Umgang mit Patienten mit nicht-spezifischen, funktionellen und somatoformen Körperbeschwerden

Abstract

In primary and secondary medicine "non-specific, functional, and somatoform bodily complaints" are common and often take a chronic course, with the patients' quality of life usually markedly impaired, and give rise to high direct and indirect costs. They are challenging as they can deteriorate in case of inappropriate behavior on the physician's part. Coordinated by both German professional associations of Psychosomatic Medicine a new evidence based guideline was developed, aiming to transfer relevant diagnostic and therapeutic knowledge to all physicians who are in charge of these patients. After establishing a stable therapeutic alliance a symptom- and coping-oriented attitude could be demonstrated to be helpful. A biopsychosocial diagnostic evaluation combines a thorough assessment of bodily complaints and early introduces a sensitive discussion of signs of psychosocial stress, which can be extended carefully in case problems of this type are present. In less severe courses, physical/social activation is recommended and the patient's explanatory disease model should be extended towards a psychological dimension. More severe and complicated courses require a more structured approach consisting of regular appointments (as opposed to ad-hoc appointments whenever the patient feels worse) and an active cooperation of the patient. A coordinated, multimodal management includes additional measures as graded activation, psychotherapy, relaxation training or--if indicated--temporary medication.

Psychosomatic Medicine in Germany: More Timely than Ever

“…Developing and coordinating evidence-based national guidelines on topics relevant to psychosomatic medicine, such as functional/somatoform or eating disorders, has been an important undertaking in recent years [22,40,41,42,43,44]. Researchers of psychosomatic medicine have also participated in several population-based cohorts in Germany (e.g.…”

Funktionelle Symptome und somatoforme Störungen in der Notaufnahme

“…Es empfiehlt sich sehr, Akzeptanz und Interesse auszudrücken und den Patienten zunächst schildern zu lassen. Psychosoziale Themen sollten schrittweise und eher beiläufig in die Anamnese eingeführt werden [21,22].…”

Tailored care for somatoform vertigo/dizziness: study protocol for a randomised controlled trial evaluating integrative group psychotherapy

“…Both IPT and SHGs may relieve the burden of patients with SVD and improve their quality of health, as shown in previous studies on patients with somatoform disorders [22,23]. Still, the effects of SHG as first-line treatment for patients with somatoform disorders are very controversial according to recent guidelines [24]. SHG without the implementation of additional therapeutic interventions could be classified as low-level non-placebo control.…”