Psychological well-being in patients undergoing stem cell transplantation

The aim of the study is to determine the psychological well-being of patients who underwent stem cell transplantation. This cross-sectional study was conducted with 100 patients. Data were collected face-to-face using an introductory information form and the Brief Symptom Inventory.When the results of the patients were examined, the interpersonal sensitivity of the sub-dimensions of the scale was found to be 5.0 ± 4.06, depression 7.60 ± 5.37, and anxiety disorder 7.90 ± 5.34. There was a significant difference between the diagnosistime of the patients and all sub-factors of the scale, except phobic anxiety. It was found that the psychological state of the patients was directly related to the time of first diagnosis. As a result, the importance of following the psychological processof the patients during the treatment process was revealed when planning nursing care.

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.

La depresión: un desafío en la práctica médica general / La depresión: un desafío en la práctica médica general

Asociada o no a una enfermedad orgánica, la depresión tiene gran prevalencia en la práctica médica pero es subdiagnosticada. El trastorno del ánimo suele coexistir con variadas quejas somáticas y dolores crónicos, configurando síndromes mixtos con un diagnóstico diferencial complejo. En este artículo se describen distintas presentaciones clínicas de la depresión en medicina general, con énfasis en los estados depresivos atípicos, depresiones enmascaradas muy relevantes por su frecuencia y consecuencias: depresión posquirúrgica, cuadros dolorosos crónicos como cefaleas o lumbago, la fatiga crónica y la fibromialgia. Solo el reconocimiento y diagnóstico de la depresión subyacente posibilitará la implementación de las adecuadas intervenciones terapéuticas. Se revisan también algunas recomendaciones para el uso de antidepresivos en atención primaria y la eventual consulta psiquiátrica. (AU)

Associated or not with an organic disease, depression has a high prevalence in medical practice but is underdiagnosed. The mood disorder usually coexists with varied somatic complaints and chronic pain, forming mixed syndromes with a complex differential diagnosis. This article describes different clinical presentations of depression in general medicine, with emphasis on atypical depressive states, masked depressions very relevant for their frequency and consequences: post-surgical depression, chronic painful conditions such as headaches or lumbago, chronic fatigue and fibromyalgia. Only the recognition and diagnosis of the underlying depression will enable the implementation of appropriate therapeutic interventions. Some recommendations for the use of antidepressant drugs in primary care and the eventual psychiatric consultation are also reviewed. (AU)

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.

Miedo al derrumbe y síntoma somático: dos buenas excusas para estudiar el proceso originario / Fear of breackdown and somatic symptom: two good excuses to study the original process

Se propone aquí pensar, desde lo teórico y clínico, y en el marco de la teoría psicoanalítica, al síntoma somático (concepto de Paul Laurent Assoun, 1998 (1)) como un equivalente y un concomitante del "miedo al derrumbe" de Winnicott (2); es decir, esa vivencia que se espera con miedo, que aunque pasada, no ocurrió para este paciente que está tendido ahora en el diván y sigue vigente como amenaza futura. Es una vivencia traumática que no tuvo lugar, pues no pudo ser inscrita, pero que se marca en ese psiquismo. Es esta la característica común que conecta el síntoma somático y el miedo al derrumbe; aquello insimbolizado pero que ha dejado huella en el cuerpo y el psiquismo ¿cuál es esta forma de inscripción previa a la simbolización primaria que articula el miedo al derrumbe y qué relación puede tener con el síntoma somático? Ejemplificando con un caso se intenta contrastar la teoría con la práctica clínica, concluyendo que la vivencia de derrumbe marca al psiquismo como un continente que determinará las vivencias posteriores dejando a perpetuidad la amenaza de derrumbe

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.

Perceptions about anxiety, depression and somatization in general medical settings: A qualitative study.

