trying to make sense of these symptoms. The PCP may feel poorly prepared and/or may have little time to assess or treat the somatic concerns. While the more disabling somatic complaints are more likely to be referred to a mental health professional, these youngsters presenting with these disabling physical symptoms bridge both medical and psychological domains and present a puzzling quandary for professionals from either field if working with them alone. [3] The nature of these symptoms requires an integrated medical and psychiatric treatment approach to successfully decrease the impairment caused by these disorders.
The term “psychosomatic disorder” is mainly used to mean “a physical disease that is thought to be caused, or made worse, by mental factors.” ... For example, chest pain may be caused by stress and no physical disease can be found.
A presentation about depressive disorder. The presentation composed of the definition, causes, types, clinical feature, diagnosis, prognosis, treatment and prevention of depression
Fibromyalgia is a disease, which is difficult to diagnose. These slides include ACR criteria 1990 and 2010 with Wide spread pain index(WPI) and Symptom severity score(SSS)
The somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition. Medically unexplained physical symptoms account for as many as 50% of new medical outpatient visits. [1] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [2] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms.
Somatization in children consists of the persistent experience and complaints of somatic distress that cannot be fully explained by a medical diagnosis. They can be represented by a wide spectrum of severity, ranging from mild self-limited symptoms, such as stomachache and headache, to chronic disabling symptoms, such as seizures and paralysis. These psychological disorders are often difficult to approach and complex to understand. It is important to note that these symptoms are not intentionally produced or under voluntary control.
In somatoform disorders, somatic symptoms become the focus of children and their families. They generally interfere with school, home life, and peer relationships. These youngsters are more likely to be considered sickly or health impaired by parents and caretakers, to be absent from school, and to perform poorly in academics. Somatization is often associated temporarily with psychosocial stress and can persist even after the acute stressor has resolved, resulting in the belief by the child and his or her family that the correct medical diagnosis has not yet been found. Thus, patients and families may continue to seek repeated medical treatment after being informed that no acute physical illness has been found and that the symptoms cannot be fully explained by a general medical condition. When somatization occurs in the context of a physical illness, it is identified by symptoms that go beyond the expected pathophysiology of the physical illness.
Recurrent complaints often present as diagnostic and treatment dilemmas to the primary care practitioner (PCP) who is trying to make sense of these symptoms. The PCP may feel poorly prepared and/or may have little time to assess or treat the somatic concerns. While the more disabling somatic complaints are more likely to be referred to a mental health professional, these youngsters presenting with these disabling physical symptoms bridge both medical and psychological domains and present a puzzling quandary for professionals from either field if working with them alone. [3] The nature of these symptoms requires an integrated medical and psychiatric treatment approach to successfully decrease the impairment caused by these disorders.
The term “psychosomatic disorder” is mainly used to mean “a physical disease that is thought to be caused, or made worse, by mental factors.” ... For example, chest pain may be caused by stress and no physical disease can be found.
A presentation about depressive disorder. The presentation composed of the definition, causes, types, clinical feature, diagnosis, prognosis, treatment and prevention of depression
Fibromyalgia is a disease, which is difficult to diagnose. These slides include ACR criteria 1990 and 2010 with Wide spread pain index(WPI) and Symptom severity score(SSS)
I was asked to present something on Fibromyalgia during a Pain Summit. I ended up describing what we know so far about clinical features, evolution of diagnostic criteria and synthesized some recent guidelines.
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Archer USMLE step 3 Psychiatry lecture notes. These lecture notes are samples and are intended for use with Archer video lectures. For video lectures, please log in at http://www.ccsworkshop.com/Pay_Per_View.html
Breakout 3.4 Asthma and psychological problems - Mike ThomasNHS Improvement
Breakout 3.4 Asthma and psychological problems - Mike Thomas
Professor of Primary Care Research, University of Southampton
Chief Medical Advisor, Asthma UK
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme
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........
adjustment disorders and distress in Palliative careruparnakhurana
Psychosocial disorders are very common in patients with advanced malignancies with the commonest being anxiety and depression. Early identification and treatment will help in improving the quality of life of patients and their families and increasing compliance towards treatment and self care,
Psychogenic Pain : Psychosomatic Point of ViewAndri Andri
This presentation was presented in "Medical Approach in Holistic Management to Relieve Pain" 13 Des 2015 at The Sunan Hotel, SOLO.
Since Pain is always subjective, Psychogenic pain is very related to psychiatric problems and very often it does not recognized by physicians in their practice.
Relationship between sleep disorder and gastrointestinal problemAndri Andri
Presentasi tentang hubungan gangguan tidur dengan gangguan lambung/gastrointestinal. Slides ini dipresentasikan pada Konas Psikiatri Biologi dan Psikofarmakologi di Makassar 30 Juli 2015
This presentation is talking about the relationship between sleep disorder and gastrointestinal disorder. Presented in National Conference of Psychiatry Biology in Makassar, Indonesia July 30th,2015
Pandangan Ilmu Kedokteran Jiwa pada KESURUPAN Andri Andri
Kasus Kesurupan di Indonesia banyak dikaitkan dengan budaya. Presentasi ini mencoba melihat masalah kesurupan lebih kepada sudut pandang ilmiah. Presentasi ini disampaikan di Fakultas Psikologi Univ Mercubuana pada tanggal 23 Mei 2015
Developing Leadership Skills: Lessons Learned from Our TeachersAndri Andri
Developing Leadership Skills: Lessons Learned from Our Teachers
Maryland Pao, MD, FAPM
Clinical Director and Deputy Scientific Director, National Institute of Mental Health, National Institutes of Health, DHHS, Bethesda, Maryland
Donald L. Rosenstein, MD, FAPM
Director, Comprehensive Cancer Support Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Karen Johnson, MD, FAPM
Associate Chair, Department of Psychiatry; Director, Consult Liaison Services, Medstar Washington Hospital Center, Professor of Psychiatry Georgetown University School of Medicine, Washington, District of Columbia
Theodore Stern, MD, FAPM
Chief, Avery D. Weisman Psychiatry Consultation Service, Massachusetts General Hospital, Ned H. Cassem Professor of Psychiatry in the field of Psychosomatic Medicine/Consultation, Harvard Medical School, Boston, Massachusetts
As early career psychiatrists advance and reach the next level in their careers, they are called upon to lead programs and their respective academic fields. But what makes an effective leader? Are leaders born? Are leaders a product of the times? Can leadership be taught? Leaders in Psychosomatic Medicine will review the available evidence base and share their own experiences.
Dr. Maryland Pao will introduce evolving ideas of leadership from the business literature from Dale Carnegie's "How to win friends and influence people" to Jim Collins' "Good to Great" to Sheryl Sandberg's "Lean In". Dr. Donald Rosenstein will discuss the often neglected topic of unsung heroes, "Deputy Leadership". Dr. Karen Johnson will provide considerations regarding academic advancement in "Negotiating Institutions: Models for Promotion". Dr. Pao will talk about choices we make to lead or not in "Lean In, Lean Out: How do we choose?" Finally, Dr. Theodore Stern will talk on "What makes a leader an effective leader?" The panel will encourage audience participation and allow time for discussion.
Learning Objectives:
To describe at least 3 ideas used by business leaders in the last few decades and understand how they might apply to leadership in the field of Psychosomatic Medicine
To understand how emotional intelligence can facilitate effective leadership
To appreciate the critical role of deputy leadership in health care organizations
Model Attribute Check Company Auto PropertyCeline George
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The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
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Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
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Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
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Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
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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
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
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