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Bailey R. Why health anxiety needs NICE clinical guidelines. Lancet Psychiatry 2024; 11:164-165. [PMID: 38218199 DOI: 10.1016/s2215-0366(23)00404-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 01/15/2024]
Affiliation(s)
- Robin Bailey
- School of Psychology, University of Bolton, Bolton BL3 5AB, UK.
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2
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Shen S, Dong Z, Sander JW, Zhou D, Li J. Somatic symptoms and related disorders in a large cohort of people with epilepsy: A cohort study. Epilepsia 2023; 64:320-334. [PMID: 36318105 DOI: 10.1111/epi.17453] [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: 07/07/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study was undertaken to characterize somatic symptoms and related disorders (SSD) in epilepsy. METHODS Adults with epilepsy under active follow-up at a tertiary epilepsy center were consecutively enrolled. The diagnosis of SSD was performed by an experienced psychologist based on the structured clinical interview for Statistical Manual of Mental Disorders, 5th edition. Detailed social/demographic data, epilepsy features, psychiatric features, life quality, disability, and economic burden were collected and compared between people with SSD and those without. Bodily distress syndrome checklist, Somatic Symptom Disorder-B Criteria Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder seven-item scale (GAD-7) were used to evaluate SSD individuals' somatic symptoms, symptom-related psychological distress, and depressive and anxious symptoms. Quality of life and disability were assessed by Quality of Life in Epilepsy Inventory 31 (QOLIE-31) and World Health Organization Disability Assessment Schedule V.2.0 (WHO DAS 2.0). A risk prediction nomogram was generated using least absolute shrinkage and selection operator (LASSO) analysis and validated. RESULTS One hundred fifty of 631 participants (24%) were diagnosed with SSD. In people with SSD, the top three most common somatic symptoms were memory impairment, headache, and dizziness (85%, 80%, and 78%, respectively), and multiple systems were involved in most (82%) people with SSD. Compared with people without SSD, those with SSD had lower QOLIE-31 total scores, and higher WHO DAS 2.0 scores and disease economic burdens. LASSO analysis suggested that a history of severe traumatic brain injury, hippocampal sclerosis, low seizure worry and medication effects scores on QOLIE-31, multiple systems affected by somatic symptoms, and a high GAD-7 score were risk factors of SSD. The nomogram was validated for good accuracy in the training and testing cohorts. SIGNIFICANCE SSD are likely to be a common comorbidity in epilepsy and harm epilepsy prognosis. Our risk prediction nomogram was successfully developed but needs further validation in larger cohorts.
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Affiliation(s)
- Sisi Shen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Zaiquan Dong
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Josemir W Sander
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- University College London Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Stichting Epilepsie Instellingen Nederland, Heemstede, the Netherlands
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinmei Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Huang WC, Liao SC, Huang WL. Chronicity of Somatic Distress and Healthy Anxiety in Patients With Somatic Symptom Disorder: One-Year Follow-up. J Acad Consult Liaison Psychiatry 2022; 63:647-649. [DOI: 10.1016/j.jaclp.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/29/2022] [Accepted: 05/13/2022] [Indexed: 12/15/2022]
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Atasoy S, Hausteiner-Wiehle C, Sattel H, Johar H, Roenneberg C, Peters A, Ladwig KH, Henningsen P. Gender specific somatic symptom burden and mortality risk in the general population. Sci Rep 2022; 12:15049. [PMID: 36065007 PMCID: PMC9445038 DOI: 10.1038/s41598-022-18814-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/19/2022] [Indexed: 11/21/2022] Open
Abstract
Gender specific all-cause mortality risk associated with a high somatic symptom burden (SSB) in a population-based cohort was investigated. The study population included 5679 women and 5861 men aged 25-74 years from the population-based MONICA/KORA Cohort. SSB was assessed following the Somatic Symptom Scale-8 and categorized as very high (≥ 95th percentile), high (60-95th percentile), moderate (30-60th percentile), and low (≤ 30th percentile). The impact of SSB on all-cause mortality risk within a mean follow-up period of 22.6 years (SD 7.1; 267,278 person years) was estimated by gender-specific Cox regression models adjusted for sociodemographic, lifestyle, somatic and psychosocial risk factors, as well as pre-existing medical conditions. Approximately 5.7% of men and 7.3% of women had very high SSB. During follow-up, 3638 (30.6%) mortality cases were observed. Men with a very-high SSB had 48% increased relative risk of mortality in comparison to men with a low SSB after adjustment for concurrent risk factors (1.48, 95% CI 1.20-1.81, p < .0001), corresponding to 2% increased risk of mortality for each 1-point increment in SSB (1.02; 95% CI 1.01-1.03; p = 0.03). In contrast, women with a very high SSB had a 22% lower risk of mortality (0.78, 95% CI 0.61-1.00, p = 0.05) and women with high SSB had an 18% lower risk of mortality (0.82; 95% CI 0.68-0.98, p = 0.03) following adjustment for concurrent risk factors. The current findings indicate that an increasing SSB is an independent risk factor for mortality in men but not in women, pointing in the direction of critical gender differences in the management of SSB, including women's earlier health care utilization than men.
