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Somatoform disorder & psychosomatic disorder
1. Case example
• D, a ten-year-old, arrived in the eye clinic complaining his
vision was deteriorating. He was a bright boy and his family
looked worried. He had thorough medical assessments, and
was found to have reduced distance vision (6/18 in both
eyes). No medical cause for this sight loss was found.
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• He attended the eye clinic with his mother and father. It
transpired his parents were divorced and had remarried. D
lived with the stepfather he did not care for, and a new baby
half-sister. Towards the end of the consultation, the mother
volunteered that her father had a neurological disease. On
airing these difficult emotional issues, D then said “I see
better”. He left the clinic with his vision normal and age-
appropriate.
3. PAIN DISORDER
• Definition:
Preoccupation with pain in the absence of
physical disease. The pain doesn’t follow a
neuroanatomic distribution. [1]
• Epidemiology:
1 month prevalence is 0.15-1.26%, >Female [2]
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5. DSM IV diagnostic criteria for pain disorder
A. Pain in one or more anatomical sites is the predominant
focus of the clinical presentation and is of sufficient
severity to warrant clinical attention
B. The pain causes clinically significant distress or impairment
in social, occupational, or other important areas of
functioning.
C. Psychological factors are judged to have an important
role in the onset, severity, exacerbation, or maintenance
of the pain.
D. The symptom or deficit is not intentionally produced or
feigned.
E. The pain is not better accounted for by a Mood, Anxiety,
or Psychotic Disorder and does not meet criteria for
Dyspareunia.
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8. SOMATOFORM DISORDER NOS
• Cannot be classified in any category
• Duration is <6 months
• Examples:
- Pseudocyesis
- Fatigue or body weakness in less than 6 months and
not due to other mental illness
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13. • Examples:
- MDD delaying recovery from MI
- Anxiety exacerbating asthma
- Pathological denial of the need of surgery in
cancer patient
- Stress related exacerbation of ulcer
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14. Etiology
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A. Stress factors
Prolonged
stress +
organ that
genetically
vulnerable to
stress
B. Neurotransmitter
response
Catecolamines,
serotonin,
dopamine
C. Endocrine
response
Cortisol
D. Immune response
Cytokines
increase
glucocorticoids
E. Physiological
factors
General
adaption
syndrome;
stress affect
HPA axis
16. Case example
• D, a ten-year-old, arrived in the eye clinic complaining his
vision was deteriorating. He was a bright boy and his family
looked worried. He had thorough medical assessments, and
was found to have reduced distance vision (6/18 in both
eyes). No medical cause for this sight loss was found.
16
• He attended the eye clinic with his mother and father. It
transpired his parents were divorced and had remarried. D
lived with the stepfather he did not care for, and a new baby
half-sister. Towards the end of the consultation, the mother
volunteered that her father had a neurological disease. On
airing these difficult emotional issues, D then said “I see
better”. He left the clinic with his vision normal and age-
appropriate.
17. SUMMARY
• Pain disorder
- Preoccupation with pain in the absence of physical
disease.
- Treatment
• Undifferentiated somatoform disorder (≥6 months)
vs. somatoform disorder NOS (<6 months)
• Psychosomatic disorder
- Mind & body
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Biological
Psychosocial
18. THANK YOU
References:
1. KAPLAN & SADOCK; Pocket Handbook of Clinical Psychiatry 5th Edition
2. LIU, L., BI, B., QIN, X., WEI, S., WANG, W., LI, Y., JIN, Q., AI, L., PHILLIPS, M. R.
& DONG, G. 2012. The prevalence of somatoform disorders in internal
medicine outpatient departments of 23 general hospitals in Shenyang,
China. General Hospital Psychiatry
3. HIDAYAT, D., INGKIRIWANG, E., ANDRI, A., ASNAWI, E., WIDYA, R. S. &
SUSANTO, D. H. 2011. The Usage of Two Minutes Method (M2M) to
Determine Mental Disorder Prevalence in Primary Care. Journal of the
Indonesian Medical Association, 60.
4. DSM IV TR
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Specify either acute (<6 months) or chronic (≥6 months), pain disorder associated with psychological factor and general medical condition or only with psychological factor.
Avoid opioid (risk of abuse)
CBT:
To recognize what seems to make the pain worse
To develop ways of coping with the painful body sensations
To keep yourself more active, even if you still have the pain