Prevalence and environmental impact factors of somatization tendencies in eastern Chinese adolescents: a multicenter observational study / Prevalência e fatores ambientais de tendências de somatização em adolescentes do leste chinês: um estudo observacional multicêntrico / Prevalencia y factores de impacto ambientales en las tendencias somatización con adolescentes de la China oriental: un estudio observacional multicéntrico

The aim of this study is at examining the prevalence and impact factors of adolescent somatization tendencies (ST) across three eastern Chinese provinces. A multicenter school-based cross-sectional study was conducted in these provinces from 2015 to 2016. The sample included 11,153 middle-school students aged 13-18 years, who were randomly selected using a multi-phase stratified cluster sampling technique. We also designed a multicenter school-based case-control study to evaluate the potential environmental impact of ST factors on this population. The overall positive rate of ST among the eastern Chinese adolescents was 12.1%. Somatic symptoms score (SSS) and positive ST rate were higher in females than males. Additionally, the SSS and positive ST rate for the 18-year-old group were significantly higher than in other age groups. In comparison to those in urban areas, adolescents in rural areas had significantly higher SSS and positive ST rate. Multiple conditional regression analyses revealed that family medical history, anxiety and depression scores; superstitious beliefs; left-behind adolescents; teacher-student support; family conflict; and family independence and achievement orientation were significantly linked to ST in adolescents. The models also indicated family medical history was the strongest impact factor to adolescent ST, even though ST were prevalent in the three studied eastern Chinese provinces. Gender, age, and dwelling differences were very significant in the SSS and positive ST rate in adolescents. This study concludes that adolescent ST are influenced by multiple environments.

O objetivo deste estudo é examinar a prevalência e fatores de impacto de tendências de somatização (TS) em adolescentes em três províncias do leste da China. Um estudo transversal multicêntrico baseado em escolas foi realizado nessas províncias de 2015 a 2016. A amostra incluiu 11.153 estudantes entre 13 e 18 anos que foram selecionados aleatoriamente usando uma técnica de amostragem estratificada por clusters multi-fase. Também elaboramos um estudo caso-controle multicêntrico baseado em escolas para avaliar o impacto ambiental potencial de fatores de TS nessa população. A taxa positiva geral de TS entre adolescentes do leste chinês foi de 12,1%. O escore de sintomas somáticos (SSS) e taxa positiva de TS foram mais altos entre mulheres do que homens. Adicionalmente, o SSS e taxa positiva de TS para o grupo de 18 anos foram significativamente mais altos do que em outros grupos etários. Em comparação com os habitantes de áreas urbanas, adolescentes de áreas rurais tiveram SSS e taxa positiva de ST significativamente mais altos. Análises de regressão múltipla condicional revelaram que o histórico de saúde da família; scores de ansiedade e depressão; crenças supersticiosas; adolescentes deixados para trás; apoio de professores a estudantes; conflito familiar; e independência familiar e orientação para sucesso estavam significativamente relacionadas a TS em adolescentes. O modelo também indicou que o histórico de saúde da família era o fator de impacto mais forte para TS em adolescentes, ainda que TS sejam prevalentes nas três províncias do leste da China estudadas. Gênero, idade e diferenças residenciais foram muito significativos para o SSS e taxa positiva de TS entre adolescentes. Este estudo conclui que TS entre adolescentes são influenciadas por múltiplos ambientes.

