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Salinero-Fort MA, Jiménez-García R, de Burgos-Lunar C, Chico-Moraleja RM, Gómez-Campelo P. Common mental disorders in primary health care: differences between Latin American-born and Spanish-born residents in Madrid, Spain. Soc Psychiatry Psychiatr Epidemiol 2015; 50:429-43. [PMID: 25273551 DOI: 10.1007/s00127-014-0962-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 09/08/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Our main objective was to estimate and compare the prevalence of the most common mental disorders between Latin American-born and Spanish-born patients in Madrid, Spain. We also analyzed sociodemographic factors associated with these disorders and the role of the length of residency for Latin American-born patients. METHODS We performed a cross-sectional study to compare Latin American-born (n = 691) and Spanish-born outpatients (n = 903) from 15 primary health care centers in Madrid, Spain. The Primary Care Evaluation of Mental Disorders was used to diagnose common mental disorders. Sociodemographic, psychosocial, and migration data were collected. RESULTS We detected common mental disorders in 49.9 % (95 % CI = 47.4-52.3 %) of the total sample. Values were higher in Latin American-born patients than in Spanish-born patients for any disorder (57.8 % vs. 43.9 %, p < 0.001), mood disorders (40.1 % vs. 34.8 %, p = 0.030), anxiety disorders (20.5 % vs. 15.3 %, p = 0.006), and somatoform disorders (18.1 % vs. 6.6 %, p < 0.001). There were no statistically significant differences in prevalence between Latin American-born patients with less than 5 years of residency and Latin American-born residents with 5 or more years of residency. Finally, multivariate analysis shows that gender, having/not having children, monthly income, geographic origin, and social support were significantly associated with several disorders. LIMITATIONS The sample was neither population-based nor representative of the general immigrant or autochthonous populations. CONCLUSIONS The study provides further evidence of the high prevalence of common mental disorders in Latin American-born patients in Spain compared with Spanish-born patients.
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Affiliation(s)
- Miguel A Salinero-Fort
- Gerencia Adjunta de Planificación y Calidad, Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain,
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Qureshi A, Collazos F, Sobradiel N, Eiroa-Orosa FJ, Febrel M, Revollo-Escudero HW, Andrés E, del Mar Ramos M, Roca M, Casas M, Serrano-Blanco A, Escobar JI, García-Campayo J. Epidemiology of psychiatric morbidity among migrants compared to native born population in Spain: a controlled study. Gen Hosp Psychiatry 2013. [PMID: 23200696 DOI: 10.1016/j.genhosppsych.2012.09.010] [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] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this paper is to explore the prevalence of psychiatric morbidity in different immigrant groups in Spain. In keeping with prior studies carried out in Europe, it is expected that the immigrant population will have elevated levels of psychopathology, with some variation across immigrant groups. DESIGN Multicenter, observational, cross-sectional study. SETTING Primary care settings of two Spanish regions. SAMPLE N=1.503 immigrants paired with the same number of Spanish controls, adjusted by gender and age. VARIABLES Demographic variables, MINI International Neuropsychiatric Interview and Standardized Polyvalent Psychiatric Interview, somatic symptoms section. Student's t tests, ORs and logistic regressions were used to analyze the data. RESULTS No differences in psychiatric morbidity were found (native born 30.9%, population vs. immigrants 29.6%, OR=.942, CI=.806-1.100) when comparing immigrants to native born Spaniards. Relative to Spaniards (30.9%), Latin American immigrants had significantly higher levels of psychopathology (36.8%), Sub-Saharan Africans (24.4%) and Asians (16%) had significantly lower levels, and Eastern Europeans (31.4%) and North Africans (26.8%) showed no significant difference. CONCLUSIONS The hypotheses were only partially supported. Although overall immigrants did not differ from the native born population, when analyzed by geographic origin, only Latin Americans had higher levels of psychopathology. It is concluded that multiple factors need to be taken into consideration when studying the mental health of immigrants given that different immigrant groups have different levels of psychopathology.
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Affiliation(s)
- Adil Qureshi
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona.
