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PubMedDate not supplied

[Therapeutic possibilities regarding somatoform disorders in soldiers].

The authors used the ICD-10 classification and presented the most common psychopathological syndromes from the category "neurotic disorders connected to stress and somatoform disorders" present amongst recruited soldiers. Recruitment to the army is a "situation which is endangering to the mental health" (from the Act on mental health protection), however socio-political changes that took place in our country are an additional factor which can lead to such disorders. The limitations in treatment of these disorders, which are due to army specifications, cause for the majority of those soldiers affected to be unable to carry out their duty. As a consequence of this, civil units carry out the therapeutic processes. Particular attention, amongst the other disorders described, is attributed to the so-called organ neuroses. The authors stress upon the need for psychoprophylactic actions which would reduce the health consequences of being recruited into the army.

Adaptation, Psychological↗

PubMed1995

Medically unexplained somatic symptoms in different cultures. A preliminary report from phase I of the World Health Organization International Study of Somatoform Disorders.

The World Health Organization has recently launched an international study of somatoform disorders in different cultures. Five centres representing distinct cultures participated in phase I of the project, the main objective of which was to test the cross-cultural applicability and reliability of instruments for the assessment of somatoform disorders. The analysis of the assessed somatic symptoms showed that various aches and pains in different parts of the body represented cross-culturally the most frequent symptoms for which there was no medical explanation. Such symptoms may indicate the presence of an underlying mental disorder but can also represent a means for culture-specific expression of psychosocial distress. This bears particular significance for health professionals in primary and general medical care, who are most likely to encounter patients presenting with multiple, persistent and medically unexplained somatic symptoms.

Adult↗

PubMed2004

The prevalence of somatoform disorders among internal medical inpatients.

OBJECTIVE: To find the prevalence of somatoform disorders (SDs) among internal medical inpatients and to study the comorbidity with other psychiatric disorders. METHODS: Of 392 eligible consecutive medical inpatients, 294 (75%) accepted to participate and, using a two-phase design, were assessed for ICD and DSM-IV somatoform diagnoses and for ICD-10 psychiatric diagnoses. RESULTS: A total of 18.1% (95% CI: 12.8-24.9%) of the patients fulfilled the diagnostic criteria for an ICD-10 disorder, and 20.2% (95% CI:14.7-27.2% ) for a DSM-IV SD. The prevalence of specified disorders revealed marked differences between the two diagnostic systems, e.g., concerning somatisation disorder (SD), which was more prevalent in the ICD-10 (5%) than in the DSM-IV (1.5%) equivalent. Quite the contrary was found in undifferentiated SD (0.7% in ICD-10 and 10% in DSM-IV). According to ICD-10 criteria, 3.5% had hypochondriasis, 2.6% a dissociative disorder, 3.2% a somatoform autonomic dysfunction, 1.5% had neurasthenia or persistent somatoform pain disorder, and 5% had an SD, unspecified. SDs were more prevalent among younger females. Thirty-six percent of the patients with SDs also had another psychiatric disorder, 11% a depression, and 25% an anxiety disorder. The physicians detected about 1/3 of the cases. CONCLUSION: Somatoform disorders were prevalent among internal medical inpatients especially among younger women.

Adult↗

PubMed2006

Selective attention, memory bias, and symptom perception in idiopathic environmental intolerance and somatoform disorders.

Idiopathic environmental intolerance (IEI) refers to a polysymptomatic condition, similar to somatoform disorders. Various processes seem to contribute to its yet unknown etiology. Attention and memory for somatic symptom and IEI-trigger words was compared among participants with IEI (n = 54), somatoform disorders (SFD; n = 44) and control participants (n = 54). Groups did not differ in a dot-probe task. However, in an emotional Stroop task, attention was biased in IEI and SFD groups toward symptom words but not toward IEI-trigger words. Only the IEI group rated trigger words as more unpleasant and more arousing, and participants remembered them better in a recognition task. These implicit and explicit cognitive abnormalities in IEI and SFD may maintain processes of somatosensory amplification.

Adolescent↗

PubMed2002

Psychiatric comorbidity and hostility in patients with psychogenic nonepileptic seizures compared with somatoform disorders and healthy controls.

