16-year-old female who starts psychiatric follow-up due to episodes of anxiety crises with dizziness and tremors.

To expose a case in which it is essential to rule out organic pathology in cases where there is anxiety and physical symptoms.

Case report and literature review

The patient explains that she was in a situation of conflict with her ex-partner, commenting that he did not accept the breakup. Sertraline was prescribed in ascending doses up to 100 mg per day with complete remission of anxiety. 8 months later, she went to the emergency room for loss of consciousness and tremor of the lower limbs. She was diagnosed with conversive disorder and was prescribed lorazepam up to 3 mg per day. Since then, there has been a worsening in the frequency of syncope occurring up to 10 times a day, limiting her academic and social life. She was evaluated by a cardiologist who diagnosed Pots Syndrome (postural orthostatic tachycardia syndrome) and started treatment with ivabradine and mineralocorticoids. With this treatment, the episodes were drastically reduced and spaced out to 1-2 per week. The dose of lorazepam is decreased until its withdrawal without worsening of the anxious symptomatology.

This disorder consists of an involvement of the autonomic nervous system in which there is a sudden drop in blood pressure together with an abrupt increase in heart rate. Its treatment is based on increasing blood volume with drugs such as corticosteroids as well as postural measures with adequate water intake.

No significant relationships.

Psychosomatic illnesses correspond to physical symptoms (with or without objectivable organic lesions), that psychological factors such as stress and personality type, would have a potential effect on their appearance, evolution and / or worsening. These psychosomatic conditions are quite common but difficult to diagnose. Doctors from different specialties are consulted by the patients and multiple examinations and investigations are run by specialists in order to get to the final diagnosis. These psychosomatic conditions may appear under different types of illnesses : respiratory (asthma), dermatological (psoriasis, eczema), digestive (gastric ulcer, ulcerative colitis, Crohn’s disease), cardiovascular (arterial hypertension, infarction), neurological (migraine)…

Study management modalities of psychosomatic disorders through cases followed in consultation at the university psychiatric hospital Ar-razi of Salé in Morocco

through cases followed in consultation at the university psychiatric hospital Ar-razi of Salé in Morocco

From the results observed in the patients recruited in this study, we retain the need for a bio-psycho-social approach, through a global approach of the patient in all its dimensions, not only biological, but also psychological and social ; we also retain the essential role of the psychiatrist in the management of these psychosomatic disorders, both in preventive and curative terms, by allowing a better understanding of the interactions between physical and mental health.

psychosomatic conditions are quite common but difficult to diagnose and the need for a bio-psycho-social approach, through a global approach of the patient in all its dimensions, not only biological, but also psychological and social is crucial.

No significant relationships.

Some research suggests that mental health problems can be brought on by the stress of having unexplained symptom. In non-western cultures especially, psychological distress is often communicated through multiple somatic complaints. The biopsychosocial model takes into consideration all factors affecting health and disease, supporting the integration of biological, psychological and social factors in the assessment and treatment.

In our study we assess prevalence of alexithymia as a potential psychopathological attribute manifesting as unexplained somatic symptoms

196 patients aged 18 to 60 with unexplained physical symptoms for at least three months, after collection of demographic data, medical and psychiatric history, were subject to Arabic version of the following scales : patient health questionnaire PHQ-15 to assess severity of somatic symptoms, patient health questionnaire PHQ-9 to assess depressive symptoms, generalized anaxiety disorder GAD-7 to assess general anxiety disorder symptoms and Toronto Alexithymia scale TAS to assess alexithymia

90% of ours ample were female patients, 49,5% showed alexithymia, 27,6% were borderline alexithymic and 23% had no alexithymia. Patients with unexplained physical symptoms showed moderate to high depressive symptoms in 81,1% of the sample, moderate to severe anxiety symptoms in 73,5%. Severity of somatic symptoms as assessed by PHQ-15 were significantly highly correlated to scores for Alexithymia (TAS), depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7) p<0,001

Alexithymia is prevalent among patients with unexplained physical symptoms. This later population has high prevalence of depressive and anxiety symptoms that go with the severity of somatic manifestations

Intensive Care Unit (ICU) delirium is a common complication after major surgery and related among other potential medical precipitants to either pre-existing cognitive impairment or the intensity and length of anesthesiology or the type of surgery. Nevertheless, in some rare situations, an organic etiology is not always found, which can be frustrating for the medical team. Some clinicians working in an intensive care unit have a reluctance to seek another hypothesis in the psychological field.

To illustrate this, we report the case of a 59-year-old woman who developed a massive delirium during her intensive care unit stay after being operated on for a left retroperitoneal sarcoma. Interestingly, she had had no previous cognitive disorders and a somatic explanation for her psychiatric disorder could not been found. Just before the surgery, she was grieving the recent loss of a colleague of the same age, and also a close friend, and therefore had a death anxiety.

With this case report, we would like to point out the importance of psychological factors that might precipitate delirium in a predominately somatic environment such as an intensive care unit.

ICU delirium can sometimes be considered as a “psychosomatic” problem with either a stress response syndrome after surgery or a defense mechanism against death anxiety. Clinicians should be aware of the possibility of such psychological factors even if they always must first rule out potential somatic causes for delirium and encourage thorough investigation and treatment of these medical causes. A collaboration with the psycho-oncologist is recommended to better manage this “psychosomatic” problem.