Relación entre sobrecompromiso y síntomas somáticos en enfermeras de un hospital de II nivel en Perú

Objetivo : Determinar la relación entre sobrecompromiso y síntomas somáticos en enfermeras de un hospital de II nivel en Perú. Material y métodos : Investigación observacional, transversal y correlacional, con una muestra probabilística de 106 enfermeras. Se aplicó el Cuestionario de Siegrist y Meter para medir sobrecompromiso y desequilibrio esfuerzo recompensa, y el Cuestionario de Salud (PHQ15) para síntomas somáticos. Se construyó un modelo de regresión logística, considerando variables sociodemográficas y laborales. Resultados : En las enfermeras que presentaron síntomas somáticos moderados-graves, el 68,3% tuvo un nivel de sobrecompromiso alto. El modelo de regresión mostró que sobrecompromiso (OR = 6,25, p < 0,01), tiempo laboral (OR = 0,74, p < 0,01) y la condición de personal (nombrado o contratado, OR = 49,20, p < 0,01) influyeron en el nivel de síntomas somáticos. El modelo discriminó correctamente el 79% (IC 95%: 0,70 - 0,88) de los casos con síntomas somáticos, siendo el valor 0,43, el que se usò para la clasificaciòn en leve-mìnimo y moderado-grave con una sensibilidad de 73% y especificidad del 74%. Conclusión : Se corroboró una relación significativa entre sobrecompromiso y síntomas somáticos, con un modelo predictivo que logró un nivel elevado de discriminación para identificar personal de enfermería en riesgo.

SUMMARY Objective : To determine the relationship between over commitment and somatic symptoms among nurses in a type II hospital in Peru. Methods : A cross-sectional study with a probabilistic sample of 106 participants was carried-out. The Siegrist and Meter questionnaire was applied to measure over commitment and imbalance effort-recompense and the Health Questionnaire (PHQ15) was applied to evaluate somatic symptoms. A logistic regression model was built considering sociodemographic and labor variables. Results : The 68.3% of nurses that presented with moderate to severe somatic symptoms had a high level of over commitment. The regression model showed that over commitment (OR = 6.25, p < 0.01), time in the working place (OR = 0.74, p < 0.01) and labor status (staff or hired temporarily OR = 49.20, p < 0.01) influenced the level of somatic symptoms. The model discriminated well the 79% (95% CI: 95%: 0.70 - 0.88) of somatic cases. A value of 0.43 was selected to discriminate between mild to moderate-severe with a sensitivity of 73% and 74% specificity. Conclusions : A signifcant correlation between over commitment and somatic symptoms ws found. The regression model attained a high discriminative level to identify nurses at risk.

Cyberchondria and Associated Factors Among Brazilian and Portuguese Dentists / Cibercondria e fatores associados entre dentistas brasileiros e portugueses

ABSTRACT Cyberchondria is a psychopathological behavior that affects people who compulsively consult the internet, by searching the symptoms of different pathologies from which they believe they are suffering, and when influenced by what they read, are sure they have some of these diseases. The aim of this study was to assess the cyberchondria level and associated factors among Brazilian and Portuguese dentists. A total 597 Brazilian and Portuguese dentists participated in this cross-sectional study. They were contacted via WhatsApp and asked to complete an online questionnaire on the Google Forms platform, from January 17 to 31, 2021, during the COVID-19 pandemic. Sociodemographic information was collected and cyberchondria was measured using the Portuguese language version of the Cyberchondria Severity Scale. Binary logistic regression models were used to estimate the unadjusted and adjusted Odds Ratio (OR) and corresponding 95% confidence interval (CI) for the association of cyberchondria and covariates. Each covariate was individually included in the regression model, and the unadjusted OR (95% CI) was estimated. Most participants were Brazilian (62.8%), women (75.5%), married (60.5%) and with children (55.6%). Average age was 42.1 years (+ 12.5). In the final model, it was found that with each increase of one year in age, the chance of a high level of cyberchondria decreased (OR=0.97; 95% CI 0.95-0.98). Brazilian dentists were 1.85 times more likely (95% CI 1.25-2.75) to have a high level of cyberchondria than Portuguese dentists. Women were 1.62 times more likely (95% CI 1.07-2.44) to have a high level of cyberchondria than men. It was concluded that young age, Brazilian nationality, and female gender favored the high level of cyberchondria among the participants in this sample during COVID-19 pandemic.

