Psych Vivas · Consultation-liaison psychiatry
Pain psychiatry and somatic symptom disorders — structured clinical viva
Fellowship viva on SSD/IAD, PHQ-15, CBT for health anxiety, duloxetine/TCA caution, SPACE/CDC opioid principles, and OUD interface.
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Reveal interpretationShowHide
Reject “label to stop thinking.” SSD is a positive diagnosis of disproportionate response to symptoms, not a licence to ignore red flags forever.[1]
Nosology. SSD vs IAD (symptom load); map hypochondriasis legacy; mention ICD-11 bodily distress / hypochondriasis framing briefly.[1]
Assessment. Alliance; PHQ-15; depression/suicide; opioid/benzo map and OUD criteria; functional goals; shared re-investigation thresholds.[7]
Treatment. CBT for health anxiety (Barsky, Tyrer CHAMP); pain psychology; duloxetine titration spine 30→60 mg when indicated; TCA low-dose night caution; deprescribe high-risk sedative–opioid combinations carefully.[2][3][5]
Opioids. SPACE: opioids not superior for function in studied chronic pain; CDC 2022 principles; dual diagnosis if OUD present.[4][6][7]
References7ShowHide
- [1]Dimsdale JE, Creed F, Escobar J, et al. Somatic symptom disorder: an important change in DSM J Psychosom Res, 2013.PMID 23972410
- [2]Tyrer P, Cooper S, Salkovskis P, et al. Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial Lancet, 2014.PMID 24139977
- [3]Barsky AJ, Ahern DK Cognitive behavior therapy for hypochondriasis: a randomized controlled trial JAMA, 2004.PMID 15039413
- [4]Krebs EE, Gravely A, Nugent S, et al. Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial JAMA, 2018.PMID 29509867
- [5]Lunn MP, Hughes RA, Wiffen PJ Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia Cochrane Database Syst Rev, 2014.PMID 24385423
- [6]Dowell D, Ragan KR, Jones CM, et al. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022 MMWR Recomm Rep, 2022.PMID 36327391
- [7]Howe CQ, Sullivan MD The missing 'P' in pain management: how the current opioid epidemic highlights the need for psychiatric services in chronic pain care Gen Hosp Psychiatry, 2014.PMID 24211157