The reasons for an unjustified visit by patients with somatoform disorders to general practitioners

Patients with somatoform disorders (SD) seek specialized psychiatric care late. Although many factors that prevent the timely visits by patients with SD for specialized psychiatric care are known, this problem requires further study.

Objective: to analyze the role of information sources and iatrogenic factors in unreasonably selecting a specialist by patients with SD to visit him/her for primary medical advice.

Patients and methods. Sixty-six women aged 19 to 40 years with new-onset SD (F 45.0) were examined. Two patient groups were identified: a study group of 41 patients (mean age, 31.5+1.2years) and a comparison group of 25 (mean age, 31.6+0.8years) (p>0.5). Primary care physicians had examined and treated the study group patients long (for 1 to 6 years) before their visit to a psychiatrist. The comparison group patients had been seen by a psychiatrist just in the first year of the disease.

Anamnestic, clinical, andpsychopathological methods were used when examining the patients.

Results and discussion. For their first visit, the patients with SD had selected a therapist and a neurologist more frequently and a cardiologist and an endocrinologist somewhat less frequently. This selection was also affected by the specialists' high titles, psychiatric consultation-avoiding behavior, and conversion mechanisms. Acquaintances' advice and Internet information as health information sources contribute to the unjustified revisits by these patients to primary medical specialists for a long time. Iatrogenic mechanisms were found to play a role in forming a false concept of a disease and destructive behavioral strategies leading to the chronization and progression of SD. Patients with SD who are long and ineffectively exposed to numerous diagnostic procedures and ineffective treatment in the primary health care need psychiatric counseling and psychotherapeutic support.

Conclusion. The diagnosis of SD remains ineffective in an outpatient setting. There is a need for an educational program on SD within the continuing health education system.

1. Parfenov VA, Golovacheva VA. Low back pain: causes, diagnosis, and treatment. Nevrologiya, neiropsikhia-triya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2009;1(1):19-22. (In Russ.). doi: 10.14412/2074-2711-2009-17

2. Pogosov AV, Bogushevs-kaya YuV. Somatic disorders (clinical-dynamic and therapeutic aspects). Psikhicheskie rasstroistva v obshchei meditsine. 2008;(3):29-34. (In Russ.).

3. Sochivko NS, Pogosov AV. Psikhiches-koe zdorov'e naseleniya [Mental health of the population]. Kursk: KGMU; 2006. 231 p.

4. Parfenov VA. Khronicheskaya bol'i ee lechenie v nevrologii [Chronic pain and its treatment in neurology]. Moscow: GEOTAR-Media; 2018. 288 p.

5. Pogosov AV, Sevost'ya-nova AO, Bogushevskaya YuV. Clinical and psychological characteristics of patients at the prenosological stage of somatic mental disorders with cardiovascular manifestations. Chelovek i ego zdorov'e. 2013;(1):119-25. (In Russ.).

6. Guthrie E. Medically unexplained symptoms in primary care. Advances In Psychiatric Treatment. 2008;14(6):432—40.

7. Agarkov AP, Varankova LV. The problem of diagnosis of somatic mental disorders in general medical and psychiatric practice. Sibirskii vestnikpsikhiatrii i narkologii. 2009;(3):103-6. (In Russ.).

8. Smulevich AB, Dubnitskaya EB, Voronova EI. On the problem of recognition of psychosomatic disorders in general medical practice. Psikhicheskie rasstroistva v obshchei meditsine. 2017;(3—4):4—10. (In Russ.).

9. Sobennikov VS. Somatizatsiya i somato-formnye rasstroistva [Somatization and somatoform disorders]. Irkutsk; 2014. 304 p.

10. Salmon P, Humphris GM, Ring A, et al. Why do primary care physicians propose medical care to patients with medically unexplained symptoms? A new method of sequence analysis to test theories of patient pressure. Psychosom Med. 2006 Jul-Aug;68(4):570-7.

11. Pogosov AV, Bogushevskaya YuV. Somatizirovannye rasstroistva (klinika, diagnosti-ka, terapiya) [Somatized disorders (clinic, diagnosis, therapy)]. Kursk: KGMU; 2008. 268 p.

12. Zakroeva AG, Lesnyak OM. Biopsychosocial approach to management of patients with major chronic non infectious diseases in primary health care. Lechashchii vrach. 2014;(10):42-6. (In Russ.).

13. Tsygankov BD, Malygin YaV, Ismailova SF. Psychological factors affecting the activity of medical care search by patients suffering from borderline mental disorders. Sibirskii vestnik psikhiatrii i narkologii. 2014;(3):9-14. (In Russ.).

14. Demcheva NK, Kalinina EV. The relationship between the clinical characteristics of mental disorders and the timeliness of psychiatric care seeking in patients with a diagnosis established for the first time. Psikhicheskoe zdorov'e. 2010;(7):28-35. (In Russ.).

15. Pogosov AV, Bogushevskaya YuV. Clinical, personality-psychological and sociodemographic factors that prevent the treatment of patients with somatization disorders for specialized care. Sibirskii vestnik psikhiatrii i narkologii. 2017;(4):22-30. (In Russ.).

16. Pogosov AV, Nikolaevskaya AO. Clinical and dynamic features of somatized mental disorders with cardiovascular manifestations in patients of the city polyclinic. Sibirskii vestnikpsikhiatrii i narkologii. 2017;(2):67-72. (In Russ.).

17. Pribytkov AA, Yerichev AN. Somatoform disorders. Part two: the methodology of cognitive-behavioral psychotherapy. Obozrenie psikhia-trii i meditsinskoipsikhologii im. V.M. Bekhtereva. 2017;(2):10-5. (In Russ.).

18. Skorik AI, Kotsyubinskii AP, Sheinina NS, et al. Psychiatric mythology and the problem of cooperation. Sotsial'naya i klinicheskayapsikhi-atriya. 2009;(3):31-6. (In Russ.).

19. Integrating mental health into primary care: a global perspective. Geneva. World Health Organization and World Organization of Family Doctors (WONCA). Geneva: WHO Press; 2008. 210 p.

20. Houtveen JH, Van Broeckhuysen-Kloth S, Lint-meijer LL, et al. Intensive multidisciplinary treatment of severe somatoform disorder: a prospective evaluation. J Nerv Ment Dis. 2015 Feb;203(2):141-8. doi: 10.1097/NMD.0000000000000250.

21. Van Dessel N, Den Boeft M, Van der Wouden JC, et al. Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database Syst Rev. 2014 Nov 1;(11):CD011142. doi: 10.1002/14651858.CD011142.pub2.

22. Smulevich AB, redaktor. Psikhosomaticheskie rasstroistva v klinicheskoipraktike [Psychosomatic disorders in clinical practice]. Moscow: Medpress-inform; 2016. 776 з.

23. Tkhostov ASh, Nelyubina AS. Ordinary views of the disease in the structure of patient and doctor identification as a predictor of patient's choice of the method of treatment (on the model of cardiovascular diseases). In: Obshchestvo remissii: na puti k narrativnoi medit-sine: sbornik nauchnykh trudov [Society of remission: on the way to narrative medicine: collection of scientific works]. Samara: Samarskii universitet; 2012. P. 12-33.

24. Bogushevskaya YuV, Nikolaevskaya AO. Clinical-dynamic and personality characteristics of patients with soma-tized disorders. Rossiiskii psikhiatricheskii zhur-nal. 2013;(4):31-6. (In Russ.).