CiteSpace-based visualization analysis of domestic and foreign research on somatic symptom disorder / 四川精神卫生

BackgroundThe etiology and pathogenesis of somatic symptom disorder are complicated， for which no effective treatment currently exists， posing a critical impact on their quality of life. ObjectiveTo analyze the current situation and development trend in domestic and foreign research on somatic symptom disorder from 2011 to 2021， and to better understand the research frontiers and hot spots in this field. MethodsOn 31 August 2022， literature on somatic symptom disorder published from January 1， 2011 to January 1， 2023 were searched in China National knowledge Infrastructure （CNKI）， Wanfang Data Knowledge Service Platform， Web of Science and PubMed， and a total of 15 035 articles were included， then the visualization analysis of the number of publications and keywords was conducted based on Microsoft Excel and CiteSpace software. ResultsIn the field of somatic symptoms disorder research from 2011 to 2021， the number of annual publications demonstrated an overall upward trend in foreign studies， and displayed a slow downward trend in domestic studies. The keyword co-occurrence network analysis revealed that the top five high-frequency keywords were "mental health" "depressive disorder" "depression" "anxiety" and "somatic symptom" in domestic studies， and were "symptom" "prevalence" "depression" "disorder" and "quality of life" in foreign studies. The burst analysis suggested that the burst terms in past five years were "somatic symptom" "syndrome" and "quality of life" in domestic studies， and were "major depressive disorder" and "outcome" in foreign studies. The clustering analysis yielded 8 clusters in domestic studies and 4 clusters in foreign studies， reflecting in the related disease， prevention and treatment protocols and epidemiological characteristics of somatic symptom disorder. ConclusionIn recent years， the publications and academic concerns regarding the research on somatic symptom disorder show an upward trend in foreign studies and are relatively inadequate in domestic studies， and both the domestic and foreign studies have been focused on the influencing factors of somatic symptom disorder. ［Funded by the Medical Health Science and Technology Project of Zhejiang Provincial （number， 2020PY064）； Medical Health Science and Technology Project of Hangzhou （number， 0020190783）］

Current research status of somatic symptom disorders in childhood / 中华实用儿科临床杂志

Somatic symptom disorder are common in childhood, and associated with high-risk adult psychiatric disorders and more unexplained hospitalization.They are one of the factors that seriously hinder health sound growth of children.In this article, domestic and foreign studies on somatic symptom disorders were reviewed to discuss their concept change, etiology and pathogenesis, clinical manifestation, diagnosis, evaluation and treatment, in order to facilitate early identification and treatment of somatic symptom disorders in childhood.

Correlation between heart rate variability and symptom severity in patients with somatic symptom disorder / 中华行为医学与脑科学杂志

Objective:To investigate the correlation between heart rate variability (HRV) and symptom severity in patients with somatic symptom disorder (SSD).Methods:Thirty-three patients with somatic symptom disorder (SSD group) who were outpatients or inpatients in Sichuan Provincial People′s Hospital from May 2020 to December 2020 and thirty-three gender-and age-matched healthy controls (HC group) were selected. The patient health questionnaire (PHQ-9), generalized anxiety disorder scale (GAD-7), patient health questionnaire PHQ-15 were applied to assess the severity of depression, anxiety and somatic symptoms in both groups. The somatic system disorder-B criteria scale (SSD-12) and the Whiteley-8 Scale (WI-8) were selected to assess the severity of symptom in SSD. All subjects underwent HRV measurement within one week of enrollment. The differences of HRV between the two groups were compared and the correlation between HRV and symptom severity were analyzed. Independent samples t-test was used for comparison between groups, and Pearson correlation analysis was used for correlation analysis between HRV index and symptom severity. Results:The levels of GAD-7, PHQ-9 and PHQ-15 in SSD group(5.0(2.0, 10.5), 8.0(3.5, 13.0), 11.0(8.0, 15.0)) were significantly higher than those in HC group (1.0(0, 2.0), 0(0, 2.0), 3(0, 6.0)), and the differences were statistically significant (all P<0.05). The SDNN ((25.41±11.24)ms), lnLF ((1.91±0.50)ms 2) and lnTP ((2.65±0.43)ms 2) in the SSD group were lower than those in the HC group ((32.87±12.01)ms, (2.27±0.43)ms 2, (2.93±0.32)ms 2), and the differences were statistically significant( t=-2.605, -3.160, -2.883, all P<0.05). RMSSD of SSD patients was negatively correlated with GAD-7, PHQ-9, and behavioral and cognitive factor scores of SSD-12 ( r=-0.360--0.404, P<0.05), lnHF was negatively correlated with GAD-7, PHQ-9 and behavioral factor scores of SSD-12 scores ( r=-0.491--0.402, all P<0.05), and lnLF/HF was positively correlated with PHQ-9 ( r=0.413, P<0.05) and lnTP was positively correlated with GAD-7 ( r=0.383, P<0.05). Conclusion:HRV is reduced in SSD patients and correlated with symptom severity, indicating the clinical potential of HRV index as a biological marker of SSD.