PURPOSE: To investigate the prevalence of psychiatric comorbidity and level of anxiety, depression, and aggression in patients with psychogenic nonepileptic seizures compared with those in patients with somatoform disorders and healthy controls. METHODS: Twenty-three patients with psychogenic nonepileptic seizures (PNESs) and 23 age- and sex-matched patients with somatoform disorders (SDs) underwent a clinical and a semistructured psychiatric interview (MINI) and filled in the Hospital Anxiety and Depression scale (HAD) and the Aggression Questionnaire (AQ). Twenty-three sex- and age-matched controls without psychopathology also underwent a clinical interview and completed the HAD and AQ. RESULTS: PNES reported more minor head injuries in the past than did the two comparison groups, and more unspecific EEG dysrhythmias were observed on EEG. Twenty-one PNES patients and 18 with SDs had comorbid psychiatric diagnoses. However, the mean number of comorbid psychiatric diagnoses was higher in the PNES group (1.9 +/- 0.3 compared with 1.5 +/- 0.5 in the SD group; p = 0.003). Ten PNES patients additionally had a somatoform pain disorder, and seven had an undifferentiated somatoform disorder. Both patient groups reported significantly higher levels of anxiety, depression, and anger than did the healthy controls, but the PNES patients had significantly higher level of hostility than both comparison groups. CONCLUSIONS: Increased psychiatric comorbidity is known to be associated with poorer response to regular interventions, and hostility is associated with more hostile coping patterns, often interfering with treatment compliance. Thus the increased prevalence of soft neurologic signs and comorbid psychiatric disorders and increased hostility as well in the PNES group, emphasizes that assessment and treatment of patients with PNES referred to a tertiary center requires an integrated approach involving both neurologic and psychiatric resources.

Adult↗

PubMed1991

Cases from the aerospace medicine residents' teaching file. Case #42. An aviator with concentration deficit, Lyme disease organic diagnostic evaluation, and a somatoform disorder.

An aviator with concentration deficit, Lyme disease organic diagnostic evaluation, and a somatoform disorder. The clinical presentation, evaluation and diagnosis of an aviator being evaluated for vague cognitive deficits of episodic and long duration with a history of rigid ideation concerning Lyme disease. The patient was diagnosed as having an atypical somatoform disorder. The aeromedical disposition of this patient is also presented.

Adult↗

PubMed1999

[The status of serotonin protein -- a serotonin transporter in thrombocytes in patients with somatoform disorders].

The role of serotonin transporter (SERT) protein in the development of somatoform disorders (SD) was investigated. An association study was performed in terms of the evaluation of the level of SERT immunoreactive (IR-SERT) protein using site-specific antibodies directed at SERT C-terminus fragment, poorly conserved among the other cotransporters. The level of the anxious symptomatology was also estimated in the patients with SD. 22 patients, who met DSM-IV criteria for somatoform disorders, and 32 normals were examined. In platelets from normals, IR-SERT protein migrated as a difuse band between 68 and 105 kDa, and a major sharper band at 43 kDa. Almost complete disappearance of platelet 43 kDa IR-SERT protein band was observed in most of the patients with SD. These findings permitted to suggest a possibility of either biosynthetic or processing abnormality of SERTs in the affected population, that might reflect a dysfunction of serotonin neurotransmission in CNS of the patients with SD.

Adult↗

PubMed2002

Somatoform disorders in children and adolescents: a comparison with other internalizing disorders.

A chart review of children and adolescents attending a university-based psychiatric outpatient clinic over a 1-year period was done. Nineteen consecutive patients with somatoform disorders were compared with 26 consecutive patients with other internalizing disorders, i.e., depressive disorders and/or anxiety disorders without disruptive behavior problems. Mean age, sex distribution, cognitive level, and duration of symptoms were not different between groups. Self- and parent-reported levels of psychopathology, including depression, anxiety, suicidal ideation, and deliberate self-harm, differentiated between somatoform disorders and other internalizing disorders at the group level. Levels of adaptive functioning and functional somatic symptoms did not. High levels of medically unexplained symptoms should prompt the clinician for assessing depressive symptoms and anxiety. Findings also support the use of DSM-IV criteria in pediatric patients to differentiate somatoform disorders from other internalizing disorders.

Adolescent↗

PubMed1992

[Effect of shift work on somatoform disorders].

An overview of the literature shows that shift work is linked with an enhanced risk of psychiatric disorders. A number of authors have reported anxious and depressive symptomatology in shift workers, but there are no data about the frequency of somatoform disorders associated with this type of work. Psychosocial stress and low socio-economic status, both often found among shift workers, are regarded as risk factors for somatoform disorders. The connection of shift work and somatoform disorders is discussed with examples of four case reports. It is suggested that shift work, which is known to be associated with an increased incidence of cardiovascular diseases, may promote the occurrence of vegetative symptoms, such as feelings of weakness and dizziness, and eventually leads to intensified self-observation, anxiousness and hypochondriasis with predominantly somatic symptoms.