RESUMO A cibercondria é um comportamento psicopatológico que atinge as pessoas que consultam compulsivamente a internet, pesquisando os sintomas das diferentes patologias de que acreditam estar sofrendo e, quando influenciadas pelo que leem, têm a certeza de possuir alguma dessas doenças. O objetivo deste estudo foi avaliar o nível de cibercondria e fatores associados entre dentistas brasileiros e portugueses. Participaram deste estudo transversal 597 dentistas brasileiros e portugueses. Eles foram contatados via WhatsApp e solicitados a preencher um questionário online na plataforma do Google Forms, no período de 17 a 31 de janeiro de 2021, durante a pandemia de COVID-19. Informações sociodemográficas foram coletadas e a cibercondria foi mensurada através da versão em língua portuguesa da Cyberchondria Severity Scale. Modelos de regressão logística binária foram usados para estimar a Odds Ratio (OR) não ajustada e ajustada e o intervalo de confiança (IC) de 95% correspondente para a associação de cibercondria e covariáveis. Cada covariável foi incluída individualmente no modelo de regressão, e o OR não ajustado (IC 95%) foi estimado. A maioria dos participantes eram brasileiros (62,8%), mulheres (75,5%), casados (60,5%) e com filhos (55,6%). A média de idade foi de 42,1 anos (+ 12,5). No modelo final, verificou-se que a cada aumento de um ano de vida, a chance de um nível elevado de cibercondria diminuía (OR = 0,97; IC95% 0,95-0,98). Os dentistas brasileiros tiveram 1,85 vezes mais probabilidade (IC95% 1,25-2,75) de apresentar alto índice de cibercondria quando comparados aos portugueses. As mulheres tinham 1,62 vezes mais probabilidade (IC 95% 1,07-2,44) de ter um alto nível de cibercondria em comparação com os homens. Concluiu-se que a idade mais jovem, a nacionalidade brasileira e o sexo feminino favoreceram o alto índice de cibercondria entre os participantes desta amostra durante a pandemia COVID-19.

Relationship between Perceived Social Support and Severity of Symptoms in Persons with Somatoform Disorder.

Somatization is a common problem in primary health care leading to disproportionately heavy demands on health services. Patients with somatoform disorder account for about 20% of the workload in general practice. In somatoform disorder multiple or unexplained physical symptoms cause substantial disability in patients, while their psychiatric distress remains unrecognised and untreated. Studies have shown that good perceived social support improves the well-being of a person and also affects the outcome of treatment in somatoform disorder. Our study aimed at investigating relationship of severity of somatic symptoms and perceived social support in people with somatoform disorder.METHODSThis study is a cross-sectional single interview study in a tertiary care centre. All patients attending psychiatry OPD of R. G. Kar Medical College and Hospital, Kolkata, diagnosed with somatoform disorder (ICD-10) fulfilling inclusion and exclusion criteria were included in this study. Total 60 patients were selected. Inclusion criteria include patients aged between 18 to 60 years, both sexes and exclusion criteria include patients with mental retardation, epilepsy, any other neurological disorder and with co-morbid mental disorder. Patient Health Questionnaire-15 (PHQ-15) and Multidimensional scale of perceived social support assessment were used to assess severity of somatic symptoms and perceived social support respectively. Data was then analysed using standard statistical methods.RESULTSOur study revealed that women (93.33%) reported more somatic symptoms than men (6.66%). There was highly significant (p value=0.00) negative correlation (r=-0.76) between social support and severity of somatic symptoms i.e. patients who perceived high acuity of social support were reported to have less severity of somatic symptoms.

Transtornos somatoformes (manifestações histéricas) em mulheres atendidas em hospital psiquiátrico de São Luís, Maranhão / Somatoform disorders (hysterical manifestations) in women served in the psychiatric hospital of São Luís, Maranhão

