General psychopathology  © Tushnik Ghosh


B- Somatoform disorders



Somatoform disorder (F45) is a group of disorders characterized by physical symptoms. However, somatoform disorders represent a psychiatric condition. The physical symptoms present in this disorder cannot be fully explained by a medical disorder, substance use, or another mental disorder. Often, the medical symptoms patients experience may be from both medical and a psychiatric illnesses. Anxiety disorders and mood disorders commonly produce physical symptoms. These physical symptoms can dramatically improve with successful treatment of the anxiety or mood disorder. Mainly somatoform disorders include (1) somatization disorder, (2) conversion disorder, (3) pain disorder, (4) hypochondriasis and (5) dysmorphic disorder. In most somatoform disorder categories, a female preponderance exists. The female-to-male ratio has been estimated to be 10:1 for somatization disorder, from 2:1 to 5:1 for conversion disorder, 2:1 for pain disorder, and 1:1 for hypochondriasis. The common symptoms of somatoform disorders are: 1. Onset of unexplained medical symptoms in persons younger than 30 years. 2. Multiple and chronic complaints of unexplained physical symptoms. 3. Multiple pain symptoms involving multiple sites, such as the head, neck, back, stomach, and limbs. 4. Unexplained gastrointestinal symptoms, such as nausea and indigestion. 5. Sexual complaint and/or menstrual complaint. 6. Pseudoneurological symptom, such as blindness or inability to walk, speak, or move. 7. Preoccupation with fear of having a serious medical illness. 8. Bodily symptoms reported consistent with patient's conception of specific illness. 9. Preoccupation persists despite medical evaluation and reassurance. 10. One or more symptoms of loss of voluntary motor or sensory function, eg, inability to walk, sudden blindness, seizers (Conversion disorder: a somatoform disorder characterized by a sudden loss of neurological function, usually in the context of a severe stressor.). 11. Preoccupation with an imagined defect in appearance. 12. May be associated with multiple, frantic, and unsuccessful attempts to correct imagined defect by cosmetic surgery. Alcohol and drug abuse are common in patients with somatoform disorders. Patients may attempt to treat their somatic pain with alcohol or other drugs. Additionally, alcohol or drug intoxication or withdrawal may induce somatic symptoms of unclear etiology, unless the physician considers the potential role of substances.

Treatment: generally antidepressants are given. SSRI are more used than TCA due to less adverse effects. Tranquilizers are given to control acute conditions. Mild neuroleptics like thioridazine, low dose of clozapine, sulperide, periciazine are used for correction of behavior.


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