Diagnostic outcome of patients referred to psychiatry with medically unexplained symptoms: a retrospective study

Objective: Medically unexplained symptoms (MUS) are commonly encountered in medical practice. In psychiatry; they are classified mostly as Somatoform Disorders and are often associated with anxiety and depression. The literature suggests that; in some cases; MUS may be ascribed to Somatoform Disorders when; fact; they are ""organic"" syndromes that are misdiagnosed. In developing countries; with fewer resources; MUS may be more difficult to assess. Method: We undertook a retrospective chart review to examine the demographics; referral pathway; management and diagnostic outcome of subjects (n = 50) referred to psychiatry with MUS over an 18 month period. Results: Subjects with MUS accounted for only 4.5of the total number of files reviewed. In only 38of cases did the final diagnosis in psychiatry concur with the referral diagnosis. In 28of cases a new ''organic"" diagnosis was made and in 72of cases a new psychiatric diagnosis was made. Subjects who were diagnosed with ""organic"" illness were seen fewer times prior to referral to psychiatry and were significantly older than other subjects. Conclusion: In developing countries like SA; a significant number of patients with MUS may have underlying ""organic"" illness; and most may have psychiatric disorders. Patients with MUS; especially older patients; should be more extensively investigated. Psychiatric referral of these patients is very appropriate."

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

Phychiatric problems of the blind: Anxiety; Somatoform; and Depressive Disorders. Menelik II Hospital; Addis Ababa; Ethiopia

Objective: To determine the magnitude of anxiety; somatoform and depressive disorders among blind people. Methods: All blind patients (according to WHO definition) who attended the Out Patient Clinics; Ophthalmology Department; Menelik II Hospital; Addis Ababa; Ethiopia; from October 2000-February 2001; were interviewed using a fully structured instrument (Composite International Diagnostic Interview (CIDI) core version 2.1). Results: 107 patients with visual loss were included in the study. Six (5.6) had acute onset versus 101 (94.4) with gradual onset. 48 (44.9) had been blind for more than one year. The most common cause of blindness was cataract (n=59; 55.1); followed by glaucoma (n=20; 18.7) and retinal detachment (n=12; 11.2). Only 5 (4.7) patients had psychiatric morbidity. Generalized anxiety disorder; depressive disorder and somatoform disorder each constituted one case. Two patients had dysthymia and one patient had social phobia. Conclusion: The reported prevalence of psychiatric problems among the blind in this study is way below those of other studies conducted in medical settings as well as in the general population. Further studies to determine the magnitude of psychiatric problems among blind people by using instruments with Amharic version of known validity are recommended; and the need to establish validity of the Amharic version of CIDI is stressed