Psychological and clinical correlates of functional somatic complaints in depression

Treatment-Resistant Late-Life Depression: A Review of Clinical Features, Neuropsychology, Neurobiology, and Treatment

Major depression is common in older adults (≥ 60 years of age), termed late-life depression (LLD). Up to 30% of these patients will have treatment-resistant late-life depression (TRLLD), defined as depression that persists despite two adequate antidepressant trials. TRLLD is challenging for clinicians, given several etiological factors (eg, neurocognitive conditions, medical comorbidities, anxiety, and sleep disruption). Proper assessment and management is critical, as individuals with TRLLD often present in medical settings and suffer from cognitive decline and other marks of accelerated aging. This article serves as an evidence-based guide for medical practitioners who encounter TRLLD in their practice.

Relationship between alexithymia and depression: A narrative review

Alexithymia has been described as difficulty in expressing as well as experiencing feelings. It has been studied in relation with medical as well as psychological conditions and has been seen to impact treatment outcomes. The current review focuses on the relationship of alexithymia with depression and the role of culture in this relationship. The keywords for literature included terms such as depression, alexithymia, depression and alexithymia, Toronto Alexithymia Scale, assessing alexithymia and depression, and alexithymia as a trait. The main findings of the review were that alexithymia and depression are highly correlated, and severity of depression and gender are independently associated with alexithymia and may interfere with treatment outcomes.

Can changes in multidimensional self-reported interoception be considered as outcome predictors in severely depressed patients? A moderation and mediation analysis

OBJECTIVE

Somatic complaints (e.g. pain) and abnormal self-reported interoception (e.g. maladaptive bodily self-focus) are common features of major depressive disorder (MDD) with sex-specific manifestations. Whereas somatic symptoms are associated with adverse clinical outcomes (e.g. residual symptoms), studies are scarce investigating the role of interoception as an outcome predictor for specific hospital treatment of MDD. Therefore, multivariate associations between changes in multidimensional self-reported interoception, somatic symptoms, and clinical improvements are explored by hypothesizing interactions with sex and an interoceptive mechanism.

METHODS

In this naturalistic study, 87 hospitalized participants suffering from MDD completed questionnaires at pre- and post-treatment assessing multidimensional self-reported interoception (MAIA-2), somatic symptom burden (SCL-90-S® SOMA), and depression severity (BDI-II). We performed a multiple hierarchical regression analysis to test for interaction effects. The mediation hypothesis was path-analytically tested in a parallel mediation model by bootstrapping confidence intervals for (in)direct effects.

RESULTS

Improvements in self-reported interoception independently predicted positive treatment response, ΔR_adj²=8.61%, ΔF(8, 74) = 3.23, p < .01. Prediction effects were moderated by sex, ΔR_adj²=5.54%, ΔF(8, 66) = 2.22, p < .05. Post-hoc analyses revealed significant effects of body confidence in women, B = -4.26, t(28) = -2.78, p < .01, and of self-regulation in men, B = -3.21, t(17) = -2.27, p < .05. Effects of somatic symptom relief on treatment outcome were partially mediated by self-reported interoception, total indirect = 2.94 [95% BCa CI 0.99, 5.69].

CONCLUSION

Interoception patterns changed significantly and predicted outcome of hospital treatment in severely depressed patients. Our study could imply the need to consider body sensations additionally as a target for antidepressive treatments. The development of tailored interoceptive interventions in depressive patients represents a promising vision for the future.

Major Depressive Disorder Is Associated with Impaired Interoceptive Accuracy: A Systematic Review

Interoception is the sense of the physiological condition of the entire body. Impaired interoception has been associated with aberrant activity of the insula in major depressive disorder (MDD) during heartbeat perception tasks. Despite clinical relevance, studies investigating interoceptive impairments in MDD have never been reviewed systematically according to the guidelines of the PRISMA protocol, and therefore we collated studies that assessed accuracy in detecting heartbeat sensations (interoceptive accuracy, IAc) in MDD (databases: PubMed/Medline, PsycINFO, and PsycARTICLES). Out of 389 records, six studies met the inclusion criteria. The main findings suggest that (i) moderately depressed samples exhibit the largest interoceptive deficits as compared with healthy adults. (ii) difficulties in decision making and low affect intensity are correlated with low IAc, and (iii) IAc seems to normalize in severely depressed subjects. These associations may be confounded by sex, anxiety or panic disorder, and intake of selective serotonin reuptake inhibitors. Our findings have implications for the development of interoceptive treatments that might relieve MDD-related symptoms or prevent relapse in recurrent depression by targeting the interoceptive nervous system.

