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Sultan N, Swinglehurst D. Living with polypharmacy: a narrative interview study with older Pakistanis in East London. BMC Geriatr 2023; 23:746. [PMID: 37968631 PMCID: PMC10652535 DOI: 10.1186/s12877-023-04392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/06/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Polypharmacy is a growing and major public health issue. It can be burdensome and risky for patients and costly to healthcare systems. Older adults and those from ethnic minority backgrounds are disproportionately affected by polypharmacy. This study focuses on medication practices among Urdu-speaking Pakistani patients, a significant ethnic group in the UK. Most existing research on medication practices within South-Asian communities centres on adherence, leaving the social and moral dimensions of polypharmacy unpacked. Understanding how British Pakistani patients understand and manage polypharmacy in the context of their daily lives is crucial to avoiding harmful polypharmacy. METHODS In-depth narrative interviews were conducted with 15 first-generation Pakistani patients using the Biographical Narrative Interview Method. Participants were recruited from GP practices in East London. All participants were prescribed ten or more regular medications (a pragmatic marker of 'higher risk' polypharmacy) and were aged over 50. Interviews were conducted with a bilingual researcher at home and were designed to elicit narratives of patients' experiences of polypharmacy in the context of their biographies and daily lives. RESULTS Polypharmacy is enacted through networks of interpersonal and socio-material relationships. The doctor-patient relationship and the family network held particular significance to study participants. In addition, participants described emotional bonds between themselves and their medicines, identifying them as 'forces for good'-substances which allowed them to maintain their health through the intercession of God. Meanings attributed to medicines and enacted through these social, emotional, and spiritual relationships contributed to emerging and sustaining polypharmacy. CONCLUSIONS Patients make sense of and manage treatments in culturally specific ways. Developing an understanding of how medication practices in different communities are enacted is important for informing meaningful and effective conversations with patients about their medicines. Our findings contribute to enabling the integration of culturally sensitive approaches to prescribing.
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Affiliation(s)
- Najia Sultan
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Deborah Swinglehurst
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Witt S, Kristensen K, Blömeke J, Hebestreit H, Wocker M, Pfister L, Bullinger M, Tüscher O, Deckert J, Graessner H, Lapstich AM, Zwaan MD, Mundlos C, Quitmann JH. [Quality of Life and Experienced Distress of Patients Suspected of having a Rare (Chronic) Health Condition - Initial Findings from the ZSE-DUO Study]. Psychother Psychosom Med Psychol 2023; 73:9-15. [PMID: 35793670 DOI: 10.1055/a-1814-3998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Patients suspected of having a rare (chronic) health condition have often gone a long way within the healthcare system. To date, little is known about the health-related quality of life of this group of patients. The study aims to describe the health-related quality of life and the perceived distress of patients suspected of having a rare (chronic) health condition and compare the results with standard values of the German population. METHODS Eighty patients suspected of having a rare (chronic) health condition were recruited in the nationwide intervention study "ZSE-DUO" and reported their health-related quality of life and perceived distress using the SF-8 and the Distress-Thermometer. RESULTS The patients rated all eight dimensions of quality of life as well as the physical and mental component scores of the SF-8 significantly lower than the general population. On average, the perceived distress was rated significantly higher. More than 90% of the sample indicated distress in the clinical range. Exhaustion, pain, limited mobility as well as worries and fears were mentioned most frequently as concrete problems, with percentages ranging from 73% to 90% of the total sample. DISCUSSION In comparison to German reference data, patients suspected of having a rare (chronic) health condition report a massive impairment of their quality of life and a high burden, which is especially characterized by physical and emotional problems. The lack of a diagnosis could explain the high proportion of emotional problems, as it can create a form of legitimation of one's own disease experience. CONCLUSION The present results underline the need for research on the psychosocial impact of the possible presence of a rare (chronic) health condition. The high distress and the impact on the physical and psychological quality of life domains also highlight the need for care in this patient group.
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Affiliation(s)
- Stefanie Witt
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Kaja Kristensen
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Janika Blömeke
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Hebestreit
- Zentrum für Seltene Erkrankungen - Referenzzentrum Nordbayern, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Maximilian Wocker
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Pfister
- Zentrum für Seltene Erkrankungen - Referenzzentrum Nordbayern, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Monika Bullinger
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Tüscher
- Zentrum für Seltene Erkrankungen, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Jürgen Deckert
- Zentrum für Seltene Erkrankungen - Referenzzentrum Nordbayern, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Holm Graessner
- Zentrum für Seltene Erkrankungen, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Anne-Marie Lapstich
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover, Germany
| | - Martina de Zwaan
- Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Christine Mundlos
- Allianz Chronischer Seltener Erkrankungen (ACHSE) e.V., Berlin, Germany
| | - Julia Hannah Quitmann
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Stieler M, Pockney P, Campbell C, Thirugnanasundralingam V, Gan L, Spittal M, Carter G. Using the Patient Health Questionnaire to estimate prevalence and gender differences of somatic symptoms and psychological co-morbidity in a secondary inpatient population with abdominal pain. Aust N Z J Psychiatry 2022; 56:994-1005. [PMID: 34482758 DOI: 10.1177/00048674211044639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Somatic disorders and somatic symptoms are common in primary care populations; however, little is known about the prevalence in surgical populations. Identification of inpatients with high somatic symptom burden and psychological co-morbidity could improve access to effective psychological therapies. METHODS Cross-sectional analysis (n = 465) from a prospective longitudinal cohort study of consecutive adult admissions with non-traumatic abdominal pain, at a tertiary hospital in New South Wales, Australia. We estimated somatic symptom prevalence with the Patient Health Questionnaire-15 at three cut-points: moderate (⩾10), severe (⩾15) and 'bothered a lot' on ⩾3 symptoms; and psychological co-morbidity with the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 at standard (⩾10) cut-points. We also examined gender differences for somatic symptoms and psychological co-morbidity. RESULTS Prevalence was moderate (52%), female predominance (odds ratio = 1.71; 95% confidence interval = [1.18, 2.48]), severe (20%), no gender difference (1.32; [0.83, 2.10]) and 'bothered a lot' on ⩾3 symptoms (53%), female predominance (2.07; [1.42, 3.03]). Co-morbidity of depressive, anxiety and somatic symptoms ranged from 8.2% to 15.9% with no gender differences. CONCLUSION Somatic symptoms were common and psychological triple co-morbidity occurred in one-sixth of a clinical population admitted for abdominal pain. Co-ordinated surgical and psychological clinical intervention and changes in clinical service organisation may be warranted to provide optimal care.
