Question

This is the fifth visit to the emergency room for Mr. Davis. Each time, he presents to the emergency room with a chief complaint of substernal chest pain. A cardiac workup is performed at each visit. Cardiac enzymes and troponin are negative. The ECG and chest x-rays are normal. Mr. Davis has been examined by a cardiologist, and his stress test is negative for ischemia. He has also been tested for gastrointestinal disease. The results of an EGD showed a mild gastritis. Despite these negative physical findings, Mr. Davis continues to miss work because of his symptoms.

Mr. Davis is told by his physicians that his symptoms are not cardiac related. Mr. Davis states that he will seek a second opinion; Mr. Davis has already been examined by five ER physicians, a cardiologist, and a gastroenterologist. Mr. Davis is convinced that all the doctors must be missing something. His primary care physician suggests that Mr. Davis see a psychiatrist. Mr. Davis does not think he needs a psychiatric workup and refuses the psychiatric referral.

   A.        Identify the three characteristic features of somatic symptom illnesses.   

B.        What are two interventions that would be appropriate for Mr. Davis?

Answer 1

A. Three characteristics of somatoform disorder

• extreme focus on physical symptoms such as pain or fatigue
• major emotional distress
• problems in functioning

Here Mr Davis has focus on the substernal chest pain.He is disturbed and reluctant to seek psychaitric consultation. He refuses to go to work.

B. Interventions for Mr. Davis

Main treatment modalities are Psychotherapy and medications

• Psychotherapy mainly focusus on the cognitive behavioral therapy that helps to reduce symptoms.
• Encourage use of relaxation techniques
• Use a pain scale if the client complains of pain, and implement pain reduction measures as required
• Encourage diversional activities such as drawing, dancing, craft work ex