Os sintomas somáticos sem explicação médica ou manifestações histéricas são freqüentes, estando associados a sofrimento mental em vários contextos. Atualmente são classificados na psiquiatria como transtornos somatoformes (TS). Estudos prévios apontam que as populações latino-americanas são propensas à somatização. No entanto, existem poucos estudos nacionais e locais sobre estes transtornos. Desse modo, este estudo objetivou verificar a ocorrência de TS em mulheres atendidas em um hospital psiquiátrico em São Luis Maranhão. Realizou-se um estudo seccional de base documental a partir dos dados coletados dos prontuários médicos das pacientes atendidas no período de Agosto de 2012 a Janeiro de 2013. Estimou-se a prevalência de TS com base em um total de 1.220 atendimentos, o que resultou em 62 casos de sintomatologia compatível com TS (5,08%), dos quais, apenas 5 receberam diagnóstico conclusivo de TS (8,06%). Os TS diagnosticados pelo CID 10 foram: quatro casos de transtorno dissociativo conversivo e um de neurovegetativo somatoforme. Os transtornos ocorreram mais frequentemente entre mulheres pardas com idade média de 34,3 anos. Os sinais e sintomas mais freqüentes foram insônia, dor de cabeça e inapetência. Os resultados apontam a necessidade de investigações mais minuciosas com os pacientes e auxílio de outros profissionais na composição de uma equipe multidisciplinar na investigação e fechamento do diagnóstico clínico. Levando-se em consideração as reformulações pelo qual o Código Internacional de Doenças versão 10 para as modificações na 11ª edição, estudos sobre os TS contribuirão de forma significativa para o processo de revisão dos sistemas diagnósticos de transtornos mentais e de comportamento.

Unexplained somatic medical symptoms or hysterical symptoms are common and frequently associated with mental distress in various contexts,representing, in general, a quarter to half of visits in primary and secondary care. They are currently classified in psychiatry as somatoform disorders (SD). Previous studies suggest that the Latin American populations are susceptible to somatization. However, there are few national and local studies on these disorders. Thus, this study aimed at verifying the occurrence of SD women attended in one psychiatric hospital in São Luís Maranhão. It was conducted a cross-sectional study of documentary basis of data collected from the medical records of patients treated during the period August 2012 to January 2013. It was estimated the prevalence of SD based on a total of 1,220 calls, which resulted in 62 cases of symptoms compatible with SD (5.08%), of which only 5 received conclusive diagnosis of SD (8.06%). The SD diagnosed by ICD 10 were: four cases of dissociative conversive disorder and a somatoform autonomic. Disorders occurred more frequently among brown women with a mean age of 34.3 years. The most common signs and symptoms were insomnia, headache and loss of appetite. The results indicate the need for more detailed investigations with patients and aid of other professionals in the composition of a multidisciplinary team in research and clinical diagnosis closure. Taking into account the reformulations by which the International Classification of Diseases version 10 for modifications in its 11th edition, the SD studies will contribute significantly to the process of revising the diagnostic systems for mental and behavioral disorders.

Distúrbios psiquiátricos menores em mulheres do extremo Sul do Brasil: prevalência e fatores associados / Minor psychiatric disorders in women from southern Brazil: prevalence and associated factors

Justificativa e Objetivos: A prevalência de distúrbios psiquiátricos menores (DPM) pode variar ao longo do tempo, ser mais frequente entre mulheres e estar influenciada por diversos fatores, alguns deles modificáveis. Este estudo, portanto, objetivou identificar essa prevalência e os fatores associados em um grupo de mulheres residentes no sul do Brasil. Métodos: Estudo transversal, realizado em município de porte médio do Extremo Sul do Brasil em 2011. Foram entrevistadas mulheres com 18 anos ou mais nos domicílios selecionados. O desfecho foi distúrbios psiquiátricos menores, avaliado com a aplicação do instrumento Self-Report Questionnaire (SRQ20) e utilizando um ponto de corte 7/8. Foram analisadas variáveis sócio demográficas, comportamentais e de saúde. Na análise estatística calculou-se a prevalência de distúrbios psiquiátricos menores e as razões de prevalência dos fatores associados, mediante uso da regressão de Poisson com variância robusta. Resultados: A prevalência de distúrbios psiquiátricos menores entre as 1595 mulheres participantes foi 21,76%. Entre os fatores associados encontrados, destaca-se o aumento linear da prevalência de distúrbios psiquiátricos menores com a idade, e também se observa uma relação inversa com a escolaridade e a renda. Há forte associação entre o desfecho e falta de suporte social, auto percepção de saúde ruim e doença crônica referida. Conclusões: A prevalência de distúrbios psiquiátricos menores foi elevada e afeta mais aos grupos com menores condições socioeconômicas, mostrando uma iniquidade que merece atenção. Outros fatores associados, também modificáveis foram o suporte social e a carga de morbidade referida, indicando a necessidade de ações de apoio nesses grupos de mulheres.