Correlates of worry and functional somatic symptoms in generalized anxiety disorder

BACKGROUND

Worry and functional somatic symptoms (FSS) are important clinical features of generalized anxiety disorder (GAD). Although there is literature on the prevalence of worry and FSS in GAD, there is limited data on psychological correlates of worry and somatic symptoms in patients with GAD.

OBJECTIVE

The purpose of this research was to evaluate the relationship of worry and FSS with somatosensory amplification, health anxiety (hypochondriasis), and alexithymia in patients with GAD.

METHODS

Forty patients with the diagnosis of GAD were assessed with Penn State Worry Questionnaire, Bradford Somatic Inventory (BSI), GAD-7 Scale, somatosensory amplification Scale (SSAS), Whiteley Index (WI), and Toronto Alexithymia Scale-20 Hindi version (TAS-H-20).

RESULTS

Worry had significant positive correlation with total scores of BSI, GAD-7 scale, TAS-H-20 subscale 1, SSAS, and WI. Younger age of onset was associated with higher FSS as assessed on BSI. BSI total score had positive correlation with total scores of GAD-7 scale, TAS-H-20 and its subscales, SSAS, WI, and with the severity grades of BSI and GAD.

CONCLUSION

Worry and FSS are associated with somatosensory amplification and hypochondriasis. In addition, somatic symptoms are associated with alexithymia.

Major Depression in Chinese Medicine Outpatients with Stagnation Syndrome: Prevalence and the Impairments in Well-Being

Stagnation syndrome, a diagnostic entity in traditional Chinese medicine (TCM), has been long regarded as the TCM counterpart of major depression in Western medicine. The study investigated the prevalence of major depression among stagnation syndrome patients and evaluated their well-being and functioning outcomes. In total, 117 patients diagnosed with stagnation syndrome were measured using Stagnation Scale, the Patient Health Questionnaire-9 (PHQ-9), and the Body-Mind-Spirit Well-Being Inventory. Results indicate major depression among stagnation syndrome patients was characterized by a high co-occurrence rate and worse physical, mental, and functional outcomes. More than one-quarter (26.5%) of the patients met the DSM-V diagnostic criteria for major depression and over half (53%) exceeded the PHQ-9 cutoff (score above 10) for moderate/severe depression symptoms. The wellness of the stagnation syndrome patients was worse (M = 298.2, SD = 66.5) than that of the general population (M = 360.9, SD = 79.9), with a large Cohen's d value of 0.9. The “wellness outlook” of the depressed stagnation syndrome patients appeared grimmer (M = 252.3, SD = 52.2). The correlation between stagnation and depression was higher for affective symptoms than somatic symptoms. Physical distress did not mediate the relationship between stagnation and daily functioning. These might suggest that stagnation syndrome and major depression may share some similar psychological mechanisms.

Suboptimal health status and psychological symptoms among Chinese college students: a perspective of predictive, preventive and personalised health

Background

Suboptimal health status (SHS) is an intermediate health status between health and illness, a syndrome characterised by the perception of health complaints, general weakness and low energy. This study aimed to investigate the prevalence of SHS and the correlation between SHS and psychological symptoms among Chinese college students and to identify the SHS-related risk factors from the perspective of predictive, preventive and personalised medicine (PPPM).

