Skip to main content

Somatization Disorder CASC Station

By
You received a call from the medical department who requested you to see a 31-year-old lady who has been an in-patient for over two weeks. During her admission, she underwent investigations for persistent pain in her upper abdomen. She has been experiencing pain for the last two months. The physicians originally believed this was gastric or duodenal, but endoscopy was negative. After a comprehensive debate on the case, the medical team has opted to get a psychiatric opinion. Upon evaluation, you found that she has visited multiple clinics and has experienced wide-ranging manifestations and pains over the last two years. However, physicians have identified no source of her symptoms so far. She is worried about her physical symptoms but does not consider them as a warning sign of any serious underlying disease. On mental state examination, she has a low mood, hopelessness, sleeplessness, and reduced appetite. These mental state findings have been present for the last two months. 
 
How would you set out to educate the patient? 
What psychosocial explanations will you exemplify to explain how the symptoms are caused?
Who should take care of her?
In which case should the patient see a physician?
What advice will you give to the family regarding further investigations?
Supplemental Questions
What non-pharmacological treatments can help her?
What medication can help her?
  1. First tell her about the results of the investigations and why she has been sent here (ie the investigations are negative, and the physician thinks the symptoms may not be organic). Then tell her why it is important to look for other (psychiatric) causes.  
  2. Tension >> butterflies in the stomach, diarrhoea, headache, high blood pressure.  
  3. ONE Psychiatrist. Must avoid going to multiple should take care of her. 
  4. Only when new physical symptoms arise should the patient see a physician. 
  5. Advice regarding further investigations: when investigations are negative, they relief the patient and reinforce demands for more.  only if the physician considers important, they will advise in liaison with a psychiatrist.  
  6. CBT for pain, increasing activity, exercise.   
  7. Medications: TCAs, duloxetine, other antidepressants.  


 

    

Comments

Post a Comment

Your Thoughts?

Popular posts from this blog

ICD-11 Criteria for Single Episode Depressive Disorder (Depressive Episode) (6A70)

By
ICD-11 Criteria for Single Episode Depressive Disorder (Depressive Episode) (6A70) Single episode depressive disorder is characterised by the presence or history of one depressive episode when there is no history of prior depressive episodes. A depressive episode is characterised by a period of depressed mood or diminished interest in activities occurring most of the day, nearly every day during a period lasting at least two weeks accompanied by other symptoms such as difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue. There have never been any prior manic, hypomanic, or mixed episodes, which would indicate the presence of a bipolar disorder. Exclusions:              Recurrent depressive disorder (6A71) Adjustment disorder (6B43) Bipolar...
Post a Comment
Read more

ICD-11 Criteria for Depression (Recurrent Depressive Disorder) 6A71

By
ICD-11 Criteria for Depression (Recurrent Depressive Disorder) 6A71 Recurrent depressive disorder is characterised by a history or at least two depressive episodes separated by at least several months without significant mood disturbance. A depressive episode is characterised by a period of depressed mood or diminished interest in activities occurring most of the day, nearly every day during a period lasting at least two weeks accompanied by other symptoms such as difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue. There have never been any prior manic, hypomanic, or mixed episodes, which would indicate the presence of a Bipolar disorder. Inclusions:                Seasonal depressive disorder Exclusions:    ...
Post a Comment
Read more

ICD-11 Criteria for Bipolar Type-1 Disorder

By
ICD-11 Criteria for Bipolar Type-1 Disorder    6A60     Bipolar type I disorder is an episodic mood disorder defined by the occurrence of one or more manic or mixed episodes. A manic episode is an extreme mood state lasting at least one week unless shortened by a treatment intervention characterised by euphoria, irritability, or expansiveness, and by increased activity or a subjective experience of increased energy, accompanied by other characteristic symptoms such as rapid or pressured speech, flight of ideas, increased self-esteem or grandiosity, decreased need for sleep, distractibility, impulsive or reckless behaviour, and rapid changes among different mood states (i.e., mood lability). A mixed episode is characterised by the presence of several prominent manic and several prominent depressive symptoms consistent with those observed in manic episodes and depressive episodes, which either occur simultaneously or alternate very rapidly (from day to day or with...
Post a Comment
Read more