Background. The recognition rates of anxiety and depression in general medical settings, despite the significant prevalence of such presentations, are low. Psychiatrists argue that the recognition and management of these conditions by physicians is less than optimal in primary care and general practice. We did this study to gain insights into physicians’ perspectives on anxiety, depression and somatization, the conceptual models they employ and the practical problems they face in managing such patients in general medical settings. Methods. Focus group discussions (FGDs) were conducted with family and primary care physicians. The FGDs for physicians were tape recorded and transcribed, verbatim. The views of psychiatrists working in liaison clinics were also ascertained. Results. Family and primary physicians admitted to a high prevalence of patients who present with medically unexplained symptoms. They noted the co-occurrence of psychosocial stress. All physicians working in general medical settings admitted to difficulty in separating anxiety, depression and somatic presentations because of milder, less distinct syndromes and overlapping symptoms. They argued that it was difficult to use the current three-category division and that a more complex classification would be time-consuming and impractical in primary care. Conclusion. Psychiatric classifications for use in primary care should consider the different context and employ physicians’ perspectives rather than push specialist concepts and criteria.

Somatização na América Latina: uma revisão sobre a classificação de transtornos somatoformes, síndromes funcionais e sintomas sem explicação médica / Somatization in Latin America: a review of the classification of somatoform disorders, functional syndromes and medically unexplained symptoms

OBJETIVO: Os sintomas sem explicação médica são frequentes e estão associados a sofrimento mental em vários contextos. Estudos prévios apontam que as populações latino-americanas são propensas à somatização. Diante da reformulação da Classificação Internacional de Doenças para sua 11ª edição, as particularidades dos nativos desta região do mundo devem ser levadas em consideração. O objetivo deste estudo é prover informações sobre somatização na população latino-americana para a tomada de decisões quanto às categorias diagnósticas ligadas a sintomas sem explicação médica na Classificação Internacional de Doenças-11ª edição. MÉTODO: Revisão extensa da produção de 1995 a 2011 sobre somatização em populações de origem latino-americana. RESULTADOS: A análise dos 106 estudos incluídos nesta revisão foi dividida em 15 categorias: revisões sistemáticas, revisões conceituais, prevalências, atenção primária, depressão e ansiedade, fatores de risco, violência, quadros orgânicos, relacionamento com profissionais e o sistema de saúde, etnia, síndromes ligadas à cultura, síndrome da fadiga crônica, fibromialgia, transtorno dismórfico corporal, e conversão e dissociação. CONCLUSÃO: Os estudos latino-americanos confirmam a dificuldade na definição categorial de quadros com sintomas sem explicação médica. O suposto "traço somatizador" das culturas latinas pode estar associado mais à expressão cultural e linguística do que a um caráter de natureza étnica, e tais particularidades devem estar na agenda na nova classificação destes fenômenos na Classificação Internacional de Doenças-11ª edição.

OBJECTIVE: medically unexplained symptoms are common and associated with mental illness in various contexts. Previous studies show that Latin American populations are prone to somatization. Given the reformulation of the International Classification of Diseases towards its 11th edition the peculiarities of the population from this region of the world shall be taken into consideration. The objective of this study is to provide information on somatization in Latin American populations to help the decision making about medically unexplained symptoms diagnostic categories in the 11th edition of the International Classification of Diseases. METHOD: Extensive review of the academic production from 1995 to 2011 on somatization in populations of Latin American origin. RESULTS: The analysis of 106 studies included in this review was divided into 15 categories: systematic reviews, conceptual reviews, prevalence, primary care, depression and anxiety, risk factors, violence, organic conditions, relationship with health care, ethnicity, culture-bound syndromes, chronic fatigue syndrome, fibromyalgia, body dysmorphic disorder, and conversion and dissociation. CONCLUSION: The Latin American studies confirm the difficulty in defining medically unexplained symptoms categories. The supposed "somatizing trace" of Latin cultures may be linked more to cultural and linguistic expression than to an ethnic nature, and these peculiarities must be on the agenda for the new classification of these phenomena in the Classification of Diseases-11th edition.

Correlates of substance use during adolescent pregnancy in São Paulo, Brazil / Correlatos do uso de substâncias durante a gravidez na adolescência em São Paulo, Brasil

OBJECTIVE: To investigate the association of cocaine and marijuana use during adolescent pregnancy in São Paulo-SP, Brazil, with psychiatric disorders, social status and sexual history. METHOD: One thousand pregnant adolescents were assessed by using the Composite International Diagnostic Interview, and sociodemographic and socio-economic questionnaire at the obstetric center of a public hospital in São Paulo. Hair samples were collected for analysis. RESULTS: The following data were associated with cocaine and/or marijuana use during the third trimester of the pregnancy: being younger than 14 years of age, having a history of more than 3 sexual partners, and having psychiatric disorders, specifically, bipolar disorder, post-traumatic stress disorder, and somatoform disorder. CONCLUSION: In early adolescence pregnancy, having 3 or more sexual partners in life for this population is significantly associated with the use of cocaine or marijuana during gestation. This association suggests that specific intervention programs should target these young women.

