Abstract Details

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.

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

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.

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.

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.