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Co mmon Psychiatric Problems in Family Practice Somatoform Disorders

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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Co mmon Psychiatric Problems in Family Practice Somatoform Disorders

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  1. 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

  2. Your most difficult patients ? Pain everywhere Comming every day Not improving / 33

  3. 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 / 33

  4. somatization desomatization resomatization / 33

  5. Definition Bodily symptoms without any organic, physical cause Lipowsky 1988 / 33

  6. Why important? • No explanatory organic cause can be found in 20-84% of patients presenting with bodily symptoms. / 33

  7. Epidemyology • More common among less educated and less income / 33

  8. Pathopysiology I. Increased bodily sensitivity Physical symptoms perceived are normal for most individuals / 33

  9. / 33

  10. Pathopysiology II. Defined patient Stress within the family stabilizes after the member bocomes “sick” / 33

  11. 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 / 33

  12. Pathopysiology IV. Dissociation Perceiving a stimulus which is not present • Phantom pain • Depersonalization • Flashback / 33

  13. Somatoform Disorders • Somatization • Conversion disorder • Hypochondriasis • Pain disorder • Body dysmorphic disorder / 33

  14. Conversion • Resemples a neurological problem • Motor or sensorial symptoms • Not explainable by neuroanatomy • “La belle indiference” • Females 10-35 years, • Lower socioeconomic class / 33

  15. Hypochondirasis • “Disease of having disease” • Severe anxiety • M/F=1 • No insight • Resistant, causing functional losses / 33

  16. Pain disorder • Main symptom is pain • M/F=1/2 • Pain increases with stress • Not explainable with nouroanatomy • Organic problem may be superimposed / 33

  17. Body Dysmorphic Disorder • Belives that there is a problem with appearance • Obsessive • M/F=1 • Frequent cosmetic surgery / 33

  18. 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 / 33

  19. / 33

  20. 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 / 33

  21. Symptoms might be exaggerated and irrational for us but they are REAL for the patient! / 33

  22. 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…” / 33

  23. 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 / 33

  24. Management – Regular visits • Frequent visits (15 min/month) • Short PE • Aim: • Prevent new symptoms • Decrease admissions to ER • Discuss open ended questions / 33

  25. 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. / 33

  26. 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... / 33 Stuart MR, Lieberman JA, 1993

  27. Management - Pharmacological • No specific medicine • Treat concomittant psychiatric problem • Deal with domiant symptom: • Pain Amitriptilline • Fatigue  Bupropion • Anxiety, sleep dist  SSRI, TCA / 33

  28. Management - Psychotherapy • Stress - somatic symptom relationship • Symptom diary • Group therapy / 33

  29. Management – Life style changes • Light exercises (3x20 min/w) • Increases self esteem • Yoga, meditation, walks • Non harmful methods: cold-warm applications, acupuncture, vitamins… / 33

  30. Management - Problems • Dont put goals you can not meet • Co-morbidity • Diagnositc requests • Emergency admissions • Phone calls / 33

  31. Concentrating on symptoms • It’s just in your • mind, take it • easy.. Unnecessary Referrals / cons. • Tests • or Rx without Dx / 33

  32. Concentrate on functions Allow patient role Frequent, short visits Single doctor / 33

  33. What did we learn? / 33

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