project echo didactic on somatic symptom disorder 04022015

8162019 Project Echo Didactic on Somatic Symptom Disorder 04022015

httpslidepdfcomreaderfullproject-echo-didactic-on-somatic-symptom-disorder-04022015 125

Identifying and Treating Somatic SymptomDisorder in the Primary Care Setting

Presented by Ruth Tadesse MS RNDate 4$



Discosures and ampearning b(ecti)es

Learning Objectives

bullIdentify 3 common types of somatization seen in

primary care setting

bullKnow DSM criteria sed to diagnose SomaticSymptom Disorder

bullIdentify at east assessment toos sed to

diagnose somatic symptom disorder bullList at east $ treatment metods sed to manage

somatic symptom disorderamp

Disclosures Ruth Tadesse has nothing to disclose



istorica +acground and Changes from

DSM III to DSM $ -Dimsdae 0 et a 12

Somatoform Disorder Somatic Symptom Disorder

(irst introdced 3)yrs ago in DSMIII as Somatoform Disorder amp

Somatoform didnrsquot translate to another language well

DSMI + concept of medicay nepained symptoms were introdcedamp Is it unexplained or unexamined medical condition

DSM repaced Somatoform Disorder wit Somatic Symptom Disorder

and -eated Disorders

The symptoms may or may not be medically unexplained If the patient primarily had anxiety but not somatic complaints the

diagnosis would be Illness nxiety Disorder

ttpwwwampdsmamporgdocmentssomatic)symptom)disorder)fact)seetamppdf

Somatic Symptom Disorder (act Seetamppdf



Differences from DSM I3 to DSM $-Dimsdae 0 et a 12

D

DSM I3 Somatoform Disorder

Somatization Disorder

0ndifferentiated

Somatoform Disorder

1onversion Disorder

2ain Disorder ypocondriasis

4ody Dysmorpic Disorder

Somatoform Disorder 5OS

DSM $ Somatic Symptom

Disorder and reated disorders

Somatic Symptom Disorder

Iness 6niety Disorder

1onversion Disorder

2sycoogica factors affecting

a medica condition(actitios Disorder

Oter specific and nonspecific

somatic symptom disorders



Somatic Symptom Disorders and ther

Reated Disorders

ttpemedicineampmedscapeampcomartice7$7)8overview



Somatic Symptom Disorder )s Iness 5n6iety

Disorder -Croicu C et a 42

5pproach to the patient 7ith mutipe somatic symptomspdf



DSM $ Criteria for Somatic Symptom Disorder

6amp One or more somatic symptoms tat are distressing or rest in significant

disrption of daiy ifeamp

4amp 9cessive togts feeings beaviors reated to te somatic symptoms or

associated eat concerns as manifested by at east one of te foowing

lt Disproportionate and persistent togts abot te seriosness of

one=s symptomsamp

lt 2ersistenty ig eve of aniety abot eat or symptomsamp

3lt 9cessive time and energy devoted to tese symptoms or eat

concernsamp

1amp 6tog any one somatic symptom may not be continosy present te

state of being symptomatic is persistent more tan gt montsamp

6merican 2syciatric 6ssociation 626lt )3ltamp Diagnostic and Statistical anual of ental

Disordersamp t edamplt asington D1 6merican 2syciatric 6ssociation 2ressamp pamp 3)7+Aamp



Case Study 8 Ms +

Msamp 4 is a 3Ayearod woman wo presents to te

9D wit abdomina painamp Se reports tat se as sffered

from cronic pain since er adoescenceamp Se as a istory

of mtipe abdomina srgeries te most recent was for

pain fet de to adesionsamp Bese operations ave faied to

redce er compaints of painamp er pysica eamination

vita signs and abs incding 141 rinaysis andcemistry profie are witin norma imitsamp Se is referred

bacC to er primary care pysician for frter eaminationamp



Case Study 8 Ms +

bull If yo are er 212 wat more wod yo iCe to Cnow

bull at additiona testsscreenings wod yo iCe to do

bull at wi yo incde nder yor differentia diagnosis

bull at do yo tinC er f menta stats eamination

wod ooC iCe

bull at wi yo prescribe to treat Msamp 4Es cronic pain



Somatic Symptom Disorder Pathophysioogy

2atopysioogy is nCnown

6ssociated wit a eigtened awareness of norma

bodiy sensations wic maybe paired wit a cognitive

bias to interpret any pysica symptom as indicative ofmedica iness

Some tend to ave atonomic arosa

4rain imaging sows redced vome of amygdaa

1omorbidity + depressive disorders aniety disorders

sbstance se and personaity disordersSomatic compaints epidemioogy and psyciatric comorbidityamppdf

ttpemedicineampmedscapeampcomartice7$7)8overviewFa))$



Somatic Symptom Disorder 0pidemioogy

Somatic Symptom Disorder 2revaence

1ommnity sampe + )amp

Medica cart review sow prevaence rate in women

as ig as

Libera criteria rates as ig as ampgt

ypocondriasis in primary care $gt

) of patients presents in primary care wit pysica

symptoms as no diagnosabe disease (emaetoMae ratio is )

