Essential Information for Patient and Family

• Stress often produces physical symptoms.
• Focus on managing the symptoms, not on discovering their cause.
• Cure may not be possible; the goal is to live the best life possible even if symptoms continue.

Specific Counselling to Patient and Family

• Acknowledge that physical symptoms are real. They are not lies or inventions.
• Ask about patient's beliefs (what is causing the symptoms?) and fears (what does he/she fear may happen?).
• Ask about what patient thinks are causing symptoms offer appropriate reassurance (e.g. Abdominal pain does not indicate cancer). Advise patients not to focus on medical worries. Use structured problem solving.
• Discuss emotional stresses that were present when symptoms arose
• Relaxation methods may help relieve pain and other symptoms related to tension (headache, neck or back pain).
• Encourage exercise and enjoyable activities. Do not wait until all symptoms are gone to return to normal routines.
• Ensure that the sleepl wake cycle is regularised.
• For patients with more chronic complaints, regularly scheduled, time-limited appointments may prevent more frequent urgent visits.
  

Medication

• Avoid unnecessary diagnostic testing or prescription of new medication for each new symptom.
• Antidepressant medication (e.g. amitryptyline 50-100mg per day) may be helpful in some cases (e.g. headache, irritable bowel syndrome, atypical chest pain).

Specialist Consultation

• Avoid referrals to medical specialists; these patients are best managed in primary care.
• Patients may be offended by psychiatric referral and seek additional medical consultation elsewhere.

What a doctor might say to a person with a unexplained somatic disorder