Somatic symptoms are often common causes for medical consultation. The treatment of somatic symptoms disorders is complicated by lack of boundary, conceptual clarity, and overemphasis on psychosocial causation and effectiveness of psychological treatments. In clinical practice all classes of psychotropics are used to treat somatic symptoms disorder. Five principal groups of drugs such as tricyclic antidepressants (TCA), serotonin reuptake inhibitors (SSRI), serotonin and noradrenalin reuptake inhibitors (SNRI), atypical antipsychotics and herbal medication are systematically studied. The evidence indicates that all five groups are effective in a wide range of disorders. All classes of antidepressants seem to be effective against somatoform and related disorders. SSRIs are more effective against hypochondriasis and body dysmorphic disorder (BDD), and SNRIs appear to be more effective than other antidepressants when pain is the predominant symptom. Research leaves many unanswered questions regarding dosing, duration of treatment, sustainability of improvement in the long term and differential response to different class drugs. Further studies need to focus on treatments based on clinical features/psychopathology and collaborative research with other specialists in understanding the relation of somatic symptom disorders and functional somatic syndromes (FSS), and comparing psychotropics and non-psychotropics and combinations treatments.

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Background: The length of stay and bed usage on acute psychogeriatric admission wards are influenced by several factors. The impact of a dedicated specialist social worker working exclusively with acutely ill psychogeriatric inpatients and with a dedicated budget for domiciliary care packages on the length of stay, bed usage, and costs was evaluated in an opportunistic “before and after” cohort study. Method: The length of stay and bed usage for a 7-month period when a dedicated social worker and a dedicated budget for domiciliary care packages were implemented were compared with an identical 7-month period the year before. Costs incurred for extracontractual referral admissions (ECRs) were also calculated for the same periods. Results: The implementation of a dedicated specialist social worker with a dedicated budget for domiciliary care packages did not demonstrate a statistically significant reduction in length of stay, but bed usage was reduced in both the local National Health Service hospital and the ECR units. The costs incurred for ECR admissions were also reduced; this reduction in costs was similar to the cost of employing a dedicated specialist social worker with the domiciliary care package. Conclusions: A dedicated specialist social worker working exclusively with psychogeriatric inpatients with a dedicated budget for domiciliary care packages was demonstrated to be cost-effective in this study. Ideally, a multicenter, randomized, and controlled study of such an intervention should be undertaken to confirm these findings.

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