OBJETIVO: Investigar, numa população de gestantes adolescentes de uma maternidade pública de São Paulo-SP, Brasil, a associação entre o consumo de cocaína e maconha durante a gravidez com distúrbios psiquiátricos, status social e história sexual. MÉTODO: Mil adolescentes grávidas foram avaliadas por meio do Composite International Diagnostic Interview e de um questionário sociodemográfico e socioeconômico no centro obstétrico de um hospital público de São Paulo. Destas, foi colhida amostra para análise de fios de cabelo. RESULTADOS: Os seguintes dados foram associados com o uso de cocaína e/ou maconha durante o terceiro trimestre de gravidez: ter menos de 14 anos, ter história de mais do que três parceiros sexuais e ter transtornos psiquiátricos, em especial, transtorno afetivo bipolar, transtorno do estresse pós-traumático e transtorno somatoforme. CONCLUSÃO: Na população de adolescentes grávidas avaliada, ter menos de 14 anos e ter três ou mais parceiros sexuais na vida está significativamente associado ao uso de maconha ou cocaína durante a gestação. Esta associação sugere que programas de intervenção específicos devem ser dirigidos a essas jovens.

Patients with conversion disorder; psycho-social stressors and life events

To assess the frequency of the various psychosocial stressors and stressful life events in patients presenting with conversion disorder. Case series study. The study was conducted in the Department of Psychiatry and Behavioural Sciences, Bahawal Victoria Hospital and Quaid-e-Azam Medical College, Bahawalpur from January, 2009 to March, 2009. The sample consisted of 100 in-patients [89 Female, 11 Male] with Conversion Disorder. They were interviewed and results were analysed from the entries in a Performa. Stressors were clearly identified in 100 patients. In all patients, we found more than one stressor. Among patients, there were [24%] in-laws problems, [23%] love problems, [21%] relationship problems with family, [20%] exam/study stress, [15%] marriage against will, [13%] demanding and pampered child, [11%] issue less, [10%] sexual abuse, [8%] demand of marriage, [6%] overage in wait of marriage, [4%] death of partner, [3%] husband abroad and [3%] patient's engagement break. We concluded that stressors and life events were present in all conversion disorder's patients and these stressful life events are important causal factors for Conversion Disorder. Conversion Disorder has strong relationship with psychosocial stressors

Validación del Cuestionario de Salud del Paciente como herramienta de tamizaje para trastornos por somatización / Validation of the Patient Health Questionnaire like screening tool for somatization disorders

El objetivo del trabajo realizado fue evaluar la utilidad del “Cuestionario de Salud del Paciente” como posible instrumento de tamizaje para Trastornos por somatización. La metodología consistió en la validación de lenguaje del instrumento, mediante su traducción doble ciego. Posteriormente se realizó su validación de contenido con un panel de expertos. El cuestionario fue aplicado en una muestra aleatoria de100 personas en la atención primaria de salud del Hospital El Pino. Se aplicó de forma anónima y se excluyeron los síntomas de los pacientes producidos por enfermedades médicas ya diagnosticadas previamente. Al analizar los resultados se constató una sospecha de un 34,15 por ciento para trastornos por somatización según el “cuestionario de salud del paciente”, la cual sería 12 veces mayor a la indicada con los criterios del CIE-10 y casi 4 veces mayor que la indicada por los criterios de Escobar. Esto podría explicarse porque los síntomas pesquisados por el cuestionario se deban a otras enfermedades orgánicas o psiquiátricas, que no se discriminan bien por esta herramienta, o a errores en su aplicación.