Methods

A cross-sectional study was conducted among 4119 college students who were enrolled from Taishan Medical University and Baoji Vocational and Technical College in the eastern and western areas of China. SHS levels of the participants were measured by an established self-reporting Suboptimal Health Status Questionnaire-25 (SHSQ-25). Psychosomatic conditions were estimated by the self-rating Symptom Checklist-90 (SCL-90) scale. Spearman correlation analysis was applied to analyse the relationship between SHSQ-25 scores and SCL-90 estimates. Logistic regression analysis was applied for multivariate analysis.

Results

The prevalence of SHS was 21.0% (864/4119), with 23.3% (701/3005) for female students and 14.6% (163/1114) for male students. The prevalence of general positive psychological symptom was 14.2% (586/4119), with 15.6% (470/3005) for female students and 10.4% (116/1114) for male students. A strong correlation was identified between SHS score and SCL-90 estimates, with the correlation coefficient (r) of 0.719. Logistic regression showed that variables significantly associated with SHS were somatisation (adjusted odds ratio (aOR) = 3.185, 95% confidence interval [CI] = 2.048-4.953), obsessive-compulsive (aOR = 3.518, 95% CI = 2.834-4.368), interpersonal sensitivity (aOR = 1.883, 95% CI = 1.439-2.463) and depression (aOR = 1.847, 95% CI = 1.335-2.554).

Conclusions

Our findings confirm that there is a high prevalence of SHS among college students and there is a strong association between SHS and psychological symptoms among Chinese college students. High susceptibility of SHS occurs particularly in vulnerable groups: female students, sophomore students, medical students and students from rural area. Identification of SHS and prompt application of personalised psychological health-supporting activities will promote college students' health status.

Somatosensory amplification, health anxiety, and alexithymia in generalized anxiety disorder

AIM

The aim of this study was to study somatosensory amplification, health anxiety (hypochondriasis), and alexithymia among patients with generalized anxiety disorder (GAD) and to evaluate the association of these variables with the severity of GAD.

MATERIALS AND METHODS

Cross-sectional design was employed, and patients were recruited from the outpatient clinic of the psychiatry department of a multispecialty tertiary care medical institute in North India. The patients who were clinically diagnosed to have GAD by the two independent qualified psychiatrists were screened with Mini International Neuropsychiatry Interview to confirm the diagnosis. Forty patients with GAD meeting the inclusion criteria were assessed with GAD-7 scale, somatosensory amplification scale (SSAS), the Whiteley Index (WI) and Toronto alexithymia scale - 20 Hindi version (TAS-H-20).

RESULTS

The mean scores of patients with GAD on SSAS, WI, TAS-H-20, and GAD-7 scale were 25.70 (SD-5.84), 7.75 (SD-3.30), 59.77 (SD- 8.63), and 13.37 (SD- 3.58), respectively. Half of the patients with GAD had significant health anxiety as defined by WI score of >7. Around 40% of GAD patients were alexithymic as defined with TAS-H-20 scores of >60. SSAS, WI, TAS-H-20 had a positive correlation with the severity of GAD as measured with GAD-7 scale.

CONCLUSIONS

GAD patients have significant somatosensory amplification, health anxiety (hypochondriasis), and alexithymia. Accordingly, there is a need to develop effective psychological interventions focused on these factors in GAD.

Suicidality in patients with somatoform disorder - the speechless expression of anger?

OBJECTIVE

To identify emotion-associated risk factors for suicidality in patients with somatoform disorders.

METHODS

A sample of 155 consecutive patients diagnosed with somatoform disorders at the Psychosomatic Ambulance of Bonn University Hospital filled in several questionnaires including the Symptom Checklist 90-Revised Version (SCL-90-R), the Toronto Alexithymia Scale (TAS-20), and the State Trait Anger Expression Inventory (STAXI). Our aim was to compare patients with suicide attempts to patients without suicide attempts via a MANCOVA (IV: Group; DV: SCL-90-R, TAS-20, STAXI; covariates: sex, age, depression, borderline personality disorder).

RESULTS

Lifetime suicide attempts were documented in 20 patients (12.9%), current active suicidal ideation in 33.6%, and thoughts of death or dying in 55.9%. Patients with lifetime suicide attempts showed significantly more psychological distress, a significantly higher alexithymia sum score, a significantly higher score on trait anger, state anger, and a stronger tendency to express anger.