Symptoms say begin in cidood adoescence or

eary adtood

Somatic compaints epidemioogy and psyciatric comorbidityamppdf

ttpemedicineampmedscapeampcomartice7$7)8overviewFa)77



Common types of somati9ation seen in

primary care -Croicu C et a 42

5cute somati9ation

Bemporary prodction of pysica symptoms associated wit

transient stressors

amp Reapsing somati9ation

-epeated episodes of pysica symptoms associated wit

repetitive stressors G aniety or depressive episodes

1amp Chronic somati9ation 5eary continos somatic focs perception of i eat

deveopment of disabiity

6pproac to te patient wit mtipe somatic symptomsamppdf



5ssessing for Somatic Symptom Disorder sing

the 1Ps -Croicu C et a 42

Predisposing

1ronic cidood inesses cidood adversities

comorbid medica iness ifetime psyciatric diagnosis

poor coping abiity

Precipitating

Medica iness psyciatric disorder socia G occpation

stress and canges in socia spport

Perpetuating

1ronic stressors maadaptive coping sCis negative

eat abits and disabiity payments 6pproac to te patient wit mtipe somatic symptomsamppdf



5ssessing Menta eath in Patients 7ith SSD

using S4 Mode -acson et a 12

Stress recenty ast weeClt yesnolt

Symptom cont cecCist of somatic symptomsH

scored as positive if more tan symptomslt

1 Sefrated overa eat poor or fair on a pointscae

eceent very good good fair poorltH scored as

positive for fair or poor responsesamplt

4 Sefrated severity of symptoms from ) none at alt to

) nbearabelt scae scored as positive for responses

greater tan

1inica predictors of menta disorders among medica otpatientsamppdf

aidation of te S$ Modeamppdf



Identifying Somatic Symptom Disorder-Croicu C et a 42

bull Do a torog istory and detaied pysica assessment

bull -e ot medica iness

bull 1onsider medication side effects

bull Identify abiity to meet basic needsbull Identify secondary gains

bull Identify abiity to commnicate emotiona needs

bull Determine sbstance se

bull 4id terapetic aiance wit te patient

bull 0se screening toos appropriate for somatic symptom

disorder SSS8 and 2




The +5T0 Techniue

+ +acground at is going on in yor ife 6nd at

brings yo in ere today

5 5ffect + ow do yo fee abot tat

T Troube + at boters yo te most abot tis

sitation

anding ow are yo anding tat

0 0mpathy + Bat mst be very diffict for yoamp

Be 46B9 Metodamppdf




Plt$ Screening for Somatic Symptom

Presence and Se)erity

ttpwwwamppJscreenersampcominstrctionsinstrctionsamppdf

ttpwwwamppJscreenersampcompdfs)$29ngisamppdf



Somatic Symptom Scae 8 = gtSSS=

-Tabe is hyperined2



0ssentia Treatment 5pproaches for Patients

7ith Somatic Symptom Disorder -Croicu C et a 42

bull Scede timeimited regar appointments eampgamp $gt

weeCslt to address compaints

bull 9pain tat atog tere may not be a reason for teir

symptoms yo wi worC togeter to improve teirfnctioning as mc as possibe

bull 9dcate patients ow psycosocia stressors and

symptoms interact

bull 6void comments iCe or symptoms are apsycoogicaampN or Bere is noting wrong wit yo