El objetivo de este estudio fue examinar la prevalencia y factores de impacto de las tendencias de somatización adolescentes (TS) en tres provincias orientales chinas. Se realizó un estudio trasversal multicéntrico, basado en escolares de estas provincias de 2015 a 2016. La muestra incluyó a 11.153 estudiantes de secundaria, con edades comprendidas entre los 13-18 años, que fueron seleccionados aleatoriamente, usando a técnicas de muestreo multifase estratificado por conglomerados. También se diseñó un estudio multicéntrico escolar de caso-control para evaluar el potencial impacto ambiental de factores TS en esta población. La tasa positiva general de TS entre adolescentes chinos orientales fue un 12,1%. El marcador de síntomas somáticos (SSS, por sus siglas en inglés) y tasa positiva de TS fueron más altos en mujeres que en hombres. Asimismo, las tasas SSS y TS positiva para el grupo de 18 años de edad fueron significativamente más altas que en otros grupos de edad. En comparación con quienes vivían en áreas urbanas, los adolescentes en áreas rurales contaban con tasas significativamente más altas de SSS y TS positivas. Los análisis de regresión múltiple condicional revelaron que el historial médico familiar, los marcadores de ansiedad y depresión; creencias supersticiosas; adolescentes a la zaga respecto al resto del grupo; el apoyo profesor-estudiante; conflictos familiares; e independencia familiar, así como la orientación de logros estuvieron vinculados a las TS en adolescentes. Los modelos también indicaron que el historial médico familiar fue el impacto más fuerte para las TS en adolescentes, a pesar de que las TS fueron prevalentes en las tres provincias chinas estudiadas. El género, edad, y las diferencias de vivienda fueron muy significativas en la tasas de SSS y TS positivas en adolescentes. Este estudio llega a la conclusión de que las TS adolescentes estaban influenciadas por múltiples entornos.

Distribution of depression, somatization and pain-related impairment in patients with chronic temporomandibular disorders

Abstract Objective the aim of this study was to describe the frequency of psychosocial diagnoses in a large sample of patients attending a tertiary clinic for treatment of temporomandibular disorders (TMD). Material and Methods six hundred and ninety-one patients who sought treatment for pain-related TMD were selected. Chronic pain-related disability (Graded Chronic Pain Scale, GCPS), depression [Symptoms Checklist-90 (SCL-90) scale for depression, DEP] and somatization levels (SCL-90 scale for non-specific physical symptoms, SOM) were evaluated through the Research Diagnostic Criteria for TMD (RDC/TMD) Axis II psychosocial assessment; TMD diagnoses were based on the Axis I criteria. Results the majority of patients presented a low disability or no disability at all, with only a small portion of individuals showing a severely limiting, high disability pain-related impairment (4.3%). On the other hand, abnormal scores of depression and somatization were high, with almost half of the individuals having moderate-to-severe levels of depression and three-fourths presenting moderate-to-severe levels of somatization. The prevalence of high pain-related disability (GCPS grades III or IV), severe/moderate depression and somatization was 14.3%, 44% and 74.1% respectively. Gender differences in scores of SCL-DEP (p=0.031) and SCL-SOM (p=0.001) scales were signficant, with females presenting the highest percentage of abnormal values. Conclusion patients with TMD frequently present an emotional profile with low disability, high intensity pain-related impairment, and high to moderate levels of somatization and depression. Therefore, given the importance of psychosocial issues at the prognostic level, it is recommended that clinical trials on TMD treatment include an evaluation of patients' psychosocial profiles.

The Influence of Depression, Anxiety and Somatization on the Clinical Symptoms and Treatment Response in Patients with Symptoms of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

This is the first study to investigate the influence of depression, anxiety and somatization on the treatment response for lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). The LUTS/BPH patients were evaluated with the Korean versions of the International Prostate Symptom Score (IPSS), the Patient Health Questionnaire-9 (PHQ-9), the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the PHQ-15. The primary endpoint was a responder rate defined by the total score of IPSS (< or = 7) at the end of treatment. The LUTS/BPH severity was significantly higher in patients with depression (whole symptoms P = 0.024; storage sub-symptom P = 0.021) or somatization (P = 0.024) than in those without, while the quality of life (QOL) was significantly higher in patients with anxiety (P = 0.038) than in those without. Anxious patients showed significantly higher proportion of non-response (odds ratio [OR], 3.294, P = 0.022) than those without, while somatic patients had a trend toward having more non-responders (OR, 2.552, P = 0.067). Our exploratory results suggest that depression, anxiety and somatization may have some influences on the clinical manifestation of LUTS/BPH. Further, anxious patients had a lower response to treatment in patients with LUTS/BPH. Despite of limitations, the present study demonstrates that clinicians may need careful evaluation of psychiatric symptoms for proper management of patients with LUTS/BPH.

