Algoritmo para el diagnóstico diferencial del trastorno por somatización en cuidado médico primario

Publicado

2009-10-01

Algoritmo para el diagnóstico diferencial del trastorno por somatización en cuidado médico primario

Algorithm for differential diagnosis of somatization disorder in primary care

Palabras clave:

atención primaria de salud, diagnóstico diferencial, epidemiología, historia, trastornos. (es)
Diagnosis, Differential, Epidemiology, History, Primary Health Care, Somatoform Disorders. (en)

Descargas

PDF
HTML

Autores/as

Óscar Rangel-Urrea Facultad de Medicina, Universidad Nacional de Colombia, Bogotá.
Nohora Barrera-Guío Facultad de Medicina, Universidad Nacional de Colombia, Bogotá.
Franklin Escobar-Córdoba Profesor Asociado, Departamento de Psiquiatría, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá.

Resumen (es)
Resumen (en)

Antecedentes. En la práctica clínica de atención primaria existe poca información sobre cómo hacer el diagnóstico de trastorno por somatización y cuáles son sus posibles entidades diferenciales, lo que lleva a un deterioro en la relación médico paciente, dificultades en el tratamiento de personas que sufren esta condición y retrasos en el diagnóstico de otras patologías médicas que se constituyen en los diagnósticos a excluir en pacientes con síntomas físicos inexplicables.

Objetivo. Determinar el diagnóstico diferencial del trastorno por somatización en cuidado médico primario y plantear un algoritmo para su abordaje.

Material y métodos. Se realizó búsqueda en las bases de datos PubMed, LILACS y Publindex, combinando las palabras clave Somatoform Disorders and Diagnosis, Differential, con 968 resultados, al agregar AND Primary Health Care, con 62 resultados en la fecha 28/07/2009; se leyeron los títulos y resúmenes, escogiendo los artículos relacionados con el objetivo de la revisión.

Resultados. Existen varias enfermedades crónicas que al comprometer varios órganos y sistemas causan síntomas inespecíficos semejantes al trastorno por somatización. Tenerlas presentes permite descartarlas de forma temprana por medio de exámenes de baja complejidad.

Conclusión. El diagnóstico de trastorno por somatización en cuidado médico primario, a pesar de ser altamente complejo, permite mediante el uso de este algoritmo orientar mejor la intervención del médico general, favoreciendo la reducción en procedimientos y consultas especializadas y el inicio temprano del tratamiento específico.

Background. There is little information about how to do the diagnosis of somatization disorder and which are the differential diseases in the primary health care, it deteriorates the doctor-patient relationship, it obstructs the treatment for people who has this illness and it delays the diagnosis of different pathologies which are in the differential diagnosis for patients with medically unexplained symptoms.

Objective. To determine the differential diagnosis of somatization disorder in primary medical care and pose an algorithm to address this.

Methods. We searched the databases, PubMed, LILACS and Publindex combining the key words Somatoform Disorders AND Diagnosis, Differential, with 968 results, add AND Primary Health Care, with 62 results on the date 28/07/2009, was read the titles and abstracts by selecting items related to the purpose of the review.

Results. There are several chronic diseases that compromise the various organ systems, causing symptoms, similar to somatization disorder. Have them present allow for early discard through tests of low complexity.

Conclusion: The diagnosis of somatization disorder in primary medical care, despite being highly complex, by allowing the use of this algorithm to better direct the intervention of the general practitioner by encouraging the reduction procedures and specialist consultations and early initiation of specific treatment.

Descargas

Los datos de descargas todavía no están disponibles.

Citas

López-Ibor J, Valdés M. Manual diagnóstico y estadístico de los trastornos mentales. Texto revisado. 2002.

Bombana J. Síntomas somáticos inexplicados clinicamente: um campo impreciso entre a psiquiatria e a clínica médica. J. bras. psiquiatr. 2006; 55: 308-312.

Schweickhardt A, Larisch A, Fritzsche K. Differentiation of somatizing patients in primary care: why the effects of treatment are always moderate. J Nerv Ment Dis. 2005; 193: 813-9.

