Functional Somatic Symptoms

Exploring the course of functional somatic symptoms (FSS) from pre- to late adolescence and associated internalizing psychopathology - an observational cohort-study

BACKGROUND

Functional somatic symptoms (FSS), which commonly cannot be attributed to well-defined organic pathology, often co-occur with internalizing psychopathology and fluctuate throughout different life stages. We examined FSS courses throughout adolescence, and the association between preadolescent FSS, FSS severity and internalizing psychopathology at late adolescence.

METHODS

Data from the Copenhagen Child Cohort (CCC2000) were utilized from assessments at ages 11-12 years (preadolescence; T0) and 16-17 years (late adolescence; T1). Self-report questionnaire and interview data on FSS, internalizing psychopathology, chronic medical conditions, and sociodemographic data from Danish national registers were available for 1285 youths. FSS courses were categorized into persistent (high FSS at T0 & T1), remission (high FSS only at T0), incident (high FSS only at T1) or no FSS (no FSS at T0 & T1). Multiple linear and multinomial logistic regressions were conducted to investigate the FSS/psychopathology association.

RESULTS

1.8% of adolescents fell into the persistent FSS course group throughout adolescence. Higher preadolescent FSS predicted FSS (b = 0.07, p < .001), anxiety (b = 0.05, p < .001) and depression (b = 0.06, p < .001) at age 16/17, even after controlling for sex, parental education, a chronic medical condition and internalizing psychopathology in preadolescence. Persistent, incident, and remittent FSS courses were associated with significantly higher mean levels of anxiety and depression compared to the reference group (no FSS).

CONCLUSIONS

FSS during pre- and late adolescence might increase and co-occur with anxiety and depression throughout adolescence, potentially due to shared underlying risk factors and processes.

[Transdisciplinary treatment of functional movement disorders: integration instead of dissociation]

Successful treatment of patients with functional motor disorders is integrative in several ways: the primary treatment goal is the (re)integration of sensorimotor, cognitive and social functioning. The prerequisites for this are an integrated biopsychosocial model of everyone involved as well as close transdisciplinary cooperation. Instead of a simple addition of treatment components, all care providers and patients act in concert.

Is there Lyme borreliosis in French Guiana? Descriptive study among patients referred for a suspected Lyme borreliosis in an Amazonian hospital between 2010 and 2022

Lyme borreliosis (LB) existence in South America is debated, especially in the Amazon region. The infection with Lyme borreliae has never been reported in French Guiana where Borrelia burgdorferi sensu lato is not found in ticks. We describe the final diagnosis and presumed place of acquisition in patients consulting for suspicion of LB. We retrospectively collected data from all consecutive patients consulting for a suspicion of LB between 2010 and 2021 at Cayenne Hospital, French Guiana. Patients were classified by an adjudication committee as confirmed LB if they met the criteria of the French consensus, as possible LB if they had compatible symptoms and a good outcome after appropriate treatment, or excluded when a differential diagnosis was found. The place of acquisition was discussed in case of possible or confirmed case. Twenty-six patients were included. Rheumatologic symptoms were the most reported (88 %) followed by neurological symptoms (61 %). Twenty-four (92 %) of these patients were born out of French Guiana. Diagnosis of LB was considered as confirmed in 2 patients (8 %), for whom the place of acquisition was likely mainland France, and as possible in 3 patients (11 %) with early localized LB presumably acquired in French Guiana. Functional somatic disorders were diagnosed in 13 (50 %) patients whereas 9 (35 %) were found with another disease. This study did not confirm the acquisition of LB in French Guiana. However, three possible autochthonous cases encourage clinicians working in the Amazon area to stay aware of LB.

Relevance of neurocognition in chronic pain syndrome: a systematic and methodical approach

INTRODUCTION

Subjective and objective deficits in neurocognitive domains are well-documented in patients with chronic pain. However, neurocognitive deficits have not been investigated consistently. The main objective of this study was to conduct a comprehensive assessment of self-rated and objectively assessed cognitive differences between patients with chronic pain (CP) and healthy controls (HC).

METHOD

The cognitive functioning of 40 CP and 41 HC was assessed using a standardized computer-based test battery, enabling a comparison of subjective and objective neurocognitive factors. To achieve this, the Vienna Test System (VTS) was utilized, incorporating standardized tests from the Cognitive Basic Assessment Battery (COGBAT) with the advantage of objectivity, reliability, validity, efficiency, utility, and standardization. This approach enables the evaluation of cognitive functioning across all pertinent domains.