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Affiliation(s)
- Seryan Atasoy
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts Der Isar, University Hospital Rechts Der Isar, Technische Universität München, Langerstr. 3, 81676, Munich, Germany.
- Department of Psychosomatic Medicine and Psychotherapy, University of Giessen and Marburg, Marburg, Germany.
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
| | - Constanze Hausteiner-Wiehle
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts Der Isar, University Hospital Rechts Der Isar, Technische Universität München, Langerstr. 3, 81676, Munich, Germany
- Department of Neurology, BG Trauma Center, Murnau, Germany
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts Der Isar, University Hospital Rechts Der Isar, Technische Universität München, Langerstr. 3, 81676, Munich, Germany
| | - Hamimatunnisa Johar
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Casper Roenneberg
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts Der Isar, University Hospital Rechts Der Isar, Technische Universität München, Langerstr. 3, 81676, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts Der Isar, University Hospital Rechts Der Isar, Technische Universität München, Langerstr. 3, 81676, Munich, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts Der Isar, University Hospital Rechts Der Isar, Technische Universität München, Langerstr. 3, 81676, Munich, Germany
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Le TL, Mylopoulos M, Bearss E, Geist R, Maunder R. Multiple symptoms and health anxiety in primary care: a qualitative study of tensions and collaboration between patients and family physicians. BMJ Open 2022; 12:e050716. [PMID: 35428616 PMCID: PMC9014049 DOI: 10.1136/bmjopen-2021-050716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with multiple, persistent symptoms and health anxiety often report poor health outcomes. Patients who are difficult to reassure are challenging for family physicians. The therapeutic alliance between a physician and a patient can influence the prognosis of these patients. Optimising the quality of the physician-patient alliance may depend on a better understanding of the interpersonal processes that influence this relationship. OBJECTIVE The purpose of this study is to understand the experiences of patients who experience multiple persistent symptoms or high health anxiety and their physicians when they interact. DESIGN, PARTICIPANTS AND SETTING A qualitative study was conducted using grounded theory of 18 patients, purposively sampled to select patients who reported high physical symptom severity, high health anxiety or both, and 7 family physicians in the same clinic. This study was conducted at a family medicine clinic in a teaching hospital. RESULTS A model of interpersonal tension and collaboration for patients and physicians in primary care was developed. Helpful attitudes and actions as well as troublesome topics influence crucial dilemmas between patients and physicians. These dilemmas include if patients feel heard and validated and the alignment of goals and mutual respect of expertise and experience between patients and physicians. These experiences contribute to a constructive collaboration and in turn positive outcomes. CONCLUSIONS This model of patient-physician interaction may facilitate providers to turn their attention away from the contentious topics and towards actions and attitudes that promote beneficial outcomes.
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Affiliation(s)
- Thao Lan Le
- Department of Psychiatry, Sinai Health System, Toronto, Ontario, Canada
| | - Maria Mylopoulos
- Wilson Centre, HoPingKong Centre for Excellence in Education and Practice, University Health Network, Toronto, Ontario, Canada
| | - Erin Bearss
- Mount Sinai Academic Family Health Team, Sinai Health System, Toronto, Ontario, Canada
| | - Rose Geist
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robert Maunder
- Department of Psychiatry, Sinai Health System, Toronto, Ontario, Canada
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Le TL, Geist R, Bearss E, Maunder RG. Childhood adversity and attachment anxiety predict adult symptom severity and health anxiety. CHILD ABUSE & NEGLECT 2021; 120:105216. [PMID: 34303992 DOI: 10.1016/j.chiabu.2021.105216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Childhood adversity is associated with somatization, including physical symptom burden and health anxiety. Attachment theory offers a developmental framework to understand adult somatization, as attachment phenomena are theoretically and empirically related to physiological regulation, affect regulation, and childhood adversity, all of which are relevant to somatization. OBJECTIVE The purpose of this study was to identify the pathways by which childhood adversity and attachment insecurity influence physical symptom burden and health anxiety in adults. PARTICIPANTS AND SETTING Three hundred and fifty-one family medicine patients from a teaching hospital in Toronto, Canada. METHODS A cross-sectional survey study was conducted to assess adverse childhood experiences, attachment insecurity, health anxiety and physical symptom severity in primary care patients. Path Analysis using structural equation modeling (AMOS V.26, IBM, 2019) was used to test the model in which childhood adversity, attachment anxiety, attachment avoidance, symptom severity interact to influence health anxiety. RESULTS The majority of the participants were white (66%), had completed post-secondary education (68%), and reported themselves to be in very good to excellent health (62%). Childhood adversity, attachment anxiety, attachment avoidance, health anxiety and symptom severity are all significantly correlated (ranges of rs = 0.29 to 0.63). Childhood adversity has a significant indirect effect on health anxiety with attachment anxiety and symptom severity as serial mediators (βindirect = 0.237, p = .001 and βdirect = 0.065, p = .244). CONCLUSIONS Overall, this model extends our understanding of the processes underlying adult somatization. Findings support that childhood adversity and attachment anxiety are predictors of symptom severity and health anxiety.