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Affiliation(s)
- Melissa Stieler
- College of Health, Medicine and Wellbeing, School of Medicine and Health Sciences, University of Newcastle, Callaghan, NSW, Australia.,Department of Surgery, John Hunter Hospital, Newcastle, NSW, Australia
| | - Peter Pockney
- College of Health, Medicine and Wellbeing, School of Medicine and Health Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Cassidy Campbell
- Department of Surgery, John Hunter Hospital, Newcastle, NSW, Australia
| | | | - Lachlan Gan
- Department of Surgery, John Hunter Hospital, Newcastle, NSW, Australia
| | - Matthew Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Gregory Carter
- College of Health, Medicine and Wellbeing, School of Medicine and Health Sciences, University of Newcastle, Callaghan, NSW, Australia.,Department of Consultation-Liaison Psychiatry, Calvary Mater Newcastle, Waratah, NSW, Australia
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Kimber J, Sullivan N, Anastasides N, Slotkin S, McAndrew LM. Understanding Veterans' Causal Attributions of Physical Symptoms. Int J Behav Med 2021; 28:299-307. [PMID: 32691396 PMCID: PMC7855405 DOI: 10.1007/s12529-020-09918-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Illness beliefs are significant contributors to health outcomes. Beliefs about the cause of physical symptoms are considered particularly important among those with medically unexplained symptoms and illnesses (MUS); yet little is known about causal beliefs among those with the most severe MUS (i.e., Veterans). The goal of the current study was to examine Veteran's causal attributions of their physical symptoms. METHOD A total of 91 combat Veterans with MUS were surveyed using a mixed-methods design about the cause of their physical symptoms, physical symptom severity, and PTSD symptoms. Causal attributions of physical symptoms were analyzed through thematic response analysis and grouped into categories. Chi-square analysis was used to assess the distribution of causal attribution types across Veterans with varying physical symptom severity and PTSD symptom severity. RESULTS Veterans with MUS reported an average of 7.9 physical symptoms, and attributed the cause of their symptoms to seven different categories ("Do not Know," "Stress/Mental Health," "Deployment/Environment," "Functional/Symptom," "Medically Explained," "Medically Unexplained Syndrome," and "Lifestyle"). Exploratory chi-square analysis revealed significant differences in causal attributions across physical symptom severity and severity of PTSD symptoms. Veterans with more severe PTSD and Veterans with more severe physical symptoms were more likely to attribute their MUS to stress/mental health or to a medically unexplained syndrome compared with those with low/no PTSD symptoms and physical symptom severity. Veterans with minimal PTSD and Veterans with minimal physical symptom severity were more likely to attribute the cause of their MUS to lifestyle choices (e.g., exercise/diet) compared with those with high PTSD and physical symptom severity. CONCLUSION Veterans with MUS endorse multiple, varied causal attributions for their physical symptoms, suggesting more complex causal beliefs than typically assumed. This has important implications for patient-provider communication and development of concordance around MUS treatment.
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Affiliation(s)
- Justin Kimber
- Department of Educational and Counseling Psychology, University at Albany, State University of New York, 1400 Washington Ave Ext, Albany, 12222, NY, USA.
| | - Nicole Sullivan
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, 07018, NJ, USA
| | - Nicole Anastasides
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, 07018, NJ, USA
| | - Sarah Slotkin
- Department of Educational and Counseling Psychology, University at Albany, State University of New York, 1400 Washington Ave Ext, Albany, 12222, NY, USA
| | - Lisa M McAndrew
- Department of Educational and Counseling Psychology, University at Albany, State University of New York, 1400 Washington Ave Ext, Albany, 12222, NY, USA
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Baitha U, Deb KS, Ranjan P, Mukherjee A, Bauddh NK, Kaloiya GS, Kumar A, Jadon RS. Estimated prevalence of medically unexplained physical symptoms in the medicine outpatient department of a tertiary care hospital in India. Gen Hosp Psychiatry 2019; 61:47-52. [PMID: 31710858 DOI: 10.1016/j.genhosppsych.2019.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE There is a paucity of scientific evidence from the Indian subcontinent regarding the magnitude and burden of Medically Unexplained Physical Symptoms (MUPS). This study aims to fill the evidence gap by assessing the prevalence and pattern of MUPS amongst patients attending the Medicine Out-Patient Department (OPD). METHODOLOGY The study assessed all consecutive new patients, presenting to the Medicine OPD of a tertiary care center in India over a period of nine months. All consenting patients, between 18 and 60 years of age, irrespective of their reason for consultation were included for the study. The diagnosis in subjects was established by a combination of clinical history, physical examination, and relevant investigations. A diagnosis of MUPS was made in cases with no demonstrable organic cause, and after agreement in the opinion of two independent physicians. All recruited patients with MUPS were subsequently evaluated on a pre-validated symptom checklist of 23 symptoms. RESULTS Out of 976 subjects included, a diagnosis of MUPS was established in 24.6% [95% CI = 21.9-27.3] of the sample. An additional 20.6% met the criteria of persistent MUPS (symptoms >2 months), and 19.7% of subjects had symptom duration of more than three months, meeting the stricter definition for 'persistent MUPS'. Prevalence was significantly higher in females (p = 0.02), and patients of MUPS were significantly younger (p = 0.004) than patients with other diagnoses. MUPS patients on average complained of 13 ± 5 symptoms and sought multiple medical consultations [Median (IQR) = 3 (2 - 6)] in the last one year. Non-specific, general symptoms (94.6%) and various types of pain (93.7%) were the most frequent complaints. Pain symptoms, genitourinary symptoms, palpitation, and nausea were more frequent in females as compared to males. DISCUSSION Medically unexplained symptoms are as common in India as in the west and therefore pose a significant burden on the healthcare delivery systems. There is a need to sensitize the medical fraternity and policymakers for this condition to develop effective services.
