Pediatric Hypochondriasis Medication
- Author: Maria Sandra Cely-Serrano, MD; Chief Editor: Caroly Pataki, MD more...
A review of somatoform disorder management in several adult psychiatric consultation-liaison services showed that recommendations were made for antidepressants in 40% of the patients, anxiolytics in 18%, sedatives in 18%, and antipsychotics in 10%. Pharmacologic management was consistent with comorbid psychiatric diagnoses of mood disorder in 39% of patients, of personality disorder in 37%, and of psychoactive substance use disorder in 19%.
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are chemically unrelated to the tricyclic, tetracyclic, or other available antidepressants. They inhibit CNS neuronal uptake of serotonin (5HT). They may also have a weak effect on norepinephrine and dopamine neuronal reuptake. They have also been used to treat anxiety, phobias, and obsessive-compulsive disorders. Growing evidence suggests the efficacy of SSRIs to treat hypochondriasis. Although controlled adult trials using fluoxetine revealed a high rate of improvement, many patients responded as well to a placebo. Medication has been particularly helpful when comorbid conditions (eg, anxiety disorder, depression) are associated with hypochondriasis.
SSRIs are greatly preferred over the other classes of antidepressants. Because the adverse effect profile of SSRIs is less prominent, improved compliance is promoted. SSRIs do not have the cardiac arrhythmia risk associated with tricyclic antidepressants. Arrhythmia risk is especially pertinent in overdose, and suicide risk must always be considered when treating a child or adolescent with mood disorder.
Physicians are advised to be aware of the following information and use appropriate caution when considering treatment with SSRIs in the pediatric population.
In December 2003, the UK Medicines and Healthcare Products Regulatory Agency (MHRA) issued an advisory that most SSRIs are not suitable for use by persons younger than 18 years for treatment of "depressive illness." After review, this agency decided that the risks to pediatric patients outweigh the benefits of treatment with SSRIs, except fluoxetine (Prozac), which appears to have a positive risk-benefit ratio in the treatment of depressive illness in patients younger than 18 years.
In October 2003, the US Food and Drug Administration (FDA) issued a public health advisory regarding reports of suicidality in pediatric patients being treated with antidepressant medications for major depressive disorder. This advisory reported suicidality (both ideation and attempts) in clinical trials of various antidepressant drugs in pediatric patients. The FDA has asked that additional studies be performed because suicidality occurred in both treated and untreated patients with major depression and thus could not be definitively linked to drug treatment.
However, one study of more than 65,000 children and adults treated for depression between 1992 and 2002 by the Group Health Cooperative in Seattle found that suicide risk declines, not rises, with the use of antidepressants. This is the largest study to date to address this issue.
Currently, evidence does not associate obsessive compulsive disorder and other anxiety disorders treated with SSRIs with an increased risk of suicide. For more information, see the FDA Web site on Antidepressant Use in Children, Adolescents, and Adults.
Selectively inhibits presynaptic serotonin reuptake with minimal or no effect on reuptake of norepinephrine or dopamine.
Bleichhardt G, Hiller W. Hypochondriasis and health anxiety in the German population. Br J Health Psychol. 2007 Nov. 12:511-23. [Medline].
Esposito M, Roccella M, Gallai B, Parisi L, Lavano SM, Marotta R, et al. Maternal personality profile of children affected by migraine. Neuropsychiatr Dis Treat. 2013. 9:1351-8. [Medline]. [Full Text].
Walker LS, Garber J, Greene JW. Somatic complaints in pediatric patients: a prospective study of the role of negative life events, child social and academic competence, and parental somatic symptoms. J Consult Clin Psychol. 1994 Dec. 62(6):1213-21. [Medline].
Rask CU, Elberling H, Skovgaard AM, Thomsen PH, Fink P. Parental-reported health anxiety symptoms in 5- to 7-year-old children: the Copenhagen Child Cohort CCC 2000. Psychosomatics. 2012 Jan-Feb. 53(1):58-67. [Medline].
Schwenzer M, Mathiak K. Hypochondriacal attitudes may reflect a general cognitive bias that is not limited to illness-related thoughts. Psychol Health. 2011 Aug. 26(8):965-73. [Medline].
Rask CU. Functional somatic symptoms in 5-7 year old children: assessment, prevalence and co-occurrence. Dan Med J. 2012 Nov. 59(11):B4537. [Medline].
Bailer J, Witthöft M, Wagner H, Mier D, Diener C, Rist F. Childhood maltreatment is associated with depression but not with hypochondriasis in later life. J Psychosom Res. 2014 Aug. 77(2):104-8. [Medline].
Noyes R Jr, Stuart S, Langbehn DR, et al. Childhood antecedents of hypochondriasis. Psychosomatics. 2002 Jul-Aug. 43(4):282-9. [Medline].
Abramowitz JS, Moore EL. An experimental analysis of hypochondriasis. Behav Res Ther. 2007 Mar. 45(3):413-24. [Medline].
Torres AR, Ferrão YA, Shavitt RG, Diniz JB, Costa DL, do Rosário MC, et al. Panic Disorder and Agoraphobia in OCD patients: clinical profile and possible treatment implications. Compr Psychiatry. 2014 Apr. 55(3):588-97. [Medline].
Weck F, Neng JM, Richtberg S, Stangier U. The restrictive concept of good health in patients with hypochondriasis. J Anxiety Disord. 2012 Dec. 26(8):792-8. [Medline].
Muse K, McManus F, Leung C, Meghreblian B, Williams JM. Cyberchondriasis: fact or fiction? A preliminary examination of the relationship between health anxiety and searching for health information on the Internet. J Anxiety Disord. 2012 Jan. 26(1):189-96. [Medline].
