Hypochondriasis: treatment options for a diagnostic quagmire

Role of Selective Serotonin Reuptake Inhibitors in the Treatment of Hypochondriasis: A Systematic Review

Hypochondriasis is a condition characterized by an unrealistic fear of having a serious medical illness resulting in health anxiety. Currently, no evidence-based pharmacological treatment options are available for the treatment of hypochondriasis. Since selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment option for anxiety disorders, they may be useful for relieving hypochondriasis symptoms. Moreover, off-label use of SSRIs in these cases is highly prevalent in clinical practice. Thus, in this study, we aimed to review the available literature to assess the role of SSRIs in the treatment of hypochondriacal symptoms. A systematic search was conducted in PubMed, Scopus, ScienceDirect, Embase, and Cochrane Database of Systematic Reviews from the date of inception to December 2022. We included only randomized clinical trials (RCTs) investigating the effect of SSRIs in the treatment of hypochondriacal symptoms. Non-RCTs, observation studies, and animal studies were excluded. The Risk of Bias 2 tool was used to assess the quality of included studies. Out of 2264 articles, six RCTs met our inclusion criteria. Studies have been conducted using different SSRIs in the treatment of primary hypochondriasis and hypochondriacal symptoms associated with other psychiatric disorders. All the studies have found that the use of SSRIs has some beneficial role in improving hypochondriacal symptoms. This suggests that SSRIs may be one of the promising pharmacological interventions in the treatment of hypochondriasis.

Health Anxiety by Proxy Disorder: A Case Report

Health anxiety by proxy (HAP) is a newly introduced term in psychiatry to describe the anxious feelings or fear of having or acquiring a serious illness. It is often accompanied by maladaptive illness behavior in the absence of true somatic symptoms. This, in turn, entails seeking medical advice and therefore doing many unnecessary investigations in an attempt to justify these symptoms. Functional impairment may appear in HAP patients, and this indicates a pathological point. To some extent, it can be said that HAP is similar to health anxiety disorder in terms of symptomatology and items. However, it is imposed on another (usually the patients' children) instead of the patient himself. Many biopsychosocial factors are suggested to play a role in the psychopathology of HAP. Until now, there are no well-established criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) or International Classification of Diseases 11^th Revision (ICD-11) to make the diagnosis of health anxiety by proxy. Although treatment protocols are missing, it appears that patients are not responding to treatment protocols for illness anxiety disorder. This requires focusing attention on conducting studies on those patients to develop clear treatment plans to help patients. In this report, we present a 28-year-old female with constant worries about her child's health, which subsequently resulted in seeking medical advice at multiple clinics with different medical specialties. Many factors were thought to be implicated in triggering her current condition. The anxious feelings reflected negatively on the patient's life, resulting in a poor functioning status. A treatment plan was initiated with a dismal response and fluctuating course. Additionally, we discussed the initial definition and the bases that could be used to facilitate the diagnosis and management of HAP disorder.

Obsessive-Compulsive Disorder and Illness Anxiety: Examining Commonalities and Comorbidity

Obsessive-compulsive disorder (OCD) and illness anxiety disorder (IAD) often co-occur. Cognitive-behavioral models of both disorders overlap and include maladaptive attentional processes, misinterpretation of thoughts and physical sensations, and engagement in repetitive behaviors in an attempt to reduce associated distress. Given commonalities in their presentation and their common co-occurrence, it is important to understand how illness anxiety affects the presentation and treatment of OCD. In this article, theoretical conceptualizations of OCD and IAD and their comorbid presentation are outlined, and assessment and differential diagnosis of these conditions are discussed. Despite shared cognitive vulnerabilities and behavioral patterns, well-validated symptom measures, along with careful functional analysis, can be used to distinguish between OCD, IAD, and comorbid presentations. Best practices for the cognitive-behavioral treatment of these co-occurring conditions are also presented, with suggestions based on both the empirical literature and detailed case studies. Finally, recommendations for future research on co-occurring OCD and IAD and their treatment are explored.

