Somatic symptom disorder - Revision history

Mholtz: Text replacement - "* " to "*"

2017-07-24T01:13:35Z

Text replacement - "* " to "*"

ClaireLewis: /* Differential Diagnosis */

2017-07-12T18:33:10Z

Differential Diagnosis

← Older revision		Revision as of 18:33, 12 July 2017
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	** [[Fibromyalgia]]		** [[Fibromyalgia]]
	** Endocrine disorders		** Endocrine disorders
	*** [[~~hyperparathyroidism~~]]		*** [[Hyperparathyroidism]]
	*** ~~thyroid~~ disorders		*** [[Thyroid]] disorders
	*** [[Addison's disease]]		*** [[Addison's disease]]
	*** [[~~insulinoma~~]]		*** [[Insulinoma]]
	*** [[~~panhypopituitarism~~]]		*** [[Panhypopituitarism]]
	** Poisonings		** Poisonings
	*** [[~~botulism~~]]		*** [[Botulism]]
	*** [[Carbon_monoxide_toxicity\|carbon monoxide]]		*** [[Carbon_monoxide_toxicity\|carbon monoxide]]
	*** [[~~heavy~~ metals]]		*** [[Heavy metals]]
	** [[Porphyria]]		** [[Porphyria]]
	** [[Multiple sclerosis]]		** [[Multiple sclerosis]]

Mholtz at 01:11, 10 July 2017

2017-07-10T01:11:16Z

← Older revision		Revision as of 01:11, 10 July 2017
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	== Background ==		==Background==

	* Somatic symptoms associated with distress and impairment that cannot be medically explained		* Somatic symptoms associated with distress and impairment that cannot be medically explained
	** Most common symptom is pain — may be specific, generalized, or nonspecific (eg, [[fatigue]])		** Most common symptom is pain — may be specific, generalized, or nonspecific (eg, [[fatigue]])
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	** Less commonly encountered in psychiatric and other mental health settings		** Less commonly encountered in psychiatric and other mental health settings

	== Clinical Features ==		==Clinical Features==

	DSM-5 Diagnostic Criteria for Somatic Symptom Disorder<ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>		DSM-5 Diagnostic Criteria for Somatic Symptom Disorder<ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>

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	</ol>		</ol>

	== Differential Diagnosis ==		==Differential Diagnosis==

	* Medical conditions		* Medical conditions
	** [[Irritable bowel syndrome]]		** [[Irritable bowel syndrome]]
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	** [[Malingering]]		** [[Malingering]]

	== Evaluation ==		==Evaluation==

	* Screen for organic causes of symptoms		* Screen for organic causes of symptoms
	* Psychiatric consultation		* Psychiatric consultation

	== Management ==		==Management==

	=== Reassurance ===		===Reassurance===
	* May be successful in young patients with no underlying medical or psychiatric illnesses with clear psycho-social stress		* May be successful in young patients with no underlying medical or psychiatric illnesses with clear psycho-social stress
	* Unlikely to be successful in patients with chronic somatization		* Unlikely to be successful in patients with chronic somatization
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	*** Development of new side effects, allergic reactions, and symptoms		*** Development of new side effects, allergic reactions, and symptoms

	=== Legitimization of Symptoms ===		===Legitimization of Symptoms===
	* Listen and attempt to understand patient's experience		* Listen and attempt to understand patient's experience
	* Explain that patient's illness causes many symptoms but does not lead to medical deterioration		* Explain that patient's illness causes many symptoms but does not lead to medical deterioration
	* Offer only guarded projections about patient's condition → safeguards sick role → may limit illness behavior		* Offer only guarded projections about patient's condition → safeguards sick role → may limit illness behavior

	=== Diagnosis ===		===Diagnosis===
	* Clarify precise meaning of terms to avoid misinterpretation		* Clarify precise meaning of terms to avoid misinterpretation
	* Somatic responses and descriptions may be better accepted than purely psychiatric diagnoses		* Somatic responses and descriptions may be better accepted than purely psychiatric diagnoses
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	** "atypical pain", "multiple complaints following injury"		** "atypical pain", "multiple complaints following injury"

