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Senger K, Heider J, Kleinstäuber M, Sehlbrede M, Witthöft M, Schröder A. Network Analysis of Persistent Somatic Symptoms in Two Clinical Patient Samples. Psychosom Med 2022; 84:74-85. [PMID: 34428004 DOI: 10.1097/psy.0000000000000999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Previous attempts to group persistent somatic symptoms (PSSs) with factor-analytic approaches have obtained heterogeneous results. An alternative approach that seems to be more suitable is the network theory. Compared with factor analysis, which focuses on the underlying factor of symptoms, network analysis focuses on the dynamic relationships and interactions among different symptoms. The main aim of this study is to apply the network approach to examine the heterogeneous structure of PSS within two clinical samples. METHODS The first data set consisted of n = 254 outpatients who were part of a multicenter study. The second data set included n = 574 inpatients, both with somatoform disorders. Somatic symptom severity was assessed with the Screening of Somatoform Disorder (SOMS-7T). RESULTS Results indicate that there are five main symptom groups that were found in both samples: neurological, gastrointestinal, urogenital, cardiovascular, and musculoskeletal symptoms. Although patterns of symptoms with high connection to each other look quite similar in both networks, the order of the most central symptoms (e.g., symptoms with a high connection to other symptoms in the network) differs. CONCLUSIONS This work is the first to estimate the structure of PSS using network analysis. A next step could be first to replicate our findings before translating them into clinical practice. Second, results may be useful for generating hypotheses to be tested in future studies, and the results open new opportunities for a better understanding for etiology, prevention, and intervention research.
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Affiliation(s)
- Katharina Senger
- From the Department of Psychology (Senger, Heider, Schröder), University of Koblenz-Landau, Landau, Germany; Department of Psychology (Kleinstäuber), Emma Eccles Jones College of Education and Health Services, Utah State University, Logan, Utah; Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Centre (Sehlbrede), University of Freiburg, Freiburg im Breisgau; and Division of Clinical Psychology and Psychotherapy (Witthöft), Johannes Gutenberg University of Mainz, Mainz, Germany
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2
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Xiao X, Yang X, Zheng W, Wang B, Fu L, Luo D, Hu Y, Ju N, Xu H, Fang Y, Fong Chan PS, Xu Z, Chen P, He J, Zhu H, Tang H, Huang D, Hong Z, Hao Y, Cai L, Ye S, Yuan J, Xiao F, Yang J, Wang Z, Zou H. Depression, anxiety and post-traumatic growth among COVID-19 survivors six-month after discharge. Eur J Psychotraumatol 2022; 13:2055294. [PMID: 35401948 PMCID: PMC8986234 DOI: 10.1080/20008198.2022.2055294] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pre-hospitalisation, hospitalisation and post-hospitalisation factors may significantly affect depression, anxiety and post-traumatic growth (PTG) among COVID-19 survivors. OBJECTIVE Our study investigated depression, anxiety and PTG and their correlates among COVID-19 survivors. METHOD A cross-sectional telephone survey recruited 199 COVID-19 patients (Mean age = 42.7; 53.3% females) at six-month follow-up after hospital discharge in five Chinese cities (i.e. Wuhan, Shenzhen, Zhuhai, Dongguan and Nanning). Their demographic information, clinical records and experiences during (e.g. severity of covid-19 symptoms, treatment and exposure to other patients' suffering) and after hospitalisation (e.g. perceived impact of covid-19, somatic symptoms after hospitalisation), and psychosocial factors (e.g. perceived discrimination, self-stigma, affiliate stigma, resilience and social support) were investigated. Depressive and anxiety symptoms were measured by the Patient Health Questionnaire (PHQ-9) and the Generalised anxiety disorder (GAD-7) scale, respectively. PTG was examined by the Post-traumatic Growth Inventory (PTGI) instrument. RESULTS The proportion of depressive symptoms <5, ≥5 and <10, ≥10 were 76.9%, 12.0% and 11.1%, respectively. The proportion of anxiety symptoms <5, ≥5 and <10, ≥10 were 77.4%, 15.1% and 7.5%, respectively. Multivariate logistic regression showed that receiving mental health care services during hospitalisation, somatic symptoms after discharge, perceived affiliate stigma and perceived impact of being infected with COVID-19 were significantly and positively associated with probable depression. Significant correlates of probable anxiety also included permanent residents of the city, somatic symptoms after discharge, perceived impact of being infected with COVID-19 and self-stigma. Social support, self-stigma and receiving mental health care services during hospitalisation were positively associated with PTG.Conclusions: The results suggest that post-hospitalisation and psychosocial factors had relatively stronger associations with depression, anxiety and PTG than pre-hospitalisation and hospitalisation factors. Promoting social support and social inclusion may be useful strategies to improve the mental health of COVID-19 survivors. HIGHLIGHTS • Post-hospitalisation and psychosocial factors had relatively stronger associations with depression, anxiety and PTG than pre-hospitalisation and hospitalisation factors, promoting social support and social inclusion may be useful strategies to improve mental health of COVID-19 survivors.
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Affiliation(s)
- Xin Xiao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China.,Center for Optometry and Visual Science, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Xue Yang
- Faculty of Medicine, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Weiran Zheng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Bingyi Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Dan Luo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Yuqing Hu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Niu Ju
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Hui Xu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Yuan Fang
- Department of Early Childhood Education, The Education University of Hong Kong, Hong Kong, People's Republic of China
| | - Paul Shing Fong Chan
- Faculty of Medicine, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Zhijie Xu
- The Fifth Affiliated Hospital of Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, People's Republic of China
| | - Ping Chen
- The Fifth Affiliated Hospital of Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, People's Republic of China
| | - Jiaoling He
- The Fifth Affiliated Hospital of Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, People's Republic of China
| | - Hongqiong Zhu
- The Fifth Affiliated Hospital of Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, People's Republic of China
| | - Huiwen Tang
- The Fifth Affiliated Hospital of Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, People's Republic of China
| | - Dixi Huang
- The Fifth Affiliated Hospital of Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, People's Republic of China
| | - Zhongsi Hong
- The Fifth Affiliated Hospital of Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, People's Republic of China
| | - Yanrong Hao
- Department of scientific research, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Lianying Cai
- Department of education, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Shupei Ye
- Dongguan Songshan Lake Central Hospital, Dongguan, People's Republic of China
| | - Jianhui Yuan
- Shenzhen Nanshan District Center for Disease Control and Prevention, Shenzhen, People's Republic of China
| | - Fei Xiao
- The Fifth Affiliated Hospital of Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, People's Republic of China
| | - Jianrong Yang
- Department of Hepatobiliary, Pancreas and Spleen Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Zixin Wang
- Faculty of Medicine, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China.,School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Shenzhen Center for Disease Control and Prevention, Shenzhen, People's Republic of China.,Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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3
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Wertenbruch-Rocke T, Hüsing P, Löwe B, Toussaint A. Application and validation of the bodily distress syndrome checklist in a psychosomatic outpatient sample. Gen Hosp Psychiatry 2021; 69:104-110. [PMID: 33588195 DOI: 10.1016/j.genhosppsych.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The BDS checklist is a self-report measure to assess the most common somatic symptoms in functional somatic syndromes, based on the diagnostic concept of Bodily Distress Syndrome. The aim of the study was to examine the psychometric properties and validity of the BDS checklist in a psychosomatic sample and to investigate whether it is suitable to detect DSM-5 somatic symptom disorders (SSD). METHOD In a cross-sectional study, n = 368 patients from a psychosomatic outpatient clinic completed the BDS checklist and a semi-structured clinical interview on SSD. Item and scale characteristics and measures of reliability and validity were determined. RESULTS The BDS checklist showed good item characteristics and reliability (Cronbach α = 0.89). Factor analysis confirmed four symptom clusters (CFI = 0.95, TLI = 0.95, RMSEA = 0.091, 90% CI = 0.085-0.097). The BDS total score showed significant correlations with other measures of somatic symptom burden (r = 0.79, p < .001), health anxiety (r = 0.46, p < .001), depression (r = 0.45, p < .001), and general anxiety (r = 0.41, p < .001). Higher BDS checklist scores were associated with higher physical and mental health impairment and higher health care use. Diagnostic accuracy regarding somatic symptom disorder was moderate (AUC = 0.72, 95% CI: 0.67-0.77). CONCLUSION Findings of our study indicate that the BDS checklist is a reliable and valid measure to assess the most common somatic symptoms in a psychosomatic setting. It is however not sufficient to detect persons at risk for somatic symptom disorder. A combination with further questionnaires could probably improve diagnostic accuracy.