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Affiliation(s)
- Thao Lan Le
- Department of Psychiatry, Sinai Health System, 600 University Avenue, Toronto, Ontario, Canada.
| | - Rose Geist
- Department of Psychiatry, The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada
| | - Erin Bearss
- Mount Sinai Academic Family Health Team, Sinai Health System, 60 Murray St, Toronto, Ontario, Canada
| | - Robert G Maunder
- Department of Psychiatry, Sinai Health System, 600 University Avenue, Toronto, Ontario, Canada
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Khoury JMB, Watt MC, MacLean K. Anxiety Sensitivity Mediates Relations Between Mental Distress Symptoms and Medical Care Utilization During COVID-19 Pandemic. Int J Cogn Ther 2021; 14:515-536. [PMID: 34178209 PMCID: PMC8216097 DOI: 10.1007/s41811-021-00113-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
Anxiety and uncertainty are common during pandemics. The present study extended previous pandemic research by investigating the role of two transdiagnostic risk factors — anxiety sensitivity (AS: fear of physiological anxiety or “fear of fear”; Reiss & McNally, 1985) and intolerance of uncertainty (IU; Buhr & Dugas, 2009) — in explaining relations between mental distress symptoms and behavioural responding during the COVID-19 pandemic. Student and community-based participants (N=457; 87.6% female) were recruited between May and July 2020 to complete measures of anxiety (health, panic, general), depression, and stress. Anxiety and related symptoms were found to be higher than in previous studies. Parallel mediation analyses showed that clinically meaningful levels of mental distress symptoms directly influenced safety behaviours and medical care utilization but also indirectly influenced the latter (vs. former) through AS-physical concerns (vs. IU). CBT interventions, targeting AS-physical concerns, may reduce mental distress symptoms during pandemic and prevent overuse of healthcare.
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Affiliation(s)
- Juliana M B Khoury
- Department of Psychology, St. Francis Xavier University, Antigonish, Nova Scotia Canada
| | - Margo C Watt
- Department of Psychology, St. Francis Xavier University, Antigonish, Nova Scotia Canada.,Departments of Psychology/Neuroscience and Psychiatry, Dalhousie University, Halifax, Nova Scotia Canada
| | - Kim MacLean
- Department of Psychology, St. Francis Xavier University, Antigonish, Nova Scotia Canada
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Kallesøe KH, Rimvall MK, Schröder A, Jensen JS, Wicksell RK, Rask CU. Adolescents with functional somatic syndromes: Symptom profiles, illness perception, illness worry and attachment orientation. J Psychosom Res 2021; 145:110430. [PMID: 33810861 DOI: 10.1016/j.jpsychores.2021.110430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/04/2021] [Accepted: 03/17/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Karen Hansen Kallesøe
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Martin K Rimvall
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Gentofte, Denmark; Department of Child and Adolescent Psychiatry, Psychiatry Region Zealand, Roskilde, Denmark
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Jens Søndergaard Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Ulrikka Rask
- Department of Clinical Medicine, Aarhus University, Denmark; Department of Child and Adolescent Psychiatry, Psychiatry, Aarhus University Hospital, Aarhus, Denmark
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Ma YJ, Wang DF, Yuan M, Long J, Chen SB, Wu QX, Wang XY, Liu TQ. The mediating effect of health anxiety in the relationship between functional somatic symptoms and illness behavior in Chinese inpatients with depression. BMC Psychiatry 2019; 19:260. [PMID: 31455294 PMCID: PMC6712795 DOI: 10.1186/s12888-019-2246-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/19/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Functional somatic symptoms in depression disorder may cause inappropriate illness behavior hindering the treatment process. Health anxiety may play a role in this relationship, but few studies have examined it. The current study aimed to investigate the role of health anxiety in the relationship between functional somatic symptoms and illness behavior in patients with depression. METHODS The present study recruited 323 hospitalized patients with depression to complete the Patient Health Questionnaire-15, Whiteley-Index-7, and Scale for the Assessment of Illness Behavior, then constructed a structural equation model to examine whether health anxiety mediated the relationship between functional somatic symptoms and illness behavior. RESULTS The results showed significant correlations between any two of the three variables of interest. More importantly, health anxiety played a partially mediating role (42.86%) in the relationship between functional somatic symptoms and illness behavior. Further analysis suggested that elderly patients reached higher health anxiety than younger patients when their functional somatic symptoms were mild. CONCLUSIONS These results highlight that health anxiety may mediate the influence of functional somatic symptoms on illness behavior. The implications of assessing and intervening in health anxiety in patients with depression were discussed.
