Hypochondriasis and related disorders. Assessment and management of patients referred for a psychiatric opinion.

This article outlines the main components of a comprehensive plan for the assessment and management of patients referred for a psychiatric opinion with hypochondriasis and related disorders. Particular emphasis is placed on the discussion of attitudes to previous medical contact, to the value of physical investigations, and to the psychiatric referral itself; these attitudes are often neglected and yet are of clinical importance because they are usually associated with resistance to psychiatric treatment. A short-term flexible therapeutic approach to the presenting syndrome itself is outlined, which is based on cognitive-behavioral strategies used in other emotional disorders and on the literature on hypochondriasis. Clinical experience with this approach suggests that nonattendance may be high even in those who present for initial assessment, but that for attenders the prognosis may be good, with 80% showing a marked or moderate improvement on discharge. Younger patients, those with a past psychiatric history, and those receiving state benefits did worse, and those with major depression had the best prognosis. Social function, personal distress, and preoccupation with symptoms all tend to improve more than the underlying physical symptoms themselves.