	=== Medications ===		===Medications===
	* Patient with somatic symptom disorder have a high affinity for medications and are reluctant to discontinue drugs, regardless of benefit		* Patient with somatic symptom disorder have a high affinity for medications and are reluctant to discontinue drugs, regardless of benefit
	** Prioritize lifestyle modification		** Prioritize lifestyle modification
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	* Antidepressants may be beneficial, including tricyclics		* Antidepressants may be beneficial, including tricyclics

	=== Mental Health Consultation ===		===Mental Health Consultation===
	* Patients resist psychiatric evaluation — threatens sick role		* Patients resist psychiatric evaluation — threatens sick role
	* Patients fear abandonment → reassure primary physician will continue caring for them		* Patients fear abandonment → reassure primary physician will continue caring for them
	* Patients may accept treatment as "stress management" or "education" that targets physical symptoms and somatic distress.		* Patients may accept treatment as "stress management" or "education" that targets physical symptoms and somatic distress.

	=== Physician Attitudes ===		===Physician Attitudes===
	* Focus on understanding patient's subjective experience		* Focus on understanding patient's subjective experience
	** Avoid telling patient nothing is wrong or symptoms require no treatment		** Avoid telling patient nothing is wrong or symptoms require no treatment
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	** Don't label as "difficult patient"		** Don't label as "difficult patient"

	=== Treatment Goals ===		===Treatment Goals===
	* Patients lack insight. Do not attempt insight-oriented psychotherapy.		* Patients lack insight. Do not attempt insight-oriented psychotherapy.
	* Do not promise or attempt cure — threatens sick role		* Do not promise or attempt cure — threatens sick role
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	** Better personal relationships		** Better personal relationships

	== Disposition==		==Disposition==

	* Provide appropriate psychiatric referrals.		* Provide appropriate psychiatric referrals.
	* Discharge with education and instructions.		* Discharge with education and instructions.
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	*** Reduce fear of abandonment		*** Reduce fear of abandonment

	== See Also ==		==See Also==
	*[[Factitious disorder]]		*[[Factitious disorder]]
	*[[Illness anxiety disorder]]		*[[Illness anxiety disorder]]
	*[[Conversion disorder]]		*[[Conversion disorder]]

	== External Links ==		==External Links==

	== References ==		==References==
	<references/>		<references/>

	[[Category:Psychiatry]]		[[Category:Psychiatry]]

Iaso: /* Disposition */

2017-02-23T13:10:07Z

Disposition

← Older revision		Revision as of 13:10, 23 February 2017
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	* Provide appropriate psychiatric referrals.		* Provide appropriate psychiatric referrals.
	* Discharge with education and instructions...		* Discharge with education and instructions.
	** There are no alarming findings		** There are no alarming findings
	** No further testing or medications are indicated ~~at this time~~		** No further testing or medications are indicated
	** Ongoing care and reassessment will be arranged		** Ongoing care and reassessment will be arranged
	* Follow up with primary-care physician ~~who~~ becomes ~~the~~ gatekeeper for all medical consultation and care.		* Follow up with primary-care physician — becomes gatekeeper for all medical consultation and care.
	** Avoid outpatient tests or hospitalization unless indicated by clear objective signs		** Avoid outpatient tests or hospitalization unless indicated by clear objective signs
	** Scheduled follow-up every 2-4 weeks ~~(on time-contingent basis~~)		** Scheduled follow-up on time-contingent basis (every 2-4 weeks)
	*** Reduce association between medical contact and necessity for escalation of illness behaviors		*** Reduce association between medical contact and necessity for escalation of illness behaviors
	*** Reduce fear of abandonment		*** Reduce fear of abandonment

Iaso: /* Evaluation, Management, Disposition */

2017-02-23T12:52:40Z

Evaluation, Management, Disposition

← Older revision		Revision as of 12:52, 23 February 2017
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	==Background==		== Background ==