The Influence of Depression, Anxiety and Somatization on the Clinical Symptoms and Treatment Response in Patients with Symptoms of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

This is the first study to investigate the influence of depression, anxiety and somatization on the treatment response for lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). The LUTS/BPH patients were evaluated with the Korean versions of the International Prostate Symptom Score (IPSS), the Patient Health Questionnaire-9 (PHQ-9), the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the PHQ-15. The primary endpoint was a responder rate defined by the total score of IPSS (< or = 7) at the end of treatment. The LUTS/BPH severity was significantly higher in patients with depression (whole symptoms P = 0.024; storage sub-symptom P = 0.021) or somatization (P = 0.024) than in those without, while the quality of life (QOL) was significantly higher in patients with anxiety (P = 0.038) than in those without. Anxious patients showed significantly higher proportion of non-response (odds ratio [OR], 3.294, P = 0.022) than those without, while somatic patients had a trend toward having more non-responders (OR, 2.552, P = 0.067). Our exploratory results suggest that depression, anxiety and somatization may have some influences on the clinical manifestation of LUTS/BPH. Further, anxious patients had a lower response to treatment in patients with LUTS/BPH. Despite of limitations, the present study demonstrates that clinicians may need careful evaluation of psychiatric symptoms for proper management of patients with LUTS/BPH.

Dolor perdurable I. Nosología y epidemiología / [Enduring pain I. Nosology and epidemiology].

Pain disorders are extraordinarily prevalent throughout clinical medicine, and are highly co-morbid with various psychiatric disorders, particularly those including depression or anxiety. Assessment of such patients tends to be based on diagnostic criteria that may not reflect the complexity of the clinical problem and can result in prioritizing somatic aspects of painful syndromes at the expense of psychiatric aspects or, conversely, over-emphasize psychiatric aspects. In the first part of this overview we consider current nosological perspectives and their potential clinical consequences, epidemiological data that underscore the association of comorbid painful and affective or anxious syndromes, and consider the importance of psychiatric assessment and treatment of such patients. The major overlap between pain disorders and psychiatric disorders, as well as the unsatisfactory state of treatments available for chronic pain syndromes, encourage a comprehensive approach to assessing and clinically managing patients with chronic pain. Many programs for pain disorder patients offer narrowly specialized treatment options. To be preferred are multi-disciplinary teams with expertise in internal medicine, neurology, pain management, and rehabilitation, as well as psychology and psychiatry. In the second part of this overview, we propose that psychiatrists can serve a key role in leading comprehensive assessment and management of complex and challenging pain-psychiatric patients who are typically only partially responsive to available treatments.

Growing up with the families of β-thalassaemia major using an accelerated longitudinal design.

Background & objectives: It is difficult for a single investigator to study the psychosocial changes that occur over the life span of an individual affected with a chronic illness like β-thalassaemia major. Therefore, a developmental epidemiological perspective is required to understand the chain of events and problems of psychological nature. We aimed to construct the picture of developmental epidemiology for psychosocial aspects in families of β-thalassaemia major patients attending a tertiary care hospital in north India. Methods: The accelerated longitudinal design was used. The sample consisted of 100 children with β-thalassaemia and their 150 parents, both groups were subdivided further so that each group represented the continuum of longitudinal course. The sampling was done for a period of 16 months from January 2004 to April 2005. Results: Overall 54 per cent of children had significant psychopathology. Within the parents groups, 10 per cent had adjustment disorder, 33.3 per cent depressive disorder, and 10 per cent had anxiety disorder and 11 per cent somatoform disorder; 95 per cent of the parents of newly diagnosed children expressed feeling of dazed and shock, fear of death, hopelessness, separation anxiety and problems with their memory and concentration. There was significant difference only in the domain of psychological health in all the three groups of parents with respect to the quality of life. Among children, quality of life improved with their progression of illness. Growing up with β-thalassaemic family was analyzed. Interpretation & conclusions: The developmental epidemiological perspective was constructed in β -thalassaemic children and their family using an accelerated longitudinal design. Such a design can test the hypothesized aetiological or developmental function of a targeted risk factor within a developmental path and may be used in studying the psychological impact of even other chronic illnesses over the life span of an individual for conceptual and holistic understanding.

