Prevalence of Somatic Symptom and Related Disorders at a Tertiary Neuroimmunology Clinic
Shlok Sarin1, Kiera Borthwick1, Rajeet Shrestha2, Hesham Abboud3
1Case Western Reserve University School of Medicine, 2Psychiatry Department, University Hospitals Cleveland Medical Center, 3Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center
Objective:

To evaluate the prevalence and characteristics of somatic symptom spectrum disorders (SSSDs) in patients referred to a tertiary neuroimmunology clinic.

Background:

Although common in practice, the prevalence of SSSDs in the neuroimmunology clinic is unknown. Discussing a primary psychiatric diagnosis as an alternative to a neurologic disorder can be difficult for both the physician and the patient.

Design/Methods:

We retrospectively evaluated patients referred to the neuroimmunology clinic diagnosed with an SSSD.  We evaluated whether the diagnosis was shared with the patient, whether a psychiatry referral was ordered, and whether the patient accepted the referral.

Results:

This study included 898 patients referred to the neuroimmunology clinic; 204 (22.7%) did not have a neuroimmunological disorder. Fifty-four patients (6.0% of total; 26.5% of non-neuroimmunological) were diagnosed with SSSDs (74% females, average age 42.5, SD 10.9). Per the DSM5-TR criteria, 33 patients (63.0%) had a functional neurologic disorder, 13 (24.1%) had somatic symptom (SSD), 5 (9.3%) had illness anxiety disorder, and 2 (3.7%) had an undefined SSD. Forty-four patients (81.5%) were referred for MS, and 10 (18.5%) for autoimmune encephalitis. Twenty-two patients (40.7%) were referred by neurologists, 16 (29.6%) were self-referrals, and 12 (22.2%) were referred by PCPs.  Eleven patients (20.4%) were healthcare workers. Psychiatric diagnosis was brought up in 38 patients (70%). A psychiatry referral was offered to 28 (73.6%%) with only 11 (28.9%) patients seeing psychiatry. Twenty-one patients (55.2%) accepted the diagnosis and 7 (18.4%) refused the diagnosis, left the room, or did not accept the referral. Thirty-seven patients (68.5%) had significant pre-existing psychiatric comorbidities. Thirty patients (55.5%) had previously been on psychiatric treatment.

Conclusions:

Among patients referred to neuroimmunology with no neuroimmunological diagnosis, SSSDs are relatively common, requiring consideration. While most patients accept psychiatry referral, a considerable number do not. Neuroimmunologists should offer psychiatric referral to these patients to avoid unnecessary repetition of investigations.

10.1212/WNL.0000000000204639