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Somatoform Disorder Management Pitfalls
Aka: Somatoform Disorder Management Pitfalls, Somatic Symptom Disorder Management Pitfalls
- See Also
- Somatoform Disorder
- Somatoform Disorder Management
- Hypochondriasis
- Pain Disorder
- Conversion Disorder
- Management: Set realistic goals
- Focus on function, not on symptoms
- Symptoms may not resolve completely
- Does not need to be frustrating
- Does not warrant a new battery of tests
- Help a patient cope with symptoms
- Successful treatment criteria
- Minimize hospital admissions and emergency visits
- Minimize potentially harmful interventions
- Management: Treat comorbid medical conditions
- Intersperse routine health examinations
- Guide treatment with objective exam findings
- Management: Frequent diagnostic testing is not needed
- Reassure patient that they are healthy
- Frequent visits will identify any serious problems
- Negotiate lab tests as needed
- Management: Avoid Opioid Analgesics
- Use Tylenol or NSAIDs as needed
- Emphasize Narcotic adverse effects
- Constipation
- Sedation
- Addictive potential
- Narcotics do not cure somatizer's need to be sick
- If Narcotics are needed
- Contract for low, fixed Narcotic doses
- Use slow onset, long acting Narcotics
- Management: Minimize frequent phone calls
- Emphasize that frequent calls are very time consuming
- Share physician's feelings and expectations
- Set limits (e.g. 2 ten minute calls between visits)
- Management: Reduce Frequent Emergency Department Visits
- ER care is counter-productive to somatoform management
- Inconsistent care
- Aggressive evaluation implies serious illness
- Potential for iatrogenic complications
- Develop joint plan with Emergency Department
- Avoid repeating lab tests or hospital admission
- Evaluation indicated for new objective findings
- Establish understanding with patient
- Regular clinic visits serve all medical needs
- Consider more frequent clinic visits
- References
- Servan-Schreiber (2000) Am Fam Physician, 61:1423-8 [PubMed]
- McCahill (1995) Am Fam Physician, 52(1):193-203 [PubMed]
- Ringel (April 1998) Patient Care, p.131-56 [PubMed]