CONCLUSION

Somatoform disorder patients with lifetime suicide attempts might have greater difficulties in identifying and describing emotions, and a tendency to intensely experience and express anger. Future longitudinal studies should further investigate possible links between difficulties in coping with anger and suicidality to improve prophylaxis and treatment of suicidal behaviour in somatoform disorder patients.

The impact of somatic symptoms on the course of major depressive disorder

OBJECTIVE

Somatic symptoms have been suggested to negatively affect the course of major depressive disorder (MDD). Mechanisms behind this association, however, remain elusive. This study examines the impact of somatic symptoms on MDD prognosis and aims to determine whether this effect can be explained by psychiatric characteristics, somatic diseases, lifestyle factors, and disability.

METHODS

In 463 MDD patients (mean age=44.9 years, 69.8% female) from the Netherlands Study of Depression and Anxiety (NESDA), we examined whether the type and number of somatic symptom clusters predicted the two-year persistence of MDD. Diagnoses of MDD were established with the Composite International Diagnostic Interview (CIDI) and somatic symptom clusters were assessed with the Four-Dimensional Symptom Questionnaire (4DSQ) somatization scale. Psychiatric characteristics, somatic diseases, lifestyle factors, and disability were taken into account as factors potentially underlying the association.

RESULTS

The cardiopulmonary, gastrointestinal, and general cluster significantly predicted the two-year persistence of MDD, but only when two or more of these clusters were present (OR=2.32, 95% CI=1.51-3.57, p=<0.001). Although the association was partly explained by MDD severity, the presence of multiple somatic symptom clusters remained a significant predictor after considering all potentially underlying factors (OR=1.69, 95%CI=1.07-2.68, p=0.03).

CONCLUSIONS

Somatic symptoms are predictors of a worse prognosis of MDD independent of psychiatric characteristics, somatic diseases, lifestyle factors, and disability. These results stress the importance of considering somatic symptoms in the diagnostic and treatment trajectory of patients with MDD. Future research should focus on identifying treatment modalities targeting depressive as well as somatic symptoms.

The network structure of major depressive disorder, generalized anxiety disorder and somatic symptomatology

BACKGROUND

Major depressive disorder (MDD) and generalized anxiety disorder (GAD) often co-occur with somatic symptomatology. Little is known about the contributions of individual symptoms to this association and more insight into their relationships could help to identify symptoms that are central in the processes behind the co-occurrence. This study explores associations between individual MDD/GAD symptoms and somatic symptoms by using the network approach.

METHOD

MDD/GAD symptoms were assessed in 2704 participants (mean age 41.7 years, 66.1% female) from the Netherlands Study of Depression and Anxiety using the Inventory of Depressive Symptomatology. Somatic symptoms were assessed with the somatization scale of the Four-Dimensional Symptom Questionnaire. The technique eLasso was used to estimate the network of MDD/GAD and somatic symptoms.

RESULTS

The network structure showed numerous associations between MDD/GAD and somatic symptoms. In general, neurovegetative and cognitive/affective MDD/GAD symptoms showed a similar strength of connections to the somatic domain. However, associations varied substantially across individual symptoms. MDD/GAD symptoms with many and strong associations to the somatic domain included anxiety and fatigue, whereas hypersomnia and insomnia showed no connections to somatic symptoms. Among somatic symptoms, excessive perspiration and pressure/tight feeling in chest were associated with the MDD/GAD domain, while muscle pain and tingling in fingers showed only a few weak associations.

CONCLUSIONS

Individual symptoms show differential associations in the co-occurrence of MDD/GAD with somatic symptomatology. Strongly interconnected symptoms are important in furthering our understanding of the interaction between the symptom domains, and may be valuable targets for future research and treatment.