	* Somatic symptoms associated with distress and impairment that cannot be medically explained		* Somatic symptoms associated with distress and impairment that cannot be medically explained
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	** Less commonly encountered in psychiatric and other mental health settings		** Less commonly encountered in psychiatric and other mental health settings

	==Clinical Features==		== Clinical Features ==

	DSM-5 Diagnostic Criteria for Somatic Symptom Disorder<ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>		DSM-5 Diagnostic Criteria for Somatic Symptom Disorder<ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>

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	</ol>		</ol>

	==Differential Diagnosis==		== Differential Diagnosis ==

	* Medical conditions		* Medical conditions
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	*** [[insulinoma]]		*** [[insulinoma]]
	*** [[panhypopituitarism]]		*** [[panhypopituitarism]]
	**Poisonings: [[botulism]], [[Carbon_monoxide_toxicity\|carbon monoxide]], [[heavy metals]]		** Poisonings
			*** [[botulism]]
			*** [[Carbon_monoxide_toxicity\|carbon monoxide]]
			*** [[heavy metals]]
	** [[Porphyria]]		** [[Porphyria]]
	** [[Multiple sclerosis]]		** [[Multiple sclerosis]]
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	** [[Malingering]]		** [[Malingering]]

	==Evaluation==		== Evaluation ==
	~~Difficult to diagnose, as often a diagnosis of exclusion. Refer to the patient's medical record~~ for ~~indication~~ of ~~repeated visits or recurrent testing.~~
			* Screen for organic causes of symptoms
			* Psychiatric consultation

	== Management ==		== Management ==

	* Screen for organic causes of symptoms
	* Psychiatric evaluation and management

	=== Reassurance ===		=== Reassurance ===
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	** Better personal relationships		** Better personal relationships

	==Disposition==		== Disposition==
	~~Home~~
			* Provide appropriate psychiatric referrals.
			* Discharge with education and instructions...
			** There are no alarming findings
			** No further testing or medications are indicated at this time
			** Ongoing care and reassessment will be arranged
			* Follow up with primary-care physician who becomes the gatekeeper for all medical consultation and care.
			** Avoid outpatient tests or hospitalization unless indicated by clear objective signs
			** Scheduled follow-up every 2-4 weeks (on time-contingent basis)
			*** Reduce association between medical contact and necessity for escalation of illness behaviors
			*** Reduce fear of abandonment

	==See Also==		== See Also ==
	*[[Factitious disorder]]		*[[Factitious disorder]]
	*[[Illness anxiety disorder]]		*[[Illness anxiety disorder]]
	*[[Conversion disorder]]		*[[Conversion disorder]]

	==External Links==		== External Links ==

	==References==		== References ==
	<references/>		<references/>

	[[Category:Psychiatry]]		[[Category:Psychiatry]]

Iaso: /* Management */

2017-02-23T12:37:59Z

Management

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 Difficult to diagnose, as often a diagnosis of exclusion. Refer to the patient's medical record for indication of repeated visits or recurrent testing.
-==Management==
+== Management ==
-Close outpatient psychotherapy focused on establishing and maintaining a relationship with the patient.
 ==Disposition==

Iaso: /* Differential Diagnosis */

2017-02-23T11:16:37Z

Differential Diagnosis

← Older revision		Revision as of 11:16, 23 February 2017
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	==Differential Diagnosis==		==Differential Diagnosis==

	* Medical ~~condition~~		* Medical conditions
	** [[Irritable bowel syndrome]]		** [[Irritable bowel syndrome]]
	** [[Fibromyalgia]]		** [[Fibromyalgia]]
	** ~~Diabetes~~, ~~heart~~ disease~~, etc~~		** Endocrine disorders
	* Psychiatric ~~condition~~		*** [[hyperparathyroidism]]
	** [[Panic disorder]]		*** thyroid disorders
			*** [[Addison's disease]]
			*** [[insulinoma]]
			*** [[panhypopituitarism]]
			**Poisonings: [[botulism]], [[Carbon_monoxide_toxicity\|carbon monoxide]], [[heavy metals]]
			** [[Porphyria]]
			** [[Multiple sclerosis]]
			** [[Systemic lupus erythematosus]]
			** [[Eponyms_(T-Z)#Wilson.27s_disease\|Wilson's disease]]
			** [[Myasthenia gravis]]
			** [[Eponyms_(F-L)#Guillain-Barr.C3.A9_syndrome\|Guillain-Barré syndrome]]
			** [[Uremia]]