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Affiliation(s)
| | | | | | - Aparna Mukherjee
- Wellcome Trust- India Alliance, Department of Pediatrics, AIIMS, New Delhi, India
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Arts MH, Benraad CE, Hanssen D, Hilderink P, de Jonge L, Naarding P, Lucassen P, Oude Voshaar RC. Frailty and Somatic Comorbidity in Older Patients With Medically Unexplained Symptoms. J Am Med Dir Assoc 2019; 20:1150-1155. [DOI: 10.1016/j.jamda.2019.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 12/22/2022]
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Khan S, Lovell K, Lunat F, Masood Y, Shah S, Tomenson B, Husain N. Culturally-adapted cognitive behavioural therapy based intervention for maternal depression: a mixed-methods feasibility study. BMC WOMENS HEALTH 2019; 19:21. [PMID: 30691431 PMCID: PMC6350293 DOI: 10.1186/s12905-019-0712-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 01/08/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND British Pakistanis are one of the largest ethnic minority groups living in the UK, with high rates of maternal depression being reported in this population. Evidence suggests that culturally-adapted Cognitive Behavioural Therapy (CBT)-based interventions for depression, may improve clinical outcomes and patient satisfaction. This study was conducted to develop and test the feasibility and acceptability of a culturally-adapted, CBT-based, manual-assisted intervention in British Pakistani mothers experiencing maternal depression. METHODS A mixed-method feasibility study that included qualitative interviews followed by the development of a CBT-based intervention for mothers with mild to moderate depression. Following the qualitative interviews, a CBT-based intervention called the Positive Health Program (PHP) was developed and delivered consisting of 12-weekly sessions. A before and after design was used to explore the feasibility and acceptability of the Positive Health Programme. RESULTS A culturally-adapted CBT-based group intervention (PHP) was acceptable to this group and improvements were reported in depression and health-related quality of life. The women's understanding of 'depression' as a general consensus was in physical terms, but with an onset triggered by psychosocial causes. The most commonly reported factors contributing to depression were marital disharmony, lack of social support, and financial difficulties. Past help offered was primarily antidepressants, which were not welcomed by most of the women. A lack of availability of culturally sensitive interventions and the limited cultural sensitivity of NHS staff was also reported. CONCLUSION This study provides preliminary evidence for the feasibility and acceptability of a CBT-based culturally-adapted group psychological intervention for British Pakistani mothers. TRIAL REGISTRATION Study ethics registration number: 10/H1005/62 (University of Manchester).
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Affiliation(s)
- Sobia Khan
- The University of Manchester, 3rd Floor (East), Jean McFarlane Building, University Place, Oxford Road, Manchester, M13 9PL, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Room 6.322a, Jean McFarlane Building, University Place, Oxford Road, Manchester, M13 9PL, UK
| | - Farah Lunat
- Lancashire Care NHS Foundation Trust, The Mount, Whalley Road, Accrington, BB5 5AD, UK
| | - Yumna Masood
- Cumbria Partnership Foundation Trust, Garburn House, Westmoreland General Hospital, Burton Road, Kendal, LA97RG, UK
| | - Sadia Shah
- Lancashire Care NHS Foundation Trust, The Mount, Whalley Road, Accrington, BB5 5AD, UK
| | - Barbara Tomenson
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Nusrat Husain
- Lancashire Care NHS Foundation Trust, The University of Manchester, 3rd Floor (East), Jean McFarlane Building, University Place, Oxford Road, Manchester, M13 9PL, UK.
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The association between somatic and psychological discomfort and health-related quality of life according to the elderly and non-elderly. Qual Life Res 2017; 27:673-681. [DOI: 10.1007/s11136-017-1715-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 02/06/2023]
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Hanssen DJC, Lucassen PLBJ, Hilderink PH, Naarding P, Voshaar RCO. Health-Related Quality of Life in Older Persons with Medically Unexplained Symptoms. Am J Geriatr Psychiatry 2016; 24:1117-1127. [PMID: 27618643 DOI: 10.1016/j.jagp.2016.07.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 06/27/2016] [Accepted: 07/06/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Research on health-related quality of life (HRQoL) in older persons with medically unexplained symptoms (MUS) is scarce, and, in contrast with younger patients, interactions with chronic somatic diseases are more complex. DESIGN In the current study we compared HRQoL between older persons with MUS and older persons with medically explained symptoms (MES). Our study sample consisted of 118 older MUS-patients and 154 older MES-patients. SETTING/MEASUREMENTS The diagnosis of MUS was ascertained by the general practitioner and confirmed by a geriatrician within a multidisciplinary diagnostic assessment. Additional characteristics, including the HRQoL (Short Form-36), were assessed during a home visit. MES-patients received two home visits to assess all measures. Multiple linear regression analyses, adjusted for age, sex, education, cognitive functioning, and psychiatric diagnoses, were performed to assess the relationship between group (MUS/MES) and HRQoL. Analyses were repeated with additional adjustments for somatization and hypochondriacal cognitions. RESULTS Older patients with MUS had a significantly lower level of HRQoL compared with older patients with MES. Even after adjustments, the presence of MUS was still associated with both a lower physical and mental HRQoL. These associations disappeared, however, after additional adjustments for somatization and hypochondriacal cognitions. Within the subgroup of MUS-patients, higher levels of hypochondriac anxiety and of somatization were significantly associated with both lower physical and mental HRQoL. CONCLUSIONS Associations between HRQoL and late-life MUS disappear when corrected for somatization and hypochondriacal cognitions, which is in line with the DSM-5 classification of somatic symptom disorder. Appropriate psychological treatment seems needed to improve HRQoL in older MUS-patients.
