Undifferentiated Somatoform Disorder

Somatoform disorders

Clinicals - History

Fact Explanation
Pain This is a common symptom at presentation. Patients may complain of abdominal pain, knee pain or limb pain, however there is no specific underlying cause. They have potential to be worsened by iatrogenic factors such as disturbed sleep . The symptoms can't be traced back to any physical cause. Symptoms are not the result of substance abuse or another mental illness. It may be result of repressed emotions or due to persistent psychological stress.
People with somatoform disorders are generally not faking their symptoms. The pain and other problems they experience are real. The symptoms can significantly affect daily functioning.
Pain
This is a common symptom at presentation. Patients may complain of abdominal pain, knee pain or limb pain, however there is no specific underlying cause. They have potential to be worsened by iatrogenic factors such as disturbed sleep . The symptoms can't be traced back to any physical cause. Symptoms are not the result of substance abuse or another mental illness. It may be result of repressed emotions or due to persistent psychological stress.
People with somatoform disorders are generally not faking their symptoms. The pain and other problems they experience are real. The symptoms can significantly affect daily functioning.
Fatigue This is common , and unexplained by other medical causes. Especially present as chronic fatigue syndrome.The symptoms can't be traced back to any physical cause, and they are not the result of substance abuse or another mental illness. Fatigue
This is common , and unexplained by other medical causes. Especially present as chronic fatigue syndrome.The symptoms can't be traced back to any physical cause, and they are not the result of substance abuse or another mental illness.
Loss of appetite Associated with loss of weight, is one of the common complaint The symptoms can't be traced back to any physical cause. And they are not the result of substance abuse or another mental illness. Loss of appetite
Associated with loss of weight, is one of the common complaint The symptoms can't be traced back to any physical cause. And they are not the result of substance abuse or another mental illness.
Gastrointestinal symptoms such as loose stools , constipation, early satiety, regurgitation etc. Gastrointestinal distress is a common presentation it often points towards medical diseases like Crohn's disease or Rectal Carcinoma. The symptoms can't be traced back to any physical cause. And they are not the result of substance abuse or another mental illness. Gastrointestinal symptoms such as loose stools , constipation, early satiety, regurgitation etc.
Gastrointestinal distress is a common presentation it often points towards medical diseases like Crohn's disease or Rectal Carcinoma. The symptoms can't be traced back to any physical cause. And they are not the result of substance abuse or another mental illness.
Urinary symptoms such as retention or frequency Non specified urinary symptoms such as retention, increased frequency are common presenting symptoms which often confused with lower urinary tract symptoms. , Urinary symptoms such as retention or frequency
Non specified urinary symptoms such as retention, increased frequency are common presenting symptoms which often confused with lower urinary tract symptoms. ,
Signs of pregnancy: including an expanding abdomen; feeling labor pains, nausea, breast changes, fetal movement; breast changes; and cessation of the menstrual period This is the mistaken belief of being pregnant based on other signs of pregnancy, this is known as pseudocyesis. The symptoms can't be traced back to any physical cause. And they are not the result of substance abuse or another mental illness. Signs of pregnancy: including an expanding abdomen; feeling labor pains, nausea, breast changes, fetal movement; breast changes; and cessation of the menstrual period
This is the mistaken belief of being pregnant based on other signs of pregnancy, this is known as pseudocyesis. The symptoms can't be traced back to any physical cause. And they are not the result of substance abuse or another mental illness.

