A preliminary study on the association between psychological problems and chest pain in patients undergoing coronary angiography / 上海交通大学学报（医学版）

Objective: To explore the role of psychological problems of somatization, anxiety, and depression in patients presenting chest pain who underwent coronary angiography (CAG). Methods: Altogether, 908 patients with chest pain referred to the cardiology inpatient department were enrolled in the present study. The enrolled patients underwent CAG and coronary angiographic results were classified into negative (<30% diameter stenosis in all vessels), mild to moderate coronary stenosis (≥30% and <75% diameter stenosis in all vessels) and severe coronary stenosis group (≥75% diameter stenosis in at least a single vessel). Patients also completed a battery of self-reported inventories before the CAG: the Self-Rating Somatic Symptom Scale (SSS), the Generalized Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9). Results: Compared with severe coronary stenosis group, male patients in the mild to moderate coronary stenosis group (n=189) seemed to have higher rate of somatization (20.6% vs 18.5%, P=0.014), higher rate of depression (20.6% vs 10.6%, P=0.008), and higher rate of anxiety (13.4% vs 6.6%, P=0.028). Compared with severe coronary stenosis group, female patients in the mild to moderate coronary stenosis group seemed to have higher rate of somatization (57.6% vs 39.4%, P=0.008). Conclusion: The positive rate of somatization symptoms in patients with mild to moderate coronary stenosis was higher than that in patients with severe coronary stenosis. These findings suggest that psychological problems may contribute in part to the development of chest pain and other physical symptoms. It is also needed to evaluate the clinical and economic benefits of early psychological interventions, especially in mild to moderate coronary stenosis patients who are presenting chest pain.

FU Huazhou's Clinical Thought for Making Interventions in Tumor-associated Depression / 浙江中医药大学学报

[Objective] To sum up Pro. FU Huazhou's clinical thought for making interventions in tumor-associated depression.[Method]By following the supervisor clinic,sorting out the related medical materials and tumor-associated depression's literature data.Summarize the supervisor's academic view and clinical thinking in the differentiation and treatment of tumor-associated depression.[Results] In professor FU Huazhou's opinion, tumor-associate d depression is the pathological depression or syndrome in the process of diagnosis and treatment of malignant tumor, which is closely related to tumor. Pro. FU's theory is based on the exploration of the etiology,emotion guidance of TCM,Chinese medicine treatment of somatization disorder.Through the guidance of emotion, improving the symptoms of somatization disorder, the life quality of tumor patients can be improved.[Conclusion] Pro. FU Huazhou makes interventions in the treatment of tumor-associated depression by using emotion guidance of TCM and putting forward the principle of"Treatment of tumor-associated depression, it is necessary to treat tumor, relieving the depressed liver as a supplement". The treatment of both mind and body shows curative effect,worth learning and promotion.

Health care utilization of mexican patients with medically unexplained physical symptoms / Uso de los servicios de salud de pacientes mexicanos con síntomas físicos medicamente inexplicables

Abstract Objective: To determine the prevalence of medically unexplained physical symptoms and the characteristics and use of health services in a group of patients with medically unexplained physical symptoms and a group of patients with other illnesses. Methods: This was a cross-sectional, retrospective and multicenter study. We included 1,043 patients over 18 years of age from 30 primary care units of a government health institution, in 11 states of Mexico, attended by 39 family physicians. The prevalence of medically unexplained physical symptoms was determined and both groups with or without symptoms were compared with regard to drug use, laboratory and other studies, leaves of absence, and referrals in the last six months. The group with medically unexplained physical symptoms was diagnosed using the Patient Health Questionnaire and the diagnostic criteria of Reid et al. Emergency or terminal illnesses were excluded. The chi square test was used with a statistical significance of p < 0.05. Results: Medically unexplained physical symptoms was diagnosed in 73 patients (7.0%). The majority were women (91.8%); their predominant symptom was from the gastrointestinal system in 56 (76.7%). This group had a greater use of clinical studies and referrals to other services (mean 1.1 vs. 0.5; p <0.0001 and 0.6 vs. 0.8; p < 0.01, respectively). Conclusions: The prevalence of medically unexplained physical symptoms was low, but with a greater impact on some health services. This could represent an overload in medical costs....au

