Somatic symptoms with psychogenic or psychiatric background: Characteristics and pitfalls

Abstract

Introduction: The characteristics of somatic symptoms seen at the first hospital visit in patients with psychogenic backgrounds remain poorly elucidated till date.

Methodology: A total of 277 patients who visited the Department of General Medicine at a single university hospital with somatic symptoms were prospectively enrolled in this study. The eventual definite diagnoses were classified into the following three groups: non-psychogenic disease (n = 128), psychogenic symptoms (n = 131), and mental illness (n = 18). Subsequently, the chief complaints and other background information of the patient obtained at the first visit were compared among the three groups.

Results: More than half of the patient with non-psychogenic diseases (60.2%) presented with a single complaint at their first hospital visit; contrarily, less than half of the patients with psychogenic symptoms (23.7%) or mental illnesses (22.2%) presented with a single complaint at the first visit. Approximately, <10% of the patients with non-psychogenic diseases had four or more multisystemic presentations at the first visit. The results of the receiver operating characteristic curve analysis revealed a fair discriminatory ability of the number of complaints to identify patients with psychogenic diseases or psychiatric backgrounds. Almost half of the non-psychogenic patients with four or more multisystemic presentations were eventually diagnosed with autoimmune-related disorders, such as Sjögren's syndrome or Behçet's disease. In conclusion, the general notion that patients with psychogenic somatic symptoms are likely to present with more complaints than patients with non-psychogenic diseases is correct. However, not a few patients who present with multiple indefinite complaints would certainly have organic diseases such as autoimmune-related disorders or neuromuscular diseases. A careful diagnostic process is required in such patients before attributing their symptoms to psychogenic or psychiatric factors.

Keywords: Chief complaint; mental illness; psychogenic; somatic symptom disorder; somatoform disorder.

Figure 1

The three patient groups established by the presence of psychogenic or psychiatric background Abbreviations: ANA, antinuclear antibody; ANCA, antineutrophil cytoplasmic antibodies; ECG, echocardiography; RF, rheumatoid factor

Figure 2

Relationship between the number of somatic complaints, psychogenic factor, and SDS score (a) Histograms of the number of somatic complaints at the first hospital visit in each of the three groups. (b) Grouped scatter plots of the SDS score by the number of somatic complaints in each disease group. Abbreviation: SDS, Zung self-rating depression score

Figure 3

The receiver operating characteristic curves to compare the discriminatory ability to doubt the presence of psychogenic background The measured area under the curve for the number of complaints was fair with 0.71, which was slightly higher than that for the SDS total score. Abbreviations: AUC, the area under the curve; SDS, Zung self-rating depression score