1
|
Ongaro G, Ballou S, Kube T, Haas J, Kaptchuk TJ. Doctors Speak: A Qualitative Study of Physicians' Prescribing of Antidepressants in Functional Bowel Disorders. Cult Med Psychiatry 2023; 47:669-683. [PMID: 35764862 DOI: 10.1007/s11013-022-09795-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Abstract
Tricyclic antidepressants (TCAs) are frequently prescribed for chronic functional pain disorders. Although the mechanism of action targets pain perception, treating patients with TCAs for disorders conceptualized as "functional" can promote stigmatization in these patients because it hints at psychological dimensions of the disorder. The goal of this study was to understand how physicians prescribe TCAs in the face of this challenge. We interviewed eleven gastroenterologists in tertiary care clinics specializing in functional gastrointestinal disorders, such as irritable bowel syndrome. We found that the physicians interviewed (1) were aware of the stigma attached to taking antidepressants for a medical condition, (2) emphasized biological, as opposed to psychological, mechanisms of action, (3) while focusing on biological mechanisms, they nevertheless prescribed TCAs in a way that is highly attentive to the psychology of expectations, making specific efforts to adjust patients' expectations to be realistic and to reframe information that would be discouraging and (4) asked patients to persist in taking TCAs despite common and, at times, uncomfortable side effects. In this context of shared decision making, physicians described nuanced understanding and behaviours necessary for treating the complexity of functional disorders and emphasized the importance of a strong patient-provider relationship.
Collapse
Affiliation(s)
- Giulio Ongaro
- Department of Anthropology, London School of Economics and Political Science, London, UK
| | - Sarah Ballou
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA.
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
| | - Tobias Kube
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Mainz, Germany
| | - Julia Haas
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Ted J Kaptchuk
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| |
Collapse
|
2
|
Marcinow M, Sandercock J, D'Silva C, Daien D, Ellis C, Dias C, Mansfield E. Making sense of symptoms, clinicians and systems: a qualitative evaluation of a facilitated support group for patients with medically unexplained symptoms. BMC FAMILY PRACTICE 2021; 22:142. [PMID: 34210272 PMCID: PMC8252243 DOI: 10.1186/s12875-021-01495-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022]
Abstract
Objectives Health services to date have inadequately addressed the physical and mental health needs of patients with medically unexplained symptoms. This qualitative study evaluates a piloted facilitated support group (FSG) developed for patients with medically unexplained symptoms to inform recommendations and resources for this patient population. Methods Using a qualitative descriptive design, we conducted and thematically analyzed semi-structured interviews with participants (n = 8) and facilitators (n = 4) to explore their experiences of the facilitated support group. Common themes that captured strengths and challenges of the facilitated support group were identified. Results The following key themes were identified through analysis of the data: Participants described 1) feeling validated through sharing similar experiences with peers; 2) learning practical symptom management and coping strategies; and 3) gaining new perspectives for navigating conversations with PCPs. Conclusions Our findings show that a facilitated support group may provide additional forms of support and resources for patients with medically unexplained symptoms, filling a gap in currently available clinical care offered by health care professionals. Potential implications: This paper highlights lessons learned that can inform the design and delivery of future supports and resources directed toward optimizing patient care for this underserved patient population. Our findings are relevant to those who are involved in direct patient care or involved in designing and implementing self-management programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01495-9.
Collapse
Affiliation(s)
- Michelle Marcinow
- Institute for Better Health, Trillium Health Partners, Administrative Building - 6th Floor, 100 Queensway West, Mississauga, ON, L5B 1B8, Canada.
| | - Jane Sandercock
- Institute for Better Health, Trillium Health Partners, Administrative Building - 6th Floor, 100 Queensway West, Mississauga, ON, L5B 1B8, Canada
| | - Chelsea D'Silva
- Institute for Better Health, Trillium Health Partners, Administrative Building - 6th Floor, 100 Queensway West, Mississauga, ON, L5B 1B8, Canada
| | - David Daien
- Family Medicine, Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, ON, L5B 1B8, Canada
| | - Carly Ellis
- Strategic Projects, Trillium Health Partners, 100 Queensway West, Mississauga, ON, L5B 1B8, Canada
| | - Christine Dias
- Medical Psychiatry Alliance, Trillium Health Partners, 100 Queensway West, Mississauga, ON, L5B 1B8, Canada
| | - Elizabeth Mansfield
- Institute for Better Health, Trillium Health Partners, Administrative Building - 6th Floor, 100 Queensway West, Mississauga, ON, L5B 1B8, Canada.,Department of Occupational Health, University of Toronto, 6 Queen's Park Crescent West, Toronto, ON, M5S 3H2, Canada
| |
Collapse
|
3
|
Petersen MW, Schröder A, Eliasen MH, Fink P, Dantoft TM, Jørgensen T. Three different approaches to delimitation of functional somatic disorders: DanFunD. J Psychosom Res 2021; 145:110475. [PMID: 33810860 DOI: 10.1016/j.jpsychores.2021.110475] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The Danish Study of Functional Disorders (DanFunD) approaches functional somatic disorders (FSD) with three delimitations: Five functional somatic syndromes (FSS), Bodily Distress Syndrome (BDS), and eight data-driven symptom profiles (SP). This paper presents each delimitation and discusses optimal approaches for further original research into FSD epidemiology. METHODS A total of 9656 adults from the general Danish population participated in this cross-sectional study. Case assignment of the three FSD delimitations was based on self-reported symptom questionnaires. Overlap of FSS, BDS, and SP and their association with poor self-perceived health were calculated as descriptive statistics and shown with Venn diagrams. Difference in self-perceived health between participants with severe FSD were compared with participants with no FSD and calculated as risk ratios with generalized linear models with binomial family and log link. RESULTS We found pronounced overlaps between any FSS, BDS, and the SP with multiple symptoms as well as for multi-organ BDS and the SP with all symptoms. Symptoms and syndromes related to clusters of musculoskeletal and general symptoms contributed particularly to poor health as did multi-organ BDS and categories of SP with multiple symptoms. CONCLUSION Each of the three delimitations has its strengths and weaknesses, and with this study, we offer a contribution to a more valid delimitation of FSD. Future research within DanFunD and other epidemiological studies may benefit from using more than just one delimitation for capturing the diverse nature of the FSD.
Collapse
Affiliation(s)
- Marie Weinreich Petersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus C, Denmark.
| | - Andreas Schröder
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus C, Denmark
| | - Marie Holm Eliasen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus C, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark; Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen C, Denmark; Faculty of Medicine, Aalborg University, Denmark
| |
Collapse
|
4
|
Thogesan M, Berle D, Hilbrink D, Kiely R, Russell-Williams C, Garwood N, Steel Z. The Inter-Rater Consistency of Clinician Ratings of Posttraumatic Stress Disorder (PTSD) Therapy Content. Psychiatr Q 2021; 92:537-548. [PMID: 32820364 DOI: 10.1007/s11126-020-09832-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Effective communication between clinicians is essential for the success of mental health interventions in multidisciplinary contexts. This relies on a shared understanding of concepts, diagnoses and treatments. A major assumption of clinicians when discussing psychological treatments with each other is that both parties have a shared understanding of the theory, rationale and application of the respective technique. We aimed to determine to what extent there is inter-rater agreement between clinicians in describing the content of group therapy sessions. Pairs of clinicians, drawn from a large multidisciplinary team (13), were asked to provide ratings of the therapeutic content and emphasis of N = 154 group therapy sessions conducted during an intensive residential treatment program for post-traumatic stress disorder (PTSD). In most therapeutic content domains there was a moderate level of agreement between clinicians regarding session content (Cohen's Kappa 0.4 to 0.6), suggesting that clinicians have a broad shared understanding of therapeutic content, but that there are also frequent discordant understandings. The implications of these findings on multidisciplinary team communication, patient care and clinical handovers are discussed and directions for further research are outlined.
Collapse
Affiliation(s)
- Manoj Thogesan
- School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - David Berle
- School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia. .,Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, Australia.
| | - Dominic Hilbrink
- St John of God Health Care, Richmond Hospital, North Richmond, NSW, Australia
| | - Rachael Kiely
- St John of God Health Care, Richmond Hospital, North Richmond, NSW, Australia
| | | | - Natasha Garwood
- St John of God Health Care, Richmond Hospital, North Richmond, NSW, Australia
| | - Zachary Steel
- School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.,St John of God Health Care, Richmond Hospital, North Richmond, NSW, Australia.,Black Dog Institute, Randwick, NSW, Australia
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Schmalbach B, Roenneberg C, Hausteiner-Wiehle C, Henningsen P, Brähler E, Zenger M, Häuser W. Validation of the German version of the Bodily Distress Syndrome 25 checklist in a representative German population sample. J Psychosom Res 2020; 132:109991. [PMID: 32160574 DOI: 10.1016/j.jpsychores.2020.109991] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The Bodily Distress Syndrome 25 (BDS 25) checklist is a self-report instrument that can be used for case finding of a BDS in both clinical practice and research. We assessed the reliability and the internal and external validity of the German version of the BDS 25 in a sample of the general German population. METHODS The psychometric properties of the BDS 25 German were examined in a representative cross-sectional German population survey which included 2386 persons aged ≥14 years. Validation instruments included the Somatic Symptom Scale 8, the Giessen Subjective Complaints List 8 and the Patient Health Questionnaire 4. Participants were asked if they had been diagnosed with fibromyalgia or irritable bowel syndrome by a physician in the past. RESULTS The acceptance was high. Only 81 (2.3%) single items were not answered. Internal consistency was sufficiently high for all four subscales and the total score (α > 0.800). Exploratory and confirmatory factor analysis revealed clear evidence for a four-factorial structure with cardiopulmonary, gastrointestinal, musculoskeletal and general symptoms. Moderate to high correlations with other measures of somatic and psychological symptom burden were found. In latent class analysis, the model featuring three classes with no, moderate and severe BDS symptoms evinced the best model fit. Participants with self-reported fibromyalgia and irritable bowel syndrome were mainly found in the moderate and severe BDS group. CONCLUSIONS The BDS 25 German has excellent psychometric properties to screen for BDS in the general population.