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Affiliation(s)
- Yue-Jiao Ma
- 0000 0001 0379 7164grid.216417.7Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Dong-Fang Wang
- 0000 0001 0379 7164grid.216417.7Psychosomatic health institute of the Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan People’s Republic of China
| | - Ming Yuan
- 0000 0001 0379 7164grid.216417.7Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Jiang Long
- 0000 0001 0379 7164grid.216417.7Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China ,0000 0001 2294 713Xgrid.7942.8Laboratory for Experimental Psychopathology, Psychological, Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Shu-Bao Chen
- 0000 0001 0379 7164grid.216417.7Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Qiu-Xia Wu
- 0000 0001 0379 7164grid.216417.7Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Xu-Yi Wang
- 0000 0001 0379 7164grid.216417.7Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan 410011 People’s Republic of China
| | - Tie-Qiao Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, The China National Clinical Research Center for Mental Health Disorders, Chinese National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, No. 139, Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China.
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Horenstein A, Rogers AH, Bakhshaie J, Zvolensky MJ, Heimberg RG. Examining the Role of Anxiety Sensitivity and Intolerance of Uncertainty in the Relationship Between Health Anxiety and Likelihood of Medical Care Utilization. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9980-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Fergus TA, Kelley LP, Griggs JO. The combination of health anxiety and somatic symptoms: a prospective predictor of healthcare usage in primary care. J Behav Med 2018; 42:217-223. [PMID: 30043146 DOI: 10.1007/s10865-018-9956-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/19/2018] [Indexed: 01/18/2023]
Abstract
Extant research provides equivocal conclusions if the combined presentation of health anxiety with severe somatic symptoms confers risk for greater future primary care usage. The present study further examined the combination of health anxiety and somatic symptoms as a predictor of healthcare usage in primary care. Using a prospective longitudinal design, a large sample (N = 530) of patients presenting for treatment at a community health center completed self-report measures assessing health anxiety and somatic symptom severity. A medical record review at the time of questionnaire administration and 1 year following that administration was completed to assess the frequency of medical visits during the preceding and subsequent year. As expected, the interactive effect between health anxiety and somatic symptom severity predicted greater subsequent year medical visits. Covariates included preceding year medical visits, sociodemographic variables, body mass index, smoking status, and depressive symptom severity. Simple effects indicated that health anxiety predicted greater subsequent year medical visits when coupled with relatively severe, but not mild, somatic symptoms. Assessing health anxiety and somatic symptom severity in primary care settings could be important for identifying individuals at risk for future frequent healthcare visits and who may benefit from intervention.
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Affiliation(s)
- Thomas A Fergus
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, 76798, USA.
| | - Lance P Kelley
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
| | - Jackson O Griggs
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
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12
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An Attachment-Based Model of the Relationship Between Childhood Adversity and Somatization in Children and Adults. Psychosom Med 2017; 79:506-513. [PMID: 27941580 DOI: 10.1097/psy.0000000000000437] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE An attachment model was used to understand how maternal sensitivity and adverse childhood experiences are related to somatization. METHODS We examined maternal sensitivity at 6 and 18 months and somatization at 5 years in 292 children in a longitudinal cohort study. We next examined attachment insecurity and somatization (health anxiety, physical symptoms) in four adult cohorts: healthy primary care patients (AC1, n = 67), ulcerative colitis in remission (AC2, n = 100), hospital workers (AC3, n = 157), and paramedics (AC4, n = 188). Recall of childhood adversity was measured in AC3 and AC4. Attachment insecurity was tested as a possible mediator between childhood adversity and somatization in AC3 and AC4. RESULTS In children, there was a significant negative relationship between maternal sensitivity at 18 months and somatization at age 5 years (B = -3.52, standard error = 1.16, t = -3.02, p = .003), whereas maternal sensitivity at 6 months had no significant relationship. In adults, there were consistent, significant relationships between attachment insecurity and somatization, with the strongest findings for attachment anxiety and health anxiety (AC1, β = 0.51; AC2, β = 0.43). There was a significant indirect effect of childhood adversity on physical symptoms mediated by attachment anxiety in AC3 and AC4. CONCLUSIONS Deficits in maternal sensitivity at 18 months of age are related to the emergence of somatization by age 5 years. Adult attachment insecurity is related to somatization. Insecure attachment may partially mediate the relationship between early adversity and somatization.