Adult↗

PubMed1987

Views of practicing psychiatrists on the treatment of anxiety and somatoform disorders.

Psychiatrists in Australia were asked to recommend treatments for several anxiety and somatoform disorders. In previous surveys they had agreed about the preferred treatments for schizophrenia and major affective disorder but not about treatments for "neurotic depression" or agoraphobia. In the present survey, no treatment was regarded as critical by a majority of psychiatrists for any of the five anxiety and somatoform disorders studied. The authors conclude that because neurotic disorders form an important part of the workload of psychiatrists, consensus procedures should be used to develop guidelines for treatment until the research literature can provide more adequate guidance.

Adult↗

PubMed2004

[Somatoform disorders--what must the general practitioner know?].

Somatoform disorders are common conditions. Provided that the diagnostic criteria are known, however, they are not difficult to diagnose. In this connection, the family doctor has it within his power, by initiating empathic client-centred (conversation) therapy with the patient, to create a basis for a confidence-building and a long-lasting physician-patient relationship. In addition to a psychotherapeutic intervention or psychodynamic treatment or behavioral treatment, we now have the first positive results of a psychopharmacological treatment regimen with opipramol and the St. John's Wort extract LI 160.

Adult↗

PubMed2001

Screening for anxiety, depressive and somatoform disorders in rehabilitation--validity of HADS and GHQ-12 in patients with musculoskeletal disease.

PURPOSE: The detection of patients with comorbid mental illness is of high clinical importance in orthopaedic rehabilitation. To simplify detection of cases, screening instruments are recommended. The study investigated the discriminant validity of the Hospital Anxiety and Depression Scale (HADS) and the General Health Questionnaire (GHQ-12) to identify patients with comorbid mental disorders, specifically anxiety, depressive and somatoform disorders. METHOD: Two hundred and six patients with musculoskeletal disease from four orthopaedic rehabilitation clinics participated in a two-stage survey: (1) patients were assessed with the GHQ-12 and HADS; and (2) they were examined for DSM-IV mental disorders by clinical standardized interview (CIDI). Validity of the two instruments regarding the detection of mental disorders was compared using ROC-analysis and CIDI-diagnoses as criteria. RESULTS: The HADS sumscale performed better in all analyses compared to the GHQ-12, specifically in detecting depressive and anxiety disorders. Best results are achieved for depressive disorders with an area under the curve (AUC) of 0.79, a sensitivity of 78% and a specificity of 71% (cut off point= 16). The positive predictive value (PPV) is best for the detection of any mental disorder with a cut-off point of 16 (46%). CONCLUSION: The HADS can be used as a screening instrument for the detection of comorbid depressive and anxiety disorders in patients with musculoskeletal disorders. Limitations in performance of screening instruments are due to: (1) different methodological approaches of tests (dimensional approach) and criterion (categorical approach); and (2) difficulties in diagnosing mental disorders in patients with prominent physical illness.

Adult↗

PubMed1994

Psychosomatic syndromes, somatization and somatoform disorders.

A psychosomatic syndrome is defined as a syndrome in which psychological processes play a substantial role in the etiology of the illness in some of the patients. The main conclusions on the extent of the biological and psychosocial contributions to several psychosomatic syndromes are presented and the relationship of these syndromes to somatization and somatoform disorders is discussed. The syndromes summarized include fibromyalgia, chronic fatigue, motility disorders of the esophagus, nonulcer dyspepsia, irritable bowel syndrome, urethral syndrome, behaviors causing disturbances of physiology, and some defined pain syndromes. The findings suggest that the extent of the biological and psychosocial contributions vary among these syndromes as well as among individuals with the same syndrome. In some syndromes the extent and nature of the biological contribution has not been established with certainty. There is evidence to suggest that many of the phenomena of the somatoform disorders are caused by clustering of psychosomatic syndromes or their incomplete or atypical manifestations and a low sensation threshold. The results of the controlled studies of various methods of psychotherapy and drug treatments of the psychosomatic syndromes are listed; these studies have practical implications because the adoption of these methods is likely to enhance the efficacy of the treatment of somatoform disorders.

Diagnosis, Differential↗

PubMedDate not supplied

A two-year follow-up study of patients with somatoform disorders.

Thirty inpatients with multiple somatoform symptoms admitted to a psychosomatic hospital were diagnosed using the Structured Clinical Interview for DSM-III-R and questionnaires. Two years later, a reexamination by interview and a follow-up questionnaire took place. The authors found high comorbidity rates not only for affective disorders (lifetime 86%), but also for anxiety disorders (lifetime 43%). Comorbidity is of high prognostic relevance: whereas patients with only somatoform disorders at first assessment may remit until second assessment, in those patients with comorbidity with other psychiatric disorders, some somatoform symptoms still remain. The rate of misdiagnosed organic disorders is estimated at lower than 10%.