Resumen Objetivo: Determinar la prevalencia de Síntomas Físicos Medicamente No Explicables y las características y uso de los servicios de salud entre el grupo de pacientes con Síntomas Físicos Medicamente No Explicables, y el grupo con otras enfermedades. Métodos: Estudio transversal, retroprospectivo y multicéntrico. Se incluyeron a 1,043 pacientes mayores de 18 años, en 30 unidades de atención primaria de una institución gubernamental en salud, en 11 estados de la República Mexicana, atendidos por 39 médicos familiares. Se estimó la prevalencia de Síntomas Físicos Medicamente No Explicables y se compararon los dos grupos con y sin estos síntomas, en cuanto al uso de medicamentos, estudios de laboratorio, de gabinete, incapacidades y referencias en los últimos seis meses. El grupo de Síntomas Físicos Medicamente No Explicables fue diagnosticado por el Patient Health Questionnaire (son los síntomas físicos más comúnmente referidos por estos pacientes en el primer nivel de atención), además de criterios diagnósticos de Reid et al. Se excluyeron urgencias o con enfermedad terminal. Se utilizó prueba Chi cuadrada con p <0.05 para significancia estadística. Resultados: El 7.0% (73) se diagnosticó como Síntomas Físicos Medicamente No Explicables, la mayoría mujeres (91.8%); el síntoma predominante pertenece al sistema gastrointestinal con 76.7% (56). Este grupo demandó mayor uso de estudios de gabinete y referencias a otros servicios (media 1.1 vs. 0.5; p <0.0001 y 0.8 vs 0.6; p <0.01, respectivamente). Conclusiones: La prevalencia de Síntomas Físicos Medicamente No Explicables fue baja, pero con impacto significativo en el uso de algunos servicios de salud. Esto pudiera representar un mayor costo comparado con otro grupo de pacientes...au

Decreased Plasma BDNF Levels of Patients with Somatization Disorder

OBJECTIVE: Brain-derived neurotrophic factor (BDNF), one of the most abundant and important neurotrophins, is known to be involved in the development, survival, maintenance, and plasticity of neurons in the nervous system. Some studies have suggested that BDNF may play a role in the pathophysiology of several psychiatric illnesses such as depression and schizophrenia. Similarly, it is likely that the alteration of BDNF may be associated with the neuro-modulation that contributes to the development of somatization disorder. METHODS: The purpose of this study was to determine whether there is an abnormality of plasma BDNF levels in patients with somatization disorder, and to analyze the nature of the alteration after pharmacotherapy using an enzyme-linked immunosorbent assay (ELISA). RESULTS: The plasma BDNF levels of the patients with a somatization disorder were significantly lower compared with those of the control volunteers (83.61±89.97 pg/mL vs. 771.36±562.14 pg/mL); moreover, the plasma BDNF levels of those patients who received an antidepressant were significantly increased after the treatment (118.13±91.45 pg/mL vs. 72.92±88.21 pg/mL). CONCLUSION: These results suggest that BDNF may play a role in the pathophysiology of somatization disorder.