Collapse
Affiliation(s)
- Bjarne Schmalbach
- Department Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Casper Roenneberg
- Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany
| | | | - Peter Henningsen
- Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany
| | - Elmar Brähler
- Department Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Markus Zenger
- Faculty of Applied Human Studies, University of Applied Sciences Magdeburg and Stendal, Stendal, Germany; Integrated Research and Treatment Center (IFB), Adiposity Diseases, Behavioral Medicine, Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Leipzig, Germany
| | - Winfried Häuser
- Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany.
| |
Collapse
|
7
|
Berens S, Engel F, Gauss A, Tesarz J, Herzog W, Niesler B, Stroe-Kunold E, Schaefert R. Patients with Multiple Functional Gastrointestinal Disorders (FGIDs) Show Increased Illness Severity: A Cross-Sectional Study in a Tertiary Care FGID Specialty Clinic. Gastroenterol Res Pract 2020; 2020:9086340. [PMID: 32411207 PMCID: PMC7204123 DOI: 10.1155/2020/9086340] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/18/2019] [Accepted: 01/11/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Overlaps between different functional gastrointestinal disorders (FGIDs) are common. However, little is known about the impact of this overlap on patients' health status. This study is aimed at analyzing the differences between patients with multiple as compared to one single FGID. METHODS A retrospective, cross-sectional study was conducted with patients presenting to a tertiary care FGID specialty clinic between 06/2012 and 01/2015 (n = 294). They were characterized primarily according to their GI symptom severity (IBS-SSS) and secondarily to their physical as well as psychosocial symptom burden, quality of life, health care utilization, and work-related impairment. Differences between patients with >1 vs. 1 FGID were analyzed. RESULTS Of the 294 patients, 92.2% fulfilled the Rome III criteria for any FGID, and 48.0% had >1 FGIDs. FGID patients had a median age of 38 [23.0] years; 72.0% were female. Median GI symptom severity (IBS-SSS) scores were 339 [126] and 232 [163] in patients with >1 and 1 FGID, respectively (p < .001). Furthermore, patients with >1 FGIDs had higher general somatic symptom severity, higher illness anxiety, lower quality of life, and more work-related impairment. Almost no differences were found regarding their somatic as well as mental comorbidities. CONCLUSIONS Multiple FGIDs are associated with an increased risk for complicated courses of illness as reflected in higher GI and somatic symptom severity, as well as stronger psychosocial and diet- and work-related impairment. Stepped and interdisciplinary models of care including psychosocial expertise and dietary advice are needed, especially for patients with multiple FGIDs.
Collapse
Affiliation(s)
- Sabrina Berens
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Felicitas Engel
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Annika Gauss
- Department of Gastroenterology, Infectious Diseases and Intoxications, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Beate Niesler
- Institute of Human Genetics, Department of Human Molecular Genetics, University of Heidelberg, Im Neuenheimer Feld 366, D-69120 Heidelberg, Germany
| | - Esther Stroe-Kunold
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Rainer Schaefert
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
- Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Hebelstrasse 2, CH-4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, CH-4056 Basel, Switzerland
| |
Collapse
|
8
|
Dischinger MI, Lange L, Vehling S. Loss of resources and demoralization in the chronically ill. Gen Hosp Psychiatry 2019; 61:10-15. [PMID: 31518884 DOI: 10.1016/j.genhosppsych.2019.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The study examined whether the association between the severity of physical symptoms and demoralization is mediated by loss of resources in individuals with chronic conditions including conventional diagnoses, functional somatic syndromes, and medically unexplained symptoms. METHOD This cross-sectional study evaluated N = 194 patients (mean age = 46, 83.5% female) who reported at least 3 months of persistent physical symptoms using the following self-report instruments: PHQ-15 (modified), Loss of Resources Inventory, Psychosocial Questionnaire - Demoralization Subscale, and PHQ-8. The mediation hypothesis was tested by multiple regression analyses controlling for age, race, employment status, income, educational attainment, and depression. RESULTS Participants experienced M = 9.3 out of 16 possible health-related losses (SD = 4.4). Average to severe demoralization scores were indicated by 59.1% of individuals, of which only 17.1% experienced high demoralization. Loss of resources fully mediated the effect of symptom severity on demoralization, explaining 56% of the variance of demoralization and inhibiting the initially significant effect of symptom severity on demoralization to nonsignificant levels [from b = 0.67, 95% CI (0.26, 1.07) to b = 0.03, 95% CI (-0.27, 0.32)]. CONCLUSION Early recognition of the loss of resources phenomena and interventions to reduce its progression through the introduction of resource gains may diminish, or even prevent, the installation of demoralization in individuals with chronic symptoms.
Collapse
Affiliation(s)
- M I Dischinger
- Department of Psychology, University of North Florida, Jacksonville, FL, United States.
| | - L Lange
- Department of Psychology, University of North Florida, Jacksonville, FL, United States
| | - S Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
9
|
Håkonsen SJ, Pedersen PU, Bygholm A, Thisted CN, Bjerrum M. Lack of focus on nutrition and documentation in nursing homes, home care- and home nursing: the self-perceived views of the primary care workforce. BMC Health Serv Res 2019; 19:642. [PMID: 31492130 PMCID: PMC6729022 DOI: 10.1186/s12913-019-4450-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 08/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background Malnutrition is a comprehensive challenge for the nursing home, home care- and home nursing sector. Nutritional care and the subsequent documentation are a common and multifaceted healthcare practice that requires that the healthcare professionals possess complex combinations of competencies in order to deliver high-quality care and treatment. The purpose of this study was to investigate how a varied group of healthcare professionals’ perceive their own competencies within nutrition and documentation and how organizational structures influence their daily work and the quality of care provided. Methods Two focus groups consisting of 14 healthcare professionals were conducted. The transcribed focus group interviews was analyzed using the qualitative content analysis approach. Results Six categories were identified: 1) Lack of uniform and systematic communication affect nutritional care practices 2) Experience-based knowledge among the primary workforce influences daily clinical decisions, 3) Different attitudes towards nutritional care lead to differences in the quality of care 4) Differences in organizational culture affect quality of care, 5) Lack of clear nutritional care responsibilities affect how daily care is performed and 6) Lack of clinical leadership and priorities makes nutritional care invisible. Conclusions The six categories revealed two explanatory themes: 1) Absent inter- and intra-professional collaboration and communication obstructs optimal clinical decision-making and 2) quality deterioration due to poorly-established nutritional care structure. Overall, the two themes explain that from the healthcare professionals’ point of view, a visible organization that allocates resources as well as prioritizing and articulating the need for daily nutritional care and documentation is a prerequisite for high-quality care and treatment. Furthermore, optimal clinical decision making among the healthcare professionals are compromised by imprecise and unclear language and terminology in the patients’ healthcare records and also a lack of clinical guidelines and standards for collaboration between different healthcare professionals working in nursing homes, home care or home nursing. The findings of this study are beneficial to support organizations within these settings with strategies focusing on increasing nutritional care and documentation competencies among the healthcare professionals. Furthermore, the results advocate for the daily involvement and support of leaders and managers in articulating and structuring the importance of nutritional care and treatment and the subsequent documentation. Electronic supplementary material The online version of this article (10.1186/s12913-019-4450-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- S J Håkonsen
- Centre of Clinical Guidelines - Danish National Clearing house, Department of Health Science and Technology, University of Aalborg, Aalborg, Denmark. .,Danish Centre of Systematic Reviews: A Joanna Briggs Institute Centre of Excellence, Aalborg, Denmark.
| | - P U Pedersen
- Centre of Clinical Guidelines - Danish National Clearing house, Department of Health Science and Technology, University of Aalborg, Aalborg, Denmark.,Danish Centre of Systematic Reviews: A Joanna Briggs Institute Centre of Excellence, Aalborg, Denmark
| | - A Bygholm
- Department of Communication and Psychology, University of Aalborg, Aalborg, Denmark
| | - C N Thisted
- Department of Public Health, Section of Nursing Science, Aarhus University, Aarhus, Denmark
| | - M Bjerrum
- Centre of Clinical Guidelines - Danish National Clearing house, Department of Health Science and Technology, University of Aalborg, Aalborg, Denmark.,Danish Centre of Systematic Reviews: A Joanna Briggs Institute Centre of Excellence, Aalborg, Denmark.,Department of Public Health, Section of Nursing Science, Aarhus University, Aarhus, Denmark
| |
Collapse
|
10
|
Claréus B, Renström EA. Physicians' gender bias in the diagnostic assessment of medically unexplained symptoms and its effect on patient-physician relations. Scand J Psychol 2019; 60:338-347. [PMID: 31124165 PMCID: PMC6851885 DOI: 10.1111/sjop.12545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/02/2019] [Indexed: 12/24/2022]
Abstract
Nonspecific, functional, and somatoform (NFS) syndromes is an umbrella term for various diagnoses with medically unexplained symptoms. These syndromes are more prevalent among women than among men, and associated with negative preconceptions that can impede rehabilitation. In two studies, we quantitatively assess how patients’ gender affects the diagnostic assessment of NFS syndromes, as well as the healthcare experiences of individuals diagnosed with NFS syndromes. In the first study, our vignette‐based experiment showed that Swedish general practitioners (N = 90) were gender biased in their diagnostic assessment of NFS syndromes, such that a female patient with back pain was more likely to be assigned a NFS syndrome compared to an otherwise identical male patient. In the second study, a large community sample of Swedish individuals with medically explained (n = 432) and unexplained pain (n = 521) evaluated their treating physician's relational conduct. Even after accounting for a variety of sociodemographic variables and other pain characteristics, women with at least one NFS syndrome percieved their physician's relational conduct as significantly poorer than other women as well as men with and without NFS syndromes. When women's pain is more likely than men's to be assessed as NFS, their rehabilitation could be prolonged as pertient alternative diagnoses and treatments are omittied and their negative healthcare experiences lower their volition to partake and persevere in treatment.
Collapse
Affiliation(s)
| | - Emma A Renström
- Department of psychology, Gothenburg University, Gothenburg, Sweden
| |
Collapse
|
11
|
Håkonsen SJ, Pedersen PU, Bygholm A, Peters MD, Bjerrum M. Speaking the same language: Development of a Nutrition Minimum Data Set for healthcare professionals in primary healthcare. Health Informatics J 2019; 26:248-263. [PMID: 30681037 DOI: 10.1177/1460458218824707] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Providing the best possible nutritional care requires accurate and precise communication between healthcare professionals. Developing a Nutrition Minimum Data Set will inform professionals in primary healthcare of which core elements should be documented and facilitate a standardized approach to the documentation of nutritional care. A two-step methodological approach was utilized in this study: (1) a systematic scoping review was conducted to map evidence underpinning the development of a Minimum Data Set and (2) the datasources were categorized using the inductive content analysis approach. A total of 32 items were identified in the datasources. Five categories were inductively derived from the data: (1) physiologic measurements, (2) ability to eat, (3) intake, (4) stress factors and (5) factors which indirectly affect intake and needs. Organizing the documentation following the structure presented in this Minimum Data Set will contribute to a standardized terminology, which may lead to increased quality of documentation, increased continuity of care and improved health outcomes.
