dothiepin-hydrochloride and Somatoform-Disorders

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.

Topics: Adult; Age Factors; Behavior Therapy; Dothiepin; Female; Humans; Hypochondriasis; Male; Medical History Taking; Middle Aged; Outcome and Process Assessment, Health Care; Patient Acceptance of Health Care; Psychiatric Status Rating Scales; Psychiatry; Referral and Consultation; Sick Role; Somatoform Disorders

The long-term outcome of facial pain treatment is largely unknown. This study reports the results of a 4-yr review which indicated that conservative treatments including drug therapy and counselling are effective for 70% of patients. Refractory pain was associated with a long complex history of pain, a preoccupation with physical symptoms and poor psychosocial adjustment.

Topics: Adaptation, Psychological; Adolescent; Adult; Aged; Combined Modality Therapy; Counseling; Dothiepin; Double-Blind Method; Facial Pain; Female; Follow-Up Studies; Humans; Life Change Events; Life Style; Male; Middle Aged; Pain Measurement; Social Adjustment; Somatoform Disorders

A group of forty patients who presented to their general practitioner with depression or somatic complaints, which were considered to be due to depression, were included in a double-blind trial of dothiepin and amitriptyline. Patient improvement as judged by the Hamilton Rating Scale (HRS) and the Comprehensive Psychopathological Rating Scale (CPRS) indicated that both groups significantly improved over the 6 week period. Only in one comparison, CPRS after 1 week, was there any statistical difference between the groups and in this case dothiepin produced a better response than amitriptyline (p less than 0.05). Statistical analysis of side-effects indicated that the frequency and severity of certain individual side-effects, hypotension, tiredness/sleepiness and dry mouth were significantly less with dothiepin than with amitriptyline at Week 1 (p less than 0.05). The overall incidence and severity of side-effects was also less with dothiepin at all assessments during the trial.

Topics: Adult; Aged; Amitriptyline; Clinical Trials as Topic; Depression; Dibenzothiepins; Dothiepin; Double-Blind Method; Female; Humans; Male; Middle Aged; Outpatients; Somatoform Disorders