RESULTS

CP reported cognitive deficits in overall performance as well as specific functions, such as attention, memory, and executive functions. Across all neurocognitive domains, CP showed a poorer performance. Affected subdomains of attention were intensity and selectivity of attention. Lower performance was found also in concentration performance, obtaining and overview, visual orientation performance and reactive stress tolerance. Regarding memory, CP performed worse in figural episodic memory and recognition tasks. In addition, CP exhibited poorer performance in mental flexibility, working memory, planning ability, and inhibition as components of executive functioning, when compared to HC.

CONCLUSIONS

CP expressed subjective cognitive deficits and demonstrated impaired neurocognitive performance.

[Psychosomatic aspects in otorhinolaryngology-historical milestones]

BACKGROUND

This investigation examined the development of psychosomatics in the field of otolaryngology in Germany using the examples of psychogenic deafness and chronic tinnitus by means of literature research. The focus of the study was on the period 1948-2022.

METHODS

A literature search was carried out in the PubMed database from 1948 and antiquarian ENT textbooks were evaluated. The search terms used were "ENT and psychosomatics," "tinnitus," "retraining therapy," "analytical psychology," "behavioral therapy," and "sensory systems."

RESULTS

Psychosomatic phenomena were mentioned in the treatment of nasal diseases and ear ailments in writings of Byzantine and medieval medicine. Even older are references to tinnitus in ancient Egyptian and Indian scripts. From the nineteenth to the mid-twentieth century, psychological abnormalities in ENT symptoms were assigned to the term hysteria. From the middle of the twentieth century, a paradigm shift in the assessment of psychosomatic disorders in otolaryngology became apparent. In the 1950s, a broad psychosomatic discussion was opened in individual lectures and book contributions on mental abnormalities in ENT diseases. With the implementation of the Psychosomatics Working Group of the German Society of Otorhinolaryngology, Head and Neck Surgery, psychosomatics in the field of ENT received the framework for scientific and clinical activity at the turn of the millennium. Psychosomatics is scientifically represented and part of the continuing education regulations for otolaryngology in Germany and at European level. It shows high standards in research, qualification of otolaryngologists, and patient care.

CONCLUSION

As of 2022, psychosomatics in otolaryngology has been steadily developing for over 70 years. The standards achieved are to be further expanded and research on cognition, affectivity, and sensory analogies intensified.

[S1 guidelines for the management of postviral conditions using the example of post-COVID-19]

These S1 guidelines are an updated and expanded version of the S1 guidelines on long COVID differential diagnostic and management strategies. They summarize the state of knowledge on postviral conditions like long/post COVID at the time of writing. Due to the dynamic nature of knowledge development, they are intended to be "living guidelines". The focus is on practical applicability at the level of primary care, which is understood to be the appropriate place for initial access and for primary care and treatment. The guidelines provide recommendations on the course of treatment, differential diagnostics of the most common symptoms that can result from infections like with SARS-CoV-2, treatment options, patient management and care, reintegration and rehabilitation. The guidelines have been developed through an interdisciplinary and interprofessional process and provide recommendations on interfaces and possibilities for collaboration.

A multidimensional longitudinal dataset on functional somatic syndromes

Functional disorders represent a prevalent health issue, significantly impacting both individuals and healthcare systems. This multidisciplinary dataset aims to enhance our comprehension of the complex interplay among various factors that contribute to functional somatic syndromes. The dataset comprises data from seemingly healthy adults (aged 18-65) in Isfahan, Iran, who were randomly selected and monitored for four consecutive years. The research data encompasses seven distinct datasets: (a) functional symptom evaluations across multiple body organs, (b) psychological assessments, (c) lifestyle factors, (d) demographic and socioeconomic variables, (e) laboratory measurements, (f) clinical examinations, and (g) historical information. A total of 1930 participants were enrolled at the study's outset in 2017. The first, second, and third annual follow-up rounds were completed with 1697 (2018), 1616 (2019), and 1176 (2020) participants, respectively. This dataset is made available for further analysis by a diverse range of researchers, healthcare policymakers, and clinicians.

