Trastornos somatomorfos y rasgos de personalidad en pacientes hospitalizados por lumbalgia crónica en El Salvador / Somatoform Disorders and Personality Traits in Hospitalized Patients with Chronic Back Pain in El Salvador

Introducción. El trastorno somatomorfo se caracteriza por la presentación de múltiples síntomas físicos que no pueden ser atribuidos a otra enfermedad física, mental o al uso de sustancias, teniendo como comorbilidad más prevalente a los trastornos de personalidad. Objetivo. Determinar la frecuencia de trastorno somatomorfo, sus características principales y diferentes rasgos de personalidad entre pacientes con lumbalgia crónica. Metodología. Estudio descriptivo transversal realizado con pacientes ingresados en el servicio de neurocirugía del Hospital General del Instituto Salvadoreño del Seguro Social. La recolección de datos se realizó a través de la escala Screening for Somatoform Symptoms 2 y la escala InternationalPersonality Disorder Examination. Las variables cualitativas fueron analizadas a través de frecuencias absolutas. Las variables cuantitativas fueron analizadas a través de medidas de tendencia central y de dispersión. Los análisis estadísticos fueron realizados en el programa Statistical Package for the Social Sicience, versión 26. Resultados. Se incluyeron 60 pacientes, 40 de ellos mujeres, 31 entre los 41 y 60 años. Veintiocho pacientes presentaron ocho o más síntomas, excluyéndose dolor lumbar. Cuarenta y cinco pacientes reportaron sintomatología por más de un año. Cincuenta y tres pacientes presentaron trastorno somatomorfo. Los trastornos de personalidad más frecuentes fueron obsesivo-compulsivos (31), límites (21) y paranoides (21). Conclusión. Los pacientes con dolor lumbar crónico que requieren ingreso hospitalario presentan una alta frecuencia de trastornos somatomorfos, con dolor en piernas o brazos como síntoma principal; además, estos pacientes se caracterizan por presentar en su mayoría rasgos de personalidad obsesivo-compulsivos.

Introduction. The somatoform symptoms disorder is characterized by multiple psychical symptoms that can't be attributed to another physical or mental health diagnosis or drug abuse, having personality disorders as the most common comorbidity. Objective. To determine the frequency of somatoform disorders, it's most important characteristics and different personality traits among patients with chronic back pain. Methodology. Cross-sectional descriptive study carried out with patients admitted to the neurosurgery department of the General Hospital of the Salvadoran Social Security Institute. Data collection was carried out using the Screening for Somatoform Symptoms 2 scale and the International Personality Disorder Examination scale. The qualitative variables were analyzed through absolute frequencies. The quantitative variables were analyzed through measures of central tendency and dispersion. The statistical analyzes were carried out using the Statistical Package for the Social Sciences version 26. Results. The study included 60 patients, 40 of them women, 31 between 41 and 60 years old. Twenty-eight patients presented eight or more symptoms, excluding low back pain. Forty-five patients reported symptoms for more than one year. Fifty-three patients presented somatoform disorder. The most frequent personality disorders were obsessive-compulsive (31), borderline (21) and paranoid (21). Conclusion. Patients with chronic lower back pain who require hospital admission have a high frequency of somatoform disorders, with the main symptom being pain in the legs or arms; furthermore, these patients are characterized by mostly presenting obsessive-compulsive personality traits

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.

Clinical study of treating somatoform pain disorder with the combination of electroacupuncture and duloxetine / 针灸推拿医学（英文版）

Objective:To observe the clinical efficacy of treating somatoform pain disorder(SPD)with electroacupuncture(EA)at the Governor and Conception Vessel points plus duloxetine.Methods:Eighty-two SPD patients were randomly allocated to an observation group and a control group,with 41 cases in each group.The control group was intervened by oral administration of duloxetine hydrochloride enteric capsules at a dose of 60 mg per time once a day;based on the medication,the observation group received additional EA treatment by selecting points from the Governor and Conception Vessels.Clinical efficacy was evaluated after 8 weeks of treatments;changes in the scores of the short-form McGill pain questionnaire(SF-MPQ),self-report symptom inventory,symptom check list-90(SCL-90),Pittsburgh sleep quality index(PSQI),and generic quality of life inventory-74(GQOLI-74)were also compared.Results:After the intervention,the observation group surpassed the control group in comparing the total effective rate(P＜0.05).The SF-MPQ score,SCL-90 somatization score,and PSQI score dropped notably in both groups after treatment,and the intra-group differences were statistically significant(P＜0.05);the three scores were significantly lower in the observation group than in the control group(P＜0.05).The GQOLI-74 score got an increase in each dimension in both groups after treatment,and the intra-group differences were also statistically significant(P＜0.05);the GQOLI-74 dimension scores were all significantly higher in the observation group than in the control group(P＜0.05).Conclusion:For patients with SPD,combining EA at the Governor and Conception Vessel points and duloxetine hydrochloride enteric capsules can markedly improve their clinical symptoms and quality of life.

