Dr. McIntosh
Presenters: Catherine Sullivan, MD, and Christina Giudice, MSN, APRN, CPNP-PC
Dr. Sullivan and Ms. Giudice presented on Somatic Symptom and Related Disorders (SSRD) and best care practices for patients with these complex disorders at PHM 2023. The presenters opened with the 2019 National Guidelines for Somatic Symptom and Related Disorders and provided definitions for specific diagnoses along this spectrum of disorders. The guidelines highlight that patients experience real physical symptoms that interfere with function as a result of underlying psychological stressors combined with persistent and maladaptive coping. They detailed the prevalence of psychological stressors and adverse childhood events and their direct causal relationship with somatization.
The presenters then discussed the challenges that patients with SSRD and their families, as well as the medical team, face when searching for a diagnosis and cure. Patients and their families often undergo weeks to months of normal testing with simultaneous difficulties with everyday life due to ongoing symptoms.
The presentation transitioned to inpatient treatment tools and they detailed a unique clinical pathway focusing on:
- Unifying language across all medical providers
- Validating symptoms
- Establishing a functional treatment plan
The treatment for SSRD is a multidisciplinary functional intervention. Tools include a functional plan order set within an electronic health record and a daily functional and activity schedule that the entire health care team has access to.
The presenters emphasized a pivot in medical diagnostics with the shift away from SSRD as a diagnosis of exclusion. A study showing 98% of patients who had an SSRD in their differential at presentation were ultimately diagnosed with an SSRD suggests that providers are skilled at diagnosing these disorders and they can be discussed with patients and their families from the start. This shift can limit the medical workup with the initiation of functional treatment sooner rather than after advanced testing. In pediatric patients, the acceptance of an SSRD diagnosis by one parent prior to discharge led to complete functional recovery of their child, regardless of the acceptance by the child, showing the importance of how SSRD is communicated to families.
The session concluded with a discussion on the overlap of COVID-19 long-haulers and SSRD and the future direction for research to advance functional treatment plans.
Key Takeaways
- Somatic Symptom and Related Disorders are distinct entities classified by real physical symptoms that interfere with function as a result of underlying psychological stressors combined with persistent and maladaptive coping
- Providers should trust their history and physical when diagnosing SSRD and pivot away from diagnoses of exclusion to focus on limiting the cycle of medical workup and starting early beneficial treatment
- Treatment plans for SSRD should include: clear communication of the SSRD; validation of symptoms; and a functional intervention plan with a multidisciplinary team
Dr. McIntosh is a first-year pediatric hospital medicine fellow at Children’s Hospital Colorado Anschutz Medical Campus in Aurora, Colo.