Collapse
|
12
|
Claréus B, Renström EA. Patients' return-to-work expectancy relates to their beliefs about their physician's opinion regarding return to work volition and ability. J Pain Res 2019; 12:353-362. [PMID: 30697062 PMCID: PMC6339447 DOI: 10.2147/jpr.s179061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose This study investigates the relationship between sick-listed patients’ return to work (RTW) expectancy and how they perceive that their physicians evaluate their ability and volition for RTW. Methods Hierarchical logistic regression controlling for sociodemographic factors and pain characteristics was carried out on cross-sectional data from 205 participants (mean age= 47.24±9.66 years, 83.9% women). They were currently on full-time sick leave with a total duration of 10 years or less and represented various diagnosed and undiagnosed pain conditions. Results A positive expectation for RTW within a year was significantly associated with the belief that the physician favorably evaluated one’s ability (OR= 1.44, 95% CI= 1.13–1.83) and volition (OR= 1.42, 95% CI= 1.11–1.83) to RTW. This held even when other variables significantly associated with RTW expectancy were accounted for. Beyond beliefs, only age made a significant contribution in our final model (OR= 0.94, 95% CI= 0.90–0.98). Conclusion The results indicate that patients’ beliefs regarding their physician’s opinion about their ability and volition for RTW influence their own RTW expectancy. Rehabilitation might be facilitated if health care professionals address and affirm patients’ ability and volition for RTW, regardless of patients’ pain characteristics or if the total duration of their sick leave is <10 years. As other studies have found that RTW expectancy is one of the strongest predictors for actual RTW, future research should test the effect of beliefs about physicians’ opinions on actual RTW rates.
Collapse
Affiliation(s)
| | - Emma A Renström
- Department of Psychology, Gothenburg University, Gothenburg, Sweden
| |
Collapse
|
13
|
Nagakura Y, Ohsaka N, Azuma R, Takahashi S, Takebayashi Y, Kawasaki S, Murai S, Miwa M, Saito H. Monoamine system disruption induces functional somatic syndromes associated symptomatology in mice. Physiol Behav 2018; 194:505-514. [DOI: 10.1016/j.physbeh.2018.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/14/2018] [Accepted: 07/03/2018] [Indexed: 12/19/2022]
|
14
|
Tierney CD, Walker-Harding LR. Early Intervention for Functional Somatic Symptoms Using Psychological Interventions Highlights the Need for a Medical Home Care Model for Pediatric Patients. J Pediatr 2017; 187:15-17. [PMID: 28483063 DOI: 10.1016/j.jpeds.2017.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/12/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Cheryl D Tierney
- Department of Pediatrics Penn State Children's Hospital Hershey, Pennsylvania
| | | |
Collapse
|
15
|
Häufigkeit somatoformer Syndrome in der Allgemeinmedizin. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2017; 63:202-212. [DOI: 10.13109/zptm.2017.63.2.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
16
|
Dantoft TM, Ebstrup JF, Linneberg A, Skovbjerg S, Madsen AL, Mehlsen J, Brinth L, Eplov LF, Carstensen TW, Schroder A, Fink PK, Mortensen EL, Hansen T, Pedersen O, Jørgensen T. Cohort description: The Danish study of Functional Disorders. Clin Epidemiol 2017; 9:127-139. [PMID: 28275316 PMCID: PMC5333638 DOI: 10.2147/clep.s129335] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The Danish study of Functional Disorders (DanFunD) cohort was initiated to outline the epidemiology of functional somatic syndromes (FSS) and is the first larger coordinated epidemiological study focusing exclusively on FSS. FSS are prevalent in all medical settings and can be defined as syndromes that, after appropriate medical assessment, cannot be explained in terms of a conventional medical or surgical disease. FSS are frequent and the clinical importance varies from vague symptoms to extreme disability. No well-described medical explanations exist for FSS, and how to delimit FSS remains a controversial topic. The specific aims with the cohort were to test delimitations of FSS, estimate prevalence and incidence rates, identify risk factors, delimitate the pathogenic pathways, and explore the consequences of FSS. The study population comprises a random sample of 9,656 men and women aged 18–76 years from the general population examined from 2011 to 2015. The survey comprises screening questionnaires for five types of FSS, ie, fibromyalgia, whiplash-associated disorder, multiple chemical sensitivity, irritable bowel syndrome, and chronic fatigue syndrome, and for the unifying diagnostic category of bodily distress syndrome. Additional data included a telephone-based diagnostic interview assessment for FSS, questionnaires on physical and mental health, personality traits, lifestyle, use of health care services and social factors, and a physical examination with measures of cardiorespiratory and morphological fitness, metabolic fitness, neck mobility, heart rate variability, and pain sensitivity. A biobank including serum, plasma, urine, DNA, and microbiome has been established, and central registry data from both responders and nonresponders are similarly available on morbidity, mortality, reimbursement of medicine, heath care use, and social factors. A complete 5-year follow-up is scheduled to take place from year 2017 to 2020, and further reexaminations will be planned. Several projects using the DanFunD data are ongoing, and findings will be published in the coming years.
Collapse
Affiliation(s)
| | | | - Allan Linneberg
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; Department of Clinical Experimental Research, Rigshospitalet, Glostrup
| | - Sine Skovbjerg
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup
| | - Anja Lykke Madsen
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup
| | - Jesper Mehlsen
- Coordinating Research Centre, Bispebjerg and Frederiksberg Hospital, Frederiksberg
| | - Louise Brinth
- Coordinating Research Centre, Bispebjerg and Frederiksberg Hospital, Frederiksberg
| | - Lene Falgaard Eplov
- Mental Health Centre Copenhagen, Research Unit, Mental Health Services, Capital Region of Denmark, Copenhagen
| | - Tina Wisbech Carstensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital; Faculty of Health Sciences, University of Aarhus, Aarhus
| | - Andreas Schroder
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital; Faculty of Health Sciences, University of Aarhus, Aarhus
| | - Per Klausen Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital; Faculty of Health Sciences, University of Aarhus, Aarhus
| | | | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research
| | - Torben Jørgensen
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen; Faculty of Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
17
|
Bullington J, Cronqvist A. Group supervision for healthcare professionals within primary care for patients with psychosomatic health problems: a pilot intervention study. Scand J Caring Sci 2017; 32:108-116. [PMID: 28156013 DOI: 10.1111/scs.12436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/10/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND In primary health care, efficacious treatment strategies are lacking for these patients, although the most prominent symptoms accounting for consultation in primary care often cannot be related to any biological causes. AIM The aim was to explore whether group supervision from a specific phenomenological theory of psychosomatics could provide healthcare professionals treating patients with psychosomatic health issues within primary care a deeper understanding of these conditions and stimulate profession-specific treatment strategies. Our research questions were as follows: (i) What is the healthcare professionals' understanding of psychosomatics before and after the intervention? (ii) What are the treatment strategies for this group of patients before and after the intervention? METHODS The study was an explorative qualitative intervention pilot study. The six participants from a primary healthcare setting in a medium-sized city in Sweden participated in the study. A supervision group was formed, based on a mix of professions, age, gender and years of clinical experience. Supervision consisted of one 75-minutes meeting every month during the course of 6 months. Participants were interviewed before and after the supervision intervention. FINDINGS The study showed two distinct categories emerged from the data. One category of healthcare professionals espoused a psycho-educative approach, while the other lacked a cohesive approach. The supervision improved the second category of healthcare professionals' understanding of psychosomatics. The psycho-educative group did not change their understanding of psychosomatics, although they felt strengthened in their approach by the supervision. Profession-specific strategies were not developed. IMPLICATIONS This pilot study indicates that a relatively short supervision intervention can aid clinicians in their clinical encounters with these patients; however, further research is necessary to ascertain the value of the specific phenomenologically based supervision intervention.
Collapse
Affiliation(s)
- Jennifer Bullington
- Department of Health Care Science, Ersta Sköndal University College, Stockholm, Sweden
| | - Agneta Cronqvist
- Department of Health Care Science, Ersta Sköndal University College, Stockholm, Sweden
| |
Collapse
|
18
|
Janssens KAM, Houtveen JH, Tak LM, Bonvanie IJ, Scholtalbers A, van Gils A, Geenen R, Rosmalen JGM. A concept mapping study on perpetuating factors of functional somatic symptoms from clinicians' perspective. Gen Hosp Psychiatry 2017; 44:51-60. [PMID: 28041577 DOI: 10.1016/j.genhosppsych.2016.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/15/2016] [Accepted: 10/24/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this concept mapping study was to identify the structure and alleged importance of perpetuating factors of functional somatic symptoms (FSS) from the perspective of professionals. Further, we examined to which extent these factors have been addressed in scientific literature. METHODS Ninety-nine perpetuating factors were sorted with respect to content using a card-sorting task by 61 experienced clinicians (62.3% psychologists, 75.4% female, mean age: 45.7 [SD: 10.6] years, mean duration of experience in treating FSS patients: 10.5 [SD: 7.6] years). These factors had been derived from in-depth interviews with 12 clinicians, with extensive experience in treating FSS. Thirty-eight clinicians rated the importance of the 99 factors on a scale ranging from 1 ('not important at all') to 10 ('extremely important'). RESULTS Hierarchical cluster analysis revealed three overarching domains of perpetuating factors: 'Hypochondria', 'Social and relational problems' and 'Symptom-related emotions and habits'. These domains comprised 16 clusters, which were rated on importance between 6.1, 'Adverse physical factors and counterproductive lifestyle', and 7.8, 'Frustration and despair regarding the symptoms'. All clusters have been addressed in scientific literature. CONCLUSIONS This study revealed an encompassing hierarchical structure of somatic, emotional, cognitive, behavioral, and social factors of importance in the perpetuation of FSS based on expert opinions. This structure will guide the development of personalized treatment of FSS.
