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Gecaite-Stonciene J, Lochner C, Marincowitz C, Fineberg NA, Stein DJ. Obsessive-Compulsive (Anankastic) Personality Disorder in the ICD-11: A Scoping Review. Front Psychiatry 2021; 12:646030. [PMID: 33796036 PMCID: PMC8007778 DOI: 10.3389/fpsyt.2021.646030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/19/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: With the shift from a categorical to a dimensional model, ICD-11 has made substantial changes to the diagnosis of personality disorders (PDs), including obsessive-compulsive (anankastic) personality disorder (OCPD). The ICD-11 PD model proposes a single diagnosis of PD with specifications regarding severity and domains. However, a systematic overview of ICD-11 anankastia is lacking. In this review we address the reformulation of the OCPD diagnosis in the ICD-11, and draw comparisons with the DSM-5, with a particular focus on diagnostic validity and clinical utility. We hypothesized that the ICD-11 PD model provides a diagnostically valid and clinically useful approach to OCPD, with specific emphasis on the anankastia domain as the primary trait qualifier. Methods: Literature published from 2010 to 2020 was systematically searched using the PubMed/MEDLINE, PsychInfo, Cochrane, and Web of Sciences search engines, in order to find all articles that addressed ICD-11 anankastia. Relevant articles were collated, and themes of these articles subsequently extracted. Results: Out of the 264 publications identified, 19 articles were included in this review. Four themes were identified, namely (a) overlap of DSM-5 OCPD with the ICD-11 PD model, (b) the factorial structure of the ICD-11 PD model with respect to the anankastia domain, (c) the clinical utility of the ICD-11 PD model, and (d) comparison of the ICD-11 PD model of anankastia with the DSM-5 alternative model for OCPD. Conclusions: The ICD-11 anankastia domain overlaps with DSM-5 OCPD traits, and the factor analyses of the ICD-11 PD model further support the diagnostic validity of this domain. There is some support for the clinical utility of the ICD-11 PD model of anankastia but further studies are needed, including of its relationship to obsessive-compulsive and related disorders.
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Affiliation(s)
- Julija Gecaite-Stonciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Christine Lochner
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Clara Marincowitz
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Naomi A Fineberg
- National Obsessive Compulsive Disorders Specialist Service, Hertfordshire Partnership University National Health Service Foundation Trust, University of Hertfordshire, Hatfield, United Kingdom
| | - Dan J Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Kosson D, Malec-Milewska M, Gałązkowski R, Rzońca P. Analysis of Anxiety, Depression and Aggression in Patients Attending Pain Clinics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2898. [PMID: 30567323 PMCID: PMC6313760 DOI: 10.3390/ijerph15122898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/15/2018] [Accepted: 12/16/2018] [Indexed: 12/26/2022]
Abstract
The aim of the study was to measure the frequency of such emotional disturbances as anxiety, depression and aggression among patients treated in a pain clinic, as well as assess the factors contributing to such disorders. Research was conducted from January 2014 to April 2018 and involved patients treated in two pain clinics in the city of Warsaw, Poland. The study used the Hospital Anxiety and Depression Scale-Modified Version (HADS-M) and the Numerical Rating Scale (NSR). 1025 patients were recruited. The main reasons for their attending the pain clinic were osteoarticular pain (43.61%) and neuropathic pain (41.56%). Emotional disturbances in the form of anxiety were diagnosed in 32.39% of all the patients, depression in 17.85%, and aggression in 46.15%. The factors determining the level of anxiety in the study group were: sex, age, pain intensity and the lack of pharmacological treatment. Depression was determined by sex, pain intensity and the time of treatment in the clinic, while aggression by age and pain intensity.
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Affiliation(s)
- Dariusz Kosson
- Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Division of Teaching, 4 Lindley St., 02-005 Warsaw, Poland.
| | - Małgorzata Malec-Milewska
- Department of Anesthesiology and Intensive Care, Medical Center for Postgraduate Education, 231 Czerniakowska St., 00-416 Warsaw, Poland.
| | - Robert Gałązkowski
- Department of Emergency Medical Services, Faculty of Health Science, Medical University of Warsaw, 81 Żwirki i Wigury St., 02-091 Warsaw, Poland.
| | - Patryk Rzońca
- Department of Emergency Medicine, Faculty of Health Sciences, Medical University of Lublin, 4-6 Staszica St., 20-081 Lublin, Poland.
