PSYCHIATRY UPDATE 2017

Treating Somatizing Patients
Alexander W. Thompson, MD, MBA, MPH, University of Iowa Carver College of Medicine

Somatizing patients experience symptoms all of the time, whether a headache or nausea, but most symptoms do not have an organic cause, and they might seek treatment for any or all symptoms. The goal of treating somatizing patients is to not harm them with unneeded workup and treatment. Dr. Thomspon recommends providing a letter to the patient’s primary care physician with your recommendations, which can reduce medical costs and improve physical function. Although there are no clear pharmacotherapies, cognitive-behavioral therapy focused on health and anxiety can help.

Fatigue

Fatigue experienced by patients with chronic fatigue syndrome is unrelenting, is not the result of ongoing exertion, and is unrelieved by rest. When approaching a patient with extreme fatigue, start with a thorough evaluation in collaboration with a primary care physician, Dr. Thompson said. Establish a rapport with the patient, limit iatrogenic harm, and treat chronic fatigue as you would any chronic condition. Rintatolimod and valganciclovir have showed some evidence of benefit, and graded exercise therapy has shown success.