Some clinical issue of somatization disorder / Монголын Анагаах Ухаан

Introduction. There is group of mental disorder characterized by several physical symptoms are not fully explained by general medical condition, individuals visit many doctors and undergo numerous physical examinations, diagnostic tests associated with their suffer but no physical cause can be found. A third somatoform pattern is somatization disorder, characterized by numerous and recurrent physical complaints that begin by age 30. The prevalence of this disorder is 1-2% among adult population and it is occurred more female than male. Goal. To study some clinical symptoms among people with somatization disorder. Materials and Methods. This study was conducted with quality research method semi-structure questionnaire among the 30 people, who admitted to state and private hospital and sanatorium in the Chingeltei, Songinokhairkhan, Khan-Uul, Sukhbaatar, Bayanzurkh and Bayangol district in Ulaanbaatar city province for medical care. We did random sampling for unexplained somatic symptom individuals by diagnostic criteria as followings: 1.Multiple, recurrent, clinically significant somatic complaints no physical cause can be found over the last 2 years. 2. There must be a history of a visit at least 3 times for professional medical help due to their constant suffer. 3. Did not accept their medical diagnose and conclusion, even though no evidence of somatic symptoms. Results. There were 20 female and 5 male patients in our study, aged 23-78 years old were involved into our interview, and the average age was 44±0.8. We were clarifying clinical symptoms, such as gastrointestinal, cardiovascular, sexual function and urinary tract for all participants. The most of participants occurred gastrointestinal symptoms, such as nausea, vomit and timpanists. Also, all of the participants experienced heart beat symptom. As four of the 5 males reported loss of libido and majority of the females occurred pollakuria and sensopathy symptoms.Conclusion. Gastrointestinal symptoms (nausea, vomit and timpanists), cardiovascular symptom (heart beat), sexual function and urinary tract (loss of libido and pollakuria) and sensor conversion (sensopathy) occur mostly for somatization disorder.

Reliability and Validity of the Turkish Version of Children's Somatization Inventory

PURPOSE: The purpose of this study was to examine the psychometric properties of the Children's Somatization Inventory (CSI) in Turkish schoolchildren and adolescents. METHODS: The CSI was translated using translation and back-translation. The participants were 813 schoolchildren, adolescents and their parents (n = 453). Content and construct validity were assessed to test the validity of the CSI-24. Internal consistency reliability, interrater reliability (child-parent agreement) and test-retest reliability were assessed to test the reliability of the CSI-24. RESULTS: Psychometric analyses of the Turkish version of the CSI-24 indicate high reliability and good content and construct validity. CONCLUSION: The Turkish version of the CSI-24 is a useful instrument for measuring self-reported somatic complaints in Turkish schoolchildren and adolescents between the ages of 9 and 15.

Pituitary Volumes Are Reduced in Patients with Somatization Disorder

OBJECTIVE: Despite of the suggested physiological relationship between somatoform disorder and disturbances in HPA axis function no volumetric study of pituitary volumes in somatization disorder has been carried out. Therefore, we aimed to use structural MRI to evaluate the pituitary volumes of the patients with somatization disorder. METHODS: Eighteen female patients with somatization disorder according to DSM-IV and same number of healthy controls were included into the study. All subjects were scanned using a 1.5-T General Electric (GE; Milwaukee, USA) scanner. Pituitary volume measurements were determined by using manuallly tracings according to standard antomical atlases. RESULTS: It was found significantly smaller pituitary volumes of the whole group of somatization patients compared to healthy (t=-3.604, p=0.001). ANCOVA predicting pituitary volumes demonstrated a significant main effect of diagnostic group (F=13.530, p0.05) or age (F=1.159, p>0.05). It was determined that there was no significant correlation between smaller pituitary volumes and the duration of illness (r=0.16, p>0.05) in the patient group. CONCLUSION: In conclusion, we suggest that the patients with somatization disorder might have significantly smaller pituitary volumes compared to healthy control subjects.

Trastornos somatomorfos en la atención primaria: características psicosociales y resultados de una propuesta de consejería familiar / Somatoform disorder in primary health care: psycho-social characteristics and results of a familiar counseling proposal

The article describes the psychosocial characteristics of patients with somatization disorder and the results of a family counseling proposal, applied by the primary care health equipment. The objective of the counseling was that the patients recovered their personal skills, that allow them to take control or the solution of their problems, and they could act independently. Method: The sample was constituted by 128 patients from seven centers of primary attention health of the Bío-Bío Region. Results show that the main patient complaint is related to the family and the application was successful for 75 percent of the cases. Discussion: The results are discussed in relation to their limitations and future projections.

