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©Advance Educational Institute & Research Centre 

Volume 5, October 2018  
www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Anum Haider 6 

 

Original Article                                                                                   DOI: 10.29052/2412-3188.v5.i1.2018.6-16 

Frequency of somatic complains among patients  

with mental illness 
Anum Haider1 & Usama Asad2 

1 Dow Medical college, Dow University of Health Sciences, Karachi 
2 Sindh Medical University, Karachi. 

Corresponding Author Email: anum.haider@duhs.edu.pk 

Received 10/05/2018; Accepted 20/09/2018; Published 10/10/2018  

 

Abstract 

Background: It is established that physical and mental disorders share common risk factors, 

among those the unhealthy lifestyle is most common. In order to achieve complete health, it is 

crucial to monitor both physical and mental health. Mental health problem is the most deserving 

area to work with because physical health issues are often neglected or mismanaged. This study 

intends to unveil the frequency of somatic (physical) health complains among patients with 

mental illness.  Methodology: In this cross-sectional study total 85 patients were enrolled from 

Psychiatry Out Patient Department, Civil Hospital Karachi, during 16th October to 13th 

November 2015. Patients were asked about the demographic details and existing somatic 

complaints from the pre-formulated questionnaire while data was analyzed on SPSS. Results: 

32.9% of the subjects were diagnosed with particular medical comorbidity. However, among 

undiagnosed somatic (physical) complains; endocrinological complaints were more frequent 

i.e.16.7% followed by 14.2% Gastrointestinal (GIT) and 13.68% Central Nervous System 

(CNS). Conclusion: The current study supported the fact that there is a high frequency of 

somatic complaints in patients with mental illness. Physical monitoring is crucial for early 

identification and better prognosis.  

 

Keywords 
Somatic Complains, Mental Illness, Unhealthy Life Style, Physical Monitoring. 

 

Introduction 

The ability to perform well at work and to 

fulfill the responsibilities depends on the 

physical and mental well-being of a person. 

If health compromises in either way it may 

hamper the overall functioning of an 

individual (Alonso et al., 2014). The 

physical and mental problems are often 

found to be interlinked but only a few 

studies have explained the basis of such 

linkage. Multisystem involvement due to 

the dysregulated inflammatory background 

is identified as the underpinning factor for 

cardiovascular and bipolar disorders 

(Leboyer et al., 2012). The main 

explanation of centrally driven pain 

conditions like Irritable bowel syndrome-

IBS, fibromyalgia, and interstitial nephritis 

can be considered as other possible 

mechanisms. These disorders mimic mood 

disorders and respond well to CNS-

neuromodulatory agents like Serotonin 

Norepinephrine Reuptake Inhibitor-SNRI 

and anticonvulsants (Phillips, 2011). 

Inflammation is a state shared by both 

physical and psychiatric disorders which 

play a bidirectional causational role, 

disrupting the neuroregulatory systems 

(serotonergic, dopaminergic, neuropeptide 

Y) and Hypothalamic-Pituitary-Adrenal 

Axis (HPA) (Nousin, 2013).  

 

Broadly if we classify the possible risk 

factors to activate the inflammatory 

mechanism, it might go into three 

dimensions; biological that includes 

obesity, sedentary lifestyle, smoking and 

any disability, psychological including 

chronic stressors, adverse life events, 

abuse, neglect) and social includes poverty, 

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Annals of Psychophysiology 
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Anum Haider 7 

 

neighborhood, social support, isolation, 

household dysfunctions. These factors act 

in an integrated manner to disrupt the HPA-

axis and neural circuitry resulting in the 

manifestation of various physical and 

psychiatric problems (Druss, 2011). The 

unhealthy lifestyle such as smoking, 

alcohol, and substance abuse, lack of 

physical activity, poor eating habits, 

suboptimal hygiene and disturbed sleep 

pattern) is identified as modifiable risk 

factor for many physical problems making 

the population more vulnerable (Scott, 

2011 & Druss, 2011).  

