Somatoform disorders in the general practice

Abstract

Somatoform disorders rank among the most frequent diagnoses in the general practices. They are considered as difficult as well as to diagnose as to treat. Without a psychotherapeutic treatment they evolve into chronic disorders in two-third of the cases. 571 patients with therapy-resistant complaints of unclear genesis were transferred to the General Practice Outpatient Department of the Hannover Medical School (in the following: GPD of the MHH) by general practitioners. They were medically treated in order to support the patients and their physicians. The patients with somatoform disorders were examined with regard to the influence of this diagnosis on the medical treatment. The results showed that almost every other patient (36% men, 64% women) suffered from a somatoform disorder in combination with one to ten other illnesses during the last seven years on the average. The treatment of the said patients required a lot of time, empathy and expertise from the treating physician, because the patients complained about a various and extensive range of disorders: organ-specific (97%), non-specific (89%), psychological disorders (67%) as well as psychosocial problems (92%), particularly job-related (57%) and associated with personal loss (72%). Although the complaints and the psychosocial strains were obviously linked, this correlation was only taken into consideration in a quarter of the cases by the previous treating physicians. In order to adjust this deficit a new biopsychosocial treatment concept was developed by the GPD of the MHH. This highly developed treatment concept enables every physician to determine physical and psychological disease factors at the same time. Three methods were applied in order to improve the diagnostics and to motivate the patients to an active co-operation: medical dialogue, medical examination and a psychosocial screening on a voluntary basis which was used by 93% of the patients with somatoform disorders. In 70% of the cases, co-morbidities linked with psychological disorders were revealed by the screening. A high co-morbidity with somatic diseases, especially diseases of the musculo-sceletal system (62%), of metabolic disturbances (45%), of the nervous system (23%) and of the cardiovascular system (22%) was found by additional somatic diagnostics and co-operation with the specialist-departments of the MHH. The results confirmed the expectations of the patients to suffer from physical and psychological disorders at the same time. Partly, the somatoform disorders were under-diagnosed by the pre-treating physician, as far as they had treated the patients exclusively somatically. Partly, the somatic co-morbidity was ignored in case of an exclusive psychosomatic oriented pre-treatment. In order to avoid a one-sided treatment for patients with therapy-resistant complaints of unclear genesis, the family doctor should apply both somatic and psychosocial diagnostics and therapy methods at an early stage and as a matter of routine.