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Fergus TA, Kelley LP, Griggs JO. The combination of health anxiety and somatic symptoms: Specificity to anxiety sensitivity cognitive concerns among patients in primary care. Psychiatry Res 2016; 239:117-21. [PMID: 27137971 DOI: 10.1016/j.psychres.2016.02.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/17/2016] [Accepted: 02/27/2016] [Indexed: 12/20/2022]
Abstract
Prior research has found that health anxiety is related to poor patient outcomes in primary care settings. Health anxiety is characterized by at least two presentations: with either severe or no/mild somatic symptoms. Preliminary data indicate that anxiety sensitivity may be important for understanding the presentation of health anxiety with severe somatic symptoms. We further examined whether the combination of health anxiety and somatic symptoms was related to anxiety sensitivity. Participants were adults presenting for treatment at a community health center (N=538). As predicted, the interactive effect between health anxiety and somatic symptoms was associated with anxiety sensitivity cognitive concerns. Health anxiety shared a stronger association with anxiety sensitivity cognitive concerns when coupled with severe, relative to mild, somatic symptoms. Contrary to predictions, the interactive effect was not associated with the other dimensions of anxiety sensitivity. We discuss the potential relevancy of anxiety sensitivity cognitive concerns to the combined presentation of health anxiety and severe somatic symptoms, as well as how this dimension of anxiety sensitivity could be treated in primary care settings.
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Affiliation(s)
- Thomas A Fergus
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA.
| | - Lance P Kelley
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
| | - Jackson O Griggs
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
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Leger KA, Charles ST, Ayanian JZ, Almeida DM. The association of daily physical symptoms with future health. Soc Sci Med 2015; 143:241-8. [PMID: 26364011 PMCID: PMC4601935 DOI: 10.1016/j.socscimed.2015.08.050] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 08/25/2015] [Accepted: 08/27/2015] [Indexed: 11/26/2022]
Abstract
RATIONALE Daily physical symptoms play a critical role in health and illness experiences. Despite their daily prevalence, the ability of these symptoms to predict future health status is debated. OBJECTIVE The current study examined whether physical symptom reports predict future health outcomes independent of trait measures of emotion. METHODS Participants (N = 1189) who completed both Midlife in the United States (MIDUS) Surveys I and II as well as the National Study of Daily Experiences (NSDE) reported their daily physical symptoms at baseline and number of reported chronic conditions and functional disability nearly 10 years later. RESULTS Physical symptoms at baseline significantly predicted the occurrence of chronic conditions and functional impairment at long-term follow-up, even after adjusting for self-reported affect, self-reported health, and previous health status. CONCLUSION Findings suggest that daily physical symptoms are unique indicators of future health status.
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Affiliation(s)
- Kate A Leger
- Department of Psychology and Social Behavior, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, United States.
| | - Susan T Charles
- Department of Psychology and Social Behavior, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, United States.
| | - John Z Ayanian
- Institute for Healthcare Policy and Innovation, Division of General Medicine, Medical School, Department of Health Management and Policy, School of Public Health, Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, United States.
| | - David M Almeida
- Department of Human Development and Human Studies, The Pennsylvania State University, 403 BBH Building, University Park, PA 16802, United States.
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15
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Herzog A, Voigt K, Meyer B, Wollburg E, Weinmann N, Langs G, Löwe B. Psychological and interactional characteristics of patients with somatoform disorders: Validation of the Somatic Symptoms Experiences Questionnaire (SSEQ) in a clinical psychosomatic population. J Psychosom Res 2015; 78:553-62. [PMID: 25840951 DOI: 10.1016/j.jpsychores.2015.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The new DSM-5 Somatic Symptom Disorder (SSD) emphasizes the importance of psychological processes related to somatic symptoms in patients with somatoform disorders. To address this, the Somatic Symptoms Experiences Questionnaire (SSEQ), the first self-report scale that assesses a broad range of psychological and interactional characteristics relevant to patients with a somatoform disorder or SSD, was developed. This prospective study was conducted to validate the SSEQ. METHODS The 15-item SSEQ was administered along with a battery of self-report questionnaires to psychosomatic inpatients. Patients were assessed with the Structured Clinical Interview for DSM-IV to confirm a somatoform, depressive, or anxiety disorder. Confirmatory factor analyses, tests of internal consistency and tests of validity were performed. RESULTS Patients (n=262) with a mean age of 43.4 years, 60.3% women, were included in the analyses. The previously observed four-factor model was replicated and internal consistency was good (Cronbach's α=.90). Patients with a somatoform disorder had significantly higher scores on the SSEQ (t=4.24, p<.001) than patients with a depressive/anxiety disorder. Construct validity was shown by high correlations with other instruments measuring related constructs. Hierarchical multiple regression analyses showed that the questionnaire predicted health-related quality of life. Sensitivity to change was shown by significantly higher effect sizes of the SSEQ change scores for improved patients than for patients without improvement. CONCLUSION The SSEQ appears to be a reliable, valid, and efficient instrument to assess a broad range of psychological and interactional features related to the experience of somatic symptoms.