Clustering of psychiatric and somatic illnesses in the general population: multimorbidity and socioeconomic correlates

The distribution of psychiatric disorders and of chronic medical illnesses was studied in a population-based sample to determine whether these conditions co-occur in the same individual. A representative sample (N = 1464) of adults living in households was assessed by the Composite International Diagnostic Interview, version 1.1, as part of the São Paulo Epidemiological Catchment Area Study. The association of sociodemographic variables and psychological symptoms regarding medical illness multimorbidity (8 lifetime somatic conditions) and psychiatric multimorbidity (15 lifetime psychiatric disorders) was determined by negative binomial regression. A total of 1785 chronic medical conditions and 1163 psychiatric conditions were detected in the population concentrated in 34.1 and 20 percent of respondents, respectively. Subjects reporting more psychiatric disorders had more medical illnesses. Characteristics such as age range (35-59 years, risk ratio (RR) = 1.3, and more than 60 years, RR = 1.7), being separated (RR = 1.2), being a student (protective effect, RR = 0.7), being of low educational level (RR = 1.2) and being psychologically distressed (RR = 1.1) were determinants of medical conditions. Age (35-59 years, RR = 1.2, and more than 60 years, RR = 0.5), being retired (RR = 2.5), and being psychologically distressed (females, RR = 1.5, and males, RR = 1.4) were determinants of psychiatric disorders. In conclusion, psychological distress and some sociodemographic features such as age, marital status, occupational status, educational level, and gender are associated with psychiatric and medical multimorbidity. The distribution of both types of morbidity suggests the need of integrating mental health into general clinical settings.

Occupational Psychiatric Disorders in Korea

We searched databases and used various online resources to identify and systematically review all articles on occupational psychiatric disorders among Korean workers published in English and Korean before 2009. Three kinds of occupational psychiatric disorders were studied: disorders related to job stress and mental illness, psychiatric symptoms emerging in victims of industrial injuries, and occupational psychiatric disorders compensated by Industrial Accident Compensation Insurance (IACI). Korea does not maintain official statistical records for occupational psychiatric disorders, but several studies have estimated the number of occupational psychiatric disorders using the Korea Workers' Compensation and Welfare Service (COMWEL, formerly KLWC) database. The major compensated occupational psychiatric disorders in Korea were "personality and behavioral disorders due to brain disease, damage, and dysfunction", "other mental disorders due to brain damage and dysfunction and to physical diseases", "reactions to severe stress and adjustment disorders", and "depressive episodes". The most common work-related psychiatric disorders, excluding accidents, were "neurotic, stress-related, and somatoform disorders" followed by "mood disorders".

Relación entre la depresión, la ansiedad y los síntomas psicosomáticos en una muestra de estudiantes universitarios del norte de México / The relationship among depression, anxiety, and somatic symptoms in a sample of university students in northern Mexico

