Somatization Symptoms in a Primary Care Clinic at a Tertiary Hospital in Southern Nigeria
Affiliation(s)
1 Department of Psychiatry, College of Medical Sciences, University of Calabar, Calabar, Nigeria. 2 Clinical Services Department, Federal Psychiatric Hospital Calabar, Calabar, Nigeria. 3 Department of Family Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
1 Department of Psychiatry, College of Medical Sciences, University of Calabar, Calabar, Nigeria. 2 Clinical Services Department, Federal Psychiatric Hospital Calabar, Calabar, Nigeria. 3 Department of Family Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
ABSTRACT
Background: Somatic symptoms that are not attributable to organic pathology are common in general practice settings however, data in most parts of Africa including southern Nigeria are still scarce. The aim of our study was to examine such somatic symptoms reported by patients attending a primary care facility at a tertiary hospital in southern Nigeria as well as to motivate future research in this area. Method: The study was conducted at the General Out Patient Clinic (GOPC) of the University of Calabar Teaching Hospital (UCTH). It was a cross sectional study in which data were obtained from the case notes of 115 patients that presented in the clinic with somatic complaints which could not be attributed to organic pathology by their physicians. Results: While 46 of the patients were males, 69 were females. Their mean age was 37.7 (SD = 11.9). Internal heat, crawling sensation, body pains and palpitations were the most prevalent symptoms reported by the patients. When the symptoms were sorted into various groups, the “subjective abnormal bodily sensation” was the most prevalent and far outnumbered the “pseudo neurological symptoms”. Conclusion: A number of patients attending the GOPC of the UCTH seek consultations for medically unexplained somatic symptom. The most prevalent of these symptoms are internal heat and crawling sensations both of which are not stated in the criteria recognized by the International Classification of Diseases—version 10 (ICD-10) for the diagnosis of psychiatric disorders.
Background: Somatic symptoms that are not attributable to organic pathology are common in general practice settings however, data in most parts of Africa including southern Nigeria are still scarce. The aim of our study was to examine such somatic symptoms reported by patients attending a primary care facility at a tertiary hospital in southern Nigeria as well as to motivate future research in this area. Method: The study was conducted at the General Out Patient Clinic (GOPC) of the University of Calabar Teaching Hospital (UCTH). It was a cross sectional study in which data were obtained from the case notes of 115 patients that presented in the clinic with somatic complaints which could not be attributed to organic pathology by their physicians. Results: While 46 of the patients were males, 69 were females. Their mean age was 37.7 (SD = 11.9). Internal heat, crawling sensation, body pains and palpitations were the most prevalent symptoms reported by the patients. When the symptoms were sorted into various groups, the “subjective abnormal bodily sensation” was the most prevalent and far outnumbered the “pseudo neurological symptoms”. Conclusion: A number of patients attending the GOPC of the UCTH seek consultations for medically unexplained somatic symptom. The most prevalent of these symptoms are internal heat and crawling sensations both of which are not stated in the criteria recognized by the International Classification of Diseases—version 10 (ICD-10) for the diagnosis of psychiatric disorders.
KEYWORDS
Somatization, Medically Unexplained Somatic Symptom, Abnormal Bodily Sensations, Southern Nigeria
Somatization, Medically Unexplained Somatic Symptom, Abnormal Bodily Sensations, Southern Nigeria
Cite this paper
Okafor, C. , Edet, B. and Asibong, U. (2015) Somatization Symptoms in a Primary Care Clinic at a Tertiary Hospital in Southern Nigeria. Journal of Biosciences and Medicines, 3, 67-73. doi: 10.4236/jbm.2015.310009.
Okafor, C. , Edet, B. and Asibong, U. (2015) Somatization Symptoms in a Primary Care Clinic at a Tertiary Hospital in Southern Nigeria. Journal of Biosciences and Medicines, 3, 67-73. doi: 10.4236/jbm.2015.310009.