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Morriss R, Kai J, Atha C, Avery A, Bayes S, Franklin M, George T, James M, Malins S, McDonald R, Patel S, Stubley M, Yang M. Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention. BMC FAMILY PRACTICE 2012; 13:39. [PMID: 22607525 PMCID: PMC3390898 DOI: 10.1186/1471-2296-13-39] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/20/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND The top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of attendance last more than two years, they may become persistent (persistent frequent or regular attendance). However, there is no long-term study of the economic impact or clinical characteristics of regular attendance in primary care. Cognitive behaviour formulation and treatment (CBT) for regular attendance as a motivated behaviour may offer an understanding of the development, maintenance and treatment of regular attendance in the context of their health problems, cognitive processes and social context. METHODS/DESIGN A case control design will compare the clinical characteristics, patterns of health care use and economic costs over the last 10 years of 100 regular attenders (≥30 appointments with general practitioner [GP] over 2 years) with 100 normal attenders (6-22 appointments with GP over 2 years), from purposefully selected primary care practices with differing organisation of care and patient demographics. Qualitative interviews with regular attending patients and practice staff will explore patient barriers, drivers and experiences of consultation, and organisation of care by practices with its challenges. Cognitive behaviour formulation analysed thematically will explore the development, maintenance and therapeutic opportunities for management in regular attenders. The feasibility, acceptability and utility of CBT for regular attendance will be examined. DISCUSSION The health care costs, clinical needs, patient motivation for consultation and organisation of care for persistent frequent or regular attendance in primary care will be explored to develop training and policies for service providers. CBT for regular attendance will be piloted with a view to developing this approach as part of a multifaceted intervention.
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Affiliation(s)
- Richard Morriss
- Psychiatry and Community Mental Health, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom.
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Bener A, Ghuloum S, Al-Mulla AAK, Al-Marri S, Hashim MS, Elbagi IEA. Prevalence of somatisation and psychologisation among patients visiting primary health care centres in the State of Qatar. Libyan J Med 2010; 5. [PMID: 21483572 PMCID: PMC3071179 DOI: 10.3402/ljm.v5i0.5266] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 05/25/2010] [Indexed: 11/25/2022] Open
Abstract
Background Medically unexplained somatic complaints are among the most common clinical presentations in primary care in developing countries and they are considerable burden for patients and health care system. Objectives The aim of this study was to determine the prevalence of somatisation in comparison to psychologisation among a sample of Qatari patients who were visiting primary health care (PHC) centres and to investigate the clinical and socio-demographic characteristics of somatisers (STs) and psychologisers (PGs). Method The survey was conducted among PHC Qatari patients during the period from January to July 2007. About 2,320 patients were approached, of whom 1,689 agreed to participate and responded to the questionnaire. Among the studied Qatari patients, 404 patients were identified for clinical interview. The first stage of the study was conducted with the help of general practitioners, using the 12-item General Health Questionnaire. The second stage was carried out by a consultant using the Clinical Interview Schedule. A specific operational criterion was used to identify STs and PGs. Results The prevalence rate of STs among the total studied sample was 12.4%, while the PGs were 11.5%. Among the identified psychiatric cases, the proportion of STs (52%) was higher than PGs (48%). Most of the diagnostic categories were more prevalent among PGs. The dissatisfaction at work and stressful life events within 12 months before the onset of the presenting symptoms were the three postulated determinants which were significantly more among STs than PGs. Conclusion The prevalence of somatised mental disorder was little higher than the psychologised mental disorder. The prevalence of somatisation and psychologisation is comparable with other reported studies from the Middle-East and Western countries. Dissatisfaction at work and stressful life events were significantly higher among STs than PGs.