Collapse
Affiliation(s)
- Karin A M Janssens
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands.
| | - Jan H Houtveen
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - Lineke M Tak
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands; Dimence, Institute for Mental Health Care, Deventer, The Netherlands
| | - Irma J Bonvanie
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - Anna Scholtalbers
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - Anne van Gils
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - Rinie Geenen
- Utrecht University, Department of Clinical and Health Psychology, Utrecht, The Netherlands; Altrecht Psychosomatic Medicine, Zeist, the Netherlands
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| |
Collapse
|
19
|
Rask MT, Carlsen AH, Budtz-Lilly A, Rosendal M. Multiple somatic symptoms in primary care patients: a cross-sectional study of consultation content, clinical management strategy and burden of encounter. BMC FAMILY PRACTICE 2016; 17:100. [PMID: 27475328 PMCID: PMC4967316 DOI: 10.1186/s12875-016-0478-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 07/07/2016] [Indexed: 12/28/2022]
Abstract
Background Consultations involving patients with multiple somatic symptoms may be considered as challenging and time-consuming by general practitioners (GPs). Yet, little is known about the possible links between consultation characteristics and GP-experienced burden of encounter. We aimed to explore consultation content, clinical management strategies, time consumption and GP-experienced burden of encounters with patients suffering from multiple somatic symptoms as defined by the concept of bodily distress syndrome (BDS). Methods Cross-sectional study of patient encounters in primary care from December 2008 to December 2009; 387 GPs participated (response rate: 44.4 %). Data were based on a one-page registration form completed by the GP and a patient questionnaire including the 25-item BDS checklist for somatic symptoms. Using logistic regression analyses, we compared patients who met the BDS criteria with patients who did not. Results A total of 1505 patients were included (response rate: 55.6 %). Health problems were less frequently reported as ‘new’ in patients with BDS (odds ratio (OR) = 0.73, 95 % confidence interval (CI): 0.54; 0.97). Medical prescriptions and referral rates were comparable in the two patient groups. Consultations focusing on mainly biomedical aspects were less frequent among patients with BDS (OR = 0.31, 95 % CI: 0.22; 0.43), whereas additional biomedical and psychosocial problems were more often discussed. GPs were more likely to ensure continuity of care in BDS patients by watchful waiting strategies (OR = 2.32, 95 % CI: 1.53; 3.52) or scheduled follow-up visits (OR = 1.61, 95 % CI: 1.09; 2.37). Patients with BDS were found to be more time-consuming (OR = 1.77, 95 % CI: 1.26; 2.48) and burdensome (OR = 2.54, 95 % CI: 1.81; 3.55) than patients without BDS. However, after adjustments for biomedical and psychosocial content of the consultation, the identified differences for time consumption and burden were no longer statistically significant. Conclusions Patients with BDS represent higher care complexity in terms of biomedical and psychosocial needs. GPs seem to allow space and time for discussing these issues and to aim at ensuring continuity in care through watchful waiting or scheduled follow-up consultations. However, the reported GP-experienced burden call for professional development.
Collapse
Affiliation(s)
- Mette T Rask
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Anders H Carlsen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Anna Budtz-Lilly
- 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
| |
Collapse
|
20
|
Murray AM, Toussaint A, Althaus A, Löwe B. The challenge of diagnosing non-specific, functional, and somatoform disorders: A systematic review of barriers to diagnosis in primary care. J Psychosom Res 2016; 80:1-10. [PMID: 26721541 DOI: 10.1016/j.jpsychores.2015.11.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Despite their prevalence and impact on patients and the health care system, non-specific, functional, and somatoform disorders are underdiagnosed. This problem is especially problematic in primary care if we are moving towards an integrated care model. The objective of the current study was to identify and aggregate potential barriers to the diagnosis in primary care settings. METHODS Our systematic review methodology followed a pre-published protocol and was registered in PROSPERO (CRD42013002540). We combined qualitative and quantitative data from studies identified in online databases and by hand searching of reference lists. Data were synthesized in a data-driven way using a grounded-theory approach. The level of evidence and assessment of bias for the final included studies was independently conducted. RESULTS Data from n=177 full text publications were independently extracted and combined in a custom database. The final list of included studies was n=42. From these, a total of n=379 barriers were identified comprising 77 barrier-level codes, 16 thematic categories and five over-arching themes, i.e., patient-related, primary-care-practitioner related, doctor-patient interactional, situational, and conceptual and operational barriers. CONCLUSION Given the thematic range of the identified barriers, the diagnostic process of non-specific, functional, and somatoform disorders in primary care is highly complex. Individual or practice-level interventions, as well as public awareness initiatives are needed to help address the diagnostic challenges. A multi-factorial understanding of symptoms with a biopsychosocial parallel diagnostic approach should be encouraged. More direct empirical investigations are also needed.
Collapse
Affiliation(s)
- Alexandra M Murray
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf & University Hospital of Psychosomatic Medicine and Psychotherapy, Schön Clinic Hamburg Eilbek, Germany.
| | - Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf & University Hospital of Psychosomatic Medicine and Psychotherapy, Schön Clinic Hamburg Eilbek, Germany
| | - Astrid Althaus
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf & University Hospital of Psychosomatic Medicine and Psychotherapy, Schön Clinic Hamburg Eilbek, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf & University Hospital of Psychosomatic Medicine and Psychotherapy, Schön Clinic Hamburg Eilbek, Germany
| |
Collapse
|
21
|
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.
Collapse
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.
| |
Collapse
|
22
|
Loengaard K, Bjorner JB, Fink PK, Burr H, Rugulies R. Medically unexplained symptoms and the risk of loss of labor market participation--a prospective study in the Danish population. BMC Public Health 2015; 15:844. [PMID: 26329362 PMCID: PMC4556215 DOI: 10.1186/s12889-015-2177-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medically Unexplained Symptoms (MUS) are frequently encountered in general practice. However, little is known whether MUS affects labor market participation. We investigated the prospective association between MUS at baseline and risk of long-term sickness absence (LTSA), unemployment, and disability pensioning in a 5-year-follow-up study. METHODS In the Danish Work Environment Cohort Study 2005, 8187 randomly selected employees from the Danish general population answered a questionnaire on work and health. Responses were linked with national registers on prescribed medication and hospital treatment. Participants were classified with MUS if they: a) had reported three or more symptoms during the last month, and b) did not have a chronic condition, neither in the self-reported nor the register data. We assessed LTSA, unemployment, and disability pensioning by linking our data with National registers of social transfer payments. RESULTS Of the 8187 participants, 272 (3.3%) were categorized with MUS. Compared to healthy participants, participants with MUS had an increased risk of LTSA (Rate ratio (RR) = 1.76, 95% CI = 1.28-2.42), and of unemployment (RR = 1.48, 95% CI = 1.02-2.15) during follow-up. MUS participants also showed an elevated RR with regard to risk of disability pensioning, however this association was not statistically significant (RR = 2.06, 95% CI = 0.77-5.52). CONCLUSION MUS seem to have a negative effect on labor market participation defined by LTSA and unemployment, whereas it is more uncertain whether MUS affects risk of disability pensioning.
Collapse
Affiliation(s)
- Katja Loengaard
- National Research Centre for the Working Environment, Lerso Parkalle 105, DK-2100, Copenhagen, Denmark.
| | - Jakob Bue Bjorner
- National Research Centre for the Working Environment, Lerso Parkalle 105, DK-2100, Copenhagen, Denmark. .,Department of Public Health, University of Copenhagen, Copenhagen, Denmark. .,QualityMetric, Lincoln, RI, USA.
| | - Per Klausen Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
| | - Hermann Burr
- Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany.
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Lerso Parkalle 105, DK-2100, Copenhagen, Denmark. .,Department of Public Health, University of Copenhagen, Copenhagen, Denmark. .,Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
23
|
A new questionnaire to identify bodily distress in primary care: The 'BDS checklist'. J Psychosom Res 2015; 78:536-45. [PMID: 25818346 DOI: 10.1016/j.jpsychores.2015.03.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 01/29/2015] [Accepted: 03/06/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Functional symptoms and disorders are common in primary care. Bodily distress syndrome (BDS) is a newly proposed clinical diagnosis for functional disorders. The BDS diagnosis is based on empirical research, and the symptoms stated in the BDS criteria have been translated into a self-report questionnaire called the BDS checklist. The aim of the present study was to investigate the psychometric properties of the checklist and to test the construct of BDS. METHOD The 30-item BDS checklist was completed by 2480 adult primary care patients in a cross-sectional study on contact and disease patterns in Danish general practice. We performed (internal) validation analyses of the collected checklist data. We also performed factor and latent class analyses to identify both BDS symptom groups and BDS patient groups. RESULTS Internal validation analyses revealed acceptable and usable psychometric properties of the BDS checklist. The factor analyses identified the four distinct determining factors for BDS: cardiopulmonary, gastrointestinal, musculoskeletal and general symptoms. Results from factor and multi-trait analyses suggested a shortening of the BDS checklist (from 30 to 25 items). The latent class analyses resulted in three severity levels (no, moderate and severe BDS); the best fit index was found for a threshold of ≥4 symptoms in a symptom group. CONCLUSION The results provide empirical support for the previously described construct of BDS with four symptom groups and three patient groups. The BDS checklist is a self-report instrument that may be used for case finding in both clinical practice and in research.
Collapse
|
24
|
Lidén E, Björk-Brämberg E, Svensson S. The meaning of learning to live with medically unexplained symptoms as narrated by patients in primary care: a phenomenological-hermeneutic study. Int J Qual Stud Health Well-being 2015; 10:27191. [PMID: 25887965 PMCID: PMC4401824 DOI: 10.3402/qhw.v10.27191] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although research about medically unexplained symptoms (MUS) is extensive, problems still affect a large group of primary care patients. Most research seems to address the topic from a problem-oriented, medical perspective, and there is a lack of research addressing the topic from a perspective viewing the patient as a capable person with potential and resources to manage daily life. The aim of the present study is to describe and interpret the experiences of learning to live with MUS as narrated by patients in primary health-care settings. METHODS A phenomenological-hermeneutic method was used. Narrative interviews were performed with ten patients suffering from MUS aged 24-61 years. Data were analysed in three steps: naive reading, structural analysis, and comprehensive understanding. FINDINGS The findings revealed a learning process that is presented in two themes. The first, feeling that the symptoms overwhelm life, involved becoming restricted and dependent in daily life and losing the sense of self. The second, gaining insights and moving on, was based on subthemes describing the patients' search for explanations, learning to take care of oneself, as well as learning to accept and becoming mindful. The findings were reflected against Antonovsky's theory of sense of coherence and Kelly's personal construct theory. Possibilities and obstacles, on an individual as well as a structural level, for promoting patients' capacity and learning were illuminated. CONCLUSIONS Patients suffering from MUS constantly engage in a reflective process involving reasoning about and interpretation of their symptoms. Their efforts to describe their symptoms to healthcare professionals are part of this reflection and search for meaning. The role of healthcare professionals in the interpretative process should be acknowledged as a conventional and necessary care activity.