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Affiliation(s)
- Tina Wertenbruch-Rocke
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Building O25 Martinistrasse 52, 20246 Hamburg, Germany.
| | - Paul Hüsing
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Building O25 Martinistrasse 52, 20246 Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Building O25 Martinistrasse 52, 20246 Hamburg, Germany
| | - Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Building O25 Martinistrasse 52, 20246 Hamburg, Germany
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Wang B, Yang X, Fu L, Hu Y, Luo D, Xiao X, Ju N, Zheng W, Xu H, Fang Y, Chan PSF, Xu Z, Chen P, He J, Zhu H, Tang H, Huang D, Hong Z, Ma X, Hao Y, Cai L, Yang J, Ye S, Yuan J, Chen YQ, Xiao F, Wang Z, Zou H. Post-traumatic Stress Disorder Symptoms in COVID-19 Survivors 6 Months After Hospital Discharge: An Application of the Conservation of Resource Theory. Front Psychiatry 2021; 12:773106. [PMID: 35058820 PMCID: PMC8764385 DOI: 10.3389/fpsyt.2021.773106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/02/2021] [Indexed: 12/17/2022] Open
Abstract
COVID-19 survivors who had acute respiratory symptoms might experience prolonged post-traumatic stress disorder (PTSD) due to further rehabilitation, somatic symptoms and related distress. The conservation of resource (COR) theory is a well-developed theory to understand how people develop PTSD symptoms in traumatic events. The current study aimed to examine the potential factors of PTSD symptoms and interrelationships among this factors among COVID-19 survivors based on the COR theory. This cross-sectional telephone survey enrolled 199 COVID-19 patients (Mean age = 42.7; 53.3% females) 6 months after their hospital discharge in five Chinese cities (i.e., Wuhan, Shenzhen, Zhuhai, Dongguan, and Nanning). The results showed that 7% of participants were classified as having probable PTSD. The significant potential factors relating to PTSD symptoms included socio-demographic status, hospitalization experiences, post-hospitalization experiences, and psychological status. Besides, the proposed statistical mediation model based on the COR framework showed good model fit, χ2(df) = 17.286 (5), p = 0.004, CFI = 0.962, NNFI = 0.951, RMSEA = 0.077. Perceived resource loss/gain fully mediated the association between exposure to other patients' suffering during hospitalization and PTSD symptoms, and partially mediated the relationships from somatic symptoms/perceived impact of being infected with COVID-19 after discharge to PTSD symptoms. On the other hand, resilience was a full mediator in the relationship from ICU experience to PTSD symptoms and a partial mediator in the relationship from perceived impact to PTSD symptoms. The results provide preliminary support on applying the COR theory to understand the factors of PTSD symptoms among COVID-19 survivors. Interventions to reduce PTSD symptoms in this population can be developed based on the modifiable psychosocial mediators.
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Affiliation(s)
- Bingyi Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xue Yang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yuqing Hu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Dan Luo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xin Xiao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.,Center for Optometry and Visual Science, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Niu Ju
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Weiran Zheng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Hui Xu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yuan Fang
- Department of Early Childhood Education, The Education University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Paul Shing Fong Chan
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Zhijie Xu
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Ping Chen
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jiaoling He
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Hongqiong Zhu
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Huiwen Tang
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Dixi Huang
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Zhongsi Hong
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiaojun Ma
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Yanrong Hao
- Department of Scientific Research, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Lianying Cai
- Department of Education, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jianrong Yang
- Department of Hepatobiliary, Pancreas and Spleen Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Shupei Ye
- Department of Emergency, SSL Central Hospital of Dongguan City, Dongguan, China
| | - Jianhui Yuan
- Shenzhen Nanshan District Center for Disease Control and Prevention, Shenzhen, China
| | - Yao-Qing Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Fei Xiao
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Zixin Wang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.,School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shenzhen Center for Disease Control and Prevention, Shenzhen, China.,Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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5
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Linden SC. Triggers and Clinical Presentations of Functional Neurological Disorders: Lessons from World War 1. Eur Neurol 2020; 83:174-181. [PMID: 32454481 DOI: 10.1159/000507698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/31/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The psychological contribution to functional neurological and somatic symptom disorders is a major topic in current medical debate. OBJECTIVE For an understanding of the processes leading to functional somatic symptoms, it is paramount to explore their relationship with stress and life events and to elucidate the contribution of cultural factors. METHODS A total of 937 case records of civilian and military patients with functional somatic disorders treated in London during World War 1 were analysed. Group differences in symptom profiles and contemporaneous diagnoses were tested with χ2 tests. RESULTS Paralyses and speech disturbances were significantly more common in soldiers (43.3 and 17.2% of cases) than in civilian male (28.1 and 6.5%) and female patients (32.4 and 7.5%), whereas female patients had the highest rates of pain (48.6%) and somatic symptoms (67%). Triggers were identified in around two-thirds of cases and included accidents, physical illness, and work stress, in addition to the combat experience of the soldier patients. The nature of the trigger influenced symptom expression, with acute (combat and noncombat) events being particularly prone to trigger loss of motor function. Symptom profiles showed a great deal of multi-morbidity and overlap, although some symptom clusters were more (motor and speech disturbance) or less common (pain and loss of energy) in soldiers than civilians. Triggering life events in civilians were similar to those reported by patients with somatic symptom disorders today, with an important role of physical factors. Patterns of multi-morbidity and symptom clusters also resembled those of modern cohorts. CONCLUSIONS Analysis of historical records, illness trajectories, and treatments can enhance the understanding of the presentation, mechanisms, and course of functional neurological and related disorders and their consistency over time.
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Affiliation(s)
- Stefanie Caroline Linden
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands,
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6
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Eliasen M, Jørgensen T, Schröder A, Dantoft TM, Fink P, Poulsen CH, Johansen NB, Eplov LF, Skovbjerg S, Kreiner S. Somatic symptom profiles in the general population: a latent class analysis in a Danish population-based health survey. Clin Epidemiol 2017; 9:421-433. [PMID: 28883742 PMCID: PMC5574686 DOI: 10.2147/clep.s137167] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Purpose The aim of this study was to identify and describe somatic symptom profiles in the general adult population in order to enable further epidemiological research within multiple somatic symptoms. Methods Information on 19 self-reported common somatic symptoms was achieved from a population-based questionnaire survey of 36,163 randomly selected adults in the Capital Region of Denmark (55.4% women). The participants stated whether they had been considerably bothered by each symptom within 14 days prior to answering the questionnaire. We used latent class analysis to identify the somatic symptom profiles. The profiles were further described by their association with age, sex, chronic disease, and self-perceived health. Results We identified 10 different somatic symptom profiles defined by number, type, and site of the symptoms. The majority of the population (74.0%) had a profile characterized by no considerable bothering symptoms, while a minor group of 3.9% had profiles defined by a high risk of multiple somatic symptoms. The remaining profiles were more likely to be characterized by a few specific symptoms. The profiles could further be described by their associations with age, sex, chronic disease, and self-perceived health. Conclusion The identified somatic symptom profiles could be distinguished by number, type, and site of the symptoms. The profiles have the potential to be used in further epidemiological studies on risk factors and prognosis of somatic symptoms but should be confirmed in other population-based studies with specific focus on symptom burden.