The objective of the work performed was to evaluate the usefulness of the “Patient Health Questionnaire” as a possible somatization disorders screening tool. The methodology consisted in validating the language of the instrument, using a double blind translation. Then the questionnaire was presented to health professionals who gave us their impressions. The questionnaire was applied to a random sample of 100 people at the primary attention health service of Hospital El Pino. It was applied anonymously, and the symptoms of patients caused by medical diseases previously diagnosed were excluded. When the results were analyzed , a suspicion of 34.15 percent in somatization disorders was found according to the “patient health questionnaire”, which would be 12 times greater than that indicated in the criteria of the CIE-10, and almost 4 times greater than the one indicated by the criteria of Escobar. This could be explained if the symptoms investigated were caused by other organic or psychiatric diseases, that had not been discriminated by this tool or errors in its application.

Somatización: consideraciones diagnósticas / Somatization: diagnostic considerations / Somatização: considerações diagnosticas

La somatización, el proceso mediante el cual las personas experimentan y expresan malestar emocional a través de síntomas físicos es uno de lo mayores retos a los que se puede ver enfrentado un médico en su práctica médica cotidiana, ya que los síntomas carecen de una causa orgánica documentada. En el presente artículo se revisan y se actualizan los conocimientos acerca de la somatización y sus diferentes trastornos, buscando ampliar las herramientas con que puede contar el médico para realizar un diagnóstico más preciso y se brindan algunas recomendaciones útiles para el manejo de los pacientes, teniendo en cuenta que la decisión de si la etiología del síntoma es psicológica y no física no es tarea fácil, como tampoco lo es, diagnosticar con exactitud el trastorno psiquiátrico que lleva a este proceso...

Somatization, the process by which people experience and express emotional distress through physical symptoms, is one of the biggest challenges a physician may face in his daily medical practice because the symptoms have no organic documentable cause. The article reviews and updates the knowledge of somatization and its various disorders, seeking to expand the tools for physicians to perform a more accurate diagnosis and provides some useful recommendations for the management of patients taking into account that the decision whether the etiology of the symptom is psychological and not physical is not easy, and neither it is to accurately diagnose the psychiatric disorder that induces this process...

A somatização o processo pelo qual as pessoas experimentam e expressam o mal- estar emocional através de sintomas físicos é um dos maiores desafios que pode ter um medico na sua prática médica no dia a dia, devido a que os sintomas carecem de uma causa orgânica documentada. Este artigo revisa e atualiza o conhecimento sobre a somatização e seus diferentes transtornos, visando ampliar as ferramentas que pode contar o medico para fazer um diagnóstico mais preciso e faz algumas recomendações úteis para o manejo dos pacientes, tendo em conta que a decisão de determinar a etiologia do sintoma psicológico ou físico não é tarefa fácil, como nem é diagnosticar com precisão o transtorno psiquiátrico que leva este processo...

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.

Overview of Somatization-Diagnosis and Management

Background: Neurologists and general practitioners frequently encounter patients with inexplicable; unintentionally produced somatic complaints otherwise known as somatoform disorders. Methods: A literature search was performed including MEDLINE; as well as local and international journals using the following keywords/ phrases and cross referencing: somatoform disorder; somatization; medically unexplained physical symptoms. Results: Illness with excessive somatic preoccupation is difficult to diagnose or categorize reliably due to rigid diagnostic criteria that often overlap with several psychiatric disorders. Conclusion: Management of patients with dysfunctional somatoform disorders is complex and challenging; particularly when initiated in a neurology outpatient or inpatient setting. The acronym CARE-MD represents a comprehensive treatment regimen that can be used to decrease physician and patient frustration; dramatically minimise health care over utilization; and improve overall well-being for patients with somatoform disorders

Clinical profile of pediatric somatoform disorders.