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Affiliation(s)
- Denise J C Hanssen
- Department of Psychiatry, Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Peter L B J Lucassen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Peter H Hilderink
- SeniorBeter, Practice for Old Age Psychiatry, Gendt, The Netherlands
| | - Paul Naarding
- Department of Old-Age Psychiatry, GGNet, Apeldoorn, The Netherlands
| | - Richard C Oude Voshaar
- University Center for Psychiatry and the Interdisciplinary Center for Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, The Netherlands
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Hilderink PH, Collard R, Rosmalen JGM, Oude Voshaar RC. How does ageing affect the impact of medically unexplained symptoms and medically explained symptoms on health-related quality of life? Int J Geriatr Psychiatry 2015; 30:737-43. [PMID: 25349149 DOI: 10.1002/gps.4219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 08/30/2014] [Accepted: 09/05/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Physical symptoms significantly impair health-related quality of life (HRQoL), but age effects and differential effects of medically unexplained symptoms (MUS) and medically explained symptoms (MES) have hardly been examined. Our objective was to determine the effect of age on the impact of MUS and MES on HRQoL. METHODS In a population-based cohort (n = 946, aged 28-75 years), MUS and MES were measured using the Composite International Diagnostic Interview and HRQoL using the EuroQol-5 dimensions (EQ-5D). Using multiple linear regression, we regressed MUS, MES and their interaction with age on HRQoL, adjusted for socio-demographic variables and the presence of depressive and anxiety disorders. In case of significant interaction terms, age-stratified results will be presented. RESULTS In the whole study population, the association between MUS and HRQoL was stronger (β = -0.35; p < 0.001) than between MES and HRQoL (β = -0.26; p < 0.001). Adjusted for depressive and anxiety disorders, differences between these associations decline (MUS: β = -0.28, p < 0.001; MES: β = -0.25, p < 0.001). Age significantly interacted with number of MUS in explaining variance in HRQoL but not with the number of MES. The impact of MUS on HRQoL is much larger in people aged below 65 years (β = -0.39, p < 0.001) versus those aged 65 years and over (β = -0.21, p = 0.002). In the older group, the association between MUS and HRQoL lost significance when adjusted for depressive and anxiety disorders (β = -0.12 p = 0.062). CONCLUSION Our results show that age affects the association between MUS and HRQoL, which suggest that older persons cope better with MUS than younger persons.
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Affiliation(s)
| | - Rose Collard
- Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen Centre for Evidence-Based Practice, Nijmegen, Netherlands
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Ferrari S, Burian R, Hahn E, Chaudhry N, Chaudhry IB, Husain N, Ta TMT, Diefenbacher A, Qureshi A, Berardi D, Braca M, Tarricone I. Somatization among ethnic minorities and immigrants: Why does it matter to Consultation Liaison Psychiatry? J Psychosom Res 2015; 79:85-6. [PMID: 25840950 DOI: 10.1016/j.jpsychores.2015.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 01/29/2015] [Accepted: 02/16/2015] [Indexed: 11/24/2022]
Affiliation(s)
- S Ferrari
- Department of Diagnostic-Clinical Medicine and Public Health, Section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy.
| | - R Burian
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelical Hospital Königin Elisabeth Herzberge, Berlin, Germany.
| | - E Hahn
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Germany.
| | - N Chaudhry
- University of Manchester, Lancashire Care Early Intervention Service, Manchester, UK.
| | - I B Chaudhry
- University of Manchester, Lancashire Care Early Intervention Service, Manchester, UK.
| | - N Husain
- University of Manchester, Lancashire Care Early Intervention Service, Manchester, UK.
| | - T M T Ta
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelical Hospital Königin Elisabeth Herzberge, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Germany.
| | - A Diefenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelical Hospital Königin Elisabeth Herzberge, Berlin, Germany
| | - A Qureshi
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - D Berardi
- Bologna Trans-cultural Psychosomatic Team, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
| | - M Braca
- Bologna Trans-cultural Psychosomatic Team, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - I Tarricone
- Bologna Trans-cultural Psychosomatic Team, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
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Husain MI, Chaudhry N, Morris J, Zafar SN, Jaffery F, Rahman R, Duddu V, Husain N. Psychosocial correlates, psychological distress, and quality of life in patients with medically unexplained symptoms: a primary care study in Karachi, Pakistan. Int J Psychiatry Med 2015; 48:235-51. [PMID: 25817521 DOI: 10.2190/pm.48.4.a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the psychosocial correlates and association of psychological distress and quality of life (QOL) in patients with medically unexplained symptoms (MUS) compared to those with medically explained symptoms (MES) in a primary care setting in Karachi, Pakistan. METHODS A cross-sectional study of 472 patients attending GP clinics between March and August 2009 in Karachi. Participants completed questionnaires to assess demographic details, somatic symptoms, anxiety, depression, and QOL. The patients' GP recorded whether the presenting complaint was medically unexplained or medically explained. RESULTS MUS subjects in our study were more educated, had better social support and fewer financial problems, were less depressed and had a better QOL than subjects who had medically explained symptoms (non-MUS). Both groups (MUS and non-MUS) were comparable in terms of anxiety and number of somatic symptoms, but non-MUS subjects were more depressed than the MUS group. In a regression analysis, the number of somatic symptoms and lower levels of anxiety predicted poorer QOL in this sample. Whether these symptoms were medically explained (or not) did not seem to contribute significantly to the QOL. CONCLUSION Our findings confirm that even in the developing world, patients with MUS are common among primary care attendees. However, patients with MUS in urban Karachi, Pakistan may differ from Western MUS subjects in the role of stress, support, and anxiety in their presentation, and may be reflective of a conceptually different group of difficulties.