			* Psychiatric conditions
			** [[Panic_attack\|Panic disorder]]
	** [[Generalized anxiety disorder]]		** [[Generalized anxiety disorder]]
	** [[Depression\|Depressive disorders]]		** [[Depression\|Depressive disorders]]

Iaso: /* Background */

2017-02-23T10:57:27Z

Background

← Older revision		Revision as of 10:57, 23 February 2017
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	==Background==		==Background==
	~~Disorder in which a patient experiences physical~~ symptoms ~~that suggest physical illness or injury, but~~ that cannot be explained ~~fully by~~ a ~~general~~ medical condition ~~or by the direct effect of a substance,~~ and ~~are not attributable to another~~ mental ~~disorder. Formerly known as somatoform disorder.~~
			* Somatic symptoms associated with distress and impairment that cannot be medically explained
			** Most common symptom is pain — may be specific, generalized, or nonspecific (eg, [[fatigue]])
			** May represent normal bodily sensations (eg, [[borborygmus]])
			** May occur concurrently or secondarily to a medical condition
			* Typically encountered in primary care and other medical settings
			** Less commonly encountered in psychiatric and other mental health settings

	==Clinical Features==		==Clinical Features==

Iaso: /* Differential Diagnosis */

2017-02-23T10:42:44Z

Differential Diagnosis

← Older revision		Revision as of 10:42, 23 February 2017
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	==Differential Diagnosis==		==Differential Diagnosis==
	*Panic disorder
	*Generalized anxiety disorder		* Medical condition
	*~~Depressive disorders~~		** [[Irritable bowel syndrome]]
	*[[~~Factitious disorder~~]]		** [[Fibromyalgia]]
	*~~Malingering~~		** Diabetes, heart disease, etc
	*[[Illness anxiety disorder]]		* Psychiatric condition
	*[[Conversion disorder]]		** [[Panic disorder]]
	*[[Delusional disorder]]		** [[Generalized anxiety disorder]]
	*Body dysmorphic disorder		** [[Depression\|Depressive disorders]]
	*Obsessive-compulsive disorder		** [[Illness anxiety disorder]]
			** [[Conversion disorder]]
			** [[Delusional disorder]]
			** [[Body dysmorphic disorder]]
			** [[Obsessive-compulsive disorder]]
			** [[Factitious disorder]]
			** [[Malingering]]

	==Evaluation==		==Evaluation==

Iaso: /* Clinical Features */

2017-02-23T10:26:52Z

Clinical Features

← Older revision		Revision as of 10:26, 23 February 2017
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	==Clinical Features==		==Clinical Features==
	*A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.<ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>		DSM-5 Diagnostic Criteria for Somatic Symptom Disorder<ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>
	*B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
	**1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.		<ol style="list-style-type: upper-alpha;">
	**2. Persistently high level of anxiety about health or symptoms.		<li>One or more somatic symptoms that are distressing or result in significant disruption of daily life.</li>
	**3. Excessive time and energy devoted to these symptoms or health concerns.		<li>Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:</li>
	*C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
			<ol style="list-style-type: numeral;">
			<li>Disproportionate and persistent thoughts about the seriousness of one’s symptoms.</li>
			<li>Persistently high level of anxiety about health or symptoms.</li>
			<li>Excessive time and energy devoted to these symptoms or health concerns.</li>
			</ol>

			<li>Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).</li>
			</ol>

	==Differential Diagnosis==		==Differential Diagnosis==