Diagnostic pitfalls in functional neurological disorders / Armadilhas diagnósticas em transtornos neurológicos funcionais

ABSTRACT The diagnosis of functional neurological disorders is a major challenge in neurologist practice. Some clinical strategies can facilitate the recognition of functional disorders, but several pitfalls make their diagnosis difficult. Here we highlight the following points of attention during evaluation of patients with functional disorder: not all bizarre behavior is functional; not every event triggered by an emotional factor is a functional disorder; not every topographic incongruity is a functional disorder; patients may present functional and organic symptoms at the same time; psychiatric comorbid condition is not always evident in the history of a functional disorder; problematic communication at the time of diagnosis can compromise treatment and prognosis. In conclusion, we emphasize that special attention to these possible pitfalls facilitate the correct diagnosis and management of functional neurological disorders.

RESUMO O diagnóstico dos transtornos neurológicos funcionais é um grande desafio na prática do neurologista. Algumas estratégias clínicas podem facilitar o reconhecimento de transtornos funcionais, porém várias armadilhas dificultam o seu diagnóstico. Destacamos aqui os seguintes pontos de atenção durante a avaliação de pacientes com transtorno funcional: nem todo comportamento bizarro é funcional; nem todo evento desencadeado por um fator emocional é um transtorno funcional; nem toda incongruência topográfica é um transtorno funcional; pacientes podem apresentar ao mesmo tempo sintomas funcionais e orgânicos; condição psiquiátrica comórbida nem sempre é evidente na história de um transtorno funcional; comunicação problemática no momento do diagnóstico pode comprometer o tratamento e prognóstico. Em conclusão, enfatizamos que atenção especial a essas possíveis armadilhas, facilitam o diagnóstico e manejo corretos dos transtornos neurológicos funcionais.

Estudo da jornada da saúde sobre a COVID-19 e suas repercussões em Guaratinguetá / Estudio de la jornada da saúde sobre covid-19 y sus repercusiones en Guaratinguetá / Study of the jornada da saúde on covid-19 and its repercussions in Guaratinguetá

Objetivo: Entender a situação da COVID-19 em Guaratinguetá e suas repercussões na saúde física e mental da população local. Método: Estudo quantitativo descritivo, com coleta de dados por meio de um questionário aplicado aos pacientes atendidos durante a Jornada da Saúde em Guaratinguetá, realizado em outubro de 2020. Resultados: 2% dos entrevistados responderam que tiveram COVID-19 e 44% relataram conhecer alguém que teve a infecção. 82% relataram concordar com as medidas de prevenção. 51% dos entrevistados responderam que se sentiram mais ansiosos ou deprimidos durante este mesmo período. Conclusão: as repercussões da pandemia não se restringem aos casos de infecção, destacando a necessidade de cuidado com a saúde física e mental da população, um grande desafio para o sistema de saúde brasileiro, com repercussões a longo prazo(AU)

Objective: To understand the situation of COVID-19 in Guaratinguetá and the repercussions of the pandemic in the local population's physical and mental health. Method: Quantitative descriptive study, with data collected by a questionnaire applied to patients attending the Jornada da Saúde in Guaratinguetá held in October 2020. Results: 2% of interviewed answered that they had COVID-19 and 44% reported knowing someone who had the infection, 82% reported agreeing with the preventive measures, 51% replied that they felt more anxious or depressed during this same period. Conclusion: the repercussions of the pandemic are not restricted to cases of infection, emphasizing the need to care for the physical and mental health of the population, a major challenge for the Brazilian health system, with long term repercussions(AU)

Objetivo: Conocer la situación del COVID-19 en Guaratinguetá y su impacto en la salud física y mental de la población local. Método: Estudio descriptivo cuantitativo, con recolección de datos mediante cuestionario aplicado en pacientes atendidos durante la Jornada da Saúde en Guaratinguetá realizado en octubre de 2020. Resultados: 2% de los entrevistados ya havian tenido COVID-19 y 44% conocer a alguien que ya la havia tenido. El 82% informó estar de acuerdo con las medidas de prevención para la misma y 51% respondió sentirse más ansioso o deprimido durante la pandemia. Conclusión: las repercusiones de la pandemia no se limitan a los casos de infección, destacando la necesidad de cuidar la salud física y mental de la población, un gran desafío para el sistema de salud brasileño, con repercusiones a largo plazo(AU)

Paroxetine alone versus paroxetine combined with gabapentin in patients with somatoform disorders / 中国医师杂志

