Physical Symptoms and Psychogenic Etiology An Investigation of Consultation Material

Summary The difficulties accompanying psychiatric consultation work are discussed. Case material of this type is of particular interest in that the psychic nature of the patient's condition is often not immediately apparent, but only appears in the course of a closer analysis of the case. Results are given of a synthesis and analysis of a psychiatric examination of 465 so-called “consultation cases” (228 boys and 237 girls) from the medical and surgical departments of Kronprinsessan Lovisas Children's Hospital, which was carried out during the years 1954–1957. Somatic disease or somatic signs and symptoms occured in 57 % of the total number of cases. In about half of these neurological diseases were found, in a quarter, endocrine disturbances. The remainder consisted of cases who had been referred here simply on the grounds of suspected psychic disturbances. The psychiatric investigation showed that in 19 % of the cases registered, no particular mental symptoms could be found. The majority of these showed physical signs and symptoms and the remainder were to be examined for pre-adoption purposes or something similar. In 35 % of cases intellectually retarded development of varying types and degrees was present. Mental symptoms combined with normal intelligence existed in 46 % of the series. In more than half of these cases no noticeable physical disease was found. This last group comprises 28 % of the entire material. The mental symptoms in those cases with normal intellectual ability have been roughly divided into cases with “uncomplicated” symptoms and cases with “conversion” symptoms respectively. While the uncomplicated symptoms were found to be evenly distributed among the different age groups the conversion symptoms appeared almost exclusively among the children of school age and over. It has become apparent through analysis that in those cases where somatic disease existed side by side with mental symptoms the latter have almost invariably consisted of uncomplicated symptoms. On the other hand, in those cases where only mental symptoms were found, the incidence of uncomplicated and conversions symptoms was found to be about equal. The reasons for this have been discussed and the difference between the groups may, among other things, possibly be accounted for by the fact that conversion symptoms tend to be more easily overlooked in patients with somatic disease. Conditions of stress in the home environment existed, however, to a lesser degree in patients with somatic disease as well as mental symptoms, than in connection with those patients who only showed mental symptoms. This speaks for the fact that the somatic disease in itself or factors connected with it play a significant part in the appearance of the mental symptoms which take the form of “uncomplicated” symptoms. It was also of interest to note that the mental-symptom picture in patients of normal intelligence who showed signs of brain injury (epileptic seizures) was no different from that of normally gifted patients with somatic disease of another type. The mental symptoms in the physically healthy showed themselves in some cases to be of a grave hysterical character and here, almost without exception, very serious environmental conditions were found to exist. In 25 % of the total number of cases continued psychiatric treatment was considered necessary.