A Case Report of Somatic Symptom Disorder Successfully Treated with Keppuchikuoto Modified Formula / 日本東洋医学雑誌

We report a case of a 74-year-old woman who suffered from uncomfortable heat under her right shoulder blade and felt anxiety about general fatigue that had been worsening mainly in the summer. She visited our Kampo clinic because of insufficient effect of various types of drug that had been prescribed by 3 doctors for about a year. We made the diagnosis of somatic symptom disorder and suggested Kampo therapy with decoction. We thought this might be caused by liver qi depression, blood deficiency, and blood stasis because he had symptoms of dry skin, cold of feet, deeply located fine pulse, pale and purple tongue with yellow thick fur, fullness in the chest and hypochondrium. Therefore we administered keppuchikuoto modified formula. Her symptom improved within about a month after taking this formulation. There was no recurrence of the physical symptom and fatigue in the summer during taking medicine for about 20 months. Evidence-based treatment in somatic symptom disorder has not been established and some cases are resistant to treatments in modern Western medicine. Kampo medicine may be useful and hopeful.

Association of attentional bias with negative cognition and childhood trauma in somatic symptom disorders / 中华行为医学与脑科学杂志

Objective:To investigate whether attentional bias exists in somatic symptom disorders and its correlation with negative cognition and childhood trauma.Methods:Totally 33 patients with physical disorder (physical disorder group) and 33 healthy controls (healthy control group) who met the inclusion and exclusion criteria in the outpatient or inpatient department of Sichuan Provincial People's Hospital were collected as the research objects.The patient health questionnaire (PHQ-15) and somatic system disorder-B criteria scale (SSD-12) were used to evaluate the severity of the disease, the childhood trauma scale (CTQ) was used to evaluate the childhood trauma experience, and the dot probe task edited by E-prime software was used to measure the reaction time.The repeated measurement variance analysis and independent sample t-test were used to compare the attention bias of the two groups, and the Pearson correlation analysis was used to analyze the correlation between attention bias, disease severity and childhood trauma. Results:The reaction time to negative pictures((510.86±124.72)ms) was longer than that to positive pictures ((504.21±117.21)ms, F=9.10, P<0.05) for physical disorder group and healthy control group, and the negative orienting index(5.22±28.02) in physical disorder group was significantly higher than that in healthy control group(-12.62±32.33)( t=2.397, P<0.05). Disengaging index to positive emotions in SSD patients was positively correlated with their negative cognition of the disease ( r=0.403, P<0.05), and the disengaging index to negative emotions in SSD patients was negatively correlated with emotional neglect ( r=-0.399, P<0.05). Conclusion:Reducing the occurrence of childhood trauma and correcting patients' negative cognition may help to improve the attention bias of somatic symptom disorders.

Questionnaire investigation of radiation rectal injury with anxiety, depression and somatic disorder / 中华胃肠外科杂志