Background and Objective: The prevalence of minor psychiatric disorders (MPD) changes along time, is more frequent in women and can be influenced by several factors, most of them modifiable. The aim of this study was to analyze the prevalence of minor psychiatric disorders and its associated factors in a sample of women living in southern Brazil. Methods: Cross-sectional study carried on in a municipality from extreme southern Brazil in 2011. Women 18 years or older were interviewed in their homes. The outcome was minor psychiatric disorders which was identified by the Self-Report Questionnaire (SRQ-20) using a 7/8 cut-off point. Demographic, socioeconomic, behavioral, and health variables were also collected. Prevalence of minor psychiatric disorders with its 95% confidence interval was calculated. Prevalence Ratios of risk factors were obtained by the Poisson regression with robust variance. Results: Prevalence of minor psychiatric disorders among the 1595 studied women was 21.76%. Amongst the associated factors we highlight the linear trend between the outcome and age. Also we remark the inverse relationship between minor psychiatric disorders with education and income. A strong association was also found with lack of social support, self perception of poor health and self referred chronic disease. Conclusion: The prevalence of minor psychiatric disorders among women was high and more related to those worst off, pointing a situation of inequity that has to be addressed. Other modifiable factors where lack of social support and poor perceived health status, suggesting the need of supportive actions to these groups of women.

Evolving Concept Of Abnormal Illness Behavior & Clinical Implications

Objectives: The concept of “Abnormal illness behavior (AIB)” has been evolved to a greater extent in the last century. Henry Sigerist introduced the concept of “illness behavior” in 1929. Mechanic & Volkart defined and further conceptualized the impression on illness behavior. Talcott Parson had given the concept of “Sick role,” and Issy Pilosky had familiarized the notion of “abnormal illness behavior.” The main objective of this article is to review the conceptual evolution on “abnormal illness behavior” and to analyze its current clinical implications. Methods: Extensive search of literature was performed regarding abnormal illness behavior, illness behavior and sick role in online web searching sites like – Google Scholar, PubMed and individual journal sites as well as google books. The literature was critically reviewed with personal inputs from authors. Results: Abnormal illness behavior ranges from denial of illness in one extreme to conscious amplification of symptoms on the other. Abnormal illness behavior is noticed in various clinical conditions like stress-related disorder, stress-related disorders, factitious disorder and malingering. Conclusions: Identifying abnormal illness behavior can prevent unnecessary and excessive utilization of medical aids for the same.

Family Stress, Somatization, Social Support and Depression among Middle-aged Workers / 한국직업건강간호학회지

PURPOSE: The purpose of this study was to identify family stress, somatization, social support, depression and its influencing factor among middle-aged workers. METHODS: The research was cross-sectional descriptive study. The subjects were 212 middle-aged workers living in Seoul and Gyeonggi-do. Data collection was done from May 21 to 31, 2015 using self-reported structured questionnaires asking about general characteristics, family stress, somatization, social support and depression. Data were analyzed using descriptive statistics, independent sample t-test, one way ANOVA, Pearson's correlation coefficient, stepwise multiple regression with SPSS/WIN 19.0 program. RESULTS: Mean score of family stress was 41.67 (range: 25~125), somatization 17.42 (range: 12~60), social support 69.79 (range: 12~84) and depression 13.01 (range: 0~60) and reported as depression in 34.0%. Social support (beta=-.36, p<.001), somatization (beta=.28, p<.001), family stress (beta=.15, p=.014) had significant association with depression and the most important variable was social support. CONCLUSION: It is suggested to check social support system in middle aged workers and needed to reinforce social support of community based on the relation of occupational category. Also, it is necessary to legalize the institutional devices to prevent and control depression to ensure industrial safety and disaster prevention.

Hysteria to conversion disorders: Babinski's contributions / Histeria aos transtornos de conversão: contribuições de Babinski

The main objective of this paper is to present the importance of hysteria on Babinski's oeuvre, and the conceptions of pithiatism from Babinski until the one of conversion disorder. Babinski gave a mental basis for hysteria in the place of Charcot's encephalopatic one, and several important semiotic tools to differentiate organic from hysterical manifestations based on studies from 1893-1917/8. His teachings were spread worldwide, and in Brazil they were also appreciated in the work on hysteria by Antonio Austregesilo, the first Brazilian neurology chairman. The neurobiological basis of hysteria conceived by Charcot is nowadays reappraised, and Babinski's neurosemiological contribution is everlasting. The patients believed to be hysterical, and the two outstanding neurologists, Charcot and Babinski, gave support for the development of the modern neurology.

