Psychosomatics 45:90-91, February 2004
© 2004 The Academy of Psychosomatic Medicine
Hypochondriasis and ECT
Thomas S. Newmark, M.D., and
Sadiq Al-Samarrai, M.D., Cooper University Hospital, Camden, N.J.
TO THE EDITOR: Hypochondriasis refers to a disorder in which there is an excessive fear or belief that one has a serious illness based on misinterpretation of somatic symptoms. This fear or belief persists, despite a physician's thorough examination and reassurance that general medical disease that could fully account for a patient's somatic concerns is not present.1
We discuss a patient with intractable hypochondriasis who was treated successfully with ECT. The patient was clearly suffering from primary hypochondriasis because she exhibited minor comorbid anxiety and minimal depression. However, these symptoms were secondary to her primary problem. There was no evidence that her hypochondriasis was secondary to anxiety or to depression.
Case Report
Ms. A was a 49-year-old married Caucasian woman who has been seen for the past 3 years. She had a long history of somatic concerns, but about 3 years ago, she became obsessed with having leukemia, Lou Gehrig's disease, and lymphoma. She also had a fear of melanoma, myasthenia gravis, and multiple sclerosis. She had had multiple medical workups, the results of which were all normal.
Over the subsequent year, she was treated with a variety of medications, including selective serotonin reuptake inhibitors, anxiolytics, and antipsychotics, without success. Although she was seen for bimonthly reassurance therapy sessions, she deteriorated to a point at which she was unable to function as a teacher and required inpatient hospitalization.
During this period, Ms. A became exceedingly anxious, panicky, and continued to have hypochondriacal preoccupations. She was given antipsychotic medication again but to no avail. As a last resort, ECT was recommended. Ms. A eventually agreed to have the treatment, and she had four sessions.
In 1968, Pilowsky studied 66 inpatients with primary hypochondriasis. The results were that 50% of all patients with ECT experienced improvement by their 2-year follow-up. The outcome was good with an illness of short duration and in the absence of a personality disorder.2
After ECT treatment, Ms. A showed significant improvement, and it continued over the next year. She exhibited much less preoccupation with the fear of having a fatal disease. She then became more cheerful and expressive, and she had a successful return to work.
Then Ms. A's condition improved rather dramatically. She was able to travel twice to Europe. Her marital relationship got better. She generally had a positive outlook on life. However, she still had one preoccupation (that the ECT would cause a brain tumor). With reassurance, she was able to overcome it. The ECT relieved her almost-psychotic obsessions regarding having a fatal disease.
Discussion
This case demonstrates that ECT is still useful for intractable hypochondriasis. Although ECT was suggested by Pilowsky in 1968 as a treatment for this disorder, it has been used rarely due to the favorable outcomes with more traditional treatments. ECT may need to be reserved for patients with hypochondriasis who are severely consumed by this disorder. There have been few studies regarding the use of ECT for the treatment of hypochondriasis. Maybe the time has come to reevaluate its usefulness in the treatment of this disorder.
REFERENCES
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV). Washington, DC, APA, 1994
- Phillips KA (ed): Somatoform and Factitious Disorders: Review of Psychiatry, vol 20. Washington, DC, American Psychiatric Publishing, 2001, p 55
Get information about faster international access.
Privacy Policy
Copyright © 2004
Academy of Psychosomatic Medicine.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
|
