Review: Somatization in the elderly.

Maudsley Hospital, Denmark Hill, London, UK.
International Journal of Geriatric Psychiatry (Impact Factor: 3.09). 12/1999; 14(12):1044-9. DOI: 10.1002/(SICI)1099-1166(199912)14:12<1044::AID-GPS55>3.0.CO;2-0
Source: PubMed

ABSTRACT Somatization is a common medical problem encountered at all levels of medical care. It is strongly associated with use of services and may be difficult to treat. Somatization in the elderly has been traditionally seen as a masked presentation of depression. Population studies have shown no consistent increase in somatization among the elderly, and the elderly may down-play physical symptoms. Among the elderly depressed, somatization is common and may be commoner if physical illness is also present. Psychological distress is usually acknowledged, not masked, in the elderly depressed. Neuroticism, as well as psychiatric illness, may be an important aetiological factor for somatization in the elderly. Treatment strategies must attend to underlying psychiatric disorders, but there is a need for studies of treatment of the phenomenon in the elderly.

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    ABSTRACT: RESUMEN Antecedentes: en el adulto mayor la depresión puede estar "enmascarada" por síntomas de tipo somático, con frecuencia de tipo doloroso, resultado de algún trastorno por somatización o ser parte de un trastorno afectivo. Esto se fundamenta en la frecuente existencia de depresión en trastornos de somatización. Ésta suele ser una expresión de los padecimientos médicos. Objetivo: describir la relación entre los síntomas somáticos dolorosos con ansiedad y la depresión en mujeres adultas mayores. Pacientes y método: se evaluaron transversalmente 17 mujeres mayores de 60 años de edad, las cuales reportaron síntomas de depresión y ansiedad acompañados de, al menos, algún síntoma doloroso durante más de seis meses. Las escalas utilizadas fueron: Inventario Neuropsiquiátrico (MINI), Inventario de Síntomas de Hopkins (SCL-90), Escala de Depresión Geriátrica (GDS-30) y Examen Breve del Estado Mental (MMSE-30). Resultados: la edad promedio de las mujeres evaluadas fue de 65.64 años (de 4.80). El diagnóstico más frecuente fue la comorbilidad entre el episodio depresivo mayor y el trastorno de ansiedad generalizada (35.2%). De acuerdo con los resultados de las subescalas del SCL-90, la depresión (1.86%; 0.85) y somatización (1.73%; 1.07) fueron las más frecuentes. El GDS-30 y el MMSE-30 se correlacionaron significativamente con la subescala de depresión del SCL-90 (r = 0.64, p < 0.05; r = 0.52, p < 0.05), respectivamente. Conclusiones: por lo general, en mujeres mayores de 60 años de edad los síntomas somáticos dolorosos coexisten con trastornos ansioso-depresivos. Palabras clave: ansiedad, depresión, somatización, trastornos. ABSTRACT Background: It has been stated that depression in the elderly may be "masked" with somatic symptoms, frequently painful symptoms, caused by somatization or affective disorders. This is based on the fact that depression generally exists in somatization disorders. Aditionally, somatization usually expresses itself in medical disorders. Objective: To describe the relationship between painful somatic symptoms with anxiety and depression in elderly women. Patients and methods: This cross-sectional trial included 17 women older than 60 years of age, who reported either anxiety, depression or both with at least one somatic painful symptom in the last 6 months. Assessment scales were: the MINI International Neuropsychiatric Inventory (MINI), Hopkins Symptom Checklist (SCL-90), Geriatric Depression Scale (GDS-30) and the Folstein Mini Mental State Examination (MMSE-30). Results: Average age of women included was 65.64 years (SD: 4.80). The most frequent psychiatric diagnosis was co-morbidity between major depressive disorder and generalized anxiety disorder (35.2%). Depression and somatization sub-scales were the most common diagnosis according to SCL-90 sub-scales (1.86%; SD: 0.85 and 1.73%; 1.07, respectively). Significant association existed between the generalized anxiety disorder and the Mini Mental State Examination scales with the depression sub-scale of the SCL-90 (r = 0.64, p < 0.05; r = 0.52, p < 0.05), respectively. Conclusions: Painful somatic symptoms often coexist with anxiety or depressive disorders in women older than 60 years of age.