Paeds Cases · mental-behavioural-and-psychosomatic
Somatic symptom and related disorders OSCE — validation, function-first plan and safeguarding
Observed structured encounter testing a validating, function-first somatic-symptom consultation: biopsychosocial assessment, single red-flag screen, the symptom-amplification reframe, an interdisciplinary plan with school reintegration, avoidance of opioid escalation, and recognition of fabricated/induced illness as a safeguarding presentation.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Station A is a 13-year-old with eight months of abdominal pain and headache, normal tests and school absence, whose family wants more tests. Station B is a 12-year-old on the ward with functional leg weakness (positive Hoover sign) after exclusion of structural disease.
Station objectives
- Validate somatic symptoms as real and screen once for red flags, without over-investigating. [1] [2]
- State the DSM-5 / DSM-5-TR principle (symptoms need not be medically unexplained) and reframe with the symptom-amplification model. [2]
- Co-build a function-first interdisciplinary plan with functional goals, school reintegration and avoidance of opioid escalation. [4]
- Establish conversion disorder on positive grounds and explain it without stigmatising language. [6]
References6ShowHide
- [1]Garralda ME Practitioner review: Assessment and management of somatisation in childhood and adolescence: a practical perspective. Journal of child psychology and psychiatry, and allied disciplines, 1999.PMID 10604395
- [2]Garralda ME Unexplained physical complaints. Child and adolescent psychiatric clinics of North America, 2010.PMID 20478496
- [3]Kozlowska K; English M; Savage B Connecting body and mind: the first interview with somatising patients and their families. Clinical child psychology and psychiatry, 2013.PMID 22969165
- [4]Claar RL; Walker LS Functional assessment of pediatric pain patients: psychometric properties of the functional disability inventory. Pain, 2006.PMID 16480823
- [5]Puri PR; Dimsdale JE Health care utilization and poor reassurance: potential predictors of somatoform disorders. Psychiatric clinics of North America, 2011.PMID 21889677
- [6]Pehlivantürk B; Unal F Conversion disorder in children and adolescents: a 4-year follow-up study. Journal of psychosomatic research, 2002.PMID 11943237