Collapse
Affiliation(s)
- Eva Lidén
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
| | | | | |
Collapse
|
25
|
Rask MT, Rosendal M, Fenger-Grøn M, Bro F, Ørnbøl E, Fink P. Sick leave and work disability in primary care patients with recent-onset multiple medically unexplained symptoms and persistent somatoform disorders: a 10-year follow-up of the FIP study. Gen Hosp Psychiatry 2015; 37:53-9. [PMID: 25456975 DOI: 10.1016/j.genhosppsych.2014.10.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective was to explore patient characteristics and 10-year outcome of sick leave and work disability for patients with recent-onset multiple medically unexplained symptoms (MUS) and persistent somatoform disorders (SD). METHOD Consecutive patients consulting their family physician (FP) completed a preconsultation questionnaire on symptoms and mental illness (n=1785). The main problem was categorized by the FP after the consultation, and a stratified subsample was examined using a standardized diagnostic interview (n=701). Patients were grouped into three cohorts: recent onset of multiple MUS (n=84); Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, persistent SD (n=183); and reference group with well-defined physical disease according to FP (n=833). Register data on sick leave and disability pension were obtained. RESULTS At index consultation, disability pension was received by 8.3% (n=7) in the recent-onset multiple MUS group, 19.1% (n=35) in the SD group and 3.5% (n=29) in the reference group. Both the recent-onset multiple MUS group [hazard ratio (HR)=2.28, 95% confidence interval (CI): 1.14-4.55] and the SD group (HR=3.26, 95% CI:1.93-5.51) had increased risk of new disability pension awards. Furthermore, the SD group had increased risk of sick leave. CONCLUSIONS Both recent-onset and persistent MUS have significant long-term impact on patient functioning in regard to working life; this calls for early recognition and adequate management of MUS in primary care.
Collapse
Affiliation(s)
- Mette T Rask
- Research Unit for General Practice, Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Marianne Rosendal
- Research Unit for General Practice, Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Morten Fenger-Grøn
- Research Unit for General Practice, Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Flemming Bro
- Research Unit for General Practice, Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Barthsgade 5, 8200 Aarhus N, Denmark.
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Barthsgade 5, 8200 Aarhus N, Denmark.
| |
Collapse
|
26
|
Rask MT, Andersen RS, Bro F, Fink P, Rosendal M. Towards a clinically useful diagnosis for mild-to-moderate conditions of medically unexplained symptoms in general practice: a mixed methods study. BMC FAMILY PRACTICE 2014; 15:118. [PMID: 24924564 PMCID: PMC4075929 DOI: 10.1186/1471-2296-15-118] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 06/03/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Symptoms that cannot be attributed to any known conventionally defined disease are highly prevalent in general practice. Yet, only severe cases are captured by the current diagnostic classifications of medically unexplained symptoms (MUS). This study explores the clinical usefulness of a proposed new diagnostic category for mild-to-moderate conditions of MUS labelled 'multiple symptoms'. METHODS A mixed methods approach was used. For two weeks, 20 general practitioners (GPs) classified symptoms presented in consecutive consultations according to the International Classification of Primary Care (ICPC) supplemented with the new diagnostic category 'multiple symptoms'. The GPs' experiences were subsequently explored by focus group interviews. Interview data were analysed according to ethnographic principles. RESULTS In 33% of patients, GPs classified symptoms as medically unexplained, but applied the category of 'multiple symptoms' only in 2.8%. The category was described as a useful tool for promoting communication and creating better awareness of patients with MUS; as such, the category was perceived to reduce the risk of unnecessary tests and referrals of these patients. Three main themes were found to affect the clinical usefulness of the diagnostic category of 'multiple symptoms': 1) lack of consensus on categorisation practices, 2) high complexity of patient cases and 3) relational continuity (i.e. continuity in the doctor-patient relationship over time). The first two were seen as barriers to usefulness, the latter as a prerequisite for application. The GPs' diagnostic classifications were found to be informed by the GPs' subjective pre-formed concepts of patients with MUS, which reflected more severe conditions than actually intended by the new category of 'multiple symptoms'. CONCLUSIONS The study demonstrated possible clinical benefits of the category of 'multiple symptoms', such as GPs' increased awareness and informational continuity in partnership practices. The use of the category was challenged by the GPs' conceptual understanding of MUS and was applied only to a minority of patients. The study demonstrates a need for addressing these issues if sub-threshold categories for MUS are to be applied in routine care. The category of 'multiple symptoms' may profitably be used in the future as a risk indicator rather than a diagnostic category.
Collapse
Affiliation(s)
- Mette T Rask
- The Research Unit for General Practice, Section for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Rikke S Andersen
- The Research Unit for General Practice, Section for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Flemming Bro
- The Research Unit for General Practice, Section for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Barthsgade 5, 8200 Aarhus N, Denmark
| | - Marianne Rosendal
- The Research Unit for General Practice, Section for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| |
Collapse
|
27
|
Stallinga HA, ten Napel H, Jansen GJ, Geertzen JHB, de Vries Robbé PF, Roodbol PF. Does language ambiguity in clinical practice justify the introduction of standard terminology? An integrative review. J Clin Nurs 2014; 24:344-52. [PMID: 24813851 DOI: 10.1111/jocn.12624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To research the use of ambiguous language in written information concerning patients' functioning and to identify problems resulting from the use of ambiguous language in clinical practice. BACKGROUND Many projects that aimed to introduce standard terminology concerning patients' functioning in clinical practice are unsuccessful because standard terminology is rarely used in clinical practice. These projects mainly aim to improve communication by reducing ambiguous language. Considering their lack of success, the validity of the argument that language ambiguity is used in clinical practice is questioned. DESIGN An integrative literature review. METHODS A systematic search of the MEDLINE (1950-2012) and CINAHL (1982-2012) databases was undertaken, including empirical and theoretical literature. The selected studies were critically appraised using a data assessment and extraction form. RESULTS Seventeen of 767 papers were included in the review and synthesis. The use of ambiguous language in written information concerning patients' functioning was demonstrated. Problems resulting from the use of ambiguous language in clinical practice were not identified. However, several potential problems were suggested, including hindered clinical decision-making and limited research opportunities. CONCLUSION The results of this review demonstrated the use of ambiguous language concerning patients' functioning, but health professionals in clinical practice did not experience this issue as a problem. This finding might explain why many projects aimed at introducing standard terminology concerning functioning in clinical practice to solve problems caused by ambiguous language are often unsuccessful. Language ambiguity alone is not a valid argument to justify the introduction of standard terminology. RELEVANCE TO CLINICAL PRACTICE The introduction of standard terminology concerning patients' functioning will only be successful when clinical practice requires the aggregation and reuse of data from electronic patient records for different purposes, including multidisciplinary decision-making and research.
Collapse
Affiliation(s)
- Hillegonda A Stallinga
- School of Nursing & Health, Wenckebach Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | | | | | | | | |
Collapse
|
28
|
Nichtspezifische, funktionelle und somatoforme Körperbeschwerden. PSYCHOTHERAPEUT 2014. [DOI: 10.1007/s00278-014-1030-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
29
|
Williamson AE, Mullen K, Wilson P. Understanding "revolving door" patients in general practice: a qualitative study. BMC FAMILY PRACTICE 2014; 15:33. [PMID: 24524363 PMCID: PMC3930014 DOI: 10.1186/1471-2296-15-33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 02/11/2014] [Indexed: 11/23/2022]
Abstract
Background ‘Revolving door’ patients in general practice are repeatedly removed from general practitioners’ (GP) lists. This paper reports a qualitative portion of the first mixed methods study of these marginalised patients. Methods We conducted qualitative semi-structured interviews with six practitioner services staff and six GPs in Scotland, utilizing Charmazian grounded theory to characterise ‘revolving door’ patients and their impact from professionals’ perspectives. Results ‘Revolving door’ patients were reported as having three necessary characteristics; they had unreasonable expectations, exhibited inappropriate behaviours and had unmet health needs. A range of boundary breaches were reported too when ‘revolving door’ patients interacted with NHS staff. Conclusions We utilise the ‘sensitising concepts’ of legitimacy by drawing on literature about ‘good and bad’ patients and ‘dirty work designations.’ We relate these to the core work of general practice and explore the role that medical and moral schemas have in how health service professionals understand and work with ‘revolving door’ patients. We suggest this may have wider relevance for the problem doctor patient relationship literature.
Collapse
Affiliation(s)
- Andrea E Williamson
- General Practice and Primary Care, School of Medicine, College of MVLS, University of Glasgow, Glasgow, Scotland.
| | | | | |
Collapse
|
30
|
Kinn Rød AM, Murison R, Mrdalj J, Milde AM, Jellestad FK, Øvernes LA, Grønli J. Effects of social defeat on sleep and behaviour: importance of the confrontational behaviour. Physiol Behav 2014; 127:54-63. [PMID: 24472325 DOI: 10.1016/j.physbeh.2014.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 10/28/2013] [Accepted: 01/14/2014] [Indexed: 11/17/2022]
Abstract
We studied the short- and long-term effects of a double social defeat (SD) on sleep parameters, EEG power, behaviour in the open field emergence test, corticosterone responsiveness, and acoustic startle responses. Pre-stress levels of corticosterone were assessed before all rats were surgically implanted with telemetric transmitters for sleep recording, and allowed 3weeks of recovery. Rats in the SD group (n=10) were exposed to 1hour SD on two consecutive days, while control rats (n=10) were left undisturbed. Telemetric sleep recordings were performed before SD (day -1), day 1 post SD, and once weekly for 3weeks thereafter. The open field emergence test was performed on day 9 and weekly for 2weeks thereafter. Blood samples for measures of corticosterone responsiveness were drawn after the last emergence test (day 23). Acoustic startle responses were tested on day 24 post SD. Overall, SD rats as a group were not affected by the social conflict. Effects of SD seemed, however, to vary according to the behaviours that the intruder displayed during the social confrontation with the resident. Compared to those SD rats showing quick submission (SDS, n=5), SD rats fighting the resident during one or both SD confrontations before defeat (SDF, n=5) showed more fragmented slow wave sleep, both in SWS1 and SWS2. They also showed longer latency to leave the start box and spent less time in the open field arena compared to SDS rats. In the startle test, SDF rats failed to show response decrement at the lowest sound level. Our results indicate that how animals behave during a social confrontation is more important than exposure to the SD procedure itself, and that rapid submission during a social confrontation might be more adaptive than fighting back.
