Psychiatric Diagnoses of Patients Presenting with Functional Somatic Symptoms in a Primary Care Clinic at a University Teaching Hospital in Nigeria

Abstract

Background: A number of patients that attend primary care medical settings present with distressing bodily complaints which are not attributable to organic (physical) pathology. The difficulties in diagnosing and treating such patients have been observed by many Health Care Practitioners. This study assesses the presence of psychological conditions and attempts to make psychiatric diagnoses (using a standardized diagnostic instrument) in patients presenting with Functional Somatic Symptoms (FSS) in a primary care clinic at the University of Calabar Teaching Hospital. Method: The study was carried out at the General Out Patients Clinic (GOPC) of the University of Calabar Teaching Hospital (UCTH). It was a cross-sectional study of a convenience sample of 100 randomly selected patients presenting with Functional Somatic Symptoms. Those who consented filled the modified version of the Enugu Somatization Scale and were interviewed with the Schedule for Clinical Assessments in Neuropsychiatry (SCAN) for possible psychiatric diagnoses. Results: While 41 of the selected patients were males, 59 were females. Their mean age was 38.5 (SD = 12.2). Frequent headaches and body heat (internal heat) were the most prevalent symptoms in the patients. ICD-10 psychiatry diagnoses using the SCAN were made in 79% of the patients studied. Depressive disorders (diagnosed in 48% of the patients) and anxiety disorders (in 21%) were the most common diagnoses. Older patients were mainly diagnosed of depressive disorders (p = 0.016) whereas younger patients tended to receive diagnoses of anxiety disorders (p = 0.039). Conclusion: Patients presenting with FSS may have diagnosable psychiatric disorders which if not recognized would go untreated. Psychiatric referral may therefore reduce the sufferings of the patients.

Pattern of psychiatric morbidity and somatic symptoms in a family medicine clinic of a University Teaching Hospital in Enugu, Southeast Nigeria

“…Another interesting observation of this study was that five (6.2%) participants did not meet the criteria for any psychiatric diagnosis. Previous studies have replicated this finding [24,59]. While it is a widespread impression that somatic symptom is mainly a feature suggestive of psychiatric morbidities, it is essential to note that these medically unexplained symptoms are not pathognomic of psychological disorders [58].…”

“…The spectrum of psychiatric morbidities among the participants might also explain why symptoms' representation of body regions was more generalised than specific. Further investigation of the distress and somatic cluster models is ongoing and looks promising [24,54].…”

“…Depression and Anxiety disorders rank highest in order of frequency of occurrence [24,25]. In particular, Okafor et al [24] found that more than two-thirds of their participants (patients with somatic symptom complaints attending primary care clinic) had psychiatric disorders, with the depressive disorder as the commonest psychiatric diagnosis. However, Okulate et al [27] observed that somatic complaints have little weight in diagnosing depression but opined that they might have more weight in diagnosing anxiety disorders.…”

“…Some studies in Nigeria have demonstrated high rates of psychiatric morbidities among patients with somatic complaints [24,25,26]. Depression and Anxiety disorders rank highest in order of frequency of occurrence [24,25].…”

“…Some studies in Nigeria have demonstrated high rates of psychiatric morbidities among patients with somatic complaints [24,25,26]. Depression and Anxiety disorders rank highest in order of frequency of occurrence [24,25]. In particular, Okafor et al [24] found that more than two-thirds of their participants (patients with somatic symptom complaints attending primary care clinic) had psychiatric disorders, with the depressive disorder as the commonest psychiatric diagnosis.…”