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PubMed1989

Communication of emotional meaning, alexithymia, and somatoform disorders: a proposal for a diagnostic axis.

In this paper, a plea is made for establishing the dimension communication of emotional meaning as a descriptive axis in biopsychosocial diagnosis. Studies on alexithymia and somatic illness suggest that this dimension possesses not only diagnostic implications but also prognostic and therapeutic ones. A transactional viewpoint considering the definitions and expectations of patients, professionals and society would convert multiaxial into multidimensional diagnosis adapted to a given culture. Somatoform disorders are taken as illustration of the usefulness of the proposed dimension for further research and theorizing.

Affective Symptoms↗
PubMed2001

[Syndromes in environmental medicine: variants of somatoform disorders].

Concerning the syndromes in environmental medicine, like Multiple Chemical Sensitivities (MCS), Idiopathic Environmental Intolerances (IEI), Sick Building Syndrome (SBS), Chronic Fatigue Syndrome (CFS), Candida Syndrome (CS), and Burnout Syndrome (BS), scientific knowledge in etiology, pathology, pathophysiology, diagnosis, therapy, prevention and prognosis is still lacking until now. A critical comparison shows that it is still impossible to find a scientifically satisfying delimitation. Syndromes in environmental medicine show clinical similarities to somatoform disorders. Furthermore, there are the following possible explanations for the existence of these syndromes: Firstly, they may be a complex interaction of environmental impacts, individual predispositions, psychological influences, as well as processes of mental perception and interpretation. Secondly, they may be an effect of distress influenced by culture and social structures and/or thirdly, they may be an latrogenic determination. A more comprehensive characterisation which better considers the complex clinical manifestations is overdue. Although there are neither scientifically validated procedures for diagnosis or therapy nor prophylactic measures, a hardly comprehensible number of partly unvalidated methods is in practical use. Until the syndromes are not finally defined the terms for the syndromes should not be applied to a certain disease. Despite all uncertainities in the evaluation of syndromes in environmental medicine, physicians have the duty to take the affected persons' problems seriously.

Environmental Medicine↗
PubMed2003

A controlled treatment study of somatoform disorders including analysis of healthcare utilization and cost-effectiveness.

OBJECTIVE: The purpose of this prospective study was to evaluate the effects of cognitive-behavioral treatment (CBT) on mental health status and healthcare utilization in patients with somatoform disorders (SFD) of a specialized tertiary care center. METHODS: According to DSM-IV interviews, 54 patients had somatization disorder (SD), 51 abridged somatization syndrome (SSI-8) and 67 other defined SFD. A clinical non-SFD comparison group consisted of 123 patients. Treatment effects were controlled against the waiting list. Cost calculations for the 2-year periods before and after treatment were based on medical and billing records from health insurance companies. RESULTS: The SFD patients improved significantly with respect to physical symptom distress, health anxieties, dysfunctional beliefs towards body and health, depression and psychosocial functioning. Their outpatient plus inpatient charges during the 2 years prior to treatment were about 2.2-fold higher than for average patients of the health system. At the 2-year follow-up, we found treatment-related cost offset of 382 (-24.5%) for outpatient and 1098 (-36.7%) for inpatient care. Indirect socioeconomic costs due to days lost from work decreased by 6702 (-35.3%). Per patient savings of 32,174 (-63.9%) were found in a subgroup of somatizing high-utilizers. CONCLUSION: The results encourage including treatment strategies to reduce somatoform illness behavior into clinical practice.

Adult↗
PubMed2003

Are syndromes in environmental medicine variants of somatoform disorders?

To date, relatively little is known about the etiology, pathophysiology, diagnosis, therapy, prevention and prognosis of environment-related syndromes like multiple chemical sensitivity (MCS), idiopathic environmental intolerance (IEI), sick building syndrome (SBS), chronic fatigue syndrome (CFS), candida syndrome (CS) and burnout syndrome (BS). Part of the reason is that these syndromes have not been clearly defined and classified in scientific categories distinct from each other, and that they show clinical similarities to classified somatoform disorders. Furthermore, there are at least three possible explanations for the existence of these syndromes: (1) The syndromes may result from the interaction of environmental factors, individual susceptibility and psychological factors (i.e., how they are perceived and seen by the patient); (2) they may reflect socially and culturally accepted methods of expressing distress; and/or (3) they may be iatrogenic. Despite all the uncertainties in evaluation of environmental syndromes, physicians have the duty to take the affected person's problems seriously. A comprehensive systematic classification which better accounts for these complex clinical manifestations is long overdue. Until these syndromes are well defined, the terms used for them should definitely not be applied to connote a specific disease process.

Environment↗
PubMed2006

Somatoform disorders, somatization and abnormal illness behaviour.

Somatization and abnormal illness behaviour (AIB) often co-exist, and their inter-relationship appears to be complex. Patients with somatization are often observed to demonstrate abnormal illness behaviour. On the other hand, somatization has been explained in terms of abnormal illness behaviour. The exact cause-effect or any other relationship is not fully understood. This review examines the available evidence to understand these two clinically important, common and interrelated phenomena, their measurements and management. Many studies have confirmed that occurrence of multiple somatic symptoms as the chief or presenting complaints are highly suggestive of abnormal illness behaviour. Recognition of AIB in somatoform disorders is important in order to avoid unnecessary tests, inappropriate treatment, and to prevent encouragement and reinforcement of abnormal behaviours.

Humans↗
PubMedDate not supplied

A symptom checklist to screen for somatoform disorders in primary care.