Objetivo. Determinar la relación existente entre la ansiedad, la depresión y los síntomas psicosomáticos en una muestra de estudiantes universitarios del norte de México. Métodos. Se realizó un estudio exploratorio a partir de cuestionarios de autoinforme aplicadosa una muestra de conveniencia de 506 estudiantes de psicología de dos universidades de Monterrey, estado de Nuevo León, México. Para evaluar los síntomas psicosomáticos se utilizó el cuestionario sobre la salud del paciente, para la depresión se empleó el inventario de Beck y la ansiedad se evaluó mediante la escala social para adolescentes. Se utilizó la correlación deSpearman para determinar el nivel de significación de la relación entre las variables y la prueba de Kruskal-Wallis para comparar los niveles de ansiedad y depresión en los grupos de estudiantesconformados según la intensidad de los síntomas psicosomáticos. Resultados. De los participantes, 129 (25,5%) presentaron síntomas psicosomáticos de intensidad media o alta, solo 4 (0,8%) manifestaron depresión intensa y únicamente 2 (0,4%) estudiantes presentaron niveles de ansiedad por encima del 75% de la puntuación máxima de la escala. La intensidad de los síntomas psicosomáticos aumentó a la par que aumentaban los niveles de ansiedad y depresión. Los síntomas psicosomáticos más frecuentes y que causaban mayor preocupación en la muestra fueron: dolores de cabeza, menstruales y de espalda, así como sentirse cansado y dificultades para dormir. Conclusiones. Se confirmó la relación directa entre la intensidad de los síntomas somáticos, la depresión y la ansiedad. Se recomienda incluir en los programas de prevención o tratamientode cualquiera de estos tres trastornos a los otros dos. Se deben implementar programas específicos para los jóvenes universitarios.

Objective. To determine how anxiety, depression, and somatic symptoms are related in a sample of university students in northern Mexico. Methods. An exploratory study was conducted through self-administered questionnairesapplied to a convenience sample of 506 psychology students at two universitiesin Monterrey, in the state of Nuevo León, Mexico. To evaluate somatic symptoms,the Patient Health Questionnaire was used; for depression, the Beck Depression Inventory; and for anxiety, the Social Anxiety Scale for Adolescents. Spearman’s correlation was used to determine to what extent the associations among the variables were significant. The Kruskal-Wallis test was used to compare anxiety and depressionlevels between groups of students organized by severity of somatic symptoms. Results. Of the participants, 129 (25.5%) presented somatic symptoms that were of medium intensity or severe; just 4 (0.8%) had severe depression; and only 2 (0.4%) studentspresented anxiety levels over 75% of the scale maximum. The severity of somatic symptoms increased in step with anxiety and depression levels. The somatic symptoms occurring most frequently and of greatest concern among the study sample were: headache, menstrual pain, and backache, as well as feeling tired and having difficulty sleeping. Conclusions. The direct association between the severity of somatic symptoms anddepression and anxiety was confirmed. It is recommended that all treatment and/or prevention programs addressing one of these conditions, include the other two as well. Programs specifically aimed at university youth should be implemented.

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.

Prevalência do transtorno dismórfico corporal em pacientes dermatológicos e avaliação da crítica sobre os sintomas nessa população / Prevalence of body dysmorphic disorder among dermatological patients and level of insight about their symptoms

São cada vez mais freqüentes as queixas cosméticas na sociedade contemporânea objetivando a perfeição das formas do corpo e da pele. Os dermatologistas e cirurgiões plásticos são frequentemente consultados para avaliar e tratar essas queixas. Sendo assim é importante conhecer o Transtorno Dismórfico Corporal, inicialmente chamado de dismorfofobia que foi pouco estudado até recentemente. Esse transtorno é relativamente comum, por vezes incapacitante, e envolve uma percepção distorcida da imagem corporal caracterizada pela preocupação exagerada com um defeito imaginário na aparência ou com um mínimo defeito corporal presente. A maioria dos pacientes apresenta algum grau de prejuízo no funcionamento social e ocupacional e como resultado de suas queixas obsessivas com a aparência podem desenvolver comportamentos compulsivos, em casos mais graves há risco de suicídio. O nível de juízo crítico é prejudicado, não reconhecem que seu defeito é mínimo ou inexistente e freqüentemente procuram tratamentos cosméticos para um transtorno psíquico. A prevalência do transtorno na população geral é de 1 a 2% e em pacientes dermatológicos e de cirurgia cosmética de 2,9 a 16%. Neste estudo investigou-se a prevalência do Transtorno Dismórfico Corporal em pacientes dermatológicos. Entrevistadores treinados avaliaram com questionários e entrevistas semi-estruturadas (SCID) pacientes que procuravam tratamentos cosméticos clínicos e cirúrgicos (grupo Cosmiatria, n=150), que procuravam a dermatologia em geral (grupo Geral, n=150) e grupo controle de 50 pacientes. Três psiquiatras independentes fizeram a melhor estimativa diagnóstica (best estimate diagnosis). Foram diagnosticados 32 pacientes (Cosmiatria 14%; Geral 6,7%; Controle 2%). As diferenças entre as prevalências nos três grupos foram significativas, bem como entre o grupo da Cosmiatria e o Controle. A regressão logística mostrou maior prevalência na Cosmiatria do que no grupo Geral e Controle, em indivíduos solteiros ...