Lipkowski Z. Somatization: the concept and its clinical application. Am J Psychiatry 1988; 145:1358-1368

McWhinney IR, Epstein RM, Freeman TR: Rethinking somatization. Adv Mind Body Med 2001; 17: 232-9.

Chandrashekar CR, Math SB. Psychosomatic disorders in developing countries: current issues and future challenges. Curr Opin Psychiatry 2006; 19: 201-6.

Kanaan RA, Lepine JP, Wessely SC. The association or otherwise of the functional somatic syndromes. Psychosom Med. 2007; 69: 855-9.

Heinrich TW. Medically unexplained symptoms and the concept of somatization. Wmj. 2004; 103: 83-7.

Huapaya LV. Psychogenesis and somatogenesis of common symptoms. Can Med Assoc J. 1975; 112: 1109-13.

Jyvasjarvi S, Joukamaa M, Vaisanen E, Larivaara P, Kivela S, Keinanen-Kiukaanniemi S. Somatizing frequent attenders in primary health care. J Psychosom Res. 2001; 50: 185-92.

Lloyd G. Medicine without signs. Br Med J (Clin Res Ed). 1983; 287(6391): 539-42

Rief W, Rojas G. Stability of somatoform symptoms—implications for classification. Psychosom Med. 2007; 69: 864-9.

Richardson RD, Engel CC, Jr. Evaluation and management of medically unexplained physical symptoms. Neurologist. 2004; 10: 18-30.

Escobar JI, Hoyos-Nervi C, Gara M. Medically unexplained physical symptoms in medical practice: a psychiatric perspective. Environ Health Perspect. 2002; 110 Suppl 4: 631-6

Smith RC, Dwamena FC. Classification and diagnosis of patients with medically unexplained symptoms. J Gen Intern Med. 2007; 22: 685-91.

Sumathipala A, Siribaddana S, Hewege S, Sumathipala K, Prince M, Mann A. Understanding the explanatory model of the patient on their medically unexplained symptoms and its implication on treatment development research: a Sri Lanka Study. BMC Psychiatry. 2008; 8: 54.

Servan-Schreiber D, Kolb NR, Tabas G. Somatizing patients: Part I. Practical diagnosis. Am Fam Physician. 2000; 61: 1073-8.

Uribe R. Modelos conceptuales en medicina psicosomática. rev.colomb.psiquiatr. 2006; XXXV: 7-20

Hakala M, Karlsson H, Kurki T, Aalto S, Koponen S, Vahlberg T, Niemi PM. Volumes of the caudate nuclei in women with somatization disorder and healthy women. Psychiatry Res. 2004; 131: 71-8.

Lowe B, Spitzer RL, Williams JB, Mussell M, Schellberg D, Kroenke K. Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. Gen Hosp Psychiatry. 2008; 30: 191-9.

Fink P, Toft T, Hansen MS, Ornbol E, Olesen F. Symptoms and syndromes of bodily distress: an exploratory study of 978 internal medical, neurological, and primary care patients. Psychosom Med. 2007; 69: 30-9.

Cabot R. Suggestions for reorganisation of hospital outpatient departments with special reference to improvement of treatment. Md State MedJ. 1907; 50: 81-91.

Nimnuan C, Hotopf M, Wessely S. Medically unexplained symptoms: an epidemiological study in seven specialities. J Psychosom Res. 2001; 51: 361-7.

Robins LN, Price RK. Adult disorders predicted by childhood conduct problems: results from the NIMH Epidemiologic Catchment Area project. Psychiatry. 1991; 54: 116-32.

Karvonen JT, Veijola J, Jokelainen J, Laksy K, Jarvelin MR, Joukamaa M. Somatization disorder in young adult population. Gen Hosp Psychiatry. 2004; 26: 9-12.

Kroenke K, Spitzer RL, Williams JB, Linzer M, Hahn SR, deGruy FV, 3rd, Brody D. Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Arch Fam Med. 1994; 3: 774-9.

Rasmussen NH, Bernard ME, Harmsen WS. Physical symptoms that predict psychiatric disorders in rural primary care adults. J Eval Clin Pract. 2008; 14: 399-406.

