Somatization disorder

Somatization disorder:

▪      The main features are multiple, recurrent, and frequently changing physical symptoms, which have usually been present for several years- before the patient is referred to a psychiatrist

▪      Most patients have a long and complicated history of contact with both primary and specialist medical services, during which many negative investigations or fruitless operations may have been carried out

▪      Symptoms may be referred to any part or system of the body, but gastrointestinal sensations (pain, belching, regurgitation, vomiting, nausea etc), and abnormal skin sensations (itching, burning, tingling, numbness, soreness etc) and blotchiness are among the commonest

▪      Sexual and menstrual complaints are also common          

Epidemiology:

▪      Lifetime prevalence in female varies form 0.2-2% and is <0 .2="" in="" men="" o:p="">

Etiology:

1. Familial factors:

▪      Genetic factors, environmental factors, or both can cause the familial aggregation; the risk to develop the disorder is 10-20% in female first-degree relatives

2. Neuro-physiological basis    

▪      Abnormalities in information processing system, loss of stimulus discrimination etc.

3. Socio-cultural factors   

▪      Degree of stigma associated with particular symptoms 

▪      Beliefs.

Diagnostic guidelines (ICD-10)   

A definite diagnosis requires the presence of all the following:

▪      At least 2 years of multiple and variable physical symptoms for which no adequate physical explanation has been found

▪      Persistent refusal to accept the advice or reassurance of several doctors that there is no physical explanation for the symptoms

▪      Some degree of impairment of social and family functioning attributable to the nature of the symptoms and resulting behavior     

Differential Diagnosis    

▪      Physical disorders (Multiple sclerosis, hypothyroidism, systemic lupus erythematosus, hyperparathyroidism, carcinoma pancreas)

▪      Affective and anxiety disorders

▪      Hypo chondriacal disorder

▪      Delusional disorders

Clinical  presentation

▪      Gastrointestinal symptoms [abdominal pain, bowel problems, nausea, vomiting, belching, regurgitation etc]

▪      Pain (extremities, back, joints etc)

▪      Conversion symptoms (pseudo seizures, fainting, in-coordination, loss of voice, difficulty in swallowing etc)

▪      Cardiac (chest pain, palpitation etc)

▪      Sexual and menstrual disturbances
Management  

1. Supportive psychotherapy: 

▪      The first step is the establishment of rapport and an empathic relation. In chronic cases symptoms reduction rather than complete cure might be a reasonable goal

2. Behavior modification

▪      Positive reinforcement may be given

3. Relaxation therapy :    

4. Drug therapy :

Antidepressants and /or benzodiazepines for short-term basis for associated depression and/or anxiety