Psychopharmakotherapie somatoformer Störungen und funktioneller somatischer Syndrome

Abstract

Patients presenting with bodily symptoms and complaints that are not explained by organic pathology or well known pathophysiological mechanisms form a major challenge to any health delivery system. From a perspective of psychiatric classification these medically unexplained somatic symptoms may be diagnosed as depressive and anxiety disorders on the one hand, as somatoform disorders on the other. Among medical specialties a separate diagnostic approach is taken to conceptualize functional somatic syndromes. From a therapeutic perspective psychotherapeutic strategies play a decisive role. There are also important issues that form a rationale for psychopharmacological interventions. The empirically significant overlap of somatoform syndromes and anxiety and depressive disorders, the conceptualization as affective spectrum disorders, the prominent role of pain symptoms, major neurobiological factors of underlying stress mechanisms, and high rates of psychiatric comorbidity in the often chronic courses of illness also stress the importance of psychopharmacotherapy. A survey will be presented on empirical studies of psychopharmacotherapy in somatoform disorders and some specific somatisation syndromes as fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and premenstrual syndrome. Findings of the antidepressant treatment of somatic symptoms in major depression will be summarised.