Mental Health Book

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Somatization ManagementAka: Somatoform Disorder Management

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  1. See Also
    1. Somatoform Disorder
    2. Somatoform Disorder Management Pitfalls
  2. Strategies to avoid
    1. Do not suggest "it's all in your head"
    2. Do not order endless testing without indications
      1. Avoid unnecessary invasive tests or medications
      2. Avoid over referring to specialists
    3. Do not focus on symptoms (focus on function instead)
  3. Protocol
    1. Assign a single designated physician
      1. Establish long-term empathetic relationship
      2. Physician's role is care not cure
    2. Schedule frequent visits (e.g. 15 minute visit/month)
      1. Replaces emergency visits and telephone calls
      2. Allows patient attention without a new symptom
      3. Not contingent on new complaints
      4. Not focused on symptoms
      5. See Primary Care Counseling below
    3. Allow the "sick role"
    4. Encourage patient to assume active role in their care
    5. Focus on function
    6. Manage comorbid psychiatric conditions
  4. Counseling
    1. Primary care counseling of psychosocial concerns
      1. Use the BATHE Technique
    2. Individual Cognitive psychotherapy
      1. Patient's own strategies have not been working
      2. Gentle challenging of maladaptive behaviors
    3. Group therapy for Somatization
      1. Stress management
      2. Problem solving
      3. Social skills training
      4. Specific interventions
        1. Amplification
        2. Need-to-be sick role
  5. Stress reduction
    1. Counseling on improving family relationship
    2. Exercise at least three 20 minute sessions per week
    3. Enjoyment time
      1. Yoga or meditation
      2. Nature walks
      3. Social gatherings or activities (e.g. Bowling)
  6. Benign measures
    1. Hot and cold packs
    2. Bandages
    3. Canes
    4. Lotions
    5. Vitamins
    6. Nutritional supplements
    7. Acupuncture
    8. Chiropractic massage therapy
    9. Biofeedback
  7. References
    1. Servan-Schreiber (2000) Am Fam Physician 61(5):1423
    2. Schwer (March 1999) Hosp Med :
    3. McCahill (1995) Am Fam Physician 52(1):193
    4. Ringel (April 1998) Patient Care :

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