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PubMed2006

Somatoform disorders: perspectives from Pakistan.

Somatoform disorders represent widespread and largely unsolved problems at the border between psychiatry and medicine. Patients with somatoform disorders often present difficult diagnostic and management problems. A series of three community-based epidemiological surveys of rural and urban populations in Pakistan found high prevalence of common mental disorders where the core presentations were somatic complaints. All the three epidemiological surveys used the Bradford Somatic Inventory (BSI), which was developed from symptom reports by psychiatric patients in Pakistan; these enquired about somatic symptoms in the local language, taking into account local cultural idioms of distress. At a conservative estimate, 66% of women and 25% men suffered from anxiety and depressive disorders whereby the complaints predominantly were somatic in nature. People in rural non-Western cultures are not psychologically minded and do not have abstract language or concepts of emotional distress and therefore communicate their emotions somatically. In Pakistan somatoform disorders possess a prominent diagnostic dilemma. The cornerstone of the management is a comprehensive medical, psychiatric and psychosocial evaluation of the patient. Patients with multiple somatic complaints not only present formidable management problems but also often have severe functional impairments that may outweigh those of patients with other so-called severe mental illnesses. Since somatoform disorders are the most common psychiatric disorders to present in non-psychiatric settings, it is important that training about them begin at undergraduate level. It should also be incorporated in the training of a wide variety of non-psychiatric specialists, both medical and non-medical.

Comorbidity↗
PubMed1984

Neuropsychological concepts of somatoform disorders.

Clinical descriptions of somatoform disorders tend to fall largely into the two main categories of conversion disorder and hypochondriasis. These disorders frequently occur in the context of other psychopathology and also tend to have a significant association with CNS disease. Evidence implicating alterations in brainstem reticular arousal and attentional mechanisms in the etiology of these disorders is reviewed. Relevant studies investigating cerebral asymmetry of function have tended to associate right hemisphere information processing style with the sensory, attentional and affective changes that characterize conversion disorders. It is suggested that brain research in the field of somatoform disorders look to the second somatosensory area (SII), which appears to be especially suited to the types of neurophysiological and neuropsychological dynamics that are generally presumed to underlie this class of maladies. Finally, it is argued that a biopsychosocial approach to the understanding of somatoform disorders requires the incorporation of neuropsychological data into a multidimensional conceptual framework.

Arousal↗
PubMed1997

[Somatoform disorders and their therapy].

Somatoform disorders are frequent manifestations of psychosocial stress and present themselves in form of unexplained somatic symptoms. Diagnostics and treatment of somatoform disorders is mainly performed in order to uncover organic pathology. However, organic pathology could not be found, which leads to repeated investigations finally contributing to increase of health costs. Authors highlight pathogenesis of somatoform disorders, summarise the syndromes of this group of disorders and give recommendations as to management and treatment.

Diagnosis, Differential↗
PubMed2000

The McGill Pain Questionnaire in patients with TMJ pain and with facial pain as a somatoform disorder.

The purpose of this study was to assess the discriminative capacity of the McGill Pain Questionnaire (MPQ) in patients with temporomandibular joint disorders (TMD) or with facial pain disorder as somatoform disorder (referred to as "atypical facial pain") (FP). The MPQ was administered to 57 TMD and 34 FP patients. Weighted MPQ item scores, subscale Pain Rating Indexes (PRI), and total Pain Rating Index were tested for significant differences (Student's t-test), and the frequency of descriptor choice was also analyzed. Furthermore, the data were processed through two systems based on a counter-propagation neural network: the Self-Organizing Map (SOM) system and a cluster-like analysis. In the FP group eleven MPQ item scores and five PRI scores were significantly higher than those of the TMJ group. There was a considerable difference in descriptor choice between the groups. SOM analysis and cluster-like analysis correctly discriminated 85% or more of the patients. In conclusion, the MPQ showed a consistent discriminative capacity between TMD and FP patients.

Adult↗
PubMed2002

[Genetics and somatoform disorders].

