Somatoform disorders in general practice - Prevalence, functional impairment and comorbidity with anxiety and depressive disorders

Leiden University, Leyden, South Holland, Netherlands
The British Journal of Psychiatry (Impact Factor: 7.99). 07/2004; 184(6):470-6. DOI: 10.1192/bjp.184.6.470
Source: PubMed


General practitioners play a pivotal part in the recognition and treatment of psychiatric disorders. Identifying somatoform disorders is important for the choice of treatment.
To quantify the prevalence of, and functional impairment associated with, somatoform disorders, and their comorbidity with anxiety/depressive disorders.
Two-stage prevalence study: a set of questionnaires was completed by 1046 consecutive patients of general practitioners (aged 25-80 years), followed by a standardised diagnostic interview (SCAN 2.1).
The prevalence of somatoform disorders was 16.1% (95% CI 12.8-19.4). When disorders with only mild impairment were included, the prevalence increased to 21.9%. Comorbidity of somatoform disorders and anxiety/depressive disorders was 3.3 times more likely than expected by chance. In patients with comorbid disorders, physical symptoms, depressive symptoms and functional limitations were additive.
Our findings underline the importance of a comprehensive diagnostic approach to psychiatric disorders in general practice.

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Available from: Just A H Eekhof, Sep 30, 2014
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    • "Longitudinal studies demonstrate a high risk of symptom persistence especially in patients with multiple MUS [11]. Moreover MUS are associated with high rates of comorbid mental disorders [12] [13], high levels of symptom-related burden, and disability in everyday life functioning [13]. Due to an extensive utilization of health care services [14] [15], health care costs are substantially higher in individuals with MUS in comparison to per capita health care costs in the general population [16], and in other clinical groups [17]. "
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    ABSTRACT: Introduction: Although cognitive behavior therapy (CBT) is the best evidenced psychological treatment for medically unexplained symptoms (MUS), effect sizes are rather moderate. Empirically evidenced deficits in emotion processing in patients with MUS make a CBT enriched with an emotion regulation training (ENCERT) a promising approach to increase treatment effects. Methods and design: This protocol describes the development and implementation of a multicenter, randomized, active-controlled study with blinded outcome assessors to compare the efficacy of ENCERT with a conventional CBT for MUS. Individuals presenting with ≥3 disabling, chronic MUS and fulfilling other predefined inclusion criteria are randomized to 20 sessions either of ENCERT or conventional CBT. Power calculations are based on the severity index of the Screening of Somatoform Disorders-7T and obtained an optimal sample size of N=244. Questionnaires on symptom severity, symptom-related psychological features, and emotion regulation skills are administered at baseline, end of therapy, and 6-months follow-up. An every-session monitoring of therapy progress, and regular patients'/therapists' ratings of quality of therapy, working alliance, outcome expectations, and adverse events are conducted. Primary statistical analysis shall verify the hypothesis of ENCERT being more efficacious than conventional CBT regarding symptom severity. Discussion: Enriching CBT with transdiagnostic therapeutic strategies addressing emotion regulation is a promising and new approach to target not only somatic symptom coping but also symptom-associated problems and comorbid mental disorders. The current trial will not only allow examining the efficacy of ENCERT but also important variables and mechanisms of the process of therapy. Trial registration: NCT01908855.
    Full-text · Article · Dec 2015 · Contemporary clinical trials
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    • "SFD is characterized by persistent physical symptoms that suggest the presence of a medical condition, but which are not fully explained either by that condition or by the direct effects of a substance or another mental disorder. Patients with SFD usually have high functional impairment and are considered difficult to treat (Hahn, 2001; de Waal, Arnold, Eekhof & van Hemert, 2004). It has been suggested that these patients interpret physical signals of affective responses exclusively within the somatic level of their functioning, due to decreased emotional awareness or a restricted capacity to recognize their emotions (Subic-Wrana, Beutel, Knebel & Lane, 2010; Subic-Wrana, Bruder, Thomas, Lane & K€ ohle, 2005). "
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    ABSTRACT: Based on the concept of somatization, psychological distress can be experienced as symptoms of physical illness. This suggests a close-fitting intra-individual association between bodily complaints and mood in patients with somatoform disorder (SFD). The contemporaneous day-to-day complaints-mood association was investigated in patients with severe chronic SFD using an ecological momentary assessment (EMA) design. Eleven patients, who had recently received specialized tertiary care treatment for severe chronic SFD, kept an online electronic diary for four consecutive weeks. They were prompted at intervals throughout the day to complete questions on their momentary primary symptoms (pain and fatigue), and mood state (negative and positive). For each measure, day-mean aggregated values were computed and analyzed using linear multilevel (mixed model) regression analysis. Fixed factor results showed that symptoms were associated with both negative mood state (β = 0.47) and positive mood state (β = -0.59). Random results, however, indicated large inter-individual differences, with correlations varying between 0.17 and 0.99 for negative affect, and between -0.88 and 0.14 for positive affect. A substantial day-to-day contemporaneous association between symptoms and affect across subjects, as well as large inter-individual differences in this association, were demonstrated in patients with severe chronic SFD. EMA-data showing the relationship between both negative and (inverse) positive mood and complaints has potential clinical relevance: providing SFD patients with feedback consisting of their personal day-to-day concurrency graph may promote their understanding of their own complaints in a broader context than the somatic area. © 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd.
    Full-text · Article · May 2015 · Scandinavian Journal of Psychology
    • ". The diagnostic overlap may be due in part to shared diagnostic criteria, such as sleep disturbances, loss of energy and impaired concentration [1] [5] [18]. In addition, treatment methods overlap in that antidepressants and cognitive–behavioral therapy are efficacious for depression, anxiety and somatization [19] [20] [21] [22]. "
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    ABSTRACT: To examine the extent of depression, anxiety, somatization, and comorbidity between depression and anxiety in patients with temporomandibular disorders (TMD) by adding the Symptom Checklist-90 Revised self-report questionnaire for anxiety to the Research Diagnostic Criteria for TMD. A total of 207 Israeli TMD patients were included in this retrospective study. Data included levels of depression, anxiety, somatization, and comorbidity in the study group as a whole, in chronic pain TMD patients compared to acute pain TMD patients, and in chronic pain TMD patients according to their Graded Chronic Pain Scale score. Spearman correlation was used to assess the level of correlation between depression, anxiety, and somatization. Fisher exact test or Pearson chi-square test was used to compare the categorical variables. When depression, anxiety, somatization, and comorbidity were analyzed in a multidimensional approach, there were statistically significant differences between subgroups as to depression and somatization only. No statistically significant differences were found as to anxiety and comorbidity. Multidimensional assessment enabled differentiation between findings of depression, anxiety, somatization, and comorbidity in subgroups of TMD patients. The findings of no statistically significant differences between subgroups of TMD patients as to anxiety and comorbidity support previous studies on TMD and anxiety, which suggest a less significant role of anxiety in chronic TMD patients as compared to depression and somatization.
    No preview · Article · May 2015
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