1. Somatisation

2. Somatisation
Somatisation is one of the most important single problems associated with a missed diagnosis of depression in primary care
BMJ 2008;336:

3. Somatisation
What is it?
Flipchart

4. Somatisation What are the difficulties?
(what do you want to get out of this session?)
Flipchart > aims and objectives

5. Problem based interviewing (PBI)
The “reattribution” model

6. Reattribution model Four distinct stages Feeling understood
Broadening the agenda
Making the link
Negotiating treatment

7. Disease illness model
Key issue

8. Feeling understood …active listening
What do I mean by active listening?

9. Feeling understood Take a full history Respond to mood cues
elicit other associated symptoms
ask about a typical pain day
Respond to mood cues
Clarification
empathic comments
probe mood state/thought content
Explore social and family factors
Check for biological symptoms
Explore patients health beliefs
Specific example
Scale
Carry out focussed physical examination

10. Reattribution model Four distinct stages Feeling understood
Broadening the agenda
Making the link
Negotiating treatment
Focus on broadening the agenda and making the link
Broadening the agenda 4m
Making the link 21m
Negotiating treatment 9m

11. Rehearsing the skills Eeek! Roleplay! 53.48 Broadening the agenda 6m
Making the link 2m
Negotiating treatment 5m

12. Exploring PBI further