References
[1] Peveler, R., Kilkenny, L. and Jubnibtg, A.L. (1997) Medically Unexplained Physical Symptoms in Primary Care: A Comparison of Self Report Screening Questionnaires and Clinical Opinion. Journal of Psychosomatic Research, 42, 245-252.
http://dx.doi.org/10.1016/S0022-3999(96)00292-9 [2] Ring, A., Dowrick, C.F., Humphris, G.M., Davies, J. and Salmon, P. (2005) The Somatising Effect of Clinical Consultation: What Patients and Doctors Say and Do Not Say When Patients Present Medically Unexplained Physical Symptoms. Social Science & Medicine, 61, 1505-1515.
http://dx.doi.org/10.1016/j.socscimed.2005.03.014 [3] Dunnell, K. and Cartwright, A. (1972) Medicine Takers, Prescribers and Hoarders. Routledge, Kegan Paul, London. [4] Hannay, D. (1978) Symptom Prevalence in the Community. Journal of the Royal College of General Practitioners, 28, 492-499. [5] Kroenke, K. and Spitzer, R. (1998) Gender Differences in the Reporting of Physical and Somatoform Symptoms. Psychosomatic Medicine, 60, 150-155.
http://dx.doi.org/10.1097/00006842-199803000-00006 [6] Kroenke, K. and Price, R. (1993) Symptoms in the Community: Prevalence, Classification and Psychiatric Comorbidity. Archives of Internal Medicine, 153, 2474-2480.
http://dx.doi.org/10.1001/archinte.1993.00410210102011 [7] Page, L. and Wessely, S. (2003) Medically Unexplained Symptoms: Exacerbating Factors in the Doctor-Patient Encounter. Journal of the Royal Society of Medicine, 96, 223-227.
http://dx.doi.org/10.1258/jrsm.96.5.223 [8] Ring, A., Dowrick, C., Humphris, G. and Salmon, P. (2004) Do Patients with Unexplained Physical Symptoms Pressurize General Practitioners for Somatic Treatment? A Qualitative Study. British Medical Journal, 328, 1057.
http://dx.doi.org/10.1136/bmj.38057.622639.EE [9] Craig, T., Boardman, A., Mills, K., Daly-Jones, O. and Drake, H. (1993) The South London Somatisation Study l: Longitudinal Course and the Influence of Early Life Experiences. British Journal of Psychiatry, 163, 579-588.
http://dx.doi.org/10.1192/bjp.163.5.579 [10] Hotopf, M., Mayou, R., Wadsworth, M. and Wessely, S. (1999) Childhood Risk Factors for Adults with Medically Unexplained Symptoms: Results from a National Birth Cohort Study. American Journal of Psychiatry, 156, 1796-1800. [11] Craig, T., Drake, H., Mills, K. and Boardman, A.P. (1994) The South London Somatisation Study II: Influence of Stressful Life Events, and Secondary Gain. British Journal of Psychiatry, 165, 248-258.
http://dx.doi.org/10.1192/bjp.165.2.248 [12] Vikram, P. and Athula, S. (2006) Psychological Approaches to Somatization in Developing Countries. Advances in Psychiatric Treatments, 12, 56-62. [13] Basky, A.J. and Kleiman, G.L. (1993) Overview: Hypochondriasis, Bodily Complaints and Somatic Styles. American Journal of Psychiatry, 140, 273-283. [14] Ohaeri, J.U. and Olatawura, M.O. (1988) The Resilience of Somatisation Symptoms to Physical Methods of Treatment. Psychopathologie Africaine, XXII, 65-78. [15] Deale, A. and Wessely, S. (2001) Patients Perception of Medical Care in Chronic Fatigue Syndrome. Social Science & Medicine, 52, 1859-1864.
http://dx.doi.org/10.1016/S0277-9536(00)00302-6 [16] Peters, S., Stanley, I., Rose, M. and Salmon, P. (1998) Patients with Medically Unexplained Symptoms: Sources of Patients Authority and Implications for Demands on Medical Care. Social Science & Medicine, 46, 559-565.