O objetivo principal deste trabalho é apresentar a importância da histeria na obra de Babinski e a concepção de pitiatismo de Babinski até a de transtorno de conversão. Babinski deu uma base mental para histeria no lugar da encefalopática de Charcot, e várias ferramentas semiológicas importantes para diferenciar manifestações orgânicas de histéricas, com base em estudos de 1893-1917/8. Seus ensinamentos foram disseminados em todo o mundo, e no Brasil eles também foram apreciados no trabalho sobre a histeria por Antonio Austregésilo, o primeiro catedrático da neurologia brasileira. A base neurobiológica da histeria concebida por Charcot é reavaliada hoje em dia, e a contribuição neurosemiológica de Babinski é perene. Os pacientes considerados histéricos e os dois grandes neurologistas, Charcot e Babinski, deram suporte para o desenvolvimento da neurologia moderna.

Trastorno somatomorfo: resolutividad en la atención primaria / Somatoform disorder: response capacity in primary care

El presente artículo, tiene como propósito conocer la capacidad resolutiva de la atención primaria, frente a las necesidades que tienen los pacientes con Trastornos Somatomorfos. Conocer también, la percepción que estos pacientes tienen acerca de la atención recibida. La muestra, está constituida por 25 pacientes pertenecientes a tres Centros de Atención Primaria de la comuna de Chillán. De acuerdo a los resultados, los pacientes perciben que sus demandas de salud sólo "a veces" son resueltas en su centro de atención primaria, pese a los notables costos en recurso humano, farmacológico y exámenes. Los resultados se discuten en relación a las limitaciones presentadas y a las proyecciones.

This paper aims to describe the response capacity of primary care to meet the needs that patients with somatoform disorders. Knowing the type of care delivered and the perception that these patients have about the care provided. The sample consists of 25 patients from three primary care centers in the commune of Chillán. Patients perceive that their health claims are resolved only sometimes in the primary care center, despite considerable human resource costs, and drug tests. The results are discussed in relation to the limitations presented and projections.

Symptomatic Hallucal Interphalangeal Sesamoid Bones Successfully Treated with Ultrasound-guided Injection: A Case Report

The hallucal interphalangeal sesamoid bone is usually asymptomatic, but it is not uncommon for it to be symptomatic in cases of undue pressure, overuse, or trauma. Even in symptomatic cases, however, patients often suffer for extended periods due to misdiagnosis, resulting in depression and anxiety that can steadily worsen to the extent that symptoms are sometimes mistaken for a somatoform disorder. Dynamic ultrasound-guided evaluations can be an effective means of detecting symptomatic sesamoid bones, and a simple injection of a small dose of local anesthetics mixed with steroids is an easily performed and effective treatment option in cases, for example, of tenosynovitis.

Hysteria and its metamorphoses / A histeria e as suas metamorfoses / L'hystérie et ses métamorphoses / La histeria y sus metamorfosis

OBJECTIVE: To investigate the historical evolution of hysteria and its possible psychopathological ramifications in today’s diagnostic classifications. Method: Clinical and historical problematization contrasting classical and contemporary references on the subject. Conclusion: Higher incidence of certain conditions and decline in the use of the construct of hysteria should be seen as different moments in a continuum.

OBJETIVO: Promover um pensamento investigativo acerca da evolução histórica da histeria e de suas eventuais ramificações psicopatológicas nas classificações diagnósticas atuais. Método: Problematização histórica e clínica a partir do contraponto entre referências clássicas e contemporâneas sobre o assunto. Conclusão: O aumento da incidência de certas condições e o declínio no uso do constructo histeria deveriam ser observados como momentos distintos de um mesmo continuum.

OBJECTTIF: Promouvoir une réflexion sur l'évolution historique de l'hystérie et ses ramifications psychopathologiques possibles dans les classifications diagnostiques actuelles. Méthode: Problématisation historique et clinique opposant les références classiques et contemporaines concernant ce sujet. Conclusion: L'incidence accrue de certaines conditions et la diminution de l'utilisation du construit "hystérie" devrait être considéré comme des moments distincts d'un même continuum.

OBJETIVO: Promover un pensamiento investigador sobre la evolución histórica de la histeria y sus posibles ramificaciones psicopatológicas en las clasificaciones diagnósticas de la actualidad. Método: Problematización clínica e histórica contrastando referencias clásicas y contemporáneas sobre el tema. Conclusión: El aumento en la incidencia de ciertas condiciones y la declinación en el uso del constructo de la histeria deberian ser observadas como momentos distintos del mismo continuum.

