Assessment of a pilot course on the management of somatization disorder for family doctors

Different psychological profiles in non-cardiac chest pain and coronary artery disease: a controlled study

The objective of the study was to identify clinical characteristics that enable non-cardiac chest pain to be differentiated from coronary artery disease. An observational case-control study was carried out in 40 patients with non-cardiac chest pain and a control group of 40 patients with coronary artery disease. Sociodemographic, medical and psychological variables were assessed. There was no difference in personality except in "emotional control", which was less in patients with non-cardiac chest pain. These patients had greater alexithymia and more frequently used coping strategies, such as religion and seeking medical help. Multivariate analysis showed that a predictive model comprising four variables (i.e., alexithymia, quality of life, and coping based on religion and seeking medical help) had a sensitivity of 85.4% and a specificity of 80.0%. This predictive model could be used as a screening test to discriminate between the two conditions.

Evaluation of general practitioners' training: how to manage patients with unexplained physical symptoms

Patients with unexplained physical symptoms ("somatoform disorders") tend to overuse the healthcare system. Therefore, the authors aimed to assess whether a training session for general practitioners (GPs) on managing patients with unexplained physical symptoms would be acceptable to GPs and lead to improvements in patient care. In a randomized clinical trial (GPs randomized), GPs got a 1-day training session and additional materials. Included were 26 GP offices in primary care and 295 patients with unexplained physical symptoms (minimum of two symptoms required). Outcome measures were healthcare utilization (number of doctor visits) 6 months before and 6 months after the index visit to the GP, somatization severity, depression, and hypochondriacal fears at the index visit to the GP's office and 6 months later. Training GPs to manage these patients led to significant reductions in healthcare utilization; patients of untrained GPs showed comparable attendance rates in the 6 months before and after the index visit. Differences in depression, somatization, and hypochondriacal fears, however, could not be attributed to the GP training. GPs rated the training as being highly relevant for their everyday practices, underlining the need for and acceptance of the training. Training GPs in managing patients with unexplained physical symptoms seems to be helpful for the reduction of excessive healthcare utilization. These 1-day workshops have high acceptability, so this approach could be a good model for empirically-validated continuing-education programs.

Somatization or Psychosomatic Symptoms?

The author describes some problems emerging from the approach to and comprehension of somatization symptoms, discussing ambiguities regarding somatization seen in the current classification manuals (ICD-10 and DSM-IV). Then the author presents a case report of a man who presented with a bizarre symptom of feminization that was successfully treated with psychotherapy. The author ends with a discussion of the relationship between meaning and symptom.

Disabling musculoskeletal pain and its relation to somatization: a community-based postal survey

BACKGROUND

Somatization (a tendency to report distress from somatic symptoms) is a little studied, but potentially important, confounder and effect modifier in occupational studies of musculoskeletal disease.

AIMS

To assess the role of somatization as a risk factor for disabling regional pain.

METHODS

A questionnaire was mailed to 4998 subjects of working age. Questions were asked about chronic and disabling pain in the past 12 months affecting the arm, low back, knee or combinations of these sites. Distress from physical symptoms was assessed using elements of the Brief Symptom Inventory and mental well-being was assessed using the short-form 36 (SF-36). Associations were examined by modified Cox regression and expressed as hazard ratios (HRs) with 95% confidence intervals (CI).

RESULTS

Among 2632 responders, 24% reported chronic pain and 25% disabling pain at one or several sites. Risk of chronic or disabling pain increased strongly according to the number of somatic symptoms reported as bothersome. For example, the HR for chronic upper limb pain in those distressed by > or =2 somatic symptoms in the past 7 days versus none was 3.9 (95% CI 2.9-5.3), and that of disabling upper limb pain was 5.8 (95% CI 4.1-8.3). Similar patterns were found for the low back and knee, and there was a gradient of increasing risk according to the number of sites with disabling pain. In comparison, associations with SF-36 mental well-being score were weaker.

CONCLUSION

Somatizing tendency should be evaluated as a possible confounder or effect modifier in studies of occupational risk factors for musculoskeletal pain.