Overview of Somatization-Diagnosis and Management

Background: Neurologists and general practitioners frequently encounter patients with inexplicable; unintentionally produced somatic complaints otherwise known as somatoform disorders. Methods: A literature search was performed including MEDLINE; as well as local and international journals using the following keywords/ phrases and cross referencing: somatoform disorder; somatization; medically unexplained physical symptoms. Results: Illness with excessive somatic preoccupation is difficult to diagnose or categorize reliably due to rigid diagnostic criteria that often overlap with several psychiatric disorders. Conclusion: Management of patients with dysfunctional somatoform disorders is complex and challenging; particularly when initiated in a neurology outpatient or inpatient setting. The acronym CARE-MD represents a comprehensive treatment regimen that can be used to decrease physician and patient frustration; dramatically minimise health care over utilization; and improve overall well-being for patients with somatoform disorders

The Patient With Excessive Worry

Worry is a normal response to uncertainty. Education; empathetic support; reassurance; and passage of time usually ameliorate ordinary worries. However; these common-sense strategies for dealing with transient worries often prove ineffective for patients with excessive worry; many of whom meet the criteria for disorders in the Diagnostic and Statistical Manual of Mental Disorders; 4th ed. Evidence-based treatments for such disorders can assist family physicians in management of persistent worry as a self-perpetuating habit across diagnostic categories. Antidepressants and cognitive behavioural therapy are effective treatments for various disorders characterised by excessive worry. Cognitive behavioural strategies that may be adapted to primary care contacts include education about the worry process; repeated challenge of cognitive distortions and beliefs that underpin worry; behavioural exposure assignments (e.g.; scheduled worry periods; worry journals); and learning mindfulness meditation

Drug collectors at Chonde Health Centre

A survey of patients not really sick but who come to the hospital to collect drugs and to avoid work