Strong cultural factors influence how patients present with psychiatric disorders. In the Indian Subcontinent there is an absence of words to describe depression and anxiety. Hence patients often resort to seeking help for physical symptoms and often deny an association with psychological conditions. They present frequently with varying somatic complaints but when interviewed psychiatric symptoms can be elicited to justify a psychiatric diagnoses.
Somatisers can have co-existing depression in up to 60% of cases and anxiety disorders up to 50%. Sinking heart is a common complaint in Asian Patients.
Somatisation is often a diagnosis by exclusion though it should not be and is the most prevalent disorder in General Practice.
In primary care Somatisers can account for 10-30% of visits. Apart from the presenting with several non specific symptoms in different organ systes, these patients often have a chronic course suggesting poor prognosis. There is a tendency to seek multiple medical opinions, reject physicians and shop around in the private practice.
Concepts of secondary gain and learnt helplessness have some validity in understanding family dynamics.
Good liaison team work and gate-keeping are important management steps and similarly recognition and effective treatment of underlying psychiatric conditions can lead to a rewarding result through compliance with treatment can be a major issue.
A couple of short case histories will be discussed.
Please contact Nick Hazell to book attendance, General Practitioners only can attend.