11 - Psychopharmacology of Functional Somatic Syndromes

Summary

The psychopharmocologist may assist the primary physician in treating some disorders that seem to stand between physical and mental conditions, such as fibromyalgia, chronic fatigue syndrome, migraine, irritable bowel syndrome, atypical facial pain and premenstrual dysphoric disorder. All of these conditions have shown some responsiveness to psychotropic drugs, as reviewed elsewhere in this volume. Our purpose here is to help the primary physician to use psychotropic drugs.

As with all treatments, the primary physician has to decide when to treat the patient, when to get a consultation and when to refer the patient to a consultant to provide ongoing care. First, let us define the various professionals in the field. A psychiatrist has medical training with additional training in the diagnosis and treatment of mental disorders. Psychiatry covers a vast field and no practitioner masters all aspects. The bedrock expertise of any psychiatrist is the diagnosis of mental disorders. Psychiatrists differ in their expertise in using different treatments.

Nonpsychiatrists often think that psychiatric diagnoses use vague, inexact criteria to diagnose vague, inexact disorders. This untruth comes, we believe, from a misunderstanding of the nature of evidence used to validate disorders. Those trained in medicine have generally learned to appreciate the value of ‘hard’ findings, i.e., those quantifiable through laboratory machinery or directly observable from imaging studies. Physicians accustomed to directly visualizing the heart or the gastrointestinal tract, for example, might consider psychiatric diagnoses ‘soft’ because they rely on the history and mental status to make diagnoses, without technology.