Objective: To observe the incidence and treatment of radiation rectal injury complicated with anxiety, depression and somatic symptom disorder. Methods: A cross-sectional survey research method was carried out. Patients with radiation rectal injury managed by members of the editorial board of Chinese Journal of Gastrointestinal Surgery were the subjects of investigation. The inclusion criteria of the survey subjects: (1) patients suffered from pelvic tumors and received pelvic radiotherapy; (2) colonoscopy showed inflammatory reaction or ulcer in the rectum. Exclusion criteria: (1) patient had a history of psycho-somatic disease before radiotherapy; (2) patient was unable to use a smart phone, unable to read and understand the questions in the questionnaire displayed on the phone; (3) patient refused to sign an informed consent form. According to the SOMA self-rating scale, PHQ-15 self-rating scale, GAD-7 and PHQ-9 self-rating scale, the electronic questionnaire of "Psychological Survey of Radiation Proctitis" was designed. The questionnaire was sent to patients with radiation rectal injury managed by the committee through the WeChat group. Observational indicators: (1) radiation rectal injury symptom assessment: using SOMA self-rating scale, radiation rectal injury symptom classification: mild group (≤3 points), moderate group (4-6 points) and severe group (> 6 points); (2) incidence of anxiety, depression and physical disorder: using GAD-7, PHQ-9 and PHQ-15 self-rating scales respectively for assessment; (3) correlation of radiation rectal injury symptom grading with anxiety, depression, and somatic symptom disorder. Results: Seventy-one qualified questionnaires were collected, of which 41 (56.9%) were from Guangzhou. Among the 71 patients, 6 were males and 65 were females; the mean age was (55.7±9.3) years old and 48 patients (67.6%) were less than 60 years old; the median confirmed duration of radiation rectal injury was 2.0 (1.0, 5.0) years. (1) Evaluation of symptoms of radiation rectal injury: 18 cases of mild (25.4%), 27 cases of moderate (38.0%), and 26 cases of severe (36.6%). (2) Incidence of anxiety, depression and somatic disorder: 12 patients (16.9%) without comorbidities; 59 patients (83.1%) with anxiety, depression, or somatic disorder, of whom 2 patients only had anxiety, 1 patient only had depression, 9 only had somatic disorder, 2 had anxiety plus depression, 4 had anxiety plus somatic disorder, 2 had depression plus somatic disorder, and 40 had all three symptoms. (3) correlation of radiation rectal injury grading with anxiety, depression, and somatic symptom disorder: as compared to patients in mild group and moderate group, those in severe group had higher severity of anxiety and somatic symptom disorder (Z=-2.143, P=0.032; Z=-2.045, P=0.041), while there was no statistically significant difference of depression between mild group and moderate group (Z=-1.176, P=0.240). Pearson correlation analysis revealed that radiation rectal injury symptom score was positively correlated with anxiety (r=0.300, P=0.013), depression (r=0.287, P=0.015) and somatic symptom disorder (r=0.344, P=0.003). Conclusions: The incidence of anxiety, depression, and somatic symptom disorder in patients with radiation rectal injury is extremely high. It is necessary to strengthen the diagnosis and treatment of somatic symptom disorder, so as to alleviate the symptoms of patients with pelvic perineum pain and improve the quality of life.

Somatic symptom disorder in the context of Chinese yin-yang culture:A case report and literature review / 中南大学学报(医学版)

Somatic symptom disorder (SSD) is a somatic disorder characterized by excessive anxiety over various somatic symptoms for a long time, which makes patients feel very painful and the quality of personal life significantly decreased. Previous studies have shown that there is a connection between the clinical manifestations of SSD patients and their cultural background. The patient in this case report was highly affected by Chinese yin-yang culture, displaying obvious Chinese characteristics. We report a patient with SSD, whose clinical manifestations were mainly sexual dysfunction and mood symptoms which were closely related to the Traditional Chinese culture of Yin and Yang. In this case, Hamilton Anxiety Scale, Hamilton Depression Scale, and International Erectile Function Questionnaire were used to evaluate the patients ' anxiety, depression, and sexual function, and the scores were 32, 33, and 9, respectively. The patient was treated with a combination of venlafaxine and mirtazapine. After 5 weeks of treatment, the patient's clinical symptoms improved significantly. The clinical manifestations of some Chinese SSD patients have obvious characteristic relevance to Chinese theory of Yin and Yang, making SSD easily to be misdiagnosed. Therefore, clinicians should pay atlention to this situation. In addition, the combination of venlafaxine and mirtazapine may have a better effect on SSD patients with chronic pain and sexual dysfunction.

Effect of Emotional Labor on Somatization among Dental Hygienists in an Area / 치위생과학회지

BACKGROUND: We investigated somatization symptoms experienced by dental hygienists due to stress from emotional labor. Our aim was to provide basic research data that could be useful in the development of efficient stress management schemes for this occupational group. METHODS: We analyzed data collected from 208 dental hygienists working in Jeollabuk-do Province, Korea. To measure the level and intensity of emotional labor among research participants, we used the Korean Emotional Labor Questionnaire. We used the Somatization Symptom Checklist-90-Revised (SCL-90-R) to measure the level of somatization symptoms among participants. RESULTS: On analyzing the level of emotional labor and somatization symptoms according to general characteristics, participants aged 23~25 years showed high scores for stress due to emotional labor (p<0.05). Working 5 days per week, subjective health status, and organizational support and protection systems were found to correlate with the level of stress due to emotional labor (p<0.05). In the analysis of correlations between emotional labor and somatization symptoms, scoring high across all domains of emotional labor was associated with scoring high for somatization symptoms in the subdomains of emotional labor. When emotional labor and demographical variables were used as independent variables, having higher scores for emotional labor and having poor subjective health status were found to be associated with having higher levels of somatization symptoms (p<0.05). CONCLUSION: Our results showed that working at night and organizational support and protection systems were correlated with emotional labor and somatization symptoms. Measures must be taken at the organizational level to reduce emotional labor and somatization symptoms.