OBJECTIVES: To study the prevalence, pattern, clinical and socio-demographic characteristics of somatoform disorders in children. METHODS: From Aug 2004 to July 2005, children up to 18 years with unexplained physical symptoms were evaluated prospectively using DSM-IV criteria. Detailed evaluation followed for those meeting criteria. RESULTS: The prevalence of Somatoform disorders was 0.59% and 0.78% among out-door and in-door patients respectively. Among 124 children (40 boys and 84 girls) meeting criteria, conversion disorder was the commonest (57.3%), followed by undifferentiated somatoform disorder (25.2%). Girls were significantly more represented among conversion disorder patients compared to other groups of somatoform disorders (78.9 vs. 52.8 %, P=0.002). In conversion disorder, 2/3rd patients presented within 3 months, whereas in other somatoform disorders, 2/3rd patients presented within 3 months after symptoms. Fainting attacks (52.1%) and ataxia (43.7%) in conversion disorder and pain abdomen (52.8%) and headache (52.8%) in other somatoform disorders, were the commonest symptoms. Stressors were identified in 73.4% and acute precipitating stressors were present in 14.4% children. Boys had significantly higher rates of poor inter-personal relations and communication problems within the family (72.5% vs. 41.7%, P=0.001), while girls had significantly higher rates of conflicts with the parents and other family members (21.4% vs. 5%, P=0.02). CONCLUSION: Somatoform disorders, particularly conversion disorder is commoner in girls. Important stressors are poor inter-personal relations and communication problems within the family in boys, and conflicts with family members among girls.

Os sintomas vagos e difusos em biomedicina: uma revisão da literatura / Vague and diffuse symptoms in biomedicine: a review of the literature

Este estudo tem como objetivo realizar um mapeamento do que vem sendo produzido academicamente sobre sintomas vagos e difusos em biomedicina. Como instrumento metodológico, realizamos um levantamento bibliográfico, abrangendo o período de 1990 a 2005. Foram selecionados quarenta artigos e estabelecidos cinco eixos temáticos para investigação: nomenclaturas dadas aos sintomas vagos e difusos; definição dos sintomas vagos e difusos; relevância da temática abordada; critérios utilizados para o diagnóstico dos sintomas vagos e difusos; e ações terapêuticas adotadas. Na discussão dos resultados, identificamos impasses da biomedicina ao lidar com sofredores de queixas indefinidas, tais como a diversidade e imprecisão conceitual em relação ao uso das nomenclaturas, o despreparo dos médicos ao se depararem com esses pacientes, a demanda considerada como de ordem psíquica, a dificuldade em estabelecer critérios diagnósticos e a utilização ineficaz de recursos terapêuticos. Como conclusão, constatamos que, subjacente a essas dificuldades, encontra-se um modelo biomédico que possui poucas ferramentas para se deparar com a singularidade do sofrimento humano e com sua dimensão fenomenológica experiencial.

The purpose of this study is to chart academic output on vague and diffuse symptoms in biomedicine. As methodological tool, we conducted a bibliographic study through the Internet ranging from 1990 to 2005. Forty papers were selected and five major theme areas were established for the survey: the nomenclatures assigned to vague and diffuse symptoms; their definitions; the relevance of the theme being addressed; the criteria used to diagnose vague and diffuse symptoms; and the therapeutic actions adopted. The discussion of the findings identifies many biomedical difficulties in dealing with sufferers from undefined complaints, including: diversity and lack of conceptual precision in the use of the nomenclature; physicians who are poorly prepared to deal with these patients; demand considered as a psychic disorder; difficulties in establishing diagnostic criteria and poor use of treatment resources. This leads to the conclusion that the biomedical model behind these difficulties has few tools for dealing with the singularities of human suffering and its experiential phenomenological dimension.

Dissociative disorders and other psychopathological groups: exploring the differences through the Somatoform Dissociation Questionnaire (SDQ-20)

OBJECTIVE: The Somatoform Dissociation Questionnaire is a self-report questionnaire that has proven to be a reliable and valid instrument. The objectives of this study were to validate the Portuguese version and to determine its capability to distinguish patients with dissociative disorders from others with psychopathological disorders. METHOD: 234 patients answered the translated version of Somatoform Dissociation Questionnaire. The Portuguese Dissociative Disorders Interview Schedule was used to validate clinical diagnosis. Patients with dissociative disorder (n = 113) were compared to a control group of 121 patients with various anxiety and depression disorders. RESULTS: Reliability measured by Cronbach's a was 0.88. The best performance of the Portuguese form was at a cut-off point of 35, which distinguishes between dissociative disorder and neurotic disorders with a good diagnostic efficacy (sensitivity = 0.73). The somatoform dissociation was significantly more frequent in dissociative disorder patients, conversion disorder patients and post-traumatic stress disorder patients. CONCLUSIONS: These findings suggest that dissociative disorders can be differentiated from other psychiatric disorders through somatoform dissociation. The Portuguese version of the Somatoform Dissociation Questionnaire has fine psychometric features that sustain its cross-cultural validity.