A Cross-Cultural Understanding of Depression Among Abused Women

Little research has addressed depression in abused women across cultures. This review examines depression and intimate partner violence (IPV) by comparing and contrasting the IPV definitions, family dynamics, coping, and expressions of depression of women in China, Japan, India, and the United States. Findings reveal that depression is expressed differently across cultures. Somatization is commonly found in Asian countries, but it is not properly assessed by existing Westernized depression assessment tools. In addition, cultural factors were shown to shape abused women's ways of adaptive coping. Cultural awareness and sensitivity are fundamental for successful assessment and intervention for abused women with depression.

Do female patients with nonpathological vaginal discharge need the same evaluation as for Dhat syndrome in males?

AIM

The aim of this study was to evaluate the concept of female Dhat syndrome characterized by the complaint of nonpathological vaginal discharge in association with somatic, anxiety, and depressive symptoms.

MATERIALS AND METHODS

A total of 26 female subjects with nonpathological vaginal discharge along with depressive and somatic complaints were assessed on a self-rated questionnaire modified from Comprehensive Questionnaire for Assessment of Dhat Syndrome designed for males. They were also assessed for psychiatric comorbidity as per ICD-10.

RESULTS

All female subjects received an ICD-10 psychiatric diagnosis, with somatoform/dissociative disorder (57.7%) being the most common. The mean age of onset of vaginal discharge was 24.6 (standard deviation - 7.0) years, noted every day or for 2-3 times per week by more than two-third of the participants. Two-fifth (61.5%) of the women described it as a milky discharge. The most common reason reported for passage of vaginal discharge was that of urinary infection or problems of urinary tract infections (42.3%) followed by vaginal infection/disease (34.6%). More than half (53.8%) of the subjects considered vaginal discharge to be responsible for weakness in the body, weakness in stamina and thinness of physique, while slightly more than two-third (69.2%) of them reported bodily weakness and sleep disturbances. Overall the clinical picture in females was similar to male patients with Dhat syndrome on most of the account.

CONCLUSIONS

Subgroup of patients with vaginal discharge attribute their somatic and mental symptoms to the passage of whitish vaginal discharge and are distressed due to the same. The clinical picture is similar to Dhat syndrome in males. There is a need to recognize female variant of Dhat syndrome as a culture-bound syndrome. Identification of the same may help in managing this subgroup of patients seeking help from the gynecologists for their nonpathological vaginal discharge or from mental health professionals for their symptoms of common mental disorders.

Depression and Political Participation

In this paper, I propose that depression is a political phenomenon insofar as it has political sources and consequences. I then investigate one aspect of this argument-whether depression reduces participation. I hypothesize that individuals with depression lack the motivation and physical capacity to vote and engage in other forms of political participation due to somatic problems and feelings of hopelessness and apathy. Moreover, I examine how depression in adolescence can have downstream consequences for participation in young adulthood. The analyses, using both cross-sectional and longitudinal data, show that voter turnout and other forms of participation decrease as the severity of depressed mood increases. These findings are discussed in light of disability rights and potential efforts to boost participation among this group.

Omega-3 Supplementation for Psychotic Mania and Comorbid Anxiety in Children

OBJECTIVES

Therapeutic benefits of omega-3 fatty acids (Ω3) for mood disorders, psychosis, and anxiety have been reported in the literature. The purpose of the present article is to provide a literature review of Ω3 supplementation for affective disorders and to illustrate the benefits of Ω3 with a case presentation of a young girl with a history of bipolar disorder-type 1 with psychotic features and generalized anxiety disorder.

METHODS

Reviewed literature includes treatment studies of the impact of Ω3 on child mood disorders supplemented by review of meta-analyses within the adult mood disorders literature. The subject of this case report participated in 11 in-depth diagnostic and functional assessments over 5 years as part of an unrelated study. Three years were presupplementation and 2 years were with supplementation with no other medication changes, thus making a naturalistic multiple-baseline single-subject experiment.

RESULTS

Augmentation over a 2 year period was notable for clinically significant and sustained improvement in depressive, manic, and psychotic symptoms.

CONCLUSION

Ω3 supplementation may be a safe, adjunct intervention for treating bipolar disorder in children and adolescents, even in the presence of psychotic and anxious features. The 2 year follow-up in this case offers hope of an accumulating and enduring benefit. Further research into mechanisms of Ω3 action and of combination treatment with other well-known interventions for mood disorders would be beneficial.