Illness perception in patients with somatic symptom disorder: a qualitative study / 中华行为医学与脑科学杂志

Objective@#To explore the perception and evaluation of patients with somatic symptom disorder about their own diseases and treatment, and to provide theoretical basis for design of illness perception questionnaire for patients with somatic symptoms disorder.@*Methods@#A semi-structured interview was conducted among 15 initial and untreated patients with somatic symptom disorder using the descriptive qualitative study. The data were sorted, encoded, classified, summarized and refined using MAXQDA10 software.@*Results@#Three main themes and six sub-themes of illness perception in patients with somatic symptom disorder were analyzed and sorted out: (1) symptom recognition: including three sub-themes, low understanding of the disease and denial of somatic symptoms as mental illness; (2)drug taking concerns: including two sub-themes worrying about side effects of drugs, drug addiction and having difficulty to stick to the long-term regular medication; (3)emotional reaction: including the obvious negative emotions of depression and helplessness sub-theme.@*Conclusion@#Patients with somatic symptom disorder have a general bias in illness perception, which has a potential adverse effect on treatment compliance. Therefore, it is necessary for clinical medical staff to early estimate patients’illness perception, and carry out mental health education and rational emotional behavior therapy.

A Study of Psychosocial Factor Affecting Attitude Toward Suicide of Adult Male and Female Inhabiting in a Province / 우울ㆍ조울병

BACKGROUND: Individual attitudes toward suicide are known to markedly influence suicidal ideation and suicidal behavior. Therefore, this study aimed to determine the factors associated with attitudes toward suicide.METHODS: This study was conducted on 3,213 adult men and women living in a province of Korea. After excluding 281 participants because of unreliable responses, the remaining 2,932 were included in the data analysis. Demographic factors were investigated, and psychological factors were evaluated. Attitudes toward suicide were evaluated using the Attitudes Towards Suicide-20, physical symptoms were evaluated using the Patient Health Questionnaire-15 (PHQ-15), self-compassion was evaluated using the Korean Self-Compassion Scale, and stress was evaluated using the Global Assessment of Recent Stress (GARS) scale. One-way analysis of variance was used to examine the psychological characteristics of attitudes toward suicide.RESULTS: Differences in various factors based on demographic characteristics were observed regarding attitudes toward suicide. Significant differences in attitudes toward suicide were observed based on severity of suicide, acceptability (F=20.332, p<0.001), prevention of suicide (F=7.700, p<0.001), and universality (F=13.741, p<0.001). The duration of suicidal ideation, self-kindness, self-judgment, common humanity, isolation, and over-identification showed differences, as did the GARS and PHQ-15 scores.CONCLUSION: This study explored the demographic and psychological factors affecting attitudes toward suicide. Adequate mediation of these factors is needed to prevent suicidal ideation and behavior.

Illness perception in patients with somatic symptom disorder:a qualitative study / 中华行为医学与脑科学杂志

Objective To explore the perception and evaluation of patients with somatic symptom disorder about their own diseases and treatment,and to provide theoretical basis for design of illness percep-tion questionnaire for patients with somatic symptoms disorder. Methods A semi-structured interview was conducted among 15 initial and untreated patients with somatic symptom disorder using the descriptive quali-tative study. The data were sorted,encoded,classified,summarized and refined using MAXQDA10 software. Results Three main themes and six sub-themes of illness perception in patients with somatic symptom dis-order were analyzed and sorted out:(1) symptom recognition:including three sub-themes,low understanding of the disease and denial of somatic symptoms as mental illness;(2)drug taking concerns:including two sub-themes worrying about side effects of drugs,drug addiction and having difficulty to stick to the long-term reg-ular medication;(3)emotional reaction:including the obvious negative emotions of depression and helpless-ness sub-theme. Conclusion Patients with somatic symptom disorder have a general bias in illness percep-tion,which has a potential adverse effect on treatment compliance. Therefore,it is necessary for clinical med-ical staff to early estimate patients’illness perception,and carry out mental health education and rational e-motional behavior therapy.