Clinicals - Examination

Fact Explanation
General Appearance Normal General Appearance
Normal
Attitude and behaviour Attitude is appropriate
Behavior demonstrates preoccupation with physical complaints and symptoms
Attitude and behaviour
Attitude is appropriate
Behavior demonstrates preoccupation with physical complaints and symptoms
Speech Normal Speech
Normal
Mood Mildly anxious and depressed. Depression and anxiety are commonly associated with somatoform disorder Mood
Mildly anxious and depressed. Depression and anxiety are commonly associated with somatoform disorder
Thoughts form of thoughts and thought content are normal Thoughts
form of thoughts and thought content are normal
Perception Normal Perception
Normal
Attention and concentration- Within normal range. Can be tested by asking the patient to tell the days of week or months of year backwards, or with the serial sevens test. Attention and concentration-
Within normal range. Can be tested by asking the patient to tell the days of week or months of year backwards, or with the serial sevens test.
Memory Both long and short term memory are preserved and within normal range Memory
Both long and short term memory are preserved and within normal range
Orientation Oriented to time, place, and person Orientation
Oriented to time, place, and person
Insight impaired . Insight appears limited in that non medical causes of symptoms are not considered; however judgment appears unimpaired. Insight
impaired . Insight appears limited in that non medical causes of symptoms are not considered; however judgment appears unimpaired.

Investigations - Diagnosis

Fact Explanation
When patient presents with symptoms, relevant investigations should be carried out in order to exclude probable medical conditions that can cause a similar kind of presentation. Investigations should be tailored to the patient's presenting symptoms. In order to rule out an organic pathology. When patient presents with symptoms, relevant investigations should be carried out in order to exclude probable medical conditions that can cause a similar kind of presentation.
Investigations should be tailored to the patient's presenting symptoms. In order to rule out an organic pathology.

Management - Supportive

Fact Explanation
Deciding the treatment setting Usually patients with somatoform disorder present to the outpatients department setting or to a General Practitioner. Patients should be managed in the same setting with the involvement of a psychiatrist. Patients with somatoform disorder very rarely need in patient care. Deciding the treatment setting
Usually patients with somatoform disorder present to the outpatients department setting or to a General Practitioner. Patients should be managed in the same setting with the involvement of a psychiatrist. Patients with somatoform disorder very rarely need in patient care.
Educating the patient. The doctor should show a genuine interest and be empathetic , respectful as well as non judgemental. Doctor has to accept that there is a problem with the patient which can not be explained medically and carefully elaborate the fact that psychological stress can make the patient ill. Educating the patient.
The doctor should show a genuine interest and be empathetic , respectful as well as non judgemental. Doctor has to accept that there is a problem with the patient which can not be explained medically and carefully elaborate the fact that psychological stress can make the patient ill.
Treatment of coexisting psychiatrist disorder Depression and certain personality disorders co exist with somatoform disorders. Treatment for the underlying disorder is important Treatment of coexisting psychiatrist disorder
Depression and certain personality disorders co exist with somatoform disorders. Treatment for the underlying disorder is important
Minimising the risk Patients with somatoform disorder tend to engage in doctor shopping for purposes of seeking medical reassurance. The condition should be carefully explained and there should be a caring, supportive environment. Minimising the risk
Patients with somatoform disorder tend to engage in doctor shopping for purposes of seeking medical reassurance. The condition should be carefully explained and there should be a caring, supportive environment.
Supportive medications Supportive medications should be provided such as analgesics for pain or antispasmodics and antacids for abdominal discomfort, and short-term hypnotics for insomnia. Supportive medications
Supportive medications should be provided such as analgesics for pain or antispasmodics and antacids for abdominal discomfort, and short-term hypnotics for insomnia.

Management - Specific

Fact Explanation
Physiotherapy This is specially recommended for patients with musculoskeletal pain. Physiotherapy
This is specially recommended for patients with musculoskeletal pain.
SSRI's Combination of the serotonin reuptake inhibitors (SSRI) such as citalopram with the atypical antidepressant paliperidone is more effective than citalopram alone for the treatment of somatoform disorder. SSRI's
Combination of the serotonin reuptake inhibitors (SSRI) such as citalopram with the atypical antidepressant paliperidone is more effective than citalopram alone for the treatment of somatoform disorder.
Cognitive behaviour therapy Symptoms and anxiety about the symptoms arise from misinterpretation of bodily symptoms. Patients are taught to identify triggers , bodily symptoms and illness related thoughts. Cognitive behaviour therapy
Symptoms and anxiety about the symptoms arise from misinterpretation of bodily symptoms. Patients are taught to identify triggers , bodily symptoms and illness related thoughts.

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