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Affiliation(s)
- Abdulbari Bener
- Department of Medical Statistics & Epidemiology, Hamad General Hospital and Hamad Medical Corporation, Doha, Qatar
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García-Campayo J, Arevalo E, Claraco LM, Alda M, Lopez del Hoyo Y. A prevention programme for somatoform disorders is effective for affective disorders. J Affect Disord 2010; 122:124-32. [PMID: 19619900 DOI: 10.1016/j.jad.2009.06.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2009] [Revised: 06/16/2009] [Accepted: 06/17/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the effectiveness of a psycho-educational programme for the primary prevention of somatoform disorders in healthy primary care patients. METHODS Randomized, controlled trial. Participants (N=104) were randomly assigned to: (1) a psycho-educational intervention, or (2) no intervention at all. The primary outcome measure was somatoform disorder psychiatric diagnosis at 5-year follow-up. Secondary outcome measures were hypochondriasis, locus of control and attribution of symptoms and psychological distress. RESULTS At 3 and 6 months, and 5 years, the intervention group significantly decreased hypochondriasis and somatic attributions; and increased psychological and normalizing attributions and internal locus of control. Five years after baseline, the prevalence of somatoform disorders showed no differences between both groups. Nevertheless, overall psychiatric morbidity was less prevalent in the intervention group (odds ratio: 2.72; 95%CI:1.10-6.72). In addition, a decrease in depression and anxiety subscales and in overall General Health Questionnaire scoring (p<.05) was found in the intervention group. CONCLUSIONS A primary prevention programme for somatization seems to be useful, not to decrease somatoform disorders, but to prevent anxiety and depressive disorders. The effects of overlapping psychobiological mechanisms are discussed.
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Affiliation(s)
- Javier García-Campayo
- Department of Psychiatry, Miguel Servet University Hospital, University of Zaragoza, Spain.
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García Campayo J, Asso E, Alda M, Andres EM, Sobradiel N. Association Between Joint Hypermobility Syndrome and Panic Disorder: A Case–Control Study. PSYCHOSOMATICS 2010. [DOI: 10.1016/s0033-3182(10)70659-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Holmstrand C, Engström G, Träskman-Bendz L. Disentangling dysthymia from major depressive disorder in suicide attempters' suicidality, comorbidity and symptomatology. Nord J Psychiatry 2008; 62:25-31. [PMID: 18389422 DOI: 10.1080/08039480801960164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Dysthymia and major depressive disorder (MDD) are both risk diagnoses for suicidal behaviour. The aim of the present study was to identify clinical differences between these disorders, with a special reference to dysthymia. We studied suicidal behaviour, comorbidity and psychiatric symptoms of inpatient suicide attempters with dysthymia and MDD. We used DSM III-R diagnostics, the Suicide Assessment Scale (SUAS) and the Comprehensive Psychopathological Rating Scale (CPRS), part of which is the Montgomery and Asberg Depression Rating Scale (MADRS). Suicide mortality, number of repeated suicide attempts, method of suicide attempt and comorbidity of Axis I did not differ between the groups. Dysthymia patients, however, suffered more than MDD patients from DSM-III-R Axis II diagnoses (above all cluster B). There was no significant difference in Axis III comorbidity. Total SUAS, CPRS and MADRS scores did not differ significantly between the groups. When studying separate SUAS and CPRS items in a multivariate analysis, the CPRS items "aches and pains", "increased speech flow", increased "agitation" and "less tendency to worrying over trifles" as well as young age remained independently associated with dysthymia. Dysthymia patients, who later committed suicide, more often reported increased "aches and pains" than those who did not commit suicide. In this small sample of suicide attempters, we conclude that dysthymia suicide attempters, more often than MDD patients, have a comorbidity with personality disorders, which combined with a picture of aches and pains, could be factors explaining their suicidality.
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Affiliation(s)
- Cecilia Holmstrand
- Department of Psychiatry, Clinical Sciences, University Hospital, Lund, Sweden.
