Clinical process in which chronic physical complaints with no clear organic cause on medical evaluation are assessed and treated together with psychological factors.
Indication
- Somatoform disorders (somatization, conversion, pain disorder)
- Unexplained chronic headache, gastrointestinal complaints, palpitations
- Chronic pain syndromes worsening with stress (fibromyalgia may coexist)
- Illness anxiety disorder (formerly hypochondriasis)
- Medically unexplained fatigue, dizziness, shortness of breath
- Physical symptoms accompanying anxiety or depression
Preparation
- Bringing previous test and report results (lab work, imaging, ECG) to the consultation
- Listing current medications and dosages
- Preparing a brief note on symptom onset and course
- Family or relative accompaniment if support is needed
How it's performed
- Detailed psychiatric interview is conducted and history of physical complaints is taken
- Previously performed medical tests are reviewed; consultation from relevant specialties is requested if needed
- After diagnosis, the condition is explained to the patient in an understandable manner
- Cognitive behavioral therapy (CBT) and, when needed, relaxation/mindfulness exercises are planned
- If symptoms are severe or depression/anxiety coexists, SSRI-class medications may be initiated
- Treatment plan is implemented in a personalized, stepwise manner
Post-procedure
- Follow-up sessions every 1-2 weeks in the initial weeks
- Gradual extension of follow-up intervals with improvement
- Keeping a symptom diary to monitor stress triggers
- Side effect and response evaluation if medication has been started
- Family meetings and psychoeducation when needed
Risks
- Transient side effects such as nausea, headache, sleep changes when medication is started
- Delayed treatment response (may take 4-8 weeks)
- Periodic flare-ups of symptoms
- Treatment duration may be prolonged with poor therapy adherence
FAQ
Are my complaints not real, am I imagining things?
No. The physical symptoms are completely real; however, the underlying cause may be psychological factors rather than an organic disease. Treatment targets this mechanism.
Is it treated only with medication?
No. The first-line treatment is most often cognitive behavioral therapy. Medication is added in cases of accompanying depression/anxiety or severe symptoms.
How long does treatment take?
It can range from 3-6 months depending on symptom severity; longer follow-up may be needed in chronic cases.
What should I do if I have suicidal thoughts?
In an emergency, call 112 or go to the nearest emergency department. Inform your physician if such thoughts arise during treatment.
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