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Joos A, Popkirov S, Lahmann C, Jöbges M, Herrmann C, Maner P, Schörner K, Birke G, Hartmann A. Illness perception in functional neurological disorder: low illness coherence and personal control. BMJ Neurol Open 2024; 6:e000648. [PMID: 38800069 PMCID: PMC11116876 DOI: 10.1136/bmjno-2024-000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Illness perception refers to patients' subjective representations and appraisals of somatic and mental symptoms. These are relevant for self-management and outcome. In clinical practice, patients with functional neurological disorder (FND) often encounter a fragmented biomedical attitude, which leaves them without clear concepts. In this context, illness perception is relevant. Methods Illness perception was assessed in FND patients and compared with samples of psychosomatic patients (PSM) as well as poststroke patients (STR). The three samples (FND, n=87; PSM, n=97 and STR, n=92) were almost all in inpatient treatment or rehabilitation. Illness perception was assessed with the revised German version of the Illness Perception Questionnaire (IPQ-R). For assessments of correlations, depressive symptoms were tested with the Patient Health Questionnaire-9, dissociative and functional neurological symptoms by the German adaption of the Dissociative Experiences Scale and biopsychosocial complexity by the INTERMED Self-Assessment questionnaire. Results Apart from the chronicity subscale, all dimensions of the IPQ-R differed between groups. FND patients perceived lower illness coherence and personal control than both other groups and attributed their illness more to chance than to behavioural risk factors. PSM patients had the strongest emotional representations. There were only few correlations with dissociative scores and biopsychosocial complexity. Conclusion Illness perception is an important issue in patients with FND with particular emphasis on low illness coherence and personal control. Missing associations with biopsychosocial complexity suggest that subjective illness perception is an important complementary but separate issue, which likely influences therapeutic alliance and self-management in FND. Future studies should assess its influences on outcome. Trial registration number DRKS00024685; German Clinical Trials Register; www.drks.de.
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Affiliation(s)
- Andreas Joos
- Psychosomatic Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Claas Lahmann
- Psychosomatic Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Michael Jöbges
- Kliniken Schmieder Konstanz, Konstanz, Baden-Württemberg, Germany
| | | | - Philipp Maner
- Psychosomatic Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kai Schörner
- Kliniken Schmieder Gailingen, Gailingen, Baden-Württemberg, Germany
| | - Gunnar Birke
- Kliniken Schmieder Gailingen, Gailingen, Baden-Württemberg, Germany
| | - Armin Hartmann
- Psychosomatic Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Kuanar Baboo AG, Ranjan P, Kaur T, Rawat N, Sarkar S, Kaloiya G, Singh A, Babu N, Baitha U, Prakash B. Evaluation of Tools to Assess Symptoms and Symptom Severity in Patients With Medically Unexplained Physical Symptoms: A Systematic Review and Narrative Synthesis. Cureus 2024; 16:e56204. [PMID: 38618386 PMCID: PMC11016182 DOI: 10.7759/cureus.56204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
A substantial portion of patients presenting to healthcare settings exhibit physical symptoms lacking clear, demonstrable organic causes. Accurate assessment of symptom severity is crucial for documenting outcomes and establishing treatment efficacy. This systematic review and narrative synthesis aims to provide researchers with insights into available and validated tools for assessing medically unexplained physical symptoms (MUPS). It involved comprehensive searches across electronic databases, including PubMed, Wiley, and Cochrane, adhering to PRISMA and COSMIN guidelines. The study comprised two phases: Phase 1 systematically reviewed tools for assessing MUPS symptoms and severity, while Phase 2 conducted a narrative synthesis of their measurement properties, focusing on validity and reliability. Out of 14,459 records, 191 articles were identified, leading to the recognition of 16 validated tools for assessing MUPS symptoms and severity. Most tools demonstrated excellent internal consistency and structural validity. However, the majority lacked cross-cultural validity. The choice of tools for the assessment of MUPS will assist clinicians and researchers in determining the severity of MUPS and developing a tailored treatment plan to improve the physical and psychological functioning of these patients.
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Affiliation(s)
| | - Piyush Ranjan
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Tanveer Kaur
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Nandini Rawat
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Siddharth Sarkar
- Psychiatry, All India Institute of Medical Sciences, New Delhi, IND
| | | | - Amandeep Singh
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Natesh Babu
- Yoga, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, IND
| | - Upendra Baitha
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Bindu Prakash
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
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Aakansha, Singh A, Ranjan P, Kaur T, Rawat N, Sarkar S, Kaloiya GS, Sahu A, Deb KS, Baitha U. Development and Validation of a Symptom Scale for Indian Patients With Medically Unexplained Physical Symptoms. Cureus 2024; 16:e55956. [PMID: 38618330 PMCID: PMC11009479 DOI: 10.7759/cureus.55956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Patients with medically unexplained physical symptoms (MUPS) account for a substantial proportion of patients visiting the outpatient department. Diagnosis of MUPS is a challenge for most physicians. An accurate diagnosis relies on obtaining a detailed history from patients regarding the nature of their symptoms, their onset, and any associated aggravating or relieving factors. This study aims to develop a symptom scale for Indian patients with MUPS. Methods The study had a mixed-method study design. Phase 1 involved designing the questionnaire using qualitative techniques, such as literature reviews, focus-group discussions, expert evaluation, and pre-testing of a Hindi and English language Likert-rated interviewer-administered scale. In phase 2, the construct validity of the questionnaire was established using quantitative approaches among 116 patients diagnosed with MUPS. Results The final questionnaire consists of 38 items, with good internal consistency (Cronbach 𝛂 = 0.916). Confirmation sampling adequacy for factor analysis was done using the Kaiser-Meyer-Olkin test (KMO value = 0.792) and Bartlett's test of sphericity (p < 0.001). The newly developed scale showed a Pearson correlation coefficient of 0.568 (p < 0.001) with Patient Health Questionnaire (PHQ)-15 scores. Conclusion A reliable and valid tool has been developed to assess patients' symptoms with MUPS in English and Hindi languages. This questionnaire can be used for assessment, screening, and diagnostic purposes as well as to chart longitudinal changes in patients with MUPS.