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Garcia-Campayo J, Alda M, Sobradiel N, Olivan B, Pascual A. Personality disorders in somatization disorder patients: a controlled study in Spain. J Psychosom Res 2007; 62:675-80. [PMID: 17540225 DOI: 10.1016/j.jpsychores.2006.12.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Revised: 11/09/2006] [Accepted: 12/18/2006] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this paper is to assess personality disorder (PD) comorbidity in somatization disorder (SD) patients compared with psychiatric controls in a Spanish sample. METHODS This is a case-control study. Selection of 70 consecutive SD patients was made, and an age-, sex-, and ethnic-group-matched control group of 70 mood and/or anxiety disorder patients recruited in psychiatric outpatient clinics was selected. PDs were measured using the International Personality Disorder Examination, and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I morbidity was measured by means of the Standardized Polyvalent Psychiatric Interview. RESULTS PD comorbidity in SD patients was 62.9%, compared to 28.2% in controls [odds ratio (OR)=3.7; 95% confidence interval (95% CI)=1.8-7.6]. The highest ORs of PD in SD patients, compared with controls, were for paranoid (OR=9.2; 95% CI=1.9-43), obsessive-compulsive (OR=6.2; 95% CI=1.2-53.6), and histrionic (OR=3.6; 95% CI=0.9-13.9) PDs. CONCLUSIONS This is a controlled study with the largest sample of SD patients. The prevalence of PD comorbidity is similar to that of a previously published controlled study but is different from those of the most frequent PD subtypes.
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Protocol for the THREAD (THREshold for AntiDepressants) study: a randomised controlled trial to determine the clinical and cost-effectiveness of antidepressants plus supportive care, versus supportive care alone, for mild to moderate depression in UK general practice. BMC FAMILY PRACTICE 2007; 8:2. [PMID: 17204136 PMCID: PMC1781451 DOI: 10.1186/1471-2296-8-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Accepted: 01/04/2007] [Indexed: 11/21/2022]
Abstract
Background Depression guidelines in the UK recommended a policy of watchful waiting for mild depression due to a lack of evidence for the effectiveness of antidepressant treatment for mild cases. However there has been relatively little research carried out in primary care to help establish the severity threshold at which antidepressant treatment is effective and cost-effective. Methods/Design The THREAD (THREshold for AntiDepressants) study is a multi-centre randomised controlled trial designed to determine the clinical and cost effectiveness of a selective serotonin reuptake inhibitor (SSRI) plus general practitioner (GP) supportive care, versus supportive care alone, for mild to moderate depression in primary care. The aim is to recruit 300 patients from three centres (Southampton, London and Liverpool). Depressive symptoms will be assessed at baseline, 12 weeks and 26 weeks, using the 17-item Hamilton Depression Rating Scale (HDRS). Two severity sub-groups of patients will be recruited, with HDRS scores of 12–15, and 16–19. Possible predictors of response will be explored including life events and difficulties and alcohol consumption. Analysis of covariance, controlling for baseline value, severity group and centre will be used to estimate the overall treatment effectiveness (difference in HDRS score) at final follow up. The primary analysis will be by 'intention to treat' using double sided tests. The interaction between severity sub-group and treatment will be tested, and if appropriate, effects within separate severity sub-groups estimated. The economic analysis will compare the two treatment groups in terms of mean costs and cost-effectiveness. Discussion The results of this study will give GPs important information to help them determine the severity of depression at which antidepressant treatment is likely to be cost-effective.
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Garcia-Campayo J, Sanz-Carrillo C, Ibañez JA, Lou S, Solano V, Alda M. Validation of the Spanish version of the SCOFF questionnaire for the screening of eating disorders in primary care. J Psychosom Res 2005; 59:51-5. [PMID: 16185998 DOI: 10.1016/j.jpsychores.2004.06.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2003] [Accepted: 06/07/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the performance of the Spanish version of a new screening tool (the SCOFF) for the detection of eating disorders (EDs) in primary care. DESIGN validation study. The psychiatric interview Schedules for Clinical Assessment in Neuropsychiatry (SCAN) was used as the "gold standard." Blinding was applied to administration of the SCOFF and the clinical interview. SETTING six primary health care centers in Zaragoza and Huesca, Spain. PARTICIPANTS 203 female patients, between the ages of 15 and 53 years, with a probable diagnosis of ED. MAIN OUTCOME MEASURE validity as assessed by sensitivity, specificity, positive predictive value and negative predictive value. In addition, test-retest reliability and the receiver operating characteristics (ROC) curve were calculated. RESULTS The best threshold point in the Spanish version was 2+ positive answers, the same as that recommended in the original British study. This cutoff point provided 97.7% sensitivity and 94.4% specificity for the detection of EDs in primary care. For each specific ED, sensitivity and specificity with this threshold point were, respectively, the following: bulimia, 97.8% and 94.4%; anorexia, 93.1% and 94.4%; and ED not otherwise specified (EDNOS), 100% and 94.4%. CONCLUSIONS The Spanish version of the SCOFF questionnaire shows excellent psychometric properties for the early detection of EDs in primary settings.