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Röhricht F, Elanjithara T. Management of medically unexplained symptoms: outcomes of a specialist liaison clinic. PSYCHIATRIC BULLETIN 2014; 38:102-7. [PMID: 25237518 PMCID: PMC4115375 DOI: 10.1192/pb.bp.112.040733] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 04/16/2013] [Accepted: 06/04/2013] [Indexed: 12/31/2022]
Abstract
Aims and method Service utilisation and clinical outcomes of a newly developed specialist primary-secondary care liaison clinic for patients with medically unexplained symptoms (MUS) were evaluated in a cross-sectional and feasibility pilot study. The impact of body-oriented psychological therapy (BOPT) was explored in a small cohort of patients with an identified somatoform disorder. Results Of 147 consecutive referrals, 113 patients engaged with the assessment process. Of patients with MUS, 42% (n = 45) had a primary diagnosis of somatoform disorder, 36% (n = 38) depressive disorder, and depressive symptoms (even subsyndromal) mediated the effect of somatic symptoms. A marked variation of presenting complaints and service utilisation across ethnic groups was noted. A significant reduction in somatic symptom levels and service utilisation was achieved for patients undergoing BOPT. Clinical implications A high proportion of patients with MUS have undiagnosed and therefore untreated mental disorders. New and locally derived collaborative care models of active engagement in primary care settings are required. Patients with somatoform disorder may benefit from BOPT; this requires further evaluation in adequately powered clinical trials.
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Affiliation(s)
- Frank Röhricht
- East London NHS Foundation Trust and University of Essex
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Creed FH, Tomenson B, Chew-Graham C, Macfarlane GJ, Davies I, Jackson J, Littlewood A, McBeth J. Multiple somatic symptoms predict impaired health status in functional somatic syndromes. Int J Behav Med 2014; 20:194-205. [PMID: 22932928 DOI: 10.1007/s12529-012-9257-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The relationship between functional somatic syndromes and multiple somatic symptoms is unclear. PURPOSE We assessed whether the number of somatic symptoms is a predictor of health status in three functional somatic syndromes (FSS). METHODS In a population-based study of 990 UK adults we assessed chronic widespread pain (CWP), chronic fatigue (CF) and irritable bowel syndrome (IBS) by questionnaire and medical record data. We assessed health status (Short Form 12 and EQ-5D), number of somatic symptoms (Somatic Symptom Inventory) and anxiety/depression (Hospital Anxiety and Depression Scale) both at baseline and at follow-up 1 year later. RESULTS The proportion of people with an FSS who also have multiple somatic symptoms (52-55 %) was similar in the three functional syndromes. The presence of multiple somatic symptoms was associated with more impaired health status both at baseline and at follow-up. This finding was not explained by severity of FSS. In the absence of multiple somatic symptoms, the health status of the FSS was fair or good. In multiple regression analysis, the number of somatic symptoms, the presence of a functional syndrome (CWP or CF) and anxiety/depression were predictors of EQ-5D thermometer at follow-up after adjustment for confounders. CONCLUSIONS Multiple somatic symptoms in people with an FSS are associated with impaired health status and this cannot be explained by more severe functional syndrome or the presence of anxiety and depression.
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Affiliation(s)
- F H Creed
- School of Community Based Medicine, University of Manchester, Oxford Road, Manchester, UK.
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Gili M, Magallón R, López-Navarro E, Roca M, Moreno S, Bauzá N, García-Cammpayo J. Health related quality of life changes in somatising patients after individual versus group cognitive behavioural therapy: a randomized clinical trial. J Psychosom Res 2014; 76:89-93. [PMID: 24439682 DOI: 10.1016/j.jpsychores.2013.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/28/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess changes in health related quality of life after a cognitive behavioural program for patients diagnosed with abridged somatization disorder in primary care. METHOD A multicentre, randomized, parallel group, controlled trial was designed. 168 patients were recruited from 29 primary health care centres in Spain and were randomly assigned to one of the three study arms: treatment as usual improved with Smith's norms, individual cognitive behavioural treatment, and group cognitive behavioural treatment. Health-related quality of life was assessed using SF-36 Health Survey. RESULTS Individual cognitive behavioural treatment achieves greater changes in health related quality of life than group cognitive behavioural therapy and treatment as usual. Improvement in health related quality of life was fully observed at 12 month, and partially at 6 months. The modality of intervention interacts with time in all dimensions except for Physical functioning and Vitality. Patients who received individual cognitive behavioural therapy treatment had better scores in Physical and Mental health summary measures at 12 month follow-up. CONCLUSIONS Individual cognitive behavioural treatment is the most effective way to improve health related quality of life in abridged somatization disorder patients, and its effects are sustained over time. Also, regardless of the type of intervention, physical functioning improves compared with treatment as usual.
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Affiliation(s)
- Margalida Gili
- Institut Universitari d´Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Ctra Valldemossa km 7,5, Palma de Mallorca, Spain; Red de Actividades Preventivas y Promoción de la Salud en Atención Primaria (RedIAPP), Avda Gran Via de les Corts Catalanes, 587 Ático, Barcelona, Spain.
| | - Rosa Magallón
- Red de Actividades Preventivas y Promoción de la Salud en Atención Primaria (RedIAPP), Avda Gran Via de les Corts Catalanes, 587 Ático, Barcelona, Spain; Arrabal Health Center, Department of Family Medicine, C/Andador Aragües del Puerto, 2-4, Zaragoza, Spain.
| | - Emilio López-Navarro
- Institut Universitari d´Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Ctra Valldemossa km 7,5, Palma de Mallorca, Spain; Red de Actividades Preventivas y Promoción de la Salud en Atención Primaria (RedIAPP), Avda Gran Via de les Corts Catalanes, 587 Ático, Barcelona, Spain.
| | - Miquel Roca
- Institut Universitari d´Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Ctra Valldemossa km 7,5, Palma de Mallorca, Spain; Red de Actividades Preventivas y Promoción de la Salud en Atención Primaria (RedIAPP), Avda Gran Via de les Corts Catalanes, 587 Ático, Barcelona, Spain.
| | - Sergio Moreno
- Facultad de Ciencias de la Salud, University San Jorge, Autovía A-23, Km 299, Zaragoza, Spain.
| | - Natalia Bauzá
- Institut Universitari d´Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Ctra Valldemossa km 7,5, Palma de Mallorca, Spain.
| | - Javier García-Cammpayo
- Red de Actividades Preventivas y Promoción de la Salud en Atención Primaria (RedIAPP), Avda Gran Via de les Corts Catalanes, 587 Ático, Barcelona, Spain; Miguel Servet University Hospital, Instituto Aragonés de Ciencias de la Salud, Department of Psychiatry, University of Zaragoza, Avenida San Juan Bosco, n(∘)13, Zaragoza, Spain.