Collapse
Affiliation(s)
- Anne Marie Kinn Rød
- Department of Biological and Medical Psychology, University of Bergen, Jonas Liesvei 91, 5009 Bergen, Norway.
| | - Robert Murison
- Department of Biological and Medical Psychology, University of Bergen, Jonas Liesvei 91, 5009 Bergen, Norway.
| | - Jelena Mrdalj
- Department of Biological and Medical Psychology, University of Bergen, Jonas Liesvei 91, 5009 Bergen, Norway.
| | - Anne Marita Milde
- Department of Biological and Medical Psychology, University of Bergen, Jonas Liesvei 91, 5009 Bergen, Norway.
| | - Finn Konow Jellestad
- Department of Biological and Medical Psychology, University of Bergen, Jonas Liesvei 91, 5009 Bergen, Norway.
| | - Leif Arvid Øvernes
- Department of Biological and Medical Psychology, University of Bergen, Jonas Liesvei 91, 5009 Bergen, Norway.
| | - Janne Grønli
- Department of Biological and Medical Psychology, University of Bergen, Jonas Liesvei 91, 5009 Bergen, Norway; Norwegian Competence Centre for Sleep Disorders, Haukeland University Hospital, Jonas Liesvei 65, 5009 Bergen, Norway.
| |
Collapse
|
31
|
de Jesus Mari J, Tófoli LF, Noto C, Li LM, Diehl A, Claudino AM, Juruena MF. Pharmacological and psychosocial management of mental, neurological and substance use disorders in low- and middle-income countries: issues and current strategies. Drugs 2013; 73:1549-68. [PMID: 24000001 DOI: 10.1007/s40265-013-0113-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Mental, neurological, and substance use disorders (MNS) are among the largest sources of medical disability in the world, surpassing both cardiovascular disease and cancer. The picture is not different in low- and middle-income countries (LAMIC) where the relative morbidity associated with MNS is increasing, as a consequence of improvement in general health indicators and longevity. However, 80 % of individuals with MNS live in LAMIC but only close to 20 % of cases receive some sort of treatment. The main aim of this article is to provide non-specialist health workers in LAMIC with an accessible guide to the affordable essential psychotropics and psychosocial interventions which are proven to be cost effective for treating the main MNS. The MNS discussed in this article were selected on the basis of burden, following the key priority conditions selected by the Mental Health Action Programme (mhGAP) developed by the World Health Organization (WHO) (anxiety, stress-related and bodily distress disorders; depression and bipolar disorder; schizophrenia; alcohol and drug addiction; and epilepsy), with the addition of eating disorders, because of their emergent trend in middle-income countries. We review best evidence-based clinical practice in these areas, with a focus on drugs from the WHO Model List of Essential Medicines and the psychosocial interventions available in LAMIC for the management of these conditions in primary care. We do this by reviewing guidelines developed by prestigious professional associations and government agencies, clinical trials conducted in LAMIC and systematic reviews (including Cochrane reviews) identified from the main international literature databases (MEDLINE, EMBASE and PsycINFO). In summary, it can be concluded that the availability and use of the psychotropics on the WHO Model List of Essential Medicines in LAMIC, plus an array of psychosocial interventions, can represent a cost-effective way to expand treatment of most MNS. The translation of these findings into policies can be achieved by relatively low supplementary funding, and limited effort engendered by governments and policy makers in LAMIC.
Collapse
Affiliation(s)
- Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Borges Lagoa 570 - 1° andar, Vila Clementino, São Paulo, SP, 04038-000, Brazil,
| | | | | | | | | | | | | |
Collapse
|
32
|
Schaefert R, Kaufmann C, Wild B, Schellberg D, Boelter R, Faber R, Szecsenyi J, Sauer N, Guthrie E, Herzog W. Specific collaborative group intervention for patients with medically unexplained symptoms in general practice: a cluster randomized controlled trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2013; 82:106-19. [PMID: 23295775 DOI: 10.1159/000343652] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 09/20/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients with medically unexplained symptoms (MUS) are frequent in primary care and substantially impaired in their quality of life (QoL). Specific training of general practitioners (GPs) alone did not demonstrate sustained improvement at later follow-up in current reviews. We evaluated a collaborative group intervention. METHODS We conducted a cluster randomized controlled trial. Thirty-five GPs recruited 304 MUS patients (intervention group: 170; control group: 134). All GPs were trained in diagnosis and management of MUS (control condition). Eighteen randomly selected intervention GPs participated in training for a specific collaborative group intervention. They conducted 10 weekly group sessions and 2 booster meetings in their practices, together with a psychosomatic specialist. Six and 12 months after baseline, QoL was assessed with the Short-Form 36. The primary outcome was the physical composite score (PCS), and the secondary outcome was the mental composite score (MCS). RESULTS At 12 months, intention-to-treat analyses showed a significant between-group effect for the MCS (p = 0.023) but not for the PCS (p = 0.674). This effect was preceded by a significant reduction of somatic symptom severity (15-item somatic symptom severity scale of the Patient Health Questionnaire, PHQ-15) at 6 months (p = 0.008) that lacked significance at 12 months (p = 0.078). As additional between-group effects at 12 months, per-protocol analyses showed less health anxiety (Whiteley-7; p = 0.038) and less psychosocial distress (PHQ; p = 0.024); GP visits were significantly (p = 0.042) reduced in the intervention group. CONCLUSIONS Compared to pure GP training, collaborative group intervention achieved a progressive, clinically meaningful improvement in mental but not physical QoL. It could bridge gaps between general practice and mental health care.
Collapse
Affiliation(s)
- R Schaefert
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Developing and implementing electronic search strategies to recruit patients with chronic musculoskeletal pain in primary care databases. Prim Health Care Res Dev 2013; 15:234-43. [PMID: 23702299 DOI: 10.1017/s1463423613000248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Identifying patients with chronic musculoskeletal pain using database searches is difficult, as chronic pain is not represented with a unique diagnostic code in electronic primary care records. Aim This paper describes the development and implementation of a search strategy to identify patients with chronic musculoskeletal pain in primary care databases to invite them to participate in a randomised controlled trial. METHODS We used an exploratory, iterative approach. The first phase involved consultations with IT specialists, practice managers and doctors to gain an understanding about the processes and issues of electronic coding. In the second and third phases, we determined the most appropriate search terms and strategies. In the final phase, we tested, modified and re-tested the search strategy until the quantity and quality of the output appeared good enough to be used in general practices with different IT systems. This strategy was then implemented to recruit participants for a trial. Findings We identified three main search 'domains': prescribing, coding and attendance. We found the most useful identifier for chronic pain was the use of repeat medication. Wide variations in coding terms for chronic pain were seen between practices and individuals. Understanding 'coding cultures' were necessary to inform the electronic searches. In the case of chronic pain, searching on repeat medication for analgesia, low dose antidepressants and carefully selected coding terms captured most relevant patients.
Collapse
|
34
|
Abstract
Somatic symptoms are often common causes for medical consultation. The treatment of somatic symptoms disorders is complicated by lack of boundary, conceptual clarity, and overemphasis on psychosocial causation and effectiveness of psychological treatments. In clinical practice all classes of psychotropics are used to treat somatic symptoms disorder. Five principal groups of drugs such as tricyclic antidepressants (TCA), serotonin reuptake inhibitors (SSRI), serotonin and noradrenalin reuptake inhibitors (SNRI), atypical antipsychotics and herbal medication are systematically studied. The evidence indicates that all five groups are effective in a wide range of disorders. All classes of antidepressants seem to be effective against somatoform and related disorders. SSRIs are more effective against hypochondriasis and body dysmorphic disorder (BDD), and SNRIs appear to be more effective than other antidepressants when pain is the predominant symptom. Research leaves many unanswered questions regarding dosing, duration of treatment, sustainability of improvement in the long term and differential response to different class drugs. Further studies need to focus on treatments based on clinical features/psychopathology and collaborative research with other specialists in understanding the relation of somatic symptom disorders and functional somatic syndromes (FSS), and comparing psychotropics and non-psychotropics and combinations treatments.
Collapse
|
35
|
Konnopka A, Schaefert R, Heinrich S, Kaufmann C, Luppa M, Herzog W, König HH. Economics of medically unexplained symptoms: a systematic review of the literature. PSYCHOTHERAPY AND PSYCHOSOMATICS 2013; 81:265-75. [PMID: 22832397 DOI: 10.1159/000337349] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 02/18/2012] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To review cost-of-illness studies (COI) and economic evaluations (EE) conducted for medically unexplained symptoms and to analyze their methods and results. METHODS We searched the databases PubMed, PsycINFO and National Health Service Economic Evaluations Database of the University of York. Cost data were inflated to 2006 using country-specific gross domestic product inflators and converted to 2006 USD purchasing power parities. RESULTS We identified 5 COI and 8 EE, of which 6 were cost-minimization analyses and 2 were cost-effectiveness analyses. All studies used patient level data collected between 1980 and 2004 and were predominantly conducted in the USA (n = 10). COI found annual excess health care costs of somatizing patients between 432 and 5,353 USD in 2006 values. Indirect costs were estimated by only one EE and added up to about 18,000 USD per year. In EE, educational interventions for physicians as well as cognitive-behavioral therapy approaches for patients were evaluated. For both types of interventions, effectiveness was either shown within EE or by previous studies. Most EE found (often insignificant) cost reductions resulting from the interventions, but only two studies explicitly combined changes in costs with data on effectiveness to cost-effectiveness ratios (ratio of additional costs to additional effects). CONCLUSIONS Medically unexplained symptoms cause relevant annual excess costs in health care that are comparable to mental health problems like depression or anxiety disorders and which may be reduced by interventions targeting physicians as well as patients. More extensive research on indirect costs and cost-effectiveness is needed.
