eMedicine Specialties > Psychiatry > Psychosomatic

Somatoform Disorders: Follow-up

Author: William R Yates, MD, Professor of Research, Department of Psychiatry, University of Oklahoma College of Medicine at Tulsa
Contributor Information and Disclosures

Updated: Feb 4, 2008

Follow-up

Further Inpatient Care

  • Somatoform disorders rarely require inpatient management. Consider inpatient care if a patient appears suicidal or requires detoxification from comorbid substance dependence. Additionally, inpatient care may be needed for patients whose somatoform disorder is incapacitating, ie, conversion disorder with motor symptoms of such severity to impair ambulation. The principles of inpatient care for somatization disorder include the following:
    • Rapid medical assessment to rule out a medical cause for the patient's symptoms
    • Assessment for evidence of psychiatric comorbidity and initiation of management for the comorbid psychiatric illness
    • Patient and family education regarding the somatoform disorder
    • An expectation of return to complete normal functioning with rehabilitation if necessary to restore function
    • Establishment of a primary care physician familiar with the management of somatoform disorders if one is not already present
    • A detailed discharge plan including primary care follow-up and psychiatric follow-up if necessary

Complications

  • Iatrogenic complications due to invasive diagnostic or surgical procedures
  • Dependence on prescription-controlled substances
  • Development of a helpless and dependent lifestyle

Prognosis

  • Somatoform disorders can range from mild and transient to severe and chronic. Early treatment improves prognosis and limits social and occupational impairment.

Patient Education

  • The key issues of patient education have been outlined in Psychosocial intervention in the Medical Care section. Key patient educational issues include the following:
    • The physician acknowledges the patient's symptoms and suffering.
    • The physician takes on the role of evaluation and monitoring of symptoms.
    • Not all symptoms indicate evidence of a pathological disease.
    • The patient should attempt to maintain interpersonal function despite symptoms.
    • Physical symptoms not due to a defined disease often remit spontaneously.
    • Indentifying key life stressors and sources of anxiety can be important.
    • Stress reduction may produce improvement in physical symptoms.
    • Aggressive surgical approaches should be used cautiously and only with the approval of a primary care physician who knows the patient well.
  • Family education is often crucial for the successful management of somatoform disorders. For the patient's family members, this education should include the following:
    • Discuss the somatoform diagnosis.
    • Expect the patient to improve and return to normal function.
    • Direct the patient to discuss any somatic symptoms with the primary care provider. Patients should not seek assistance from family members in assessing the seriousness of their symptoms or the diagnosis relating to their symptoms
    • The primary care provider should direct any need for subspecialty evaluation.
    • Family members should spend time with and pay attention to the patient when symptoms are absent. For the patient, this reinforces the idea that their symptoms do not bring special attention from others.
    • Family members may help by providing distraction activities if somatic symptoms are present, eg, going for a walk or going out to a movie.
  • For excellent patient education resources, visit eMedicine's Muscle Disorders Center. Also, see eMedicine's patient education articles Fibromyalgia, Chronic Fatigue Syndrome, and Chronic Pain.

Miscellaneous

Medicolegal Pitfalls

  • Failure to identify a medical cause for physical symptoms
  • Use of unnecessary and invasive diagnostic testing for physical symptoms caused by somatization
  • Adverse effects of multiple medications used in attempt to control symptoms
  • Prescription drug abuse for controlled substance
  • Lack of coordination of care by multiple physicians who may be unaware of other physicians treating the patient
 


More on Somatoform Disorders

Overview: Somatoform Disorders
Differential Diagnoses & Workup: Somatoform Disorders
Treatment & Medication: Somatoform Disorders
Follow-up: Somatoform Disorders
Multimedia: Somatoform Disorders
References
[ CLOSE WINDOW ]

References

  1. Baruffol E, Thilmany MC. Anxiety, depression, somatization and alcohol abuse. Prevalence rates in a general Belgian community sample. Acta Psychiatr Belg. May-Jun 1993;93(3):136-53. [Medline].

  2. Martin A, Rauh E, Fichter M, Rief W. A one-session treatment for patients suffering from medically unexplained symptoms in primary care: a randomized clinical trial. Psychosomatics. Jul-Aug 2007;48(4):294-303. [Medline].