Coelho L, ávila A. Controvérsias sobre a somatização. Rev. psiquiatr. clín. 2007; 34: 278-284.

Vadacca M, Buzzulini F, Rigon A, Coppolino G, Palma Modoni A, Massa R, Afeltra A. [Neuropsychiatric lupus erythematosus]. Reumatismo 2006; 58: 177-86.

Ferreira S, D'Cruz DP, Hughes GR. Multiple sclerosis, neuropsychiatric lupus and antiphospholipid syndrome: where do we stand? Rheumatology (Oxford) 2005; 44:434-42.

Compston A, Coles A. Multiple sclerosis. Lancet 2002; 359: 1221-31.

Miller D, Barkhof F, Montalban X, Thompson A, Filippi M. Clinically isolated syndromes suggestive of multiple sclerosis, part I: natural history, pathogenesis, diagnosis, and prognosis. Lancet Neurol. 2005; 4: 281-8.

Poser CM, Brinar VV. Diagnostic criteria for multiple sclerosis. Clin Neurol Neurosurg. 2001; 103: 1-11.

Hutto B. Syphilis in clinical psychiatry: a review. Psychosomatics 2001; 42: 453-60.

Gupta MA. Somatization disorders in dermatology. Int Rev Psychiatry. 2006; 18: 41-7.

Bass C, Bond A, Gill D, Sharpe M. Frequent attenders without organic disease in a gastroenterology clinic. Patient characteristics and health care use. Gen Hosp Psychiatry. 1999; 21: 30-8.

Granberg D, Oberg K. Neuroendocrine tumours. Cancer Chemother Biol Response Modif. 2005; 22: 471-83.

Toth M, Pronai L, Nemeth AM, Tulassay Z. [Carcinoid tumors]. Orv Hetil 2002; 143(19 Suppl):1087-92.

Lips CJ, Lentjes EG, Hoppener JW. The spectrum of carcinoid tumours and carcinoid syndromes. Ann Clin Biochem. 2003; 40 (Pt 6): 612-27.

Ruszniewski P, O'Toole D. [Clinical spectrum of digestive neuroendocrine tumors]. Rev Prat 2002; 52: 262-7.

De Siervi A, Rossetti MV, Parera VE, Mendez M, Varela LS, del CBAM. Acute intermittent porphyria: biochemical and clinical analysis in the Argentinean population. Clin Chim Acta. 1999; 288: 63-71.

Nordmann Y, Puy H. Human hereditary hepatic porphyrias. Clin Chim Acta. 2002; 325: 17-37.

Monneuse O, Causeret S, Lifante JC, Berger N, Lapras V, Peix JL. [Primary juvenile hyperparathyroidism. Report of 24 cases]. Ann Chir. 2002; 127: 276-80.

Lundgren E, Ljunghall S, Akerstrom G, Hetta J, Mallmin H, Rastad J. Case-control study on symptoms and signs of «asymptomatic» primary hyperparathyroidism. Surgery. 1998; 124: 980-5; discussion 985-6.

Meza NW, Rossi NE, Galeazzi TN, Sanchez NM, Colmenares FI, Medina OD, et al. Cysticercosis in chronic psychiatric inpatients from a Venezuelan community. Am J Trop Med Hyg. 2005; 73: 504-9.

Reyes M, Blanck HM, Grossniklaus D. Hemochromatosis: What every clinician and health care professional needs to know. Department of Health and Human Services Centers for Disease Control and Prevention. 2002; 1: 1-98.

Turner C. A review of myasthenia gravis: Pathogenesis, clinical features and treatment. Current Anaesthesia & Critical Care. 2007; 18: 15-23.

Anglin RE, Rosebush PI, Mazurek MF. The neuropsychiatric profile of Addison's disease: revisiting a forgotten phenomenon. J Neuropsychiatry Clin Neurosci. 2006; 18: 450-9.

Attia J, Margetts P, Guyatt G. Diagnosis of thyroid disease in hospitalized patients: a systematic review. Arch Intern Med. 1999; 159: 658-65.

Caixeta M, Chaves M, Reis OR. [Organic somatoform disorder. Case report]. Arq Neuropsiquiatr. 1999; 57: 120-5.