Evidencebased treatment

The evidence for an effective treatment of patients with chronic multiple symptoms is very sparse, as only two randomized controlled studies have been published/3 35) The first study included 38 patients with somatization disorder who were randomly assigned to treatment or control groups and followed for 18 months.(34> After 9 months the control group were crossed over and received the same treatment as the intervention group. The intervention comprised a specialized psychiatric consultation, comments from which were then sent to the primary care physicians outlining a standard management approach to patients with somatization disorder (see below). Health-care use was reduced by 53 per cent in the intervention group, mainly due to a reduction in the number of hospital admissions. A similar intervention and study design was used by Smith et al.(3,36> in their study of 73 patients, although these patients had fewer symptoms. This study showed a decline in health-care use of between 33 and 52 per cent, without reducing the patients' satisfaction with care.

The outlines for treatment in the remaining part of this section are not evidence based; rather they are based on clinical experience and on studies of less chronic cases of patients complaining of medically unexplained symptoms.

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