[Posted on 12 September, 2017 by Elisabeth Fernell]
You’ll sometimes hear, regarding patients with psychiatric symptoms and disorders, things like “Could it be something somatic?” or “We need to conduct a somatic examination!”. What does a somatic, i.e. physical examination actually mean when it comes to these patients? One might also come across phrasings like “somatic differential diagnosis in examination of children and adults with neuropsychiatric and psychiatric conditions”. Talking about performing a somatic examination seems especially common when addressing psychiatric symptoms, but do the symptoms themselves not indicate the presence of a physical abnormality involving the brain? “Somatic” can never be a differential diagnosis or the counterpart to “psychiatric”.
Comparing with other functionally impairing symptoms, such as headaches or stomach problems, there is no discussion about whether one should make a somatic examination. The symptoms/problems are mapped out and potential causes are examined medically.
In the field of neurology, the brain is unquestionably treated as a physical organ. No one speaks of somatic examination for conditions like epilepsy or cerebral palsy. Epilepsy, cerebral palsy and disorders that manifest behaviourally, such as ADHD and autism, all stem from the same brain. Of course they do! All conditions require a medical assessment of cause(s). The term cognitive medicine, introduced by professor Anders Wallin in Gothenburg, along with associates, has opened the door to closer collaboration between neurology and psychiatry! The term ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations), coined a number of years ago by professor Christopher Gillberg, Gothenburg, also highlights the necessity of collaboration between (child) psychiatry and (child) neurology. All the symptoms – manifesting in behaviour and function – whether they are grounded in cognition, deficits with regard to executive functions, the ability to employ “theory-of-mind” or problems with intellectual functions – necessitate assessment of medical cause(s) as part of the investigation work. Some of these causes can be identified using today’s medical technology. There is, however, a relatively large percentage of patients for whom we are presently unable to pinpoint the specific cause, even though we know that whatever that cause is, ultimately originates with disorders in the “somatic” brain. Some medical ailments affect several organs, including the central nervous system, the brain, and generate psychiatric symptoms. Distinguishing between the terms somatic and psychiatric simply cannot be relevant, as it implies that they should somehow be considered opposites!