http://dx.doi.org/10.1016/S0277-9536(97)00200-1 [17] Morakinyo, O. (1983) A Phenomenological Study of Functional Abnormal Bodily Sensations in African Psychiatric patients. Psychopathologie Africaine, XIX, 343-355. [18] Okhomina, F.O.A. and Ebie, J.C. (1973) Heat in the Head as a Psychiatric Symptom. In: Andonakoh, C.C., Ed., Procedings of the 4th Pan African Psychiatric Congress Workshop on Neurosis in Africa-Accra, New Times Corporation, Accra. [19] Ayonrinde, A. (1977) Heat in the Head or Body: A Semantic Confusion. African Journal of Psychiatry, I, 59-63. [20] Lipowski, Z.J. (1998) Somatization: The Concept and Its Clinical Application. American Journal of Psychiatry, 145, 1358-1368. [21] World Health Organization (2006) The ICD-10 Classification of Mental & Behavioural Disorders—Clinical Descriptions and Diagnostic Guidelines. WHO, Geneva. [22] Prince, R. (1985) The Concept of Culture-Bound Syndrome: Anorexia Nervosa and Brain-Fag. Social Science and Medicine, 21, 197-203.
http://dx.doi.org/10.1016/0277-9536(85)90089-9 [23] Andrian, F., Mark, O., Marc, G., Milton, F., Steven, S., Lantigua, R.A., et al. (2001) Medically Unexplained Symptoms in an Urban General Medicine Practice. Journal of Psychosomatics, 42, 261-268.
http://dx.doi.org/10.1176/appi.psy.42.3.261 [24] Orenstein, H. (1989) Briquet Syndrome in Association with Depression and Panic: A Recoceptualization of Briquet Syndrome. American Journal of Psychiatry, 146, 334-338.
http://dx.doi.org/10.1176/ajp.146.3.334 [25] Ohaeri, J.U. and Odejide, O.A. (1994) Somatization Symptoms among Patients Using Primary Healthcare Facilities in a Rural Community in Nigeria. American Journal of Psychiatry, 151, 728-731.
http://dx.doi.org/10.1176/ajp.151.5.728 [26] Hobbs, P., Ballinger, C., Greenwood, C., Martins, B. and Mc Clure, A. (1984) Factor Analysis and Validation of the General Health Questionnaire in Men: A General Practice Survey. British Journal of Psychiatry, 144, 270-275.
http://dx.doi.org/10.1192/bjp.144.3.270
[1] Peveler, R., Kilkenny, L. and Jubnibtg, A.L. (1997) Medically Unexplained Physical Symptoms in Primary Care: A Comparison of Self Report Screening Questionnaires and Clinical Opinion. Journal of Psychosomatic Research, 42, 245-252.
http://dx.doi.org/10.1016/S0022-3999(96)00292-9 [2] Ring, A., Dowrick, C.F., Humphris, G.M., Davies, J. and Salmon, P. (2005) The Somatising Effect of Clinical Consultation: What Patients and Doctors Say and Do Not Say When Patients Present Medically Unexplained Physical Symptoms. Social Science & Medicine, 61, 1505-1515.
http://dx.doi.org/10.1016/j.socscimed.2005.03.014 [3] Dunnell, K. and Cartwright, A. (1972) Medicine Takers, Prescribers and Hoarders. Routledge, Kegan Paul, London. [4] Hannay, D. (1978) Symptom Prevalence in the Community. Journal of the Royal College of General Practitioners, 28, 492-499. [5] Kroenke, K. and Spitzer, R. (1998) Gender Differences in the Reporting of Physical and Somatoform Symptoms. Psychosomatic Medicine, 60, 150-155.
http://dx.doi.org/10.1097/00006842-199803000-00006 [6] Kroenke, K. and Price, R. (1993) Symptoms in the Community: Prevalence, Classification and Psychiatric Comorbidity. Archives of Internal Medicine, 153, 2474-2480.
http://dx.doi.org/10.1001/archinte.1993.00410210102011 [7] Page, L. and Wessely, S. (2003) Medically Unexplained Symptoms: Exacerbating Factors in the Doctor-Patient Encounter. Journal of the Royal Society of Medicine, 96, 223-227.
http://dx.doi.org/10.1258/jrsm.96.5.223 [8] Ring, A., Dowrick, C., Humphris, G. and Salmon, P. (2004) Do Patients with Unexplained Physical Symptoms Pressurize General Practitioners for Somatic Treatment? A Qualitative Study. British Medical Journal, 328, 1057.
http://dx.doi.org/10.1136/bmj.38057.622639.EE [9] Craig, T., Boardman, A., Mills, K., Daly-Jones, O. and Drake, H. (1993) The South London Somatisation Study l: Longitudinal Course and the Influence of Early Life Experiences. British Journal of Psychiatry, 163, 579-588.
