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Wazir MNK, Kakakhel S, Gul AN, Awan Q, Khattak AF, Yousaf N, Wahid F. Psychiatric Illnesses, Somatic Complaints, and Treatments in a Tertiary Care Hospital in Khyber Pakhtunkhwa, Pakistan: A Cross-Sectional Study. Cureus 2023; 15:e43151. [PMID: 37692647 PMCID: PMC10484353 DOI: 10.7759/cureus.43151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Psychiatric disorders differ in frequency and symptoms based on the cultural and ethnic background of patients. This can make diagnosing and treating patients challenging globally. In Pakistan, most psychiatric patients report multiple somatic complaints. Our goal was to investigate the causes of these complaints, identify common psychiatric conditions, and analyze their various manifestations in clinical practice. We also aimed to identify ways to improve the quality of care provided to our patients. METHODOLOGY We collected and organized data by utilizing predetermined tables from a sample of 231 patients who visited the outpatient clinics. Inpatients were not included in this study because of the absence of a psychiatric unit at our facility. Patients' past medical and psychiatric records were thoroughly examined, and pertinent information was extracted. The most common psychiatric disorders within the studied population were diagnosed based on the International Classification of Diseases, Tenth Revision (ICD-10) diagnostic criteria. RESULTS In this study, a sample size of 231 was examined to determine the most common diseases (ICD-10) in males and females. In males, the most prevalent diseases were mixed anxiety and depression (MAD), depression, generalized anxiety disorder (GAD), bipolar affective disorder (BPAD), social phobia, and obsessive-compulsive disorder (OCD). Females, on the other hand, presented more with depression, GAD, mixed anxiety and depression, conversion or dissociative disorder, OCD, and panic attacks. Headaches were the most frequently reported symptom, experienced by 61.9% the of participants, followed by lethargy, extremity pains, palpitations, loss of appetite, heartburn or acidity, heaviness on the head, shoulder pains, bloating, dizziness, chest pains, hot flashes or shivering, and constipation. Meanwhile, a quarter of the males did not complain of any somatic symptoms, compared to 10% of the females. Additionally, 7.3% of females reported more than six somatic symptoms, compared to 5.7% of males. When it came to treatment preferences, 73.6% of the participants preferred medication over psychotherapy and over a combination of both. The Statistical Product and Service Solutions (SPSS) Statistics version 22 (IBM SPSS Statistics, Armonk, NY, USA) was used to conduct a chi-square test of independence to analyze the obtained data. For post hoc analysis of quantitative data (i.e., the number of somatic symptoms reported by participants), one-way analysis of variance (ANOVA) was applied, followed by Tukey's honestly significant difference (HSD) test. CONCLUSIONS This is the first comprehensive study of its kind for this population and region. It emphasizes that clinicians should be aware of the variety of somatic symptoms and psychiatric presentations among this population. Such awareness can improve clinical practices and reduce the burden on health services.
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Affiliation(s)
| | | | - Aqsa N Gul
- Psychology, Islamia College, Peshawar, PAK
| | | | - Almas F Khattak
- Community Medicine and Research, Northwest School of Medicine, Peshawar, PAK
| | - Nowsher Yousaf
- Occupational Health Safety and Environment (OHS&E), Northwest General Hospital and Research Center, Peshawar, PAK
| | - Fakhria Wahid
- Occupational Health Safety and Environment (OHS&E), Northwest General Hospital and Research Center, Peshawar, PAK
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Choi Y, Park IH, Kim JE, Kwon O, Kim AR, Park HJ, Lee JH, Kim JH. Acupuncture for Psychosomatic Symptoms of Hwa-byung, an Anger Syndrome: A Feasibility Randomized Controlled Trial. Front Psychol 2021; 12:651649. [PMID: 34630196 PMCID: PMC8498113 DOI: 10.3389/fpsyg.2021.651649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/19/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives: Emerging studies found the potential effects of acupuncture for treating chronic pain and mental disorders, namely, depressive and anxiety disorders. Acupuncture is widely used for treating culture-related anger syndrome, Hwa-byung. This pilot trial aimed to investigate the feasibility of a clinical trial testing acupuncture for the psychosomatic symptoms of Hwa-byung. Methods: A total of 26 patients with Hwa-byung planned to be randomly assigned to the acupuncture or sham acupuncture groups. About 10 treatment sessions were applied over 4 weeks. The 100-mm visual analog scale was used to measure the six major Hwa-byung symptoms: stuffiness in the chest, heat sensations, pushing-up in the chest, feeling a mass in the throat, feelings of unfairness, and hard feelings. The criteria for assessing the success of this pilot trial were defined as improvement in three or more of the six Hwa-byung symptoms after treatment, with an effect size >0.2. Results: A total of 15 patients were finally included and randomly assigned to the acupuncture group (n = 7) or the sham acupuncture group (n = 8). After 10 treatment sessions, the Cohen's d effect sizes for acupuncture compared to sham acupuncture were >0.2 for each one of the six major Hwa-byung symptoms, which met our a priori criteria for success. Also, the effect size for the somatic symptoms of “stuffiness in the chest” was 0.81 (95% CI −0.40, 2.20), referring to a large effect size. Conclusions: Our results suggest that acupuncture treatment would be regarded as an acceptable intervention for a full-scale study of psychosomatic symptoms in patients with Hwa-byung. Trial Registration:cris.nih.go.kr, identifier: KCT0001732.