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Aragonès E, Labad A, Piñol JL, Lucena C, Alonso Y. Somatized depression in primary care attenders. J Psychosom Res 2005; 58:145-51. [PMID: 15820842 DOI: 10.1016/j.jpsychores.2004.07.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2003] [Accepted: 07/21/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study is to determine, within the context of primary care, the frequency of the various ways in which depression is presented with respect to somatic symptoms and to compare depressed patients who present their distress somatically with those with psychological complaints. METHOD In the two-phase cross-sectional study, first, we screened 906 consecutive patients, and second, we interviewed in detail 306 selected patients. RESULTS The prevalence of depression was 16.8% (CI 95%: 13.4-20.2). There were 59 cases with psychological presentation, 45 somatizers and 16 had organic disorders with depressive comorbidity. Somatizers had lower level of education, and somatized depression was less serious and caused less repercussion. Detection, antidepressive treatment and psychiatric care were lower for somatizers than for psychologizers. CONCLUSIONS Somatization is a frequent way to present depression in primary care. For somatizers, depression is less severe and is associated with less repercussion. Somatization is associated with the under-detection of the underlying psychiatric process.
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Affiliation(s)
- Enric Aragonès
- Constantí Primary Care Centre, Catalan Health Institute, Spain.
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García-Campayo J, Claraco LM, Sanz-Carrillo C, Arévalo E, Monton C. Assessment of a pilot course on the management of somatization disorder for family doctors. Gen Hosp Psychiatry 2002; 24:101-5. [PMID: 11869744 DOI: 10.1016/s0163-8343(01)00178-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Somatization disorder (SD) patients are difficult to treat and produce negative feelings in health professionals. Smith et al.'s guidelines have demonstrated cost-effectiveness in the treatment of these patients, but family doctors consider it difficult to put these into practice in the long term. The objective of this paper is to design and assess a pilot course, based on Smith's norms, to train general practitioners for the everyday management of SD patients in primary care. We have designed a 20-h practical course, using role-playing and video recording with standardized patients, and focusing on micro-skills recommended by the literature on the subject. Assessment of the efficacy of the course is made by evaluation of baseline and post course video recordings by researchers unaware of the order of the interviews. The comparison of baseline and post course assessments demonstrated a significant improvement in several key skills (giving a name to the illness, explaining the psychological and biological basis of the disease, and emphasizing stress reduction) but no change on others (explaining that SD is a well-known disorder, empowering the patient, not blaming the patient for his or her illness, and instilling hope). Finally, other skills such as assessing the patient's opinion of the illness, recognizing the reality of symptoms and informing that there is no life risk, were correctly done from the beginning and, therefore, showed no change. We found that training may facilitate the development of certain skills. However, some doctors' abilities might also require the use of techniques such as Balint groups to modify negative emotions, such as anger and fear, toward these patients.
