Treatment
The principles of assessment of people with unexplained symptoms involve consideration of psychological factors from the outset, appropriate physical investigations to exclude a physical cause, understanding the person’s beliefs and expectations, identification of anxiety/depression or other psychiatric disorders and detection of underlying psychosocial problems.
The principles of treatment of people with medically unexplained symptoms include emphasising that the symptoms are real and that medical care is appropriate, provide physical treatment for associated or identified physical disease, explanation and reassurance, discussion of psychological factors, treatment of any associated psychiatric disorder, agreeing a treatment plan aimed at restoring lost functions and avoidance of unnecessary further investigation.
Conversion disorder
Treatment of recent onset conversion disorder involves assessment to exclude any underlying physical disorder, psychiatric evaluation and reassurance that the condition will resolve rapidly.
If the condition has been present for more than a few weeks, treatment should be directed towards the underlying psychological cause and any personal or social problem that have precipitated the symptoms. Cognitive behavioural therapy (CBT) and other psychological therapies may be helpful.
There is no specific drug treatment for conversion disorder but if the symptoms are secondary to underlying anxiety or depression, medication to treat these usually helps.
The symptoms should be managed by encouraging self care and avoiding reinforcement, by for example, avoiding provision of a wheelchair to people who have difficulty walking, although chronic disability may be improved by use of such aids.
Somatisation disorder
Somatisation disorder is difficult to treat. It entails stopping the cycle of “doctor shopping” and inappropriate physical investigation and treatment. Psychiatric management involves enabling the person to make the link between emotional and physical symptoms aided by specific psychological interventions like cognitive behavioural therapy and use of antidepressant or anxiolytic medication. Contracts agreed between patient and doctor can allow the patient to visit the doctor regularly for support, without the need to present symptoms.
Hypochondriasis
Hypochondriasis is often difficult to treat. Repeated reassurance does not help. Control of investigations, encouragement of constructive ways of dealing with symptoms, antidepressant medication and cognitive behavioural therapy are helpful.
Body Dysmorphic Disorder
BDD is difficult to treat. Avoidance of inappropriate surgery, SSRI antidepressants, other antidepressants and CBT may be helpful.
Pain disorder
Any associated psychiatric or physical disorder should be treated. Specific treatment involves education including correction of inappropriate health beliefs, antidepressant medication, psychological treatments (CBT, relaxation therapy, biofeedback, and hypnosis), physical rehabilitation (exercise therapy) and addressing any contributing social problems.
Treatment of pain disorder requires a multidisciplinary approach by health care professionals (physical, psychological and social) and may be delivered by specific pain relief clinics.
Amended May 2009
