Classification of somatoform disorders (by ICD-10 code). Designation according to ICD-10 Comparison with DSM-IV* Criteria according to ICD-10 F45.0: somatization disorder1 DSM-IV 300.81: Somatization disorder Multiple symptoms or localization (≥ 6 out of ≥ 2 domains), occurring repeatedly and changing frequently For at least 2 years Course: chronic and fluctuating Frequent disturbances of social, interpersonal … Somatoform Disorders: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing) of the skin and mucous membranes. Auscultation (listening) of the heart [heart complaints]. Auscultation of the lungs Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive … Somatoform Disorders: Examination
There is no obligatory laboratory examination. Depending on clues in the history or physical examination, laboratory tests are performed as indicated.
Therapy target Improvement of the symptomatology Therapy recommendations Medications are prescribed in the therapy of somatoform disorder at most temporarily (four to six weeks at most) and not as the only form of therapy. Antidepressants should be used only in the presence of relevant psychological comorbidity Patients taking opioids or benzodiazepines should be attempted to … Somatoform Disorders: Drug Therapy
There is no obligatory medical device diagnosis. Medical device diagnostics are performed as indicated, depending on clues in the history or physical examination.
To prevent somatoform disorders, attention must be paid to reducing individual risk factors. Behavioral risk factors Stimulant use Alcohol (woman: > 40 g/day; man: > 60 g/day). Psycho-social situation Stress Disease-related risk factors Alcohol dependence Anxiety disorders Depression Personality disorders
The following symptoms and complaints may indicate somatoform disorder: Repeated presentation to the physician because of a wide variety of physical symptoms, but these symptoms are not physically justifiable The affected person is convinced of a physical cause of the symptomatology, however This leads to distrust of the doctor and thus often to increased changes … Somatoform Disorders: Symptoms, Complaints, Signs
Pathogenesis (development of disease) Somatoform disorders usually have a multifactorial genesis. Individuals with somatoform disorders often have psychosocial and/or sociocultural stress factors. In addition, trauma is also frequently present. In addition, comorbidities such as depression or anxiety/panic disorders are usually found in those affected. Etiology (causes) Biographical causes Ethnic minorities Socioeconomic factors Low socioeconomic status … Somatoform Disorders: Causes
The following are the most important diseases or complications that may be contributed to by somatoform disorders: Psyche – Nervous System (F00-F99; G00-G99). Psychological conflicts (in the private environment, or with the doctor).
Medical history (history of illness) represents an important component in the diagnosis of somatoform disorders. Family history Are there frequent mental health problems in your family? Social history Do you feel comfortable in your family, in your job? What is your profession? Is there any evidence of psychosocial stress or strain due to your family … Somatoform Disorders: Medical History
Psyche – Nervous System (F00-F99; G00-G99). Anxiety disorders Artificial disorder – feigning illness (Munchausen’s syndrome) to achieve a gain of illness. Hypochondriacal disorder – Strong belief of suffering from a serious illness, although the affected person is objectively physically healthy. Conversion disorder – Fixation on supposed neurological diseases. In addition to these mental illnesses, physically … Somatoform Disorders: Or something else? Differential Diagnosis
General measures A detailed history (taking of medical history) and physical examination should be performed to identify somatoform disorders. However, examinations that are not absolutely necessary should not be performed. Especially not if only the patient asks for them. Care should be provided with the help of a treatment plan Attention should be paid to … Somatoform Disorders: Therapy
