Further Inpatient Care
Somatic symptom 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 somatic symptom 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:
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Rapid medical assessment to rule out a medical cause for the patient's symptoms
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Assessment for evidence of psychiatric comorbidity and initiation of management for the comorbid psychiatric illness
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Patient and family education regarding the somatic symptom disorder
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An expectation of return to complete normal functioning with rehabilitation if necessary to restore function
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Establishment of a primary care physician familiar with the management of somatic symptom disorders if one is not already present
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A detailed discharge plan including primary care follow-up and psychiatric follow-up if necessary
Complications
Iatrogenic complications may occur from invasive diagnostic or surgical procedures.
Other complications may include (1) dependence on prescription-controlled substances and (2) development of a helpless and dependent lifestyle.
Dysfunctional illness perception has been demonstrated to be related to active suicidal ideation independent of other psychiatric comorbidities. [11]
Prognosis
Somatic symptom 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 are outlined Medical Care. Key patient educational issues include the following:
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The physician acknowledges the patient's symptoms and suffering.
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The physician takes on the role of evaluation and monitoring of symptoms.
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Not all symptoms indicate evidence of a pathological disease.
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The patient should attempt to maintain interpersonal function despite symptoms.
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Physical symptoms not due to a defined disease often remit spontaneously.
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Identifying key life stressors and sources of anxiety can be important.
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Stress reduction may produce improvement in physical symptoms.
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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 somatic symptom disorders. For the patient's family members, this education should include the following:
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Discuss the somatoform diagnosis.
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Expect the patient to improve and return to normal function.
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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
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The primary care provider should direct any need for subspecialty evaluation.
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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.
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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 patient education resources, see the Muscle Disorders Center, as well as Fibromyalgia, Chronic Fatigue Syndrome, and Chronic Pain.
Other helpful Web sites include the following:
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MedlinePlus, Somatoform pain disorder
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American Academy of Family Physicians, Somatoform Disorder
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MayoClinic.com, Conversion disorder
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Somatic symptom diagnoses in a series of university hospital psychiatric consultations.