Objective:To compare the efficacy and safety of paroxetine alone and paroxetine combined with gabapentin in patients with somatoform disorder (SFD).Methods:From July 2018 to December 2020, 108 adult patients with SFD were prospectively selected from the psychological clinic of Jining First People′s Hospital. All patients were divided into the control group (52 cases) and the observation group (56 cases) according to the random number table method. The control group only received paroxetine, and the observation group received paroxetine combined with gabapentin for 12 weeks. Before treatment, at the end of treatment and at the 3-month follow-up after treatment, the levels of anxiety, depression and quality of life in the two groups of SFD patients were assessed by Symptom Checklist 90 (SCL-90), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and the Short Form-36 Health Survey (SF-36), respectively. Adverse event during treatment was recorded with Treatment Emergent Symptom Scale (TESS). At the end of treatment and at the 3-month follow-up after treatment, the therapeutic efficacy was evaluated with the patient′s Global Impression of Change (GIC).Results:At the end of treatment, GIC scores of the control group and the observation group were 3 (2-4) and 2 (1.25-3) respectively ( Z=2.081, P=0.037), and the treatment efficiency (GIC score ≤3) was 65.4%(34/52) and 83.9%(47/56), respectively, with a statistically significant difference (χ 2=4.945, P=0.026). Compared with that before treatment, the SCL-90, HAMA and HAMD scores of the two groups at the end of treatment were significantly reduced (all P<0.05); the SCL-90 somatization and anxiety factor scores of the observation group were lower than those of the control group (all P<0.05), and the HAMA somatization anxiety score of the observation group at the end of treatment was lower than that of the control group ( P<0.05). Compared with that before treatment, the scores of physical health and mental health in the two groups at the end of treatment and 3 months follow-up after treatment were significantly increased (both P<0.05), but there was no significant difference between the two groups (both P<0.05). There was no statistical difference in the total incidence of adverse events between the two groups ( P=0.085), but the incidence of vertigo in the observation group was significantly higher than that in the control group (χ 2=4.405, P=0.036). Conclusions:Paroxetine combined with gabapentin can further increase the effective rate of paroxetine treatment and improve the anxiety of SFD patients, but it has no significant impact on the quality of life, and has the potential risk of increasing dizziness, lethargy and other adverse reactions.

Trastornos somatomorfos y conversivos en otorrinolaringología pediátrica: revisión de la literatura

Resumen Los trastornos somatomorfos (TS) corresponden a un conjunto de entidades de expresión polimorfa cuya característica común es la relevancia de los síntomas somáticos asociados a un malestar psicológico significativo evidente o no, pero sin una base estructural delimitada. Si la sintomatología se asocia al sistema nervioso se denominan trastornos conversivos (TC). Su etiología tiene una naturaleza multicausal y compleja y se expresan en todos los sistemas del organismo. Los TS y los TC han sido poco estudiados en la otorrinolaringología pediátrica y su enseñanza es escasa en la formación médica. Se realizó una búsqueda sistemática sobre TS y TC en otorrinolaringología pediátrica en las bases de datos PubMed/Medline, SciELO y Cochrane Library. Se incluyeron 49 referencias, principalmente estudios observacionales y revisiones narrativas. Los cuadros clínicos descritos fueron el estridor funcional, la sordera psicógena, el trastorno facticio y el vértigo psicógeno. El proceso diagnóstico requiere de la evaluación otorrinolaringológica y psiquiátrica. En todos los estudios se reconoció que los participantes tenían alguna alteración afectiva prominente, aunque a veces oculta. El análisis del contexto social y escolar, además de los antecedentes familiares de TS, TC o cualquier desorden mental son elementos primordiales. La terapia es multidisciplinaria, incluyendo intervenciones otorrinolaringológicas, fonoaudiológicas, psicológicas y psicofarmacológicas. Sin embargo, la evidencia que sustenta a las intervenciones especializadas es escasa. Los niños, niñas y adolescentes con TS y TC presentan hallazgos clínicos y biológicos que no se presentan en los simuladores. Un adecuado diagnóstico y tratamiento se relacionan con un buen pronóstico.

Abstract Somatoform disorders (SD) make up a group of entities with polymorphic expression, characterized by the relevance of somatic symptoms associated to a significant psychological stress whether or not noticeable, but without a defined structural basis. When the symptomatology is related to the nervous system, they are known as conversion disorders (CD). Their etiology has a multicausal and complex nature, having expressions in all the body systems. SD and CD have been scarcely studied in pediatric otolaryngology and are poorly reviewed during medical training. We performed a systematic search on SD and CD in pediatric otolaryngology in PubMed/Medline, SciELO and Cochrane Library databases. We included 49 references, mostly observational studies and narrative reviews. The most described clinical pictures were functional stridor, psychogenic deafness, factitious disorder, and psychogenic vertigo. The diagnostic process requires otolaryngologic and psychiatric evaluations. All studies showed that participants had some relevant affective alteration, although sometimes unnoticeable. Thus, some essential elements are social and school context, family history of SD or CD or any mental disorder. Therapy involves a multidisciplinary approach, including otolaryngologic, audiological, psychological and psychopharmacological interventions. However, evidence supporting specialized interventions is still scarce. Children and adolescents who suffer from SD and CD show clinical and biological findings which are not found in malingering. Proper diagnosis and treatment are related to a good prognosis.