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Affiliation(s)
- Yujin Choi
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - In-Hye Park
- Department of Korean Medicine, College of Korean Medicine, Sangji University, Wonju, South Korea
| | - Jung-Eun Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Ojin Kwon
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Ae-Ran Kim
- R&D Strategy Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Hyo-Ju Park
- R&D Strategy Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Jun-Hwan Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea.,Korean Medicine Life Science, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Joo-Hee Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Sangji University, Wonju, South Korea.,Research Institute of Korean Medicine, Sangji University, Wonju, South Korea
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Deng K, Wong YJ, Li JPF, McCullough KM. Dialectical coping and well-being among Chinese college students: the mediating role of resilience. COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2020.1783641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Kuo Deng
- Department of Counseling and Educational Psychology, Indiana University Bloomington, Bloomington, IN, USA
| | - Y. Joel Wong
- Department of Counseling and Educational Psychology, Indiana University Bloomington, Bloomington, IN, USA
| | - Jonah P. F. Li
- Department of Counseling and Educational Psychology, Indiana University Bloomington, Bloomington, IN, USA
| | - Keiko M. McCullough
- Department of Counseling and Educational Psychology, Indiana University Bloomington, Bloomington, IN, USA
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Lihua M, Tao Z, SiYong H, Suwen W, Xiaoxuan Y, Yichen G, Caiyun Z, Yan B. Obsessive-compulsive disorder in general hospital outpatients: prevalence, correlates, and comorbidity in Lanzhou, China. Asia Pac Psychiatry 2014; 6:308-18. [PMID: 24323671 DOI: 10.1111/appy.12113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 10/13/2013] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The prevalence of obsessive-compulsive disorder (OCD), risk factors, and comorbidity rates of Chinese outpatients in Lanzhou general hospitals are unknown. METHOD The prevalence rate of OCD was estimated in a representative sample of outpatients in three classes of general hospitals in Lanzhou, China. The rate of OCD within the sample, which was composed of 1,576 individuals aged 16 years or older, was assessed using the World Health Organization Composite International Diagnostic Interview Version 3.0. RESULTS The weighted prevalence of OCD were 4.31% (lifetime), 2.86% (12-month), and 1.97% (30-day). Multivariate logistic regression identified the following independent predictors of having lifetime OCD: having a higher level of education, being unemployed, an internal medicine outpatient, a female, 16-35 years old, divorced/widowed/separated, and having a low family income. OCD had a significant comorbid association with neuroses, based on the International Statistical Classification of Diseases and Related Health Problems-10th Revision. DISCUSSION These findings show a lower prevalence rate of OCD in Lanzhou general hospitals than that reported for some specialized outpatient clinics in Western countries. Further investigations are required to explore the relationships between OCD and the risk factors identified in the current study. Resolving methodological problems may lead to more accurate prevalence estimates in future epidemiological studies. Our findings suggest that there is an urgent need to improve the ability of clinicians to detect OCD in outpatients.
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Affiliation(s)
- Ma Lihua
- Nursing Department, The First Hospital of Lanzhou University, Lanzhou City, China
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Lee BO. Ambivalence over emotional expression and symptom attribution are associated with self-reported somatic symptoms in Singaporean school adolescents. ASIAN JOURNAL OF SOCIAL PSYCHOLOGY 2012. [DOI: 10.1111/ajsp.12005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
There is a wide debate among the researchers and clinicians over the diagnostic categories subsumed under the rubric of somatoform disorders (SDs). Recent proposals vary from radical views that call for removing this category altogether to the conservative views that suggests cosmetic changes in the diagnostic criteria of SDs. We have the reviewed the relevant literature through PUBMED search supplemented with manual search on current concepts of SD.
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Affiliation(s)
- Amlan K. Jana
- Department of Psychiatry, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | | | - Joyita Mazumdar
- Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India
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Saint Arnault D, Kim O. Is there an Asian idiom of distress? Somatic symptoms in female Japanese and Korean students. Arch Psychiatr Nurs 2008; 22:27-38. [PMID: 18207054 PMCID: PMC2239242 DOI: 10.1016/j.apnu.2007.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 05/19/2007] [Indexed: 11/23/2022]
Abstract
The term 'idiom of distress' is used to describe culturally specific experiences of suffering. Most of these studies have been conducted with small groups, making comparison of symptom profiles difficult. Female undergraduate and graduate students in Japan (n = 50) and Korea (n = 61) completed the Beck Depression Inventory (BDI) and 7-day daily reports of their experiences of 46 somatic symptoms. Between-culture comparisons revealed that BDI scores did not differ; however, the Korean women had significantly higher somatic distress means than the Japanese women. Despite the higher Korean distress mean, regression analysis showed that somatic distress explained 30% of the variance of BDI score for the Japanese but only 22% of the variance for the Koreans. Within-culture comparisons showed that both high-BDI Japanese and Koreans had 19 somatic distress symptoms with significantly higher means than their low-BDI counterparts; 11 somatic symptoms were shared by the two groups. Multidimensional scaling matrices were used to compare symptom proximities and revealed cultural differences. The problems with using broad racial categories in clinical research, the clinical significance of these findings, and the implications for psychiatric nursing assessment and practice are discussed.