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Affiliation(s)
- Marie Eliasen
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark, Glostrup
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark, Glostrup.,Department of Public Health, University of Copenhagen, Copenhagen.,Department of Clinical Medicine, Aalborg University, Aalborg
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus C
| | - Thomas Meinertz Dantoft
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark, Glostrup
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus C
| | - Chalotte Heinsvig Poulsen
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark, Glostrup.,Mental Health Centre Copenhagen, The Capital Region of Denmark, Hellerup, Denmark
| | - Nanna Borup Johansen
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark, Glostrup
| | - Lene Falgaard Eplov
- Mental Health Centre Copenhagen, The Capital Region of Denmark, Hellerup, Denmark
| | - Sine Skovbjerg
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark, Glostrup
| | - Svend Kreiner
- Department of Public Health, University of Copenhagen, Copenhagen
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Dehoust MC, Schulz H, Härter M, Volkert J, Sehner S, Drabik A, Wegscheider K, Canuto A, Weber K, Crawford M, Quirk A, Grassi L, DaRonch C, Munoz M, Ausin B, Santos-Olmo A, Shalev A, Rotenstein O, Hershkowitz Y, Strehle J, Wittchen HU, Andreas S. Prevalence and correlates of somatoform disorders in the elderly: Results of a European study. Int J Methods Psychiatr Res 2017; 26:e1550. [PMID: 28150357 PMCID: PMC6877225 DOI: 10.1002/mpr.1550] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 09/08/2014] [Accepted: 10/10/2014] [Indexed: 11/12/2022] Open
Abstract
Somatoform disorders have rarely been addressed in epidemiological and health care services studies of the elderly. The few existing studies vary considerably in their methodologies limiting comparability of findings. Data come from the MentDis_ICF65+ study, in which a total of 3142 community-dwelling respondents aged 65-84 years from six different countries were assessed by the Composite International Diagnostic Interview adapted to the needs of the elderly (CIDI65+). The 12-month prevalence rate for any somatoform disorders was found to be 3.8, whereby the prevalence for somatization disorder according to DSM-IV was 0%, the prevalence for abridged somatization was 1.7% and the rate for 12-months somatoform pain disorder was 2.6%. We found a significant variation by study centre (p < 0.005). There was a significant gender difference for pain disorder, but not for abridged somatization. Significant age-related effects revealed for both disorder groups. Somatoform disorders were found to be associated with other mental disorders [odds ratio (OR) anxiety =4.8, OR affective disorders 3.6], as well as with several impairments and disabilities. Somatoform disorders are prevalent, highly impairing conditions in older adults, which are often associated with other mental disorders and should receive more research and clinical attention.
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Affiliation(s)
- Maria Christina Dehoust
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Volkert
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Sehner
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Drabik
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandra Canuto
- Division of Liaison Psychiatry and Crisis Intervention, University Hospitals of Geneva and Faculty of Medicine of the University of Geneva, Geneva, Switzerland
| | - Kerstin Weber
- Division of Liaison Psychiatry and Crisis Intervention, University Hospitals of Geneva and Faculty of Medicine of the University of Geneva, Geneva, Switzerland
| | - Mike Crawford
- Royal College of Psychiatrists, College Centre for Quality Improvement, London, UK
| | - Alan Quirk
- Royal College of Psychiatrists, College Centre for Quality Improvement, London, UK
| | - Luigi Grassi
- Section of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Chiara DaRonch
- Section of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Manuel Munoz
- School of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Berta Ausin
- School of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Anna Santos-Olmo
- School of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Arieh Shalev
- Department of Psychiatry, Hadassah University Medical Centre, Jerusalem, Israel
| | - Ora Rotenstein
- Department of Psychiatry, Hadassah University Medical Centre, Jerusalem, Israel
| | - Yael Hershkowitz
- Department of Psychiatry, Hadassah University Medical Centre, Jerusalem, Israel
| | - Jens Strehle
- Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany
| | - Sylke Andreas
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Institute for Psychology, Alpen-Adria Universität Klagenfurt, Klagenfurt am Wörthersee, Austria
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8
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Goldberg DP, Reed GM, Robles R, Bobes J, Iglesias C, Fortes S, de Jesus Mari J, Lam TP, Minhas F, Razzaque B, Garcia JÁ, Rosendal M, Dowell CA, Gask L, Mbatia JK, Saxena S. Multiple somatic symptoms in primary care: A field study for ICD-11 PHC, WHO's revised classification of mental disorders in primary care settings. J Psychosom Res 2016; 91:48-54. [PMID: 27894462 DOI: 10.1016/j.jpsychores.2016.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 09/30/2016] [Accepted: 10/03/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE A World Health Organization (WHO) field study conducted in five countries assessed proposals for Bodily Stress Syndrome (BSS) and Health Anxiety (HA) for the Primary Health Care Version of ICD-11. BSS requires multiple somatic symptoms not caused by known physical pathology and associated with distress or dysfunction. HA involves persistent, intrusive fears of having an illness or intense preoccupation with and misinterpretation of bodily sensations. This study examined how the proposed descriptions for BSS and HA corresponded to what was observed by working primary care physicians (PCPs) in participating countries, and the relationship of BSS and HA to depressive and anxiety disorders and to disability. METHOD PCPs referred patients judged to have BSS or HA, who were then interviewed using a standardized psychiatric interview and a standardized measure of disability. RESULTS Of 587 patients with BSS or HA, 70.4% were identified as having both conditions. Participants had an average of 10.9 somatic symptoms. Patients who presented somatic symptoms across multiple body systems were more disabled than patients with symptoms in a single system. Most referred patients (78.9%) had co-occurring diagnoses of depression, anxiety, or both. Anxious depression was the most common co-occurring psychological disorder, associated with the greatest disability. CONCLUSION Study results indicate the importance of assessing for mood and anxiety disorders among patients who present multiple somatic symptoms without identifiable physical pathology. Although highly co-occurring with each other and with mood and anxiety disorders, BSS and HA represent distinct constructs that correspond to important presentations in primary care.
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Affiliation(s)
| | - Geoffrey M Reed
- World Health Organization, Geneva, Switzerland; Global Mental Health Program, Columbia University, New York, NY, USA
| | - Rebeca Robles
- National Institute of Psychiatry 'Ramón de la Fuente Muñiz', Mexico, DF, Mexico
| | - Julio Bobes
- University of Oviedo, CIBERSAM, Oviedo, Asturias, Spain
| | | | - Sandra Fortes
- Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Tai-Pong Lam
- University of Hong Kong, Hong Kong, People's Republic of China
| | | | | | - José Ángel Garcia
- National Institute of Psychiatry 'Ramón de la Fuente Muñiz', Mexico, DF, Mexico
| | - Marianne Rosendal
- Research Unit for General Practice, University of Southern Denmark, Denmark
| | | | - Linda Gask
- University of Manchester, Manchester, United Kingdom
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9
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Hetland J, Torsheim T, Aarø LE. Subjective health complaints in adolescence: dimensional structure and variation across gender and age. Scand J Public Health 2016. [DOI: 10.1177/140349480203000309] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aims: The aim of this study is to investigate dimensional structures in subjective health complaints in adolescents and to examine the variation in levels and dimensionality across gender and age groups. Methods: Data from two studies were used: (1) a study based on a convenience sample, consisting of 1427 Norwegian students (11- to 15-year-olds) from schools participating in the European Network of Health Promoting Schools; (2) a nationwide survey amongst 7,059 Norwegian students (aged 11, 13, 15, and 16) from the Health Behaviour in School-aged Children (HBSC) study. Subjective health complaints were measured by revised versions of the HBSC symptoms checklist (HBSC-SCL). Results: In study 1 confirmatory factor analysis revealed that a model of two highly correlated factors, which can be labelled somatic and psychological, fitted the data reasonably well (CFI = 0.91). This two-factor model was applied in study 2 and latent means were tested across sub-samples defined by gender and age. The results indicate that girls show higher mean levels compared with boys on both factors. There is also an indication of an increase in these factors with age amongst girls, while amongst boys there is less, if any, difference across age groups. The correlation between the somatic and psychological factors was virtually constant across age groups and gender. Conclusions: The identification of a somatic and a psychological factor indicates the existence of two different dimensions that may have different aetiologies. The gender difference in latent means across age groups may suggest a different developmental pattern amongst girls and boys.