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Affiliation(s)
- Annabel Herzog
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek.
| | - Katharina Voigt
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek
| | | | | | | | - Gernot Langs
- Schön Klinik Bad Bramstedt, Bad Bramstedt, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek
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16
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Lee S, Creed FH, Ma YL, Leung CM. Somatic symptom burden and health anxiety in the population and their correlates. J Psychosom Res 2015; 78:71-6. [PMID: 25466323 DOI: 10.1016/j.jpsychores.2014.11.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Somatic symptom burden and health anxiety demonstrate overlapping clinical characteristics but their relationship in the general population is unclear. This study examined the association between these dimensions after adjustment for confounders and their respective correlation with outcome measures. METHODS A randomly selected population-based sample of 3014 respondents aged 15-65 was interviewed by telephone using a structured questionnaire that included the 15-item Patient Health Questionnaire (PHQ-15), Whiteley-7, Kessler-6, Sheehan Disability Scale, socio-demographic variables and items regarding health care utilization. Respondents who scored 10 or above on PHQ-15 and 4 or above on Whiteley-5 were regarded as having high somatic symptom burden and high health anxiety respectively. RESULTS Somatic symptom burden and health anxiety are moderately correlated after adjustment for confounders (p<.001). Both have important effects on psychological distress, functional impairment and health care utilization independent of each other (ps<.001). A considerable number of respondents (5.7%) reported both high somatic symptom burden and high health anxiety and this group showed the greatest general psychological distress, functional impairment and health care utilization. CONCLUSION This study demonstrates the close association of somatic symptom burden and health anxiety but also their independent association with psychological distress, functional impairment and health care utilization. The findings support the concept of the DSM-5 category of somatic symptom disorder, but also demonstrate that individuals with high somatic symptom burden or high health anxiety alone may merit separate diagnoses. More sophisticated studies of the relationship between somatic symptom burden and health anxiety are needed.
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Affiliation(s)
- Sing Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China; Hong Kong Mood Disorders Center, The Chinese University of Hong Kong, Hong Kong, China.
| | - Francis H Creed
- School of Community-based Medicine, The University of Manchester, United Kingdom
| | - Yee-Ling Ma
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Candi Mc Leung
- Hong Kong Mood Disorders Center, The Chinese University of Hong Kong, Hong Kong, China
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17
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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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18
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Fergus TA, Valentiner DP, Holzman JB. The Combination of Health Anxiety and Somatic Symptoms: Examining Associations With Health-Related Beliefs and Gender Differences. J Cogn Psychother 2014; 28:274-286. [DOI: 10.1891/0889-8391.28.4.274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Current diagnostic criteria suggest that some individuals experience health anxiety and severe somatic symptoms, whereas others experience health anxiety and either no or mild somatic symptoms. However, to date, our understanding of potential differences among individuals with health anxiety and varying severity of somatic symptoms remains limited. Adopting a dimensional approach, we completed this study to help fill this gap in the literature by examining whether the interactive effect between health anxiety and somatic symptoms was related to health-related beliefs among men (n = 211) and women (n = 220). Among both men and women, health anxiety was related to certain health-related beliefs, particularly anxiety sensitivity, only when coupled with severe somatic symptoms. Conceptual and therapeutic implications of these results are discussed.
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19
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Tomenson B, Essau C, Jacobi F, Ladwig KH, Leiknes KA, Lieb R, Meinlschmidt G, McBeth J, Rosmalen J, Rief W, Sumathipala A, Creed F. Total somatic symptom score as a predictor of health outcome in somatic symptom disorders. Br J Psychiatry 2013; 203:373-80. [PMID: 24072756 DOI: 10.1192/bjp.bp.112.114405] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The diagnosis of somatisation disorder in DSM-IV was based on 'medically unexplained' symptoms, which is unsatisfactory. AIMS To determine the value of a total somatic symptom score as a predictor of health status and healthcare use after adjustment for anxiety, depression and general medical illness. METHOD Data from nine population-based studies (total n = 28 377) were analysed. RESULTS In all cross-sectional analyses total somatic symptom score was associated with health status and healthcare use after adjustment for confounders. In two prospective studies total somatic symptom score predicted subsequent health status. This association appeared stronger than that for medically unexplained symptoms. CONCLUSIONS Total somatic symptom score provides a predictor of health status and healthcare use over and above the effects of anxiety, depression and general medical illnesses.
