FUNKTIONAL-forschungsprojekt: Früherkennung und behandlung funktioneller/somatoformer beschwerden in der allgemeinarztpraxis

Medically unexplained physical symptoms are typical for functional/ somatoform disorders. General practitioners play a key role in the medical care for this often difficult group of patients. In the FUNKTIONAL-research project (ISRCTN27782834) a guideline based curriculum for early diagnosis and treatment of functional/somatoform disorders in general practice has been developed cooperatively by GPs and specialists from university; the most important aspects are summarized in this article. After a characterization of the clinical picture etiological models are outlined as a basis for treatment strategies. As a general attitude calmness and an "as well as"-attitude are recommended, whose practical realisation is "simultaneous diagnostics", that is the parallel performance of organic diagnostics and psychosocial anamnesis; according to 8 leading questions early indicators for functional/somatoforme disorders are emphasized. The importance of a clear setting and of developing a sustainable working alliance are underlined. Telling the diagnostic findings should be combined with working on the extension of the patient's explanatory model leading to a biopsychosocial understanding of his/her disorder. After checking possible differential diagnoses the diagnosis should be dearly made and be discussed with the patient. After that a goal-oriented treatment planning follows. Basic treatment and extended treatment steps are introduced and criteria for a transfer to specialised psychotherapy are given. Finally the importance of psychohygiene of the GP is emphasized.