Collapse
Affiliation(s)
- Alexander Konnopka
- Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. a.konnopka @ uke.de
| | | | | | | | | | | | | |
Collapse
|
36
|
Fjorback LO, Arendt M, Ornbøl E, Walach H, Rehfeld E, Schröder A, Fink P. Mindfulness therapy for somatization disorder and functional somatic syndromes: randomized trial with one-year follow-up. J Psychosom Res 2013; 74:31-40. [PMID: 23272986 DOI: 10.1016/j.jpsychores.2012.09.006] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/17/2012] [Accepted: 09/14/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To conduct a feasibility and efficacy trial of mindfulness therapy in somatization disorder and functional somatic syndromes such as fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome, defined as bodily distress syndrome (BDS). METHODS We randomized 119 patients to either mindfulness therapy (mindfulness-based stress reduction and some cognitive behavioral therapy elements for BDS) or to enhanced treatment as usual (2-hour specialist medical care and brief cognitive behavioral therapy for BDS). The primary outcome measure was change in physical health (SF-36 Physical Component Summary) from baseline to 15-month follow-up. RESULTS The study is negative as we could not demonstrate a different development over time for the two groups (F(3,2674)=1.51, P=.21). However, in the mindfulness therapy group, improvement was obtained toward the end of treatment and it remained present at the 15-month follow-up, whereas the enhanced treatment as usual group achieved no significant change until 15-month follow-up. The change scores averaged half a standard deviation which amounts to a clinically significant change, 29% changed more than 1 standard deviation. Significant between-group differences were observed at treatment cessation. CONCLUSION Mindfulness therapy is a feasible and acceptable treatment. The study showed that mindfulness therapy was comparable to enhanced treatment as usual in improving quality of life and symptoms. Nevertheless, considering the more rapid improvement following mindfulness, mindfulness therapy may be a potentially useful intervention in BDS patients. Clinically important changes that seem to be comparable to a CBT treatment approach were obtained. Further research is needed to replicate or even expand these findings.
Collapse
Affiliation(s)
- Lone Overby Fjorback
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark.
| | | | | | | | | | | | | |
Collapse
|
37
|
Wahlström L, Michélsen H, Schulman A, Backheden M, Keskinen-Rosenqvist R, Backheden H. Longitudinal course of physical and psychological symptoms after a natural disaster. Eur J Psychotraumatol 2013; 4:21892. [PMID: 24379941 PMCID: PMC3875347 DOI: 10.3402/ejpt.v4i0.21892] [Citation(s) in RCA: 11] [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: 07/03/2013] [Revised: 11/22/2013] [Accepted: 11/30/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND After disaster, physical symptoms are common although seldom recognized due to lack of knowledge of the course of symptoms and relation to more studied psychological symptoms. OBJECTIVE This study aimed to investigate the change in the reporting of different physical symptoms after a disaster, including possible factors for change, and whether psychological symptoms predict physical symptoms reporting at a later point in time. METHOD A longitudinal study of citizens of Stockholm who survived the 2004 Indian Ocean tsunami. A total of 1,101 participants completed questionnaires on somatic symptoms, general distress, posttraumatic stress, exposure, and demographic details 14 months and 3 years after the disaster. Physical symptoms occurring daily or weekly during the last year were investigated in four symptom indices: neurological, cardiorespiratory, gastrointestinal, and musculoskeletal. We used generalized estimating equations (GEE) analysis to determine odds ratios for a change in symptoms, and pathway analysis to predict the influence of psychological symptoms on physical symptoms. RESULTS There was a general decrease of reporting in all physical symptom indices except the musculoskeletal symptom index. The change in the neurological symptom index showed the strongest association with exposure, and for women. General distress and posttraumatic stress at 14 months postdisaster predicted physical symptoms at 3 years. CONCLUSION Physical symptoms were predicted by psychological symptoms at an earlier time point, but in a considerable proportion of respondents, physical symptoms existed independently from psychological symptoms. Physicians should be observant on the possible connection of particular pseudoneurological symptoms with prior adversities.
Collapse
Affiliation(s)
- Lars Wahlström
- Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hans Michélsen
- Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Abbe Schulman
- Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Backheden
- Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | |
Collapse
|
38
|
Mindfulness therapy for somatization disorder and functional somatic syndromes: analysis of economic consequences alongside a randomized trial. J Psychosom Res 2013; 74:41-8. [PMID: 23272987 DOI: 10.1016/j.jpsychores.2012.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/27/2012] [Accepted: 09/14/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of the present study is to estimate the economic consequences of somatization disorder and functional somatic syndromes such as fibromyalgia and chronic fatigue syndrome, defined as bodily distress syndrome (BDS), when mindfulness therapy is compared with enhanced treatment as usual. METHODS A total of 119 BDS patients were randomized to mindfulness therapy or enhanced treatment as usual and compared with 5950 matched controls. Register data were analyzed from 10years before their inclusion to 15-month follow-up. The main outcome measures were disability pension at the 15-month follow-up and a reduction in total health care costs. Unemployment and sickness benefit prior to inclusion were tested as possible risk factors. RESULTS At 15-month follow-up, 25% from the mindfulness therapy group received disability pension compared with 45% from the specialized treatment group (p=.025). The total health care utilization was reduced over time in both groups from the year before inclusion (mean $5325, median $2971) to the year after inclusion (mean $3644, median $1593) (p=.0001). This overall decline was seen in spite of elevated costs due to assessment and mindfulness therapy or enhanced treatment as usual. The BDS patients accumulated significantly more weeks of unemployment and sickness benefit 5 and 10years before inclusion (p<.0001) than the population controls. CONCLUSIONS Mindfulness therapy may prevent disability pension and it may have a potential to significantly reduce societal costs and increase the effectiveness of care. Accumulated weeks of unemployment and sickness benefit are possible risk factors for BDS.
Collapse
|
39
|
'Divided we fail': understanding inter-relations and the role of the generalist. Br J Gen Pract 2012; 62:596-8. [PMID: 23211167 DOI: 10.3399/bjgp12x658377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
40
|
Schaefert R, Hausteiner-Wiehle C, Häuser W, Ronel J, Herrmann M, Henningsen P. Non-specific, functional, and somatoform bodily complaints. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:803-13. [PMID: 23248710 PMCID: PMC3521192 DOI: 10.3238/arztebl.2012.0803] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 09/19/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND 4-10% of the general population and 20% of primary care patients have what are called "non-specific, functional, and somatoform bodily complaints." These often take a chronic course, markedly impair the sufferers' quality of life, and give rise to high costs. They can be made worse by inappropriate behavior on the physician's part. METHODS The new S3 guideline was formulated by representatives of 29 medical and psychological specialty societies and one patient representative. They analyzed more than 4000 publications retrieved by a systematic literature search and held two online Delphi rounds and three consensus conferences. RESULTS Because of the breadth of the topic, the available evidence varied in quality depending on the particular subject addressed and was often only of moderate quality. A strong consensus was reached on most subjects. In the new guideline, it is recommended that physicians should establish a therapeutic alliance with the patient, adopt a symptom/coping-oriented attitude, and avoid stigmatizing comments. A biopsychosocial diagnostic evaluation, combined with sensitive discussion of signs of psychosocial stress, enables the early recognition of problems of this type, as well as of comorbid conditions, while lowering the risk of iatrogenic somatization. For mild, uncomplicated courses, the establishment of a biopsychosocial explanatory model and physical/social activation are recommended. More severe, complicated courses call for collaborative, coordinated management, including regular appointments (as opposed to ad-hoc appointments whenever the patient feels worse), graded activation, and psychotherapy; the latter may involve cognitive behavioral therapy or a psychodynamic-interpersonal or hypnotherapeutic/imaginative approach. The comprehensive treatment plan may be multimodal, potentially including body-oriented/non-verbal therapies, relaxation training, and time-limited pharmacotherapy. CONCLUSION A thorough, simultaneous biopsychosocial diagnostic assessment enables the early recognition of non-specific, functional, and somatoform bodily complaints. The appropriate treatment depends on the severity of the condition. Effective treatment requires the patient's active cooperation and the collaboration of all treating health professionals under the overall management of the patient's primary-care physician.
Collapse
Affiliation(s)
- Rainer Schaefert
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Thibautstrasse 2, Heidelberg, Germany.
| | | | | | | | | | | |
Collapse
|
41
|
Hansen HS, Rosendal M, Fink P, Risør MB. The General Practitioner's Consultation Approaches to Medically Unexplained Symptoms: A Qualitative Study. ISRN FAMILY MEDICINE 2012; 2013:541604. [PMID: 24967320 PMCID: PMC4041244 DOI: 10.5402/2013/541604] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 09/02/2012] [Indexed: 11/23/2022]
Abstract
Background. The prevalence of medically unexplained symptoms (MUSs) in primary care is about 10-15%. The definition of MUS is descriptive and there are no specific diagnostic criteria for MUS in primary care. Furthermore, a general practitioner's (GP's) categorisation of patients with MUS shows large variation. The aim of the present study is to investigate how GPs employ the definition of MUS and how they manage patients with MUS in daily practice. Methods. With a grounded theory approach five focus group interviews with GPs were performed. The interviews addressed how GPs managed MUS and their reflections on the course and prognosis for MUS patients. Results. Consultations about MUS develop around the individual patient and usually include several appointments. We identified three different types of consultations: (1) "searching for a disease," (2) "going by the routine," and (3) "following various paths." These types of consultations spanned from a biomedical approach to an approach where multiple explanations were offered to explain the patient's problem. The choice of consultation types was influenced by the GP, the patient and contextual factors which, in turn, affected the diagnostic process. Conclusions. A diagnosis of MUS is contextually embedded and the diagnostic process is shaped by the consultation.