Reliability and Validity of the Korean Version of Health Anxiety Questionnaire

OBJECTIVE: Health anxiety can be defined by concern about health in the absence of a pathology. The Health Anxiety Questionnaire (HAQ) based on the cognitive-behavioral model can be useful for evaluating the severity and the structure of health anxiety. This study aims to verify the reliability and validity of Korean version of HAQ (K-HAQ). METHODS: For reliability, test-retest reliability and internal consistency were analyzed. For construct validity, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted. Receiver Operating Characteristic (ROC) analysis was performed to identify the optimal cut-off score. RESULTS: Cronbach’s alpha was 0.92, and r value of test-retest reliability was 0.84. In the EFA, 4- and 5-factor model showed cumulative percentile of variance of 60% or more. In the CFA, the 4-factor model was found to be the most appropriate and simplest (χ²=397.33, df=187, CFI=0.909, TLI=0.888, RMSEA=0.077). In the ROC analysis, the cut-off score was 20 points. CONCLUSION: It is expected that K-HAQ can be helpful to evaluate the severity of health anxiety and make therapeutic plans because K-HAQ can help explore the cognitive, emotional, and behavioral structure of health anxiety by each factor.

Comparison of the Bupropion versus Aripiprazole Adjunctive Therapy for the Treatment of Female Depression : Post-Hoc Analyses from a Randomized Prospective Open-Label Multi-Center Study / 우울ㆍ조울병

OBJECTIVES: The purpose of this study was to examine effects of adjunctive aripiprazole versus bupropion, on depressive symptoms of female depression.METHODS: Sixty six female patients with major depressive disorders were enrolled from a six-week, randomized prospective open-label multi-center study. Participants were randomized to receive aripiprazole (2.5–10 mg/day) or bupropion (150–300 mg/day). Montgomery Asberg Depression Rating Scale, 17-item Hamilton Depression Rating scale (HAM-D17), Iowa Fatigue Scale, Drug-Induced Extrapyramidal Symptoms Scale, Psychotropic-Related Sexual Dysfunction Questionnaire scores, and Clinical Global Impression-Severity (CGI-S) were obtained at baseline and after one, two, four, and six weeks. Changes on individual items of HAM-D17 were assessed as well as on composite scales (anxiety, insomnia and drive), and on four core subscales that capture core depression symptoms.RESULTS: Overall, both treatments improved depressive symptoms, without causing serious adverse events. There were significant differences in the HAM-D17 total score (p=0.046) and CGI-S (p=0.004), between aripiprazole and bupropion augmentation, favoring aripiprazole over bupropion. Aripiprazole revealed significantly greater effect size in depressed mood (p=0.006), retardation (p=0.005), anxiety psychic (p=0.032), and general somatic symptom (p=0.01).CONCLUSION: While both treatments were effective, results of this study suggested that aripiprazole may be preferable, in treating general and core symptoms of female depression.

Gender Differences in Somatic Symptoms and Current Suicidal Risk in Outpatients with Major Depressive Disorder

OBJECTIVE: Although somatic symptoms are common complaints of patients with major depressive disorder (MDD), their associations with suicide are still unclear. METHODS: A total of 811 MDD outpatients of aged between 18 to 64 years were enrolled nationwide in Korea with the suicidality module of the Mini-International Neuropsychiatric Interview (MINI) and the Depression and Somatic Symptom Scale (DSSS). RESULTS: On stepwise regression analysis, current suicidality scores were most strongly associated with chest pain in men, and neck or shoulder pain in women. Severe chest pain was associated with higher current suicidality scores in men than in women, whereas severe neck or shoulder pain showed no significant differences between the genders. In conclusion, MDD patients of both sexes with suicidal ideation showed significantly more frequent and severe somatic symptoms than those without. Current suicidal risk was associated with chest pain in men, and neck or shoulder pain in women. CONCLUSION: We suggest that clinicians pay attention to patients' somatic symptoms in real world practice.

Conversive gait disorder: you cannot miss this diagnosis / Distúrbio conversivo da marcha: você não pode deixar de fazer esse diagnóstico

Bizarre, purposeless movements and inconsistent findings are typical of conversive gaits. The objective of the present paper is to review some phenomenological aspects of twenty-five consecutive conversive gait disorder patients. Some variants are typical – knees give way-and-recover presentation, monoparetic, tremulous, and slow motion – allowing clinical diagnosis with high precision.