OBJETIVO: O objetivo deste estudo foi adaptar, validar e determinar a confiabilidade da versão portuguesa do Somatoform Dissociation Questionnaire e determinar a sua capacidade de discriminar doentes que dissociam de outros doentes. Método: O Somatoform Dissociation Questionnaire foi traduzido para o português e retrovertido para o inglês de forma a garantir a sua base conceitual. Os sujeitos responderam também à versão portuguesa do Dissociative Disorders Interview Schedule de forma a validar o seu diagnóstico clínico. O estudo incluiu 234 sujeitos divididos entre 113 doentes com patologias dissociativas e 121 doentes com outras patologias do foro ansioso e depressivo. RESULTADOS: O Somatoform Dissociation Questionnaire versão portuguesa mostrou o seu melhor desempenho no ponto de corte 35, apresentando uma sensibilidade de 0,73. O alfa de Cronbach revelou uma consistência interna de 0,88. A dissociação somatoforme foi significativamente mais freqüente nos doentes com patologias dissociativas, patologias conversivas e distúrbio de stress pós-traumático. CONCLUSÕES: A versão portuguesa do Somatoform Dissociation Questionnaire mostrou-se um instrumento útil para discriminar doentes com patologia de foro dissociativo de outros doentes.

La importancia de la detección y el tratamiento de los síntomas somáticos en pacientes latinoamericanos con depresión mayor / The importance of detection and treatment of somatic symptoms in Latin American patients with major depression

OBJETIVO: La depresión mayor es una enfermedad caracterizada por la presencia tanto de síntomas mentales como somáticos, los cuales afectan en forma significativa los procesos diagnósticos y terapéuticos así como el pronóstico. MÉTODO: Usamos una búsqueda de artículos publicados hasta Junio 2006 cruzando términos que nos permitieran incluir artículos que hiciesen referencia a la comorbilidad entre depresión mayor y síntomas somáticos, a la prevalencia de dicha comorbilidad en Latinoamericanos y/o al impacto y el patrón de uso de antidepresivos en pacientes con depresión mayor y síntomas somáticos asociados. RESULTADOS: Los síntomas somáticos en Latinoamericanos con depresión mayor son frecuentes, probablemente más que en otras poblaciones, afectan significativamente la respuesta al tratamiento, se asocian a mayor refractariedad y cronicidad y no siempre son tenidos en cuenta en la práctica psiquiátrica de algunos países Latinoamericanos, donde la práctica usual de prescribir dosis bajas de antidepresivos podría comprometer el control de los síntomas somáticos residuales y asociarse a mayores tasas de recurrencias. CONCLUSION: Los clínicos que laboran en Latinoamérica deben ser acuciosos en la detección de los síntomas somáticos de sus pacientes con depresión mayor y siempre procurar la prescripción de dosis terapéuticas del antidepresivo de su selección.

OBJECTIVE: Major depression is a disease characterized by the presence of mental and somatic symptoms, the latter affecting considerably the diagnostic and therapeutic procedures and the prognosis. METHOD: We searched for published articles until June 2006 crossing several terms which allow us to include those articles referring to the comorbidity of major depression and somatic symptoms, the prevalence of that comorbidity in Latino Americans, and/or the impact and patterns of use of the antidepressant treatments in patients with major depression and associated somatic symptoms. RESULTS: Somatic symptoms in Latino Americans with major depression are common, probably more than in other populations around the world. They compromise the response to treatment, are associated with refractoriness and chronicity, and are usually denied in the psychiatry practice in some Latin American countries, where the practice in prescribing low doses of antidepressants is common and could affect the control of residual somatic symptoms with higher rates of recurrences. CONCLUSION: Clinicians working in Latin American countries must be prepared to detect somatic symptoms in their patients with major depression, looking for the prescription of appropriate therapeutic doses of the antidepressants.