Management of somatising patients

Abstract

Somatisers are heterogenous group. It ranged from atypical depression to factitious disorder at the end of the spectrum. In between is a diverse group of somatoform disorders. Somatising patients are commonly seen in primary care practices. The mental symptoms behind somatic complaints are usually overlooked, thus the correct diagnosis could not be reached and the patients are inadequately treated. The management of somatising patients needs special skills to facilitate treatment and referral when necessary. Ten important points in planning of the treatment were discussed. The first interview with patient is crucial because it will determine the outcome of the therapeutic alliance. The style and approaches of the interview can be adopted depending upon the orientation of the psychiatrist and the nature of the patient's problems. Reattribution approach of interview is commonly used in general practice and it is suitable for somatisers who have some psychological understanding. The choice of subsequent treatment depends to a large extent on the way in which formulation is made