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Antidepressant and Group Psychosocial Treatment for Depression: A Rater Blind Exploratory RCT from a Low Income Country. Behav Cogn Psychother 2013; 42:693-705. [DOI: 10.1017/s1352465813000441] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Research in the West shows that group psychological intervention together with an antidepressant treatment leads to more effective treatment of a depressive disorder. There are no treatment trials from low income countries comparing the efficacy of antidepressant treatment with a group psychological intervention. Aim: To conduct a feasibility trial to compare the efficacy of an antidepressant to a group psychosocial intervention, for low income women attending primary health care in Karachi, Pakistan. Method: This was a preliminary RCT in an urban primary health care clinic in Karachi, Pakistan. Consecutive eligible women scoring >12 on the CIS-R and >18 on Hamilton Depression Rating Scale (HDRS) (n = 66) were randomly assigned to antidepressants or a psychosocial treatment in group settings. The primary outcome measure was HDRS score; secondary outcome measures were disability and quality of life. Results: More than half of the patients in both groups improved (50% reduction in HDRS scores); at end of therapy at 3 months 19 (59.4%) vs 18 (56.2%), and at 6-month follow-up 21(67.7%) vs 20(62.5%) for antidepressants and psychosocial intervention respectively. Although HDRS, BDQ and EQ5-D scores all improved considerably in both groups from start to end of treatment, and these improvements were largely maintained after a further 3 months, the differences between the two treatments were not statistically significant. Conclusion: Psychosocial intervention was as effective as antidepressants in reducing depression and in improving quality of life and disability at the end of therapy. However, these findings need further exploration through a larger trial.
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Bruusgaard D, Tschudi-Madsen H, Ihlebæk C, Kamaleri Y, Natvig B. Symptom load and functional status: results from the Ullensaker population study. BMC Public Health 2012; 12:1085. [PMID: 23249448 PMCID: PMC3540018 DOI: 10.1186/1471-2458-12-1085] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 12/12/2012] [Indexed: 11/24/2022] Open
Abstract
Background There is evidence to support that the number of self-reported symptoms is a strong predictor of health outcomes. In studies examining the link between symptoms and functional status, focus has traditionally been on individual symptoms or specific groups of symptoms. We aim to identify associations between the number of self-reported symptoms and functional status. Methods A questionnaire was sent to people in seven age groups (N = 3227) in Ullensaker municipality in Southern Norway. The Standardised Nordic Questionnaire and the Subjective Health Complaints Inventory were used to record 10 musculoskeletal symptoms and 13 non-musculoskeletal symptoms, respectively. Four COOP-WONCA charts were used to measure functional status. Results We found a strong linear association between the number of self-reported symptoms and functional status. The number of symptoms explained 39.2% of the variance in functional status after adjusting for the effects of age and sex. Including individual symptoms instead of only the number of symptoms made little difference to the effect of musculoskeletal pain but affected the influence of non-muscular symptoms. Including even minor problems captured substantially more of the variance in functional status than including only serious problems. Conclusions The strong association between the number of symptoms and functional status, irrespective of type of symptom, might indicate that the symptoms share some common characteristics. The simple act of counting symptoms may provide an approach to study the relationships between health and function in population studies and might be valuable in research on medically unexplained conditions.
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Affiliation(s)
- Dag Bruusgaard
- Department of Community Health Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Khoo EM, Mathers NJ, McCarthy SA, Low WY. Somatisation disorder and its associated factors in multiethnic primary care clinic attenders. Int J Behav Med 2012; 19:165-73. [PMID: 21562781 DOI: 10.1007/s12529-011-9164-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Somatisation disorder (SD) has been reported as common in all ethnic groups, but the estimates of its prevalence have varied and the evidence for its associated factors has been inconsistent. PURPOSE This study seeks to determine the prevalence of SD and its associated factors in multiethnic primary care clinic attenders. METHODS This cross-sectional study was on clinic attenders aged 18 years and above at three urban primary care clinics in Malaysia. The operational definition of SD was based on ICD-10 criteria for SD for research, frequent attendance, and excluded moderate to severe anxiety and depression. The instruments used were the ICD-10 symptom list, the Hospital Anxiety and Depression Scale, a semi-structured questionnaire, and SF-36. RESULTS We recruited 1,763 patients (response rate 63.8%). The mean age of respondents was 44.7 ± 15.8 years, 807 (45.8%) were male; there were 35.3% Malay, 30.1% Chinese and 34.6% Indian. SD prevalence was 3.7%; the prevalence in Malay was 5.8%, Indian 3.0% and Chinese 2.1%. Significant associations were found between SD prevalence and ethnicity, family history of alcoholism, blue-collar workers and the physical component summary (PCS) score of SF-36. Multivariate analysis showed that SD predictors were Malay ethnicity (OR 2.7, 95% CI 1.6, 4.6), blue-collar worker (OR 2.0, 95% CI 1.2, 3.5) and impaired PCS score of SF-36 (OR 0.92, 95% CI 0.90, 0.95). CONCLUSION The prevalence of SD was relatively uncommon with the stringent operational criteria used. SD preponderance in blue-collar workers may be attributable to secondary gain from getting sickness certificates and being paid for time off work.
