Somatoform Disorders Treatment & Management

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

Medical Care

  • Emergency department care: Somatoform disorders may present to the emergency room for assessment and treatment during periods of acute increase in symptom severity.
    • Electroconvulsive therapy is not effective for somatoform disorders, but it may successfully treat depression occurring in the context of a somatoform disorder.
    • Obtain necessary studies to rule out physical causes such as myocardial infarction or appendicitis.
    • Intravenous or oral acute sedation with benzodiazepines may be used.
    • Avoid long-term benzodiazepines for somatoform disorders.
    • Avoid acute or long-term narcotic analgesics for somatoform disorders.
  • Treatment of conversion disorder in the emergency department: Conversion disorder may be interpreted by the patient and family as a sign of an acute and potentially catastrophic medical condition. ED personnel should quickly rule out potential life-threatening, disabling, or treatable causes for the symptoms. Emotional support should be provided to patient's family members. Early consultation with a psychiatrist may limit unnecessary medical or surgical interventions. Referral to psychiatrist may be prefaced by stating that the cause for the medical symptoms have not been found and that in similar cases, assessment of the role of stress by a medical psychiatrist may be helpful in reducing the discomfort experienced by the patient.
  • Psychosocial interventions (primary care management)
    • Randomized trials have demonstrated the value of physician education in the management of the patient with somatization.[2, 3]
    • Cognitive-behavioral psychotherapy strategies may be specifically helpful in reducing distress and high medical use.
    • Psychosocial interventions directed by physicians form the basis for successful treatment.
    • A strong relationship between the patient and the primary care physician can assist in long-term management.
    • Psychoeducation can be helpful by letting the patient know that physical symptoms may be exacerbated by anxiety or other emotional problems. However, be careful because patients are likely to resist suggestions that their condition is due to emotional rather than physical problems.
    • The primary care physician should inform the patient that the symptoms do not appear to be due to a life-threatening, disabling, medical condition and should schedule regular visits for reassessment and reinforcement of the lacking severity of ongoing symptoms.
    • The patient also may be told that some patients with similar symptoms have had spontaneous improvement, implying that spontaneous improvement may occur.
    • However, the physician should accept the patient's physical symptoms and not pursue a goal of symptom resolution.
    • Indeed, regular, noninvasive, medical assessment reduces anxiety and limits health care–seeking behavior; this may be facilitated by regularly scheduled visits with the patient's primary care physician.
    • Encourage patients to remain active and limit the effect of target symptoms on the quality of life and daily functioning.
    • Family members should not become preoccupied with the patients physical symptoms or medical care.
    • Family members should direct the patient to report symptoms to their primary care physician.
  • Psychosocial interventions for specific somatoform disorders
    • Somatization disorder: Patients may resist suggestions for individual or group psychotherapy because they view their illness as a medical problem. Patients who accept psychotherapy may be able to reduce health care utilization. Psychosocial interventions that focus on maintaining social and occupational function despite chronic medical symptoms may be helpful.
    • Conversion disorder: Limited studies about specific psychotherapy exist for conversion disorder. Behavior therapy or hypnosis may be effective. Symptoms often resolve spontaneously.
    • Hypochondriasis: Physicians should attempt to answer questions and reduce the patient's fear of a specific illness. Group psychotherapy may provide social support and reduce anxiety. Cognitive therapy strategies may help by focussing on distorted disease-related cognitions. Individual insight-oriented psychotherapy has not been proven effective.
    • Pain disorder: Behavior therapy, including biofeedback, can be helpful. Hypnosis also may be considered for chronic pain syndromes. Some outcome data supports the effectiveness of individual psychotherapy. Exploration of interpersonal effects of chronic pain may reduce social complications of pain.
  • Cognitive-behavioral therapy: Recent studies have shown that cognitive-behavioral therapy reduces depressive symptoms in people with somatic diseases. In particular, this type of therapy is especially effective for patients who fit the criteria for a depressive disorder. Cognitive-behavioral therapy was superior to control conditions, with even greater effects to groups restricted to participants with depressive disorder.[4]
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Consultations

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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.

References

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  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. Beltman MW, Voshaar RC, Speckens AE. Cognitive-behavioural therapy for depression in people with a somatic disease: meta-analysis of randomised controlled trials. Br J Psychiatry. Jul 2010;197(1):11-9. [Medline].

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