Psychological correlates and psychiatric morbidity in patients with Dhat syndrome

AIM

The aim of this study was to examine psychological factors in the form of somatosensory amplification, alexithymia and hypochondriasis in patients with Dhat syndrome. Secondary aims of the study were: (1) To evaluate the influence of psychiatric comorbidity on the psychological correlates; (2) to compare the prevalence of psychological correlates in those with Dhat syndrome and in those with depression and somatoform disorders.

MATERIALS AND METHODS

A total of 106 subjects diagnosed with Dhat syndrome as per International Classification of Diseases-10 (ICD-10) criteria were assessed on Toronto Alexithymia Scale (TAS-20), Somatosensory Amplification Scale (SSAS) and Whitely Index (WI). Psychiatric comorbidity was diagnosed as per ICD-10. Data on 50 patients with depression and 119 patients with somatoform disorder was used for comparison.

RESULTS

The age at onset of Dhat syndrome was 22.54 (standard deviation [SD] - 7.5) years, and duration of illness was 5.04 (SD - 4.2) years. Depressive disorders were diagnosed in 13.2%, anxiety disorders in 15.1%, erectile dysfunction in 14.2% and premature ejaculation in 17% of cases. The mean SSAS total score was 23.12 (SD - 7.99), mean total TAS-20 score was 63.3 (SD - 13.3) and mean WI score was 8.23 (SD - 2.7). About two third of the patients had alexithymia (n = 67; 63.2%) and hypochondriasis (n = 69; 65.1%). Comparison of the psychological correlates between those with Dhat syndrome alone (n = 59) and those with comorbid psychiatric disorder (n = 47) revealed no significant differences. Patients with only Dhat syndrome had significantly higher scores for somatosensory amplification when compared with those with somatoform disorders, but no difference was seen between those with depression and Dhat syndrome alone. Compared to patients with Dhat syndrome alone, those with depression had higher prevalence of alexithymia and hypochondriasis.

CONCLUSION

There are differences in the prevalence of somatosensory amplification, hypochondriasis and alexithymia between those with Dhat syndrome alone and those with depression and somatoform disorders.

Influence of the number and severity of somatic symptoms on the severity of depression and suicidality in community-dwelling elders

INTRODUCTION

Older adults commonly experience somatic symptoms, and those who do are more likely to have depressive disorders as well. Our goal in this study is to examine the influence of the number and severity of somatic symptoms on the severity of depressive symptoms, including suicidality, in elderly adults.

METHODS

This study was conducted as part of the Ansan Geriatric (AGE) Study, a community-based cohort study in Ansan City, South Korea. A total of 3,210 elderly adults aged 60 years or over (1,388 males and 1,770 females) participated in this study. The Korean version of the Beck Depression Inventory (BDI) was used to measure depressive symptoms and suicidality. Somatic symptoms were assessed by the Patient Health Questionnaire-15 (PHQ-15).

RESULTS

Both mild and severe somatic symptoms significantly increased the risk for severe depression and high suicidality. Severe somatic symptoms doubled the risk for severe depression and suicidal intent.

DISCUSSION

Somatic symptoms not fully explained as medical illnesses are closely associated with late-life depression, even after adjustments for comorbid physical illnesses and other confounding factors. The presence of somatic symptoms concurrent with, but not fully explained by comorbid physical illness or disability, seems to be an independent marker for predicting the severity of late-life depression and suicidality.

Personality traits influencing somatization symptoms and social inhibition in the elderly

PURPOSE

Somatization is a common symptom among the elderly, and even though personality disorders have been found to be associated with somatization, personality traits have not yet been explored with regard to this symptom. The aim of this study is to investigate the relationship between personality traits and somatization, and social inhibition.