Adult↗

PubMedDate not supplied

[Epidemiology of somatoform disorders in the general French population].

A telephone survey based on 504 interviews, representative of the French population over 18, allowed to gauge the annual prevalence and identify the characteristics of somatoform disorders. This study was based on the inventory of 19 symptoms divided into 5 categories: gastrointestinal, pain, dermatological, cardiorespiratory and gynaecologic/urinary. "Medical somatoform disorders" (MSD) were defined as the repeated occurring, during the previous year, of not less than 1 symptom with an evolution duration equal or superior to 6 months, and causing personal and familial or professional problems. Such disorders had, in addition, to motivate one or more medical consultations concluding to the lack of somatic disease. These criteria included those proposed in DSM IV for the diagnosis of "Undifferentiated Somatoform Disorder", except for the exclusion criteria (E) which was not included in this study. Three out of four subjects (76% of the population) declared to endure not less than 1 somatic symptom in the course of the previous year. Near 1 out of 5 subjects (19%) had one MSD. MSD were more frequent among females than among males (sex-ratio F/M = 1.82). This data traces 3 types of phenomena: the somatic disorders prevalence and the consultation ratio in case of somatic disorders were higher among females than males; conversely, MSD ratio among somatic disorders consultants is higher among males than females. MSD prevalence does not vary with age, except for an underrepresentation among patients aged over 65 (13%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Somatoform disorder in primary care: course and the need for cognitive-behavioral treatment.

Medically unexplained physical symptoms are prevalent in primary care. Of all patients attending the family physician, 16% have a somatoform disorder as described by DSM-IV. Cognitive-behavioral treatment has been demonstrated to be effective in secondary care. However, the course of somatoform disorders and their need for treatment have not yet been established in primary care. In this study, data from 1,046 attendees in family practice were analyzed for prevalence, course, and eligibility for treatment. Over a 6-month follow-up, the prevalence of somatoform disorder decreased from 16.1% to 12.3%. After assessment of eligibility, about 5% of patients demonstrated a need for treatment.

Adult↗

PubMed2006

General medical and psychiatric perspectives on somatoform disorders: separated by an uncommon language.

PURPOSE OF REVIEW: While Diagnostic and Statistical Manual of Mental Disorders-IV provided updated definitions and diagnostic criteria for the diagnoses subsumed under the category of somatoform disorders, various nosological questions are still unresolved. We assessed current research activity on important key concepts related to nosology, validity, and reliability of the Diagnostic and Statistical Manual of Mental Disorders-IV somatoform diagnoses. RECENT FINDINGS: The initial Medline search for articles from 2000 through 2005 yielded a total of 912 articles. After checking for redundancy and excluding publications using other than Diagnostic and Statistical Manual of Mental Disorders-IV diagnostic criteria, a total of 101 articles was further reviewed. Heterogeneity of papers precluded statistical approaches; thus, a descriptive and narrative review was pursued. SUMMARY: It appears that applying the specific categories and criteria as proposed by Diagnostic and Statistical Manual of Mental Disorders-IV only captures a small proportion of the phenomena of interest at the interface of medicine and psychiatry. A paradigm shift towards 'general medical/psychiatry interface disorders' in exchange for the current dichotomy of 'mind' vs. 'body' disorders, may reduce stigma associated with current diagnostic labeling, improve user acceptability, and stimulate research in this important but still fragmented clinical area that still lacks agreed-upon diagnostic definitions.

Diagnostic and Statistical Manual of Mental Disord↗

PubMed1999

Toward empirically based criteria for the classification of somatoform disorders.

There is a major need for an empirical evaluation of classification criteria for somatoform disorders. The present study analyzes psychometric properties of the existing criteria for somatization disorder. The full sample consisted of 324 patients seeking help because of "psychosomatic problems." Data from a subsample of carefully diagnosed patients with somatization syndrome (n = 76) and a clinical comparison group (n = 32) permitted the analysis of the discriminative power of items. Twenty-one somatic symptoms adopted from DSM-IV and ICD-10 criteria did not exhibit the necessary psychometric characteristics (item probability, item-total correlation, etc.). Thirty-two somatic symptoms showed a satisfactory psychometric performance. A cut-off of seven or more symptoms yielded the best discrimination between low and high disability. New criteria for somatization syndrome ("polysymptomatic somatoform disorder") are proposed taking into account for the strong association of somatization and abnormal illness behavior.

Culture↗