The nosological status of somatoform disorders has long been unclear. Only with DSM-III in 1980 did the situation become more settled. This means that earlier theoretical speculation and empirical investigations are difficult to evaluate. It has not been possible to confirm empirically many psychoanalytic notions about environmental causes of somatoform disorders; however, Freud's emphasis on a genetic basis seems to be confirmed. Furthermore, genetic research suggests a certain connection between alcoholism and criminality on the one hand and somatization disorders on the other. This does not mean that manifest alcoholism and criminality is prevalent among people with somatoform disorders. Cultural, gender-specific barriers and environmental factors prevent much co-morbidity. It should, however, be noted that little research has been taking place over the last 25-30 years; we could hardly be said to be beginning to understand the interplay between genes and environment in the development of somatoform disorders.

Diseases in Twins↗
PubMed2005

[Somatoform disorders--an update].

Somatoform disorders occur frequently. The patients complain about numerous physical problems and/or pain for which, as a rule, an organic pathological cause cannot be not found. They are not willing to or cannot accept psychosomatic explanations. The real cause is faulty stress processing due to earlier biographical factors, for example, an early attachment disorder. A behavioral therapy could help the patient cope with the everyday routine; it influences the symptoms and signs, but does not fundamentally change them. Psychodynamic approaches are very promising. For comorbidity with anxiety or a depressive disorder as well as certain forms of fibromyalgia, psychopharmaceutical drugs should be additionally given.

Behavior Therapy↗
PubMed2001

Proprioception in somatoform disorders.

20 patients with somatoform disorders as defined by DSM-IV and 20 healthy controls were examined for their proprioception. Several psychophysiological theories of somatoform disorders suggest biased proprioceptive abilities. The primary question is, whether we may find an inaccurate myogen perception in somatization as suggested by the approach of Bischoff or a more precise proprioception as may be derived from concepts of a higher awareness of body reactions. Furthermore it is expected, that somatoform patients perceive their muscle tension more intensely than do healthy subjects. Proprioceptive abilities were tested using a visual EMG biofeedback task. Resulting objective data and subjective ratings were analyzed within a psychophysiological regression approach which allows one to estimate the reliability, precision and intensity of proprioception. Results revealed that somatoform subjects demonstrated a more precise but not a more intense perception of muscle tension than did healthy controls.

Adult↗
PubMed1997

Explained and unexplained medical symptoms in generalized anxiety and panic disorder: relationship to the somatoform disorders.

We have examined the numbers and types of symptoms in a sample of 90 patients with generalized anxiety disorder (GAD) and 77 patients with panic disorder (PD) collected from six different sites during the conduct of a multicenter clinical trial. This information was obtained utilizing the Health Questionnaire, a 47-item self-report list of medical symptoms, patterned after the Somatization Disorder section of the Diagnostic Interview Schedule. Although the patients in this sample had a wide variety of medically explained and unexplained physical symptoms, none of them qualified for a diagnosis of somatization disorder by DSM-III-R criteria. GAD and PD patients reported remarkably similar numbers of explained and unexplained medical symptoms. The panoply of somatic symptoms presented by these patients presents a formidable diagnostic challenge for clinicians. These findings suggest that the pattern of overutilization of medical services that is well documented for PD patients may also be found for GAD patients.

Adult↗
PubMed2004

Recognizing and treating uncommon behavioral and emotional disorders in children and adolescents who have been severely maltreated: somatization and other somatoform disorders.

This article reviews current knowledge about somatoform disorders in children and adolescents. Somatoform disorders are likely to occur more frequently in children and adolescents who have been severely maltreated than in others. The symptoms of somatoform disorders are reviewed, strategies for distinguishing somatoform disorders from other disorders are examined, and treatment strategies are explored.

Adolescent↗
PubMed1992

Lifetime diagnoses in patients with somatoform disorders: which came first?