Longitudinal assessment of the temporal stability and predictive validity of the Revised Paranormal Belief Scale

The Revised Paranormal Belief Scale (RPBS) is the prevailing measure of supernatural credence. However, there exists only limited evidence to support the temporal stability and predictive validity of the instrument over time. Acknowledging this, the present study assessed the test-retest reliability of the RPBS using a large, heterogeneous sample across multiple trials. In addition, predictive validity was tested using a longitudinal statistical model, which focused on allied health outcomes (Perceived Stress and Somatic Complaints). A sample of 1,665 (M _age = 54.40, 853 females, 804 males, five non-binary and three not disclosing of gender) completed study measures at three time points separated by 2 month intervals. Prior to assessing temporal stability, assessment of structural validity and longitudinal invariance occurred. Test-retest reliability of the RPBS was in the moderate to high range across time intervals, and good internal consistency was observed. Furthermore, satisfactory stability coefficients existed for RPBS subfactors. Data-model fit for the predictive model was acceptable. Belief in the paranormal explained low variance over time in Perceived Stress and Somatic Complaints (between 2.4 and 4.2%). Findings supported the stability and reliability of the RPBS. In addition, they aligned with the notion that paranormal belief in the absence of high scores on cognitive-perceptual factors (e.g. transliminality and schizotypy), has a benign influence on perceived health.

Efficacy of mindfulness- and acceptance-based cognitive-behavioral therapies for bodily distress in adults: a meta-analysis

Objective

Bodily distress, i.e., somatoform disorders and associated functional somatic syndromes, is highly prevalent, often persistent and highly disabling. It has been proposed that "third wave" therapies may be beneficial variants of cognitive behavioral treatments. However, evidence on their efficacy is scarce. This meta-analysis examines the efficacy of "third wave" psychotherapies (mindfulness-based cognitive therapy [MBCT], mindfulness-based stress reduction [MBSR], and acceptance and commitment therapy [ACT]) in adults with bodily distress.

Method

We included randomized controlled trials (RCTs) treating adults with bodily distress using MBCT, MBSR, and ACT compared to inactive and non-specific control groups. A random effects model was used. The primary outcome was somatic symptom severity. Secondary outcomes were degrees of depression and of anxiety, health anxiety, perceived health status, mindfulness, psychological inflexibility, and pain acceptance.

Results

Sixteen RCTs with 1,288 participants were included in the analysis (k = 4 MBCT, k = 7 MBSR, k = 5 ACT; k = 7 fibromyalgia, k = 5 irritable bowel syndrome, k = 1 chronic fatigue syndrome, k = 2 bodily distress, k = 1 medically unexplained symptoms). However, not all studies provided data for each of the relevant outcomes. The analyses revealed that "third wave" therapies were more effective than control conditions in reducing somatic symptom severity (k = 15, n = 1,100, g = -0.51, 95%CI -0.69; -0.32). Heterogeneity was moderate (I ² = 52.8%, 95%CI 15.1 to 73.8). Effects for secondary outcomes were small to moderate with varying degrees of heterogeneity. We did not find differences between the different therapy approaches (mindfulness- vs. acceptance-based therapies); neither therapy dosis (i.e., total duration of therapy sessions) nor number of sessions were significant moderators of efficacy.

Conclusions

The therapies addressing mindfulness and acceptance proved to be more effective than control conditions. Hence, they are promising treatment approaches for bodily distress. However, there is still need for research on which patient groups may benefit from these psychological approaches.

Systematic review registration

https://osf.io/g7hby, identifier: 10.17605/OSF.IO/4RZGC.

Does the practice of mindfulness reduce somatic symptoms and COVID-19-related anxiety? A community-based survey

Objective

Since the beginning of COVID-19 pandemic, several studies have shown an increase of psychological distress in the general population. Previous research demonstrated that high levels of anxiety are associated with reporting more somatic symptoms. The ability to adaptively regulate emotions is essential to deal with stressful situations, and it is one of the main components of mindfulness practice. The aim of the present study was to document the effect of mindfulness practice on somatic symptoms and psychological distress in the context of COVID-19 pandemic.

Methods

The study has a descriptive cross-sectional design. During the second wave of COVID-19 pandemic, between November 2020 and January 2021 participants living in France responded to an online survey on the impact of COVID-19 on psychological distress and physical health. The questionnaire included the assessment of COVID-19-related anxiety, mindfulness practice and experience, dispositional mindfulness, somatization, depression, generalized anxiety, and emotion regulation.

