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Kajikawa N, Yoshimoto H, Yokoya S. Descriptive Study of Patients Treated in a Psychosomatic Internal Medicine Declared by Japanese Family Medicine Clinic. J Clin Med Res 2023; 15:360-367. [PMID: 37575353 PMCID: PMC10416189 DOI: 10.14740/jocmr4939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Background Psychosomatic internal medicine (PSIM) assesses psychosocial factors and provides holistic consideration. In Japan, PSIM physicians seem to be recognized as providers of mental health services, but family medicine did not so. When family physicians confront with psychological problems, high dropout rate is reported so it is needed to reveal factors related to dropouts, The purpose of this study is to describe characteristics of patients, treatment dropouts and its related factors in PSIM practice by family physician. Methods This cross-sectional study used data from the medical records of the Kitaibaraki Center of Family Medicine located in Kitaibaraki City, Ibaraki, Japan. The study included all new patients who made an appointment and visited the PSIM in this clinic from January 2020 to December 2022.Chief complaints and diagnoses were coded based on the International Classification of Primary Care, version 2 (ICPC-2). Results In total, 377 new patients were included in this study. The mean age was 39.9 ± 20.2 years. We found that 69.2% of patients who visited the clinic had a psychological chief complaint and 84.1% of primary diagnoses consisted of a psychological problem. One hundred sixty-five patients (43.8%) were still receiving treatment 6 months after the initial visit. Of the patients who ended treatment within 6 months after the initial visit, 84 patients (39.2%) dropped out. In multivariate analysis, the dropouts were less likely to occur patients with primary diagnosis of psychological problem (odds ratio (OR): 0.35, 95% confidence interval (CI): 0.19 - 0.67). Conclusions Patients who visited a PSIM wanted consultation about psychological problems. Patients with a diagnosis of a psychological problem at the initial visit were less likely to drop out.
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Affiliation(s)
- Natsuki Kajikawa
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Kitaibaraki Center for Family Medicine, Kitaibaraki, Ibaraki, Japan
| | - Hisashi Yoshimoto
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Kitaibaraki Center for Family Medicine, Kitaibaraki, Ibaraki, Japan
- Research and Development Center for Lifestyle Innovation in University of Tsukuba, Ibaraki, Japan
| | - Shoji Yokoya
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Kitaibaraki Center for Family Medicine, Kitaibaraki, Ibaraki, Japan
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Tian P, Ma Y, Hu J, Zhou C, Liu X, Chen Q, Dang H, Zou H. Clinical and psychobehavioral features of outpatients with somatic symptom disorder in otorhinolaryngology clinics. J Psychosom Res 2021; 148:110550. [PMID: 34175726 DOI: 10.1016/j.jpsychores.2021.110550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In the Otorhinolaryngology Department, patients exhibiting somatic symptoms without a medical cause are frequently neglected and left untreated. The aim of this study was to characterize the psychosomatic features of outpatients with somatic symptom disorder (SSD) to better identify patients needing treatment. METHODS This cross-sectional study enrolled 883 consecutive patients with medically unexplained symptoms. A semistructured clinical interview was employed to confirm the diagnosis of SSD. Data, including sociodemographic and clinical measures, were collected. The Patient Health Questionnaire-15 (PHQ-15) and Somatic Symptom Scale-China (SSS-CN) were used to assess the severity of somatic symptoms; the Patient Health Questionnaire-9 (PHQ-9) was used to assess depression; the General Anxiety Disorder-7 (GAD-7) was used to assess anxiety; and the 12-item Short-form Health Survey (SF-12) was used to assess quality of life (QoL). RESULTS Based on the DSM-5 criteria, 641 patients were placed in the SSD group, and 212 were placed in the normal group. Compared with the normal group, the SSD group had significantly more doctor visits, longer symptom durations, higher GAD-7 and PHQ-9 scores, and lower physical composite scores (PCSs) and mental composite scores (MCSs). Spearman's correlation analysis and multiple linear regression analyses showed that the SSS-CN score, PHQ-15 score and the patient's subjective feeling that his or her daily life was affected by the disorder were significant risk factors for low PCSs; the SSS-CN, PHQ-15, PHQ-9, and GAD-7 scores were independent risk factors for low MCSs. CONCLUSION Our findings demonstrated that SSD patients are not rare in otorhinolaryngology clinics in China and that their QoL is significantly affected by SSD. Otolaryngologists should thoroughly evaluate these patients from the perspective of psychosomatic medicine.