Sakai R, Nestoriuc Y, Nolido NV, Barsky AJ. The prevalence of personality disorders in hypochondriasis. J Clin Psychiatry. 2010 Jan. 71(1):41-7. [Medline].
Greeven A. van Balkom AJ. Visser S. Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a control randomized trial. American Journal of Psychiatry. 2007 jan. 164(1):91-9. [Medline].
Thomson AB, Page LA. Psychotherapies for hypochondriasis. Cochrane Database Syst Rev. 2007 Oct 17. CD006520. [Medline].
Eilenberg T, Kronstrand L, Fink P, Frostholm L. Acceptance and commitment group therapy for health anxiety - Results from a pilot study. J Anxiety Disord. 2013 Jun. 27(5):461-8. [Medline].
Sorensen P, Birket-Smith M, Wattar U, Buemann I, Salkovskis P. A randomized clinical trial of cognitive behavioural therapy versus short-term psychodynamic psychotherapy versus no intervention for patients with hypochondriasis. Psychol Med. 2011 Feb. 41(2):431-41. [Medline].
Warwick HM, Clark DM, Cobb AM, Salkovskis PM. A controlled trial of cognitive-behavioural treatment of hypochondriasis. Br J Psychiatry. 1996 Aug. 169(2):189-95. [Medline].
Weck F. Treatment of Mental Hypochondriasis: A Case Report. Psychiatr Q. 2013 Aug 10. [Medline].
Schweitzer PJ, Zafar U, Pavlicova M, Fallon BA. Long-term follow-up of hypochondriasis after selective serotonin reuptake inhibitor treatment. J Clin Psychopharmacol. 2011 Jun. 31(3):365-8. [Medline].
Abramowitz JS, Deacon BJ. Severe health anxiety: why it persists and how to treat it. Compr Ther. 2004 Spring. 30(1):44-9. [Medline].
Albrecht S, Naugle AE. Psychological assessment and treatment of somatization: adolescents with medically unexplained neurologic symptoms. Adolesc Med. 2002 Oct. 13(3):625-41. [Medline].
Barsky AJ, Ahern DK. Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. JAMA. 2004 Mar 24. 291(12):1464-70. [Medline].
Barsky AJ, Coeytaux RR, Sarnie MK, Cleary PD. Hypochondriacal patients' beliefs about good health. Am J Psychiatry. 1993 Jul. 150(7):1085-9. [Medline].
Bouman TK, Visser S. Cognitive and behavioural treatment of hypochondriasis. Psychother Psychosom. 1998 Jul-Oct. 67(4-5):214-21. [Medline].
Campo JV, Jansen-McWilliams L, Comer DM, Kelleher KJ. Somatization in pediatric primary care: association with psychopathology, functional impairment, and use of services. J Am Acad Child Adolesc Psychiatry. 1999 Sep. 38(9):1093-101. [Medline].
Campo JV, Reich MD. Somatoform disorders. Netherton S, Walker CE, Holmes D, eds. Child and Adolescent Psychological Disorders: A Comprehensive Textbook. New York, NY: Oxford Univ Press; 1999. 320-43.
Lewis M, ed. Child and Adolescent Psychiatry? A Comprehensive Textbook. Williams & Wilkins; 1996.
Egger HL, Costello EJ, Erkanli A, Angold A. Somatic complaints and psychopathology in children and adolescents: stomach aches, musculoskeletal pains, and headaches. J Am Acad Child Adolesc Psychiatry. 1999 Jul. 38(7):852-60. [Medline].
Escobar JI, Gara M, Waitzkin H, et al. DSM-IV hypochondriasis in primary care. Gen Hosp Psychiatry. 1998 May. 20(3):155-9. [Medline].
Fallon BA, Schneier FR, Marshall R, et al. The pharmacotherapy of hypochondriasis. Psychopharmacol Bull. 1996. 32(4):607-11. [Medline].
Fritz GK, Fritsch S, Hagino O. Somatoform disorders in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 1997 Oct. 36(10):1329-38. [Medline].
Haugaard JJ. Recognizing and treating uncommon behavioral and emotional disorders in children and adolescents who have been severely maltreated:somatization and other somatoform disorders. Child Maltreat. 2004. May 9(2):169-76. [Medline].
Hiller W, Leibbrand R, Rief W, Fichter MM. Differentiating hypochondriasis from panic disorder. J Anxiety Disord. 2005. 19(1):29-49. [Medline].
Hitchcock PB, Mathews A. Interpretation of bodily symptoms in hypochondriasis. Behav Res Ther. 1992 May. 30(3):223-34. [Medline].
Kellner R. Somatization and Hypochondriasis. New York, NY: Praeger-Greenwood; 1986.
Lieb R, Pfister H, Mastaler M, Wittchen HU. Somatoform syndromes and disorders in a representative population sample of adolescents and young adults: prevalence, comorbidity and impairments. Acta Psychiatr Scand. 2000 Mar. 101(3):194-208. [Medline].
Livingston R, Witt A, Smith GR. Families who somatize. J Dev Behav Pediatr. 1995 Feb. 16(1):42-6. [Medline].
Longley SL, Watson D, Noyes R Jr. Assessment of the hypochondriasis domain: the multidimentional inventory of hypochondriacal traits (MIHT). Psychol Assess. 2005. Mar 17(1):3-14. [Medline].
Noyes R Jr, Happel RL, Yagla SJ. Correlates of hypochondriasis in a nonclinical population. Psychosomatics. 1999 Nov-Dec. 40(6):461-9. [Medline].