Collapse
Affiliation(s)
- Henriette Schou Hansen
- Research Unit for General Practice, Aarhus University, Vennelyst Boulevard 6, 8000 Aarhus C, Denmark
- Research Clinic for Functional Disorders, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Marianne Rosendal
- Research Unit for General Practice, Aarhus University, Vennelyst Boulevard 6, 8000 Aarhus C, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Mette Bech Risør
- Research Unit for General Practice, Department of Community Medicine, University of Tromsø, 9037 Tromsø, Norway
| |
Collapse
|
42
|
Definition and structure of body-relatedness from the perspective of patients with severe somatoform disorder and their therapists. PLoS One 2012; 7:e42534. [PMID: 22905144 PMCID: PMC3419208 DOI: 10.1371/journal.pone.0042534] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 07/09/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND How a patient is connected with one's body is core to rehabilitation of somatoform disorder but a common model to describe body-relatedness is missing. The aim of our study was to investigate the components and hierarchical structure of body-relatedness as perceived by patients with severe somatoform disorder and their therapists. METHODS Interviews with patients and therapists yielded statements about components of body-relatedness. Patients and therapists individually sorted these statements according to similarity. Hierarchical cluster analysis was applied to these sortings. Analysis of variance was used to compare the perceived importance of the statements between patients and therapists. RESULTS The hierarchical structure included 71 characteristics of body-relatedness. It consisted of three levels with eight clusters at the lowest level: 1) understanding, 2) acceptance, 3) adjustment, 4) respect for the body, 5) regulation, 6) confidence, 7) self-esteem, and 8) autonomy. The cluster 'understanding' was considered most important by patients and therapists. Patients valued 'regulating the body' more than therapists. CONCLUSION According to patients with somatoform disorders and their therapists, body-relatedness includes awareness of the body and self by understanding, accepting and adjusting to bodily signals, by respecting and regulating the body, by confiding and esteeming oneself and by being autonomous. This definition and structure of body-relatedness may help professionals to improve interdisciplinary communication, assessment, and treatment, and it may help patients to better understand their symptoms and treatment. (German language abstract, Abstract S1; Spanish language abstract, Abstract S2).
Collapse
|
43
|
Zonneveld LNL, van Rood YR, Timman R, Kooiman CG, Van't Spijker A, Busschbach JJV. Effective group training for patients with unexplained physical symptoms: a randomized controlled trial with a non-randomized one-year follow-up. PLoS One 2012; 7:e42629. [PMID: 22880056 PMCID: PMC3413637 DOI: 10.1371/journal.pone.0042629] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 07/09/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although cognitive-behavioral therapy for Unexplained Physical Symptoms (UPS) is effective in secondary care, studies done in primary care produced implementation problems and conflicting results. We evaluated the effectiveness of a cognitive-behavioral group training tailored to primary care patients and provided by a secondary community mental-health service reaching out into primary care. METHODOLOGY/PRINCIPAL FINDINGS The effectiveness of this training was explored in a randomized controlled trial. In this trial, 162 patients with UPS classified as undifferentiated somatoform disorder or as chronic pain disorder were randomized either to the training or a waiting list. Both lasted 13 weeks. The preservation of the training's effect was analyzed in non-randomized follow-ups, for which the waiting group started the training after the waiting period. All patients attended the training were followed-up after three months and again after one year. The primary outcomes were the physical and the mental summary scales of the SF-36. Secondary outcomes were the other SF-36-scales and the SCL-90-R. The courses of the training's effects in the randomized controlled trial and the follow-ups were analyzed with linear mixed modeling. In the randomized controlled trial, the training had a significantly positive effect on the quality of life in the physical domain (Cohen's d = 0.38;p = .002), but this overall effect was not found in the mental domain. Regarding the secondary outcomes, the training resulted in reporting an improved physical (Cohen's d = 0.43;p = 0.01), emotional (Cohen's d = 0.44;p = 0.01), and social (Cohen's d = 0.36;p = 0.01) functioning, less pain and better functioning despite pain (Cohen's d = 0.51;p = <0.001), less physical symptoms (Cohen's d = -.23;p = 0.05) and less sleep difficulties (Cohen's d = -0.25;p = 0.04) than time in the waiting group. During the non-randomized follow-ups, there were no relapses. CONCLUSIONS/SIGNIFICANCE The cognitive-behavioral group training tailored for UPS in primary care and provided by an outreaching secondary mental-health service appears to be effective and to broaden the accessibility of treatment for UPS. TRIAL REGISTRATION TrialRegister.nl NTR1609
Collapse
Affiliation(s)
- Lyonne N L Zonneveld
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
44
|
Soler JK, Okkes I. Reasons for encounter and symptom diagnoses: a superior description of patients' problems in contrast to medically unexplained symptoms (MUS). Fam Pract 2012; 29:272-82. [PMID: 22308181 DOI: 10.1093/fampra/cmr101] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This is a review of the literature on the role of symptoms in family practice, with a focus on the diagnostic approach in family medicine (FM). We found two, contrasting, approaches to reducing symptoms presented by patients in primary care, especially those which do not immediately allow the definition of a disease-label diagnosis. Years of research into 'medically unexplained symptoms' (MUS) has failed to support an international body of knowledge and cannot convincingly support the philosophy on which the reduction itself is based. This review supports the approach of researching reasons for encounter as they present to the family doctor, without artificial mind-body metaphors. The medical model is shown to be an incomplete reduction of FM, and the concept of MUS fails to improve this situation. A new model based on a substantial paradigm shift is needed. That model should be the biopsychosocial model, reflected in the philosophical concepts of the International Classification of Primary Care and the value of the patient's 'reason for encounter'. There is more to life than medicine may diagnose, and FM should strive to move closer to the lives of our patients than the medical model alone could allow.
Collapse
Affiliation(s)
- Jean Karl Soler
- Faculty of Life and Health Sciences, University of Ulster, Coleraine, Northern Ireland.
| | | |
Collapse
|
45
|
Abstract
OBJECTIVE: To investigate the historical evolution of hysteria and its possible psychopathological ramifications in today’s diagnostic classifications. Method: Clinical and historical problematization contrasting classical and contemporary references on the subject. Conclusion: Higher incidence of certain conditions and decline in the use of the construct of hysteria should be seen as different moments in a continuum.
Collapse
|
46
|
Arigo D, Suls JM, Smyth JM. Social comparisons and chronic illness: research synthesis and clinical implications. Health Psychol Rev 2012; 8:154-214. [PMID: 25053133 DOI: 10.1080/17437199.2011.634572] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The chronically ill patient must adjust to new life circumstances and manage ongoing threats to personal health. Patients often make comparisons with each other, which can have effects on their psychological and physical well-being. One question is whether health psychologists can develop interventions to strategically facilitate the use of such comparisons to optimise adjustment. This paper critically reviews evidence on patients' comparisons in studies using selection, narration and reaction methods. Discussion focuses on gaps in the empirical literature and describes some new basic concepts in social comparison, which may advance knowledge about the process in medical patients. Recommendations also are provided about the kinds of studies needed to inform the future design of effective social comparison interventions.
Collapse
Affiliation(s)
- Danielle Arigo
- a Department of Psychology , Syracuse University , 430 Huntington Hall, Syracuse , NY 13244 , USA
| | | | | |
Collapse
|
47
|
Schröder A, Oernboel E, Licht RW, Sharpe M, Fink P. Outcome measurement in functional somatic syndromes: SF-36 summary scores and some scales were not valid. J Clin Epidemiol 2012; 65:30-41. [DOI: 10.1016/j.jclinepi.2011.03.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 03/14/2011] [Accepted: 03/22/2011] [Indexed: 01/01/2023]
|
48
|
The risk assessment score in acute whiplash injury predicts outcome and reflects biopsychosocial factors. Spine (Phila Pa 1976) 2011; 36:S263-7. [PMID: 22020622 DOI: 10.1097/brs.0b013e31823881d6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN One-year prospective study of 141 acute whiplash patients (WLP) and 40 acute ankle-injured controls. OBJECTIVE This study investigates a priori determined potential risk factors to develop a risk assessment tool, for which the expediency was examined. SUMMARY OF BACKGROUND DATA The whiplash-associated disorders (WAD) grading system that emerged from The Quebec Task-Force-on-Whiplash has been of limited value for predicting work-related recovery and for explaining biopsychosocial disability after whiplash and new predictive factors, for example, risk criteria that comprehensively differentiate acute WLP in a biopsychosocial manner are needed. METHODS Consecutively, 141 acute WLP and 40 ankle-injured recruited from emergency units were examined after 1 week, 1, 3, 6, and 12 months obtaining neck/head visual analog scale score, number of nonpainful complaints, epidemiological, social, psychological data and neurological examination, active neck mobility, and furthermore muscle tenderness and pain response, and strength and duration of neck muscles. Risk factors derived (reduced cervical range of motion, intense neck pain/headache, multiple nonpain complaints) were applied in a risk assessment score and divided into seven risk strata. RESULTS A receiver operating characteristics curve for the Risk Assessment Score and 1-year work disability showed an area of 0.90. Risk strata and number of sick days showed a log-linear relationship. In stratum 1 full recovery was encountered, but for high-risk patients in stratum 6 only 50% and 7 only 20% had returned to work after 1 year (P < 5.4 × 10). Strength measures, psychophysical pain measurements, and psychological and social data (reported elsewhere) showed significant relation to risk strata. CONCLUSION The Risk Assessment score is suggested as a valuable tool for grading WLP early after injury. It has reasonable screening power for encountering work disability and reflects the biopsychosocial nature of whiplash injuries.
Collapse
|
49
|
Reattribution reconsidered: narrative review and reflections on an educational intervention for medically unexplained symptoms in primary care settings. J Psychosom Res 2011; 71:325-34. [PMID: 21999976 DOI: 10.1016/j.jpsychores.2011.05.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 04/19/2011] [Accepted: 05/05/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Medically unexplained symptoms (MUS) refer to bodily symptoms without a physical health explanation. In the context of MUS, reattribution is a process of attributing physical symptoms to a psychological cause. We review the use of a consultation model which employs reattribution, and which has been extensively utilised in teaching and research in primary care. METHODS Literature search for studies utilising the reattribution model. Narrative review of the results. RESULTS Data was extracted from 25 publications from 13 studies. The model has been modified over time and comparison between studies is limited by differences in methodology. The skills of the model can be acquired by training, which also improves practitioners' attitudes to MUS. However impact on clinical outcomes has been mixed and this can be explained in part from the findings of nested qualitative studies. CONCLUSIONS The reattribution model is too simplistic in its current form to address the needs of many people presenting with MUS in primary care. Reattribution of physical symptoms to psychological causes is often unnecessary. Further research is required into the effectiveness of stepped and collaborative care models in which education of primary care practitioners forms one part of a complex intervention. The consultation process is best seen as both a conversation and ongoing negotiation between doctor and patient in which there are no certainties about the presence or absence of organic pathology.
Collapse
|
50
|
Functional somatic syndromes and somatoform disorders in special psychosomatic units: organizational aspects and evidence-based treatment. Psychiatr Clin North Am 2011; 34:673-87. [PMID: 21889686 DOI: 10.1016/j.psc.2011.05.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|