20 years old female with complaints of nausea, vomiting and pain in the legs. Her physical examination and lab investigations are normal. What would be the most probable diagnosis ?
Somatoform pain disorder (may be) ??? Somatoform disorders The somatoform disorders are heterogenous group that have common presenting feature suggestive of physical illness, symptoms or preoccupation. As a feature of this group the symptoms are unexplained by general medical condition or are dispropoionate to symptoms that might be expected from a general medical condition. - To establish one of the these diagnosis the clinician must rule out accult physical disorders that might better explain the symptoms. Types of somatoform disoreders Category Key characteristics * Multiple symptoms - pain, gastrointestinal, sexual dysfunction Somatization * Symptoms vary over time disorder * Chronic condition-often with extensive treatment history * Not intentional * Symptoms affect voluntary motor or sensory system * Symptoms do not conform to neuroanatomic structures Conversion disorder * May reflect, symbolically, past or current stressor * Patient may not be upset by the symptoms * Not intentional * Chronic preoccupation with having a serious disease Hypochondriasis * Patient misattributes symptom or test results. * Preoccupation not solely due to affective status Body dysmorphic * Preoccupation with an imagined defect in physical appearance Disorder * May exaggerate mild anomay Chronic pain * Pain is the central anomaly Syndrome * May begin after specific injury * Can lead to serious functional impairment and medication overuse Somatization disorder Previously somatiation disorder was referred to as hysteria or Briquet's syndrome. It is a chronic fluctuating condition that usually begins after the age of 30 and extends over many years. The patient presents with multiple symptoms, including pain, gastrointestinal symtpmatology, neurologic symptoms and sexual dysfunction, which may vary considerably over time. He or she may have a long history of past extensive treatment including surgery. Typically, the patient seeks out multiple providers because of dissatisfaction with prior treatment, and may end up on complex combinations of medications because of frustration on the pa of both patient and physician Significant impairment in work and social. functioning are common Criteria for somatization disorder As described in the Diagnostic and statistical Manual-IV -Patients should have a history of pain in at least four different sites. - Two different gastrointestinal symptoms other than pain. - At least one sexual symptom, and one neurologic symptom. Conversion disorder Conversion disorder presents with deficits of the voluntary motor or sensory neurologic system and often mimic recognized neurologic or other medical conditions. As with somatization disorder the symptoms are not intentionally produced; often, the underlying psychological factors are expressed in physical symptoms. Common presentations include loss of sensation in a single limb or pa of a limb, double vision blindness, deafness, difficulty with swallowing and paralysis. On careful exam, the symptoms typically do not conform to recognized anatomic pathways. Pain disorders Pain disorders are characterized by a specific, predominant focus on pain as the presenting symptom. The pain usually does not .follow established anatomic patterns. However, if may be impossible to differentiate from established medical conditions such as lumbar disc disease. Although work-ups typically are negative, prior invasive treatment may lead to physical .findings that completely muddy the diagnosis. Indeed, pain disorders may develop after prior injury or treatment, which provides some pathophysiologic explanation. for the symptoms. Pain disorders may occur throughout the lifespan and are more common in women than man. The course may be persistent and lead to severe .functional impairment and extensive use of pain medication.
Generalized anxiety disorder
Conversion disorder
Somatoform pain disorder
Somatisation disorder