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Somatic Symptom Disorders Workup

  • Author: William R Yates, MD, MS; Chief Editor: Eduardo Dunayevich, MD  more...
 
Updated: May 07, 2014
 

Laboratory Studies

If indicated, specific studies used to rule out somatization due to general medical conditions include the following:

  • Thyroid function studies - Thyroid stimulating hormone (TSH) at 0.4-10 mIU/L and thyroxine at 5.0-12.5 ng/dL
  • Pheochromocytoma screen - Urine catecholamines, homovanillic acid (HVA) 2-12 mg per 24 hours, vanillylmandelic acid (VMA) 2-7 mg per 24 hours, metanephrines less than 1.6 mg per 24 hours, and norepinephrine plus epinephrine less than 100 mcg per 24 hours
  • Urine drug screen - Including cannabis, amphetamine, hallucinogens, cocaine, opioids, benzodiazepines
  • Blood studies - To screen for occult alcoholism
  • Psychological testing - Minnesota Multiphasic Personality Inventory (MMPI) may provide insight into the likelihood of a somatic symptom disorder. (Negative MMPI studies should encourage further pursuit of a medical cause for the symptoms.)
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Imaging Studies

Imaging studies are not routinely used in diagnosing the somatic symptom disorders. However, functional MRI may be of use in the diagnosis of some conditions such as unexplained visual loss.[11] Imaging studies also may be helpful to rule out unexplained physical symptoms due to a medical disorder.

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Procedures

Avoid invasive diagnostic procedures and aggressive surgical assessment.

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Contributor Information and Disclosures
Author

William R Yates, MD, MS Research Psychiatrist, Laureate Institute for Brain Research; Professor of Research, Department of Psychiatry, University of Oklahoma College of Medicine at Tulsa

William R Yates, MD, MS is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Eduardo Dunayevich, MD Executive Director, Clinical Development, Amgen

Eduardo Dunayevich, MD is a member of the following medical societies: Schizophrenia International Research Society

Disclosure: Received salary from Amgen for employment; Received stock from Amgen for employment.

Additional Contributors

Mohammed A Memon, MD Chairman and Attending Geriatric Psychiatrist, Department of Psychiatry, Spartanburg Regional Medical Center

Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, American Psychiatric Association

Disclosure: Nothing to disclose.

References
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  2. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. Fourth Edition. Washington, DC: American Psychiatric Association; 2000. Text Revision.

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  9. Maes M, Galecki P, Verkerk R, Rief W. Somatization, but not depression, is characterized by disorders in the tryptophan catabolite (TRYCAT) pathway, indicating increased indoleamine 2,3-dioxygenase and lowered kynurenine aminotransferase activity. Neuro Endocrinol Lett. 2011. 32(3):264-73. [Medline].

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  18. Egloff N, Cámara RJ, von Känel R, Klingler N, Marti E, Ferrari ML. Hypersensitivity and hyperalgesia in somatoform pain disorders. Gen Hosp Psychiatry. 2014 May-Jun. 36(3):284-90. [Medline].

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Somatic symptom diagnoses in a series of university hospital psychiatric consultations.
 
 
 
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