Somatización, ansiedad y depresión en niños y adolescentes / Somatization disorder, anxiety and depression in children and adolescents

Los trastornos de salud mental como depresión y ansiedad tienden a coexistir frecuentemente con los trastornos de somatización, siendo estos últimos una causa frecuente de consulta en especialidades médicas en niños y adolescentes. Es necesario poder pesquisarlos y diagnosticarlos para poder tratarlos adecuadamente. En la actualidad se cuenta con tratamientos eficaces y seguros para estos cuadros, ya sea estén aislados o en comorbilidad. Tanto la terapia cognitivo conductual como los inhibidores selectivos de recaptura de serotonina, solos o combinados, han demostrado ser intervenciones exitosas en estos niños y adolescentes. En el presente artículo se realiza una revisión de cómo se conceptualizan como una dimensión psicopatológica actualmente estos trastornos y cómo se relacionan entre ellos.

Psychiatric disorders such as depression and anxiety are frequently comorbid with somatization disorders, the latter ones are a common cause for medical specialties consultation in the pediatric population. It is thus necessary to identify and diagnose these disorders in order to be able to treat them. Currently, there are safe and effective treatments for these disorders, whether they are isolated or comorbid. Both cognitive behavioral therapy and selective serotonin reuptake inhibitors, alone or combined, have proven to be successful in treating these children and adolescents. This is a review of the current conceptualization of this psychopathologic dimension and how these disorders are interrelated.

A significant relationship between personality traits and adhesive capsulitis

SUMMARY OBJECTIVE We investigated the associations between adhesive capsulitis (AC) and a specific psychological profile. METHODS We assessed 72 patients with phase-II AC. In our study, 36 patients were affected by primary disease and 36 by secondary disease. The inclusion criteria were as follows: unilateral AC and pain in the shoulder for at least two months. The exclusion criteria were: psychiatric and neurological manifestations with a previous diagnosis and inability to comprehend the instruments. Outcomes were determined at 52 weeks. Shoulder pain severity was assessed with the Visual Analog Scale. We also measured the range of motion with a universal goniometer and the strength with the Medical Research Council. We assessed the personality traits of our patients with the Cloninger's Temperament and Character Inventory and the Multidimensional Perfectionism Scale. RESULTS Patients with primary AC needed more time to improve the symptomatology compared to the group with the secondary disease (p<0.01). Patients with primary AC complained of severe and lasting pain more frequently than patients with the secondary disease (p< 0.01). In patients with primary disease, the prevalence of perfectionism, low levels of novelty seeking, and high levels of harm avoidance were 88.2 and 86.2%, and 80.4, respectively, and below 20 percent in patients with secondary AC disease. CONCLUSION We found a significant correlation between primary AC and particular personality traits, indicating an interaction between psychological and somatic factors.

RESUMO OBJETIVO Investigar as associações entre a capsulite adesiva (CA) e um perfil psicológico específico. METODOLOGIA Foram avaliados 72 pacientes com CA fase II. Em nosso estudo, 36 pacientes foram afetados pela doença primária e 36 pela secundária. Os critérios de inclusão foram os seguintes: CA unilateral e dor no ombro durante por pelo menos dois meses. Os critérios de exclusão foram: manifestações neurológicas e psiquiátricas com um diagnóstico prévio e incapacidade de compreender os instrumentos de medição utilizados. Os resultados foram determinados após 52 semanas. A intensidade da dor no ombro foi avaliada usando a Escala Visual Analógica. Também medimos a amplitude de movimento com um goniômetro universal e a força com a escala do Conselho de Pesquisa Médica. Avaliamos os traços da personalidade dos nossos pacientes através do Inventário de Temperamento e Caráter de Cloninger e da Escala Multidimensional de Perfeccionismo. RESULTADOS Pacientes com CA primária precisaram de mais tempo para melhorar a sintomatologia quando comparados ao grupo secundário (p<0,01). Pacientes com CA primária apresentaram mais queixas de dor intensa e duradoura do que pacientes secundários (p< 0,01). Em pacientes com a doença primária, a prevalência de perfeccionismo, baixos níveis de procura por novidade, e altos níveis de prevenção de danos foram 88,2, 86,2% e 80,4, respectivamente, e abaixo de 20% em pacientes secundários. CONCLUSÃO Encontramos uma correlação significativa entre CA primária e traços de personalidade específicos, indicando uma interação entre fatores psicológicos e somáticos.

Brain glucose metabolism network and connectivity in patients with somatoform disorders / 中华核医学与分子影像杂志