http://dx.doi.org/10.1192/bjp.163.5.579 [10] Hotopf, M., Mayou, R., Wadsworth, M. and Wessely, S. (1999) Childhood Risk Factors for Adults with Medically Unexplained Symptoms: Results from a National Birth Cohort Study. American Journal of Psychiatry, 156, 1796-1800. [11] Craig, T., Drake, H., Mills, K. and Boardman, A.P. (1994) The South London Somatisation Study II: Influence of Stressful Life Events, and Secondary Gain. British Journal of Psychiatry, 165, 248-258.
http://dx.doi.org/10.1192/bjp.165.2.248 [12] Vikram, P. and Athula, S. (2006) Psychological Approaches to Somatization in Developing Countries. Advances in Psychiatric Treatments, 12, 56-62. [13] Basky, A.J. and Kleiman, G.L. (1993) Overview: Hypochondriasis, Bodily Complaints and Somatic Styles. American Journal of Psychiatry, 140, 273-283. [14] Ohaeri, J.U. and Olatawura, M.O. (1988) The Resilience of Somatisation Symptoms to Physical Methods of Treatment. Psychopathologie Africaine, XXII, 65-78. [15] Deale, A. and Wessely, S. (2001) Patients Perception of Medical Care in Chronic Fatigue Syndrome. Social Science & Medicine, 52, 1859-1864.
http://dx.doi.org/10.1016/S0277-9536(00)00302-6 [16] Peters, S., Stanley, I., Rose, M. and Salmon, P. (1998) Patients with Medically Unexplained Symptoms: Sources of Patients Authority and Implications for Demands on Medical Care. Social Science & Medicine, 46, 559-565.
http://dx.doi.org/10.1016/S0277-9536(97)00200-1 [17] Morakinyo, O. (1983) A Phenomenological Study of Functional Abnormal Bodily Sensations in African Psychiatric patients. Psychopathologie Africaine, XIX, 343-355. [18] Okhomina, F.O.A. and Ebie, J.C. (1973) Heat in the Head as a Psychiatric Symptom. In: Andonakoh, C.C., Ed., Procedings of the 4th Pan African Psychiatric Congress Workshop on Neurosis in Africa-Accra, New Times Corporation, Accra. [19] Ayonrinde, A. (1977) Heat in the Head or Body: A Semantic Confusion. African Journal of Psychiatry, I, 59-63. [20] Lipowski, Z.J. (1998) Somatization: The Concept and Its Clinical Application. American Journal of Psychiatry, 145, 1358-1368. [21] World Health Organization (2006) The ICD-10 Classification of Mental & Behavioural Disorders—Clinical Descriptions and Diagnostic Guidelines. WHO, Geneva. [22] Prince, R. (1985) The Concept of Culture-Bound Syndrome: Anorexia Nervosa and Brain-Fag. Social Science and Medicine, 21, 197-203.
http://dx.doi.org/10.1016/0277-9536(85)90089-9 [23] Andrian, F., Mark, O., Marc, G., Milton, F., Steven, S., Lantigua, R.A., et al. (2001) Medically Unexplained Symptoms in an Urban General Medicine Practice. Journal of Psychosomatics, 42, 261-268.
http://dx.doi.org/10.1176/appi.psy.42.3.261 [24] Orenstein, H. (1989) Briquet Syndrome in Association with Depression and Panic: A Recoceptualization of Briquet Syndrome. American Journal of Psychiatry, 146, 334-338.
http://dx.doi.org/10.1176/ajp.146.3.334 [25] Ohaeri, J.U. and Odejide, O.A. (1994) Somatization Symptoms among Patients Using Primary Healthcare Facilities in a Rural Community in Nigeria. American Journal of Psychiatry, 151, 728-731.
http://dx.doi.org/10.1176/ajp.151.5.728 [26] Hobbs, P., Ballinger, C., Greenwood, C., Martins, B. and Mc Clure, A. (1984) Factor Analysis and Validation of the General Health Questionnaire in Men: A General Practice Survey. British Journal of Psychiatry, 144, 270-275.
http://dx.doi.org/10.1192/bjp.144.3.270