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Co mmon Psychiatric Problems in Family Practice Somatoform Disorders. Saudi Diploma in Family Medicine Center of Post Graduate Studies i n F amily M edicine. Dr. Zekeriya Aktürk zekeriya.akturk@gmail.com www.aile.net. Your most difficult patients ?. Pain everywhere. Comming every day.

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Presentation Transcript
slide1

Common Psychiatric Problems

in Family Practice

Somatoform Disorders

Saudi Diploma in Family Medicine

Center of Post Graduate Studies in Family Medicine

Dr. Zekeriya Aktürk

zekeriya.akturk@gmail.com

www.aile.net

/ 33

slide2

Your most difficult patients ?

Pain everywhere

Comming every day

Not improving

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aim objectives
Aim-Objectives
  • At the end of this session, the trainees will increase their knowledge in managing somatoform disorders
    • Explain the pathopysiology
    • List symptoms which might be somatic
    • List diagnostic criteria of somatoform disorders
    • Explain the management principles of somatisation
    • Categorize the somatoform disorders

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slide4

somatization

desomatization

resomatization

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definition
Definition

Bodily symptoms without any organic, physical cause

Lipowsky 1988

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slide6

Why important?

  • No explanatory organic cause can be found in 20-84% of patients presenting with bodily symptoms.

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epidemyology
Epidemyology
  • More common among less educated and less income

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pathopysiology
Pathopysiology

I. Increased bodily sensitivity

Physical symptoms perceived are normal for most individuals

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pathopysiology10
Pathopysiology

II. Defined patient

Stress within the family stabilizes after the member bocomes “sick”

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pathopysiology11
Pathopysiology

III. Need to be sick

Becoming physically sick is less stressfull than being unsuccessfull

“There is no medicine or

surgery to remove the

need to be sick”

Barsky,1997

BARSKY,1997

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pathopysiology12
Pathopysiology

IV. Dissociation

Perceiving a stimulus which is not present

  • Phantom pain
  • Depersonalization
  • Flashback

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somatoform disorders
Somatoform Disorders
  • Somatization
  • Conversion disorder
  • Hypochondriasis
  • Pain disorder
  • Body dysmorphic disorder

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conversion
Conversion
  • Resemples a neurological problem
  • Motor or sensorial symptoms
  • Not explainable by neuroanatomy
  • “La belle indiference”
  • Females 10-35 years,
  • Lower socioeconomic class

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hypochondirasis
Hypochondirasis
  • “Disease of having disease”
  • Severe anxiety
  • M/F=1
  • No insight
  • Resistant, causing functional losses

/ 33

pain disorder
Pain disorder
  • Main symptom is pain
  • M/F=1/2
  • Pain increases with stress
  • Not explainable with nouroanatomy
  • Organic problem may be superimposed

/ 33

body dysmorphic disorder
Body Dysmorphic Disorder
  • Belives that there is a problem with appearance
  • Obsessive
  • M/F=1
  • Frequent cosmetic surgery

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slide18

I

Organic cause?

Substance abuse?

Other psychiatric dis.?

yok

II

Neurological symptom

conversion

Pain disorder

III

Pain predominant

Too busy with disease

Hypochondriasis

IV

Many symptoms

Somatization dis.

V

Intentional symptoms

Malingering

VI

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diagnostic criteria
Diagnostic Criteria
  • At least three symptoms of uknown cause (generally in different systems)
  • Chronic course (more than two years)

Since too

long

Too many

systems

Too many

symptoms

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slide21

Symptoms might be

exaggerated and

irrational

for us but they are

REAL for the patient!

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management discuss the diagnosis
Management – Discuss the diagnosis

“We counldn’t find anything serious after the exam or investigations. But htere is something bothering you. Although the reason is not clear, this is a situation we face frequently…”

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management discuss the diagnosis23
Management – Discuss the diagnosis

What is my diagnosis:

“Better we should discuss how we can help you instead of the name. However, although there are a lot of names given, we frequently call this situation as “Somatoform disorder”

Chronique fatigue syndrome

Fibromyalgia

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management regular visits
Management – Regular visits
  • Frequent visits (15 min/month)
  • Short PE
  • Aim:
    • Prevent new symptoms
    • Decrease admissions to ER
  • Discuss open ended questions

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management regular visits25
Management – Regular visits
  • Don’t try to loose the symptoms, better try to teach how to deal with them
  • Patients expect more “care” than “cure”.
  • Patients expect continuous relationship.

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management bathe ing the patient
Management – BATHE’ing the patient

Background

How is your life going?

Affect

What do you feel?

Trouble

What is the most important problem?

Handle

What can help you?

Empathy

I understand you. This is a tough situation...

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Stuart MR, Lieberman JA, 1993

management pharmacological
Management - Pharmacological
  • No specific medicine
  • Treat concomittant psychiatric problem
  • Deal with domiant symptom:
    • Pain Amitriptilline
    • Fatigue  Bupropion
    • Anxiety, sleep dist  SSRI, TCA

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management psychotherapy
Management - Psychotherapy
  • Stress - somatic symptom relationship
  • Symptom diary
  • Group therapy

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management life style changes
Management – Life style changes
  • Light exercises (3x20 min/w)
  • Increases self esteem
  • Yoga, meditation, walks
  • Non harmful methods: cold-warm applications, acupuncture, vitamins…

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management problems
Management - Problems
  • Dont put goals you can not meet
  • Co-morbidity
  • Diagnositc requests
  • Emergency admissions
  • Phone calls

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slide31

Concentrating on

symptoms

  • It’s just in your
  • mind, take it
  • easy..

Unnecessary

Referrals / cons.

  • Tests
  • or Rx without Dx

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slide32

Concentrate on

functions

Allow patient role

Frequent, short visits

Single doctor

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