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Srivastava S, Bhatia MS, Gautam P. 25 Hydroxyvitamin D levels, quality of life, and disability in long-standing patients of somatization. Ind Psychiatry J 2018; 27:87-91. [PMID: 30416297 PMCID: PMC6198590 DOI: 10.4103/ipj.ipj_73_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Somatization disorder is a debilitating condition, in which patients have multiple physical complaints with no explained cause and no relief even after consultations. AIM The present study examined the association of 25-hydroxyvitamin D (25[OH]D) levels, quality of life, disability, and symptom profile in long standing with somatization disorder. METHODS One-hundred three patients of somatization disorder suffering for ≥2 years, visiting psychiatry outpatient clinic during two consecutive summer season (April to June) of 2015-2016 were recruited. Symptom profile was studied using Patient-Health-Questionnaire (PHQ-15) items (somatic symptoms), PHQ-9 items (depressive symptoms), Generalized Anxiety Disorder-7 (GAD-7) item (anxiety symptoms).quality of life was assessed using the World Health Organization Quality of Life BREF 26 item, and disability measure was World Health Organization Disability Assessment Schedule (WHODAS) 2.0. 25(OH) D levels were estimated using chemiluminescence binding assay. RESULTS The poor quality of life in somatization disorder was significantly associated with disability, symptom profile using PHQ-15, PHQ-9, and GAD-7. 25(OH)D levels were deficient in 56.31% of the study population. CONCLUSION The high somatic symptom severity in majority of patients suffering from somatization disorder needs more attention from psychiatrists across cultures so that functional status and quality of life can be improved. Routine estimation of Vitamin D levels and correction of its deficiency may bring about symptomatic relief at an early stage, thereby reducing the morbidity associated with the disorder.
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Affiliation(s)
- Shruti Srivastava
- Department of Psychiatry, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
| | - Manjeet Singh Bhatia
- Department of Psychiatry, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
| | - Priyanka Gautam
- Department of Psychiatry, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
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Pawl RP. Commentary on NIH Guidelines for research on chronic low back pain. Surg Neurol Int 2014; 5:S347-8. [PMID: 25289158 PMCID: PMC4173198 DOI: 10.4103/2152-7806.139665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 06/12/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ronald P Pawl
- Associate Professor, Neurosurgery, University of Illinois at Chicago (Retired), USA
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Gili M, Magallón R, López-Navarro E, Roca M, Moreno S, Bauzá N, García-Cammpayo J. Health related quality of life changes in somatising patients after individual versus group cognitive behavioural therapy: a randomized clinical trial. J Psychosom Res 2014; 76:89-93. [PMID: 24439682 DOI: 10.1016/j.jpsychores.2013.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/28/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess changes in health related quality of life after a cognitive behavioural program for patients diagnosed with abridged somatization disorder in primary care. METHOD A multicentre, randomized, parallel group, controlled trial was designed. 168 patients were recruited from 29 primary health care centres in Spain and were randomly assigned to one of the three study arms: treatment as usual improved with Smith's norms, individual cognitive behavioural treatment, and group cognitive behavioural treatment. Health-related quality of life was assessed using SF-36 Health Survey. RESULTS Individual cognitive behavioural treatment achieves greater changes in health related quality of life than group cognitive behavioural therapy and treatment as usual. Improvement in health related quality of life was fully observed at 12 month, and partially at 6 months. The modality of intervention interacts with time in all dimensions except for Physical functioning and Vitality. Patients who received individual cognitive behavioural therapy treatment had better scores in Physical and Mental health summary measures at 12 month follow-up. CONCLUSIONS Individual cognitive behavioural treatment is the most effective way to improve health related quality of life in abridged somatization disorder patients, and its effects are sustained over time. Also, regardless of the type of intervention, physical functioning improves compared with treatment as usual.
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Affiliation(s)
- Margalida Gili
- Institut Universitari d´Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Ctra Valldemossa km 7,5, Palma de Mallorca, Spain; Red de Actividades Preventivas y Promoción de la Salud en Atención Primaria (RedIAPP), Avda Gran Via de les Corts Catalanes, 587 Ático, Barcelona, Spain.
| | - Rosa Magallón
- Red de Actividades Preventivas y Promoción de la Salud en Atención Primaria (RedIAPP), Avda Gran Via de les Corts Catalanes, 587 Ático, Barcelona, Spain; Arrabal Health Center, Department of Family Medicine, C/Andador Aragües del Puerto, 2-4, Zaragoza, Spain.