Mental illness itself, is more likely to be 

associated with disability and physical 

problems such as obesity, metabolic 

syndrome, Diabetes Mellitus-DM, 

cardiovascular and respiratory issues are 

almost twice more common in patients with 

severe mental illness than that of general 

population and it may also increase the 

mortality risk up to five times (Scott et al., 

2009 & Hayward, 1995). The association of 

mental illness with other somatic complains 

and medical comorbidities may play a 

synergistic role by adding on the burden. It 

not only impairs quality of life but also 

compromises life expectancy to such an 

extent that almost 30 years of life may be 

lost in this population (Scott et al., 2009 & 

Hayward, 1995). 

Beside Psychotropic use such as 

antipsychotics which have established role 

in causing obesity and metabolic syndrome, 

there is a complex interplay of 

neurobiological (genetics, leptin 

sensitivity, HPA axis), Psychological 

(Negative emotions, stress proneness, Type 

A Personality, hostility) and social factors 

(low social support, poverty, alcohol, 

substance use) in the presentation of 

physical health problems (Taylor et al., 

2012 & Smith, 2011). 

Cardiovascular problems are among the 

most commonly identified physical 

comorbidities in patients with mental 

illness while the possible underlying 

phenomenon studied is perseverative 

cognition especially those with mood and 

anxiety disorders which may delay 

physiological recovery from acute stress 

but also increases the risk for 

cardiovascular damage (Larsen, 2009). 

Despite the high rate of physical 

comorbidity, it’s going to be unattended 

and mislabeled as psychosomatic or 

functional at a significantly high rate and 

ultimately worsening the psychological 

stability, treatment adherence, life 

expectancy and quality of life (Hert, 2011 

& Gray, 2012).  

Studies have reported that psychiatrists 

were found to be more frequent in 

overlooking medical problems in patients 

with medical illness than that of physicians, 

however, the physical comorbidity rate was 

actually estimated to be 43% in those 

patients (Koryani, 1979). Patients with 

mental illness, the most hampering factor 

identified in seeking help is a stigma 

(Mercer et al., 2012). This delay in 

identification and management of physical 

health problems in mentally ill patients 

makes premature mortality highly 

prevalent. Even in high-income countries, 

the male population with mental illness die 

around 20 years while females 15 years 

earlier than the general population 

(Thornicroft, 2011 & Lawrence, 2013). 

Besides, presenting as a comorbidity, 

physical problems may also manifest 

psychiatric problems and may be 

misdiagnosed as a psychiatric illness. Hall 

et al in his study reviewed the previously 

diagnosed psychiatric cases by a 

combination of physical, psychiatric and 

neurological examinations followed at labs. 

He came up with the medical diagnosis in 

around 46% of cases (Hall et al., 1980). The 

ultimate question arises in mind, how such 

an important presentation can be 

overlooked by health professionals? The 

research has proposed the possible answer 

like lack of screening and assessment of 

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Annals of Psychophysiology 
©Advance Educational Institute & Research Centre 

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ISSN 2412 - 3188 
 

Anum Haider 8 

 

physical health aspects. Other possibilities 

are variable presentations due to patient and 

carer’s race and ethnic characteristics, the 

deficits in a system including lack of 

resources, poverty, inaccessible health 

services (Hert et al., 2011 & Hitchen, 

2011). At a system level, actions are not 

easy to recognize but at the individual level, 

simple and basic care can improve the 

suboptimal medical care. Psychiatrists can 

play a crucial role by expanding the clinical 

paradigm including physical monitoring 

and adherence to treatment guidelines. 

Educating patients to control suboptimal 

lifestyle factors and promoting healthy 

health behaviors (diet, exercise, smoking 

cessation) may have a remarkable 

advantage over physical health outcomes 

(Hert et al., 2011 & Hitchen, 2011). 

Considering the importance of the subject 

and lack of research in this regard 

especially in the third world countries like 

Pakistan, this study aimed to determine the 

frequency of somatic complains among 

patients with mental illness so that clear 

picture may come upon the surface to better 

raise the consideration on an important 

area.   

As it has a bidirectional impact, physical 

and mental disorders may synergistically 

affect not only an individual's quality of life 

but at the gross level adversely affects the 

economy. At the individual level it hampers 

the productivity and impairs the economy 

by high utilization of resources. There is a 

high need to narrate the future health plan 

accordingly, to better cope with the 

discussed issue and to get the better health 

outcome and economy consequently. 