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Affiliation(s)
- Peng Tian
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yan Jiang Xi Road, Haizhu District, Guangzhou, Guangdong 510120, People's Republic of China
| | - Yun Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yan Jiang Xi Road, Haizhu District, Guangzhou, Guangdong 510120, People's Republic of China
| | - Junwu Hu
- Department of Psychology, School of Public Health, Southern Medical University, No. 1023. South Shatai Road, Baiyun District, Guangzhou, Guangdong 510515, People's Republic of China
| | - Chao Zhou
- Guangzhou Psychiatric Hospital, No. 36, Ming Xin Road, Fangcun, Liwan District, Guangzhou, Guangdong 510120, People's Republic of China
| | - Xiang Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yan Jiang Xi Road, Haizhu District, Guangzhou, Guangdong 510120, People's Republic of China
| | - Qiujian Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yan Jiang Xi Road, Haizhu District, Guangzhou, Guangdong 510120, People's Republic of China
| | - Hua Dang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yan Jiang Xi Road, Haizhu District, Guangzhou, Guangdong 510120, People's Republic of China.
| | - Hua Zou
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yan Jiang Xi Road, Haizhu District, Guangzhou, Guangdong 510120, People's Republic of China.
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Nakao M, Takeuchi T. Alexithymia and Somatosensory Amplification Link Perceived Psychosocial Stress and Somatic Symptoms in Outpatients with Psychosomatic Illness. J Clin Med 2018; 7:E112. [PMID: 29748483 PMCID: PMC5977151 DOI: 10.3390/jcm7050112] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 05/06/2018] [Accepted: 05/08/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Psychosomatic patients often complain of a variety of somatic symptoms. We sought to clarify the role of clinical predictors of complaints of somatic symptoms. METHODS We enrolled 604 patients visiting a psychosomatic outpatient clinic. The outcome was the total number of somatic symptoms, and the candidate clinical predictors were perceived psychosocial stress, alexithymia, somatosensory amplification, adaptation, anxiety, and depression. All participants completed questionnaires assessing the outcome and the predictors. RESULTS The average number of reported somatic symptoms was 4.8; the most frequent was fatigue (75.3%), followed by insomnia (56.1%), low-back pain (49.5%), headache (44.7%), and palpitations (43.1%). Multiple regression analysis showed that the total number of somatic symptoms was significantly associated with the degree of perceived psychosocial stress, alexithymia, somatosensory amplification, and depression. Also, structural equation models indicated links between excessive adaptation (via perceived psychosocial stress, alexithymia, and somatosensory amplification) and the total number of somatic symptoms. CONCLUSION The results suggested that the association between psychosocial stress and reported somatic symptoms is mediated by alexithymia and somatosensory amplification in psychosomatic patients.
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Affiliation(s)
- Mutsuhiro Nakao
- Department of Psychosomatic Medicine, School of Medicine, International University of Health and Welfare, Narita, Chiba 286-8686, Japan.
- Department of Psychosomatic Medicine, Teikyo University Hospital, Tokyo 173-8605, Japan.
| | - Takeaki Takeuchi
- Department of Psychosomatic Medicine, Teikyo University Hospital, Tokyo 173-8605, Japan.
- Department of Psychosomatic Medicine, School of Medicine, Toho University Hospital, Tokyo 143-8541, Japan.
