How should we monitor a patient with health anxiety?

From the Guidelines

Monitoring patients with health anxiety requires a comprehensive approach, with regular follow-up appointments and the use of validated assessment tools, as recommended by the most recent guideline update 1. The approach should address both psychological and physical aspects of the condition, with a focus on preventing medical neglect and excessive healthcare utilization. Key components of monitoring include:

• Regular follow-up appointments, initially every 2-4 weeks, then gradually extending to monthly or quarterly as symptoms improve
• Use of validated assessment tools, such as the GAD-7 scale, to objectively track anxiety levels 1
• Focused and purposeful physical examinations, avoiding unnecessary tests that may reinforce anxiety
• Cognitive behavioral therapy (CBT) as the first-line treatment, typically requiring 12-16 weekly sessions
• Medication, such as SSRIs, may be indicated, with careful consideration of adverse effect profiles and potential interactions 1
• Patient education and involvement of family members in the treatment plan, as appropriate
• Clear communication guidelines about when additional medical evaluation is warranted versus when reassurance-seeking behavior should be redirected. It is essential to tailor the monitoring approach to the individual patient's needs, taking into account variables such as symptom severity, functional impairment, and patient preference, as suggested by the stepped care model 1.

From the Research

Monitoring a Patient with Health Anxiety

To monitor a patient with health anxiety, the following steps can be taken:

• Regular assessments of anxiety levels and symptoms using standardized measures, such as the Generalized Anxiety Disorder-7 (GAD-7) scale 2
• Monitoring of physical symptoms, such as palpitations, shortness of breath, and dizziness, which are commonly associated with anxiety disorders 2
• Evaluation of the patient's response to treatment, including psychological therapy, pharmacotherapy, or a combination of both 3, 2
• Consideration of patient preference, current and prior treatments, medical and psychiatric comorbid illnesses, age, sex, and reproductive planning when selecting treatment 2

Treatment Options

Treatment options for health anxiety include:

• Cognitive behavioral therapy (CBT), which has been shown to be effective in reducing anxiety symptoms 3, 2, 4
• Mindfulness-based stress reduction (MBSR), which has been found to be noninferior to escitalopram in reducing anxiety symptoms 5
• Pharmacotherapy, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), which are commonly used to treat anxiety disorders 3, 2
• Brief psychosocial interventions, such as those delivered by medical assistants in primary care, which may be effective in reducing health anxiety symptoms 6

Implementation and Barriers

When implementing treatment for health anxiety, it is essential to consider the potential barriers and facilitators, including:

• Patient engagement and adherence to treatment 6
• Availability and accessibility of treatment options 6
• Clinician-patient communication and collaboration 6
• Patient preference and values 2