Methodology 

A cross-sectional study was conducted in 

Psychiatry Out Patient Department, Civil 

Hospital Karachi, thrice per week during 

16th October to 13th November 2015. 

Convenience sampling technique was used 

and informed consent was obtained. 

Patients presented with the reliable 

informant and clearly defined somatic 

complains, agree to visit the site and 

diagnosed with mental illness from ICD-10 

diagnostic criteria previously and proficient 

in speaking the Urdu language were 

included in the study. However, those who 

were unstable or unwilling were excluded. 

Total 85 patients were selected and 

interviewed via a semi-structured 

questionnaire. The questionnaire includes 

chief complaints of the major vital systems 

such as cardiovascular system (CVS), 

respiratory system, central nervous system 

(CNS), Gastrointestinal (GI), endocrine, 

dental, dermatological, genitourinary and 

locomotory system. The list of somatic 

complains was adapted from the local book 

of bedside techniques. Data was analyzed 

using SPSS version.19. 

Result 

Among 85 patients, the mean age of 

presentation was 34.87 ± 13.46years.  

Majority of the study participants were 

males 56(66%) and married 42(49.4%). 

About one third 28(32.9%) of the patients 

were observed with diagnosed medical 

comorbidity. Among these, Hypertension 

(16.7%) was the most frequent followed by 

hepatitis, Tuberculosis (TB), Asthma, 

Diabetes mellitus (DM) and hyperlipidemia 

as shown in table 1. 

 

 

 

 

 

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Anum Haider 9 

 

Table 1: Demographic Characteristics 

Variables Mean + SD 

Age (years) 34.87±13.46 

 N (%) 

Gender 
Male 

Female 

56(66) 

29(34) 

Marital status 
Married 

Single 

Divorced 

42(49.4) 

40(47) 

3(3.5) 

Medical Comorbidity  
(HTN, DM, Hepatitis, T.B, Asthma & Hyperlipidemia) 

28(32.9) 

*HTN= Hypertension, DM= Diabetes Mellitus, TB= Tuberculosis  

*SD=Standard Deviation, N=frequency 

 

 

 
*NOS=Not Otherwise Specified 

 

Figure 1: Frequency of psychiatric illness (n=85) 

In the studied sample, Schizophrenia was the more frequently found psychiatric diagnosis i.e. 

42.4% followed by psychosis 24.7%, depression 8.2% and bipolar disorder 5.9%. 

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%
42.40%

1.20% 1.20%

24.70%

8.20%
5.90% 4.70%

2.40% 2.40%
4.70%

2.40%

P
e

rc
e

n
ta

ge
s

Mental Illnesses

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Anum Haider 10 

 

 
Figure 2: Frequency of Psychotropic Use 

 

According to the results in figure 2, Antipsychotics use was also found to be pronounced 

(78.8%) among the studied population. 

 

*CVS=Cardiovascular system; CNS= Central Nervous System; GI= Gastrointestinal Tract 

 

Figure 3: Frequency of Physical Complaints in the vital organ systems 

Among undiagnosed physical complains of the vital organ systems, Endocrinological 

complaints were found to be more frequent 16.7% followed by GI 14.2%, CNS 13.68%, CVS 

12.7%, Respiratory 10%, Renal 9.7%, Dental 9.1%, dermatological 6.38%, musculoskeletal 

6.08% and genital 1.2%.  

 

While the most frequent Systemic complains among studied systems were; Palpitation(45%), 

Breathing problems (37%), Constipation (20%), Increased frequency in micturition (50%), 

Rash (60%), Joint pain (80%), Polydipsia (54.5%), Xerostomia (85.5%), unspecified genital 

complaints (100%) and headache (42%) as described in Table 2. 

