Differential Treatment Response Between Hypochondriasis With and Without Prominent Somatic Symptoms

Background: Health anxiety may exist with or without prominent somatic symptoms, but the impact of somatic symptoms on treatment response is unclear. The study objective was to examine this question further as symptom burden may impact choice of type of treatment.Methods: This exploratory study used...

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Autores principales:	Brian A. Fallon, Cale Basaraba, Martina Pavlicova, David K. Ahern, Arthur J. Barsky
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	hypochondriasis illness anxiety disorder somatic symptom disorder cognitive behavioral therapy fluoxetine treatment response Psychiatry RC435-571
Acceso en línea:	https://doaj.org/article/530dd4f6301d47bc835fadf520897331
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spelling	oai:doaj.org-article:530dd4f6301d47bc835fadf5208973312021-11-08T07:48:10ZDifferential Treatment Response Between Hypochondriasis With and Without Prominent Somatic Symptoms1664-064010.3389/fpsyt.2021.691703https://doaj.org/article/530dd4f6301d47bc835fadf5208973312021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fpsyt.2021.691703/fullhttps://doaj.org/toc/1664-0640Background: Health anxiety may exist with or without prominent somatic symptoms, but the impact of somatic symptoms on treatment response is unclear. The study objective was to examine this question further as symptom burden may impact choice of type of treatment.Methods: This exploratory study used a unique database from a prior trial of 193 individuals with DSM-IV hypochondriasis who had been randomly assigned to either cognitive behavioral therapy, fluoxetine, combined therapy, or placebo. Two subgroups were newly defined—no/low somatic burden (n = 42) and prominent somatic burden (n = 151). Response was defined by ≥30% improvement in hypochondriasis.Results: Among high somatic hypochondriacal participants, compared to placebo, the odds of being a responder were significantly greater among those who received fluoxetine, either alone (OR = 4.46; 95% CI: 1.38, 14.41) or with cognitive behavioral therapy (OR = 3.56; 95% CI: 1.19, 10.68); the estimated odds were not significantly different for those receiving cognitive behavioral therapy alone (OR = 1.81; 95% CI: 0.59, 5.54). In contrast, among low somatic hypochondriacal participants, compared to placebo, the observed odds of being a responder were similar in magnitude and direction for those who received cognitive behavioral therapy, either alone (OR = 3.00; 95% CI: 0.38, 23.68) or in combination with fluoxetine (OR = 3.60; 95% CI: 0.62, 21.03), compared to the odds for those receiving fluoxetine alone (OR = 0.90; 95% CI: 0.14, 5.65). High somatic hypochondriacal individuals assigned to any fluoxetine group had significantly greater odds of being a responder than those who had not received fluoxetine (OR = 2.70; 95% CI: 1.33, 5.48). Low somatic hypochondriacal individuals assigned to any cognitive behavioral therapy group had significantly greater odds of being a responder than those who had not received cognitive behavioral therapy (OR = 8.03; 95% CI: 1.41, 45.67).Conclusion: These findings indicate that somatic symptom burden may be important in guiding treatment selection among individuals with marked health anxiety, as hypochondriacal individuals with high somatic burden responded more often to fluoxetine while those with low somatic burden responded more often to cognitive behavioral therapy. Systematic replication with larger studies is needed.Brian A. FallonBrian A. FallonCale BasarabaMartina PavlicovaDavid K. AhernArthur J. BarskyFrontiers Media S.A.articlehypochondriasisillness anxiety disordersomatic symptom disordercognitive behavioral therapyfluoxetinetreatment responsePsychiatryRC435-571ENFrontiers in Psychiatry, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	hypochondriasis illness anxiety disorder somatic symptom disorder cognitive behavioral therapy fluoxetine treatment response Psychiatry RC435-571
spellingShingle	hypochondriasis illness anxiety disorder somatic symptom disorder cognitive behavioral therapy fluoxetine treatment response Psychiatry RC435-571 Brian A. Fallon Brian A. Fallon Cale Basaraba Martina Pavlicova David K. Ahern Arthur J. Barsky Differential Treatment Response Between Hypochondriasis With and Without Prominent Somatic Symptoms
description	Background: Health anxiety may exist with or without prominent somatic symptoms, but the impact of somatic symptoms on treatment response is unclear. The study objective was to examine this question further as symptom burden may impact choice of type of treatment.Methods: This exploratory study used a unique database from a prior trial of 193 individuals with DSM-IV hypochondriasis who had been randomly assigned to either cognitive behavioral therapy, fluoxetine, combined therapy, or placebo. Two subgroups were newly defined—no/low somatic burden (n = 42) and prominent somatic burden (n = 151). Response was defined by ≥30% improvement in hypochondriasis.Results: Among high somatic hypochondriacal participants, compared to placebo, the odds of being a responder were significantly greater among those who received fluoxetine, either alone (OR = 4.46; 95% CI: 1.38, 14.41) or with cognitive behavioral therapy (OR = 3.56; 95% CI: 1.19, 10.68); the estimated odds were not significantly different for those receiving cognitive behavioral therapy alone (OR = 1.81; 95% CI: 0.59, 5.54). In contrast, among low somatic hypochondriacal participants, compared to placebo, the observed odds of being a responder were similar in magnitude and direction for those who received cognitive behavioral therapy, either alone (OR = 3.00; 95% CI: 0.38, 23.68) or in combination with fluoxetine (OR = 3.60; 95% CI: 0.62, 21.03), compared to the odds for those receiving fluoxetine alone (OR = 0.90; 95% CI: 0.14, 5.65). High somatic hypochondriacal individuals assigned to any fluoxetine group had significantly greater odds of being a responder than those who had not received fluoxetine (OR = 2.70; 95% CI: 1.33, 5.48). Low somatic hypochondriacal individuals assigned to any cognitive behavioral therapy group had significantly greater odds of being a responder than those who had not received cognitive behavioral therapy (OR = 8.03; 95% CI: 1.41, 45.67).Conclusion: These findings indicate that somatic symptom burden may be important in guiding treatment selection among individuals with marked health anxiety, as hypochondriacal individuals with high somatic burden responded more often to fluoxetine while those with low somatic burden responded more often to cognitive behavioral therapy. Systematic replication with larger studies is needed.
format	article
author	Brian A. Fallon Brian A. Fallon Cale Basaraba Martina Pavlicova David K. Ahern Arthur J. Barsky
author_facet	Brian A. Fallon Brian A. Fallon Cale Basaraba Martina Pavlicova David K. Ahern Arthur J. Barsky
author_sort	Brian A. Fallon
title	Differential Treatment Response Between Hypochondriasis With and Without Prominent Somatic Symptoms
title_short	Differential Treatment Response Between Hypochondriasis With and Without Prominent Somatic Symptoms
title_full	Differential Treatment Response Between Hypochondriasis With and Without Prominent Somatic Symptoms
title_fullStr	Differential Treatment Response Between Hypochondriasis With and Without Prominent Somatic Symptoms
title_full_unstemmed	Differential Treatment Response Between Hypochondriasis With and Without Prominent Somatic Symptoms
title_sort	differential treatment response between hypochondriasis with and without prominent somatic symptoms
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/530dd4f6301d47bc835fadf520897331
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Differential Treatment Response Between Hypochondriasis With and Without Prominent Somatic Symptoms

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