PracticeUpdate Conference Series European Congress of Psychiatry 2019

Consider Psychiatric Referrals for Patients With Unexplained Somatic Complaints Expensive and elaboratemedical testingmay only waste time andmoney, and delay an accurate diagnosis. P rimary care physicians should keep in mind the possibility of a psychiatric diagnosis among patients who present with somatic complaints that are not readily linked to a physical illness, according to new research.

Dr. Bitri pointed out that while these patients were investing significant time and money in trying to find a source of their symptoms, they were quickly los- ing hope that they would ever get better. “Through this study, I wanted to raise the awareness among medical staff about comorbidities and somatization,” she said. “I wanted to emphasize that, as doctors, we have the duty to see the patient as a whole human being, and we should not only focus on the physical origin of their complaints. Sometimes, we can be the only door the patient can go through for help, and we should properly utilize our ability to help. We can save lives.” Dr. Bitri and colleagues conducted a prospective study at the American Hospital of Tirana in which they analyzed the medical files of 134 patients diagnosed with a psychiatric disorder after pre- senting to the primary care department between August 2015 and January 2018. The patients were asked about the duration of physical symptoms and whether this was the first medical evaluation for these complaints. According to Dr. Bitri, the most commonly reported symptoms were general fatigue, numbness in sev- eral parts of the body and in the head, stomach pain, nausea, headache, dizziness, and sleeping problems. Overall, 42% of patients reported that this was their first medical visit for these complaints, meaning that more than half had previously visited a physician for these same issues and had not been referred to a psychiatrist for evaluation. Among these latter patients, 23% had been referred to a neurologist for suspected anxiety disorders. When psychiatric issues are overlooked, noted Dr. Bitri, “the somatic complaints get worse with time.” In addition, hopelessness can set in when patients are unable to get relief after multiple visits to medical professionals. To help avoid this pitfall, Dr. Bitri recommends that primary care physicians conduct “a detailed medical history before prescribing expensive and specific laboratory examinations.… As doctors, we should absolutely exclude physical diseases and we should perform laboratory examinations [as indicated], but it makes no sense to order [say, an] MRI of the whole body before doing a detailed medical analysis.”

“I took the idea to conduct this study from my [own] patients,” presenter Sonila Tivari Bitri, MD, from the American Hospital in Tirana, Albania, told Elsevier’s PracticeUpdate . “Many of them were presenting in my office with many somatic complaints. And the most interesting and painful part of the story is that for the same complaints they had consulted several doctors, family doctors and internal medicine specialists, without finding the right solution.”

" … as doctors, we have the duty to see the patient as a whole human being, and we should not only focus on the physical origin of their complaints. "

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