Monday, 10 April 2017

Somatic symptom and related disorders

Somatic symptom and related disorders are mental health disorders characterized by an intense focus on physical (somatic) symptoms, which cause significant distress and/or interfere with daily functioning.

Most mental health disorders are characterized by mental symptoms. That is, people have unusual or disturbing thoughts, moods, and/or behaviors. However, in somatic symptom disorders, the person's main concern is with physical (somatic—from soma , the Greek word for body) symptoms, such as pain, weakness, fatigue, nausea, or other bodily sensations. The person may or may not have a medical disorder that causes or contributes to the symptoms. However, when a medical disorder is present, the person responds to it excessively.

Everyone reacts on an emotional level when they have physical symptoms. However, people with a somatic symptom disorder have exceptionally intense thoughts, feelings, and behaviors in response to their symptoms. To distinguish a disorder from a normal reaction to feeling ill, the responses must be intense enough to cause significant distress to the person (and sometimes to others) and/or make it difficult for the person to function in daily life.
The different responses people have define the specific disorder they have, as in the following:

Conversion disorder, physical symptoms that resemble those of a nervous system (neurologic) disorder develop. The symptoms are commonly triggered by mental factors such as conflicts or other stresses.
  • An arm or leg may be paralyzed, or people may lose their sense of touch, sight, or hearing.
  • Many physical examinations and tests are usually done to make sure symptoms do not result from a physical disorder.
  • Reassurance from a supportive, trusted doctor can help, as can hypnosis and cognitive-behavioral therapy.
Conversion disorder is thought to be caused by mental factors, such as stress and conflict, which people with this disorder experience as (convert into) physical symptoms.

Although conversion disorder tends to develop during late childhood to early adulthood, it may appear at any age. The disorder appears to be more common among women.

Symptoms

The symptoms—such as paralysis of an arm or leg or loss of sensation in a part of the body—suggest nervous system dysfunction. Other symptoms may resemble a seizure or involve problems with thinking, difficulty swallowing, or loss of one of the special senses, such as vision or hearing.

Often, symptoms begin after some distressing social or psychologic event. Symptoms are not intentional. They are severe enough to cause substantial distress and to interfere with functioning.

People may have only one episode in their lifetime or episodes that occur sporadically. Usually, the episodes are brief.

Diagnosis

Doctors first check for physical, particularly neurologic, disorders that can account for the symptoms by taking a thorough medical history, doing a thorough physical examination, and doing tests. The key to the diagnosis is that symptoms do not match those caused by any neurologic disorder. For example, the person may tremble and think that the trembling is caused by a seizure disorder. But when the person is distracted, the trembling disappears. If people have a seizure disorder, distractions do not stop the trembling.

Once doctors determine that the symptoms do not match those caused by any neurologic disorder, doctors consider the diagnosis of conversion disorder. The diagnosis is made based on all the information from the evaluation.

Treatment

A supportive, trustful doctor-patient relationship is essential. The most helpful approach may involve collaboration of a primary care doctor with a psychiatrist and a doctor from another field, such as a neurologist or internist.

After the doctor rules out a possible physical disorder and reassures the person that the symptoms do not indicate a serious underlying disorder, the person may begin to feel better, and the symptoms may fade.

The following treatments may help:
  • Hypnosis may help by enabling people to control how stress and other mental states affect their bodily functions.
  • Microanalyses is a rarely used procedure similar to hypnosis except that people are given a sedative to make them drowsy.
  • Psychotherapy, including cognitive-behavioral therapy, is effective for some people.
Any other psychiatric disorders (such as depression) should be treated.

Case Study
Name
Julie Andresson
Age
15
Gender
Female
Father
James Hilton
Mother
Ankita
Sibling
8 sisters 1 brother
Birth order
7th
Education
5th class
Occupation
Student
Information

Name Ankita Sharma Age     50 years           Relation         Mother

Presenting complaints with duration
Complaint no
Complaint
Complaint duration
1
Unable to walk
5 months
2
Unable to speak correct
5 months
3
Weeping spells


History of present illness

Patient was in USOH 2 years back when she suffers from typhoid fever, constipation and loss of consciousness. She was taken to various hospitals and was treated. Complaints of fits and unconsciousness ended but complaints of on and off fever continued 7 to 8 months. Patient become bed ridden, unable to walk and was taken to hospitals 5 months back.

Patient become unconscious, she was unable to eat and to open her eyes. Spoon feeding was initiated and continued for 3 months ,patient also remained constipated.
Patient was adopted by her uncle ( Taya Abu) who at that time had no child.  Later the uncle got married again and has children. Patient thought that their love and attention was divided, although the patient did not admit it.

Medical history

Typhoid before 1 year.

Family history

She has 8 real sisters and 1 brother but she was adopted by her uncle. She was very happy with her aunt and uncle. She loved her cousins like real brothers and sisters. When she was in mayo hospital she missed her uncle and aunt. In hospital with her own mother she thought about her uncle and aunt. She said that her uncle and aunt are her real parents. She was not accepting her real mother and father as her real parents. . In hospital she said that her real sisters are fed up of her, they abuse her. They are behaving very badly during her illness. She wanted to see her uncle and aunt. She wanted to be her Aunt and Uncle and waiting for them.

Personal history

In personal history, client has good relation with the family who adopted her. She said that she has good friendship with her one of her eight sisters. She also stated that she takes suggestions from her that sister only. The client was a good student and a religious person.

School history

She was good student in school. Due to typhoid she leave the school in 5th class.

Forensic history

No forensic history

Attitude of self

Friendly and soft nature

Religious

Christian

Predominant mood

Good relation with sisters and brother

Leisure activities and interest

Playing video games , watching TV

Present socio economic circumstances

Lower

Mental states and examination

A young girl well oriented ,wearing shalwar, kameez and dupatta on her head, unable to walk, unable to sit, having no proper eye contact, as patient is unable to open her eyes.

Talking style
She was talking very slow
Rate rhythm , volume as unable

Mood
Normal

Objective Mood

Low

Mood responsiveness

Appropriate

Content of thought

None

General information (intelligence)

what is the color of our flag?

Abstract thinking

Difference between apple and ball?

Appropriate answer Insight

I have no any psychiatric problem I am not physical fit.
Psychiatric history

DIGNOSE

Conversion  300,11

Prognosis


Protective factor
Risk Factor
Personality


Environment
There may be a history of childhood abuse by her uncle and aunt. They send her back to her real parents. If she will think or see them again she will be again depressed.
Stress full life events
Age


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