 

78.80%

10.80%

10.40%

-Antipsychotics -Antidepressants -others

0 5 10 15 20

-Endocrine

-GI

-CNS

-CVS

-Respiratory

-Renal

-Dental

-Dermatological

-Musculoskeletal

-Genital

16.7

14.2

13.68

12.7

10

9.7

9.1

6.38

6.08

1.2

Percentage %

P
h

ys
ic

al
 C

o
m

p
la

in
ts

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Table 2: Distribution of physical complains in individual systems 

Physical Systems Complaints N (%) 

Cardiovascular 

Palpitation 

Chest pain 

Syncope 

Unspecified/mixed 

5(45) 

3(27) 

2(19) 

1(9) 

 

 

Gastrointestinal 

 

Constipation                                                                                                                                                                                        

Nausea 

Vomiting 

Abdominal pain 

Heartburn 

Dysphagia 

Jaundice 

Diarrhea 

Unspecified/mixed 

 

3(20) 

2(15) 

1(7.6) 

1(7.6) 

2(15) 

1(7.6) 

1(7.6) 

1(7.6) 

1(7.6) 

 

Endocrinological 

 

Polydipsia 

Heat intolerance 

Cold intolerance 

Sweating 

Unspecified/mixed 

8(54.5) 

2(13) 

1(6) 

2(13) 

2(13) 

Respiratory  

Breathing problem 

Cough & Flu 

Hemoptysis 

Mixed Symptoms 

3(37) 

2(25) 

1(12.5) 

2(25) 

Renal 

Increased frequency  

Dysuria 

Unspecified/mixed 

4(50) 

3(37.5) 

1(12.5) 

 

Dental 
Xerostomia 

Poor oral hygiene 

6(85.5) 

1(14.5) 

Dermatological 
Rash 

itching 

3(60) 

2(40) 

Musculoskeletal 
Joint pain 

Unspecified 

4(80) 

1(20) 

Genital Unspecified 

 

1(100) 

 

Central nervous system 

 

Headache 

Fits 

Blackouts 

Dizziness 

Unspecified/mixed 

 

5(42) 

2(16.6) 

1(8.2) 

2(16.6) 

2(16.6) 

 

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Discussion 

Other studies pertinent to this subject also 

found chronic physical health problems as 

frequent as 74% among patients with severe 

mental illness and about half of the 

individuals had experience of more than 

two kinds of chronic physical health 

problems. Chronic pulmonary illness was 

found to be more prevalent in such 

problems (Jones et al., 2004).  In our study, 

about one third (33%) of the patients were 

already diagnosed with certain medical 

comorbidity. While in the undiagnosed 

physical complains endocrinological, GI, 

CNS and CVS related complaints were 

more frequent (Figure 3). 

Due to common risk factors (obesity, 

smoking, dyslipidemia) and antipsychotic 

use, disorders such as cardiovascular 

diseases and diabetes mellitus mostly 

prevails in people with severe mental 

illness (Schizophrenia, Depression, and 

Bipolar disorder) (Hert et al., 2009). Our 

study sample was pronounced with 

psychotic patients (Schizophrenia 42.4%, 

Psychosis NOS 24.7%) and similarly the 

antipsychotic use 78.8% (Figure 2). This is 

controversial to the available evidence 

where neurotic problems like depression, 

anxiety are considered to be more prevalent 

than psychotic disorders. It may be due to 

the fact that people with neurotic problems 

usually hardly seek help from psychiatric 

facility and therefore psychotic problems 

seem to be over presented. In our study 

overall female proportion is lesser i.e. 34%, 

this might be due to cultural inhibition and 

less acceptance of psychological problems. 

As we broadly compare our study results to 

previous evidences, (Table 2), constipation 

has been found a frequent problem (20%) 

in psychiatric patients especially of old age 

(Vessurun et al., 2016). Other 

gastrointestinal complaints like nausea, 

anorexia, and flatulence we also found 

prevalent mostly in neurotic patients and 

ultimately label to be suffering from 

irritable bowel syndrome (Sobański et al., 

2015). Palpitation is one of the frequent 

physical complaint in our patients (Table 

2). Studies have identified bidirectional 

relation of cardiovascular and psychiatric 

problems, both direct and neurochemical 

effects (Christoph et al, 2014 & Shah et al., 

2004). It is very important to identify its 

exact relationship in particular patient 

because the management plan would vary 

(Alijaniha et al., 2016). Headache also has 

a remarkable association with psychiatric 

problems (Table 2). The evidence supports 

its both comorbid and associated 

presentation with Psychiatric disorders, 

especially migraine headache with that of 

tension, irritability and anxiety (Shakya, 

2015). Frequent drinking of water i.e., 

polydipsia has an association with 

Schizophrenia, anxiety and depressive 

disorders. But it has its medical basis and 

medical complications (hyponatremia) as 

well. The reliable and economical 

physiological tests are available to easily 

differentiate and manage this condition 

(Calara et al., 2017).  

