Somatic symptoms with psychogenic or psychiatric background: Characteristics and pitfalls

Tetsuya Akaishi; Michiaki Abe; Atsuko Masaura; Junichi Tanaka; Shin Takayama; Ko Onodera; Takehiro Numata; Kota Ishizawa; Satoko Suzuki; Minoru Ohsawa; Takeshi Kanno; Tadashi Ishii

doi:10.4103/jfmpc.jfmpc_1100_20

Somatic symptoms with psychogenic or psychiatric background: Characteristics and pitfalls

J Family Med Prim Care. 2021 Feb;10(2):1021-1027. doi: 10.4103/jfmpc.jfmpc_1100_20. Epub 2021 Feb 27.

Authors

Tetsuya Akaishi^{1

2}, Michiaki Abe^{1

2}, Atsuko Masaura¹, Junichi Tanaka¹, Shin Takayama¹, Ko Onodera¹, Takehiro Numata¹, Kota Ishizawa¹, Satoko Suzuki¹, Minoru Ohsawa^{1

3}, Takeshi Kanno^{1

4}, Tadashi Ishii^{1

2}

Affiliations

¹ Department of Education and Support for Regional Medicine, Tohoku University Hospital, Japan.
² Tohoku Medical Megabank Organization, Tohoku University, Japan.
³ Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, Japan.
⁴ Division of Gastroenterology, Tohoku University Hospital, Japan.

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.