Current DSM-IV somatoform diagnoses may inadequately capture many somatizing patients in primary care. By using data from two studies (1,000 and 258 patients, respectively), the authors determined 1) the optimal threshold on a checklist of 15 physical symptoms to screen for a recently proposed somatoform diagnosis, multisomatoform disorder (MSD), and 2) the concordance between MSD and somatization disorder. The optimal threshold for pursuing a diagnosis of MSD was seven or more physical symptoms. The majority (88%) of the patients who met criteria for MSD had either full or abridged somatization disorder. MSD was intermediate between abridged and full somatization disorder in terms of its association with functional impairment, psychiatric comorbidity, family dysfunction, and health care utilization and charges.

Adolescent↗
PubMed2000

Hemifacial spasm or somatoform disorder--postexcitatory inhibition after transcranial magnetic cortical stimulation as a diagnostic tool.

Hemifacial spasm (HFS) presents a frequent movement disorder. It is thought to have an organic origin. It therefore has to be distinguished from other facial involuntary movements, especially psychogenic tics, because the therapeutic approach differs. The present study opted to evaluate the diagnostic value of the postexcitatory inhibition (pI) after transcranial magnetic stimulation (TMS). After stimulating the contralateral hemisphere with the conventional flat coil and recording from the mentalis muscle, in 10 healthy controls and 10 patients postexcitatory inhibition was determined. PI showed no side to side difference in healthy controls (96.9 + 12.7 ms right, 87.9 +/- 10.8 ms left side, interhemispheric difference 6.4 +/- 3.8 ms). In 8 patients with hemifacial spasm, the duration of pI on the non-affected side did not differ from the healthy controls (87.9+/-43.5 ms). During spasm, pI on the affected side shortened increasingly until no inhibition could be induced. Afterwards the spasm pI was prolonged significantly (up to 140 ms longer than opposite side) before returning to normal values. Two patients presented no side differences of pI during the "spasm". An emotional conflict situation could be evaluated, supporting the diagnosis of somatoform disorder. As postexcitatory inhibition is mainly due to cerebral mechanisms, the electrophysiological results of the study pointed to a cortical influence on the hemifacial spasm. TMS seems to be an electrophysiological tool which allows a differentiation between organic and psychogenic spasm and enables a different therapeutic approach.

Adult↗
PubMed2001

[Somatoform disorders in ulcers].

We studied correlations between psychoemotional and vegetative disorders in ulcer. 60 patients with ulcer varying in severity were examined. The severity was judged by the disease history, endoscopic and x-ray findings. Emotional and personality characteristics were evaluated by answers in special questionnaires, vegetative deviations were studied with special tests, scale, cardiointervalogram. It was found that more severe course of ulcer correlated with growing vegetative dysfunction. The progressive ulcer course ran with predominance of sympathetic autonomic nervous system and is accompanied with marked psychoemotional tension and development of anxiodepressive personality traits.

Adult↗
PubMed1995

[From "functional syndrome to "somatoform disorder". The new ICD-10 classification].

Somatization disorders are particularly common in internal and general medicine. They affect in particular the gastrointestinal tract (irritable colon, non-ulcerous dyspepsia), the cardiovascular system (cardiac phobia), the respiratory system (hyperventilation syndrome) and include chronic pain syndromes. The earlier term "functional syndrome" has been discarded in favor of the category "somatization disorders". The new ICD10 classification created the basis for this internationally accepted revision. The classification into subtypes and the diagnostic criteria for somatization disorders in accordance with ICD10 are presented, as also are relevant differential diagnoses and co-morbidity.

Humans↗
PubMedDate not supplied

[Readiness for behavioural change in somatoform disorders].

The readiness for behavioural change in patients with somatoform symptoms constitutes an important construct in psychotherapy research. However, no psychometric instrument is available yet for assessing this construct. This study, therefore, attempts to adapt a questionnaire for the assessment of the "readiness for behavioural change" in patients with chronic pain (FQ-STAPM) to patients with somatoform symptoms. Various psychometric test criteria of the questionnaire are examined. The sample consists of n=103 in- and outpatients with multiple somatoform symptoms. Item characteristics, reliability (internal consistency), and construct validity for three of the four adapted scales are acceptable. Furthermore, the four-factor-structure of the FQ-STAPM can be confirmed. Moderate changes on the adapted scales of the FQ-STAPM are detected in a longitudinal design. The results corroborate the applicability of the instrument in patients with somatoform symptoms.

Adult↗
PubMed1997

[In the grey area body body, psyche and social difficulties. I: New developments in diagnosis and therapy of somatoform disorders (exemplified by chronic pain patients)].

The so-called psychosomatic or functional conditions (notably somatoform pain disorders) often cause difficulties in diagnostic classification, clinical management and assessment of disability. Recent trends in diagnosis are reviewed. We describe our first clinical experience of interdisciplinary evaluation of pain patients by functional capacity evaluation and an ergonomically oriented rehabilitation program. This interdisciplinary approach could constitute a new field of close collaboration between physiatry/physical medicine, physiotherapy and psychiatry.

Adaptation, Psychological↗
PubMed1994

Alexithymia in somatoform disorder patients with chronic pain.

The prevalence of alexithymia in fifty-five motor vehicle accident survivors who had chronic pain complaints and met DSM-III-R criteria for somatoform pain disorder was 53%. Alexithymic and non-alexithymic patients did not differ on self-reports of current pain severity or in the number of pain locations. Alexithymic patients were found to use significantly more words to describe their pain, suggesting they may have a more diffuse style in communicating their pain experience.

Accidents, Traffic↗