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PubMedDate not supplied

Consultation-liaison psychiatrists' management of somatoform disorders.

The authors studied interventions recommended by consultation-liaison (C-L) psychiatrists when they diagnosed somatoform disorder prospectively in a cohort of 4,401 consecutive inpatients referred to the C-L psychiatry service of a general teaching hospital, using standardized MICRO-CARES methodology. A DSM-III-R somatoform disorder was diagnosed in 2.9%, somatoform pain disorder in 1.4%, conversion disorder in 0.7%, hypochondriasis or somatization disorder undifferentiated/not otherwise specified in 0.6%, and somatization disorder in 0.2%. In 3.4%, somatoform disorder was considered a differential diagnosis. Psychiatric comorbidity included mood disorder (39%), personality disorder (37%), and psychoactive substance use disorder (19%). Recommendations were made about antidepressants in 40% of the patients, anxiolytics in 18%, sedatives in 18%, and antipsychotics in 10%. Psychiatrists recommended the following: more laboratory tests for 14%; additional medical/surgical consultations for 11%; an increase in the vigor of medical treatment for 13%; and psychological treatment for 76%; also they stressed an earlier discharge of 16%. Psychiatrists were more likely to request a prolongation of inpatient stay for patients with comorbid somatoform, mood, anxiety, and personality disorder. Differences in characteristics and treatment of the subgroups tended to be consistent with their constructs and comorbid psychiatric diagnoses.

Adult↗

PubMed2004

Pharmacotherapy of somatoform disorders.

OBJECTIVE: This paper reviews the published literature on the pharmacologic management of somatoform disorders. METHODS: Using Medline, the author identified all articles published between 1970 and 2003 on this topic, selecting the best-designed studies for inclusion. RESULTS: The review reveals that patients with the obsessional cluster of somatoform disorders (hypochondriasis and body dysmorphic disorder [BDD]) respond well to serotonin reuptake inhibitors (SRIs). Less is known about the pharmacologic responsiveness of patients with the primarily somatic cluster of somatoform disorders (somatization, pain), a patient group that is common in the health provider's office. CONCLUSIONS: Improvements in the design of future clinical trials are needed. A particular focus needs to be applied to study the neglected area of the pharmacologic treatment of syndromal and subsyndromal somatization and pain disorders.

Humans↗

PubMed1995

Somatoform disorders in different cultures--a mail questionnaire survey.

A mail questionnaire survey was organized by WHO to obtain expert opinion on the cross-cultural applicability of ICD-10 definitions of somatoform disorders. A response was obtained from 42 experts in 23 countries representing all five continents. The results showed that the ICD-10 concept of somatoform disorders was generally acceptable for use across cultures. However, a number of culture-specific symptoms, characteristics and terms that do not appear in ICD-10 were found to be common and important for the diagnosis of somatoform disorders in particular cultures. Pointing out the relative restrictiveness of ICD-10 criteria for somatization disorder, the experts emphasized the usefulness of having the more inclusive category of undifferentiated somatoform disorder. The survey was organized as the starting point of the WHO International Study of Somatoform Disorders. The major goal of the study is to improve understanding of the somatic presentation of psychological disorders in different cultures.

Cross-Cultural Comparison↗

PubMed1997

Association between tinnitus and somatoform disorders.

Pathophysiological mechanisms are often unknown in patients suffering from "idiopathic" tinnitus, and the presence of other unexplained physical symptoms such as those seen in somatoform disorders can be assumed. This study investigates how often tinnitus exists in general medical out-patients with and without somatoform disorders. In an international study initiated by the World Health Organization (WHO), 1275 patients from 12 participating centers located in 11 different countries were examined by means of the WHO Somatoform Disorders Schedule. The overall prevalence of unexplained tinnitus was 11%; however, tinnitus was clearly more frequent among patients with somatization disorder (42%) or hypochondriacal disorder (27%). It was also more frequent than a great number of other symptoms considered to be typical of somatoform disorders. Tinnitus was also related to depression, anxiety, and to symptoms indicating autonomic arousal. Three possible conclusions are discussed: (i) tinnitus may be a somatoform symptom; (ii) the findings may indicate a substantial comorbidity of two different conditions; (iii) tinnitus and somatization may be linked through common mechanisms of arousal and somatic anxiety.

