Somatoform Disorders Follow-up

  • Author: William R Yates, MD, MS; Chief Editor: Eduardo Dunayevich, MD   more...
 
Updated: Aug 3, 2010
 

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
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Complications

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

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

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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.
    • Identifying 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.
  • Other helpful Web sites include the following:
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Contributor Information and Disclosures
Author

William R Yates, MD, MS  Research Psychiatrist, Laureate Institute for Brain Research; Professor of Research, Department of Psychiatry, University of Oklahoma College of Medicine at Tulsa

William R Yates, MD, MS is a member of the following medical societies: American Academy of Family Physicians and American Psychiatric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mohammed A Memon, MD  Chairman and Attending Geriatric Psychiatrist, Department of Psychiatry, Spartanburg Regional Medical Center

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief 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.

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Somatoform diagnoses in a series of university hospital psychiatric consultations.
 
 
 
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