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Affiliation(s)
- Aakansha
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Amandeep Singh
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Piyush Ranjan
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Tanveer Kaur
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Nandini Rawat
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Siddharth Sarkar
- Psychiatry, All India Institute of Medical Sciences, New Delhi, IND
| | | | - Anamika Sahu
- Clinical Psychology, All India Institute of Medical Sciences, New Delhi, IND
| | | | - Upendra Baitha
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
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Doering S, Herpertz S, Pape M, Hofmann T, Rose M, Imbierowicz K, Geiser F, Bierling AL, Weidner K, Rademacher J, Michalek S, Morawa E, Erim Y, Teigelack P, Teufel M, Hartmann A, Lahmann C, Peters EMJ, Kruse J, von Boetticher D, Herrmann-Lingen C, Nöhre M, de Zwaan M, Dinger U, Friederich HC, Niecke A, Albus C, Zwerenz R, Beutel M, Sattel HC, Henningsen P, Stein B, Waller C, Hake K, Spitzer C, Stengel A, Zipfel S, Weimer K, Gündel H, Kessler H. The multicenter effectiveness study of inpatient and day hospital treatment in departments of psychosomatic medicine and psychotherapy in Germany. Front Psychiatry 2023; 14:1155582. [PMID: 37608994 PMCID: PMC10440687 DOI: 10.3389/fpsyt.2023.1155582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Background Reliable outcome data of psychosomatic inpatient and day hospital treatment with a focus on psychotherapy are important to strengthen ecological validity by assessing the reality of mental health care in the field. This study aims to evaluate the effectiveness of inpatient and day hospital treatment in German university departments of Psychosomatic Medicine and Psychotherapy in a prospective, naturalistic, multicenter design including structured assessments. Methods Structured interviews were used to diagnose mental disorders according to ICD-10 and DSM-IV at baseline. Depression, anxiety, somatization, eating disorder and posttraumatic stress disorder (PTSD) symptoms, as well as personality functioning were assessed by means of questionnaires on admission and at discharge. Results 2,094 patients recruited by 19 participating university hospitals consented to participation in the study. Effect sizes for each of the outcome criteria were calculated for 4-5 sub-groups per outcome domain with differing severity at baseline. Pre-post effect sizes for patients with moderate and high symptom severity at baseline ranged from d = 0.78 to d = 3.61 with symptoms of PTSD, depression, and anxiety showing the largest and somatization as well as personality functioning showing somewhat smaller effects. Conclusions Inpatient and day hospital treatment in German university departments of Psychosomatic Medicine and Psychotherapy is effective under field conditions. Clinical trial registration https://drks.de/search/de/trial/DRKS00016412, identifier: DRKS00016412.
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Affiliation(s)
- Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Clinical Center for Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Vienna, Austria
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Magdalena Pape
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Tobias Hofmann
- Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthias Rose
- Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katrin Imbierowicz
- Department of Psychosomatic Medicine and Psychotherapy, University of Bonn, Bonn, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University of Bonn, Bonn, Germany
| | - Antonie Louise Bierling
- Department of Psychotherapy and Psychosomatic Medicine, Carl Gustav Carus Faculty of Medicine, Technische Universität, Dresden, Germany
- Institute for Material Science and Nanotechnology, Technical University of Dresden, Dresden, Germany
- Department of Clinical Psychology, Friedrich-Schiller University, Jena, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Carl Gustav Carus Faculty of Medicine, Technische Universität, Dresden, Germany
| | - Jörg Rademacher
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Silke Michalek
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Per Teigelack
- Clinic of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eva Milena Johanne Peters
- Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University of Giessen, Giessen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University of Giessen, Giessen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Dirk von Boetticher
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Ulrike Dinger
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of General Internal Medicine and Psychosomatics, University Hospital, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital, Heidelberg University, Heidelberg, Germany
| | - Alexander Niecke
- Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christian Albus
- Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heribert Christian Sattel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Munich, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Munich, Germany
| | - Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - Karsten Hake
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Andreas Stengel
- Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Campus Fulda, University of Marburg, Marburg, Germany
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