PATIENTS AND METHODS

As part of a cross-sectional study of a community sample, 126 elderly Thais aged 60 years or over completed self-reporting questionnaires related to somatization and personality traits. Somatization was elicited from the somatization subscale when using the Symptom Checklist SCL-90 instrument. Personality traits were drawn from the 16 Personality Factor Questionnaire and social inhibition was identified when using the inventory of interpersonal problems. In addition, path analysis was used to establish the influence of personality traits on somatization and social inhibition.

RESULTS

Of the 126 participants, 51% were male, 55% were married, and 25% were retired. The average number of years in education was 7.6 (standard deviation =5.2). "Emotional stability" and "dominance" were found to have a direct effect on somatization, as were age and number of years in education, but not sex. Also, 35% of the total variance could be explained by the model, with excellent fit statistics. Dominance was found to have an indirect effect, via vigilance, on social inhibition, which was also influenced by number of years in education and emotional stability. Social inhibition was not found to have any effect on somatization, although hypothetically it should.

CONCLUSION

"Emotional stability", "dominance", and "vigilance", as well as age and the number of years in education, were found to have an effect on somatization. Attention should be paid to these factors in the elderly with somatization.

Personality Assessment Inventory profiles of university students with eating disorders

BACKGROUND

Eating disorders are complex disorders that involve medical and psychological symptoms. Understanding the psychological factors associated with different eating disorders is important for assessment, diagnosis, and treatment.

METHODS

This study sought to determine on which of the 22 Personality Assessment Inventory (PAI) scales patients with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified (EDNOS) differed, and whether the PAI can be used to classify eating disorder subtypes. Because we were interested in both whether the PAI could be used to differentiate eating disorder subtypes from each other, as well as from other disorders, we also included a group of patients with major depression.

RESULTS

The three eating disorder groups did differ significantly from each other, and from the patients with depression, on a number of the PAI scales. Only two PAI scales (Anxiety and Depression), however, exceeded a T-score of 70 for the patients with anorexia nervosa, no scales exceeded a T-score of 70 for the patients with bulimia nervosa or EDNOS, and only two exceeded a T-score of 70 for the patients with depression (Depression and Suicide). A discriminant function analysis revealed an overall correct classification between the groups of 81.6%.

CONCLUSIONS

The PAI helps to understand the psychological factors associated with eating disorders and can be used to assist with assessment. Continued investigation using the PAI in an eating disordered population is supported.

How to assess common somatic symptoms in large-scale studies: a systematic review of questionnaires

OBJECTIVE

Many questionnaires for assessment of common somatic symptoms or functional somatic symptoms are available and their use differs greatly among studies. The prevalence and incidence of symptoms are partially determined by the methods used to assess them. As a result, comparison across studies is difficult. This article describes a systematic review of self-report questionnaires for somatic symptoms for use in large-scale studies and recommends two questionnaires for use in such studies.

METHODS

A literature search was performed in the databases Medline, PsycINFO and EMBASE. Articles that reported the development, evaluation, or review of a self-report somatic symptom measure were included. Instrument evaluation was based on validity and reliability, and their fitness for purpose in large scale studies, according to the PhenX criteria.

RESULTS

The literature search identified 40 questionnaires. The number of items within the questionnaires ranged from 5 to 78 items. In 70% of the questionnaires, headaches were included, followed by nausea/upset stomach (65%), shortness of breath/breathing trouble (58%), dizziness (55%), and (low) back pain/backaches (55%). Data on validity and reliability were reported and used for evaluation.

CONCLUSION

Questionnaires varied regarding usability and burden to participants, and relevance to a variety of populations and regions. Based on our criteria, the Patient Health Questionnaire-15 and the Symptom Checklist-90 somatization scale seem the most fit for purpose for use in large-scale studies. These two questionnaires have well-established psychometric properties, contain relevant symptoms, are relatively short, and are available in multiple languages.

IPS multicentric study: Functional somatic symptoms in depression

BACKGROUND

As a pilot project, Indian Psychiatric Society conducted the first multicentric study involving diverse settings from teaching institutions in public and private sectors and even privately run psychiatric clinics.

AIM OF THE STUDY

To study the typology of functional somatic complaints (FSC) in patients with first episode depression.

