Somatic Symptom And Related Disorders Research Articles

63.0 Pathways and Protocols in Somatic Symptom and Related Disorders: Putting the Functional in Functional Disorders

We aim to present standardized approaches to working with patients with somatic symptom and related disorders (SSRD). We will review ways to assess needs and design interventions for care providers and families, which align with systems' changes in working with this vulnerable and challenging population

63.6 Four-Phase Systems Approach to Somatic Symptom and Related Disorders

Practice parameters for addressing somatic symptom and related disorders (SSRD) indicate that collaborative care is required, yet most institutions are not yet practicing in this way. This presentation will describe a systematic approach to SSRD using four phases, authored by Drs. Pirlot, Chapman, and De Souza in a new multidisciplinary integrated clinical pilot.

Case complexity in outpatients in a centre of excellence for somatic symptom disorder -a cross-sectional study-

Background: At the Clinical Centre of Excellence for Body, Mind and Health, integrated care models are used to provide treatment to patients with Somatic Symptom and Related Disorders (SSD). The aim of this study is to describe complexity of SSD patients using the INTERMED. This instrument has been developed for patients with chronic medical conditions. So far, it has not been used in a population with medically (un-)explained symptoms. Method: The INTERMED indicates case complexity according to the biopsychosocial model of health. It was used to measure case complexity in outpatients with SSD. In this cross-sectional study, data was collected retrospectively from patient files. A quantitative description of complexity will be provided with descriptive statistics and Pearson correlations of complexity scores and demographic variables. Results: Of the total sample (N = 262), 37.7% was male, mean (SD) age was 41.7 (13.2), with an average educational level. The mean INTERMED score was 24.1, indicating high overall complexity in this SSD population. More specifically, 72.6% of the scores indicated complexity to high complexity. The total score correlated significantly with high age (r = .20). Conclusion: The current study demonstrated that SSD patients are complex on multiple levels, indicating the need of individual case management and multi-disciplinary involvement. Compared to other studies, SSD patients were more complex compared to patients with rheumatoid arthritis (Mean < 20), complex regional pain syndrome (Mean = 19) and liver pre-transplant patients (Mean = 20). Patients with a combination of substance abuse, a medical condition and psychiatric illness were more complex than our SSD sample (Mean = 37). The results indicate that patients with SSD in a centre of excellence are highly complex. The INTERMED provides a comprehensive overview of patient functioning and can be used in clinical practice to investigate patient complexity. Further research should focus on its clinical use in psychiatric settings, its implementation, and its use in long-term monitoring of patient outcomes. Early examination of case complexity will contribute to improved case management, treatment selection, and multidisciplinary involvement. The current study emphasizes the need for integrated patient care for SSD patients, exceeding normal medical and psychiatric procedures.

Bullying Victimization in Medically Hospitalized Patients With Somatic Symptom and Related Disorders: Prevalence and Associated Factors.

The purpose of this study is to describe the prevalence of bullying victimization among medically admitted patients with somatic symptom and related disorders (SSDs) and to compare demographic, diagnostic, and psychosocial characteristics of bullied versus nonbullied patients. Medically admitted patients at a tertiary pediatric facility referred to the Psychiatry Consultation Service with somatic concerns were assessed via a quality improvement (QI) initiative, the SSD Standardized Clinical Assessment and Management Plan (SSD-SCAMP). Retrospective chart and QI data on adolescent and young adult patients assessed via SSD-SCAMP from May 2012 - December 2014 were reviewed. Medical records of 282 patients (aged 12-22 years) diagnosed with SSDs were reviewed. Approximately 37% had a history of bullying victimization. Compared with nonbullied patients, bullied patients had higher somatization scores, more functional neurologic symptoms, and longer admissions. Bullied patients also had higher rates of comorbid anxiety, suicidal histories, and family psychiatric histories. Furthermore, bullied patients also had higher rates of learning disabilities and school accommodations and endorsed more significant life events within the year before hospitalization. This study describes the unique health and psychosocial challenges experienced by medically hospitalized bullied adolescents and young adults with SSDs. The findings highlight the importance of a multidisciplinary approach to assessment and management. By implementing QI initiatives such as the SSD-SCAMP, providers can bridge the gap between the clinical needs and long-term management of patients with SSDs.

Electroconvulsive therapy treatment in patients with somatic symptom and related disorders.

ObjectiveMedically unexplained somatic complaints are highly prevalent, and lead to significant impairment and disability. The number of effective treatment modalities for somatic symptom and related disorders (SSDs) or somatoform disorders (SDs) remains limited. To date, there is no formal indication for electroconvulsive therapy (ECT) in SSD or SD. We report on the largest case series to date regarding the effectiveness of ECT in patients with SSD and SD.MethodsA retrospective chart review of all patients treated with an index course of ECT at the Neuropsychiatric Program at the University of British Columbia Hospital from 2000 to 2010 was conducted. The primary outcomes consisted of changes in pseudoneurologic symptoms, pain symptoms, cardiopulmonary symptoms, and gastrointestinal symptoms. Complaints were examined pre- and post-ECT.ResultsTwenty-eight participants were included in this study. Twenty-one participants received right unilateral ECT. Six received bifrontal ECT. One received bitemporal ECT. Eighteen of 21 participants reported improvement in pseudoneurologic symptoms; eleven of 14 participants reported improvement in pain symptoms; one participant reported improvement in cardiopulmonary symptoms; and one of two participants reported improvement in gastrointestinal symptoms. This paper discusses the putative mechanism of action of ECT in the treatment of SD/SSD.ConclusionThis retrospective study suggests that ECT could be included as part of the existing treatment for refractory SSD and SD, particularly in refractory cases with comorbid mood disorders.