Thread by @CroakeyNews

First concurrent sessions after lunch break are about to begin. I'll be tweeting from the consultation-liaison psychiatry session. First presentation is titled 'Health anxiety in a general hospital setting' by Michael Murphy, Ben Storer & Haldane Begg. @blackdoginst #RANZCP2022

Definition for health anxiety on the attached slide. Health anxiety is normal but can turn into a pathological state - Michael Murphy #RANZCP2022

DSM-5 set up to help GPs and other medical (nonpsychiatric) clinicians #RANZCP2022

Health anxiety an umbrella term looking at Somatic Symptom Disorder and Anxiety disorder - Michael Murphy #RANZCP2022

Is there a dilemma in the medically ill? Having a fear of cancer recurrence and cancer progression is normal - Michael Murphy #RANZCP2022

Health anxiety is looking over and above general fears about health. 8.5% in Australian primary care have health anxiety - Michael Murphy #RANZCP2022

Health anxiety is a remitting condition, causes distress and can be disabling (and is quite notable). Health anxiety also likely means that many people are not seeking healthcare- Michael Murphy #RANZCP2022

Murphy discusses translational research about health anxiety in the hospital setting. Are there high numbers of HA in hospital outpatient setting (care avoidance is part of the disorder), and how can we help them? - Michael Murphy #RANZCP2022

If they find patients with health anxiety, what are the treatments for them? Is it the same as in GP setting, for example - Michael Murphy #RANZCP2022

If a patient is naturally avoidant of health, the challenge is finding what would work to help them - Role of social work and exercise in health anxiety - Michael Murphy #RANZCP2022

In a case study, social work helped allow goal setting on finances & accommodation (in considering movement away from Sydney) & increasing exercise. He was not agreeable to therapy, did not find iCBT helpful and declined medication - Michael Murphy #RANZCP2022

If only a single intervention was applied with the patient, it is likely that he would not have improved - Michael Murphy #RANZCP2022

In a second case study, a pt with longstanding worries about complications of diabetes with strong ideas that everything is a complication, and that they were his fault - Hal Begg #RANZCP2022

For example, he believed a slight cramp in his calf was a sign of neuropathy & had fears of having hypoglycemic episodes at work - Hal Begg #RANZCP2022

His treatement was managed with a multimodal approach - engaged with exercise physiologist, CBT via iCBT and face-to-face. Overall, high level of satisfaction with the program - Hal Begg #RANZCP2022

This case study highlighted the value of identifying health anxiety patients early and developing a plan that works for them - Hal Begg #RANZCP2022

CBT is accepted as primary psychological therapy for health anxiety & the evidence base is larger and more robust than for pharmacotherapy, but there is a role for pharmacotherapy - Hal Begg #RANZCP2022

A review of the literature found that SSRIs moderately effective and well tolerated in RCT settings - more studies required to validate in naturalistic settings - Hal Begg #RANZCP2022

Prelim evaluation of the SHAPE project @blackdoginst indicates less uptake of assessment than hoped - Ben Storer #RANZCP2022

Data linkage in the SHAPE trial is aiming to look at the relationship between health anxiety and healthcare utilisation rates, particularly in the 2 years prior - Ben Storer #RANZCP2022

In health anxiety, diagnosis is often contested by patients, often seeking reassurance, some patients will be care-seeking or care-avoidant - Ben Storer #RANZCP2022

Doctors need to be mindful about the language used with patients with health anxiety, not to diminish their concerns - Ben Storer #RANZCP2022

A focus group with doctors on their views of working with patients with health anxiety identified 5 barriers- diagnostic terminology, identification, hospital & clinical factors (lack of time, resources), doctor's emotions & stigma about HA - Ben Storer #RANZCP2022