1 / 33

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.

salena
Télécharger la présentation

Co mmon Psychiatric Problems in Family Practice Somatoform Disorders

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related