Approach to the patient with multiple somatic symptoms

Carmen Croicu; Lydia Chwastiak; Wayne Katon

doi:10.1016/j.mcna.2014.06.007

Approach to the patient with multiple somatic symptoms

Med Clin North Am. 2014 Sep;98(5):1079-95. doi: 10.1016/j.mcna.2014.06.007. Epub 2014 Jul 9.

Authors

Carmen Croicu¹, Lydia Chwastiak², Wayne Katon³

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 359911, 325 Ninth Avenue, Seattle, WA 98104, USA. Electronic address: croicu@u.washington.edu.
² Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 359911, 325 Ninth Avenue, Seattle, WA 98104, USA.
³ Division of Health Services and Psychiatric Epidemiology, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, 1959 Northeast Pacific, Seattle, WA 98195, USA.

PMID: 25134874
DOI: 10.1016/j.mcna.2014.06.007

Abstract

Primary care providers play a crucial role in the recognition and appropriate treatment of patients with multiple somatic complaints. Both the number of somatic symptoms and the persistence of symptoms are associated with co-occurring depression or anxiety disorders. It can be challenging to simultaneously address possible medical causes for physical symptoms while also considering an associated psychiatric diagnosis. In this article, strategies to improve the care and outcomes among these patients are described, including collaboration, education about the interaction between psychosocial stressors and somatic symptoms, regularly scheduled visits, focus on improving functional status, and evidence-based treatment of depression and anxiety.

Keywords: Anxiety; Collaborative care; Depression; Somatic symptoms; Somatization.

Publication types

Review

MeSH terms

Antidepressive Agents / therapeutic use
Anxiety Disorders / diagnosis
Anxiety Disorders / psychology
Anxiety Disorders / therapy
Causality
Cognitive Behavioral Therapy
Depression / diagnosis
Depression / therapy
Diagnostic and Statistical Manual of Mental Disorders
Humans
Medical History Taking
Patient Care Team
Physical Examination
Physician-Patient Relations
Primary Health Care*
Referral and Consultation
Risk Factors
Severity of Illness Index
Somatoform Disorders / diagnosis*
Somatoform Disorders / psychology
Somatoform Disorders / therapy*
Stress, Psychological / psychology
Surveys and Questionnaires

Substances

Antidepressive Agents