Mental disorders - Research Paper Example

? Ashley Simpson Abnormal Psychology Somatoform disorder Human mind is an extremely complex organ and has uncountable relays and neuron transmitters that help in normal perception for any individual. Any slight problem in this relay system can affect health and normal activity. Somatoform disorder according to American Psychiatric Association (2000) is defined as mental disorder in which there are symptoms of physical illness or injury but they can’t be fully explained by a general medical condition and are not related to any other medical condition. The patient might present with severe pain in emergency room but detail assessment would rule out any possible medical condition associated with it. Such patients have to suffer a lot since most of the doctors consider somatoform disorder as they last diagnosis and patient has to undergo painful procedure of repeated tests and takes various medications for pain. Diagnostic and Statistical Manual for Mental Disorders Text Revision (DSM-IV-TR) classifies somatoform disorder into various types. They include somatization disorder, conversion disorder, pain disorder, hypochondriasis, and body dysmorphic disorder. It is indeed a challenge for any physician to differentiate them from related medical conditions clinically because they all present in a different manner clinically. Some of the terms such as somatization are proper diagnostic terms that are used specifically for this disorder whereas pain and conversion disorders are the commonly used terms that are manifest various types of anxiety and depression. There are various patho-physiological theories given for this disease. It might actually be the hypersensitivity of the normal physiological sensations that are usually inhibited through some neurons. Another theory suggests the role of autonomic nervous system in this disorder. It implies that autonomic nervous system send message of pain to peripheral nerves instead of transmission of that message to brain. This pain would be without any pathological cause apparently and hence would be terms as somatoform disorder. Due to increase autonomic stimulation, there will be increase in acitivity of other related systems that can cause increase pain perception such as causing tachycardia and hyper motility of gut. Several studies have also showed that some of the brain part is actually reduced in patients with this disorder which suggest some biological role as well. Amygdala size is especially considerably reduced which does show that some of this part is indeed involved and there is some solid biological basis for this disorder (Atmaca M 2011). The diagnosis of this disease can be made after proper ruling out all other related clinical conditions. It is very important to do this because only the treatment options for all these diseases are very different and specific medication would depend upon specific diagnosis. To begin with, there should be routine lab tests like blood Cp should be done. Megaloblastic anemia caused by vitamin B 12 deficiency causes also cause demyelization of spinal nerves and hence it is important to rule that out before going into further investigations. Hyperthyroidism also causes tachycardia and diarrhea so thyroid function tests which include thyroid stimulating hormone and thyroxin should be done. Levels of homovannillic acid (HVA), Vanillymandelic acid (VMA) and metanephrines and nor epinephrine plus epinephrine should be done with urine sample to rule out pheochromocytoma. There needs to be detail examination of blood sample to rule out alcoholism. Urine drug screening is also important because just like all the other differential diagnosis mentioned, they give a picture similar to Somatoform disorder. After doing all these investigations and ruling out all the possible biological causes for the symptoms, psychological assessment of the patient needs to be done in detail. That includes taking detailed history of all the past events in his life. Minnesota Multiphasic Personality Inventory (MMPI) has proved to be an important diagnostic tool for this problem and is now used on regular basis (William R Yates 2012). Imagining studies like MRI are helpful for ruling out any biological problem and a negative test would actually strengthen out diagnosis and we would be able to focus more on psychological treatment of patient. There are three types of interventions that can be done for this problem, drugs, psychological interventions and counseling. Benzodiazepines are used for initial phase as sedatives but their long term use is not supported. Electroconvulsive therapy is not effective primarily for this disorder but is effective in treatment of secondary depression that comes along with this. Psychosocial interventions have proved to be very effective for this treatment and various studies have shown that proper education for the patient from his psychiatrist has been effective in most of the patients (Martin A 2007). Behavior therapy and Psychosocial interventions by physicians are the primary needs of treatment for this patient. He should be well explained about the nature of his disease. His family members counseling needs to done so that they understand the true nature of disease and help the patient in recovery. There are specific management options for different specific types of disorders as well. Extensive research is being done on somatoform disorder today and it is also termed as one of the most common psychiatric problems around. There have been studies which question the validity of the current diagnostic tool for this disease (Bernd Lowe 2008). Moreover, studies are conducted to see the prevalence and new treatment options for the disease. The cost for the treatment of this disorder is also being kept under study (D. Russell Crane 2012). Public is also made aware of this disease and there have been several studies which check the validity of public awareness for this disorder (Annabel Nagel 2012). Bibliography American Psychiatric Association. Task Force on DSM-IV. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Pub. ISBN 978-0-89042-025-6. pp 485 Annabel Nagel, DiplPsych, Katharina Voigt, DiplPsych, Bjorn Meyer, Heide Glaesmer, Bernd Lowe and Elmar Brahler (2012). Public Familiarity With the Terms Somatoform Disorder and Functional Disorder in Germany: Results From a Representative Population Survey. Prim Care Companion CNS Disord.; 14(1): PCC.11m01209. Atmaca M, Sirlier B, Yildirim H, Kayali A.(2011) Hippocampus and amygdalar volumes in patients with somatization disorder. Prog Neuropsychopharmacol Biol Psychiatry. ;35(7):1699-703 Bernd Lowea, Christoph Mundtb, Wolfgang Herzoga, Romuald Brunnerc, Matthias Backenstrassb, Klaus Kronmullerb, Peter Henningsen (2008). Validity of Current Somatoform Disorder Diagnoses: Perspectives for Classification in DSM-V and ICD-11. Psychopathology;41:4-9 (DOI: 10.1159/000109949) D. Russell Crane, Lori B. Morton, David Fawcett, Adam Moore, Jeffry Larson, Jonathan Sandberg (2012). Somatoform Disorder: Treatment Utilization and Cost by Mental Health Professions. Contemporary Family Therapy, Volume 34, Issue 3, pp 322-333 Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) retrieved online from medscape. http://emedicine.medscape.com/article/294908-overview Martin A, Rauh E, Fichter M, Rief W (Jul-Aug 2007). A one-session treatment for patients suffering from medically unexplained symptoms in primary care: a randomized clinical trial. Psychosomatics.;48(4):294-303 William R Yates, Mohammed A Memon, Francisco Talavera, Harold H Harsch (2012). Somatoform Disorders Treatment & Management. Retrieved from medscape. http://emedicine.medscape.com/article/294908-treatment Read More