Somatic Presentations of Distress in Primary Care

Chanaka Wijeratne, MD, MB, BS, FRANZCP, Conjoint Senior Lecturer in Psychiatry, University of New South Wales, Sydney, AUS.

Somatic presentations such as fatigue, headache, and abdominal and joint pain are common in primary care, although investigation may not readily identify an underlying cause. Such “functional somatic syndromes” are best conceptualized within a multifactorial, inclusive illness model rather than as diagnoses of exclusion (that is, of medical pathology). For instance, the syndrome of fatigue occurs in up to 25% of older people and is predicted by factors as diverse as female gender, more severe medical illness, and concurrent anxiety and depression. Although the management of functional somatic syndromes is frustrating to the clinician, the importance of a multimodal management model is emphasized.

Key words: functional somatic syndromes, older adults, primary care.