MATERIALS AND METHODS

A total of 741 patients from 16 centers across the country participated in the study. They were assessed on Bradford Somatic Symptom inventory for FSC, Beck Depression Inventory for severity of depression, and Comprehensive Psychopathological Rating Scale- anxiety index (CPRS-AI) for anxiety symptoms.

RESULTS

The mean age of the study sample was 38.23 years (SD-11.52). There was equal gender distribution (male - 49.8% vs. females 50.2%). Majority of the patients were married (74.5%), Hindus (57%), and from nuclear family (68.2%). A little over half of the patients were from urban background (52.9%). The mean duration of illness at the time of assessment was 25.55 months. Most of the patients (77%) had more than 10 FSCs, with 39.7% having more than 20 FSCs as assessed on Bradford Somatic Inventory. The more common FSC as assessed on Bradford Somatic Inventory were lack of energy (weakness) much of the time (76.2%), severe headache (74%) and feeling tired when not working (71%), pain in legs (64%), aware of palpitations (59.5%), head feeling heavy (59.4%), aches and pains all over the body (55.5%), mouth or throat getting dry (55.2%), pain or tension in neck and shoulder (54%), head feeling hot or burning (54%), and darkness or mist in front of the eyes (49.1%). The prevalence and typology of FSCs is to a certain extent influenced by the sociodemographic variables and severity of depression.

CONCLUSION

Functional somatic symptoms are highly prevalent in Indian depressed patients and hence deserve more attention while diagnosing depression in Indian setting.

Is a diagnosis of "mild traumatic brain injury" a category mistake?

BACKGROUND

Efforts to produce definitions and diagnostic standards for mild traumatic brain injury (TBI) have a long and complex history. The diagnosis of TBI must be considered in the larger context of neuropsychiatric diagnosis. A major reconceptualization of diagnosis is now underway in which the classical syndrome conceptualization is being discarded. We address the question, what are the implications of this revision of thinking in the specific context of TBI?

METHODS

A recent literature on logical structures for neuropsychiatric disorders was reviewed. The symptom pattern of TBI was identified, and a literature survey determined the frequency of these symptom patterns in other disorders and in healthy control populations.

RESULTS

The frequency of symptom endorsement in populations without a history of TBI can be equal to endorsement frequencies in populations with a history of mild TBI. In some studies, the frequency of symptom endorsement in healthy controls having no history of head injury actually exceeded the endorsement rates in a comparison group with a history mild TBI.

CONCLUSION

The heterogeneity of this clinical population and their clinical presentations, the absence of a unitary etiology of postinjury deficits, and the complex idiosyncratic time course of the appearance of these deficits argue against the valid implementation of the classical model of diagnosis. In addition, the accepted criteria of diagnostic utility are not satisfied. TBI is not a disease; it is an event. More precisely, TBI is an event or a sequence of events that can, in some instances, lead to a diagnosable neurological or psychiatric disorder.

Indianizing psychiatry - Is there a case enough?

Psychiatry is different from all other branches of medicine as it pertains on "psyche" which is intangible, effervescent and indefinable. It is influenced by interviewer and client's communication skills, personality, socio-cultural beliefs and interpretations. The inference of "normal" and "abnormal" varies across cultures and understanding of the cultural nuances is an integral part of understanding psychopathology. Knowledge gained in one culture cannot be extrapolated completely to another culture. Indian psyche is distinct as it is has been influenced by various invaders into the country, collectivism and interdependence. Because of all these factors, presentation of mental illness is different in the Indian culture and many a times it is difficult to fit patients into the categories developed by the Western world. Similar factors also influence attitude towards treatment seeking and visit to magico-religious healers and those practicing alternative system of medicine. Moreover, the principles of Western psychotherapy cannot be applied to the Indian subjects. Compared to West, family plays a vital role in all major decision in an individual's life including his treatment and care. They bear the major burden and take up the responsibility of care of the persons with mental illness and dampen the effect of limited resources. These families cope by trusting and passing on the responsibility to almighty. Hence, there is a need for Indianization of psychiatry.