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Affiliation(s)
- Jorn Hetland
- Research Centre for Health Promotion, University of Bergen, Norway,
| | | | - Leif E. Aarø
- Department of Psychosocial Sciences, University of Bergen
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Eliasen M, Kreiner S, Ebstrup JF, Poulsen CH, Lau CJ, Skovbjerg S, Fink PK, Jørgensen T. Somatic Symptoms: Prevalence, Co-Occurrence and Associations with Self-Perceived Health and Limitations Due To Physical Health - A Danish Population-Based Study. PLoS One 2016; 11:e0150664. [PMID: 26930630 PMCID: PMC4773248 DOI: 10.1371/journal.pone.0150664] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/16/2016] [Indexed: 01/17/2023] Open
Abstract
A high number of somatic symptoms have been associated with poor health status and increased health care use. Previous studies focused on number of symptoms without considering the specific symptoms. The aim of the study was to investigate 1) the prevalence of 19 somatic symptoms, 2) the associations between the symptoms, and 3) the associations between the somatic symptoms, self-perceived health and limitations due to physical health accounting for the co-occurrence of symptoms. Information on 19 somatic symptoms, self-perceived health and limitations due to physical health was achieved from a population-based questionnaire survey of 36,163 randomly selected adults in the Capital Region of Denmark in 2006/07. Chain graph models were used to transparently identify and describe the associations between symptoms, self-perceived health and limitations due to physical health. In total, 94.9% of the respondents were bothered by one or more of the 19 somatic symptoms. The symptoms were associated in a complex structure. Still, recognisable patterns were identified within organ systems/body parts. When accounting for symptom co-occurrence; dizziness, pain in legs, respiratory distress and tiredness were all strongly directly associated with both of the outcomes (γ>0.30). Chest pain was strongly associated with self-perceived health, and other musculoskeletal symptoms and urinary retention were strongly associated with limitations due to physical health. Other symptoms were either moderate or not statistically associated with the health status outcomes. Opposite, almost all the symptoms were strongly associated with the two outcomes when not accounting for symptom co-occurrence. In conclusion, we found that somatic symptoms were frequent and associated in a complex structure. The associations between symptoms and health status measures differed between the symptoms and depended on the co-occurrence of symptoms. This indicates an importance of considering both the specific symptoms and symptom co-occurrence in further symptom research instead of merely counting symptoms.
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Affiliation(s)
- Marie Eliasen
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark
- * E-mail:
| | - Svend Kreiner
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette F. Ebstrup
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark
| | - Chalotte H. Poulsen
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark
- Mental Health Centre Copenhagen, The Capital Region of Denmark, Gentofte, Denmark
| | - Cathrine J. Lau
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark
| | - Sine Skovbjerg
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark
| | - Per K. Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Torben Jørgensen
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Budtz-Lilly A, Schröder A, Rask MT, Fink P, Vestergaard M, Rosendal M. Bodily distress syndrome: A new diagnosis for functional disorders in primary care? BMC FAMILY PRACTICE 2015; 16:180. [PMID: 26669977 PMCID: PMC4681035 DOI: 10.1186/s12875-015-0393-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 12/03/2015] [Indexed: 12/14/2022]
Abstract
Background Conceptualisation and classification of functional disorders appear highly inconsistent in the health-care system, particularly in primary care. Numerous terms and overlapping diagnostic criteria are prevalent of which many are considered stigmatising by general practitioners and patients. The lack of a clear concept challenges the general practitioner’s decision-making when a diagnosis or a treatment approach must be selected for a patient with a functional disorder. This calls for improvements of the diagnostic categories. Intense debate has risen in connection with the release of the fifth version of the ‘Diagnostic and Statistical Manual of Mental Disorders’ and the current revision of the ‘International Statistical Classification of Diseases and Related Health Problems’. We aim to discuss a new evidence based diagnostic proposal, bodily distress syndrome, which holds the potential to change our current approach to functional disorders in primary care. A special focus will be directed towards the validity and utility criteria recommended for diagnostic categorisation. Discussion A growing body of evidence suggests that the numerous diagnoses for functional disorders listed in the current classifications belong to one family of closely related disorders. We name the underlying phenomenon ‘bodily distress’; it manifests as patterns of multiple and disturbing bodily sensations. Bodily distress syndrome is a diagnostic category with specific criteria covering this illness phenomenon. The category has been explored through empirical studies, which in combination provide a sound basis for determining a symptom profile, the diagnostic stability and the boundaries of the condition. However, as bodily distress syndrome embraces only the most common symptom patterns, patients with few but impairing symptoms are not captured. Furthermore, the current lack of treatment options may also influence the acceptance of the proposed diagnosis. Summary Bodily distress syndrome is a diagnostic category with notable validity according to empirical studies. Nevertheless, knowledge is sparse on the utility in primary care. Future intervention studies should investigate the translation of bodily distress syndrome into clinical practice. A particular focus should be directed towards the acceptability among general practitioners and patients. Most importantly, it should be investigated whether the new category may provide the basis for better treatment and improved clinical outcome.
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Affiliation(s)
- Anna Budtz-Lilly
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
| | - Mette Trøllund Rask
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
| | - Mogens Vestergaard
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Marianne Rosendal
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
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Exploring somatization types among patients in Indonesia: latent class analysis using the Adult Symptom Inventory. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2014. [DOI: 10.5114/cipp.2014.47810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
<b>Background</b><br />
The aim of this study was to explore somatization types by reducing patient complaints to their most basic and parsimonious characteristics. We hypothesized that there were latent groups representing distinct types of somatization.<br />
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<b>Participants and procedure</b><br />
Data were collected from patients undergoing both inpatient and outpatient treatment at two hospitals in Yogyakarta, Indonesia (N = 212).<br />
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<b>Results</b><br />
Results from latent class analysis revealed four classes of somatization: two classes (Classes 1 and 2) referring to levels of somatization and two classes (Classes 3 and 4) referring to unique types of somatization. The first two classes (Classes 1 and 2; low and high levels of somatization, respectively) corresponded to the number of different symptoms that patients reported out of the list of physical symptoms in the Adult Symptom Inventory. The second two classes (Classes 3 and 4; non-serious and critical complaints, respectively) corresponded to two different sets of symptoms. Patients in Class 3 tended to report temporary mild complaints that are common in daily life, such as dizziness, nausea, and stomach pain. Patients in Class 4 tended to report severe complaints and medical problems that require serious treatment or medication, such as deafness or blindness.<br />
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<b>Conclusions</b><br />
The present study do confirm somatization as a unidimensional experience reflecting a general tendency to report somatic symptoms, but rather support the understanding of somatization as a multidimensional construct.
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13
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Williams GC, Halvari H, Niemiec CP, Sørebø Ø, Olafsen AH, Westbye C. Managerial support for basic psychological needs, somatic symptom burden and work-related correlates: A self-determination theory perspective. WORK AND STRESS 2014. [DOI: 10.1080/02678373.2014.971920] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Witthöft M, Hiller W, Loch N, Jasper F. The latent structure of medically unexplained symptoms and its relation to functional somatic syndromes. Int J Behav Med 2014; 20:172-83. [PMID: 22618306 DOI: 10.1007/s12529-012-9237-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Medically unexplained symptoms are the hallmark of somatoform disorders and functional somatic syndromes. PURPOSE Although medically unexplained symptoms represent a common phenomenon both in the general population as well as in medical settings, the exact latent structure of somatic symptoms remains largely unclear. METHOD We examined the latent structure of medically unexplained symptoms by means of the Patient Health Questionnaire-15 (PHQ-15) questionnaire (i.e., a popular symptom checklist) and provide support for the construct validity of our model. The data were analyzed using confirmatory factor analysis in a general population sample (study 1; N = 414) and in a sample of primary care patients (study 2; N = 308). We compared four different latent structure models of medically unexplained symptoms: a general factor model, a correlated group factor model, a hierarchical model, and a bifactor model. RESULTS In study 1, a bifactor model with one general factor and four independent specific symptom factors (i.e., gastrointestinal, pain, fatigue, and cardiopulmonary symptoms) showed the best model fit. This bifactor model was confirmed in the primary care sample (study 2). Additionally, the model explained 59 % of the variance of the irritable bowel syndrome (IBS). In this structural equation model, both the general factor (14 %) as well as the gastrointestinal symptom factor (42 %) significantly predicted the IBS. CONCLUSION The findings of both studies help to clarify the latent structure of somatic symptoms in the PHQ-15. The bifactor model outperformed alternative models and demonstrated external validity in predicting IBS.
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Affiliation(s)
- Michael Witthöft
- Division of Clinical Psychology and Psychotherapy, Johannes Gutenberg University of Mainz, Wallstrasse 3, Mainz, Germany.