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Affiliation(s)
- Barbara Tomenson
- Barbara Tomenson, MSc, Biostatistics Unit, Institute of Population Health, University of Manchester, UK; Cecilia Essau, PhD, Department of Psychology, Whitelands College, University of Roehampton, London, UK; Frank Jacobi, PhD, Technische Universität Dresden, Germany; Karl Heinz Ladwig, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany; Kari Ann Leiknes, MD, PhD, Norwegian Knowledge Centre for the Health Services, Oslo, Norway; Roselind Lieb, PhD, Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Switzerland; Gunther Meinlschmidt, PhD, Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Switzerland, and Research Department of Psychobiology, Psychosomatics and Psychotherapy, Clinic of Psychosomatic Medicine and Psychotherapy, LWL University Hospital & Faculty of Medicine, Ruhr University Bochum, Germany; John McBeth, PhD, Arthritis Research UK Primary Care Centre, Keele University, UK; Judith Rosmalen, PhD, University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen, The Netherlands; Winfried Rief, PhD, Department of Clinical Psychology, University of Marburg, Germany; Athula Sumathipala, MD, PhD, King's College London, UK; Francis Creed, FMedSci, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
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20
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Voigt K, Wollburg E, Weinmann N, Herzog A, Meyer B, Langs G, Löwe B. Predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder: prospective 1-year follow-up study. J Psychosom Res 2013; 75:358-61. [PMID: 24119943 DOI: 10.1016/j.jpsychores.2013.08.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 08/21/2013] [Accepted: 08/24/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To compare the predictive validity and clinical utility of DSM-IV somatoform disorders and DSM-5 Somatic Symptom Disorder (SSD) at 12-month follow-up. METHODS In a sample of psychosomatic inpatients (n=322, mean age=45.6 years (SD 10.0), 60.6% females) we prospectively investigated DSM-IV somatoform disorders and the DSM-5 diagnosis of SSD plus a variety of psychological characteristics, somatic symptom severity, and health-related quality of life at admission, discharge, and follow-up. RESULTS DSM-IV diagnoses and DSM-5 SSD similarly predicted physical functioning at follow-up; SSD also predicted mental functioning at follow-up. Bodily weakness, intolerance of bodily complaints, health habits, and somatic attribution at admission were significant predictors of physical functioning at follow-up. The change in physical functioning during inpatient therapy was a significant predictor for the course of physical functioning until follow-up. CONCLUSIONS Psychological symptoms appear to be predictively valid diagnostic criteria for the 12-month functional outcome in patients with SSD. Mental functioning can be better predicted by the DSM-5 diagnosis than by DSM-IV diagnoses. Not the change in single psychological features but in physical functioning during the treatment interval predicted the change in physical functioning until follow-up.
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Affiliation(s)
- Katharina Voigt
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany.
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21
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Abstract
In medically ill patients the term 'somatic symptoms' is used to understand those symptoms which cannot be fully understood in the light of existing medical illness(es). These include a number of physical symptoms and also certain clinical syndromes such as irritable bowel syndrome, fibromyalgia, and chronic fatigue syndrome among others. However, it is increasingly recognized that such patients have larger degrees of psychological morbidities, especially depressive and anxiety disorders, and have disproportionately elevated rates of medical care utilization, including outpatient visits, hospitalizations and total healthcare costs. In view of this psychological morbidity, significant distress and functional impairment, the role of the consultation-liaison psychiatrist is prominent in the management of these patients. A consultation-liaison (CL) psychiatrist is expected to be part of the primary care team to manage patient with unexplained SS, and at the same time is expected to guide colleagues to practice a patient-centred approach to improve the outcome of patients with such symptoms. The clinical work of a CL psychiatrist involves evaluation of patients with medically unexplained symptoms for probable psychiatric disorders and treatment of psychiatric morbidity and also management of patients without psychiatric morbidity. Management strategies include reattribution, cognitive behaviour therapy and antidepressants, with each strategy showing varying degrees of success.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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22
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Sharma BB, Singh S, Sharma VK, Choudhary M, Singh V, Lane S, Lepping P, Krishna M, Copeland J. Psychiatric morbidity in chronic respiratory disorders in an Indian service using GMHAT/PC. Gen Hosp Psychiatry 2013; 35:39-44. [PMID: 23122486 DOI: 10.1016/j.genhosppsych.2012.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 09/24/2012] [Accepted: 09/26/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The study aimed to assess psychiatric morbidity in stable chronic respiratory disorders and to examine the pattern of psychiatric illness in specific respiratory disorders in Northern India. METHODS All consecutive patients with stable chronic respiratory illnesses who attended the respiratory disease clinic were recruited in the study. Their healthy attendants were interviewed as a control group. The research clinician, trained in the use of the Global Mental Health Assessment Tool, Primary Care Version (GMHAT/PC), interviewed all the participants. The respiratory consultant made the respiratory illness diagnosis. The data were analyzed comparing the patient and the control group by using relative risk and adjusted odds ratios. RESULTS Of 391 patients with respiratory illness, 44.8% had a mental illness identified by GMHAT/PC interview compared with 24.3% of 177 attendants (controls). Anxiety (20.6%), depression (13.2%) and obsessive compulsive disorders (4.6%) were the most frequently identified mental disorders in the respiratory disease group. Chronic obstructive pulmonary disease and bronchial asthma when combined with rhinitis had a significantly higher prevalence of comorbid mental illness than those illnesses alone. CONCLUSION Patients with chronic respiratory illness have high mental health comorbidity. Physicians and practitioners can be trained to identify mental illness using computer-assisted tools such as GMHAT/PC (which is easy to use by clinicians and well accepted by patients). A holistic approach of providing care to such patients may improve their overall outcome and quality of life.