medicayampN




0ssentia Treatment 5pproaches for Patients 7ith

Somatic Symptom Disorder -Croicu C et a 42

bull 6void te temptation to order nnecessary repetitive or

invasive investigations

bull 9dcate te patient on ow to cope wit teir symptoms

instead of focsing on a crebull 9vaate somatic symptom brden

bull 1oaborate wit te patient in setting treatment goas

bull Screen for common psyciatric conditions associated

wit somatic compaints sc as depression and aniety

bull Breat identified comorbid psyciatric disorders






bull 1ase management to minimize economic impact

bull Medications to treat aniety and depression SS-Islt

bull Sort term se of aniety meds dependence is a risClt

bull 5onparmacoogica treatments

bull 14B + Sows promising evidence

bull 2sycodynamic terapy

bull Integrative terapy


ttpwwwampsciencedirectampcomampiboffamposampedsciencearticepiiS))A$)))77



Summary

bull Sceding a regar visit wit te patient redces or

eiminates nnecessary 9D visitsamp

bull Identifying risCs sc as cidood trama can sggest

screening for somatic symptom disorders singappropriate assessment toos 2 G SSS8ltamp

bull Identifying screening for and treating common psyciatric

comorbidities sc as depression 27lt and aniety

P6DAlt can decrease somatic symptom brdenampbull 5onparmacoogica interventions sc as 14B as

sown evidence in decreasing somatic symptom disorderamp

bull Berapetic aiance wit te patient wit somatic

compaints improves otcomesamp



References

6merican 2syciatric 6ssociation )3ltamp Diagnostic and statistica mana of menta

disordersamp t editionamp 6merican 2syciatric 6ssociation 2ressamp

1roic 1amp 1wastiaC Lamp G Katon amp )$ltamp 6pproac to te patient wit mtipe somatic

symptomsamp edical linics of $orth mericaamp amp lt )A7)7amp

Dimsdae Qamp 9amp 1reed (amp 9scobar Qamp RLevenson Qamp )3ltamp Somatic symptom disorder 6n

important cange in DSMamp ournal of (scyhosomatic Researchamp )+- 38amp

DS Somatic Symptom Disorder act Sheet a0ailable online


PerC4amp KomannSamp KroenCe Kamp RLowe 4amp )$ltamp Be Somatic Symptom Scae8 SSS

8ltamp 6 4rief Measre of somatic symptom brdenamp Internal edicine 1)23lt 377

$)AampPierC 4amp Komann Samp Bossaint 6amp RLowe 4amp )$ltamp 6ssessing somatic symptom brdenamp

6 psycometric comparison of te 2atient eat estionnaire + 2lt and te

Somatic Symptom Scae 8SSS8lt



References Cont

QacCson QampLamp OEMaey 2amp G KroenCe Kamp 778ltamp 1inica 2redictors of Menta Disorders 6mong

Medica Otpatients aidation of te S$ Modeamp The ournal of onsultation and 3iaison

(sychiatry + lt $3+$3gtamp

KroenCe Kamp ))3ltamp 2atients presenting wit somatic compaints epidemioogy psyciatric

comorbidity and management International 4ournal of methods in psychiatric research amp15 lt

3$$3

KroenCe Kamp QacCson QampLamp G 1amberin Qamp 77Altamp Depressive and aniety disorders in patients

presenting wit pysica compaintsamp The merican ournal of edicine 16+ lt 337+3$Aamp

Martin 6amp -a 9amp (icter Mamp G -ief amp ))Altamp 6 Onesession treatment for patients sffering

from medicay nepained symptoms in primary care 6 randomized cinica triaamp

(sychosomaticsamp $8$lt 7$3)3amp

-avesteign amp ittCampf Kamp Lcassen 2amp Ree 1amp ))7ltamp Detecting somatoform disorders in

primary care wit te 2amp nnals of amily edicineamp A 338ampan Desse 5amp den 4oeft van der oden Qamp1amp Rvan MarwijC amp )$ltamp 5onparmacoogica

interventions for somatoform disorders and medicay nepained pysica symptoms M02Slt

in adtsamp ochrane Database Systematic Re0iew amplt oamp pamp1D)$1D)$



The 0nd

Peroamp

Series

4egins on

)$)7



Discosures and ampearning b(ecti)es

Learning Objectives

bullIdentify 3 common types of somatization seen in

primary care setting

bullKnow DSM criteria sed to diagnose SomaticSymptom Disorder

bullIdentify at east assessment toos sed to

diagnose somatic symptom disorder bullList at east $ treatment metods sed to manage

