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Somatization and Symptoms Evaluation
Author Bios
Introduction
Defining Somatization
Detecting Symptoms
Dimensions of Symptoms
Measuring Symptoms
Psychiatric Comorbidity
Interpreting Symptom Measures
Functional Syndromes and Symptoms
Currently selected section: Etiology of Symptoms
Levels of Etiological Certainty
Strengthening Etiological Classification
Confounding Etiological Factors
Symptoms and Patient Expectations
Interpreting Patient Responses
Measuring Multiple Symptoms
Global Rating of Change
Measuring Somatization
Measuring Other Domains
Conclusions

 

Etiology of Symptoms

        

 

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Selection BPsychogenic (i.e. panic disorder and/or somatization disorder)

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Establishing a precise etiology for a symptom is often more complicated than it is for discrete medical disorders.

First, there are frequently multiple physical as well as psychosocial factors that could be implicated in an individual patient. For example, in one study nearly half of the patients presenting with a chief complaint of dizziness had two or more factors causing or contributing to their symptoms (Kroenke et al.,1992). Fatigue in the patient with rheumatoid arthritis and depression, or persistent dizziness in the patient with diabetic neuropathy, atrial fibrillation, and chronic somatization, are examples of where it might be difficult to distill a "pure" cause.

Second, the prognosis and treatment responsiveness of symptoms can further complicate etiological ascertainment. Symptoms can be notoriously labile, their natural history marked by spontaneous recovery, sporadic recurrences, or recalcitrance (Kroenke, 2003).

About 70% of patients presenting with any given symptom will report improvement several weeks after the index visit, and over half not improved at this time point will gradually improve by 3 months. However, due to recurrence in some of those initially improved, the proportion of patients seeking care for symptoms whose symptoms are chronic or recurrent is 20-25%.

The prognosis of physical symptoms is illustrated in Figure 9.1.

Figure 9.1: Prognosis of Symptoms in Primary Care
Graphic depiction of prognosis of symptoms, described

Further, specific treatments for symptoms is often lacking, especially for nonpain symptoms such as fatigue, dizziness, palpitations, and functional gastrointestinal complaints.

Finally, symptoms are particularly susceptible to the placebo effects of an intervention, confounding somewhat our ability to use therapeutic response as one criterion for ascertaining cause. The various factors affecting the response of symptoms to treatment make cross-over trials especially problematic in evaluating new therapies for symptoms (Woods et al.,1989).


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