THE PHARMACOTHERAPY OF HYPOCHONDRIASIS

This article addresses the diagnosis and pharmacologic treatment of hy pochondriasis. Diagnostic issues are reviewed briefly, focusing on the need for a thorough medical re-consideration of the patient's present ing symptoms. Because the diagnosis rests on the absence of a medical cause to account for the presence or intensity of the physical symptom s, neither self-report forms nor non-medically trained interviewers sh ould be used to definitively make the diagnosis of hypochondriasis. We review the case reports and small uncontrolled series on the pharmaco logic treatment of hypochondriasis, emphasizing the growing body of ev idence suggesting particular efficacy for the serotonin reuptake inhib itors. Preliminary results from an ongoing placebo-controlled trial of hypochondriasis using fluoxetine are presented. While the controlled trial supports the open treatment data in revealing a high rate of imp rovement among patients completing treatment with fluoxetine, it also demonstrates that many patients respond to placebo as well. In conclus ion, although the traditional nihilistic attitude regarding the possib ility of successful treatment of hypochondriacs appears no longer warr anted, the question remains open as to whether SSRIs have particular e fficacy in patients with hypochondriasis or whether nonspecific treatm ent effects are the primary cause of improvement.