Thirty inpatients with somatoform disorders were examined with the structured clinical interview SCID for psychiatric lifetime diagnosis. In the present diagnoses, we found a concordance of 63% for somatoform and affective disorders and the lifetime comorbidity of both disorders was 87%. Additionally, patients with somatoform disorders frequently had a history of other psychiatric disorders (for example, anxiety disorders, 40%). For 73% of patients with somatoform disorders and a history of affective disorders, the onset of the somatoform disorder was prior to the onset of another psychiatric disorder. The time interval between the onsets of somatoform disorders and affective disorders was greater than 1 year for most patients; for 46% of the patients with a history of both disorders, the time interval between the two disorders was more than 5 years. The course of illness for somatoform and affective disorders was quite different; while affective disorders tended to episodic periods with interim remissions, the somatoform disorders usually showed long, chronic courses (mean duration of the current somatoform disorder was 11.9 years). Finally, the Symptom Check List SCL-90R demonstrated good discrimination between patients with affective and anxiety disorders. However, the SCL-90R failed to discriminate patients with somatoform disorders from affective- and anxiety-disordered subjects. Therefore, the development of other psychometric scales is necessary for the evaluation of patients with somatoform disorders.

Adult↗
PubMed2006

Somatoform disorders in the workplace in Japan.

The literature related to somatoform disorders in the workplace is very limited, and these disorders need more attention from mental health professionals in the workplace as well as from employers. Over the last decade, major changes have taken place in the work environment in Japan. More stress and less support from supervisors or colleagues in the workplace have made employees stressed out. The number of employees with mental disorders, including somatoform disorders, taking sick leave has significantly increased. In our multi-centre collaborative study, somatoform disorders were the third most prevalent psychiatric disorder in employees, after mood and schizophrenic disorders. Employees with neurotic disorders manifested physical symptoms more frequently than those without. Young employees frequently reported somatic symptoms such as general malaise, nausea, constipation, diarrhoea, headache, stiff shoulder, and dizziness. A rational new approach is needed to tackle this important psychopathology increasingly seen among employees.

Adult↗
PubMedDate not supplied

Screening for DSM-IV somatoform disorders in chronic pain patients.

BACKGROUND: The Screening Instrument for Somatoform Symptoms (SOMS) has been developed for selecting subjects with various somatoform disorders. To date, this instrument has not been used for pain patients. The purpose of this study was, therefore, to apply the SOMS to chronic pain patients, and to compare different SOMS cutoff item scores with regard to their sensitivity, specificity and (positive and negative) predictive value for selecting subjects with DSM-IV somatoform disorders among pain patients. METHODS: In a consecutive sample of 105 chronic pain outpatients, the SOMS was administered in addition to an operationalized psychiatric assessment according to DSM-IV. RESULTS: Patients with a somatoform disorder reported significantly more SOMS symptoms than patients without somatoform disorders (p < 0.02). As shown, a cutoff score of >/=4 somatoform items appeared useful for determining a somatoform disorder. However, only a limited number of cases could be correctly classified by the SOMS (range 53-66%). CONCLUSION: Therefore, the applicability of the SOMS as a screening instrument for somatoform disorders in chronic pain patients awaits further clarification.

Adult↗
PubMed2004

Somatoform disorders after temporal lobectomy.

OBJECTIVE: Depression, anxiety, and psychosis are the most frequent psychiatric disorders after epilepsy surgery. The only new-onset somatoform disorder reported postoperatively is conversion disorder. We identified 10 patients who developed somatoform disorder other than nonconversion epileptic seizures after anterior temporal lobectomy. METHOD: We retrospectively reviewed the charts of 325 anterior temporal lobectomy and 125 extratemporal surgeries between 1991 and 2000. RESULTS: Seven of the patients developed undifferentiated somatoform disorder after anterior temporal lobectomy, 1 had pain and body dysmorphia, another had pain disorder, and another had body dysmorphia alone, but none were found after extratemporal surgeries (chi-square = 3.93; P < or = 0.05). Somatoform disorder was significantly more common in right anterior temporal lobectomy (n = 9) than left anterior temporal lobectomy (n = 1) (chi-square = 6.5; P < or = 0.025). CONCLUSIONS: Our findings suggest that right temporal resection contributes to the development of somatoform disorders in our patients and that right temporal dysfunctions may contribute to idiopathic somatoform disorders.