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Affiliation(s)
- Bharat Bhushan Sharma
- Division of Allergy and Pulmonary Medicine, SMS Medical College Hospital, Jaipur, India
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Abstract
The somatoform disorders, as currently defined in DSM-IV and ICD-10, have been criticized for their complexity and poor clinical utility. In this paper we consider these criticisms as well as the conceptual question of whether there is sufficient evidence for classifying them as mental and behavioural disorders. The review suggests that, as currently defined, somatoform disorders do not fulfil a recently articulated set of criteria for mental and behavioural disorders. In particular, the disorders are not defined according to positive psychological and behavioural disorders and evidence is sparse to support their classification as different and distinct diagnoses. Any revision of the disorders should not be based on 'medically unexplained' symptoms. Rather, the relevant diagnoses should include a combination of bothersome somatic symptoms with several other psychological features including beliefs about somatic symptoms and evidence of marked concerns about health and illness. Finally, the review presents a set of proposals for the revision of these disorders, by the Somatic Disorders and Dissociative Disorders Working Group of the WHO International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders, which attempt to take account of the criticisms and current understanding of somatic experiences.
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Affiliation(s)
- Francis Creed
- School of Community-based Medicine, University of Manchester, UK
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24
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Voigt K, Wollburg E, Weinmann N, Herzog A, Meyer B, Langs G, Löwe B. Predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder--comparison with DSM-IV somatoform disorders and additional criteria for consideration. J Psychosom Res 2012; 73:345-50. [PMID: 23062807 DOI: 10.1016/j.jpsychores.2012.08.020] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 08/29/2012] [Accepted: 08/30/2012] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Major changes to the diagnostic category of somatoform disorders are being proposed for DSM-5. The effect of e.g. the inclusion of psychological criteria (criterion B) on prevalence, predictive validity, and clinical utility of "Somatic Symptom Disorder" (SSD) remains unclear. A prospective study was conducted to compare current and new diagnostic approaches. METHODS In a sample of N=456 psychosomatic inpatients (61% female, mean age=44.8±10.4 years) diagnosed with somatoform, depressive and anxiety disorders, we investigated the current DSM-5 proposal (SSD) plus potential psychological criteria, somatic symptom severity, and health-related quality of life at admission and discharge. RESULTS N=259 patients were diagnosed with DSM-IV somatoform disorder (56.8%). With a threshold of 6 on the Whiteley Index to assess psychological criteria, the diagnosis of SSD was similarly frequent (51.8%, N=230). However, SSD was a more frequent diagnosis when we employed the recommended threshold of one subcriterion of criterion B. Patients diagnosed with only SSD but not with DSM-IV somatoform disorder showed greater psychological impairment. Both diagnoses similarly predicted physical functioning at discharge. Bodily weakness and somatic and psychological attributions at admission were among significant predictors of physical functioning at discharge. Reduction of health anxiety, bodily weakness, and body scanning significantly predicted an improvement of physical functioning. CONCLUSIONS Psychological symptoms enhance predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder compared to DSM-IV somatoform disorders. The SSD diagnosis identifies more psychologically impaired patients than its DSM-IV precursor. The currently suggested diagnostic threshold for criterion B might increase the disorder's prevalence.
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Affiliation(s)
- Katharina Voigt
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany.
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25
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Abstract
OBJECTIVE To assess whether the number of somatic symptoms and health anxiety are independent predictors of future health care use after adjusting for confounders. METHODS In a random sample of the adult UK population, questionnaires assessed the number of somatic symptoms (Somatic Symptom Inventory), health anxiety (Whiteley Index), anxiety/depression (Hospital Anxiety and Depression Scale), the number of physical illnesses and demographic variables. The number of consultations in primary care was obtained from medical records for 1 year before and after questionnaire assessment, and negative binomial regression analyses identified predictors of consultation rate. RESULTS The sample included 961 participants (58.0% response) with complete medical record data for 609 participants. After adjustment for consultation rate in the prior year, the predictors of subsequent consultation rate in primary care were the number of physical illnesses, off work through illness, Whiteley Index (incidence rate ratio [IRR] = 1.22, 95% confidence interval [CI] = 1.09-1.35), and the Whiteley Index-by-Somatic Symptom Inventory interaction term. Reported physical abuse predicted an increased consultation rate in women (IRR = 2.30, 95% CI = 1.08-4.90) but a reduced rate in men (IRR = 0.43, 95% CI = 0.22-0.84), interaction p = 0.003. CONCLUSIONS These data raise the possibility that both increased health anxiety and number of bothersome somatic symptoms predict frequent medical consultations. A more complex model of predicting future health care use is needed than has been studied previously, which is potentially relevant to the current discussions of the proposed DSM-V and International Classification of Diseases, 11th Revision, diagnostic guidelines regarding complex somatic symptom disorders.
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