El presente artículo tiene como propósito, describir las características psicosociales de los pacientes con trastornos somatomorfos y los resultados de una propuesta de consejería familiar aplicada a estos por equipos de salud en la atención primaria. El objetivo de la consejería fue que los pacientes recuperaran sus competencias personales, a objeto de tener el control o resolución de sus problemas, y poder funcionar autónomamente. Método: La muestra, estuvo constituida por 128 pacientes, pertenecientes a 7 centros de Salud de atención primaria de la Región del Bío-Bío. Resultados: Muestran que la queja principal estaba relacionada con la familia y que la aplicación de la consejería fue exitosa en un 75 por ciento de los casos. Discusión: Los resultados son discutidos en relación a sus limitaciones y proyecciones futuras.

Terapia familiar breve y atención primaria: un caso de trastorno somatomorfo / Brief familiar therapy in primary health care: a case of somatization disorder

En este artículo se presenta un modelo de Terapia Familiar que puede ser útil en la atención primaria para el tratamiento de pacientes somatomorfos o con trastornos somatomorfos. El objetivo fue describir un caso de trastorno somatomorfo y una forma de intervención a través de la Terapia Familiar Breve. El Método incluyo la recogida de la historia clínica y aplicación de la Terapia Familiar Breve por dos profesionales de la salud: psicólogo y médico de familia. Los resultados muestran una disminución de la sintomatología y recuperación de su competencia personal para funcionar autónomamente. Se discute el valor de la aplicación de la Terapia Familiar Breve o de corta duración en la atención de pacientes con trastornos somatomorfos y la importancia de usar estrategias que mejoren la resolutividad del sistema.

This article presents a model of familiar therapy useful at primary health care for the treatment of patients with somatization disorder or somatization. The objective is to describe a case of somatization disorder and an intervention form of Brief Family Therapy. The method included the recollection of clinical history and the application of Brief Family Therapy by two health professionals: a psychologist and a family doctor. The results showed symptomatology reduction and patient autonomy. The use of Brief Family Therapy with somatization disorder is discussed in primary care and the importance of improving the system resoluty.

Stress of Mothers-in-Law from Multi-Cultural Families / 성인간호학회지

PURPOSE: This study examined relationships among stress, stress coping strategies, and somatization in mothers-in-law from multi-cultural families in a rural area. METHODS: Elderly mothers-in-law (n=227) living with foreign daughters-in-law completed a self-reporting questionnaire. Data were collected from April to August 2009. Questions related to stress (Visual Analog Scale, VAS), coping strategies (Coping Strategy Scale) for stress, and somatization (Symptom Check List 90, Revised). SPSS/WIN 12.0 program was used for descriptive analysis, t-test, one-way ANOVA, Pearson correlation, and multiple regression analyses. RESULTS: Subjects had a moderate level of stress (5.03). There were significant differences in stress level according to age, educational level, religion, chronic disease, health status, number of children, agreement of an international marriage of her sons, satisfaction in living with a foreign daughter-in-law, and family conflict. Stress showed a significant positive correlation with offensive coping strategy, passive strategy, and somatization. Stress, offensive coping strategy, and passive coping strategy affected the level of somatization. CONCLUSION: In a family situation involving co-habitation of mother- and foreign daughter-in-law, increased stress experienced by the mother-in-law can lead to increased offensive and passive coping strategies, and increased somatization. More effective means of stress reduction are needed for mothers-in-law from multi-cultural families.

