Definition and Overview

Psychosomatic medicine follow-up is a visit to a psychosomatic medicine specialist after the initial consultation.

Psychosomatic disorders are conditions that involve both the body and mind. The latter has a profound effect on the former that it can possibly lead to increased risk of long-term disability and even premature death.

For the past several years, the term psychosomatic has been largely associated with a disease that’s “all in the mind” or imagined illness. However, experts define it as something that is quantifiable, which means that there are test results that can confirm or negate a patient’s psychosomatic signs and symptoms.

Further, psychosomatic disorders are different from somatoform diseases as the latter are more “subjective.” This means that they are perceived by the patient but test results cannot confirm their presence.

To illustrate the differences between the two, a patient who has an increased level of anxiety may experience faster heart rate or blood pressure, which can be confirmed by simple tests. On the other hand, a patient may feel a shoulder pain, but the tests may say that it’s perfectly fine.

It’s essential to know these differences, as treatment and management are also not the same.

Psychosomatic illnesses are believed to be connected with the central nervous system. The body has its own flight-fight response, which determines the level of stress. As the body goes through a stress response, it sends signals to the brain, which may then cause the release of particular hormones that can disrupt regular functions when they become imbalanced or less regulated.

Who Should Undergo and Expected Results

A psychosomatic follow-up may be recommended if:

  • The patient has been diagnosed with certain medical conditions – Some conditions are believed to be aggravated by psychosomatic tendencies. These include heart disease and psoriasis.

  • The patient is diagnosed with a mental disorder – A psychosomatic illness is heavily influenced by the state of the mind. Thus, if it’s imbalanced or unstable, the likelihood of being psychosomatic also increases.

  • A serious illness has led to a mental disorder – It’s also possible that the situation is the other way around—that is, the knowledge of a serious condition like cancer causes a mental issue like depression, which can have a profound effect on the body. It can cause sleep deprivation, loss of appetite, and poor immune system, all of which can worsen the illness or even introduce a new one.

  • The test results corroborate the psychosomatic illness – Many tests can be performed to determine whether the patient is psychosomatic, the results of which may require subsequent follow-up visits.

With consistent psychosomatic follow-up visits, it’s expected that the symptoms are prevented, reduced, or eliminated, thereby reducing the likelihood of more serious outcomes, more so if there’s a preexisting condition.

How Does the Procedure Work?

A patient who may be experiencing a high level of stress may be referred to a doctor and a psychiatrist. The doctor, who could be a general physician, may be helpful in diagnosing or confirming conditions through a series of tests. The expertise of a psychiatrist may be necessary to deal with the mind aspect of the disorder.

During the initial consultation, the patient may be provided with a series of tests or exams, which will be the basis of the treatment plan. Treatments can significantly vary and may involve drugs and therapies such as cognitive behavioral therapy (CBT).

The follow-up is then scheduled. The interval is not the same for every patient as the cases can be vastly different. Those who exhibit severe symptoms may need to make follow-ups more often, such as once a week.

During the follow-up, the doctor may:

  • Ask questions about any new or worsening signs and symptoms such as difficulty in breathing or increased anxiety
  • Assess the effectiveness of the treatment
  • Adjust or modify the treatment whenever necessary
  • Conduct tests to measure symptoms
  • Suggest admission when necessary

Possible Risks and Complications

Overall, psychosomatic medicine is complex, particularly since it involves the connection of the mind and body. To treat it, both also have to be dealt with. Not everyone, however, is comfortable dealing with a psychiatrist or a therapist while others may not be entirely convinced that what they are experiencing is only psychosomatic. Both of these may prevent the patient from seeking treatment, more so honor the follow-up.

Regular exams that can establish the connection between the mind and body, as well as a consistent explanation of the condition, may help the patient be more committed to follow-up visits.

References:

  • McEwen BS. Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev 2007; 87: 873–904.

  • McCauley J, Kern DE, Kolodner K et al. Clinical characteristics of women with a history of childhood abuse. JAMA 1997; 277: 1362–8.

  • Walker EA, Gelfand A, Katon WJ et al. Adult health status of women with histories of childhood abuse and neglect. Am J Med 1999; 107: 332–9.

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