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15
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Rosmalen JGM, Tak LM, de Jonge P. Empirical foundations for the diagnosis of somatization: implications for DSM-5. Psychol Med 2011; 41:1133-1142. [PMID: 20843407 DOI: 10.1017/s0033291710001625] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of this study was to develop empirically validated criteria for the diagnoses of clinically relevant somatization. METHOD This study was performed in a population-representative cohort consisting of 461 males (47.8%) and 503 females (52.2%), with an average age of 55.8 years (s.d.=11.1). Somatization, anxiety and depression were derived from the Composite International Diagnostic Interview. Mplus was used to perform confirmative factor analyses on the current DSM-IV symptom groups; on alternative symptom clusters previously suggested; and to perform latent class analysis in order to define an empirically derived cut-off for somatization. RESULTS The existence of symptom groups as described in DSM-IV was not supported by our data, whereas a differentiation between cardiopulmonary, musculoskeletal, gastrointestinal and general somatic symptoms did fit our data. Latent class analysis revealed two classes characterized by few (n=859) and many (n=105) symptoms. The class of subjects could be approached by a simple cut-off of four functional symptoms (sensitivity 79%, specificity 98%, positive predictive value 82%, negative predictive value 97%) regardless of the number of organ systems involved. CONCLUSIONS This study in a large population-representative cohort suggests that a simple symptom count can be used as a dimensional diagnosis of somatization. In those instances in which a categorical diagnosis is preferred, a simple cut-off of four out of 43 functional symptoms best fitted our data. We did not find any added value for incorporating the number of symptom clusters into the diagnostic criteria.
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Acoustic neuroma identified after electroconvulsive therapy in a patient with recurrent major depression and undifferentiated somatoform disorder. J ECT 2010; 26:330-1. [PMID: 20357670 DOI: 10.1097/yct.0b013e3181cadc1f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Little is known about the safety of electroconvulsive therapy (ECT) in patients with brain tumors, especially in patients with acoustic neuroma, which is difficult to diagnose early. For patients with somatoform disorder, physicians may alter the sensitivity to the somatic complaints, making it even more difficult to make an early diagnosis of "silent" brain tumors. This report describes a rare case involving treatment of refractory major depression and somatoform disorder that developed into increased intracranial pressure after ECT, possibly due to an undiagnosed acoustic neuroma. It is suggested that for patients with refractory major depression with somatoform disorders, the threshold of suspicion for silent tumors should be lowered and pre-ECT brain imaging study should be performed, specifically when the pattern of symptoms of the central nervous system-related somatoform syndrome changes.
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18
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Validity of the Ghent Multidimensional Somatic Complaints Scale in a clinical sample. J Psychosom Res 2010; 68:535-8. [PMID: 20488269 DOI: 10.1016/j.jpsychores.2009.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 11/19/2009] [Accepted: 11/30/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the validity of the Ghent Multidimensional Somatic Complaints Scale (GMSCS) in a Clinical Sample. METHOD Three hundred fifty-four non-clinical subjects and 151 clinical patients completed the GMSCS, an 18-item five-factorial scale for the assessment of somatic complaints. RESULTS The five-factorial structure was reliable and valid in the non-clinical as well as the clinical sample. Furthermore, group differences after controlling for the other factors were only significant for pain and fatigue. CONCLUSION The GMSCS is a suitable multidimensional scale for assessing five clusters of somatic complaints in a clinical (primary care and pain patients) and non-clinical population.
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HÄUSER WINFRIED, SCHMUTZER GABRIELE, BRÄHLER ELMAR, GLAESMER HEIDE. A Cluster Within the Continuum of Biopsychosocial Distress Can Be Labeled “Fibromyalgia Syndrome” — Evidence from a Representative German Population Survey. J Rheumatol 2009; 36:2806-12. [DOI: 10.3899/jrheum.090579] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.We tested the hypothesis that “fibromyalgia syndrome” is a biopsychosocial continuum disorder.Methods.A cross-sectional survey of a representative sample of the German general population with persons ≥ 14 years of age was conducted based on face-to-face contacts. Physical distress was measured by the regional pain scale (RPS) and the Patient Health Questionnaire 15 (PHQ-15), psychological distress by the PHQ-9, and social distress by the Oslo Social Support Scale. Health-related quality of life (HRQOL) was measured by the 12-item form of the Medical Outcome Study Short Form Health Survey. A k-means clustering procedure with 2–8 clusters preset was used to classify the scores of the RPS, PHQ-9, and PHQ-15. The number of clusters retained was based on the stability and interpretability of the clusters. The cluster analysis was first performed with a randomly selected half of the sample and then cross-validated on the second half of the total sample.Results.A 4-cluster solution produced the most stable and meaningful results. Cluster 1 was very low on all symptom scores. Cluster 2 was low on pain sites, somatic symptoms, and depression. Cluster 3 was high on pain scores, moderate on somatic symptoms, and low on depression. Cluster 4 was high on all symptom scores. The centroids of cluster 4 met the survey criteria of fibromyalgia syndrome. Cluster 4 reported a lower HRQOL and less social support compared to the other 3 groups.Conclusion.A cluster within the continuum of biopsychosocial distress can be labeled fibromyalgia syndrome.
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20
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Boone KB. Fixed belief in cognitive dysfunction despite normal neuropsychological scores: neurocognitive hypochondriasis? Clin Neuropsychol 2009; 23:1016-36. [PMID: 18923966 DOI: 10.1080/13854040802441135] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A subset of patients who present for neuropsychological testing report dysfunction in daily life activities secondary to cognitive deficits, but are found on formal testing to have no objective abnormalities, raising the possibility of "neurocognitive hypochondriasis." Such a case is presented, and the factors that appear to give rise to this presentation are explored. Cases of hypochondriacal overconcern regarding cognitive function are likely not rare, particularly given research showing there is little correlation between objective report of cognitive dysfunction and actual test scores in such conditions as mild traumatic brain injury, chronic fatigue syndrome, fibromyalgia, toxic mold exposure, and post-polio syndrome.
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Affiliation(s)
- Kyle Brauer Boone
- Center for Forensic Studies, Alliant International University - LA, 1000 South Fremont Avenue, Alhambra, CA91803, USA.
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21
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Beirens K, Fontaine JRJ. Development of the Ghent Multidimensional Somatic Complaints Scale. Assessment 2009; 17:70-80. [PMID: 19700738 DOI: 10.1177/1073191109337187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present study aimed at developing a new scale that operationalizes a hierarchical model of somatic complaints. First, 63 items representing a wide range of symptoms and sensations were compiled from somatic complaints scales and emotion literature. These complaints were rated by Belgian students (n = 307) and Belgian adults (n = 603). Exploratory factor analyses identified a gastrointestinal, cardiorespiratory, pain, temperature regulation, and fatigue factor. Next, the number of complaints was reduced to 18. Second, the short scale, called the Ghent Multidimensional Somatic Complaints Scale (GMSC), was administered to Belgian students (n = 735), Belgian adults (n = 664), and Turkish adults (n = 222). Confirmatory factor analysis confirmed that a higher-order model with five first-order and one second-order factor fitted best. Regression analyses demonstrated that the first-order factors were differentially related to anxiety, depression, anger, age, and gender. In sum, the GMSC scale offers the possibility to assess individual differences in somatic complaints from a hierarchical perspective.
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Affiliation(s)
- Koen Beirens
- Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.
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22
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Walker LS, Beck JE, Garber J, Lambert W. Children's Somatization Inventory: psychometric properties of the revised form (CSI-24). J Pediatr Psychol 2009; 34:430-40. [PMID: 18782857 PMCID: PMC2722132 DOI: 10.1093/jpepsy/jsn093] [Citation(s) in RCA: 184] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 08/11/2008] [Accepted: 08/12/2008] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To conduct a multimethod psychometric evaluation to refine the Children's Somatization Inventory (CSI) and to investigate its dimensionality. METHOD The CSI was administered to 876 pediatric patients with chronic abdominal pain at their initial visit to a pediatric gastroenterology clinic. Tools from three psychometric models identified items that most effectively measured the construct of somatization and examined its dimensionality. RESULTS Eleven statistically weak items were identified and removed, creating a 24-item CSI (CSI-24). The CSI-24 showed good psychometrics according to the three measurement models and correlated .99 with the original CSI. The CSI-24 has one dominant general factor but is not strictly unidimensional. CONCLUSIONS The CSI-24 is a reliable and psychometrically sound refinement of the original CSI. Findings are consistent with the view that somatization has a strong general factor that represents a continuum of symptom reporting, as well as minor components that represent specific symptom clusters in youth with chronic abdominal pain.