Results

A total of 569 people (mean age = 39.8 years, 90% women) were included in the study. COVID-19 related anxiety was associated with higher levels of somatic symptoms, generalized anxiety, and depression. About half of the sample (n = 318, 56%) reported moderate to severe somatic symptoms that were associated with higher levels of depression and anxiety, lower levels of dispositional mindfulness and to the use of maladaptive emotion regulation strategies. Overall, 164 subjects (28.8%) reported practicing meditation. No differences were found in dispositional mindfulness (MAAS score) between beginners and advanced practitioners, regardless of the type, years, frequency, and length of practice. Participants with less experience in mindfulness practice reported a significant higher number of somatic symptoms than non-practitioners and a higher use of rumination. Moreover, mindfulness experience was associated with the use of more adaptive emotion regulation strategies.

Conclusion

Mindfulness meditation has been promoted as a practice enhancing well-being and helping to cope with the psychological impact of stressful events. However, in a distressing situation as COVID-19 pandemic, a limited experience in mindfulness practices might result in the development or endurance of somatic symptoms. Adequate training and a focus on mindful acceptance, may contribute to enhance the effectiveness of mindfulness practice.

Incidence of post-COVID syndrome and associated symptoms in outpatient care in Bavaria, Germany: a retrospective cohort study using routinely collected claims data

OBJECTIVES

To estimate the treatment incidence of post-COVID syndrome (postinfectious sequelae present at least 12 weeks following infection) in the context of ambulatory care in Bavaria, Germany, and to establish whether related diagnoses occur more frequently than in patients with no known history of COVID-19.

DESIGN

Retrospective cohort analysis of routinely collected claims data.

SETTING

Ambulatory care in Bavaria, Germany, observed from January 2020 to March 2022 (data accessed May 2022).

PARTICIPANTS

391 990 patients with confirmed COVID-19 diagnosis, 62 659 patients with other respiratory infection and a control group of 659 579 patients with no confirmed or suspected diagnosis of COVID-19.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome is diagnosis of post-COVID syndrome documented in ambulatory care. Secondary outcomes are: chronic fatigue syndrome, psychological disorder, fatigue, mild cognitive impairment, disturbances of taste and smell, dyspnoea, pulmonary embolism and myalgia.

RESULTS

Among all patients with confirmed COVID-19, 14.2% (95% CI 14.0% to 14.5%) received a diagnosis of a post-COVID syndrome, and 6.7% (95% CI 6.5% to 6.9%) received the diagnosis in at least two quarterly periods during a 2-year follow-up. Compared with patients with other respiratory infections and with controls, patients with COVID-19 more frequently received a variety of diagnoses including chronic fatigue syndrome (1.6% vs 0.6% and 0.3%, respectively), fatigue (13.3% vs 9.2% and 6.0%), dyspnoea (9.9% vs 5.1% and 3.2%) and disturbances of taste and smell (3.2% vs 1.2% and 0.5%). The treatment incidence of post-COVID syndrome was highest among adults aged 40-59 (19.0%) and lowest among children aged below 12 years (2.6%).

CONCLUSIONS

Our results demonstrate a moderately high incidence of post-COVID syndrome 2 years after COVID-19 diagnosis. There is an urgent need to find efficient and effective solutions to help patients with dyspnoea, fatigue, cognitive impairment and loss of smell. Guidelines and treatment algorithms, including referral criteria, and occupational and physical therapy, require prompt and coherent implementation.

What does low psychological distress mean in patients with no mental disorders and different pains of the musculoskeletal system?

OBJECTIVES

The aim of this study is to define the different levels of psychological distress in patients suffering from pain and functional disorders of the musculoskeletal system.

METHODS

This investigation was conducted as a retrospective study of 60 patients randomly selected of a German specialized orthopaedic hospital within the year 2016, whose therapeutic approaches are based on a non-surgical orthopaedic multimodal approach of manual therapy. All patients were suffering from pain and functional disorders of the musculoskeletal system. Two groups were formed: one without and one with additional mental disorders according to ICD-10. The impairment score (ISS) according to Schepank was determined.

RESULTS

The somatic sub score of the ISS was the highest sub score in both patient groups. The cumulative value of the ISS score of patients with both a mental disorder and pain in the musculoskeletal system was higher than for patients without concomitant mental disorder. For patients without concomitant mental disorder, the cumulative ISS exceeded the test criteria for mentally healthy individuals.

