||Psychosocial Functioning of Persons Who Develop Serious Mental Illness after Exhibiting a Somatic Prodrome in Adolescence
Hiroko, Hasuya ,
Takahiro, Nemoto ,
Tomoyuki, Funatogawa ,
Naoyuki, KatagiriMasafumi, Mizuno
68 , 2015-12 , The Medical Society of Toho University
Background: Adolescents who present with medically unexplained somatic symptoms and subsequently develop serious mental illness (SMI) are often seen in psychiatric practice. We investigated the characteristics of somatic symptoms, development of psychiatric symptoms, and psychosocial functioning in such patients. Methods: We retrospectively reviewed the medical records of patients seen in the psychiatric outpatient clinic of 2 university hospitals in Tokyo. All patients who exhibited a medically unexplained somatic prodrome and later experienced onset of an SMI were included in the analysis. We used the Children's Global Assessment Scale (CGAS) to evaluate level of psychosocial functioning at 3 time points: when the first medically unexplained somatic symptom appeared, when the first psychiatric symptom appeared, and at psychosis onset (definitive diagnosis). Results: Eighteen patients met the study inclusion criteria. Headache (33.3%) was the most common somatic symptom preceding an SMI. Hypobulia (44.4%) was the most common first psychiatric symptom, followed by impaired concentration (38.9%). Analysis of CGAS scores for psychosocial functioning when the first medically unexplained somatic symptom appeared, when the first psychiatric symptom appeared, and at psychosis onset showed that CGAS scores were lower than those for healthy people when the first somatic symptom appeared, and significantly decreased thereafter, i.e., when the first psychiatric symptom appeared and at psychosis onset. Conclusion: Physicians examining adolescents with medically unexplained somatic symptoms should obtain a comprehensive history and examination findings and pay careful attention to psychosocial functioning, with the risk of mental illness in mind. In addition, such patients should be evaluated over time for changes in psychosocial functioning.