A follow-up study of patients with medically unexplained symptoms referred to a liaison psychiatry service

Measurement of Somatic Symptoms in the General Population: Standardization of the Russian PHQ-15

<p>The Patient Health Questionnaire (PHQ-15) is a self-report measure assessing presence and severity of somatic symptoms [15]. The aim of this study was to standardize the Russian version of PHQ-15. The study included 1157 respondents from the general population aged 18 to 71. In addition to the PHQ-15, the participants completed the Russian Depression, Anxiety, and Stress Scales-21 (DASS-21), evaluating the psychological distress symptoms. The results showed that 91% of the respondents reported at least one symptom bothering them in the past four weeks. Regarding gender and age specifics of somatization, the most predisposed to the psychosomatic burden were females and persons aged 35-49 years. Moreover, 28.2% of the respondents demonstrated a high level of somatization, as well as increased scores of depression, anxiety, and stress compared to the participants with low and moderate psychosomatic burden. In conclusion, the Russian version of PHQ-15 has been successfully standardized and can be recommended for screening and monitoring of medically unexplained symptoms.</p>

Functional Somatic Symptoms

BACKGROUND

Approximately 10% of the general population and around one third of adult patients in clinical populations suffer from functional somatic symptoms. These take many forms, are often chronic, impair everyday functioning as well as quality of life, and are cost intensive.

METHODS

The guideline group (32 medical and psychological professional societies, two patients' associations) carried out a systematic survey of the literature and ana- lyzed 3795 original articles and 3345 reviews. The aim was to formulate empirically based recommendations that were practical and user friendly.

RESULTS

Because of the variation in course and symptom severity, three stages of treatment are distinguished. In early contacts, the focus is on basic investigations, reassurance, and advice. For persistent burdensome symptoms, an extended, simultaneous and equitable diagnostic work-up of physical and psychosocial factors is recommended, together with a focus on information and self-help. In the pres- ence of severe and disabling symptoms, multimodal treatment includes further elements such as (body) psychotherapeutic and social medicine measures. Whatever the medical specialty, level of care, or clinical picture, an empathetic professional attitude, reflective communication, information, a cautious, restrained approach to diagnosis, good interdisciplinary cooperation, and above all active interventions for self-efficacy are usually more effective than passive, organ- focused treatments.

CONCLUSION

The cornerstones of diagnosis and treatment are biopsychosocial ex- planatory models, communication, self-efficacy, and interdisciplinary mangagement. This enables safe and efficient patient care from the initial presentation onwards, even in cases where the symptoms cannot yet be traced back to specific causes.

How does ageing affect the impact of medically unexplained symptoms and medically explained symptoms on health-related quality of life?

BACKGROUND

Physical symptoms significantly impair health-related quality of life (HRQoL), but age effects and differential effects of medically unexplained symptoms (MUS) and medically explained symptoms (MES) have hardly been examined. Our objective was to determine the effect of age on the impact of MUS and MES on HRQoL.

METHODS

In a population-based cohort (n = 946, aged 28-75 years), MUS and MES were measured using the Composite International Diagnostic Interview and HRQoL using the EuroQol-5 dimensions (EQ-5D). Using multiple linear regression, we regressed MUS, MES and their interaction with age on HRQoL, adjusted for socio-demographic variables and the presence of depressive and anxiety disorders. In case of significant interaction terms, age-stratified results will be presented.

RESULTS

In the whole study population, the association between MUS and HRQoL was stronger (β = -0.35; p < 0.001) than between MES and HRQoL (β = -0.26; p < 0.001). Adjusted for depressive and anxiety disorders, differences between these associations decline (MUS: β = -0.28, p < 0.001; MES: β = -0.25, p < 0.001). Age significantly interacted with number of MUS in explaining variance in HRQoL but not with the number of MES. The impact of MUS on HRQoL is much larger in people aged below 65 years (β = -0.39, p < 0.001) versus those aged 65 years and over (β = -0.21, p = 0.002). In the older group, the association between MUS and HRQoL lost significance when adjusted for depressive and anxiety disorders (β = -0.12 p = 0.062).

CONCLUSION

Our results show that age affects the association between MUS and HRQoL, which suggest that older persons cope better with MUS than younger persons.