Adult↗

PubMed1997

ICD-10 and DSM-IV symptoms of somatoform disorders in different cultures.

In spite of an effort to harmonize the latest editions of International Classification of Diseases (ICD) and Diagnostic and Statistical Manual (DSM), a number of differences between the two classification systems still exist. One of these differences is related to the category of somatoform disorders. The cross-cultural applicability of ICD-10 and DSM-IV criteria for somatoform disorders have been explored in the context of the ongoing WHO International Study of Somatoform Disorders. The study demonstrated that the current diagnostic concepts of somatoform disorders are cross-culturally acceptable in spite of the differences in their descriptions and classifications. However, it was found that a number of culture specific symptoms of somatoform disorders which do not appear in ICD-10 and DSM-IV were important and necessary for their diagnosis in specific cultures.

Adult↗

PubMed2006

Behavioural mechanisms and cognitive-behavioural interventions of somatoform disorders.

Due to the lack of adequate cure or medication for somatoform disorders, cognitive-behavioural intervention or cognitive-behavioural therapy (CBT) seems to be an optimal treatment resource for patients with these disorders, since the cause of the somatoform disorders cannot to be explained by medical illness, but can be analyzed in the process of both responding and operant conditioning. According to the reviews, randomized controlled trials are limited, but the efficacy of the intervention is quite impressive. Most of the studies use multiple treatment strategies, and no standardized treatment methods have been established. In general, the following steps are taken in CBT treatments: (1) assessment; (2) rationale of treatment choice; (3) course of treatment; (4) evaluation of treatment; and (5) reviewing treatment effects. In CBT, functional analysis in the assessment session is the key to success, to identify the relationship among discriminative stimuli and consequences, in order to reduce the undesirable behaviour, and the most effective approach of the treatment would be a combination of multiple techniques. However, as the efficacy of the treatments is established, expansion of accurate knowledge of functional analysis and training sessions for health care providers and patients should be provided. Further research should explore the effect of individual techniques, and comparison should be made to identify the relative benefits of the techniques using both individual, and group format.

Cognitive Behavioral Therapy↗

PubMed1999

[Somatoform disorders. What is wrong when there is "nothing" wrong?].

Patients with somatoform and dissociative disorders complain of symptoms suggesting physical disease. These patients are high utilizers of health services but seldom receive relevant treatment. Recently empirical data have been obtained concerning epidemiology, familiar distribution, and relation to personality in these disorders. Somatoform patients often have comorbid depression and anxiety disorder. These complications are often overlooked, but accessible to psychopharmacological treatment. A number of psychotherapeutic techniques have been developed for treatment in general practice and in hospital settings.

Anxiety Disorders↗

PubMed1998

Fluvoxamine for somatoform disorders: an open trial.

Although the pharmacologic treatment of somatoform disorders has scarcely been investigated, there is reason to believe that antidepressants might be useful. We examined the response of 29 patients with somatoform disorders from a general medicine clinic to a selective serotonin reuptake inhibitor, fluvoxamine. The drug was administered in doses of up to 300 mg daily for 8 weeks. Sixty-one percent of the patients who took medication for at least 2 weeks were at least moderately improved. In addition to antidepressant effects, fluvoxamine had other beneficial effects and was well-tolerated. The benefits of drug therapy were modest but appear to warrant a placebo-controlled trial.

Adult↗

PubMed1985

Childhood psychologic environmental exposure in women with diagnosed somatoform disorders. A case-control study.

Fifty-three female patients with diagnosed somatoform disorders (having pronounced somatic symptoms without objective somatic signs) were studied regarding childhood exposure to death, divorce, serious somatic illness and prolonged pain in members of their core family. Similar registrations were made in a control group of 53 healthy women. The two groups were compared using the case-control method. The results revealed a more frequent exposure in the somatoform disorder patients regarding all four items, and for serious somatic illness and prolonged pains the difference was statistically significant. Further elaboration of the data suggested that exposure to pain in the family was the most important of the studied factors. The findings are thought to demonstrate the environmental etiologic impact on somatoform disorders occasioned by such psychologic exposure as those registered. The possibility of a genetic etiologic implication of the findings is also discussed.

