Undifferentiated somatoform disorder. This category should be used when somatic complaints are numerous, variable and durable, but at the same time a complete and typical clinical picture of somatisation disorder is not detected. For example, it may not be a pushy and dramatic presentation of complaints, the latter may be relatively few in number or may be entirely absent violation of social and family functioning. Presumption of psychological condition may occur, or might not, but there should be no physical basis for psychiatric diagnosis.
Symptoms of undifferentiated somatoform disorder
Symptoms are resembling physical illness, but despite this constant complaints of excessive detail, are vague, imprecise and inconsistent in time. Somatic framed emotional instability, anxiety, depressed mood, do not reach the level of depression, the decline of physical and mental powers, in addition, are often irritable, there is a feeling of inner tension and frustration. Exacerbation of the disease is provoked not by exercise or change in weather conditions, but by emotionally significant stress.
Diagnosis of undifferentiated somatoform disorder
The presence of multiple, changing physical symptoms in the absence of any systemic diseases that could explain these symptoms
The constant concern about the symptom leading to prolonged or multiple (3 or more) suffering Consultation and surveys in the outpatient service, with advice on the unavailability for any reason Persistent refusal to accept medical opinion that there is insufficient physical causes of available symptoms or only short-term agreement with them (up to several weeks).
Undifferentiated somatoform disorder can be diagnosed when the minimum duration of symptoms is reduced to 6 months, when it is fully met the criteria 1 and 3, criterion 2 can be only partially
Important differentiation with the following disorders
Somatic disorders. Most difficult is to differentiate somatoform disorder of some systemic diseases such as multiple sclerosis, systemic lupus erythematosus, etc., beginning with nonspecific, transient symptoms. Here, the diagnosis must be extracted from a set of clinical symptoms, those which are characteristic of these diseases. For example, multiple sclerosis often begins with a transient motor, sensory (paresthesia), and visual disturbances. In hyperparathyroidism can occur osteoporosis (loosening and tooth loss) and systemic lupus erythematosus often begins with fever, which gradually joins polyserositis.
However, the likelihood of an independent somatic disorders in these patients is not lower than that of ordinary people in the same age. Particular attention must be accorded in the event of a change in emphasis in the complaints of patients or their stability when you need to continue investigations.
Affective (depressive) and anxiety disorders. Depression and anxiety is often accompany varying degrees of somatisation disorders, but they should not be described separately except in cases where they are quite obvious and stable in order to justify their own diagnosis. The appearance of multiple somatic symptoms after the age of 40 years may indicate a primary manifestation of a depressive disorder.
Hypochondriacal disorder. In somatisation disorder it focuses on the symptoms themselves and their individual manifestation, whereas in hypochondriacal disorder, attention is focused more on the alleged existence of a progressive and serious disease process and its debilitating effects. In hypochondriacal disorder patients often asked about the survey in order to confirm the nature of the alleged disease, whereas patients with somatisation disorder treatment requests in order to remove the existing symptoms. In somatisation disorder patients usually have excessive use of drugs, whereas patients with hypochondriacal disorder, fear drugs, their side effects and seek support and reassurance through frequent visits to various doctors.
Delusional disorders (such as schizophrenia with somatic delusions and depressive disorders with hypochondriacal ideas). Bizarre particular ideas, are combined with a smaller number of them and a more permanent nature of the physical symptoms – the most typical of the delusional disorders.
Longer (2 years) and more intensely marked symptoms are diagnosed as somatoform disorder.
Treatment of undifferentiated somatoform disorder
The main role belongs to the treatment of psychotherapy. Pharmacotherapy aims to create opportunities and psychotherapy is conducted to correct symptoms. The choice of drugs in each case is determined by the characteristics of symptoms and associated symptoms. Pharmacotherapy for the following groups of drugs: drugs of choice are antidepressants (tricyclics and SSRI) drugs, the second choice are beta-blockers and mood stabilizers, in the initial stages of treatment, the combination of antidepressant with benzodiazepine, antipsychotic drugs are also used with a sedative effect, as reserve drugs in severe anxiety, which can not be cut short are benzodiazepines. In addition, the treatment of somatoform disorders should be supplemented with vasoactive, nootropic drugs and vegetostabilisers.