Nearly a third of patients who attend clinics and emergency rooms show symptoms that have no apparent clinical basis, E.S. Krishnamoorthy, senior consultant in clinical neurology and neuropsychiatry, Voluntary Health Services, said on Monday.
While all of them would fall into the broad category of “unexplained medical symptoms,” Dr. Krishnamoorthy went on to describe situations in which the symptoms matched certain common medical conditions, but clearly emanated from psychiatric causes.
Some of the psychiatric causes include depression, hypochondriasis, personality disorders, reaction to severe stress, psychoses (rarely) and somatoform disorders. Classic in this category are the non-epileptic seizure and non-cardiac chest pain. In both instances, patients are not reassured that there is no physical cause for their physical symptoms.
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In many cultures with an emphasis on “appropriateness,” a number of patients are unable to give voice to their concerns, anxieties and worries. In this context, they tend to “somatise” – convert into a physical symptom. This is more common in cultures that do not encourage disclosure, studies have proved, he said.
However, once you put these patients on therapy, they start talking and expressing their thoughts. This often results in alleviation of symptoms.
Dr. Krishnamoorthy was delivering a series of three lectures on the subject ‘Exploration of the Brain and Mind Interface,' organised by the Madras Psychology Society at the Universityof Madras.
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To psychiatrists, and students of the Psychology department of the varsity, his suggestions were to take the problem seriously and rule out any organic cause first. The medical professional who treats unexplained medical symptoms must also explore the patient's past psychiatric health, family and cultural setting, before providing the patient with understandable explanations.
Shun pejorative terms
At all costs, the use of pejorative terms must be shunned, and the patient must also be protected from guilt or self-blame. It is also necessary to emphasise the benefit of a psycho-somatic disorder, he said.
Ultimately, patients who do well are those who have an acute onset of symptoms that have a definite origin in the mind and are treatable. It also helps if the patient is mono-symptomatic and the symptoms last over a relatively short duration, Dr. Krishnamoorthy explained.
Dr. Krishnamoorthy's first lecture dealt with the role of the brain in human emotion, with particular emphasis on the role of the limbic system, the oldest part of the human brain.
It dealt with evolution, through anatomy and physiology, to human traits like mood, anxiety, schizophrenic symptoms; and social constructs like creativity and religiosity.
The third lecture for the day, ‘The Mystic Mind', analysed experiences that philosopher J. Krishnamurti underwent during his transformation, using analogies from modern medicine and neuropsychiatry. Dr. Krishnamoorthy also focussed on the interplay between science and philosophy.
S. Karunanidhi, head, Department of Psychology, University of Madras, said the Madras Pscyhology Society Endowment Lectures, of which Dr. Krishnamoorthy was the latest orator, had, in the past, invited similarly-accomplished luminaries in the field of psychology, psychiatry and neuropsychiatry.