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Affiliation(s)
- E M Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Soler JK, Okkes I. Reasons for encounter and symptom diagnoses: a superior description of patients' problems in contrast to medically unexplained symptoms (MUS). Fam Pract 2012; 29:272-82. [PMID: 22308181 DOI: 10.1093/fampra/cmr101] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This is a review of the literature on the role of symptoms in family practice, with a focus on the diagnostic approach in family medicine (FM). We found two, contrasting, approaches to reducing symptoms presented by patients in primary care, especially those which do not immediately allow the definition of a disease-label diagnosis. Years of research into 'medically unexplained symptoms' (MUS) has failed to support an international body of knowledge and cannot convincingly support the philosophy on which the reduction itself is based. This review supports the approach of researching reasons for encounter as they present to the family doctor, without artificial mind-body metaphors. The medical model is shown to be an incomplete reduction of FM, and the concept of MUS fails to improve this situation. A new model based on a substantial paradigm shift is needed. That model should be the biopsychosocial model, reflected in the philosophical concepts of the International Classification of Primary Care and the value of the patient's 'reason for encounter'. There is more to life than medicine may diagnose, and FM should strive to move closer to the lives of our patients than the medical model alone could allow.
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Affiliation(s)
- Jean Karl Soler
- Faculty of Life and Health Sciences, University of Ulster, Coleraine, Northern Ireland.
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Husain MI, Duddu V, Husain MO, Chaudhry IB, Rahman R, Husain N. Medically unexplained symptoms--a perspective from general practitioners in the developing world. Int J Psychiatry Med 2012; 42:1-11. [PMID: 22372021 DOI: 10.2190/pm.42.1.a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES In this study, we explored the attitudes toward Medically Unexplained Symptoms (MUS) of 500 general practitioners (GPs) in Karachi, Pakistan. Using a questionnaire previously developed by Reid et al. (2001), we aimed to investigate whether GPs' attitudes toward medically unexplained symptoms are similar to those of GPs in the developed world. METHODS Five hundred GPs on the database of primary care centers at the Pakistan Institute of Learning and Living in Karachi were all sent a covering letter explaining the purpose of the survey with a case vignette, a questionnaire, and a stamped addressed envelope. One month later, non-respondents received a telephone call from an investigator to remind them of the study. RESULTS Of the 429 respondents, 68.5% (294) were male and 31.5% (135) female. Although 80.2% of respondents felt that the main role of GPs was to provide support and reassurance, 76.9% of respondents also agreed that GPs had a role in referring patients with MUS for further investigations to identify a cause. Two hundred and four (47.55%) respondents agreed that somatization was useful concept, only 146 (34.03%) felt that there was effective treatment for it. CONCLUSION For the most part, Pakistani GPs' attitudes toward MUS are not very different to those of their counterparts in the West. Both agree that the GP has an important role in providing reassurance and counseling. However, our survey also shows that Pakistani GPs are less likely to place emphasis on an underlying psychiatric diagnosis and tend to focus on looking for an underlying physical cause.
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Affiliation(s)
- Muhammad Ishrat Husain
- Department of Psychiatry, South West London and St George's NHS Trust, Springfield University Hospital, London, UK.
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The detection of mood and anxiety in people with epilepsy using two-phase designs: Experiences from a tertiary care centre in Oman. Epilepsy Res 2012; 98:174-81. [DOI: 10.1016/j.eplepsyres.2011.09.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 09/16/2011] [Accepted: 09/17/2011] [Indexed: 11/22/2022]
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[Medically unexplained and somatoform complaints and disorders in the elderly: a systematic review of the literature]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2011; 57:115-40. [PMID: 21626477 DOI: 10.13109/zptm.2011.57.2.115] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To provide a systematic overview of the research concerning the frequency of medically unexplained, somatoform complaints and disorders in the elderly, their risk factors, comorbidity, course, management in primary and secondary care, and psychotherapy. METHOD We evaluated 248 clinical and randomized trials, reviews, meta-analyses and practice guidelines for adult samples identified from "PubMed" and "PsycInfo" using the search terms "somatoform" OR "medically unexplained" OR "somatization" OR "somatisation" in combination with other terms for their relevance for the elderly. Other relevant trials were identified from the references from these publications. RESULTS Medically unexplained, somatoform complaints and disorders occur in older persons and are more frequent in elderly women than in elderly men. Although many studies found no increased frequency of somatoform complaints in the elderly, based on present research we cannot draw final conclusions concerning the frequency of somatoform disorders and complaints in the elderly, and we cannot give evidence based recommendations for their treatment in primary and secondary care and psychotherapy. DISCUSSION This situation results from the special problems encountered in the diagnosis of somatoform complaints and disorders in the elderly, from problems in conceptualisation also found in younger adults, and from the lack of research concerning treatment focussed solely on the old and very old.
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Matalon A, Kotliroff A, Blumberg G, Yaphe J, Kitai E. Non-specific symptoms as clues to changes in emotional well-being. BMC FAMILY PRACTICE 2011; 12:77. [PMID: 21791042 PMCID: PMC3160367 DOI: 10.1186/1471-2296-12-77] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 07/26/2011] [Indexed: 11/26/2022]
Abstract
Background - Somatic symptoms are a common reason for visits to the family physician. The aim of this study was to examine the relation between non-specific symptoms and changes in emotional well-being and the degree to which the physician considers the possibility of mental distress when faced with such patients. Methods - Patients who complained of two or more symptoms including headache, dizziness, fatigue or weakness, palpitations and sleep disorders over one year were identified from the medical records of a random sample of 45 primary care physicians. A control group matched for gender and age was selected from the same population. Emotional well-being was assessed using the MOS-SF 36 in both groups. Results - The study group and the control group each contained 110 patients. Completed MOS questionnaires were obtained from 92 patients, 48 patients with somatic symptoms and 44 controls. Sixty percent of the patients with somatic symptoms experienced decreased emotional well being compared to 25% in the control group (p = 0.00005). Symptoms of dizziness, fatigue and sleep disturbances were significantly linked with mental health impairments. Primary care physicians identified only 6 of 29 patients (21%) whose responses revealed functional limitations due to emotional problems as suffering from an emotional disorder and only 6 of 23 patients (26%) with a lack of emotional well being were diagnosed with an emotional disorder. Conclusions - Non-specific somatic symptoms may be clues to changes in emotional well-being. Improved recognition and recording of mental distress among patients who complain of these symptoms may enable better follow up and treatment.
