Medical Care
Somatic symptom disorder emergency department care
Somatic symptom 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 somatic symptom disorders, but it may successfully treat somatic symptoms related to an underlying mood 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 somatic symptom disorders. Avoid acute or long-term narcotic analgesics for somatic symptom disorders.
Primary care management
Randomized trials have demonstrated the value of physician education in the management of the patient with somatization. [20, 21] 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.
Regular exercise has been demonstrated to reduce functional somatic syndromes in some patients. [22]
Psychosocial interventions
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. Somatic symptom disorders have been linked to impairments in emotion processing, which may contribute to the development of medically unexplained physical complaints. This may make emotion processing an important target for psychotherapeutic approaches to the treatment of somatic symptom disorders. [23]
Studies have shown that cognitive-behavioral therapy [24] 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. [25]
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Somatic symptom diagnoses in a series of university hospital psychiatric consultations.