The Chinese version of the screening for somatoform symptoms-7 / 中华行为医学与脑科学杂志

ObjectiveTo revise the Chinese version of the screening for somatofonn symptoms-7( SOMS-7).Methods——( 1 )306 patients with somatoform disorder were selected in Psychiatry Clinic of Shengjing Hospital of China Medical University.(2) With convenient sampling,207 residents were selected in Xian village of Xintang town of Zengcheng district in Guangzhou and 288 in Tongji Road community of Chancheng district in Foshan.Besides,283 residents were selected in Changnan Community of Huanggu District and Jixiang Community of Dadong District in Shenyang.After 10 to 14 days,63 female and 73 male of the community subjects were selected randomly to fill in the scale again.All of the subjects filled in the Chinese version of the SOMS-7.Results ( 1 ) The internal consistency of the Chinese version of the SOMS-7 was 0.944 for female and 0.945 for male.The test-retest reliability was 0.869 for symptom count and 0.823 for severity index.The correlation with somatization subscale of SCL-90 was 0.805 for symptom count and 0.824 for severity index.(2) Based on the diagnostic criteria of somatoform disorder in DSM-Ⅳ,ROC curves were drawn.The AUC was 0.935 for symptom count and 0.942 for severity index in female,while 0.916 for symptom count and 0.926 for severity index in male.When 2.5 (female) or 1.5 (male) was chosen for symptom count and 15.5 (female) or 14.5 (male) for severity index,the youden in-dex reached a maximum.ConclusionThe Chinese version of the SOMS-7 showed a good reliability and validity,being reliable and valid as a tool to screen patients with somatoform disorder.

Escala de Avaliação do Transtorno Dismórfico Corporal (EA-TDC): propriedades psicométricas / Assessment Scale for Body Dysmorphic Disorder (AS-BDD): psychometric properties

Este estudo analisou as propriedades psicométricas da segunda versão da Escala de Avaliação do Transtorno Dismórfico Corporal - EA-TDC, de auto-relato, 40 itens, desenvolvidos para avaliar três critérios do Transtorno Dismórfico Corporal caracterizado por: preocupação excessiva com um imaginado defeito na aparência; sofrimento clinicamente significativo e prejuízo funcional em campos importantes da vida; a preocupação não é melhor explicada por outro transtorno. A análise de construto por juízes indicou acordo sobre 35 itens. Esses foram respondidos por 30 pacientes diagnosticados com TDC e 400 universitários. A validade de critério indicou capacidade de discriminação dos itens entre os indivíduos dos dois grupos amostrais. A análise fatorial exploratória sugeriu estrutura unidimensional da escala que permite medir, "preocupação excessiva e sofrimento com um imaginado defeito e os prejuízos sobre o funcionamento em diferentes áreas da vida". Os itens retidos revelaram excelente consistência interna. Definição de pontos de cortes e da capacidade de discriminar outros transtornos devem ser pesquisados.

This study analyzed the psychometric properties of the second version of the Assessment Scale for Body Dysmorphic Disorder (AS-BDD). It is a scale of self-report, with 40 items, developed to evaluate 3 dimensions of Body Dysmorphic Disorder (BDD): (a) excessive concern with a minor or imagined flaw in his/her personal physical characteristics, (b) significant clinical suffering and functional damage in important areas of life, and (c) such concern is not better explained by another disorder. The construct analysis by judges indicated accordance in 35 items which were answered by 30 patients diagnosed with BDD and 400 university students. The validity of criterion measures indicated ability to discriminate the items among the individuals of both sampled groups. The exploratory factor analysis suggested a unidimensional structure of the scale which allows to measuring "excessive concern with a minor or imagined flaw in his/her personal physical characteristics and the functional damages in different areas of life". The withheld items have shown excellent internal consistency. Cut point definitions and the ability to discriminate other disorders should be further studied.

