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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.
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 ageappropriate.
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OUTLINE
Somatoform disorder - Pain disorder - Undifferentiated somatoform disorder - Somatoform disorder not otherwise specific (NOS)
Psychosomatic disorder
By: Siti Nurulismah
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PAIN DISORDER
Definition: Preoccupation with pain in the absence of physical disease. The pain doesnt follow a neuroanatomic distribution. [1]
Epidemiology: 1 month prevalence is 0.15-1.26%, >Female [2]
behavioral
Pain threshold
psychodynamics
Treatment:
Antidepressant Analgesia Psychoeducation Cognitive behavioral therapy Massage
Biological
Psychosocial
D S M I V
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PSYCHOSOMATIC DISORDER
Definition Psyche (mind) & Soma (body) Prevalence 12.5% [3]
Treatment
Etiology
Classification
Diagnosis
Hypertension
- Psychological theories: inhibit anger, guilt over hostile impulse, need to gain approval from authority - Acute stress, chronic stress - Hormonal changes
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Disease
Psychiatric symptoms
Impaired performance and behavior Dementia Myxedema madness; Delusional Paranoid Aggressive behavior Inability to function during attack
AIDS Hypothyroidism
Pheochromocytoma
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Diagnosis
DSM IV criteria for psychological factor affecting medical condition:
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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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Etiology
B. Neurotransmitter response Catecolamines, serotonin, dopamine
Treatment
Collaborative approach Biological Psychosocial
Supportive psychotherapy Dynamic insight oriented psychotherapy Group therapy Family therapy Cognitive behavioral therapy
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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.
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 ageappropriate.
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SUMMARY
Pain disorder
- Preoccupation with pain in the absence of physical disease. Biological - Treatment
Psychosocial
Undifferentiated somatoform disorder (6 months) vs. somatoform disorder NOS (<6 months)
Psychosomatic disorder
Mind & body
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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
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. DSM IV TR
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4.
THANK YOU
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