Somatoform Disorders

Casebank History
1

Patient will present with lump or mole on hand or chest and worried about cancer

Take history of PC

Why worried for cancer

FLAWS

Do systemic review
PAF
DESA
Job?

Then ask about previous visits
Ask about do they understand whats going on?
Hows its affecting their life
What troubles them most about this situation
How they are handling
Access mood sleep work
Social hx support

Examine them
And thn explain and reassure
Tell them its something really difficult to understand at the moment
The relation between body and mind is not fully understood and sometimes stress and other mental health problems can cause physical symptoms that are really distressing

Tell them relaxation options
Yoga excercise lifestyle changes if you find anything in hx
And ask them if they are willing for talking therapy as it can help to understand the reason of their symptoms

Adress concerns
Show support

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2

Isn’t it hypochondriasis?

3

Yes it is! It’s also known as Hypochondriasis.

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4

Hypochondriasis is different where they keep on thinking and obsessing over a simple symptom

5

Oh is it? I’ll then research on both topic and share both cases later.

6

In Somatisation disorder there are multiple physical symptoms and they do so many investigations with no physical cause since the patient refuses to accept negative test results
In hypochondrial disorder patient persistantly believes that there is a serious underlying disease,so here also the patient refuses to accept reassurance or negative test results

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7

hypochondriasis is a type of somatoform disorder in wich patient obssively worries about getting a serious disease.it is also known as health anxiety
management
keep a diary of your symptoms/thoughts
write those thoughts down then challege those thoughts
keep yourself busy
yoga, meditation, exercise, counselling sessions
treat underlying anxiety and depresssion
CBT if above measures fail

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8

SOMATIC DISORDER
28 yr old man presented with a lump on chest and mole on hand
Had some investigation and everything came back normal
Now presented with a neck lump
Talk to the pt

Background info
Doctor Iam worried about cancer?
Is it cancer?
How you rule out it is not cancer?
Will you not take a sample?

Approach
Pt. I have cancer
Doctor. I can see that you look worried and anxious. Is there is any thing specific that make you feel that It is cancer?

  1. Explore presentening complain … when did you notice the lump? Where exactly the lump is? How big it is ? Is there any pain dischare bleeding from it? Have you developed any pain in the pasy?

  2. Family history of cancer

  3. Systemic reveiw
    Headache or fever?
    Cough or chest pain?
    Problem with you gut diarrhea constipation?
    Any problem with your waterworks?

  4. Ask about previous visits
    â—Ź I have going through your notes and I noticed ypu habe visited the practice twice in the last week.
    â—Ź can you please walk me through those two visits?
    What did they tell you what was wrong?
    Did they do any tests?
    Did they tell you the results of the tests?
    If No, tell that every test is normal

Now USE “BATHE” technique

BACKGROUNG > HOW WOULD YOU DESCRIBE WHAT IS HAPPENING OR GOING ON IN YOUR LIFE AT THE MOMENT ?

AFFECT > HOW DO YOU FEEL ABOUT WHATS HAPPENINH ?

TROUBLE > WHAT TROUBLES YOU THE MOST ABOUT THE SITUATION?

HANDLING > WHAT HELPS YOU HANDLE THIS SITUATIONS AND FEELINGS ?

EMPATHY > THIS IS TOUGH SITUATION TO BE IN. AND YOUR REACTION/ YOUR WORRY / YOUR CONCERN MAKES SENSE TO ME.

Effect of symptoms (panic)
Do you feel any chest pain ?
Shortness of breath?
Palpitations?
Tingling or numbness around mouth?
Feeling anxiety?

Sleep (has it affected? How many hours do you sleep?)

Job(what do you do for living? Has this situation affected you job)

Social life(has you talked to anyone in family or friends about it? Has this situation affected the way you spend your free time?)

Alcohol (do you smoke or drink alcohol? Would you say you have increased smoking or drinking since this started worrying you? )

MOOD ? SCALE? FOR HOW LONG YOUR MOOD HAVE BEEN LIKE THIS?

REFLECTION QUESTION

  1. WHAT DO YOU THINK ABOUT WHAT OTHER DOCTORS TOLD YOU IN THE LAST VISITS?
  2. WHAT DO YOU THINK ABOUT THE FACT THAT THE TESTS DONE LAST TIME CAME BACK NORMAL ?

EXAMINAION
NO LUMP
NO SWELLING
SOME SCRATH MARKS

DIAGNOSIS
all my examinations are normal and the tests that have been done last time were also normal.
This shows that there is no life threatening illness that could put your life at risk

But you have a serious and impairing condition that we do see very frequently but doesnt completely understood.

You have a worry that you may have cancer. This worry is affecting your health and quality of life.

Although there is no cure of this but we have some options which can help you deal with situation in a better way

  1. We can offer Counselling session known as cognative behaviour therapy that can help you cope with this. It can help you understand this condition and also give you strategies. Would that be ok if you could go to counselling sessions they can be really beneficial.

  2. We highly encourage you to exercise. It will help improve your worry.

  3. Let me reassure you that this is highly unlikely to be cancer. But we will call you on regular visits to test you time to time tp see everything is fine and there are no changes. And if there any, we can pick it up early.

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9

Somatization Disorder is a psychiatric condition where individuals experience chronic, multiple, and recurrent physical symptoms with no apparent medical cause. These symptoms often lead to excessive thoughts, feelings, and behaviors related to the health concern.

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