CONCLUSIONS

Patients without mental disorder but with chronic pain of the locomotoric system receive a psychological pain management program, as it is part of the billing code OPS 8-977 to the health insurance companies in Germany. However, the data show that these patients also have a substantial somatic subscore and a cumulative ISS above the level of healthy individuals. The absence of psychological disorders (according to ICD-10) in patients with pain of the musculoskeletal system should not lead to the assumption that these patients are psychologically inconspicuous. Subsyndromal mental findings (below ICD-10) can be one aspect of a mental disorder presenting with primarily somatic symptoms. In this case, patients would benefit from a psychotherapeutic program in a similar way as the patients with mental disorders according to ICD-10.

Evaluation of a new body-focused group therapy versus a guided self-help group program for adults with psychogenic non-epileptic seizures (PNES): a pilot randomized controlled feasibility study

OBJECTIVE

Psychogenic non-epileptic seizures (PNES), a common phenomenon in neurological settings, are regarded as a paroxysmal type of functional neurological disorder (FND). In a substantial proportion, PNES are disabling with poor long-term outcomes and high economic costs. Despite the clinical and financial consequences of PNES, there is still a lack of controlled clinical trials on the treatment of this challenging disorder. The study aims to evaluate the feasibility and collect first evidence of the efficacy of a group based-intervention in PNES-patients.

METHODS

A pilot randomized controlled feasibility study with a parallel-group design was performed in adult outpatients with PNES to evaluate a new body-focused group therapy (CORDIS) versus guided self-help groups. Self-assessment of dissociation (Dissociation Experience Scale-DES-20) and seizure severity (Liverpool Seizure Severity Scale-LSSS) were assessed two weeks before and two weeks after the treatment intervention and also six months after treatment as primary outcome parameters.

RESULTS

A total of 53 patients were recruited from a specialized outpatient clinic, and out of those, 29 patients completed either the body-focused group therapy program (n = 15) or a guided self-help group (SHG) therapy (n = 14). When analyzing the ITT sample (n = 22 CORDIS group, n = 20 SHG), both groups showed an effect on seizure severity and level of dissociation. In the per protocol sample (n = 13 CORDIS group, n = 12 SHG), CORDIS was superior to the self-help group for reducing seizure severity 6 months after the treatment.

SIGNIFICANCE

CORDIS is a newly developed body-focused group therapy program for adults with PNES. Further studies should include a multicentric design with a higher number of participants.

Differences of medically unexplained symptoms among patients of different ages and sexes in the psychological clinic of a general hospital and the influencing factors of MUS: A cross-sectional study

OBJECTIVE

To analyse differences in sex, age, depression, insomnia, psychological stress, resilience, and perceived social support among patients with medically unexplained symptoms (MUS) in a psychological clinic of a general hospital, and to explore the influencing factors of MUS.

METHODS

This is a cross-sectional study. Seven hundred forty-six first-time patients were assessed with the integrated psychosomatic comprehensive evaluation system (IPS) to evaluate their MUS, depression, insomnia, psychological stress, resilience, and perceived social support. The psychological characteristics were compared with regard to sex and age group (<25 years, low age group; 26-44 years, middle age group; >45 years, high age group). The relationships between age and MUS were explored, and how psychological stress affects MUS was analyzed using the mediator effect model.

RESULTS

Different age groups had significant differences in sex, MUS, depression, psychological stress, resilience, and perceived social support. In further pairwise comparison, no significant difference existed in depression, psychological stress, resilience and perceived social support in the middle and low age groups, depression and psychological stress were higher than those in the high age group, resilience and perceived social support were lower than those of the high age group. MUS were higher in the middle age group than in the low age group. No significant difference existed between the two groups and the high age group. Age, severity of MUS, and perceived social support were significantly different between the sexes. Differences in MUS between men and women in different age groups were analyzed using two-factor analysis of variance. It revealed no interaction between sex and different age groups on MUS. The main effect analysis showed that the effects of different age groups on MUS were statistically significant. Based on pairwise comparative analysis, the MUS score in the low age group was lower than that in the middle age group. To clarify a nonlinear relationship between age and MUS, threshold effect analysis was conducted. The results indicated that the piecewise linear regression model could better depict the relationship between age and MUS. The inflection point was at the age of 60 years. Before the age of 60 years, MUS increased with age. No significant correlation existed between age and MUS after the age of 60 years. To understand the influencing factors of MUS, the intermediary effect model was analyzed using MUS as the dependent variable, psychological stress as the independent variable, resilience as mediator variable M1, perceived social support as mediator variable M2, and depression as mediator variable M3. Resilience, perceived social support, and depression had significant mediator effects on the effects of psychological stress on MUS with a total indirect effect of 69.81%.