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Affiliation(s)
- Denise Saint Arnault
- Nursing Research Center, Michigan State University, East Lansing, MI 48824, USA.
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Han J, Zhu Y, Li S, Chen X, Put C, Van de Woestijne KP, Van den Bergh O. Respiratory complaints in Chinese: cultural and diagnostic specificities. Chest 2005; 127:1942-51. [PMID: 15947306 DOI: 10.1378/chest.127.6.1942] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES We investigated the qualitative components of a wide range of Chinese descriptors of dyspnea and associated symptoms, and their relevance for clinical diagnosis. MEASUREMENTS Sixty-one spontaneously reported descriptors were elicited in Chinese patients to make a symptom checklist, which was administered to new groups of patients with different cardiopulmonary diseases, to patients with medically unexplained dyspnea and to healthy subjects. RESULTS Test-retest reliability was satisfactory for most of the descriptors. A principal component analysis on 61 descriptors yielded the following eight factors: dyspnea-effort of breathing; dyspnea-affective aspect; wheezing; anxiety; tingling; palpitation; coughing and sputum; and dying experience. Although the descriptors of dyspnea-effort of breathing resembled Western wordings and were shared by patients with a variety of diseases, the descriptors of dyspnea-affective aspect appeared to be more culturally specific and were primarily linked to the diagnosis of medically unexplained dyspnea, whereas wheezing was specifically linked to asthma. CONCLUSIONS Three factors of breathlessness were found in Chinese. The descriptors of dyspnea-effort of breathing and wheezing appear to be similar to Western descriptors, whereas the dyspnea-affective aspect seems to bear cultural specificity.
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Affiliation(s)
- Jiangna Han
- Laboratory of Respiratory Psychophysiology, Department of Pneumology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Yeung A, Howarth S, Chan R, Sonawalla S, Nierenberg AA, Fava M. Use of the Chinese version of the Beck Depression Inventory for screening depression in primary care. J Nerv Ment Dis 2002; 190:94-9. [PMID: 11889362 DOI: 10.1097/00005053-200202000-00005] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Many Asian-Americans are unfamiliar with depression and its treatment. When depressed, they generally seek treatment from their primary care physicians and complain about their physical symptoms, resulting in under-recognition and under-treatment of depression. This study evaluates the effectiveness of the Chinese version of the Beck Depression Inventory (CBDI) for screening depression among Chinese-Americans in primary care. A total of 503 Chinese-Americans in the primary care clinic of a community health center were administered the CBDI for depression screening. Patients who screened positive (CBDI > or = 16) were interviewed by a psychiatrist using the Structured Clinical Interview for DSM-III-R, patient version (SCID-I/P) for confirmation of the diagnosis. Patients who screened negative (CBDI < 16) were randomly selected to be interviewed using the depression module of the SCID-I/P. The results of the SCID-I/P interview were used as the standard for evaluating the sensitivity and specificity of the CBDI. A total of 815 Chinese-Americans in a primary care clinic were approached, and 503 completed the CBDI. Seventy-six (15%) screened positive (CBDI > or = 16), and the prevalence of major depression was 19.6% by using extrapolated results from SCID-I/P interviews. When administered by a native-speaking research assistant, the CBDI has good sensitivity (.79), specificity (.91), positive predictive value (.79), and negative predictive value (.91). Despite the commonly believed tendency to focus on physical symptoms rather than depressed mood, Chinese-Americans are able to report symptoms of depression in response to a questionnaire. The CBDI, when administered by research assistants, has good sensitivity and specificity in recognizing major depression in this population. Lack of interest among Chinese-American patients in using the CBDI as a self-rating instrument has limited its use for depression screening in primary care settings.
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Affiliation(s)
- Albert Yeung
- Depression Clinical and Research Program, Massachusetts General Hospital, 50 Staniford St., Suite 401, Boston, Massachusetts 02114, USA
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Unger JB, Li Y, Johnson CA, Gong J, Chen X, Li C, Trinidad DR, Tran NT, Lo AT. Stressful life events among adolescents in Wuhan, China: Associations with smoking, alcohol use, and depressive symptoms. Int J Behav Med 2001. [DOI: 10.1207/s15327558ijbm0801_01] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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