Movimentos bizarros, sem finalidade e inconsistentes são típicos das marchas conversivas. O objetivo deste artigo é descrever os aspectos fenomenológicos de vinte e cinco pacientes com distúrbio conversivo da marcha, salientando que algumas variantes são tão típicas – dobrando os joelhos e recuperando, monoparética, trêmula e em câmara lenta – que praticamente não possuem diagnóstico diferencial.

A Research Using PHQ-15 on the Somatic Symptoms of the First Visiting Patients with Depressive Disorder at a University Hospital

OBJECTIVES: Somatic symptoms are mostly accompanied with depression and the evaluation about the aspect of somatic symptoms of depressive patients helps diagnose, treat and the prognosis. This clinical study was performed to acquire the characteristics of somatic symptoms of depression and their relations with other factors. METHODS: The PHQ-15 was administered to analyze the aspect and the frequency of somatic symptoms among depressive patients. In addition, the associations between the PHQ-15 score and BDI score, GARS score, sociodemographic factors and clinical characteristics were analyzed. RESULTS: Of 201 patients, fatigue (93.6%) and sleep difficulty (81.7%) included in DSM-IV depression diagnosis category showed the most frequency. A headache (68.4%), gastrointestinal symptoms (79.8%) and unspecific pain (91.6%) were highly reported. PHQ-15 total score was significantly associated with female patients, blue-collar workers and unemployed state, higher GARS score, and the case consulted by other physicians. However, it was not significantly associated with the age. CONCLUSION: In this study, headaches were significantly more common than gastrointestinal symptoms among patients with depression, and these findings suggest changes of somatic symptoms tendency of depressive patients in South Korea. A severity of somatic symptoms were associated with the female, high GARS score, blue-collar workers and at the case consulted by other physicians. In conclusion, the materials from PHQ-15 in somatic symptoms are valuable to diagnose and treat depressive patients.

The Influence of Life Stress on the Severity of Depression and Somatic Symptoms in Depressive Women / 신경정신의학

OBJECTIVES: Stressful life events play the important role in depression. Somatic symptoms have also been closely linked to life stress. This study aimed to investigate the influence of life stress during four different life stages (childhood, adolescent, from 19 years to last year, the year prior to interview) on the severity of depression and somatic symptoms in depressive women. METHODS: Seventy women who had been diagnosed with major depressive disorder or dysthymic disorder according to the DSM-IV TR, and whose ages varied from 21 to 72 years (average age : 41 years), completed the Mooney Problem checklist, the Beck Depression Inventory (BDI), and Wittenborn`s somatic symptom scale. RESULTS: Life stressors which significantly influenced the severity of depression were difficulties with parents in the initial life stage, difficulties with other people in the third and fourth stages, and difficulties with social relationships in the fourth stage Further, somatic symptoms were influenced by health problem in the second period, difficulties with partners were prominent in the third stage, and difficulties with other people were noted in the fourth stage. The severity of depression showed a significantly positive correlation both with autonomic nervous system (p<0.001) and menopausal symptoms (p<0.001). After controlling for age, the severity of depression showed a significant positive correlation with stressors in the first stage (p<0.05), third stage (p<0.05), and fourth stage (p<0.01). Somatic symptom scores exhibited a significantly positive correlation with stressors in the second (p<0.05) and fourth stages (p<0.05). CONCLUSION: Current results suggested that the severity of depression and somatic symptoms were influenced by difficulties with other people in the fourth stage. The results of this study suggests that depression and somatic symptoms can be abbreviated by regulating excess stress.

Trastorno depresivo mayor en México: la relación entre la intensidad de la depresión, los síntomas físicos dolorosos y la calidad de vida