Adolescent↗

PubMed2005

Biological sensitisation and psychological amplification: gateways to subjective health complaints and somatoform disorders.

Subjective health complaints without known physical pathology are common and might develop into somatoform disorders. Normalization of neuroticism and anxiety in patients with duodenal ulcer disease after a relapse-free state is acquired and maintained is an indication that biological factors influence psychological factors. Recent research has shown that psychological and behavioural changes, on the other hand, have the capacity to change the brain. Visceral hyperalgesia is an example of biological sensitisation, but the abnormal sensory perception can be normalised by hypnotherapy. The dual-etiology hypothesis of functional somatic syndromes implies that in some patients with somatoform disorders there is a predominant biological etiology, whereas in others there is a predominant psychological etiology. The theory is supported by recent research, and may result in better handling of patients. Cognitive factors like catastrofising amplifies subjective physical symptoms and emotions effect the perception of them. In preventive health care the following slogans are proposed as antidotes preventing subjective health complaints form developing into somatoform disorders: Do not listen to your body's signals! Do not trust your feelings! Do not trust your thoughts!

Health↗

PubMedDate not supplied

A new approach to the assessment of the treatment effects of somatoform disorders.

A new 53-item instrument for the evaluation of treatment effects in somatoform disorders, the Screening for Somatoform Symptoms-7 (SOMS-7), is presented. It covers all somatic symptoms mentioned as occurring in somatization disorder, according to DSM-IV and ICD-10. A group of 325 patients was assessed at the beginning and end of treatment to compute scores of reliability and validity. The new scale showed high internal consistency (alpha=0.92) and revealed two composite indices: somatization symptom count and somatization severity index. These indices discriminated patients fulfilling complete criteria for somatoform disorders, patients with somatization syndrome, and patients with other mental and psychosomatic disorders. The instrument confirmed symptom reductions between admission and discharge, while in another group composed of wait-listed patients, no significant decrease in symptoms was observed. In sum, the SOMS-7 seems to be a comprehensive, reliable, and valid instrument for the evaluation of treatment effects in patients with somatoform disorders.

Adult↗

PubMedDate not supplied

Somatoform disorders: comorbidity with other DSM-III-R psychiatric diagnoses in Greece.

From a total sample of 1,448 psychiatric outpatients, 175 (12.1%) received a diagnosis of a somatoform disorder according to DSM-III-R criteria. One hundred twenty-two (70%) of these patients had another current axis I diagnosis, and this rate increased to 79% (139 of 175) when lifetime psychiatric diagnoses were recorded. The most frequent comorbid diagnoses were depressive disorders, i.e., dysthymia and major depression, and then anxiety disorders, mainly panic disorder. One hundred ten (63%) of the somatoform patients met the criteria for a personality disorder, significantly higher than the rate (52%) for the rest of the total sample (n = 1,273), who were used as a control group. The most frequent comorbid personality disorders were histrionic, dependent, and personalities of cluster B in general. Hypochondriasis was the only somatoform disorder that was additionally significantly related to obsessive-compulsive personality disorder. Somatoform patients with a concomitant personality disorder manifested more severe overall psychopathology as measured by the Minnesota Multiphasic Personality Inventory (MMPI) and a worse level of functioning than those without. The results of the present study show that (1) patients with somatoform disorders have a high rate of comorbidity with other clinical syndromes and personality disorders, and (2) the presence of a personality disorder is related to more severe overall psychopathology and a worse level of functioning. All of the above indicate that special attention must be paid to the interaction between somatoform disorders, other clinical syndromes, and personality structure at the level of both clinical and research practice.

Adult↗

PubMed2003

[Psychotherapy of somatoform disorders].

OBJECTIVES: To present a review of the current state of the art of psychotherapy of somatoform disorders from a psychodynamic-interpersonal perspective. METHODS: The review is based on an analysis of the literature used for evidence-based guidelines on the treatment of somatoform disorders and on our own experiences and models of these disorders. An elaboration of practical aspects of psychotherapy with these patients makes up an essential part of the review. RESULTS AND DISCUSSION: Psychotherapy of somatoform disorders is efficient and effective if the typical interpersonal patterns of these patients are taken into account and if the therapist maintains a more active attitude, avoiding early psychosocial interpretations of the somatoform complaints.