The Development of Illness Anxiety Disorder in a Patient After Partial Thyroidectomy

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), characterises illness anxiety disorder (IAD) as the preoccupation with having or acquiring a serious illness in the absence of somatic symptoms (or, if present, symptoms that are only mild in severity). DSM-5 includes illness anxiety disorder in the category called somatic symptom and related disorders, characterised by prominent somatic concerns, distress, and impaired functioning. More often than in psychiatric settings, individuals with illness anxiety disorder are encountered in primary care and specialist medical settings. Despite negative laboratory results, the benign course of the alleged disease over time, and adequate reassurances from specialists, their conviction of being ill persists. Illness anxiety preoccupations are heterogeneous, and the degree of insight is variable. Their illness-related preoccupation interferes with their relationships with family, friends, and coworkers. They are frequently addicted to internet searches about their feared illness, inferring the worst from the information (or false information) they uncover. Patients with illness anxiety disorder often have comorbid psychopathology, especially anxiety and depressive disorders. Typically, illness anxiety disorder is chronic. Physical symptoms are absent or mild and frequently represent a misinterpretation of normal bodily sensations. This case report presents the case of a patient diagnosed with IAD by a psychiatrist. The patient had been seen by his primary care physician and therapist for three years without any improvement in his symptoms before he was referred to a psychiatrist. After undergoing a partial thyroidectomy in 2018, this patient has been experiencing increasing symptoms of recurrent anxiety/fear consistent with IAD, despite extensive medical examinations that have consistently revealed normal results.

Illness Anxiety Disorder: A Case Report and Brief Review of the Literature

Illness anxiety disorder (IAD) is defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) as the preoccupation with having or acquiring a serious illness, in the absence of somatic symptoms (or, if present, symptoms that are only mild in severity). Patients with IAD experience persistent anxiety or fear of having or acquiring a serious illness, which adversely affects their daily life. They remain unsatisfied with their physician’s reassurances to the contrary, mainly because their distress is created by the anxiety of the meaning, significance, and cause of the complaints and not necessarily due to the physical presentations. IAD remains a huge burden on both the health facility and for the managing healthcare provider. In this report, we present the case of a patient with IAD, which has been managed for the past five years with recurrent visits to the physician with no resolution of signs and symptoms. Despite extensive medical workup over this period, which repeatedly showed normal test results, the patient continued to have anxiety over his ill health and complained of recurrent mild somatic symptoms. After his most recent appointment, he got very upset and booked a flight to his home country to have a second opinion to validate his illness. Physicians are encouraged to build a therapeutic alliance with patients with IAD, rather than ordering expensive or unnecessary diagnostic tests or treatment.

A Recommendation for the Management of Illness Anxiety Disorder Patients Abusing the Health Care System

Introduction. Illness anxiety disorder (IAD) entails a preoccupation with having a serious, undiagnosed illness in which somatic symptoms are, if present, mild in intensity (American Psychiatric Association, 2013). Case Report. This is a case of seventy-three-year-old Saudi man who started visiting the primary health care center around twenty-five years ago. With concerns of having cancer, the patient continuously visited the hospital, costing over $170,000. Throughout this period, the patient has been exposed to extensive unnecessary imaging studies and laboratory tests that have effects on his life in all aspects with such concerns. Five years ago, a family doctor has put an end to that by directing the patient to the right path. The doctor made several actions; most importantly, he directed the patient to a cognitive behavioral therapy which significantly improved a range of hypochondriacal beliefs and attitudes. This patient's case demonstrates the fundamental importance of a proper health system that limits such patients from abusing the health system and depleting the medical resources. Moreover, this case emphasizes the important role of the family physician who can be the first physician to encounter such patients. Thus, proper understanding of the nature of such disorder is a key element for better diagnosis and management.