Anxiety in a patient with somatic symptom disorder: myth or reality?

E.S. Akarachkova^1,2, E.V. Dovgan³, L.R. Kadyrova⁴, L.V. Klimov⁵, A.A. Kondrashov^6, O.V. Kotova^1,7, D.I. Lebedeva^8,9

¹Autonomous Non-commercial Organization "Stress under Control", Moscow

²Almatek LLC, Moscow

³Smolensk Regional Clinical Hospital, Smolensk

⁴Kazan State Medical Academy, the branch of the Russian Medical Academy of Continuous Professional Education, Kazan

⁵Integritas Clinic LLC, Moscow

⁶Pirogov Russian National Research Medical University, Moscow

⁷RUDN University, Moscow

⁸Regional Treatment and Rehabilitation Center, Tyumen

⁹Tyumen State Medical University, Tyumen 

For many decades, the need to include anxiolytic drugs in general somatic routine has been actively discussed, but still the doctor faces diagnostic and legal difficulties in establishing a diagnosis and prescribing psychotropic medications. Within the framework of the standard medical care, only a psychiatrist can diagnose an anxiety disorder. In this article, the authors tried to answer the following questions that commonly arise in the work of a general practitioner. What is the probability of meeting a patient with anxiety at the visit? Why should a doctor be extremely attentive to the somatic manifestations of anxiety in this patient? What kind of help can a doctor (who is not a psychiatrist) provide within the limits of his competence in somatic manifestations of stress and anxiety? What medications are allowed to be used in this case? In which cases should the patient be recommended to visit a psychiatrist? When and what preventive and non-drug treatment methods for anxiety can be recommended to the patient? The authors concluded that it is necessary to medically relieve anxiety in a patient who has applied for a visit to the specialist with active somato-vegetative complaints. The therapy choice and the evaluation of its efficacy depend on the anxiety severity. If there is a positive effect, it is necessary to apply non-drug methods for the secondary prevention as soon as possible.

Keywords: anxiety, dysautonomia, stress, coping strategies, constructive ways to overcome distress, Hospital Anxiety and Depression Scale, anxiolytics, neurosteroids, ethifoxin.

For citation: Akarachkova E.S., Dovgan E.V., Kadyrova L.R., Klimov L.V., Kondrashov A.A., Kotova O.V., Lebedeva D.I. Anxiety in a patient with somatic symptom disorder: myth or reality? RMJ. 2024;5:2–6.