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PubMed2006

Towards better understanding and management of somatoform disorders.

Much research has recently been conducted on somatoform disorders demonstrating their clinical importance, associated health-service burden and economic cost. These conditions are often comorbid with other mental and physical disorders and particularly prevalent in primary care and general medical settings. Although culture-specific manifestations and variations of somatization occur--it is now accepted that medically unexplained somatic symptoms are a universal phenomenon. The management of somatoform disorders is generally a complex and lengthy process; however, a number of recent studies have demonstrated the effectiveness of short-term treatments such as cognitive behaviour therapy and educational interventions. Despite advances in their understanding and treatment, debate still surrounds the conceptualization and categorization of somatoform disorders, with a number of experts proposing a complete re-evaluation and reassignment of this diagnostic classification category. The following paper represents a review of recently published literature on frequency, characteristics, conceptualization, impact and management of somatoform disorders.

Cognitive Behavioral Therapy↗
PubMed2003

The neglect of somatoform disorders by old age psychiatry: some explanations and suggestions for future research.

AIM: The somatoform disorders have long been ignored by old age psychiatry. The main aim of this paper is to identify and examine possible reasons for this neglect. METHOD: A selective review of the general literature on somatoform disorders. RESULTS: Significant conceptual, diagnostic and classificatory problems have impeded the consideration of somatoform disorders in older people. There is a perception that somatoform disorders are infrequent and have not been validated as independent clinical disorders. However, we present evidence that the more broadly defined somatoform disorders are common in all age groups in primary care and meet criteria for the determination of clinical validity. General difficulties in the assessment of psychiatric disorders in primary care, the setting in which somatoform disorders are most common, are compounded by a lack of support from old age psychiatry services. Effective psychological therapies may not be readily available to sufferers. CONCLUSION: There is a need for change in the conceptualisation and nosology of the somatoform disorders. The formulation of age appropriate diagnostic criteria and presentations is a prerequisite for determining the clinical validity of these disorders in older people. This can be followed by study of their frequency, associated risk factors and treatment. A system of education that enhances the management of these disorders within primary care and old age psychiatry services is needed.

Aged↗
PubMed1993

Somatoform disorders: diagnosis and treatment.

Somatoform disorders are a group of syndromes in which patients focus on and complain of physical symptoms when there is no demonstrable underlying organic pathology or when complaints are in excess of what is expected. Medical and psychiatric physicians must seek better treatment and diagnosis.

Diagnosis, Differential↗
PubMed2006

[Somatoform disorders: diagnosis and treatment].

Somatoform disorders include several diagnoses, the treatment of which concerns somaticians as well as psychiatrists. This paper defines those diagnosis features, differential diagnosis, epidemiological aspects and etiology hypothesis. Regarding treatments, emphasis is stressed upon, the high level of collaboration between somaticians and psychiatrists, regarding those long term follow-up, well known for potential high-costs in terms of individual suffering and financial terms.

Female↗
PubMed1997

Epidemiology of somatoform disorders: a community survey in Florence.

Since the exclusion of somatic causes is necessary for somatoform disorders (SMD) to be diagnosed, there is little information on the prevalence of such disorders in the community. As the method we have previously developed [general practitioners (GPs) with psychiatric training who interview samples representative of the general population] seemed to be appropriate to deal with the problem, we carried out a community survey focused on somatoform disorders. The prevalence rates of DSM-III-R somatoform disorders were studied in two wards of the city of Florence. In order to be representative of the general population, 673 subjects randomly selected were interviewed by their own GP. Four GPs, all with specific training in psychiatry, participated in the interviewing process. The 1-year prevalence figures were as follows: 0.7% body dysmorphic disorder; 4.5% hypochondriasis; 0.6% somatoform pain disorder; 0.3% conversion disorder; 0.7% somatization disorder; 13.8% undifferentiated somatoform disorder. No specific comorbidity was found between somatoform disorders and mood or anxiety disorders. Although the sample investigated was small, this study may be seen as one of the first in an area where knowledge is still scant. The prevalence rates of somatoform disorders were generally found to be slightly lower than expected.

Adolescent↗
PubMed1998

Managing somatoform disorders.

The management of somatoform disorders is a confusing and difficult area. There are many iatrogenic complications, including unnecessary and repetitive investigations and surgery, drug dependence and "doctor shopping". Somatisation is a world wide phenomenon and a common presentation of psychological distress. Three main groups of patients are encountered in general practice: those with high levels of somatic symptoms, those with illness fear, and those with somatic presentations of other psychiatric illnesses. Management is straightforward for the acute cases and consists of trying to get the patient to accept a link between the psychosocial conflicts and the symptoms. Management is very difficult for chronic cases, where care, not cure, is the goal, as is an attempt to limit harm to the patient and limit the cost to the health system.

