Pharmacological interventions for somatoform disorders in adults

Prevalence and strong association of high somatic symptom severity with depression and anxiety in a Chinese inpatient population

“…Our results remind of the nonpsychiatric physicians that the patients with high symptom severity might have the mental health problems rather than the effects of the general medical conditions. Given that previous studies have documented effective treatments including pharmacotherapies and psychotherapies for HSSS and relevant mental disorders such as somatoform disorders in the DSM‐IV (Kleinstäuber, Witthöft, & Hiller, ; Kleinstäuber et al, ), the correct identification of these inpatients might be of great help for relieving the individual patient's distress and social disease burden.…”

“…Given that previous studies have documented effective treatments including pharmacotherapies and psychotherapies for HSSS and relevant mental disorders such as somatoform disorders in the DSM-IV (Kleinstäuber, Witthöft, & Hiller, 2011;Kleinstäuber et al, 2014), the correct identification of these inpatients might be of great help for relieving the individual patient's distress and social disease burden.…”

Somatic symptom disorder, a new DSM-5 diagnosis of an old clinical challenge

“…However, a Cochrane Review of 26 randomised controlled trials comparing the efficacy of various antidepressants, antipsychotics and natural products in treatment of somatoform disorders, concluded that the evidence is of low quality in studies suggesting efficacy of amitriptyline, citalopram, clomipramine, fluoxetine, flupentixol, milnacipran, mirtazapine, paliperidone, paroxetine, reboxetine, sertraline, trazodone, quetiapine, venlafaxine, butterbur root, lemon balm leaf-Ze 185, passionflower herb, St John's wort or valerian root 18. The authors noted that current evidence is limited by small sample sizes, high risk of bias and lack of follow-up assessment 18…”

How should we manage adults with persistent unexplained physical symptoms?

“…[11][12][13][14] We found no new randomised controlled trials since publication of the reviews. Studies restricted to specific functional syndromes (such as irritable bowel syndrome) were excluded.…”

“…A combination of SSRIs and antipsychotics is more effective than SSRIs alone, though evidence is of low quality (standardised mean difference 0.77 (0.32 to 1.22); 2 studies, 107 participants; I 2 =23%). 11 The review found low quality evidence favouring natural products such as St John's wort compared with placebo (standardised mean difference −0.74 (−0.97 to −0.51); 2 studies, 322 participants; I 2 =0%).…”