Adolescent↗
PubMed2006

[Differentiation of somatoform disorders in TCM acupuncture-moxibustion outpatient service].

OBJECTIVE: To strengthen differentiation of somatoform disorders and probe into regular rules of TCM syndrome differentiation treatment. METHODS: Clinical data of 93 cases of somatoform disorders were collected from clinic departments of TCM acupuncture and moxibustion in general hospitals, and were divided into somatoform disorders group (n=41), depression group (n=30) and neurosis group (n=22) according to diagnostic criteria of CCMD-III. Zung's self-evaluating anxiety scale (SAS), and self-evaluating depression scale (SDS) were used for quantitative evaluation and comparison of severities of emotional disorders, and TCM syndrome type differentiation was carried out. RESULTS: Somatoform disorders were most marked by pain, abnormal sensation of the skin mainly on the head, four limbs, etc. in TCM acupuncture and moxibustion clinic department, and the severities of anxiety and depression in the somatoform disorders group are lower than those in other two groups, and stagnation of the liver-qi is main TCM syndrome. CONCLUSION: Strengthening differentiation of somatoform disorders, treatment based on the liver and exerting advantages of TCM in diagnosis and treatment may increase clinical therapeutic effects on somatoform disorders in TCM acupuncture and moxibustion treatment.

Acupuncture Therapy↗
PubMed2006

Somatoform disorders: the role of consultation liaison psychiatry.

The somatoform disorders are encountered commonly in both primary and secondary care. Despite their high incidence, few hospitals have teams with the expertise to manage this group of conditions. The lack of appropriate carers leads to inappropriate care, including increased numbers of admissions and investigations, to the detriment of the patients. The absence of appropriate care also increases the cost to the health services. Multidisciplinary Consultation Liaison (C-L) Psychiatry teams operate within non-psychiatric settings and are dedicated to the mental health care of patients presenting in these areas. Their unique skills and approaches offer support and education to these non-psychiatric teams and care to this group of patients. They are thus ideally placed to assess, diagnose and manage individuals presenting with somatoform disorders. Unfortunately, these teams are not widely available, largely because the current climate within psychiatry leads services to concentrate on what is defined as serious mental illness, a term usually used synonymously with psychotic disorders, despite the large number of people suffering from somatoform disorders and the cost of their care. The dislike that some colleagues have for this group of conditions may further hamper the creation of these services. In order to provide efficient assessment of and treatment for individuals with somatoform disorders, C-L Psychiatry teams must be created to lead clinical development, research and training in this discipline. These teams will also lead on the further research required.

Humans↗
PubMed2004

Recognition and management of somatoform disorders.

Many clinicians have encountered patients with a somatoform disorder without recognizing the clinical presentation. Somatoform disorders can confound a diagnosis, consume inordinate amounts of treatment time, and may cause treatment failure. Recognition and management of somatoform disorders in prosthodontic patients is discussed in this clinical report to assist practitioners in avoiding initiation of prosthodontic treatment for patients with physical symptoms that are caused by a psychologic disorder rather than organic disease.

Aged↗
PubMed2001

Somatoform disorders: severe psychiatric illnesses neglected by psychiatrists.

BACKGROUND: Somatoform disorders have few peers in terms of personal morbidity and cost to the health service, yet many psychiatrists train without any experience of them. AIMS: To review the prevalence, disability and economic burden of somatoform disorders, and to explore the reasons why they are neglected by psychiatrists. METHOD: A selective review of the key literature. RESULTS: Psychiatrists' current preoccupation with so-called 'serious mental illness' gives somatoform disorders low priority. Some health planners have erroneously equated severity with diagnosis rather than level of need and disability. As a consequence the development of psychiatric services has been neglected. CONCLUSIONS: Greater recognition of the importance of somatoform disorders will only occur if high quality research and teaching receive priority, and if the Royal Colleges continue to press for increasing public awareness of their importance. Services should be driven by clinical need rather than diagnosis.

Attitude of Health Personnel↗