Objective@#To observe the alteration of brain glucose metabolic network in patients with somatoform disorders (SFD).@*Methods@#18F-fluorodeoxyglucose (FDG) PET images of 18 SFD patients (10 males, 8 females; age: (39.5±12.0) years; illness duration: (3.67±3.20) years) and 21 matched healthy controls (13 males, 8 females; age: (43.9±8.4) years) in Huashan Hospital of Fudan University from October 2011 to December 2012 were enrolled to construct the brain glucose metabolic networks for 2 groups (SFD group, control group) respectively. Then the global network properties (normalized clustering coefficient, normalized shortest path length, small-worldness and global efficiency) and local parameters (clustering coefficient and betweenness centrality of the node) were calculated using the graph theory. Differences between 2 groups were compared by permutation test with 1 000 permutations. The top 20% (18/90) were classified as Hub nodes based on the results of clustering coefficient and betweenness centrality of the node.@*Results@#Small-worldness of SFD patients was similar to that of healthy controls (σ>1). There were decreased tendency in normalized clustering coefficient and global efficiency, and increased tendency in normalized shortest path length in SFD patients, but without significant differences (P>0.05). Compared to healthy controls, the betweenness centrality of left pallidum, left amygdala, left precuneus and right angular gyrus increased (permutation test, P<0.05); the betweenness centrality of left middle temporal gyrus, right superior occipital gyrus decreased (permutation test, P<0.05); the clustering coefficients of bilateral pallidum, bilateral thalamus, and left amygdala decreased (permutation test, P<0.05). Most changed Hub nodes (16/24) belonged to limbic system.@*Conclusion@#The changes of topological properties of brain glucose metabolic network in SFD patients including the decreased tendency of small-worldness and global efficiency, as well as the altered Hub nodes, may provide valid imaging evidences for brain dysfunction of somatization symptoms.

Brain glucose metabolism network and connectivity in patients with somatoform disorders / 中华核医学与分子影像杂志

Objective To observe the alteration of brain glucose metabolic network in patients with somatoform disorders (SFD).Methods 18F-fluorodeoxyglucose (FDG) PET images of 18 SFD patients (10 males 8 females;age:(39.5±12.0) years;illness duration:(3.67±3.20) years) and 21 matched healthy controls (13 males,8 females;age:(43.9±8.4) years) in Huashan Hospital of Fudan University from October 2011 to December 2012 were enrolled to construct the brain glucose metabolic networks for 2 groups (SFD group,control group) respectively.Then the global network properties (normalized clustering coefficient,normalized shortest path length,small-worldness and global efficiency) and local parameters (clustering coefficient and betweenness centrality of the node) were calculated using the graph theory.Differences between 2 groups were compared by permutation test with 1000 permutations.The top 20％ (18/90) were classified as Hub nodes based on the results of clustering coefficient and betweenness centrality of the node.Results Small-worldness of SFD patients was similar to that of healthy controls (σ＞ 1).There were decreased tendency in normalized clustering coefficient and global efficiency,and increased tendency in normalized shortest path length in SFD patients,but without significant differences (P＞0.05).Compared to healthy controls,the betweenness centrality of left pallidum,left amygdala,left precuneus and right angular gyrus increased (permutation test,P＜0.05);the betweenness centrality of left middle temporal gyrus,right superior occipital gyrus decreased (permutation test,P＜0.05);the clustering coefficients of bilateral pallidum,bilateral thalamus,and left amygdala decreased (permutation test,P ＜ 0.05).Most changed Hub nodes (16/24) belonged to limbic system.Conclusion The changes of topological properties of brain glucose metabolic network in SFD patients including the decreased tendency of small-worldness and global efficiency,as well as the altered Hub nodes,may provide valid imaging evidences for brain dysfunction of somatization symptoms.

Del trastorno conversivo a los trastornos neurológicos funcionales. ¿Superando el diagnóstico por descarte? / From Conversion Disorders to Functional Neurological Disorders. Overcoming the Rule-out Diagnosis?

RESUMEN Los trastornos neurológicos funcionales, antes llamados trastornos conversivos, son un problema clínico frecuente en los servicios de neurología y psiquiatría y en atención primaria. En las nuevas categorías diagnósticas se hace énfasis en las características positivas necesarias para el diagnóstico de este trastorno. Se realizó una revisión narrativa de la literatura médica para determinar las diferencias y las ventajas clínicas que la actual clasificación aporta al diagnóstico y el tratamiento de los trastornos neurológicos funcionales. Se identifican las diferencias conceptuales entre los trastornos conversivos y los trastornos neurológicos funcionales y las implicaciones de estos cambios en el abordaje clínico. La nueva propuesta diagnóstica para los trastornos neurológicos funcionales brinda la oportunidad de transformar un diagnóstico realizado a partir del descarte de otras afecciones en otro en el que se verifica la presencia de signos neurológicos que apuntan al trastorno y se pueden ensenar al paciente, y a partir de ellos, plantear estrategias de tratamiento.

ABSTRACT Functional neurological disorders, formerly referred to as conversion disorders, are a frequent clinical problem in neurology, psychiatry and primary care departments. In the new diagnostic categories, emphasis is placed on the positive characteristics necessary to diagnose this disorder. A narrative review of the scientific medical literature related to the subject was performed in order to determine the differences and advantages that the new classification of functional neurological disorders gives to doctors and patients. Historical, diagnostic, clinical and treatment concepts related to functional neurological disorders are reviewed. The conceptual differences between conversion disorders and functional neurological disorders and the implications of these changes in the clinical approach are identified. The new proposed diagnosis for functional neurological disorders provides the opportunity to transform a diagnosis made by ruling out other pathologies to a diagnosis where the presence of neurological signs suggestive of the disorder are verified and can be taught to the patient, and based on them, treatment strategies posed. © 2017 Asociacion Colombiana de Psiquiatria. Published by Elsevier España, S.L.U. All rights reserved.

