1.  General guidelines about somatoform disorder

Repeated presentation of physical symptoms, together with persistent requests for medical investigations, in spite of repeated negative findings and reassurances by doctors that the symptoms have no physical basis.

Ø  If a person has one or more distressing symptoms for more than 6 months, then he/she has somatoform disorder. (DSM V)

·       Disproportionate & persistent thought about physical symptoms.

·       Persistently high level of anxiety about health or symptoms.

·       Excessive time & energy devoted to these symptoms or health concerns.

History taking and examination including MSE                                                                                                            Annexure 1 Special emphasis

·       Medical history

2.     a) Investigations required

i.                Psychometric investigations:

ii.                Laboratory: (if physical complications are present)

a)     Comorbidity – Major depressive disorder, generalized anxiety disorder and panic disorder.

b)    Differential Diagnosis – Hypochondriacal delusions. In addition, the presence of unpleasant and frightening physical sensations can be regarded as a culturally acceptable explanation for the development and persistence of a conviction of physical illness.

3.  Treatment

a)     Psychopharmacology

·       Treatment with SSRI's and if accompanied with anxiety - Benzodiazepine

·       Symptomatic and supportive

Treatment of Somatoform Disorders

Somatoform disorders are difficult to treat as patients often cling to the belief that their symptoms have an underlying physical cause. Reassurance by a doctor does not usually help as they feel their doctors cannot find the cause for their symptoms.

A strong doctor-patient relationship is a key to getting help in patients with somatoform disorders. Seeing a single health care provider with experience managing somatoform disorders can help cut down on unnecessary tests and treatment (Box-2). The focus of treatment is on improving daily functioning, not on managing symptoms. Stress reduction is often an important part of getting better. Stress management techniques, Counseling for family and friends, Promotion of self-care activities, relaxation and breathing exercises, Lifestyles change and occupational counseling may be useful and can be done at primary level. Medications do not have much of a role except if the disorder is associated with underlying mental illnesses such as depression, anxiety or substance abuse. Still, antidepressants such as amitriptyline, imipramine and selective serotonin reuptake inhibitors (SSRIs) along with short-term anti- anxiety agents such as benzodiazepines have been found effective.

Specific treatments for somatoform disorders

-        General advice Lifestyle change Relaxation

-        Drug treatments

Antidepressants

Anti-Anxiety drugs (short duration)

-        Occupational and social

Occupational counseling

Problem solving for social problems

-        Psychological treatment

Cognitive-behavioral and other therapies

b)     Psychosocial Intervention – nature of illness, etiology, progression, consequences, prognosis, treatment.

c)     Psychoeducation – nature of illness, etiology, progression, consequences, prognosis, treatment.

Psychotherapy

i.          Relaxation Techniques

ii.          Cognitive Behavioural Therapy (CBT) -It help you to change unhelpful or unhealthy ways of thinking, feeling and behaving.

i.            Family counselling

ii.            Physical Activity / Activity Scheduling

ü  Exercising: Playing tennis, golf or basketball, going to the gym, or getting out for a hike

ü  Nurturing relationships: Going out to dinner, seeing a movie, or attending a play with friends or family

ü  Self-education: going to the library, reading more

ü  Participating in hobbies: Taking a cooking class, learning how to knit or paint, or learning to play an instrument

ü  Expanding self-care: Learning mindfulness techniques, practicing relaxation therapy, visualizing, or doing yoga

a)     Combined Treatment

4.  Follow-up

a.  Psychiatry opd/ DMHP

b.  Physical check-up at OPD

c.  Through telephonic conversation TeleManas14416/18008914416

5.  Referrals

a)     Depending upon the severity and complications of the patient, he/she may need to be referred to Psychiatry department.

b)     To TeleManas

c)     To the nearest DMHP

d)     To psychiatry OPD at Kulikawn Hospital an ZMC

e)     To higher centers outside Mizoram through Referral Board.