The reasons for an unjustified visit by patients with somatoform disorders to general practitioners

Abstract

Patients with somatoform disorders (SD) seek specialized psychiatric care late. Although many factors that prevent the timely visits by patients with SD for specialized psychiatric care are known, this problem requires further study.Objective: to analyze the role of information sources and iatrogenic factors in unreasonably selecting a specialist by patients with SD to visit him/her for primary medical advice.Patients and methods. Sixty-six women aged 19 to 40 years with new-onset SD (F 45.0) were examined. Two patient groups were identified: a study group of 41 patients (mean age, 31.5+1.2years) and a comparison group of 25 (mean age, 31.6+0.8years) (p>0.5). Primary care physicians had examined and treated the study group patients long (for 1 to 6 years) before their visit to a psychiatrist. The comparison group patients had been seen by a psychiatrist just in the first year of the disease.Anamnestic, clinical, andpsychopathological methods were used when examining the patients.Results and discussion. For their first visit, the patients with SD had selected a therapist and a neurologist more frequently and a cardiologist and an endocrinologist somewhat less frequently. This selection was also affected by the specialists' high titles, psychiatric consultation-avoiding behavior, and conversion mechanisms. Acquaintances' advice and Internet information as health information sources contribute to the unjustified revisits by these patients to primary medical specialists for a long time. Iatrogenic mechanisms were found to play a role in forming a false concept of a disease and destructive behavioral strategies leading to the chronization and progression of SD. Patients with SD who are long and ineffectively exposed to numerous diagnostic procedures and ineffective treatment in the primary health care need psychiatric counseling and psychotherapeutic support.Conclusion. The diagnosis of SD remains ineffective in an outpatient setting. There is a need for an educational program on SD within the continuing health education system.