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Affiliation(s)
- Lynn S Walker
- Division of Adolescent Medicine and Behavioral Science, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232-3571, USA.
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Abstract
PURPOSE Patients with conversion disorder present with symptoms of sensory and motor dysfunction that are not explained by known physical disorders or pathophysiological mechanisms. Correct diagnosis and prompt, effective management of patients with this disorder is essential. Healthcare providers may be unaware of the important role of physical therapy in the management of patients with conversion disorder. While numerous reports have suggested the need for physical therapy management of this disorder, there is a lack of reports outlining specific physical therapy management principles or daily treatment progression. The purpose of this series of case reports is to provide an overview of conversion disorder and describe successful physical therapy management strategies used to treat three patients with movement impairment due to this disorder. CASE DESCRIPTION The patients were 18-, 20-, and 34-year-old women treated in a hospital inpatient rehabilitation setting. Behavioral modification and shaping techniques formed the basis for the physical therapy treatment approach. Abnormal movement patterns were ignored, and correct movement patterns were reinforced using feedback and praise. The patients advanced through a progressively more difficult therapy program based on treatment approaches used with analogous neurological conditions. OUTCOMES All three patients showed complete resolution of their symptoms and returned to independent mobility, independent living, and to work or school.
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Affiliation(s)
- Debra Ness
- Mayo Clinic, Rochester, Minnesota, MN, USA.
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24
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Noyes R, Stuart SP, Watson DB. A Reconceptualization of the Somatoform Disorders. PSYCHOSOMATICS 2008; 49:14-22. [DOI: 10.1176/appi.psy.49.1.14] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kroenke K, Sharpe M, Sykes R. Revising the Classification of Somatoform Disorders: Key Questions and Preliminary Recommendations. PSYCHOSOMATICS 2007; 48:277-85. [PMID: 17600162 DOI: 10.1176/appi.psy.48.4.277] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As the DSM-V process unfolds, Somatoform Disorders are a diagnostic category for which major revisions seem warranted. The Conceptual Issues in Somatoform and Similar Disorders (CISSD) project recently convened three workshops, involving 24 experts. The CISSD identified key questions related to stakeholders; terminology; appropriate axis (I versus III); medically unexplained criteria; status of functional somatic syndromes; and symptom counts, grouping, lifetime recall, and checklists. Preliminary recommendations include substantial revision of the category of Somatization Disorder, elimination of Undifferentiated Somatoform Disorder and Pain Disorder, terminology changes, and potential shifting of certain disorders to different DSM categories or axes.
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Affiliation(s)
- Kurt Kroenke
- Indiana University School of Medicine and Regenstreif Institute, Indianapolis, IN 46202, USA.
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Course and predictors of medically unexplained pain symptoms in the general population. J Psychosom Res 2007; 62:119-28. [PMID: 17270569 DOI: 10.1016/j.jpsychores.2006.08.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 08/07/2006] [Accepted: 08/24/2006] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The objective of this study was to explore the course and the predictors of clinically significant medically unexplained pain symptoms (MUS-pain) within the 6 months preceding the interviews at baseline and on follow-up in the general population. METHODS A Norwegian general population study of 605 persons interviewed with the Composite International Diagnostic Interview Somatoform Section was conducted in 1989/1990 (baseline), and 421 persons (69.6% response rate; 242 women and 179 men) were reinterviewed in 2000/2001 (follow-up). Cases of recent MUS-pain compared with those at baseline were assessed on follow-up. Four blockwise logistic regression analyses were undertaken to find predictors (such as stressful life events, living alone, depression and anxiety, and physical morbidity) for recent MUS-pain in 2001. RESULTS A small "stable" group of recent MUS-pain sufferers (8% of all reinterviewed and 33.6% of those with recent MUS-pain at baseline) was evident. In this group almost all were women. In addition to female gender being a significant (P<.05) marker of recent MUS-pain (which gives a twofold-higher risk compared with men), only depression--not the occurrence of prior recent MUS-pain--remained a significant (P<.05) predictor in the final model, increasing the likelihood of having recent MUS-pain by threefold. CONCLUSION The prognosis of MUS-pain is relatively good, except for a small group (mainly women) that is prone to chronicity. Clinicians should examine for depression when confronted with MUS-pain patients and should be aware of the twofold-higher risk in women for persistent MUS-pain over a long time.
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Noyes R, Stuart S, Watson DB, Langbehn DR. Distinguishing between hypochondriasis and somatization disorder: a review of the existing literature. PSYCHOTHERAPY AND PSYCHOSOMATICS 2006; 75:270-81. [PMID: 16899963 DOI: 10.1159/000093948] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A valid classification is important for further understanding of the somatoform disorders. The main disorders in this grouping - somatization disorder and hypochondriasis - have lengthy historical traditions and are defined in a contrasting manner. Various authors point to distinguishing demographic and clinical features, but there have been few direct comparisons of patients with these disorders. A review of the literature indicates those domains where differences are most likely to be found. Research assessing these may serve to refine and validate these key somatoform categories and/or dimensions.
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Affiliation(s)
- Russell Noyes
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.
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Karvonen JT, Veijola J, Kantojärvi L, Miettunen J, Ekelund J, Lichtermann D, Läksy K, Joukamaa M. Temperament profiles and somatization--an epidemiological study of young adult people. J Psychosom Res 2006; 61:841-6. [PMID: 17141675 DOI: 10.1016/j.jpsychores.2006.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 05/23/2006] [Accepted: 06/27/2006] [Indexed: 01/30/2023]
Abstract
OBJECTIVE We assessed the temperament profiles of young adult somatizers in an epidemiological setting. We hypothesized that somatizers would have a characteristic temperament profile. METHODS The sample consisted of 984 subjects at the age of 31 years. Data on somatization were gathered from a review of all public health outpatient records. Subjects with four or more somatization symptoms according to the DSM-III-R criteria were classified as somatizers. Temperament profiles were assessed using the Temperament and Character Inventory (TCI). RESULTS Six males (1.3%) and 61 females (11.5%) met our criteria for somatization. Harm avoidance and reward dependence of the TCI profiles were associated with somatization symptoms in the whole sample. In logistic regression analysis, sex and psychological distress were associated with somatization but not with temperament profiles. CONCLUSION We did not find a characteristic temperament profile for somatizers. This finding is in contrast to suggestions that somatization is associated with temperament profiles.
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Affiliation(s)
- Juha T Karvonen
- Department of Psychiatry, Out-patient Clinic of Adolescent Psychiatry, Oulu, Finland
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Olatunji BO, Deacon BJ, Abramowitz JS, Tolin DF. Dimensionality of somatic complaints: factor structure and psychometric properties of the Self-Rating Anxiety Scale. J Anxiety Disord 2006; 20:543-61. [PMID: 16198532 DOI: 10.1016/j.janxdis.2005.08.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Revised: 07/27/2005] [Accepted: 08/19/2005] [Indexed: 11/29/2022]
Abstract
Somatic complaints are often key features of anxiety pathology. Although most measures of anxiety symptoms capture somatic complaints to some degree, the Self-Rating Anxiety Scale (SAS) was developed primarily as a measure of somatic symptoms associated with anxiety responding. We evaluated the psychometric properties and factor structure of the SAS in two large undergraduate samples who completed the SAS and measures of anxiety and depression. Exploratory factor analysis revealed four lower-order SAS factors in both samples: (1) anxiety and panic; (2) vestibular sensations; (3) somatic control; and, (4) gastrointestinal/muscular sensations. The SAS demonstrated good reliability in both samples, and the correlations between the SAS factors and other anxiety variables provide supportive evidence for convergent validity, though evidence for discriminant validity was limited. The strengths and limitations of the SAS are offered as well as the implications of our findings for the nature and assessment of somatic complaints in anxiety disorders.