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Valdes-Stauber J, Bachthaler S. Clinical and care intensity differences among patients suffering from somatic diseases electively referred to a consultation and liaison service. Int J Psychiatry Med 2018; 53:141-158. [PMID: 29264939 DOI: 10.1177/0091217417749794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Background This investigation mainly explores possible care differences among patients hospitalized because of medical conditions being electively referred to a psychiatric-psychosomatic consultation and liaison service. Methods A four-year survey ( N = 2518 individuals) based on clinical and care variables selected from the basic documentation. STATISTICS Chi-square tests, analysis of variance, logistic and multivariate regression analyses, considering statistical modeling assumptions. Results A current psychiatric comorbidity has been found in 75% (less in cancer patients), mainly adjustment and anxiety (45%), mood (22%), and organic mental disorders (12%). The functioning score (Global Assessment of Functioning) was 59.4 and was especially low in patients suffering from unclear medical conditions. The performance status (Eastern Cooperative Oncology Group) amounted to 1.63 and was especially high in patients suffering from orthopedic conditions, infections, and cancer. Each patient received on average of 2.26 (SD = 2.81) contacts and 111 minutes (SD = 160) of total treatment time. In multivariate models, care differences among medical conditions are reduced. Men and older people have received less than the average amount of treatment, but psychiatrically comorbid patients and those with lower functionality and performance status have received more intensive psychological support. Conclusions As a quality feature of consultation and liaison service, patients suffering from psychiatric comorbidity, lower functionality, and lower performance status receive more intensive care and more post-discharge recommendations. Cancer patients and patients with pain as a leading diagnosis as well as strained mothers of hospitalized children have received more intensive treatment by consultation and liaison service despite lower psychiatric comorbidity levels. More attention has to be paid to men and older people independently of their physical condition.
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Nakamura Y, Takeuchi T, Hashimoto K, Hashizume M. Clinical features of outpatients with somatization symptoms treated at a Japanese psychosomatic medicine clinic. Biopsychosoc Med 2017; 11:16. [PMID: 28670335 PMCID: PMC5488391 DOI: 10.1186/s13030-017-0104-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background Somatization is produced due to the summation of psychological factors, irrespective of the presence or absence of physical factors. A group of diseases with severe pain and other disorders exhibit so-called Medically Unexplained Symptoms (MUS), and the characteristics of patients with MUS are largely unexplained. In this paper, the characteristics of a series of new patients with somatization treated in a Japanese university hospital are discussed. Method The subjects were 871 patients who newly visited the Department of Psychosomatic Medicine, Toho University Omori Medical Center between January and December of 2015. Under the assumption that the definition of somatization is same as that of MUS, the correlation between somatization and the age, sex, academic background, chief complaints, reasons for visiting the medical center, diagnosis, symptoms, presence or absence of a referral form, continued treatment after the first visit, and marital status of these patients at the time of their respective examinations were evaluated. Results Of the patients studied, 68% suffered from somatization. Among them, 11% met the definition of Functional Somatic Symptoms (FSS) and 74% had somatization associated with mood disorder or anxiety disorder. Digestive symptoms were reported by 33%, headaches by 24%, and unusual sensations by 21%. Whereas no correlation was found between somatization symptoms and the patients’ academic background, marital history, or medical history after the first visit, a positive correlation (p < 0.05) was found between somatization and patients who had been referred by their doctor. Conclusion Many of the studied patients who suffered from somatization, regardless of age and sex, were referred to us by doctors from other hospitals. It was concluded that many patients difficult to diagnose or deal with are referred the Department of Psychosomatic Medicine of Japanese university hospitals, thus these hospitals must assume great responsibility for preventing mistaken diagnoses by conducting effective psychological treatment and thorough medical examinations.
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Affiliation(s)
- Yuzo Nakamura
- Department of Psychosomatic Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Takeaki Takeuchi
- Department of Psychosomatic Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Kazuaki Hashimoto
- Department of Psychosomatic Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Masahiro Hashizume
- Department of Psychosomatic Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541 Japan
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Nakao M. Key aims of the special series "the meaning of behavioral medicine in the psychosomatic field". Biopsychosoc Med 2016; 10:3. [PMID: 26913060 PMCID: PMC4765062 DOI: 10.1186/s13030-016-0055-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 12/28/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mutsuhiro Nakao
- Teikyo University Graduate School of Public Health & Department of Psychosomatic Medicine, Teikyo University Hospital, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605 Japan
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