Diagnostic labyrinths of somatoform disorders in Russian healthcare practice
ORIGINAL PAPERS
Abstract
Introduction.The high prevalence of somatoform disorders in general medical care is associated with a significant delay in diagnosis (“diagnostic odyssey”), creating a substantial clinical and economic burden. The study aimed to characterize the diagnostic-therapeutic pathway and clinical-psychological profile of patients with verified somatoform disorders within the Russian healthcare system.Materials and methods.A prospective observational cohort study with a retrospective analysis of pre-hospital data was conducted. The final cohort included 39 patients withInternational Classification of Diseases, 10th revision,F45 diagnoses. Methods included: reconstruction of the patient pathway based on medical records, psychometric testing (Hospital Anxiety and Depression Scale, HADS), and a structured clinical interview to assess alexithymia, catastrophizing, and locus of control.Results.The median duration of the diagnostic pathway was 4 years (2–7 years). Patients consultedan average5 (3–8) internists and underwent 9 (6–12) instrumental and laboratory tests; test duplication was noted in 61.5% of cases. Pre-hospital diagnoses were predominantly syndromic: “vegetative dystonia” (71.8%), “irritable bowel syndrome” (30.8%), “osteochondrosis” (25.6%). The psychological profile was dominated by alexithymia (74.4%) and anxiety (HADS-A, Me=8 (6–11)). A strong association was found between an external locus of control and increased diagnostic delay.Discussion.The results demonstrate systemic issues: lack of referral algorithms, internists’ knowledge gap regarding somatoform disorders, and communication barriers. Syndromic diagnoses (“vegetative dystonia”, “irritable bowel syndrome”) often mask psychiatric disorders, delaying pathogenetic treatment.Conclusions.Key indicators for referral to a psychiatrist include polymorphic chronic complaints, their catastrophic interpretation, low efficacy of symptomatic therapy, and a long history of “doctor shopping”. Optimizing care requires screening for anxiety in primary care and developing clear interdisciplinary guidelines.
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