This document discusses psychosomatic medicine, which explores the relationships between social, psychological, and behavioral factors on physical health and quality of life. It addresses how patients often present somatic symptoms to doctors without an identifiable organic cause, which can be distressing for both parties. Psychosomatic medicine aims to understand these medically unexplained symptoms and how to best assess and treat the underlying psychological issues like depression or anxiety that may be contributing. Common conditions include somatic symptom disorder, illness anxiety disorder, conversion disorder, and factitious disorder. The document examines the role of doctors in responding to patients' concerns and avoiding unnecessary or risky medical interventions when no underlying disease is found.

1. Psychosomatic medicine

2. “I have a headache…I must have a brain
tumor!”

3.  It is an interdisciplinary medical field
exploring the relationships among
social, psychological, and behavioral
factors on bodily processes and quality
of life
 Consists of distressing somatic
symptoms with abnormal thoughts,
feelings and behaviours in response
to those symptoms

4.  A substantial proportion of patients
resenting to primary care, or to any
individual hospital specialty, will have
symptoms for which, after adequate
investigation, no cause can be found.

5.  Non-specific symptoms without underlying
organic pathology are very common and
usually transient.
 Where they become prolonged enough to
merit medical attention they may present
to any specialty, with presentations such
as pain, loss/disturbance of function, and
altered sensation.

6. Kroenke et al Am J Med 1989

8. Patients present to doctors with
illness (symptoms and behaviours)
doctors diagnose and treat disease
(pathology and other recognized
syndromes)
The ‘problem’ of MUS arises, in part, from the different
meanings symptoms hold for patient and doctor

9.  If there is no recognized diagnosis
available the doctor may respond with
‘there’s nothing wrong’, expecting to be
met with pleasure!!!!!

11. Examining the role of
doctors

12.  GP somatic interventions related to
 negative view of self
 positive view of others
 i.e. more likely if GP values patient, values
somatic interventions, devalues own
psychological skills.
 Salmon et al, Gen Hosp Psych 2008

13.  Ability to assess and treat the frequently
comorbid depressive/anxiety symptoms
 A tolerance for diagnostic uncertainty
 Ability to take a long-term view of
improvements.

14.  A long-held belief was that, despite
repeated negative findings, all such
patients (or a majority) would eventually
be found to suffer from an organic
disease
 This concern was largely based on
older, poorly conducted studies with
significant methodological flaws.

15. excess negative
investigations
Irradiation
operative procedures
Those disorders associated
with chronic pain carry the
risk of iatrogenic opiate
dependency.

18.  Symptoms directly related to psychiatric disorders,
such as depression, anxiety disorders, or psychosis.
 Functional somatic illness(atypical chest pain, CFS,
IBS, fibromyalgia, hyperventilation syndrome, tension
headache).
 Conversion and dissociative disorders (functional
neurological disorder)
 Pain disorders.
 Somatization disorder (somatic symptom disorder).
 Factitious disorder.
 Malingering.
 Uncommon medical syndromes which have not yet
been diagnosed.

19. Somatic Symptom Disorder
• Combination of somatization,
pain disorder and
hypochondriasis
• Presence of Symptom,
medically explained or not
• Health Concern is a central
role in their life.

20. Illness Anxiety Disorder
 Formerly Hypochondriasis
 Excessive worry or reaction on
physical symptoms
 Not normal health concerns

21. Conversion
Disorder
 Functional neurological
symptoms disorder
 Freud’s Conversion hysteria
 Dramatic loss of function
resembling a serious
neurological disorder.

22. Factitious Disorder
 a form of mental illness where an
individual will deliberately
produce, or exaggerate
symptoms in order to gain
sympathy and attention.
 Divided into:
 Imposed on self
 Imposed on another (Previously
by proxy)

23. To be continued…