健康知识库

.Illness anxiety disorder is a diagnosis (table 1) that was introduced with publication of the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). The disorder was derived in part from the diagnosis of hypochondriasis, which was eliminated from DSM-5. In DSM-5, patients previously diagnosed with hypochondriasis are nearly always diagnosed with either somatic symptom disorder (if physical complaints are prominent) or illness anxiety disorder (if physical complaints are minimal or nonexistent). The core clinical feature of illness anxiety disorder is persistent preoccupation with having a serious medical illness despite appropriate medical evaluation and reassurance. (See 'Terminology and DSM-5' above and "Illness anxiety disorder: Epidemiology, clinical presentation, assessment, and diagnosis", section on 'Clinical presentation'.) ●The primary goal in managing illness anxiety disorder is to improve coping with health fears rather than eliminate them (caring rather than curing). General principles for primary care clinicians to follow in initially managing illness anxiety disorder include scheduling regular visits, acknowledging health fears, evaluating for and treating diagnosable general medical disease, limiting diagnostic tests and referrals to specialists, providing reassurance that serious medical diseases have been ruled out, treating comorbid psychiatric disorders, and explicitly making functional improvement the goal of treatment. (See 'General principles' above.) ●Psychotherapy can be efficacious for illness anxiety disorder that does not respond to the general principles for initially managing the disorder. For these unresponsive patients, we suggest cognitive-behavioral therapy (CBT) as first line treatment rather than other psychotherapies (Grade 2C). For patients with illness anxiety disorder who do not respond to or who lack access to CBT, we suggest mindfulness based cognitive therapy or acceptance and commitment therapy as second line treatment (Grade 2C). (See 'Choosing treatment' above and 'First line' above and 'Second line' above.) However, psychotherapy for illness anxiety disorder is often ineffective, unavailable, or declined. For these patients, we prescribe antidepressant medications. We typically use selective serotonin reuptake inhibitors (eg, fluoxetine or paroxetine). However, serotonin-norepinephrine reuptake inhibitors are a reasonable alternative. (See 'Third line' above.) In addition, we use antidepressants as first line treatment for patients with illness anxiety disorder plus comorbid anxiety disorders and/or depressive disorders, as well as patients who are incapacitated by illness anxiety disorder. The drug is prescribed adjunctively with psychotherapy, or as monotherapy if psychotherapy is unavailable or refused.?

●Other psychotherapy options for treating illness anxiety disorder include problem solving therapy, relaxation training, and behavioral stress management. (See 'Other options' above.)?

●The prognosis of illness anxiety disorder appears to vary from poor to good depending upon how outcome is defined; remission is uncommon, but many patients improve. (See 'Prognosis' above.)