Studying ICD-11 Primary Health Care bodily stress syndrome in Brazil: do many functional disorders represent just one syndrome?

Objective: Disorders characterized by "distressing unexplained somatic symptoms" are challenging. In the ICD-11 Primary Health Care (PHC) Guidelines for Diagnosis and Management of Mental Disorders (ICD-11 PHC), a new category, bodily stress syndrome (BSS), was included to diagnose patients presenting unexplained somatic symptoms. The present study investigated the association of BSS with anxiety, depression, and four subgroups of physical symptoms in a Brazilian primary health care (PHC) sample. Methodology: As part of the international ICD-11 PHC study, 338 patients were evaluated by their primary care physicians, followed by testing with Clinical Interview Schedule (CIS-R) and World Health Organization Disability Assessment Schedule, Version 2.0 (WHODAS 2.0). BSS was diagnosed in the presence of at least three somatic symptoms associated with incapacity. The association between anxiety, depression, and four subgroups of physical symptoms with being a BSS case was analyzed. Results: The number of somatic symptoms was high in the overall sample of 338 patients (mean = 8.4), but even higher in the 131 BSS patients (10.2; p < 0.001). Most BSS patients (57.3%) had at least three symptoms from two, three, or four subgroups, and these were associated with anxiety and depression in 80.9% of these patients. The symptom subgroup most strongly associated with "being a BSS" case was the non-specific group (OR = 6.51; 95%CI 1.65-24.34), followed by musculoskeletal (OR = 2,31; 95%CI 1.19-4.72). Conclusion: Somatic symptoms were frequent in a sample of PHC patients in Brazil. In the present sample, one third were BSS cases and met the criteria for at least two symptom subgroups, supporting the hypothesis that different functional symptoms are related to each other.

Preliminary development of self-screening questionnaire for somatoform symptoms / 中华行为医学与脑科学杂志

Objective To develop a simple,multi-dimensional self-screening questionnaire for som-atoform symptoms(SQSS). Methods Based on theoretical framework,the study developed the items of the questionnaire. The first draft of the questionnaire was screened through the expert evaluation method. Four groups of 359 subjects were selected to test the reliability and validity of questionnaire. Results The explor-atory factor analysis showed that the four factors(somatic symptoms,negative perception,illness behavior and social function) were extracted and the interpretable percentage of variance was 61. 165%. The correlation between the subscales and the total scales was 0. 740-0. 887,and the correlation coefficient between the sub-scales was 0. 503-0. 625. The Crobanch's α coefficient of the questionnaire was 0. 926,and the Spearman-Brown score of the questionnaire was 0. 868. The retest correlation coefficient of the total scale was 0. 876. A cutoff of 23 points in the SQSS was identified for screening somatoform disorders, and the sensitivity was 0. 880 and the specificity was 0. 606. Conclusion SQSS has good reliability and validity,and can be prelim-inarily used as a self-screening tool for patients with somatoform symptoms or disorders in clinical settings.

Effect of College Students' Perceived Stress, Cognitive Response to Stress, and Somatization on Heart Rate Variability

PURPOSE: The purpose of this study was to investigate how college students' perceived stress, cognitive stress, and somatization affect their heart rate variability (HRV). METHODS: This study is a cross-sectional survey research on 191 university students, registered at the G University. The perceived stress scale (PSS) and cognitive stress response scale, were used to assess level of stress. The somatization symptom scale of the Symptom Check List 90 (SCL-90), was used to assess level of somatization caused by stress. To assess heart rate variability (HRV), we conducted a five-minute test using a pulse wave analyzer, to analyze short-term HRV. RESULTS: The SCL-90 somatization score had relatively high positive correlation (p<.001) with cognitive stress, but low positive correlation (p<.001) with perceived stress. Cognitive stress response had low negative correlation (p<.001) with 1nSDNN and 1nRMSSD among HRV parameters. Perceived stress was not correlated with HRV. Multiple regression analysis showed that variables of perceived stress, cognitive stress, and somatization symptoms, could not explain HRV. By contrast, one of the HRV indicators, 1nSDNN, was affected by age, gender, and aggressive-hostile thought, the latter being a subscale of the cognitive stress response scale. CONCLUSION: This study suggests that stress evaluation for people in early adulthood will be more effective, if the evaluation examines cognitive stress and heart rate variability.