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Affiliation(s)
- Andre Matalon
- Department of Family Medicine, Faculty of Medicine, Tel-Aviv University, Ramat Aviv, 69978, Israel
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Husain N, Chaudhry N, Durairaj SV, Chaudhry I, Khan S, Husain M, Nagaraj D, Naeem F, Waheed W. Prevention of: self harm in British South Asian women: study protocol of an exploratory RCT of culturally adapted manual assisted Problem Solving Training (C- MAP). Trials 2011; 12:159. [PMID: 21693027 PMCID: PMC3132723 DOI: 10.1186/1745-6215-12-159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 06/21/2011] [Indexed: 12/02/2022] Open
Abstract
Background Suicide is a major public health problem worldwide. In the UK suicide is the second most common cause of death in people aged 15-24 years. Self harm is one of the commonest reasons for medical admission in the UK. In the year following a suicide attempt the risk of a repeat attempt or death by suicide may be up to 100 times greater than in people who have never attempted suicide. Research evidence shows increased risk of suicide and attempted suicide among British South Asian women. There are concerns about the current service provision and its appropriateness for this community due to the low numbers that get involved with the services. Both problem solving and interpersonal forms of psychotherapy are beneficial in the treatment of patients who self harm and could potentially be helpful in this ethnic group. The paper describes the trial protocol of adapting and evaluating a culturally appropriate psychological treatment for the adult British South Asian women who self harm. Methods We plan to test a culturally adapted Problem Solving Therapy (C- MAP) in British South Asian women who self harm. Eight sessions of problem solving each lasting approximately 50 minutes will be delivered over 3 months. The intervention will be assessed using a prospective rater blind randomized controlled design comparing with treatment as usual (TAU). Outcome assessments will be carried out at 3 and 6 months. A sub group of the participants will be invited for qualitative interviews. Discussion This study will test the feasibility and acceptability of the C- MAP in British South Asian women. We will be informed on whether a culturally adapted brief psychological intervention compared with treatment as usual for self-harm results in decreased hopelessness and suicidal ideation. This will also enable us to collect necessary information on recruitment, effect size, the optimal delivery method and acceptability of the intervention in preparation for a definitive RCT using repetition of self harm and cost effectiveness as primary outcome measures. Trial Registration Current Controlled Trials 08/H1013/6
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Affiliation(s)
- Nusrat Husain
- The Lantern Centre, Lancashire Care NHS Foundation Trust, Vicarage Lane, Fulwood, Preston, Lancashire PR2 8DY, UK
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van Boven K, Lucassen P, van Ravesteijn H, olde Hartman T, Bor H, van Weel-Baumgarten E, van Weel C. Do unexplained symptoms predict anxiety or depression? Ten-year data from a practice-based research network. Br J Gen Pract 2011; 61:e316-25. [PMID: 21801510 PMCID: PMC3103694 DOI: 10.3399/bjgp11x577981] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 11/14/2010] [Accepted: 01/11/2011] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Unexplained symptoms are associated with depression and anxiety. This association is largely based on cross-sectional research of symptoms experienced by patients but not of symptoms presented to the GP. AIM To investigate whether unexplained symptoms as presented to the GP predict mental disorders. DESIGN AND SETTING Cross-sectional and longitudinal analysis of data from a practice-based research network of GPs, the Transition Project, in the Netherlands. METHOD All data about contacts between patients (n = 16,000) and GPs (n = 10) from 1997 to 2008 were used. The relation between unexplained symptoms episodes and depression and anxiety was calculated and compared with the relation between somatic symptoms episodes and depression and anxiety. The predictive value of unexplained symptoms episodes for depression and anxiety was determined. RESULTS All somatoform symptom episodes and most somatic symptom episodes are significantly associated with depression and anxiety. Presenting two or more symptoms episodes gives a five-fold increase of the risk of anxiety or depression. The positive predictive value of all symptom episodes for anxiety and depression was very limited. There was little difference between somatoform and somatic symptom episodes with respect to the prediction of anxiety or depression. CONCLUSION Somatoform symptom episodes have a statistically significant relation with anxiety and depression. The same was true for somatic symptom episodes. Despite the significant odds ratios, the predictive value of symptom episodes for anxiety and depression is low. Consequently, screening for these mental health problems in patients presenting unexplained symptom episodes is not justified in primary care.
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Affiliation(s)
- Kees van Boven
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, The Netherlands
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Creed F. Medically unexplained symptoms--blurring the line between "mental" and "physical" in somatoform disorders. J Psychosom Res 2009; 67:185-7. [PMID: 19686873 DOI: 10.1016/j.jpsychores.2009.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 07/03/2009] [Accepted: 07/03/2009] [Indexed: 11/29/2022]
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Hyphantis T, Tomenson B, Paika V, Almyroudi A, Pappa C, Tsifetaki N, Voulgari PV, Drosos AA, Pavlidis N, Creed F. Somatization is associated with physical health-related quality of life independent of anxiety and depression in cancer, glaucoma and rheumatological disorders. Qual Life Res 2009; 18:1029-42. [DOI: 10.1007/s11136-009-9527-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 08/06/2009] [Indexed: 02/07/2023]
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Creed F. The outcome of medically unexplained symptoms--will DSM-V improve on DSM-IV somatoform disorders? J Psychosom Res 2009; 66:379-81. [PMID: 19379953 DOI: 10.1016/j.jpsychores.2008.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 10/29/2008] [Accepted: 10/29/2008] [Indexed: 10/20/2022]
Affiliation(s)
- Francis Creed
- Psychiatry Research Group, Medical School, Manchester Royal Infirmary, Manchester, England.
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