EpistemisSomatization
Specialty: Psychiatry.
Why it occurs
- Primary somatic symptom disorder (formerly somatization disorder or Briquet)
- Generalized anxiety disorder
- Underlying major depressive disorder (masked depression)
- Conversion or dissociative disorder (loss of neurological function)
- Post-traumatic stress disorder (trauma somatization)
- Histrionic personality disorder
Initial workup
Exhaustive but rational screening for organic pathology (general analysis, basic immunology with ANA, PCR, ESR, thyroid hormones); avoid performing unnecessary invasive or “iastrogenic” tests that reinforce illness behavior; somatic symptoms assessment scale (PHQ-15).
red flags
Suspected malicious secondary gain versus actual undiagnosed organic medical pathology (e.g., early-onset multiple sclerosis, acute intermittent porphyria, systemic lupus erythematosus, pheochromocytoma).
Standard management
- Duloxetine — dual inhibitor with excellent profile for chronic somatoform pain and comorbid anxiety
- Amitriptyline — tricyclic at low doses, e.g. e.g., 10-25 mg at night, very useful in painful and tension somatizations
- Pregabalin — for the management of hypersensitivity to pain and generalized anxiety
- Escitalopram — to reduce hypervigilance to bodily sensations
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Psychiatry
- Listed causes
- 6
- Treatment options
- 4