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Sanz-Carrillo C, García-Campayo J, Rubio A, Santed MA, Montoro M. Validation of the Spanish version of the Perceived Stress Questionnaire. J Psychosom Res 2002; 52:167-72. [PMID: 11897235 DOI: 10.1016/s0022-3999(01)00275-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To validate in Spanish the Perceived Stress Questionnaire (PSQ), a questionnaire to assess stress for research purposes in psychosomatic patients. METHOD The test was administered to a healthy population (N=174) of nursing students and health workers and to a clinical sample (N=80) of patients attending a psychiatric outpatient consultation. RESULTS Concurrent validity: General and Recent PSQ scores correlated high with trait anxiety (r=.65), moderate with depression (r=.46) and psychological disturbance (r=.51) and poor with state anxiety (r=.22). Predictive validity: PSQ scores were higher in "psychiatric cases" than in "psychiatric noncases" (P<.01), and correlated highly with somatic symptoms of psychological origin (r=.62) in the clinical subsample. Internal consistency was 0.9 for the General and 0.87 for the Recent PSQ. Test-retest reliability of the General PSQ was 0.80. DISCUSSION The Spanish version of PSQ presents good psychometric properties and it seems to be a valuable instrument for psychosomatic researchers.
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Noyes R, Langbehn DR, Happel RL, Stout LR, Muller BA, Longley SL. Personality dysfunction among somatizing patients. PSYCHOSOMATICS 2001; 42:320-9. [PMID: 11496021 DOI: 10.1176/appi.psy.42.4.320] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To examine the nature and extent of personality dysfunction related to somatization, the authors administered the Structured Interview for DSM-IV Personality and the NEO Five-Factor Inventory to a series of somatizing and nonsomatizing patients in a general medicine clinic. A greater percentage of somatizers met criteria for one or more DSM-IV personality disorders, especially obsessive-compulsive disorder, than did control patients. Somatizers also differed from control patients with respect to self-defeating, depressive, and negativistic personality traits and scored higher on the dimension of neuroticism and lower on the dimension of agreeableness. In addition, initial and facultative somatizers showed more personality pathology than true somatizers. These findings suggest that certain personality disorders and traits contribute to somatization by way of increased symptom reporting and care-seeking behavior.
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Affiliation(s)
- R Noyes
- Department of Psychiatry, University of Iowa Colleges of Medicine and Public Health, Iowa City 52242, USA.
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Garcia-Campayo J, Sanz-Carrillo C, Baringo T, Ceballos C. SPECT scan in somatization disorder patients: an exploratory study of eleven cases. Aust N Z J Psychiatry 2001; 35:359-63. [PMID: 11437810 DOI: 10.1046/j.1440-1614.2001.00909.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE There are no previous studies using single photon emission computed tomography (SPECT) scans in somatization disorder (SD) patients. The aim of this paper is to assess SPECT imaging abnormalities in SD patients and study any relation to laterality. METHOD Eleven SD patients from the Somatization Disorder Unit of Miguel Servet University Hospital, Zaragoza, Spain, not fulfilling criteria for any other psychiatric disorder and showing normal computed tomography (CT) and magnetic resonance imaging (MRI) images were studied with SPECT. Patients with DSM-IV axis I comorbidity were ruled out because it has been demonstrated that SPECT scans can show abnormalities in patients with depression and anxiety disorders. The technique used for SPECT was 99mTc-D,1,hexamethylpropyleneamide-oxime (99mTc-HMPAO) in four patients and 99mTc-bicisate in the other seven. The SPECT scans were evaluated without knowledge of clinical data and entirely by visual inspection. RESULTS Seven out of 11 (63.6%) SD patients showed hypoperfusion in SPECT imaging. In four cases there was hypoperfusion in the non-dominant hemisphere and the predominance of pain symptoms took place in the contralateral hemibody. In the other three patients hypoperfusion was bilateral. The anatomical regions affected were cerebellum (four cases), frontal and prefrontal areas (three cases), temporoparietal areas (two cases) and the complete hemisphere (one case). CONCLUSIONS A proportion of SD patients may present hypoperfusion in SPECT images, uni- or bilaterally, in different brain areas. Possible aetiological explanations for this finding are discussed. Controlled studies are necessary to confirm or refute this hypothesis.
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Affiliation(s)
- J Garcia-Campayo
- Miguel Servet University Hospital and University of Zaragoza, Spain.