Evidence-Based Medicine↗

PubMed1984

Somatoform disorders: before and after DSM-III.

The somatoform disorders were included as a new category of mental disorders in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. The authors review the major features of somatization disorder, conversion disorder, psychogenic pain disorder, and hypochondriasis and present a survey of the recent literature about each.

Adaptation, Psychological↗

PubMed1997

Somatoform disorders in children and adolescents: a review of the past 10 years.

OBJECTIVE: To review the literature on somatoform disorders in children and adolescents relevant to recertification by the American Board of Psychiatry and Neurology. METHOD: The psychiatric, pediatric, and psychological literatures were searched for clinical or research articles in the past 10 years dealing with somatization and somatoform disorders. RESULTS: Somatizing presentations are organized conceptually; somatization disorder, body dysmorphic disorder, hypochondriasis, conversion disorder, vocal cord dysfunction, pain disorder, and recurrent abdominal pain are described in children and adolescents; empirical evidence for treatment efficacy is scant, but clinically reasonable approaches are applied. CONCLUSION: More developmentally appropriate diagnostic schemas and better outcome studies are needed in all the somatoform disorders for children and adolescents.

Adolescent↗

PubMed1996

[Brief family therapy: an option for the treatment of somatoform disorders in primary care].

OBJECTIVE: To study the application of the brief family therapy model to the treatment of somatoform disorders in scheduled primary care consultations. DESIGN: Intervention study. SETTING: Cazoña Health Centre, Santander. PATIENTS: 18 patients who had suffered somatoform disorder for at least a year. INTERVENTIONS: A general practitioner trained in short-term family therapy applied this treatment under the supervision of a specially trained psychologist. MEASUREMENTS AND RESULTS: The variables of the research into the results of brief family therapy were collected. These showed 61.1% therapeutic success, 27.8% failure and 11.1% abandonment. There were no relapses at the six-month control. Total number of consultations varied between 1 and 11, average 4.6; the average interval between consultations was 27 days, with an average length of 48 minutes for each consultation. Time between the first and last consultation varied from 1 to 242 days, average 96 days. Brevity of treatment was related to its therapeutic success. CONCLUSIONS: Training in brief family therapy, with supervision at the start, can provide primary care doctors with a treatment alternative for resolving somatoform disorders without the patient having to accept a psychological reason for his/her complaints.

Adult↗

PubMed1989

A pilot study of a modified Balint group using cognitive approaches to physician attitudes about somatoform disorder patients.

This is a pilot study of the use of cognitive therapy theories and techniques in a time-limited Balint group of family physicians with a focus on the care of the somatoform disorders. Family physicians often find these patients difficult and unpleasant to treat. Physicians in the group were compared with other family physicians in a pre and post test of attitudes towards patients with somatoform disorders. In addition, the beliefs of the physicians were elicited. After the 13 session Balint group was completed, attitudes of the family physicians in the group improved so that they were less likely to feel that somatizing patients take up too much of their time (p less than 0.05). Underlying beliefs about somatoform disorder patients were identified in the group and subsequently modified. This study suggests that a time-limited cognitive therapy Balint group, focusing on somatoform disorder patients, results in improved attitudes toward the care of these patients.

Attitude of Health Personnel↗

PubMed2005

Effects of Yoku-kan-san on undifferentiated somatoform disorder with tinnitus.

Up to the present, there have been few strategies that are completely effective in treating undifferentiated somatoform disorder with tinnitus. We herein report that Yoku-kan-san (TJ-54), one of Japan's traditional herbal medicines, is an effective treatment for tinnitus in undifferentiated somatoform disorder complicated with headache and insomnia. TJ-54 has been also used as an effective treatment for insomnia and irritability in recent centuries and is considered to have some effects on the excitability of nerves. Further studies are needed to confirm the efficacies of Japanese herbal medicines.

Adult↗