A Comparative Study on Alexithymia in Depressive, Somatoform, Anxiety, and Psychotic Disorders among Koreans

OBJECTIVE: Little is known about the characteristic differences in alexithymic construct in various psychiatric disorders because of a paucity of direct comparisons between psychiatric disorders. Therefore, this study explored disorder-related differences in alexithymic characteristics among Korean patients diagnosed with four major psychiatric disorders (n=388). METHODS: Alexithymic tendencies, as measured by the Korean version of the 20-item Toronto Alexithymia Scale (TAS-20K), of patients classified into four groups according to major psychiatric diagnosis were compared. The groups consisted of patients with depressive disorders (DP; n=125), somatoform disorders (SM; n=78), anxiety disorders (AX; n=117), and psychotic disorders (PS; n=68). RESULTS: We found that substantial portions of patients in all groups were classified as having alexithymia and no statistical intergroup differences emerged (42.4%, 35.9%, 35.3%, and 33.3% for DP, SM, PS, and AX). However, patients with DP obtained higher scores in factor 2 (difficulties describing feelings) than those with SM or AX, after adjusting for demographic variables. CONCLUSION: These findings suggest that alexithymia might be associated with a higher vulnerability to depressive disorders and factor 2 of TAS-20K could be a discriminating feature of depressive disorders.

A Consideration for the Indication of Daikankyoto or Daikankyoganryo / 日本東洋医学雑誌

We studied contemporary indication of daikankyoto and daikankyoganryo. We administered either of these Kampo prescriptions for thirty-three patients with intractable muscle stiffness of neck, shoulder and back.Twenty-four patients were able to take the prescriptions for more than four weeks (long term group), and nine patients stopped taking the prescriptions less than four weeks (interrupted group). In long term group, fourteen patients (58%) improved their chief compliant. The Kampo formulations of fourteen effective cases were daikankyoto (13 cases) and daikankyoganryo (1 case). Comparative analysis has been done between long term group and nine cases of interrupted group. The characteristics of long term group were higher body mass index, firmer abdomen and more positive cases of epigastric resistance sign. Kansui root dose was 0.81 gram a day in long term group and 0.57 gram a day in interrupted group, which showed statistically-significant difference. We found twenty-seven side-effects in twenty four patients (73%) including eighteen patients with nausea and six patients with diarrhea. In side effects, there was no statistically significant difference between two groups. These side effects were promptly improved after discontinuation or dose reduction of Kansui root. We report clinical courses of six improved cases in this paper, two severe stiff neck, shoulder and back cases, each one case of psychosomatic disorder, depression, spasmodic torticollis and gastroesophageal reflux. These prescriptions should be administered more commonly to the patients with severe stiff neck, shoulder and back.

Three Cases of Somatoform Disorder Considered as "Hontonki" Disease, Successfully Treated with Keishikakeito / 日本東洋医学雑誌

We report three cases with somatoform disorder which were considered as “Hontonki” disease, successfully treated with keishikakeito. Case1 was a 34-year old male who was suffering from headache and palpitation. He said ‘Something pierces and it goes up from the chest to the head.' We considered his complaint as Hontonki disease and administered keishikakeito. After one week, the headache disappeared and four weeks later, palpitation and tinnitus were definitely improved. Case2 was a 22-year old male. His complaints were excessive strain and general fatigue. Because he had coldness of lower extremities and spasmodic headache, we interpreted these symptoms Hontonki disease and administered keishikakeito. After that these symptoms and his psychological test scores improved markedly. Case 3 was a 75-year old female. Severe headache and palpitations presented after remodeling her home. Three weeks later taking keishikakeito, her symptoms had disappeared dramatically. Recently, Hontonki disease are often compared with panic disorder, and it is possible that some somatoform disorder cases include Hontonki disease. It is important to consider the possibility of Hontonki disease behind the physical complaints such as headache and palpitation, when we use keishikakeito.

Three Cases of Somatoform Disorder Considered as “Hontonki” Disease, Successfully Treated with Keishikakeito / 日本東洋医学雑誌

We report three cases with somatoform disorder which were considered as “Hontonki” disease, successfully treated with keishikakeito. Case1 was a 34-year old male who was suffering from headache and palpitation. He said ‘Something pierces and it goes up from the chest to the head.' We considered his complaint as Hontonki disease and administered keishikakeito. After one week, the headache disappeared and four weeks later, palpitation and tinnitus were definitely improved. Case2 was a 22-year old male. His complaints were excessive strain and general fatigue. Because he had coldness of lower extremities and spasmodic headache, we interpreted these symptoms Hontonki disease and administered keishikakeito. After that these symptoms and his psychological test scores improved markedly. Case 3 was a 75-year old female. Severe headache and palpitations presented after remodeling her home. Three weeks later taking keishikakeito, her symptoms had disappeared dramatically. Recently, Hontonki disease are often compared with panic disorder, and it is possible that some somatoform disorder cases include Hontonki disease. It is important to consider the possibility of Hontonki disease behind the physical complaints such as headache and palpitation, when we use keishikakeito.