A survey on clinical features of somatization disorder / 中华全科医师杂志

To investigate clinical features of somatization disorder. Methods Seventy-nine paeeeeee with somatization disorder (SD), diagnosed based on the Chinese Classification and Diagnostic Criteria of Mental Disorders, version 3 ( CCMD-3 ) during September 2006 to August 2008, were selected and assessed by serf-edited somatic symptom list ( SSSL), symptom checklist-90 ( SCL-90 ), Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD). Results Sixty-two symptoms in two to six systems were involved in SDs, with a mean and standard deviation of 12.4 ± 6.6 symptoms in 4.2 ± 0.9 systems. The skin, nervous system, gastrointestinal system, respiratory and circulatory systems were the most involved in those symptoms. Depression, anxiety and hostile mood, number and total score of somatic symptoms all correlated positively with the total scores of HAMA and scores of somatic anxiety and mental anxiety (P < 0.01 ), but not with the total score of HAMD (P > 0.05 ). Conclusions Multiple systems were involved in SD, usually with complicated symptoms including depression and anxiety, which was prone to inappropriate medical diagnoses. Number and severity of somatic symptoms positively correlated with severity of anxious symptoms.

The Stress Coping Strategies and Psychological Characteristics in Patients with Somatization Disorder / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the stress coping strategies and psychological characteristics, such as combined psychopathology and tendency of symptom interpretation, in patients with somatization disorder. METHODS: Thirty patients meeting the criteria of DSM-IV somatization disorder were compared with thirty controls. We evaluated the subjects using Symptom Checklist-90-Revised (SCL-90-R), Somato-Sensory Amplification Scale (SSAS), Symptom Interpretation Questionnaire (SIQ), and The Ways of Stress Coping Questionnaire (SCQ). Independent t-test and Pearson correlation analysis were used. RESULTS: From the results of SCL-90-R subscales, the scores of somatization, obsession-compulsion, depression, anxiety, and psychoticism were significantly higher in patients with somatization disorder than normal controls. Somatization disorder patients had greater amplification of physical sensation in SSAS and significantly higher score in physical interpretation of SIQ compared with psychological or environmental interpretation. In the SCQ of somatization disorder patients, we observed generally lower levels of total coping scores than the control group and significant positive correlation between passive coping style of SCQ and psychological interpretation of SIQ. CONCLUSION: These results show that patients with somatization disorder have various psychopathology, greater amplification of physical sensation, physical interpretation tendency of symptoms, and insufficient copying strategy.

Clinical Study on Paroxetine Combined with Small Dose of Doxepin for Somatization Disorder / 中国药房

OBJECTIVE:To evaluate the efficacy and adverse effects of paroxetine alone or in combination with small dose of doxepin for somatization disorder.METHODS:280 patients with somatization disorder were randomly assigned to receive paroxetine alone or in combination with small dose of doxepin for 8 weeks.Clinical global impression scale(CGI)and symptom check list(SCL-90)were used to assess the efficacy,and treatment emergent symptom scale(TESS)was used to assess the adverse effects.RESULTS:After treatment for 8 weeks,CGI score showed the total effective rate was 87.5% in the patients treated with paroxetine alone versus 93.8% in those treated with paroxetine in combination with small dose of doxepin(P0.05).CONCLUSION:Paroxetine in combination with small dose doxepin showed better efficacy for somatization disorder yet without increasing adverse effects as compared with paroxetine alone.

Efficacy of Venlafaxine Combined with Bailemian Capsule in the Treatment of Somatization Disorder / 中国药房

OBJECTIVE:To observe the efficacy and adverse reaction of venlafaxine combined with Bailemian capsule for somatization disorder.METHODS:145 patients with somatization disorder were randomly assigned to receive venlafaxine alone (single group) or in combination with Bailemian capsule (combined group) for 8 weeks.Clinical global impression scale (CGI) and symptom check (SCL-90) were used to assess the efficacy and treatment emergent symptom scale (TESS) was used to assess the adverse reactions.RESULTS:After 8 weeks of treatment,CGI score showed the total effective rate were 88.14% for single group and 94.18% for combined group (P

A Case of Factitious Herniated Lumbar Disc

The authors present a case of factitious disorder manifestating as a lumbar disc herniation. This 38-year-old woman has been operated on over ten times during a 20-year-period. Surgeons should be alert to avoid unnecessary operations for this uncommon but potentially serious disorder.