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Garcia-Campayo J, Sanz-Carrillo C. A review of the differences between somatizing and psychologizing patients in primary care. Int J Psychiatry Med 2000; 29:337-45. [PMID: 10642907 DOI: 10.2190/fmj2-uk3y-fkb8-dcgn] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This article reviews all published studies on somatizing and psychologizing patients in primary care, according to Bridges and Goldberg's criteria [1]. METHOD A review of the Medline base from 1985 to 1998 was carried out. RESULTS Somatization is a concept valid, reliable, and stable over time. There are no differences between somatizers and psychologizers in sociodemographics, social problems or past medical and psychiatric history. The main clinical and diagnostic difference is a predominance of depressive symptoms and disorders in psychologizers. Finally, the most remarkable differences between somatizers and psychologizers are found in personality traits, such as attribution of somatic symptoms. However, some traits considered important in the outcome of somatizers, such as hypochondriasis or locus of control, show no differences between both groups of patients. CONCLUSION Contrary to what was expected, the comparison between these two groups of patients give few clues for the etiology and treatment of somatization. Follow-up studies should be the main source of data to answer these questions.
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El-Rufaie OE, Al-Sabosy MA, Bener A, Abuzeid MS. Somatized mental disorder among primary care Arab patients: I. Prevalence and clinical and sociodemographic characteristics. J Psychosom Res 1999; 46:549-55. [PMID: 10454171 DOI: 10.1016/s0022-3999(98)00101-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aims of this study were to estimate the prevalence of somatized mental disorder (SMD) in comparison to psychologized mental disorder (PMD) among a sample of primary health care (PHC) Arab patients, and to investigate the clinical and sociodemographic characteristics of SMD. The first stage of study was conducted by general practitioners (GPs), using the 12-item General Health Questionnaire (GHQ-12). The second stage was carried out by a psychiatrist using the Clinical Interview Schedule (CIS) and an inquiry schedule. Specific operational criteria were used to identify SMD and PMD. The estimated prevalence rate of SMD among the total screened sample was 12%. SMD patients constituted 48% of the psychiatric patients identified, whereas, for the PMD group, this figure was 42%. Educational level was significantly lower in the SMD group. Headache, backache, and abdominal pain were the most commonly presented somatic symptoms. The symptoms pursued a chronic and persistent course and most patients experienced multiple symptoms. The most common ICD-10 psychiatric diagnoses among both SMD and PMD patients were mixed anxiety and depressive disorder, generalized anxiety disorder, and mood and adjustment disorders. Recurrent depressive disorder and dysthymia were significantly more prevalent in the PMD group. The severity of psychiatric illness identified was greater among psychologizers than the somatizers of mental disorder.
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Affiliation(s)
- O E El-Rufaie
- Department of Psychiatry, Faculty of Medicine, UAE University, Al-Ain, United Arab Emirates
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García-Campayo J, Lobo A, Pérez-Echeverría MJ, Campos R. Three forms of somatization presenting in primary care settings in Spain. J Nerv Ment Dis 1998; 186:554-60. [PMID: 9741561 DOI: 10.1097/00005053-199809000-00006] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this paper is to study the prevalence and clinical characteristics of functional, hypochondriacal, and presenting somatization (FSTS, HSTS, and PSTS, respectively) defined by standardized criteria, as well as the validity of their distinction in primary care in Spain. A two-stage epidemiological study of a representative sample (N = 1559) of primary care patients was carried out. In the first phase, the validated Spanish versions of General Health Questionnaire, Mini-Mental State Examination, and CAGE were used. In the second phase, the Standardized Polyvalent Psychiatric Interview, an interview for the multiaxial assessment of medical patients, was employed. The prevalence of any form of somatization in Spain was 21.3% (FSTS: 16.2%, PSTS: 9.4%, HSTS: 6.7%). Overlap of any of the three clinical forms was very frequent (42.7%). FSTS patients tended to be more chronic and showed higher scores in fatigue but lower scores in both depression and anxiety. Chronicity was frequent among somatizers, particularly in those who fulfilled more than one kind of somatization. Differences in diagnostic distribution among the three groups were also observed. In conclusion, this is the first study giving support to the validity of the distinction among three types of somatization in Spain, but overlap was more frequent than reported in North American studies.