Dor lombar e transtornos mentais comuns na Estratégia Saúde da Família: uma associação pouco reconhecida / Low back pain and common mental disorders in Family Health Strategy: an association little recognized / Dolor lumbar y trastornos mentales comunes en la Estrategia Salud de la Familia: una asociación poco reconocida

Objetivo: Descrever o perfil sociodemográfico dos pacientes atendidos na Estratégia Saúde da Família de quatro capitais brasileiras (Rio de Janeiro, São Paulo, Porto Alegre e Fortaleza) com dor lombar e investigar a associação entre dor lombar e depressão, ansiedade e somatização. Métodos: Estudo de corte transversal com 1857 pacientes atendidos nos anos de 2009 (setembro a novembro) e 2010 (junho a agosto). Instrumentos: rastreio de somatização (SOMS-2), avaliação de ansiedade e depressão (HAD), Questionário Geral do Paciente, para dados sociodemográficos e o Formulário do Profissional Assistente, com as informações referentes as consultas. A dor lombar foi analisada a partir da frequência de três diferentes formas de apresentação: queixa autorreferida pelo paciente, sintoma registrado pelo médico e diagnóstico de lombalgia confirmado pelo médico. Resultados: 77,3% eram mulheres com mais de quatro anos de estudo e renda per capita inferior a um salário mínimo e meio. Encontramos associação significativa de queixa de dor lombar com ansiedade (OR=1,5, 95% IC 1,02-2,16) e somatização (OR=1,8, 95% IC 1,12-2,88), mas não com depressão. Pacientes que apresentavam queixa de dor lombar, porém sem registro do sintoma pelo médico, apresentaram associações ainda mais fortes com ansiedade (OR=1,6, 95% IC 1,03-2,63) e somatização (OR=2,3, 95% IC 1,33-3,99). A confirmação do diagnóstico de dor lombar pelo médico não se associou significativamente com nenhum transtorno. Conclusão: Considerando a dor lombar como uma das queixas de maior prevalência na Atenção Primária e sua associação significativa com ansiedade e somatização, recomenda-se a abordagem da ansiedade e somatização em pacientes com queixa de dor lombar.

Objective: To describe the demographic profile of the patients assisted in the Family Health Strategy of four Brazilian capitals (Rio de Janeiro, São Paulo, Porto Alegre and Fortaleza) with low back pain and investigate the association between low back pain and depression, anxiety and somatization. Methods: Cross-sectional study with 1857 patients served in the years 2009 (September to November) and 2010 (June to August). Instruments: Screening of somatization (SOMS-2), evaluation of anxiety and depression (HAD), General Questionnaire of the Patient, for sociodemographic data and the Form of the Professional Assistant, with the information regarding the consultations. The low back pain was analyzed from the frequency of three different forms of presentation: auto reference complaint by the patient, symptom recorded by the doctor and diagnosis of backache confirmed by the doctor. Results: 77.3% were women with more than four years of study and per capita income less than a minimum wage and a half. We found significant association of low back pain complaints with anxiety (OR=1.5, 95% IC 1,02-2,16) and somatization (OR=1.8, 95% IC 1,12-2,88) but not with depression. Patients who complained of low back pain, but there was no record of the symptom by the doctor, presented even stronger associations with anxiety (OR=1.6, 95% IC 1,03-2,63) and somatization (OR=2.3, 95% IC 1,33-3,99). Confirmation of the diagnosis of low back pain by the doctor has not been associated significantly with any disorder. Conclusion: Considering low back pain as one of the most prevalence complaints in Primary Care and its significant association with anxiety and Somatization, it is recommended to approach anxiety and somatization in patients with a complaint of low back pain.

Objetivo: Describir el perfil demográfico de los pacientes asistidos en la Estrategia Salud de la Familia de cuatro capitales brasileño (Rio de Janeiro, São Paulo, Porto Alegre y Fortaleza) con dolor lumbar e investigar la asociación entre el dolor lumbar y la depresión, ansiedad y somatización. Métodos: Estudio transversal con 1857 pacientes atendidos en los años 2009 (septiembre a noviembre) y 2010 (junio a agosto). Instrumentos: seguimiento de la somatización (SOMS-2), evaluación de la ansiedad y depresión (HAD), Cuestionario General del Paciente, para datos sociodemográficas y el Reporte del Profesional Asistente, con la información relativa a las consultas. El dolor lumbar fue analizado a partir de la frecuencia de tres diversas formas de presentación: queja auto-referida por el paciente, síntoma registrado por el médico y diagnosis del lumbago confirmado por el médico. Resultados: 77,3% fueron mujeres con más de cuatro años de estudio y renta per cápita menos de un salario mínimo y medio. Encontramos la asociación significativa de queja del dolor lumbar con la ansiedad (RM=1,5, el 95% IC 1,02-2,16) y somatización (RM=1,8, el 95% IC 1,12-2,88) pero no con la depresión. Los pacientes que se quejaron de dolor lumbar, pero no había registro del síntoma por el médico, presentaron asociaciones incluso más fuertes con la ansiedad (RM=1,6, el 95% IC 1,03-2,63) y somatización (RM=2,3, el 95% IC 1,33-3,99). La confirmación del diagnóstico de dolor lumbar por el médico no se ha asociado significativamente con ningún trastorno. Conclusión: Considerando el dolor lumbar como una de las quejas prevalentes de la mayoría en la Atención Primaria y su asociación significativa con la ansiedad y la somatización, se recomienda abordar a la ansiedad y a la somatización en pacientes con quejas de dolor lumbar.