resumen está disponible en el texto completo

SUMMARY Background: Major Depressive Disorder (MDD) is a disease associated to emotional, vegetative and physical symptoms, including for the latter those pain-related symptoms. MDD has a high prevalence rate with a substantial burden of illness, and it expected that by 2020 it will become the second cause of world disability. The diagnosis of MDD is difficult due to the high prevalence of painful physical symptoms, and also due to the fact these symptoms are more evident that the embedded emotional ones. Over 76% of patients with MDD, report painful physical symptoms observed, like headache, abdominal pain, back pain and unspecific-located pain; observing these symptoms can even predict depression severity. In addition, the likelihood of psychiatric disease increases, importantly, with the number of physical symptoms observed; moreover, the remission of physical symptoms predicts the complete remission in MDD. We present an observational, prospective study to examine the clinical profile of Mexican outpatients suffering MDD and determine the relationship between depression severity, painful physical symptoms in quality of life and depression. Methods: Adult patients with current episodes of MDD, treated with antidepressants were included. MDD was defined according to the criteria of the Statistical Manual of Mental Disorders - 4th Edition (DSM-IV) or in the International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Patients should have been free of depression symptoms prior to the current episode for at least 2 months. Duration of current episode should not exceed two years. Treatment-resistant patients and those with other psychiatric diagnosis were excluded. Treatment-resistance was defined as: a) a failure to respond to treatment when two different antidepressants were employed at therapeutic doses for at least four weeks each, b) when the subject was previously treated with IMAO inhibitors, c) when electro-convulsive therapy (ECT) was previously employed. Other exclusion criteria comprise previous or current diagnosis of schizophrenia, schizophreniform or schizoaffective disorder, bipolar disorder, dementia or mental impairment. Patients were selected in 34 centers in Mexico. Patients were classified according to the presence (SFD+) or absence (SFD-) of painful physical symptoms using the Somatic Symptom Inventory (SSI); SFD+ was defined as scores ≥ 2 for the pain-related items in the SSI (items 2, 3, 9, 14, 19, 27 and 28). Visual Analogue Scale (VAS) quantified pain severity (cervical pain, headache, back pain, shoulder pain, interference of pain in daily activities and vigil-time with pain). HAMD17 and CGI-S determined depression severity, while the Quality of Life in Depression Scale (QLDS) quantified subjective well-being. Linear regression models were employed to compare groups for VAS, HAMD17, CGI-S, and QLDS, to fit the confusions or clinical predictors when needed. Proportions between groups were established with Fisher exact test or logistic regression. Significance levels were established at 0.005 due to the observational nature of the study. In the result tables, standard deviation (SD) is reported as a variation around the mean value as Mean ± SD, and 95% confidence intervals are denoted 95% IC. Results: A total of 313 patients were enrolled in the study. All of the enrolled patients were Mexican, almost them were women and had at least a previous MDD episode. Painful physical symptoms were reported by 73.7% of patients, these patients were classified into the SFD+ group. Neither statistical nor clinical significant differences between the SFD+ and SFD- groups were found when analyzing socio-demographic variables (age, gender, ethnical origin) and disease history variables (number of previous episodes of MDD, in the last 24 months, duration of current episode). At baseline, patients had a CGI-S mean score of 4.6 and HAMD17 of 26.3. HAMD17 mean score (27.1) in SFD+ patients was significantly higher (p<0.0001) than the SFD- patients (23.8), but nonsignificant differences between groups were found for the subscales central, Maier & retard. CGI-S scores were similar between SFD+ and SFD-; 4.6 and 4.5 respectively (p>0.05). Prevalent painful physical symptoms were also the most painful, when a five-point scale was employed to measure severity, and comprised muscular pain (84.9%), cervical pain (84.2%) and headache (83.5%). SFD+ patients had higher pain severity in all VAS scales (p<0.0001), with perceived severity scores twice as large when compared to SFDgroup. In particular, the global pain VAS reported average values of 49.0 and 19.7 for the SFD+ and SFD- groups respectively. Patients came to the first psychiatric consultation treated with psychotherapy (27.9%), antidepressants (37.3%), anxiolytics (28.6%) and analgesics (9.7%); more than 50% of all patients were not taking any drugs or receiving psychotherapy for treatment of MDD at baseline. Analgesics were used only by 9.7% of patients for the treatment of painful physical symptoms in their current MDD episode. No significant differences between groups were found when comparing the use of psychotherapy, antidepressants, anxiolytics, antipsychotics, mood stabilizers or analgesics. Quality of life was poor for all patients, but significantly worse in the SFD+ group than in the SFD- group (QLDS scores of 23.2 and 20.0 respectively, p<0.001). Discussion: The diagnosis and symptoms manifestation can be influenced by local socio-cultural factors, in particular cultural differences are associated with the prevalence of painful physical symptoms, but this finding is not consistent. The results of this study can be extrapolated to the MDD Mexican population, as selection criteria comprised only operative diagnosis criteria, and not enrollment into the study took place due to the presence of painful physical symptoms. Patients included into the study presented a moderate to severe disease as measured with the HAMD17 scores. The high prevalence of painful physical symptoms in patients with depression was confirmed in this study; it has been reported the patients report pain-related symptoms as the main (even the only) symptom when consulting general practitioners. Painful physical symptoms in MDD include headache, cervical pain, back pain or neck pain; the presence of painful physical symptoms in depression is associated to higher intakes medication, but in this study more than 50% of subjects were not receiving any treatment, including psychotherapy. The treatment of MDD is by no means optimal, as only 30%- 40% of these patients reach complete remission of symptoms with their first antidepressant. Psychological symptoms respond to antidepressant treatment, but in general, this is not the case for the physical symptoms. The lack of efficacy can be explained as a failure in the treatment of these painful physical symptoms. Resolving these symptoms is even a predictor for the complete remission of MDD; the evidence might suggest that treatment of emotional and physical manifestations of depression could improve successful-treatment rates. Conclusion: As found in other reports, a high prevalence of painful physical symptoms was found in MDD patients. Increase in pain severity is associated with higher HAMD17 scores but not CGI-S scores; this discrepancy in the final rates obtained with both scales suggests that both emotional and physical dimensions of MDD should be considered when the clinical assessment is performed. We concluded that clinical judgment of Mexican psychiatrists differs between their global impression and a semi-structured interview in the same patient and therefore is fundamental that the clinical evaluation consists of both emotional and physical manifestations as important components of MDD.

