1813728, 1250 PM ‘Somatic symptom disorder with predominant pain treated by electroconvulsive therapy: a case repor - ScienceDirect The American Journal of Geriatric Psychiatry Voli, ve, Supplement, Ab 202, Paes 10607 poser Nimber E58 Somatic symptom disorder with predominant pain treated by electroconvulsive therapy: a case report in Hong Park MD, MS", Megan Kummerlowe 00, Janets Leal MD. Show more << Share 99 Cte hipeseicrgOt0Lepjage 200201202 7 Get righs and content 7 Introduction Somatic symptom disorder is a challenging condition for which there are limited pharmacological modalities available for treatment, Tete have been no epidemiologic studies on somatic symptom disorder since the adoption of DSM-S in 2013, but somatic symptom disorder has been considered with a prevalence of around 5 % based on previous research in somatization disorder (Creed etal, 2004). The diagnosis of somatic symptom disorder is often delayed. As somatic symptoms progress tothe level of functional decline, patients are eventually referted to psychiatrists or additional assessment and treatment. Unfortunately, the underlying neurobiology ofthis condition is largely unknown, Given these circumstances, the current treatment guideline recommends initial treatment targeting comorbid depressive symptoms or anxiety as well as a cognitive behavior approach, Patients benefit from scheduled visits with a primary care provider andl collaborative care among all providers (Kurlansik etal. 2016). The goal of treatment isnot to cure symptoms but the management of symptoms to maintain an individual's function in life, However, there are certain refractory and debilitating cases of somatic symptom disorder despite multiple trials and therapeutic approaches, As withthe indication of electroconvalsive therapy (ECT) for refractory depression, bipolar disorder, and schizophrenia, there have been several case reports highlighting ECT for the treatment of somatic symptom disorder (Gahr etal, 2011, Suda etal, 2008), Methods ‘We present a case of somatic symptom disorder (with predominant pain in chest, abdomen, and back) refractory to multiple ‘medications without primary mood disorders, which was eventually treated with an acute course of ECT. Results ‘A.68-year-old male with no previous psychiatric history sel-presented to theemergency roomwith the chief complaint of pain frequently over the course of three years, with greater than 50 presentations in 12 months. Chief complaints included left-sided-chest pain, facial patesthesias, and numbness and tingling sensation in his left arm and ankle, Broad medical workup including EKG, troponin, EMG, chest and abdomen CT, brain and whole spine MRI showed no medical cause for the pain. Trials of duloxetine, nortriptyline, gabapentin, Tramadol and hydromorphone were tried without improvement, Weekly cognitive behavioral therapy for his nonadaptive health seeking behavior and anxiety was conducted. Eventually, he was admitted to the hospital to pursue an ECT trial to target his chronic pain symptoms diagnosed as a somatic symptom disorder, Prior to his initial ECT treatment, pain was rated as 10 plus out of 10 Following one ECT treatment, pain was rated as two on the day of treatment. He initially experienced side effects of ECT including ‘generalized confusion and disorientation to time and place, however this resolved within several hours. Pain increased to $ one day after the first ET, however it continued to improve over the course of receiving ECT with 0 after the sixth session over the two weeks, Throughout the course of ECT, his mood was reported as “fine” with a stable score of 15 in PHQ-9, Conclusions psi sconce comisciencolatclelabs'pitS1064748 122002585, 11813728, 1250 PM ‘Somatic symptom disorder witn predominant pain treated by electroconvulsve therapy: a case repor - ScienceDirect ‘We suggest that ECT could be considered as a possible treatment option for refractory somatic symptom disorder. [tis unclear about the ‘efficacy of ECT for somatic symptom disorder with the current evidence base. Further esearch with alarge number of cases and with a focus on the biological approach are still needed to elucidate the underlying mechanism of action to support the indication of ECT for ‘somatic symptom disorder ‘This research was funded by Allauthors have ne funding toreport References (0) Cited by (0) Recommended articles (6) Research stele Assessment of tryptophan metabolism and signs of depression in individuals with carbohydrate malabsorption Psychiatry Reseach, Volume 262, 2018, p. 595-599 Show abstract Research ate Effects of temperature, air movement and initial metabolic rate on thermal sensation during transient state in the tropics Building and Environment, Volume 155, 2028, pp. 70-82 Show abstract Research rele ‘The relationship of cortical activity induced by pain stimulation with clinical and cognitive features of somatic symptom disorder: A controlled functional near infrared spectroscopy study Journal of Psychosomatic Research, Volume 140, 2021, Article 110300 Show abstract Research rele ‘The unifying diagnostic construct of bodily distress syndrome (BDS) was confirmed in the general population Journal o Psychosomatic Research Valume 128, 2020, Ail 109868 Show abstract Research sree Associations between cognitive performance and the rehabilitation, medical care and social support provided to French children with Prader-Willi syndrome European Journal of Medical Genetics, Volume 83, Issue 12, 2020, Article 104068 Show abstract Resear sel A single case report of Body Oriented Psychological Therapy for a patient with Chronic Conversion Disorder ‘he Arts in Paychotherapy, Volume 61,2018, p. 38-63 Show abstract hlpsutwww.sciencedrect con/sciancelatclelabsipiS1064748122002585 281813728, 1250 PM ‘Somatic symptom disorder with predominant pain treated by electroconvulsve therapy: a case repor - ScienceDirect ‘View fll text opp © 202 Pu by Hae ns ae Strtonerongavnectenettinartn hlpsutwww.sciencedrect con/sciancelatclelabsipiS1064748122002585 @RELX™ a