A 26-year-old graduate student comes to the office due to chronic headaches that he
describes as "debilitating." He tends to experience the headaches at night and has
difficulty falling asleep. He has no fever or vomiting. The patient has had similar
headaches for the past year and underwent a complete workup last year that included a
brain CT scan and ophthalmological evaluation; all were negative. His physical
examination is normal. Despite reassurance from the physician, the patient continues to
be excessively worried and thinks he may have a brain tumor or aneurysm. He has an
upcoming deadline for his dissertation and is concerned that his insomnia is affecting his
productivity. He is unable to focus on his studies due to persistent worrisome thoughts.
Which of the following is the most appropriate next step in management?
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A 26-year-old graduate student comes to the office due to chronic headaches that he
describes as "debilitating." He tends to experience the headaches at night and has
difficulty falling asleep. He has no fever or vomiting. The patient has had similar
headaches for the past year and underwent a complete workup last year that included a
brain CT scan and ophthalmological evaluation: all were negative. His physical
examination is normal. Despite reassurance from the physician. the patient continues to
be excessively worried and thinks he may have a brain tumor or aneurysm. He has an
upcoming deadline for his dissertation and is concerned that his insomnia is affecting his
productivity. He is unable to focus on his studies due to persistent worrisome thoughts.
Which of the following is the most appropriate next step in management?
Explanation: User
Explanation: User
This patient's excessive preoccupation and persistent anxiety about his headaches are
suggestive of somatic symptom disorder. Symptoms are typically more prominent
during periods of psychological stress. Optimal management includes regularly
scheduled visits with a single provider to develop the physician-patient relationship and
monitor the condition, while avoiding unnecessary diagnostic testing (Choice C) and
specialist referrals. The physician should focus on discussing the role of
psychosocial stressors on somatic symptoms and promoting stress reduction and
healthy behaviors (eg, sleep hygiene, relaxation techniques, exercise, diet, return to
productive activities).
This patient's excessive preoccupation and persistent anxiety about his headaches are
suggestive of somatic symptom disorder. Symptoms are typically more prominent
during periods of psychological stress. Optimal management includes regularly
scheduled visits with a single provider to develop the physician-patient relationship and
monitor the condition, while avoiding unnecessary diagnostic testing (Choice C) and
specialist referrals. The physician should focus on discussing the role of
psychosocial stressors on somatic symptoms and promoting stress reduction and
healthy behaviors (eg, sleep hygiene, relaxation techniques, exercise, diet, return to
productive activities).
(Choices A and F) Providing reassurance or repeated explanations is minimally
effective as these patients are rarely reassured by negative findings.
References:
1. Somatic symptom disorder.