Adult↗
PubMed1988

EEG frequency analysis in conversion and somatoform disorder.

Patients with "hysterical" neurologic symptoms have long puzzled neurologists and psychiatrists. "Hysteria" has recently been subdivided into conversion and somatoform disorder. We applied computerized EEG frequency analysis to 10 patients with diagnosed conversion disorder, 10 somatoform disorder patients, and 10 control subjects. One minute EEG samples composed of 4 sec epochs were recorded from left frontal (F7-C3), right frontal (F8-C4), left posterior (T5-01) and right posterior (T6-02) derivations. Spectral power was calculated for 4 bands (0.25-4HZ, 4.25-8Hz, 8.25-13Hz, and 13.25-30Hz), and for the full frequency range. Low (0.25-8Hz) and high (8.25-30Hz) frequency bands were compared to determine high/low power ratios on the left and right (PHLL) and (PHLR), ratios of left/right front (PLRF) and posterior (PLRP) power, mean alpha frequency deviation frontally (FLRF) and posteriorly (FLRP), and mobility of left and right frontal power (MOLF and MORF). No significant differences were found between conversion disorder patients and controls in PHLL, PHLR, PLRP, and MORF. PLRF, FLRF and MOLF differed significantly between patients and controls. Power and frequency ratios of right frontal mobilities suggested a decrease in high frequency power, reduction in mean alpha frequency, and lower predominant frequency in the right frontal area in somatoform disorder patients as compared to controls, but significance was not reached. Somatoform and conversion disorder patients differed significantly in these spectral measures. These observations suggest that the two "hysterical" disorders may have distinct pathophysiology, and may be due to eventually identifiable cerebral dysfunction in some cases.

Adult↗
PubMedDate not supplied

Somatoform disorders among first-time referrals to a neurology service.

Consecutive new neurology inpatients and outpatients (N=198) were assessed for somatoform disorders by using the Schedules for Clinical Assessment in Neuropsychiatry. Sixty-one percent of the patients (59% of the female patients and 63% of the male patients) had at least one medically unexplained symptom, and 34.9% fulfilled the diagnostic criteria for an ICD-10 somatoform disorder (27.7% of the male patients, 41.3% of the female patients, 20.5% of the inpatients, and 43.2% of the outpatients). The prevalence figures were about the same when DSM-IV criteria for somatoform disorders were used. Of the patients with a somatoform disorder, 60.5% also had another mental disorder. Somatization disorder, somatoform autonomic dysfunction, pain disorder, and neurasthenia were equally prevalent (6%-7%); dissociative (conversion) disorders and undifferentiated somatoform disorders were found in 2-3% of the patients. Fifty percent of the patients with somatoform disorders were identified by the neurologists.

Aged↗
PubMed2000

Opipramol for the treatment of somatoform disorders results from a placebo-controlled trial.

Although somatoform disorders are highly prevalent, so far there is no established pharmacological treatment. Opipramol is a psychopharmacon widely prescribed in Germany. Early trials with opipramol showed the drug's effectiveness in anxiety states coupled with somatic complaints. Therefore, the efficacy of opipramol in somatoform disorders was evaluated using adequate clinical trial methods. A multicentre, randomized, 6-week, placebo-controlled clinical trial was performed in a total of 200 patients suffering from somatoform disorders according to ICD-10. In the main outcome criterion, the somatic subscore of the Hamilton Anxiety Scale, and in nearly all other outcome criteria opipramol (200 mg/day) was statistically more effective than placebo. A similar number of adverse events was noted in both groups. The results of this first-placebo-controlled study in somatoform disorders suggest efficacy of opipramol in this indication but need replication.

Adolescent↗
PubMed2005

Cognitive processing of emotional information in depression, panic, and somatoform disorder.

Emotional Stroop tasks (subliminal/supraliminal exposures), implicit memory tasks (tachistoscopic word identification), and explicit memory tasks (free recall after incidental learning) with 4 word types (physical threat, positive, negative, and neutral words) were administered to patients with major depressive disorder (n=30), panic disorder (n=33), somatoform disorder (n=25), and healthy control participants (n=33). On the Stroop task, panic patients showed subliminal interferences for physical threat and negative words, depressive patients showed supraliminal interferences for negative words, and somatoform patients showed supraliminal interferences for physical threat words. No patient groups demonstrated implicit memory biases. On the explicit memory task, depressive and panic patients showed memory biases for negative words; somatoform patients showed biases for physical threat words.

