Are treatments for common mental disorders also effective for functional symptoms and disorder?

摘要

OBJECTIVE: To consider whether the many types of treatments for mental disorders--both those specifically targeting illness mechanisms and nonspecific elements--are also effective in treating functional symptoms and syndromes. The paper discusses the need for well-organized care that emphasizes early treatment and recognition of more complex problems in primary and secondary medical care. METHODS: Evidence from a wide range of research and clinical experience is used to identify and illustrate general themes. RESULTS: Despite a limited evidence base, it is clear that both specific and nonspecific interventions that are effective with mental disorders are also effective in treating functional complaints. They are also helpful in the management of maladaptive reactions to physical disorders. Delivery is most effective as stepped care. CONCLUSIONS: There is a particular need for more evidence on the effectiveness of the nonspecific elements of treatment and of their most appropriate delivery by nonspecialists in general medical settings. Experience with a variety of treatment methods will enhance our understanding of psychological and other etiological variables and thereby influence the development of improved definitions in Diagnostic and Statistical Manual of Mental Disorders-5(th) Edition. It is argued that a main focus of review of somatoform disorder should be the resolution of conceptual problems.