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Affiliation(s)
- Bunmi O Olatunji
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 15 Parkman Street, ACC 812, Boston, MA 02114, USA.
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Interian A, Allen LA, Gara MA, Escobar JI, Díaz-Martínez AM. Somatic Complaints in Primary Care: Further Examining the Validity of the Patient Health Questionnaire (PHQ-15). PSYCHOSOMATICS 2006; 47:392-8. [PMID: 16959927 DOI: 10.1176/appi.psy.47.5.392] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors examined the reliability and validity of the PHQ-15, a measure of current somatic complaints. An index of medically unexplained symptoms was used as a key criterion. Data were utilized from medical outpatients enrolled in a treatment study for moderate-to-severe somatization (N=172). Approximately 68% of the sample was Hispanic. Results showed that the PHQ-15 was moderately related to a history of medically unexplained symptoms among non-Hispanic participants. Results indicated ethnic differences on the validity profile of the PHQ-15 showing that the criterion variables were less predictive of the PHQ-15 among Hispanics than among non-Hispanics. Also, among the Hispanic group, the PHQ-15 was less related to medically unexplained symptoms and more to psychiatric distress. General support was provided for using the PHQ-15 with clinical samples composed of non-Hispanics. Also, the PHQ-15 appears to measure medically unexplained symptoms, psychiatric distress, and physical functioning. Further study is recommended to better evaluate ethnic variations and other types of validity for the PHQ-15.
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Affiliation(s)
- Alejandro Interian
- Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, 671 Hoes Lane D306, Piscataway, NJ 08854-5635, USA.
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Leiknes KA, Finset A, Moum T, Sandanger I. Methodological issues concerning lifetime medically unexplained and medically explained symptoms of the Composite International Diagnostic Interview: a prospective 11-year follow-up study. J Psychosom Res 2006; 61:169-79. [PMID: 16880019 DOI: 10.1016/j.jpsychores.2006.01.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Revised: 12/15/2005] [Accepted: 01/04/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objectives of this study were (a) to elucidate the methodological problems arising when examining lifetime symptom data by exploring the accuracy of recall of medically unexplained symptoms (MUS) and medically explained symptoms (MES) in the general population, based on interviews using the Composite International Diagnostic Interview (CIDI) Somatoform Section C, in 1990 and 2001, and (b) to find predictors for failure at follow-up to recall symptoms reported previously at baseline (i.e., symptoms "lost"). METHODS Four hundred twenty-one persons (response rate, 69.6%; 242 women and 179 men) were reinterviewed in 2001 from a baseline population of 605. Thirty-eight clinically significant MUS and MES were assessed. Linear multiple regression analyses with the numbers of MUS-lost (medically unexplained symptoms lost to recall) and MES-lost (medically explained symptoms lost to recall) as dependent variables were undertaken to find factors affecting symptom loss. RESULTS A wide range of individual symptoms (22-100%) were lost to recall at follow-up, indicating a large degree of measurement error, mainly due to faulty recall. The number of symptoms recalled when they were grouped was better (approximately 50% for "1-3" symptoms). Recall variability and MUS/MES transition over time undermined the credibility of this distinction. Gender and age emerged as significant (P<.01) predictors for MUS-lost, and a decrease in physical morbidity for MES-lost. Men tended to forget more symptoms than women, and younger respondents with high levels of baseline MUS remembered slightly better at follow-up. CONCLUSION Lifetime symptom data elicited in community surveys by such instruments as the CIDI should be viewed with caution. Methodological errors weakening data credibility could lead to false impressions of true change over time. A MUS/MES distinction is difficult to maintain.
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Affiliation(s)
- Kari A Leiknes
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
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Schweickhardt A, Larisch A, Fritzsche K. Differentiation of somatizing patients in primary care: why the effects of treatment are always moderate. J Nerv Ment Dis 2005; 193:813-9. [PMID: 16319704 DOI: 10.1097/01.nmd.0000188975.22144.3d] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The heterogeneity of somatizing patients influences outcomes, especially in unselected samples in primary care. A cluster analysis was performed as secondary analysis on an existing data set of 127 somatizing patients included in a randomized controlled clinical trial. Anxiety and depression (HADS), number and intensity of physical symptoms (SOMS), physical and emotional functioning (short form of the SF-36 Health Survey), health beliefs (KKU-G), and psychological distress (General Health Questionnaire) were used for clustering. Outcome, treatment satisfaction, and diagnosis were calculated and compared for the clusters. We differentiated three groups from this analysis: one with elevated emotional and physical stress, one in which emotional stress dominated, and one with low emotional and physical stress. The three groups did not differ in diagnoses of somatoform disorders. The high-stress groups improved over time, whereas the depression and emotional-functioning scores in the low-stress group deteriorated. All patients were satisfied with the treatment provided. Deterioration in the scores of the low-stress group may be a result of a clinically valuable change process, in that patients who were initially in denial were able to open up and admit their problems. The increased satisfaction with treatment supports this interpretation. This so-called response shift must be taken into account in the planning of studies.
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Affiliation(s)
- Axel Schweickhardt
- Department of Psychosomatics and Psychotherapy, University Hospital of Freiburg, Hauptstrasse 8, 79104 Freiburg, Germany
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Creed F, Barsky A. A systematic review of the epidemiology of somatisation disorder and hypochondriasis. J Psychosom Res 2004; 56:391-408. [PMID: 15094023 DOI: 10.1016/s0022-3999(03)00622-6] [Citation(s) in RCA: 246] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2002] [Accepted: 01/27/2003] [Indexed: 12/13/2022]
Abstract
BACKGROUND This paper reviews current knowledge regarding the prevalence and associated features of somatisation disorder and hypochondriasis in population-based and primary care samples. METHOD A systematic review of the literature, which used a standardised definition of somatisation disorder or hypochondriasis and which examined the characteristics and associated features of these disorders in population-based samples or primary care settings. RESULTS In population-based studies the prevalence of somatisation disorder and hypochondriasis was too low to examine associated features reliably. In studies using abridged criteria, a clear female predominance was not found in either disorder; there was a consistent relationship with few years of education. There was a close relationship with anxiety and depressive disorders, with a linear relationship between numbers of somatic and other symptoms of distress in several studies, including longitudinal studies. No studies showed that these symptom clusters fulfil the criteria of characteristic onset, course and prognosis required to merit the status of discrete psychiatric disorders. CONCLUSIONS On existing evidence, somatisation disorder and hypochondriasis cannot be regarded as definite psychiatric disorders. There is some evidence that numerous somatic symptoms or illness worry may be associated with impairment and high health care utilisation in a way that cannot be solely explained by concurrent anxiety and depression, but further research using population-based samples is required.
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Guz H, Doganay Z, Ozkan A, Colak E, Tomac A, Sarisoy G. Conversion and somatization disorders; dissociative symptoms and other characteristics. J Psychosom Res 2004; 56:287-91. [PMID: 15046964 DOI: 10.1016/s0022-3999(03)00069-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2002] [Accepted: 01/15/2003] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is a difference in classification of conversion disorder in ICD-10 and DSM-IV. Conversion disorder is included in dissociative disorders in ICD-10. In view of this, we aimed to clarify this discrepancy in the classification of this diagnosis. METHODS We assessed 87 patients with conversion disorder and 71 patients with somatization disorder for sociodemographic characteristics, suicide ideation, psychiatric symptoms and dissociative symptoms using the Patient Information Form, the Dissociative Experience Scale (DES), the Symptom Check List (SCL-90-R) and the Suicide Ideation Scale. RESULTS The number of the high school graduates, singles and students with conversion disorders was higher than the number of patients with the same characteristics who have somatization disorder. In conversion disorder, the SCL-90-R total score and the score in paranoid ideation, psychoticism subgroups were higher than the scores in somatization disorders. There were no statistical differences in suicide ideation and the total score of dissociative symptoms between the two disorders. The number of patients whose total DES score of 30 and above was higher in conversion disorders. DISCUSSION As a result of this present study, we concluded that to enlighten the concepts of conversion, further somatization and dissociation studies are necessary.
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Affiliation(s)
- Hatice Guz
- Department of Psychiatry, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey.
