Somatic symptoms in consultation-liaison psychiatry

Abstract

In medically ill patients the term 'somatic symptoms' is used to understand those symptoms which cannot be fully understood in the light of existing medical illness(es). These include a number of physical symptoms and also certain clinical syndromes such as irritable bowel syndrome, fibromyalgia, and chronic fatigue syndrome among others. However, it is increasingly recognized that such patients have larger degrees of psychological morbidities, especially depressive and anxiety disorders, and have disproportionately elevated rates of medical care utilization, including outpatient visits, hospitalizations and total healthcare costs. In view of this psychological morbidity, significant distress and functional impairment, the role of the consultation-liaison psychiatrist is prominent in the management of these patients. A consultation-liaison (CL) psychiatrist is expected to be part of the primary care team to manage patient with unexplained SS, and at the same time is expected to guide colleagues to practice a patient-centred approach to improve the outcome of patients with such symptoms. The clinical work of a CL psychiatrist involves evaluation of patients with medically unexplained symptoms for probable psychiatric disorders and treatment of psychiatric morbidity and also management of patients without psychiatric morbidity. Management strategies include reattribution, cognitive behaviour therapy and antidepressants, with each strategy showing varying degrees of success.

Catatonia in the general hospital: a case series wading through diagnostic & management challenges

“…28 Referral rates to consultation liaison Psychiatry services depend on physician knowledge & attitudes on mental health issues of patients under their care (29-31). [29][30][31] As a start we need academic & research activity directed to yield an assessment of needs to guide future direction, with the aim of development of sustainable & contextualized Consultation Liaison Psychiatry services in public sector hospitals of Pakistan. We propose that Psychiatry needs to be integrated as an essential specialty to be taught & tested in professional exams in under-graduate medical education.…”

Differences of medically unexplained symptoms among patients of different ages and sexes in the psychological clinic of a general hospital and the influencing factors of MUS: A cross-sectional study

“…Studies have confirmed that the outpatient and inpatient costs of patients with MUS are high ( 38 ) and that direct and indirect expenditures are increased, especially for patients with severe MUS ( 31 ). The present study and a previous study ( 39 ) demonstrated that MUS were closely associated with psychosocial factors.…”

Investigating Attachment Insecurity and Somatosensory Amplification, and the Mediating Role of Interpersonal Problems

“…This does not imply dismissal of the legitimacy of somatosensory concerns, but rather to consider whether features of attachment anxiety and interpersonal sensitivity might exacerbate or perpetuate unhelpful aspects of symptom amplification. This could inform case formulation and intervention in work with patients who exhibit somatosensory amplification in the context of medically unexplained symptoms (Grover & Kate, 2013). Medical approaches, typically involving multiple examinations and laboratory tests, may be usefully supplemented by a psychosocial lens, particularly if psychosocial care can be integrated earlier in the investigation and intervention process (Chew-Graham et al, 2017).…”