CONCLUSION

The middle age group had greater MUS than the low age group. Before the age of 60 years, MUS increased with increasing age. Women had more severe MUS than men. Resilience, perceived social support, and depression had significant mediating effects on the effects of perceived stress on MUS. These findings suggest that clinicians should make more comprehensive and detailed evaluations and timely intervention for middle-aged and female patients. Improving psychological resilience and social support can reduce the impact of psychological stress on MUS. Therefore, psychotherapy and multidisciplinary comprehensive treatment are very important for patients is very important for patients.

Patients With Somatoform Disorders Are Prone To Expensive and Potentially Harmful Medical Procedures

BACKGROUND

Patients with functional somatic syndromes (FSS) might be prone to potentially harmful medical investigations in ambulatory care. The primary aim was to investigate whether patients with FSS are more likely to undergo diagnostic examinations such as radiography, computed tomography (CT), magnetic reso - nance imaging (MRI), and outpatient surgical procedures. The secondary aim was to evaluate the extent to which coordination of care by primary care physicians reduces healthcare utilization.

METHODS

Retrospective cohort study using longitudinal regression analysis of routine data. FSS patients were weighted in the regression model to allow a representative comparison with the Bavarian population. The observation period was from 5 years before until 10 years after the diagnosis of FSS.

RESULTS

The cohort comprised 43 676 patients with FSS and a control group of 50 003 patients without a diagnosis of FSS. The FSS patients exhibited continuously increased healthcare utilization over the 15-year period. The relative risk (RR) for FSS patients was up to 1.48 (95% confidence interval [1.46; 1.50]) for radiography, 2.01 [1.94; 2.08] for CT, 1.91 [1.87; 1.96] for MRI, and 1.30 [1.27; 1.34] for outpatient surgery. Compared with patients whose treatment was coordinated by their primary care physician, patients with no such coordination showed higher service utilization. The ambulatory care costs were up to 1.37 [1.36; 1.38] times greater.

CONCLUSION

Patients with FSS more frequently undergo potentially harmful and costly diagnostic testing and outpatient surgery. Coordination of care by the primary care physician is associated with lower healthcare utilization.

Psychopathology and Somatic Complaints: A Cross-Sectional Study with Portuguese Adults

(1) Background: Functional somatic symptoms (FSS) are physical symptoms that cannot be fully explained by medical diagnosis, injuries, and medication intake. More than the presence of unexplained symptoms, this condition is associated with functional disabilities, psychological distress, increased use of health services, and it has been linked to depressive and anxiety disorders. Recognizing the difficulty of diagnosing individuals with FSS and the impact on public health systems, this study aimed to verify the concomitant incidence of psychopathological symptoms and FSS in Portugal. (2) Methods: For this purpose, 93 psychosomatic outpatients (91.4% women with a mean age of 53.9 years old) and 101 subjects from the general population (74.3% women with 37.8 years old) were evaluated. The survey questionnaire included the 15-item Patient Health Questionnaire, the 20-Item Short Form Survey, the Brief Symptom Inventory, the Depression, Anxiety and Stress Scale, and questions on sociodemographic and clinical characteristics. (3) Results: Increases in FSS severity were correlated with higher rates of depression, anxiety, and stress symptoms. The findings also suggest that increased rates of FSS are associated with lower educational level and female gender. (4) Conclusion: Being aware of the relationship between FSS and psychopathological symptoms and the need to explore psychosocial issues during clinical interviews may favor early detection of these cases. The early detection of mental disorders is essential for individuals’ adherence to treatments, reflecting on healthcare costs.

Diagnostic and treatment barriers to persistent somatic symptoms in primary care - representative survey with physicians

Background

Many patients consult their primary care physician with persistent somatic symptoms such as pain or sickness. Quite often these consultations and further diagnostic measures yield no medical explanation for the symptoms – patients and physicians are left in uncertainty. In fact, diagnostic and treatment barriers in primary care hinder timely health-care provision for patients suffering from persistent somatic symptoms (PSS). The significance of individual barriers is still unknown. We compare and quantify these barriers from the perspective of primary care physicians and identify subpopulations of primary care physicians who experience particular barriers as most severe.