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Reuber M, House AO, Pukrop R, Bauer J, Elger CE. Somatization, dissociation and general psychopathology in patients with psychogenic non-epileptic seizures. Epilepsy Res 2003; 57:159-67. [PMID: 15013057 DOI: 10.1016/j.eplepsyres.2003.11.004] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2003] [Revised: 11/10/2003] [Accepted: 11/23/2003] [Indexed: 10/26/2022]
Abstract
The etiology of psychogenic non-epileptic seizures (PNES) remains uncertain. Previous studies have shown that PNES patients are characterized by high levels of somatization, dissociation and general psychopathology but a correlation of measures of these features and PNES severity or outcome has never been demonstrated, although this would strengthen a possible etiological link. This study measured somatization (Screening Test for Somatoform Symptoms-2), dissociation (Dissociative Experience Scale, DES), and general psychopathology (Symptom Checklist-90-Revised, SCL-90) in 98 patients with PNES and 63 patients with epilepsy. All mean scores were raised in the PNES compared to the epilepsy group. However, only measures of somatization and general psychopathology discriminated between patients with PNES and epilepsy in a logistic regression model (even when patient gender was controlled for). In PNES patients, high somatization scores correlated with poor outcome and greater seizure severity even after correction was made for dissociation and psychopathology. Dissociation and psychopathology scores were not independently associated with outcome or severity. The results suggest that, as a group, patients with PNES are best characterized by their tendency to express psychosocial distress by producing unexplained somatic symptoms which are brought to medical attention. Although dissociation may be relevant in some individuals it does not appear to be an independent factor across the whole PNES patient group.
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Affiliation(s)
- Markus Reuber
- Academic Unit of Neurology, Division of Genomic Medicine, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, England S10 2JF, UK.
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Fischler B, Tack J, De Gucht V, Shkedy ZI, Persoons P, Broekaert D, Molenberghs G, Janssens J. Heterogeneity of symptom pattern, psychosocial factors, and pathophysiological mechanisms in severe functional dyspepsia. Gastroenterology 2003; 124:903-10. [PMID: 12671886 DOI: 10.1053/gast.2003.50155] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Categorization of functional dyspepsia into subgroups is based on expert opinion according to (dominant) symptoms or on underlying pathophysiological mechanisms. We used an evidence-based approach to the determination of subtypes of functional dyspepsia. METHODS Consecutive functional dyspepsia patients were recruited from a tertiary referral center. The following were performed: (1) exploratory (EFA) and confirmatory factor analysis (CFA) of symptom patterns in a large group of patients with functional dyspepsia; (2) external validation of these factors by the determination of their association pattern with physio- and psychopathological mechanisms, and with health-related quality of life and sickness behavior; and (3) cluster analysis of their distribution in this population. RESULTS Both EFA and CFA do not support the existence of functional dyspepsia as a homogeneous (unidimensional) condition. A 4-factor model is found to be valid, with differential distribution within the patient population according to cluster analysis. Factor 1 is characterized by nausea, vomiting, early satiety, and weight loss and factor 2 by postprandial fullness and bloating. Both factor 1 and 2 are associated with delayed emptying, but only factor 1 is associated with younger age, female sex, and sickness behavior. Factor 3 is characterized by pain symptoms and associated with gastric hypersensitivity and several psychosocial dimensions including medically unexplained symptoms and health-related quality of life dimensions. Factor 4, characterized by belching, is also associated with hypersensitivity, but is unrelated to psychosocial dimensions. CONCLUSIONS In a tertiary care population, functional dyspepsia is a heterogeneous condition characterized by 4 major dimensions differentially associated with psychopathological and physiopathological mechanisms.
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Affiliation(s)
- Benjamin Fischler
- Department of Psychiatry, University Hospital Gashuisberg, Leuven, Belgium
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Abstract
OBJECTIVE To review the status of consultation-liaison psychiatry and the factors shaping it, and suggest strategies for its future development. METHOD In addition to searches of the main computerized psychiatric databases and review of relevant Commonwealth of Australia publications, the author drew on discussions with national and international colleagues in his role as convenor of the International Organization for Consultation-Liaison Psychiatry. RESULTS Physical/psychiatric comorbidity and somatization, the conditions in which consultation-liaison psychiatry specializes, are the commonest forms of psychiatric presentation in the community. They are as disabling as psychotic disorders, and comorbid depression in particular is a predictor of increased morbidity and mortality. Acknowledging this, the Second Australian National Mental Health Plan called for consultation-liaison psychiatry to be allowed to participate fully in the mental health care system. It stated that failure to define the term 'severe mental health problems and mental disorders' in the First Plan had led to some public mental health systems erroneously equating severity with diagnosis rather than level of need and disability. The call has been largely unheeded. The implication for patient care is both direct and indirect; the context created for psychiatry training by such a restricted focus is helping to perpetuate the neglect of such patients. This is a worldwide problem. CONCLUSIONS Proactive involvement with consumers is required if the problem is to be redressed. At a service level, development of a seamless web of pre-admission/admission/post-discharge functions is required if patients with physical/psychiatric comorbidity and somatoform disorders are to receive effective care, and consultation-liaison psychiatry services are to be able to demonstrate efficacy. Focus on comorbidity in the Australian Third National Mental Health Plan may force resolution of the current problems.
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Affiliation(s)
- Graeme C Smith
- Department of Psychological Medicine, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia.
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De Gucht V, Fischler B. Somatization: a critical review of conceptual and methodological issues. PSYCHOSOMATICS 2002; 43:1-9. [PMID: 11927751 DOI: 10.1176/appi.psy.43.1.1] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite its apparent clinical importance and the extensive research that has been conducted in the past decades, somatization remains a complex concept. Two distinct ways of looking at somatization can be distinguished: somatization as a phenomenon that is secondary to psychological distress (presenting somatization) and somatization as a primary phenomenon characterized by medically unexplained symptoms (functional somatization). The literature was analyzed in terms of this distinction and a selective review was conducted, focusing on a critical analysis of conceptual and methodological issues related to presenting and functional somatization. A number of measurement issues related to somatization in general were also highlighted. On the basis of the available data, the strengths and weaknesses of different concepts are pointed out. Conclusions are formulated regarding which concepts or approaches might be useful both clinically and from a research perspective. Finally, a number of suggestions for future research are offered.
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Affiliation(s)
- Véronique De Gucht
- Faculty of Medicine, Catholic University Leuven, University Hospital of Gasthuisberg, Leuven, Belgium.
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Smith GC, Clarke DM, Handrinos D, Dunsis A, McKenzie DP. Consultation-liaison psychiatrists' management of somatoform disorders. PSYCHOSOMATICS 2000; 41:481-9. [PMID: 11110111 DOI: 10.1176/appi.psy.41.6.481] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The authors studied interventions recommended by consultation-liaison (C-L) psychiatrists when they diagnosed somatoform disorder prospectively in a cohort of 4,401 consecutive inpatients referred to the C-L psychiatry service of a general teaching hospital, using standardized MICRO-CARES methodology. A DSM-III-R somatoform disorder was diagnosed in 2.9%, somatoform pain disorder in 1.4%, conversion disorder in 0.7%, hypochondriasis or somatization disorder undifferentiated/not otherwise specified in 0.6%, and somatization disorder in 0.2%. In 3.4%, somatoform disorder was considered a differential diagnosis. Psychiatric comorbidity included mood disorder (39%), personality disorder (37%), and psychoactive substance use disorder (19%). Recommendations were made about antidepressants in 40% of the patients, anxiolytics in 18%, sedatives in 18%, and antipsychotics in 10%. Psychiatrists recommended the following: more laboratory tests for 14%; additional medical/surgical consultations for 11%; an increase in the vigor of medical treatment for 13%; and psychological treatment for 76%; also they stressed an earlier discharge of 16%. Psychiatrists were more likely to request a prolongation of inpatient stay for patients with comorbid somatoform, mood, anxiety, and personality disorder. Differences in characteristics and treatment of the subgroups tended to be consistent with their constructs and comorbid psychiatric diagnoses.
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Affiliation(s)
- G C Smith
- Monash University Department of Psychological Medicine and Southern Healthcare Network, Clayton, Victoria, Australia.
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