somatic symptom disorderamp

Disclosures Ruth Tadesse has nothing to disclose


















D



0ndifferentiated

Somatoform Disorder

1onversion Disorder








1onversion Disorder








Reated Disorders















one=s symptomsamp



concernsamp







Case Study 8 Ms +











Case Study 8 Ms +





wod ooC iCe




















as ig as






eary adtood







5cute somati9ation


transient stressors











Predisposing



poor coping abiity

Precipitating



Perpetuating















greater tan














disorder SSS8 and 2




The +5T0 Techniue





sitation



Be 46B9 Metodamppdf











-Tabe is hyperined2










symptoms interact


medicayampN






























Summary













References
















References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7


















D



0ndifferentiated

Somatoform Disorder

1onversion Disorder








1onversion Disorder








Reated Disorders















one=s symptomsamp



concernsamp







Case Study 8 Ms +











Case Study 8 Ms +





wod ooC iCe




















as ig as






eary adtood







5cute somati9ation


transient stressors











Predisposing



poor coping abiity

Precipitating



Perpetuating















greater tan














disorder SSS8 and 2




The +5T0 Techniue





sitation



Be 46B9 Metodamppdf











-Tabe is hyperined2










symptoms interact


medicayampN






























Summary













References
















References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7




Reated Disorders















one=s symptomsamp



concernsamp







Case Study 8 Ms +











Case Study 8 Ms +





wod ooC iCe




















as ig as






eary adtood







5cute somati9ation


transient stressors











Predisposing



poor coping abiity

Precipitating



Perpetuating















greater tan














disorder SSS8 and 2




The +5T0 Techniue





sitation



Be 46B9 Metodamppdf











-Tabe is hyperined2










symptoms interact


medicayampN






























Summary













References
















References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7














one=s symptomsamp



concernsamp







Case Study 8 Ms +











Case Study 8 Ms +





wod ooC iCe




















as ig as






eary adtood







5cute somati9ation


transient stressors











Predisposing



poor coping abiity

Precipitating



Perpetuating















greater tan














disorder SSS8 and 2




The +5T0 Techniue





sitation



Be 46B9 Metodamppdf











-Tabe is hyperined2










symptoms interact


medicayampN






























Summary













References
















References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7



Case Study 8 Ms +











Case Study 8 Ms +





wod ooC iCe




















as ig as






eary adtood







5cute somati9ation


transient stressors











Predisposing



poor coping abiity

Precipitating



Perpetuating















greater tan














disorder SSS8 and 2




The +5T0 Techniue





sitation



Be 46B9 Metodamppdf











-Tabe is hyperined2










symptoms interact


medicayampN






























Summary













References
















References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7



Case Study 8 Ms +





wod ooC iCe




















as ig as






eary adtood







5cute somati9ation


transient stressors











Predisposing



poor coping abiity

Precipitating



Perpetuating















greater tan














disorder SSS8 and 2




The +5T0 Techniue





sitation



Be 46B9 Metodamppdf











-Tabe is hyperined2










symptoms interact


medicayampN






























Summary













References
















References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7



















as ig as






eary adtood







5cute somati9ation


transient stressors











Predisposing



poor coping abiity

Precipitating



Perpetuating















greater tan














disorder SSS8 and 2




The +5T0 Techniue





sitation



Be 46B9 Metodamppdf











-Tabe is hyperined2










symptoms interact


medicayampN






























Summary













References
















References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7





5cute somati9ation


transient stressors











Predisposing



poor coping abiity

Precipitating



Perpetuating















greater tan














disorder SSS8 and 2




The +5T0 Techniue





sitation



Be 46B9 Metodamppdf











-Tabe is hyperined2










symptoms interact


medicayampN






























Summary













References
















References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7





Predisposing



poor coping abiity

Precipitating



Perpetuating















greater tan














disorder SSS8 and 2




The +5T0 Techniue





sitation



Be 46B9 Metodamppdf











-Tabe is hyperined2










symptoms interact


medicayampN






























Summary













References
















References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7













greater tan














disorder SSS8 and 2




The +5T0 Techniue





sitation



Be 46B9 Metodamppdf











-Tabe is hyperined2










symptoms interact


medicayampN






























Summary













References
















References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7












disorder SSS8 and 2




The +5T0 Techniue





sitation



Be 46B9 Metodamppdf











-Tabe is hyperined2










symptoms interact


medicayampN






























Summary













References
















References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7



The +5T0 Techniue





sitation



Be 46B9 Metodamppdf











-Tabe is hyperined2










symptoms interact


medicayampN






























Summary













References
















References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7










-Tabe is hyperined2










symptoms interact


medicayampN






























Summary













References
















References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7










symptoms interact


medicayampN






























Summary













References
















References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7





























Summary













References
















References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7



References
















References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7



References Cont






3$$3












The 0nd

Peroamp

Series

4egins on

)$)7



The 0nd

Peroamp

Series

4egins on

)$)7

project echo didactic on somatic symptom disorder 04022015

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