Breathing problem and impaired lung 

function have found to be frequent 

especially in Schizophrenia. Its 

pathological presentation is almost similar 

to that of pneumonia, chronic obstructive 

pulmonary disease and chronic bronchitis 

while clinically it can be easily missed 

(Partti et al., 2015). Our patients also had 

breathing complains (Table 2). Psychiatric 

disorders like bipolar affective disorder, 

depressive disorder, and anxiety are 

identified as risk factor for joint pain 

disorder like osteoarthritis possibly due to 

medication side effects and unhealthy 

lifestyle or obesity (Huang et al., 2016). 

Urinary complains are also frequent as in 

our study mental health professionals rarely 

take it considerable to rule out possible 

pathologies (Przydacz et al., 2017). Genital 

problems are usually unreported, 

unaddressed or misidentified (Basson et al., 

2018 & Grover et al., 2016). In our study, 

most genital complains were unspecified it 

might be due to taboo or insufficient 

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professional skills (Table 2). Xerostomia is 

identified as a frequent dental problem 

study (85.5%) possibly due to poor diet and 

medication side effects (Tomar et al., 2011 

& Kisley et al., 2011). 

With such frequent presentation, physical 

disorders are often missed even by non-

mental health professionals. Various direct 

or indirect factors are responsible such as 

poor communication and handling skills for 

challenging behavior of the patient, 

complex clinical presentation and 

overburdening (Shefer et al., 2014).To 

overcome this issue of a significant 

association between physical and 

psychiatric problems which worsen quality 

of life and increases the health care burden, 

there is a high need to take certain steps. 

Education and awareness of healthcare 

professionals are instrumental among all. 

Beside these improving communication 

among primary care and specialist health 

professionals by inclusion of mental health 

with general medical care (Druss, 2011), 

involving significant other in the care to 

emulate and maintain healthy behaviors 

and habits such as physical activity, proper 

sleep, avoidance of smoking, alcohol or 

other substance abuse and intake of healthy 

diet (Happell 2012 & Thoits, 2011) and 

monitoring physical and mental health 

status and effect of treatment (Carlier, 2012 

& Eldridge, 2011). Although interventional 

studies evidence is scarce (Hardy et al., 

2011) but there are good results of even 

involving mental health nurses in 

improving care and services by monitoring 

physical health (Bradshaw, 2012).  

The study has certain limitations, results 

cannot be generalized due to small sample 

size and short study duration, the 

demographic details were insufficient, the 

association and correlation of variables 

could not be studied and the medical 

specialist opinion couldn't seek about those 

physical complaints. Our study is an 

initiation towards more specific and 

extensive work in this subject like assessing 

a large sample size that includes both urban 

and rural population for a long duration to 

study, the sequence of development of 

various medical and psychiatric disorders, 

correlation of physical and psychiatric 

illness, interventional studies regarding 

awareness of patients about acquiring 

healthy lifestyle and regular physical 

checkup in case of presence of risk factors 

and also education of mental health 

professionals regarding monitoring, early 

identification and its impact on clinical 

outcome as well as for liaison work 

involving general health professionals 

regarding approaching patients with 

psychiatric presentation. 

Conclusion 

Our study concluded that somatic 

complaints are frequent in patients with 

psychiatric illness in almost all systems i.e. 

CVS, GI, CNS, respiratory, dental, genital, 

dermatological, endocrine, musculoskeletal 

and renal. Physical monitoring is crucial for 

early identification. It is recommended to 

identify, properly investigate and manage 

somatic complains in patients with mental 

illness to improve overall prognosis and 

quality of life. It can be achieved by 

improving the skills of health professionals. 

 

Conflicts of Interests  

None. 

Acknowledgment 

We would like to acknowledge the patients 

enrolled in the study and their attendants for 

cooperation. 

 

Funding 

None.  

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Volume 5, October 2018  
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ISSN 2412 - 3188 
 

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©Advance Educational Institute & Research Centre 

Volume 5, October 2018  
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Anum Haider 16 

 

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