Schrander-Stumpel Theunissen Hulsmans syndrome
Overview
A rare syndrome characterized mainly by vitiligo, psychomotor retardation, cleft lip and other facial anomalies.
Symptoms
* Vitiligo * Psychomotor retardation * Cleft palate * Psychomotor retardation * Somatic retardation
Causes
* Anxiety * Depression * Hypothyroidism * Premenstrual syndrome * Hypochondriasis * Somatization disorder * Chronic fatigue syndrome * Fibromyalgia * Panic disorder * Malingering * Conversion reaction
Diagnosis
This presentation is marked by multiple vague complaints, symptoms out of proportion to the physical findings, symptoms outside the anticipated spectrum of the organic disease, and symptoms that do not follow anatomic distributions. The patient is often more concerned with the physician accepting authenticity of symptoms than relieving them. Vague, diffuse descriptions or overly detailed and elaborate symptoms are suggestive. The patient seems to be amplifying normal bodily sensations. Psychological factors may be revealed in the symbolic choice of words (e.g., “lump in the throat”). “Stress” for most patients is an acceptable framework within which to obtain psychological information. Care must be taken during the interview not to suggest that the symptoms are “all in the head.” A thorough and thoughtful history and physical examination are the basis for chosing specific diagnostic tests, and signal to the patient that the complaints are being taken seriously.
Treatment
The goal of treatment is to help the patient learn to live with her signs and symptoms. After diagnostic evaluation has ruled out organic causes, the patient should be told that she has no serious illness currently but will receive care for her genuine distress and ongoing medical attention for her symptoms. The most important aspect of treatment is a continuing supportive relationship with a health care provider who acknowledges the patient’s signs and symptoms and is willing to help her live with them. The patient should have regularly scheduled appointments to review her complaints and the effectiveness of her coping strategies. The patient with somatization disorder seldom acknowledges any psychological aspect of her illness and rejects psychiatric treatment.