Somatic symptom disorders: Clinical

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Somatic symptom disorders: Clinical

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A 59-year-old woman comes to the clinic for a follow-up following a left lower limb amputation 2 weeks ago. The limb was amputated below the knee due to diabetic complications, and was replaced with a prosthetic leg. The patient complains of distressing pains coming from the amputated limb, and has also experienced odd tingling and itchy sensations. After excluding potential causes such as ischemia, infection, and neuroma, a diagnosis of phantom limb syndrome is made. Which of the following is the most appropriate first-line pharmacotherapy for this patient?

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Somatic symptom disorders, formerly known as somatoform disorders, are unexplained physical symptoms that are recurrent and cause significant distress and impairment to someone’s daily life.

The exact cause of somatic symptom disorders isn't clear, but there may be biological causes like having an increased sensitivity to pain.

Many symptoms are also affected by a person’s emotional response to symptoms - so they’re affected by attitude and personality.

Some conditions may also be learned behaviors like learning that being sick attracts attention. And this can especially happen when a person develops the condition in early childhood.

Somatic symptom disorders are more commonly seen in people with a history of substance abuse, anxiety, and depression.

Somatic symptoms can be wide-ranging like pain, tingling, shortness of breath, to general fatigue and weakness.

In somatic symptom disorder, the history, physical exam, test results, and imaging are either normal or don’t explain a person's symptoms.

Often, in addition to the symptoms themselves, individuals have a lot of anxiety about the symptoms.

The complaints are recurrent and should occur for at least six months.

Finally, the symptoms should not be better explained by another mental disorder, and it should cause significant distress or impairment in all areas of functioning.

The seven conditions in the category in DSM-5 called somatic symptom and related disorders include somatic symptom disorder, illness anxiety disorder, conversion disorder, psychological factors affecting other medical conditions, factitious disorder, other specified somatic symptom and related disorder, and finally, unspecified somatic symptom and related disorder.

The most studied condition in this category is somatic symptom disorder.

First, individuals must have at least one somatic symptom which causes significant interference with daily life.

Second, they must have persistent and excessive thoughts, feelings, or behaviors related to the somatic symptoms as shown by at least one of the following three features: disproportionate thoughts about the seriousness of the symptoms, major anxiety about health or symptoms, and devoting excessive time and energy to them.



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