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Affiliation(s)
- J García-Campayo
- Department of Psychiatry, Hospital Miguel Servet, Zaragoza, Spain
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Garcia-Campayo J, Sanz-Carrillo C, Yoldi-Elcid A, Lopez-Aylon R, Monton C. Management of somatisers in primary care: are family doctors motivated? Aust N Z J Psychiatry 1998; 32:528-33. [PMID: 9711367 DOI: 10.3109/00048679809068327] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this paper is to assess the attitudes of Spanish general practitioners towards somatisers and the degree of involvement that family doctors are ready to adopt in the care of these patients. METHOD A postal questionnaire on attitudes was sent to a representative sample (n = 135) of general practitioners from two health districts of the region of Aragon. Seventy (51.8%) of them returned usable questionnaires. RESULTS Most of the general practitioners were interested in the treatment of somatisers and considered that they should be treated at primary care level. However, when specific treatment tasks were proposed, they only accepted to act as a filter to specialised care and to care for patients with chronic functional syndromes. Additionally, they refuse to detect presenting somatisers, to prescribe psychotropic drugs or offer any psychological approach, and to avoid reinforcing abnormal illness behaviour in these patients and their families. These findings can be explained because the main emotions somatisers produce in doctors are frustration and anger. CONCLUSIONS Family doctors need a lot more help, education and support in the management of somatisers, and psychiatrists need to provide it. Any management program for the treatment of somatisers in primary care should include methods to modify general practitioners' attitudes towards these patients.
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Affiliation(s)
- J Garcia-Campayo
- Unidad de Trastornos Somatomorfos, Hospital Miguel Servet, Zaragoza, Spain
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García-Campayo J, Larrubia J, Lobo A, Pérez-Echeverría MJ, Campos R. Attribution in somatizers: stability and relationship to outcome at 1-year follow-up. Grupo Morbilidad Psiquica y Psicosomática de Zaragoza (GMPPZ). Acta Psychiatr Scand 1997; 95:433-8. [PMID: 9197910 DOI: 10.1111/j.1600-0447.1997.tb09658.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of this study was to determine whether attributional style is a stable pattern in somatizers, to analyse the sociodemographic and psychopathological characteristics that can modify it, and to study the relationship between attributional pattern and outcome. A total of 147 somatizers and 46 psychologizers from a representative sample (n = 1559) of primary care patients in Zaragoza, Spain were followed up for 1 year. Attribution of somatic symptoms was a stable construct in somatizers. Patients who modified attribution were younger (by 15 years on average), tended to be without a partner, and had a shorter illness duration (by 20 months on average) than those who maintained it. Attribution showed no correlation with outcome at the 1-year follow-up.
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Affiliation(s)
- J García-Campayo
- Department of Psychiatry, Hospital Miguel Servet, Zaragoza, Spain
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García-Campayo JJ, Sanz-Carrillo C, Perez-Echeverria MJ, Campos R, Lobo A. Screening of somatization disorder: validation of the Spanish version of the Othmer and DeSouza test. Acta Psychiatr Scand 1996; 94:411-5. [PMID: 9020991 DOI: 10.1111/j.1600-0447.1996.tb09882.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objective of this study was to validate the Spanish version of the Othmer and DeSouza Screening Test for Somatization Disorder. We have designed a validity study using the Standardized Polyvalent Psychiatric Interview, an instrument specifically designed to diagnose psychiatric morbidity in medical settings as the 'golden rule'. The control group displayed 'functional' and 'presenting' somatization. The Othmer and DeSouza Screening Test, with a threshold of three symptoms, shows 88% sensitivity, 78% specificity and a misclassification rate of 17%. It is concluded that Othmer and DeSouza's screening test, with a threshold of three symptoms, is a useful tool for the diagnosis of somatization disorder in medical and primary care settings in Spain. Discrepancies with US findings are discussed on a cross-cultural basis.
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