Dermatosis autoinfligida: presentación de un caso y revisión / Self-inflicted dermatosis: presentation of a case and review

Las dermatosis autoinfligidas representan un motivo habitual de consulta, así como un desafío diagnóstico y terapéutico. Se caracterizan por la autoprovocación de lesiones cutáneas de manera consciente o inconsciente en el contexto de trastornos psiquiátricos complejos. Comunicamos el caso de una paciente que consultó al Servicio de Dermatología por úlceras irregulares y sobreinfectadas localizadas en rostro, de 2 meses de evolución. El caso representó una dificultad diagnóstica ya que solo a partir del interrogatorio exhaustivo y los exámenes complementarios, que descartaron otras patologías, se arribó al diagnóstico de úlceras autoprovocadas en contexto de patología psiquiátrica que requirió manejo interdisciplinario. (AU)

Self-inflicted dermatoses are a frequent cause for consultation and represent a diagnostic and therapeutic challenge. They are characterized by the conscious or unconscious self-generation of cutaneous lesions in the context of complex psychiatric disorders. We report the case of a patient who consulted at the dermatology department with two months history of irregular and superinfected ulcers located on the face. This case represented a diagnostic difficulty since only from an exhaustive interrogation and complementary examinations, which ruled out other pathologies, we arrived at the diagnosis of self-inflicted ulcers in the context of psychiatric pathology that required interdisciplinary management. (AU)

Synergistic Approach Of Ayurvedic Principles And Life Style Modifications To Combat Psychosomatic Disorders

The modern world has come to a challenge where most of the untreated conditions are resulting into complications and are burdened over society. To fetch all these, physicians are trying to limit such conditions by applying various scientific theories and methods to explain the basic underlying mechanism of health and diseases. Understanding of physical conditions through psychological approach is the mainstream of such conditions and is termed as Somatoform disorders or psychosomatic illnesses as explained by World Health Organization in international Statistical Classification of Diseases and Related Health Problems. Stress is the contributing factor that doesn't allow the individual to remain in harmony with the surroundings and threatens the body's ability to maintain homeostasis. Dietary changes, mind-body therapies including meditation, stress relaxation techniques and Yoga can bring harmony back to individual suffering from such disorders.

Analysis of Relationship between Reflux Symptom Index and Psychiatric Problems / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study investigated the relationship between reflux symptom index (RSI) and psychiatric problems such as depression, somatization, and anxiety. SUBJECTS AND METHOD: We prospectively analyzed 231 patients with symptoms with laryngopharyngeal reflux (LPR) using the RSI and the reflux finding score. RESULTS: Seventy nine patients (34.2%) were diagnosed with LPR. A significant correlation was detected between the RSI and depression (18.4±8.3 vs. 12.3±7.0, p < 0.001), anxiety (19.5±8.5 vs. 13.0±7.3, p < 0.001), and somatization (19.2±9.1 vs. 13.6±7.5, p < 0.001). A multivariate analysis confirmed a significant association between heartburn and depression [odds ratio (OR): 1.241, 95% confidence interval (CI): 1.003–1.537, p=0.047], choking and anxiety (OR: 1.747, 95% CI: 1.297–2.352, p < 0.001), and choking and somatization (OR: 1.707, 95% CI: 1.248–2.336, p=0.001). CONCLUSION: Our preliminary results suggest that patients with high RSI may need to be carefully evaluated for psychiatric problems.

Curative efficacy of Yixin Bardiranjibuya Keli in treatment of somatoform disorders / 中国生化药物杂志

Objective To evaluate the clinical efficacy of Yixin Bardiranjibuya Keli combined with escitalopram in the treatment of somatoform disorders.Methods 90 patients with somatoform disorders from March 2014 to March 2015,were recruited in our hospital as the subjects of this study.According to the random number method,the observation group and the control group were divided into observation group(45 cases)and control group(45 cases).The control group was treated with escitalopram,and the observation group was treated with Yixin Bardiranjibuya Keli on the basis of the control group.(SCL-90),Hamilton Depression Rating Scale(HAMD),Hamilton Anxiety Scale(HAMA),Health Status Questionnaire(SF-36PCS),Mental Health Overall Evaluation(SF-36PCS)before and after treatment,MCS score,adverse reaction,and curative effect.Results After treatment,the scores of SCL-90,HAMD and HAMA in the observation group were significantly lower than those in the control group [(2.40±0.53)vs.(2.47±0.56),(7.32±1.08)vs.(13.69±2.81),(4.82±1.21)vs.(9.93±2.02)],respectively(P<0.05),and the scores of SF-36PCS and MCS were significantly higher than those of the control group(P<0.05).The total effective rate was 95.55(48.38±11.02)points(P<0.05),and the adverse reactions were significantly lower than those in the control group [8.88％(4/45)vs 24.44％(11/45)％,Significantly higher than the control group 73.33％(P<0.05).Conclusion Yixin Bardiranjibuya Keli combined with escitalopram for the treatment of somatosensory disorder is significant and effective in relieving anxiety and depression of the patients and improving the physical symptoms of the patients,which can be used as the first choice of treatment.