Article

Exploration of DSM-IV criteria in primary care patients with medically unexplained symptoms.

Department of Medicine, Michigan State University, East Lansing, Michigan, USA.
Psychosomatic Medicine (Impact Factor: 4.09). 01/2005; 67(1):123-9. DOI: 10.1097/01.psy.0000149279.10978.3e
Source: PubMed

ABSTRACT Investigators and clinicians almost always rely on Diagnostic and Statistical Manual of Mental Disorder, 4th edition's (DSM-IV) somatoform disorders (and its derivative diagnoses) to characterize and identify patients with medically unexplained symptoms (MUS). Our objective was to evaluate this use by determining the prevalence of DSM-IV somatoform and nonsomatoform disorders in patients with MUS proven by a gold standard chart review.
In a community-based staff model HMO, we identified subjects for a clinical trial using a systematic and reliable chart rating procedure among high-utilizing MUS patients. Only baseline data are reported here. The World Health Organization Composite International Diagnostic Interview provided full and abridged DSM-IV diagnoses. Patients with full or abridged DSM-IV somatoform diagnoses were labeled "DSM somatoform-positive," whereas those without them were labeled "DSM somatoform-negative."
Two hundred six MUS patients averaged 13.6 visits in the year preceding study, 79.1% were females, and the average age was 47.7 years. We found that 124 patients (60.2%) had a nonsomatoform ("psychiatric") DSM-IV diagnosis of any type; 36 (17.5%) had 2 full nonsomatoform diagnoses, and 41 (19.9%) had >2; 92 (44.7%) had some full anxiety diagnosis and 94 (45.6%) had either full depression or minor depression diagnoses. However, only 9 of 206 (4.4%) had any full DSM-IV somatoform diagnosis, and only 39 (18.9%) had abridged somatization disorder. Thus, 48 (23.3%) were "DSM somatoform-positive" and 158 (76.7%) were "DSM somatoform-negative." The latter exhibited less anxiety, depression, mental dysfunction, and psychosomatic symptoms (all p <.001) and less physical dysfunction (p = .011). Correlates of this DSM somatoform-negative status were female gender (p = .007), less severe mental (p = .007), and physical dysfunction (p = .004), a decreased proportion of MUS (p <.10), and less psychiatric comorbidity (p <.10); c-statistic = 0.77.
We concluded that depression and anxiety characterized MUS patients better than the somatoform disorders. Our data suggested radically revising the somatoform disorders for DSM-V by incorporating a new, very large group of now-overlooked DSM somatoform-negative patients who were typically women with less severe dysfunction.

0 Followers
 · 
87 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: In der 5. Auflage des Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ist eine Revision der diagnostischen Klassifikation somatoformer Störungen erfolgt. Das Ziel des vorliegenden Beitrags besteht darin zu untersuchen, ob sich a) Patienten mit den DSM-IV-Diagnosen Somatisierungsstörung, Schmerzstörung und Hypochondrie sowie b) Patienten mit den DSM-5-ähnlichen Diagnosen ,,somatic symptom disorder“ (SSD) und ,,illness anxiety disorder“ hinsichtlich ihrer Krankheitsangst und ihrer Kognitionen bezüglich der Wahrnehmung und Interpretation somatischer Symptome unterscheiden.Es wurden Daten von 269 Patienten, die sich in stationärer psychosomatischer Behandlung in der Schön Klinik Bad Bramstedt befanden, analysiert. Die Diagnostik für somatoforme Störungen erfolgte anhand des Strukturierten Klinischen Interviews für DSM-IV (SKID).Patienten mit der DSM-IV-Diagnose Hypochondrie unterschieden sich hinsichtlich des Ausmaßes ihrer Krankheitsangst sowie der katastrophisierenden Bewertung von Körpersymptomen von Patienten mit anderen somatoformen Störungen. Patienten mit Illness anxiety disorder unterschieden sich im Ausmaß der katastrophisierenden Bewertung von Körpersymptomen, im Ausmaß vegetativer Missempfindungen, im Selbstkonzept körperlicher Schwäche und in der Intoleranz von körperlichen Beschwerden von Patienten mit SSD.Krankheitsängste und Katastrophisierung von Körperbeschwerden spielen bei Patienten mit somatoformen Störungen grundsätzlich eine Rolle. Auch bei Patienten mit SSD und somit im Vordergrund stehenden Körpersymptomen spielen krankheitsbezogene dysfunktionale Kognitionen eine Rolle. Im Hinblick auf eine psychotherapeutische Behandlung sollten Krankheitsangst und Befürchtungen bezüglich der eigenen Gesundheit bei allen Patienten mit somatoformen Störungen thematisiert werden.
    Psychotherapeut 11/2013; 58(6). DOI:10.1007/s00278-013-1019-z · 0.78 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Somatization, the process by which people experience and express emotional distress through physical symptoms, is one of the biggest challenges a physician may face in his daily medical practice because the symptoms have no organic documentable cause. The article reviews and updates the knowledge of somatization and its various disorders, seeking to expand the tools for physicians to perform a more accurate diagnosis and provides some useful recommendations for the management of patients taking into account that the decision whether the etiology of the symptom is psychological and not physical is not easy, and neither it is to accurately diagnose the psychiatric disorder that induces this process.
    01/2009; 17(1):55-64.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aims: To determine what diagnostic terms are utilized by general practitioners (GPs) when seeing patients with mixed emotional and physical symptoms. Method: Prototype cases of depression, anxiety, hypochondriasis, somatization and undifferentiated somatoform disorders were sourced from the psychiatric literature and the author's clinical practice. These were presented, in paper form, to a sample of GPs and GP registrars who were asked to provide a written diagnosis. Results: Fifty-two questionnaires were returned (30% response rate). The depression and anxiety cases were identified correctly by most participants. There was moderate identification of the hypochondriasis and somatization disorder cases, and poor identification of the undifferentiated somatoform case. Conclusion: Somatization and undifferentiated somatoform disorders were infrequently recognized as diagnostic categories by the GPs in this study. Future research into the language and diagnostic reasoning utilized by GPs may help develop better diagnostic classification systems for use in primary care in this important area of practice.
    Primary Health Care Research & Development 01/2014; 16(02):1-7. DOI:10.1017/S1463423613000558

Full-text (2 Sources)

Download
9 Downloads
Available from
Aug 15, 2014