Somatic symptom disorder in primary care: A collaborative approach

,

doi:doi: 10.12788/jfp.0384

Behavioral Health

Somatic symptom disorder in primary care: A collaborative approach

J Fam Pract. 2022 April;71(3):E8-E12 | doi: 10.12788/jfp.0384

PDF Download

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th edition (DSM-5). American Psychiatric Publishing; 2013.

2. Johnson KK, Bennett C, Rochani H. Significant improvement of somatic symptom disorder with brief psychoeducational intervention by PMHNP in primary care. J Am Psychiatr Nurses Assoc. 2020;28:171-180. doi: 10.1177/1078390320960524

3. Weigel A, Maehder K, Witt M, et al. Psychotherapists’ perspective on the treatment of patients with somatic symptom disorders. J Psychosom Res. 2020;138:110228. doi: 10.1016/j.jpsychores.2020.110228

4. American Psychiatric Association. Handbook of Differential Diagnosis. American Psychiatric Publishing; 2014;234-235.

5. Mayo Clinic. Somatic symptom disorder. Accessed February 21, 2022. www.mayoclinic.org/diseases-conditions/somatic-symptom-disorder/symptoms-causes/syc-20377776?p=1

6. Toussaint A, Riedl B, Kehrer S, et al. Validity of the Somatic Symptom Disorder-B Criteria Scale (SSD-12) in primary care. Fam Pract. 2018;35:342-347. doi: 10.1093/fampra/cmx116

7. Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64:258-66. doi: 10.1097/00006842-200203000-00008

8. Kroenke K, Spitzer RL, Williams JB, et al. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010;32:345-359. doi: 10.1016/j.genhosppsych.2010.03.006

9. Toussaint A, Löwe B, Brähler E, et al. The Somatic Symptom Disorder - B Criteria Scale (SSD-12): factorial structure, validity and population-based norms. J Psychosom Res. 2017;97:9-17. doi: 10.1016/j.jpsychores.2017.03.017

10. First MB, Williams JBW, Karg RS, Spitzer RL, eds. Structured Clinical Interview for DSM-5 Disorders, Research Version. American Psychiatric Association, 2015.

11. First MB, Williams JBW, Karg RS, Spitzer RL, eds. Structured Clinical Interview for DSM-5 Disorders, Clinician Version. American Psychiatric Publishing; 2016.

12. McDaniel SH, Hepworth J, Campbell TL, et al, eds. Family Oriented Primary Care. Springer Publishing Co; 2005:1-15.

13. Hunter Integrated Pain Service (2016). Brainman videos. Hunter New England Local Health District. New South Wales, Australia. Accessed February 21, 2022. www.tga.gov.au/chronic-pain-management-video-resource-brainman

14. Murray AM, Toussaint A, Althaus A, et al. The challenge of diagnosing non-specific, functional, and somatoform disorders: a systematic review of barriers to diagnosis in primary care. J Psychosom Res. 2016;80:1-10. doi: 10.1016/j.jpsychores.2015.11.002

15. Leaviss J, Davis S, Ren S, et al. Behavioral modification interventions for medically unexplained symptoms in primary care: systematic reviews and economic evaluation. Health Technol Assess. 2020;24:1-490. doi: 10.3310/hta24460

16. Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med. 2007;69:881-888. doi: 10.1097/PSY.0b013e31815b00c4

17. Steinbrecher N, Koerber S, Frieser D, et al. The prevalence of medically unexplained symptoms in primary care. Psychosomatics. 2011;52:263-271. doi: 10.1016/j.psym.2011.01.007

18. Kessler R, Stafford D. Primary care is the de facto mental health system. In Kessler R, Stafford D, eds. Collaborative Medicine Case Studies: Evidence in Practice. Springer Publishing Co, 2008; 9-21.

19. Barsky AJ, Ahern DK, Bauer MR, et al. A randomized trial of treatments for high-utilizing somatizing patients. J Gen Intern Med. 2013;28:1396-1404. doi: 10.1007/s11606-013-2392-6

20. Newby JM, Smith J, Uppal S, et al. Internet-based cognitive behavioral therapy versus psychoeducation control for illness anxiety disorder and somatic symptom disorder: A randomized controlled trial. J Consult Clin Psychol. 2018;86:89-98. doi: 10.1037/ccp0000248

21. van Dessel N, den Boeft M, van der Wouden JC, et al. Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database Syst Rev. 2014(11):CD011142. doi: 10.1002/14651858.CD011142.pub2

22. Verdurmen MJ, Videler AC, Kamperman AM, et al. Cognitive behavioral therapy for somatic symptom disorders in later life: a prospective comparative explorative pilot study in two clinical populations. Neuropsychiatr Dis Treat. 2017;13:2331-2339. doi: 10.2147/NDT.S141208

23. Liu J, Gill NS, Teodorczuk A, et al. The efficacy of cognitive behavioural therapy in somatoform disorders and medically unexplained physical symptoms: a meta-analysis of randomized controlled trials. J Affect Disord. 2019;245:98-112. doi: 10.1016/j.jad.2018.10.114

24. Abbass A, Leichsenring F, Steinert C. Re: Jing et al., the efficacy of cognitive behavioural therapy in somatoform disorders and medically unexplained physical symptoms: a meta-analysis of randomized controlled trials. J Affect Disord. 2019;255:S0165-0327(18)33197-5. doi: 10.1016/j.jad.2019.02.055

Illness anxiety disorder is also characterized by significant health-related concerns; however, physical symptoms are either mild or absent.

Ongoing elevated screening scores for anxiety and depression refractory to interventions may signal somatic symptom disorder.

Possible causes of SSD are varied and complex, including genetic and biological factors, family dynamics, behavioral modeling/learning, personality traits, difficulties with emotional regulation, and awareness.⁵ Patients may present with ongoing requests for symptom explanations, feelings of helplessness, fear of having concerns dismissed, and low motivation for change.³

Aids in supporting a diagnosis of SSD

It’s not appropriate to rely solely on questionnaires to make the diagnosis of SSD. However, brief screening tools are a time-efficient way to capture patients’ experiences and perceptions.⁶ Along with other components of clinical evaluation, brief symptom screens can both support the diagnosis and help in longitudinal symptom assessment.

Patient Health Questionnaire-15 (PHQ-15), developed for self-report screening in primary care, has desirable psychometric properties including appropriate internal reliability; convergent validity with measures of functional status, disability days, and symptom-related burden; and discriminant validity from measures of depressive symptoms.⁷ The PHQ-15 is an open access tool that is available in several languages. The respondent is asked to rate the extent of being bothered by a range of medical symptoms in the proceeding 4 weeks. Total scores range from 0 to 30, with higher scores indicating greater symptom aggravation. Cutoffs of 5, 10, and 15 correspond to mild, moderate, and severe symptom levels.⁸

Somatic Symptom Disorder - B Criteria Scale (SSD-12) aims to capture SSD symptoms in line with Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria. It assesses cognitive, affective, and behavioral aspects of SSD.⁹ The SSD-12 is copyrighted and its use requires registration and purchase. Cutoffs by age and gender are available. SSD-12 has demonstrated appropriate reliability and validity.⁹

Continue to: Structured Clinical Interview for DSM Disorders