Adult↗
PubMed2006

A pathologist's perspective of the somatoform disorders.

OBJECTIVE: The object of this study was to revisit the evidence that somatoform disorders should be classified as mental and not physical disorders, as viewed through the eyes of a pathologist rather than a psychiatrist. METHODS: An academic clinical pathologist was asked to review recent widening in the concepts of physical disease and to comment on whether these changes made the criteria for designating somatoform disorders as mental disorders more workable or less workable. RESULTS: The review showed that somatoform disorders share many characteristics with certain types of physical conditions, especially those with multiorgan manifestations and multifactor causes. The criteria used to separate somatoform disorders from physical diseases are now less clear than when this distinction was first proposed. CONCLUSION: Discussions for reviewing the status of the somatoform disorders for DSM-V need input from a wide range of medical disciplines besides psychiatry.

Humans↗
PubMed1989

Somatoform disorders in the general hospital inpatient setting.

The somatoform disorders present dilemmas on acute inpatient medical/surgical services because they may closely mimic authentic physical illness and result in misapplied medical treatment. However, there have been few diagnostic studies of this important group in the medical/surgical inpatient setting. Inpatient psychiatric consultations at Mount Sinai Medical Center during 1980-1987 were recorded using a 384-item computerized data base protocol. DSM-III somatoform disorders were identified in 33 of 1801 initial consultations (1.8%) and in 35 of 1363 at time of termination (2.6%); demographic and diagnostic characteristics of somatoforms and others were compared. The question of a psychogenic component to the illness and problem with pain management were the most common stated reasons for consultation. Somatoform patients were more likely than others to be female (p less than 0.05), Hispanic (p less than 0.05), and to have Axis II comorbidity (p less than 0.001). Axis III comorbidity was present in 94%. Thirty-one percent of patients diagnosed as somatoform on final follow-up assessment had not been diagnosable as somatoform on initial assessment. The findings emphasize the necessity of ongoing assessment in improving diagnostic certainty, as well as the prevalence and importance of medical comorbidity among patients with somatoform disorders in this setting.

Hospitals, General↗
PubMed2006

Somatoform disorders as disorders of affect regulation: a development perspective.

This paper considers the role of disturbances in affect regulation in the development and course of somatoform disorders. We first give an overview of contemporary theories in the field of psychosomatic medicine that links deficits in emotion regulation to the process of somatization, and then review recent empirical research that focuses on the association between affect regulation and somatoform disorders, with an emphasis on studies investigating the alexithymia construct. Overall, the findings suggest that somatoform disorders are linked to a diminished capacity to consciously experience and differentiate affects and express them in an adequate or healthy way. It must be noted, however, that this result has not been obtained exclusively for somatoform disorders. A promising approach to further our understanding of the developmental roots of impaired affect regulation in somatoform disorders is attachment research. The attachment research reviewed in this paper indicates that a dismissing status of attachment is linked to defensive forms of processing and expressing emotions. We present some new data that not only provide empirical support of a high proportion of dismissing attachment in somatoform disorders but also suggest that the degree to which somatoform disorder patients employ dismissing attachment strategies is strongly related to affect dysregulation. Finally, some implications for psychotherapeutic interventions in patients with somatoform disorders are considered.

Affective Symptoms↗
PubMed2006

Conceptual issues in undifferentiated somatoform disorder and chronic fatigue syndrome.

PURPOSE OF REVIEW: To review the conceptual problems in distinguishing between undifferentiated somatoform disorder and chronic fatigue syndrome, for both may present with fatigue as the main symptom. RECENT FINDINGS: The differences and/or similarities between undifferentiated somatoform disorder and chronic fatigue syndrome have not been studied, conceptually or empirically. The literature fails to present discriminant validity of chronic fatigue syndrome in relation to undifferentiated somatoform disorder. A critical feature is implied in the definition of undifferentiated somatoform disorder but absent from the definitions of chronic fatigue syndrome: some patients experience their fatigue as being exclusively physical and not as mental, which is prima facie peculiar, for fatigue is necessarily a mental experience. One is not able to experience fatigue without a mind (or a brain). This experience is characterized as a 'mindless' fatigue, underpinned by pathological reductionist thinking. By not recognizing this critical feature, diagnostic endeavours may perpetuate the problem as a function of the patient's difficulty. SUMMARY: Proponents of chronic fatigue syndrome should distinguish chronic fatigue syndrome from undifferentiated somatoform disorder, if chronic fatigue syndrome is a distinct entity at all. Further, the 'mindless' quality is a critical feature that needs consideration in refining the concept of undifferentiated somatoform disorder.

Diagnosis, Differential↗