Somatoform Autonomic Dysfunction

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Case Report :
A 47 year old male ,married, from middle socio-economic
status with no family history of mental illness was referred
from medical unit to the psychiatric unit with complaints
of recurrent belching, abdominal distention ,fatigue and
anxiety since 2 years. On mental status examination
Patient is well conscious and alert but have anxious
cognition about bleaching .On physical examination coarse
tremor of both hand was present .Heart rate was 90 b/m
and B.P 140/80 mm of Hg .Investigation showed normal
CBC,RFT,LFT and urine examination.USG was normal.
What may be the diagnosis?
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Somatoform Autonomic Dysfunction
Prepared by Smriti Shrestha

B.Sc. Nursing 3rd year ,
KUSMS
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Objective ( 1/3)
General Objective:
At the end of this teaching learning session, the
students will be able to explain about: Somatoform
autonomic dysfunction
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Objective ( 2/3)
Specific Objectives :
At the end of this session ,the student will be able to :
define somatoform autonomic dysfunction
describe the epidemiology of Somatoform autonomic
dysfunction
enlist the causes of Somatoform autonomic
dysfunction
list down the clinical feature of Somatoform
describe the ICD 10 criteria of Somatoform autonomic
dysfunction
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Objective (3/3)
describe the differential diagnosis of somatoform
autonomic dysfunction and Generalized anxiety
disorder(GAD).
describe the management of Somatoform autonomic
dysfunction
describe the Nursing management of Somatoform
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Definition ( 1/2)
According to ICD-10, in this disorder, symptoms
are presented by the patient as if they were due to a
physical disorder of an organ system that is
predominantly under autonomic control i.e. the
cardiovascular, gastrointestinal, or respiratory
system.
E.g. Palpitation ,hiccough ,flatulence , dysuria
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Definition ( 2/2)
There is preoccupation with, and distress
regarding, the possibility of a serious (but often
unspecified) disorder of the particular organ
system
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Epidemiology (1/1)
According to ICD 10 3.2 % of general population
have somatoform autonomic dysfunction
More common in females
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CLINICAL FEATURES
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ICD 10 diagnostic criteria ( 1/2)
Definite diagnosis requires all of the following:
(a) Symptoms of autonomic arousal, such as

palpitations, sweating, tremor, flushing, which are
persistent and troublesome

(b) Additional subjective symptoms referred to a
specific organ or system
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ICD 10 diagnostic criteria ( 2/2)
(c) Preoccupation with and distress about the
possibility of a serious (but often unspecified)
disorder of the stated organ or system, which does
not respond to repeated explanation and
reassurance by doctors

(d) No evidence of a significant disturbance of
structure or function of the stated system or organ
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Differential Diagnosis
 Generalized anxiety disorder is based on the
predominance of the psychological, components of
autonomic arousal, such as fear and anxious.
In somatization disorders, autonomic symptoms
may occur but they are neither prominent nor
persistent in comparison with the many other
sensations and feelings, and the symptoms are not
so persistently attributed to one stated organ or
system.
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Nursing Management ( 1/6)
Nursing Assessment :
Assess for the genetic predisposition ,
Environmental factors
Assess the patient vital signs and performed the
physical examination
Assesss the patients mental status. Ask questions to
determine if the patient has suicidal ideations or
possible substance abuse.
 Assess numerous autonomic complaints (may
involve many different organs or systems)
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Fears of or rumination on disease
Assess the insight of patient towards mental
problem.
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Nursing Diagnosis:
Ineffective coping related to somatoform
autonomic dysfunction as evidence by failure to do
activities of daily living as normal, verbalization of
distress.
Anxiety related to lack of knowledge regarding
symptoms, progression of condition and treatment
regimens evidence by feeing of discomfort
Deficient knowledge related to lack of interest in
learning, severe anxiety
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Nursing Management:
Establish the trustworthy relationship with patient

by listening ,displaying warmth
Maintain the calmness in your approach to the
client
Avoid asking or forcing client to make choices
Allow the patient to express his /her feelings and
thoughts .
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Promote behavior modification by acknowledging
the patient efforts to positively cope with his /her
current condition, as well as giving more attention
and time discussing positive changes in
symptoms
Provide comfort measures for the patient in terms
of temperature of the room , positioning of the bed.
Encourage the patient to perform relaxation
techniques, such as deep breathing
exercise ,guided imagery .
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Encourage participation in activities and provide
the positive reinforcement .
Administer SSRIs and benzodiazepine as order.
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Assignment : Write any 5 differences between
GAD and Somatoform autonomic dysfunction
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Reference (1/2)
CowenP.Harrison P.Burns T.Shorter Oxford
Textbook of psychiatry.7th edition.Great Claredon
Street,Oxford,OX26DP,UK:Oxford University
Press;2018
Sreevani R.A guide to mental health and
psychiatric nursing .3rd Edition.delhi,India: Jaypee
Brothers medical publishers(p) LTD:2010
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Reference(2/2)
Ahuja N.A short textbook of psychiatric7th
edition.Delhi,India: Jaypee Brothers medical
publishers(p) Ltd;2011
World Health Organization . The ICD-10
Classification of Mental and Behavioural
Disorders. Clinical descriptions and diagnostic
guidelines
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1

Prepared by Smriti Shrestha

E.g. Palpitation ,hiccough ,flatulence , dysuria

(a) Symptoms of autonomic arousal, such as

Establish the trustworthy relationship with patient

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