Methods

We mailed a questionnaire to primary care physicians (PCP) in Germany and asked them which barriers they consider most important. We invited a random sample of 12,004 primary care physicians in eight federal states in Germany. Physicians provided anonymous mailed or online responses. We also mailed a postcard to announce the survey and a mail reminder. Main measures were Likert rating scales of items relating to barriers in the diagnosis and treatment of PSS in primary care. Information on demography and medical practice were also collected.

Results

We analyzed 1719 data sets from 1829 respondents. PCPs showed strongest agreement with statements regarding (1.) their lack of knowledge about treatment guidelines, (2.) their perceptions that patients with PSS would expect symptom relief, (3.) their concern to overlook physical disease in these patients, and (4.) their usage of psychotropic drugs with these patients. More experienced PCPs were better able to cope with the possibility of overlooking physical disease than those less experienced.

Conclusions

The PCPs in our survey answered that the obligation to rule out severe physical disease and the demand to relieve patients from symptoms belong to the most severe barriers for adequate treatment and diagnosis. Moreover, many physicians admitted to not knowing the appropriate treatment guidelines for these patients. Based on our results, raising awareness of guidelines and improving knowledge about the management of persistent somatic symptoms appear to be promising approaches for overcoming the barriers to diagnosis and treatment of persistent somatic symptoms in primary care.

Trial registration

German Clinical Trials Register (Deutschen Register Klinischer Studien, DRKS)

https://www.drks.de/drks_web/setLocale_EN.do

The date the study was registered: October 2^nd 2017

The date the first participant was enrolled: February 9^th 2018

DRKS-ID: DRKS00012942

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01397-w.

[Upper abdominal pain: a frequent and multifaceted leading symptom in primary care internal medicine]

Upper gastrointestinal symptoms are among the most common reasons for medical consultation and represent a challenge for general practitioners in the outpatient care setting. History taking, symptom evaluation and physical examination are the crucial steps toward establishing an initial working diagnosis. The subsequent abdominal ultrasound and laboratory analyses are essential tools for the differential diagnosis.

Comorbidities of Patients with Functional Somatic Syndromes Before, During and After First Diagnosis: A Population-based Study using Bavarian Routine Data

Functional somatic syndromes (FSS) are characterised by the presence of one or multiple chronic symptoms that cannot be attributed to a known somatic disease. They are thought to arise though a complex interaction of biological and psychosocial factors, but it is unclear whether they share a common aetiology. One hypothesis supported by recent studies is that the FSS are postinfectious disorders, as is widely recognised for a subset of patients with irritable bowel syndrome. Our study used claims data submitted by office-based physicians to compare groups of patients with different FSS in the five years before and after the point of first diagnosis. Even five years prior to diagnosis, FSS patients consulted more frequently for a range of psychological and somatic conditions than did controls. Following diagnosis, consultation rates increased further and remained persistently high. Five years after diagnosis, between 34% (somatization disorder) and 66% (fibromyalgia) of patients were still being treated for the condition. Both prior gastrointestinal and upper-respiratory infection were associated with an increased risk of developing an FSS. We therefore recommend that patients at risk should be identified at an early stage and the underlying psychosocial and somatic issues addressed to prevent progression of the condition.

Injury Severity and Psychological Distress Sustained in the Aftermath of the Attacks of 11 September 2001 Predict Somatic Symptoms in World Trade Center Health Registry Enrollees Sixteen Years Later

The World Trade Center attacks of 11 September 2001 (9/11) have been associated with the subsequent development of chronic diseases. Few studies have investigated the burden of somatic symptoms on attack victims, or the association of such symptoms with exposure to the 9/11 attacks. World Trade Center Health Registry (Registry) enrollees who were present south of Chambers Street during or immediately after the 9/11 attacks and who provided consistent answers regarding injury sustained on 9/11 were followed prospectively for up to 16 years post-9/11/01. We employed linear regression to evaluate the associations between injury severity, psychological distress and somatic symptoms in 2322 persons who completed all four Registry surveys and a subsequent Health and Quality of Life survey. Twenty-one percent of subjects had a “very high” burden of somatic symptoms, greater than in populations not exposed to a disaster. Somatic symptoms exhibited a dose-response association separately with injury severity and psychological distress trajectories. Victims of the 9/11 attacks suffer from a substantial burden of somatic symptoms which are associated with physical and psychological consequences of exposure to the attacks. Physical and mental health professionals need to work together when treating those exposed to complex disasters such as 9/11.