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Irritable bowel syndrome (IBS)

For Gulf War veterans who meet the diagnostic criteria for IBS, the committee recommends that:

  • cognitive behavioral therapy, tricyclic antidepressants (TCAs), and smooth-muscle relaxants be considered in appropriate age-specific, carefully selected clinical settings and

  • results of treatment studies be monitored to clearly establish therapeutic effectiveness of these agents in the various subgroups of patients diagnosed with IBS.

Panic disorder

For Gulf War veterans who meet criteria for panic disorder, the committee recommends treatment with antidepressant medication and cognitive behavioral therapy.

Post-traumatic stress disorder (PTSD)

For Gulf War veterans who meet the criteria for PTSD and with no contraindications, the committee recommends treatment with antidepressant medication and cognitive behavioral therapy.

Medically unexplained symptoms

For Gulf War veterans with unexplained symptoms, the committee recommends that:

  1. • for the purposes of treatment efficacy and effectiveness studies, explicit criteria for medically unexplained physical symptoms (apart from chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) be developed and used uniformly in treatment studies and

  2. • treatment studies of antidepressant medications, cognitive behavioral therapy, and a stepped intensity-of-care program be implemented for medically unexplained symptoms.




TABLE ES-4 Nine Steps in Patient-Centered Care

1

The patient must express all of his or her concerns during the clinical encounter.

2

The physician addresses all of the patient's concerns.

3

The physician and the patient share models of disease and symptoms.

4

The physician and patient must share goals for treatment.

5

The physician and the patient should agree on treatment goals, state them explicitly, and set priorities.

6

The physician and the patient should share their respective ideas about the purpose and course of treatments.

7

The physician and patient should identify potential difficulties in the care plan.

8

The physician and the patient should plan how to overcome anticipated compliance difficulties.

9

The physician should provide written information on the disease and treatment regimen.



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