| | - Emilio López-Navarro
- Institut Universitari d´Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Ctra Valldemossa km 7,5, Palma de Mallorca, Spain; Red de Actividades Preventivas y Promoción de la Salud en Atención Primaria (RedIAPP), Avda Gran Via de les Corts Catalanes, 587 Ático, Barcelona, Spain.
| | - Miquel Roca
- Institut Universitari d´Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Ctra Valldemossa km 7,5, Palma de Mallorca, Spain; Red de Actividades Preventivas y Promoción de la Salud en Atención Primaria (RedIAPP), Avda Gran Via de les Corts Catalanes, 587 Ático, Barcelona, Spain.
| | - Sergio Moreno
- Facultad de Ciencias de la Salud, University San Jorge, Autovía A-23, Km 299, Zaragoza, Spain.
| | - Natalia Bauzá
- Institut Universitari d´Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Ctra Valldemossa km 7,5, Palma de Mallorca, Spain.
| | - Javier García-Cammpayo
- Red de Actividades Preventivas y Promoción de la Salud en Atención Primaria (RedIAPP), Avda Gran Via de les Corts Catalanes, 587 Ático, Barcelona, Spain; Miguel Servet University Hospital, Instituto Aragonés de Ciencias de la Salud, Department of Psychiatry, University of Zaragoza, Avenida San Juan Bosco, n(∘)13, Zaragoza, Spain.
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Bergander B, Erdur L, Kallenbach-Dermutz B, Deter HC. Younger and older chronic somatoform pain patients in psycho-diagnostics, physician-patient relationship and treatment outcome. Biopsychosoc Med 2013; 7:4. [PMID: 23379640 PMCID: PMC3573985 DOI: 10.1186/1751-0759-7-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 02/01/2013] [Indexed: 12/02/2022] Open
Abstract
Introduction Patients with chronic pain are found with highly variable clinical presentation and differing physical complaints. They are seen as a heterogenic group. Based on clinical observations, elderly patients seem to differ from younger patients with chronic pain. We examined whether there were systematic differences between young and old pain patients. Methods As part of a routine evaluation of university hospital care, a newly developed psychosomatic treatment model for chronic somatoform pain disorders was examined. The basis for treatment efficacy was a target-oriented, specific somatic and psychological intervention that included a stable physician-patient relationship. Particular attention was paid to differences in treatment outcome with regard to changes in both physical and psychopathological symptom levels. We hypothesised that younger pain patients had higher psychological burden and benefitted more from our treatment than older pain patients. Results Overall, 179 inpatients (57.5% women) with chronic pain were examined (age between 16 and 79 years). The group as a whole yielded high scores on the somatisation dimension (SCL-90) and showed a considerable amount of psychopathological symptoms, such as depressive mood and anxiety (HADS) and a great emotional instability (FPI-R). Age differences were only found with regards to patients’ degree of aggression (SCl-90): younger patients showed higher aggressive tendencies than older ones (p< 0.05). The treatment offered helped patients in both age groups especially with regard to reduction of depressive mood (HADS, p< 0.01) and anxiety levels (HADS, p< 0.01). Regression analysis showed different age groups and gender as significant predictors of anxiety reduction under therapy (R2=.108; model: p< 0.01). Discussion and conclusion Results show that younger chronic pain patients suffer more from a considerable amount of psychological distress than older ones, but our treatment approach was equally effective in both groups. However, age and gender differences, as well as the patient’s baseline level of anxiety influenced the outcome. These factors need to be studied in future research.
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Affiliation(s)
- Bernd Bergander
- Department of Psychosomatics and Psychotherapy, Charité Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, 12200, Germany.
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[20 years of professional specialist for psychosomatic medicine and psychotherapy in Germany]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2012; 58:106-25. [PMID: 22786842 DOI: 10.13109/zptm.2012.58.2.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This contribution provides an overview of the development of the professional specialty area of psychosomatic medicine and psychotherapy since its establishment by the German Parliament in 1992. RESULTS First, the reasons behind the decision to create this professional specialty are elucidated. Then, the three revisions of the official training regimen, the subsequent development of the number of specialists in both outpatient and inpatient sectors, and the development of hospital wards for psychosomatic disorders and rehabilitation clinics for this purpose are discussed. The creation of this specialty may be judged to have been a successful venture that has led to a better treatment of the concerned patients. The recent development of specific psychosomatic research points to the increasing emphasis on special studies of bio-psycho-social interactions, which in turn have shaped and will continue to shape the contours of this specialty. DISCUSSION The necessary further developments in continuing education as well as increasing cooperation with other disciplines and other pending decisions concerning treatment alternatives are discussed.
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