Comparative study of antidepressant combined with improved Morita therapy in the treatment of somatoform disorder / 中华行为医学与脑科学杂志

Objective To explore the effects of antidepressant combined with improved Morita therapy in the treatment of somatoform disorder. Methods 78 patients with somatoform disorder were randomly divided into study group (medication combined with improved Morita therapy,39 cases) and control group (medication,39 cases). Both groups were assessed with symptom checklist 90 (SCL-90), Eysenck personality questionnaire ( EPQ )and global assessment scale ( GAS ) before and after treatment. Results After treatment, the factor scores in SCL-90 of the study group were (1. 14±0.41),(1.81 ±0.44),(1.27 ±0.41),(1.20±0.54),(1.49 ±0. 66 ), ( 1.25 ± 0. 42 ), ( 1. 09 ± 0.48), ( 1.07 ± 0. 42 ), ( 1.16 ± 0. 42 ), and that of the control group were ( 1. 46±0.44) ,(2.19±0.50),(1.56±0.40),(1.54±0.56),(1.85 ±0.48),(1.47±0.44),(1.33±0.54),( 1.38 ± 0. 58 ), ( 1.38 ± 0. 45 ), there were significant differences ( P ＜ 0. 05, P ＜ 0. 01 ). EPQ-E and EPQ-N of the study group were 7.02 ±4.06 and 12.7 ±3.89 respectively ,EPQ-E and EPQ-N of the control group were 14.8± 4.3 and 8.97 ± 4.32 respectively, there were significant differences ( P ＜ 0.05 ). The obvious effective rates of two groups were 82. 05% and 56.41% (x2 =4.875, P＜0. 05 ). Conclusion The effects of antidepressant combined with improved Morita therapy is much better in the treatment of somatoform disorder.

Trastorno dismórfico corporal / Body dysmorphic disorder

Anteriormente llamado dismorfofobia, el trastorno dismórfico corporal (TDC) se define como la preocupación excesiva y desproporcionada por un defecto mínimo o imaginario en la apariencia física. El defecto generalmente se encuentra en la cara, aunque puede ser en cualquier parte del cuerpo. Es una enfermedad de mal pronóstico que remite raramente de forma completa y provoca un deterioro en la vida del paciente, el cual demanda constantemente soluciones médicas o quirúrgicas; sin embargo, si es oportunamente sospechada y tratada, tiene un curso más favorable. Estos pacientes frecuentemente consultan a dermatólogos y cirujanos plásticos, con la idea de mejorar sus defectos físicos. Su trastorno psiquiátrico habitualmente es subdiagnosticado, lo que puede desencadenar una acción iatrogénica e incluso consecuencias médico-legales.

Formerly called dysmorphophobia, body dysmorphic disorder (BDD) is defined as the exaggerated, out of proportion preoccupation with the slightest or imaginary defect of the body s appearance. The defect is normally found on the face, although it can also be present in any part of the body. The prognosis for this condition is poor, and rarely goes entirely into remission, deteriorating the patient s quality of life. Those who suffer from this syndrome demand medical or surgical solutions. However, if early diagnosis and treatment are made the course of the disease may improve. Patients frequently seek dermatologists and plastic surgeons consultation to overcome these defects. Psychiatric disorders are commonly under-diagnosed and may lead to atrogenic actions, and possible legal consequences.

A Case of Paraneoplastic Stiff-Person Syndrome Presenting Multiple Somatic Symptoms / 신경정신의학

Stiff-person syndrome (SPS) is an unusual autoimmune neurological disease. We report a woman who developed stiff-person syndrome associated with thymoma. A 42-year-old woman visited a general hospital complaining of progressive rigidity in her neck and both lower legs. She also had other symptoms including whole body pruritus, dysphargia, dysarthria, diplopia, and a visual hallucination-like symptom. Emotional distress preceded her symptoms. After a extensive neurologic workup, she was transferred from the neurologic ward to the psychiatric ward under the impression of conversion or somatoform disorder. During her psychiatric admission, we found a prolonged involuntary MUAP discharge on her electromyograph, and positive anti-GAD and anti-GQ1b antibodies. In addition, a chest CT scan revealed a thymic epithelial tumor. We report a case of stiff-person syndrome presenting multiple unexplained somatic symptoms, which was initially diagnosed as a conversion or somatoform disorder.