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Somatization Disorder CASC Station

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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.  


 

    

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