Pharmacotherapy

Drug use must be carefully monitored. Hypochondriacal patients are often already taking many pharmacotherapeutic agents when they arrive at the next physician’s office. Immediate withdrawal of these drugs is usually impossible. Rather, the physician should begin with small adjustments (eg, slowly decreasing the dose of drugs to which tolerance can develop). Hypochondriacal patients are usually receptive to withdrawal if the physician remains firm in the conviction to eliminate these drugs and is willing to withdraw them gradually. Whenever possible, potentially addicting hypnotics, anxiolytics, and analgesics should be avoided. Rather, low doses of sedating antidepressants (eg, amitriptyline 25 mg orally at bedtime) can be prescribed for sleep, and nonnarcotic analgesics can be used to relieve pain.
If drugs are a major contributing factor to dysfunction, hospitalization may be necessary to achieve withdrawal. Antidepressants and anxiolytics should be reserved for specific symptoms that are targeted for improvement. If the drugs are ineffective, they should be discontinued promptly.
Therapeutic adjuncts: A number of therapeutic adjuncts are available for managing the elderly hypochondriacal patient. An exercise program, physical therapy, and massage may be very effective for patients with poor health habits (eg, lack of exercise and its attendant adverse effects on muscles and joints). Physical therapy for the hospitalized patient breaks the routine of the sick and passive person. If pain and tension are primary complaints, biofeedback may be especially helpful. For the homebound patient, nutritional programs (eg, Meals on Wheels or lunch programs at senior centers) can break the cycle of social isolation.