  3. Smith GR Jr, Monson RA, Ray DC. Psychiatric consultation in somatization disorder. A randomized controlled study. N Engl J Med. May 29 1986;314(22):1407-13. [Medline].

  4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Text Revision. Washington, DC, American Psychiatric Association. 2000.

  5. Barsky AJ, Ahern DK. Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. JAMA. Mar 24 2004;291(12):1464-70. [Medline].

  6. Baumeister H, Härter M. Prevalence of mental disorders based on general population surveys. Soc Psychiatry Psychiatr Epidemiol. May 21 2007;[Medline].

  7. Bleichhardt G, Timmer B, Rief W. Cognitive-behavioural therapy for patients with multiple somatoform symptoms--a randomised controlled trial in tertiary care. J Psychosom Res. Apr 2004;56(4):449-54. [Medline].

  8. Chioqueta AP, Stiles TC. Suicide risk in patients with somatization disorder. Crisis. 2004;25(1):3-7. [Medline].

  9. de Waal MW, Arnold IA, Eekhof JA, van Hemert AM. Somatoform disorders in general practice: prevalence, functional impairment and comorbidity with anxiety and depressive disorders. Br J Psychiatry. Jun 2004;184:470-6. [Medline].

  10. Dickinson WP, Dickinson LM, deGruy FV. A randomized clinical trial of a care recommendation letter intervention for somatization in primary care. Ann Fam Med. Nov-Dec 2003;1(4):228-35. [Medline].

  11. Fink P, Sorensen L, Engberg M. Somatization in primary care. Prevalence, health care utilization, and general practitioner recognition. Psychosomatics. Jul-Aug 1999;40(4):330-8. [Medline].

  12. Kroenke K, Spitzer RL, deGruy FV 3rd. A symptom checklist to screen for somatoform disorders in primary care. Psychosomatics. May-Jun 1998;39(3):263-72. [Medline].

  13. Morriss RK, Gask L, Ronalds C. Clinical and patient satisfaction outcomes of a new treatment for somatized mental disorder taught to general practitioners. Br J Gen Pract. Apr 1999;49(441):263-7. [Medline].

  14. Phillips KA. Body dysmorphic disorder: diagnostic controversies and treatment challenges. Bull Menninger Clin. Winter 2000;64(1):18-35. [Medline].

  15. Phillips KA, Albertini RS, Rasmussen SA. A randomized placebo-controlled trial of fluoxetine in body dysmorphic disorder. Arch Gen Psychiatry. Apr 2002;59(4):381-8. [Medline].

  16. Smith GR Jr, Rost K, Kashner TM. A trial of the effect of a standardized psychiatric consultation on health outcomes and costs in somatizing patients. Arch Gen Psychiatry. Mar 1995;52(3):238-43. [Medline].

  17. Smith RC, Gardiner JC, Lyles JS, et al. Exploration of DSM-IV criteria in primary care patients with medically unexplained symptoms. Psychosom Med. Jan-Feb 2005;67(1):123-9. [Medline].

  18. Werring DJ, Weston L, Bullmore ET. Functional magnetic resonance imaging of the cerebral response to visual stimulation in medically unexplained visual loss. Psychol Med. May 2004;34(4):583-9. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

somatization, body dysmorphic disorder, conversion disorder, hypochondriasis, somatization disorder, somatoform disorder NOS, somatoform disorder not otherwise specified, unexplained physical symptoms

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

William R Yates, MD, Professor of Research, Department of Psychiatry, University of Oklahoma College of Medicine at Tulsa
William R Yates, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, American Academy of Family Physicians, and American Psychiatric Association
Disclosure: Forest Laboratories Grant/research funds Other

Medical Editor

Mohammed A Memon, MD, Medical Director of Geriatric Psychiatry, Department of Psychiatry, Spartanburg Regional Hospital System
Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eduardo Dunayevich, MD, Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati; Clinical Research Physician, Neuroscience, Lilly Research Laboratories
Eduardo Dunayevich, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; BMS Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Other; Northstar Grant/research funds Other; Novartis  Other

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.