The Effect of Maternal State Anxiety on the Children's Somatic Symptom in Attention-Deficit/Hyperactivity Disorder

OBJECTIVES: The aim of the present study was to examine whether anxiety and depression of children and mothers were associated with the children's medically unexplained somatic symptoms in attention-deficit/hyperactivity disorder(ADHD). METHODS: 83 clinic-referred boys with ADHD and 52 boys without ADHD were included in this study. The frequency of the medically unexplained somatic symptoms, such as general-ache, headache, nausea, eye problems, skin problems, abdominal pain, vomiting was evaluated using the somatic symptom domain of the Child Behavior Checklist(CBCL). Children's anxiety and depression were evaluated using Kovacs Children's Depression Inventory(CDI) and Spielberger's State-Trait Anxiety Inventory(STAI) for children. Maternal anxiety and depression were measured by Spielberger's State-Trait Anxiety Inventory(STAI) and Beck's Depression Inventory(BDI). Stepwise linear regression analysis was used to examine the hypothesis. RESULTS: Score of maternal state anxiety affects the T score of the somatic symptom domain in CBCL significantly(adjusted R2=0.057; p=0.026). CONCLUSION: The frequency of medically unexplained somatic symptom of children perceived by mothers was associated with the high level of maternal state anxiety in ADHD. Frequent maternal report of the children's somatic symptom may be a warrant for the evaluation and management of the maternal state anxiety in ADHD.

Maintenance Period of Venlafaxine ER Treatment in Patients Having Major Depressive Disorder with Somatic Symptoms / 대한정신약물학회지

OBJECTIVES: Medically unexplained physical symptoms comprised the predominant complaints of patients with depression in clinical settings. Previously, tricyclic antidepressants, which inhibit both presynaptic reuptake of serotonin and norepinephrine, had been used to relieve pain as well as treat depression. The objective of this study was to evaluate the efficacy of venlafaxine ER, which also has the effects on both serotonin and norepinephrine, in patients suffering from depression with somatic symptoms. METHODS: The subjects were recruited from outpatients who had been treated for depression with venlafaxine ER. They were divided into two groups, based on whether they voiced somatic symptoms as their chief complaint (somatic group) or not (non-somatic group). In addition, they were also divided into two groups according to whether they met the criteria of multisomatoform disorder (DSM-IV, Primary Care Version). The duration from the time venlafaxine ER was used to the point when treatment was changed because of the recurrence of symptoms or side effects was assessed and compared using survival analysis in the two groups. RESULTS: Sixty-four patients fulfilled the inclusion criteria of this study, and 39 patients 'were placed into the somatic group', while the other 25 patients 'were placed into the non-somatic group'. The survival rates of maintenance treatment in the somatic group was significantly higher than in the non-somatic group (logrank test p=0.033), and the mean duration of maintenance treatment in the somatic group was 41.5+/-3.38 weeks, while that in the non-somatic group was 26.0+/-4.95 weeks. When the subjects were classified by the criteria of multisomatoform disorder, no significant difference was observed between the two groups (logrank test p=0.314). CONCLUSION: In the present study, treatment venlafaxine ER was maintained longer in patients suffering from depression with somatic complaints, which suggests the efficacy of venlafaxine ER on somatic symptoms of these patients. Large-scale, controlled trials are needed to confirm our findings.