Cosmetic concerns are increasingly pervading the contemporary societies, focusing on body shape and the skin perfection. Dermatologists and plastic surgeons are frequently consulted to evaluate and treat these concerns. Therefore it is important to be aware of the Body Dysmorphic Disorder, also known as dysmorphophobia, little studied until recently. This disorder is relatively common sometimes causing impairment involving a distorted perception of the body image characterized by an excessive preoccupation with an imagined or minimal appearance defect. Most of the patients experience some degree of impairment in social or occupational functioning and as a result, their obsessive thoughts, may lead to repetitive behaviors and in severe cases, to attempted suicide. Most individuals have poor insight and they do not acknowledge the defect is minimal or inexistent and seek out cosmetic treatments for a psychiatric disorder. The prevalence of this disorder among general population ranges from 1 to 2 % and in dermatological and cosmetic surgery patients ranges from 2, 9 to 16%. This study assessed the prevalence of Body Dysmorphic Disorder in dermatological patients. Trained interviewers used questionnaires (BDDQ) and semi-structured clinical interviews (SCID) to access patients seeking clinical or surgical cosmetic treatments (Cosmetic group, n=150), seeking dermatology in general (General group, n=150) and a control group of 50 subjects. Three independent psychiatrists assigned the best estimate diagnosis and 32 patients were diagnosed with the disorder (Cosmetic 14%, General 6, 7% and Control 2%). Prevalence differences in the three groups were significant, also for Cosmetic and Control groups. In the logistic regression a higher prevalence has been noticed in the Cosmetic group (when compared with General and Control groups), in patients that are not currently married and with less body mass index. The severity of the symptoms assessed by a validated...

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.

Trastorno de somatización: una relectura del síndrome de Briquet” / Somatoform Disorders: a re-reading of Briquet syndrome

Varios estudios nacionales y extranjeros señalan que entre un tercio y un cuarto de los síntomas físicos que son causa de consulta médica corresponderían a somatización, entendiendo por ello la sintomatología corporal en que no es posible demostrar una causa orgánica (Escobar y cols. 1989). Una gran variedad de cuadros psiquiátricos pueden explicar completa o parcialmente la presencia de tales síntomas, como ocurre con la depresión y la angustia, cuadros clínicos de gran prevalencia. La nomenclatura psiquiátrica ha variado considerablemente a través de la historia, procurando por un lado perfeccionar la comprensión de las enfermedades descritas, y por otro, evitar la dispersión de criterios al momento de la clasificación de enfermedades y cuadros sindrómaticos. Un criterio relativamente nuevo, el de trastorno de somatización, ha tenido un devenir particularmente azaroso. Por una parte, su génesis se encuentra en las excelentes descripciones que hicieron algunos clínicos hace ya un siglo y medio, como es la de Paul Briquet (1859). Desde otro lado, el sistema de clasificación norteamericano DSM ha fluctuado en sus últimas versiones entre reconocer el aporte de Briquet, y renegar del mismo (DSM-IV). La somatización ha sido descrita como “la expresión del distrés personal y social en un idioma de quejas o síntomas corporales con requerimiento de ayuda médica” (Bass y Benjamín, 1993). A través de un breve recorrido histórico, nos proponemos recoger el aporte clínico y semiológico de las presentaciones psíquicas acompañadas de somatización, cuadros que en la actualidad consumen una gran cantidad de recursos en los diferentes niveles de los sistemas de salud. Sugerimos que a través de una distinción clínica de mayor precisión, los médicos y profesionales de la salud se pueden encontrar en un mejor pie al momento de diagnosticar y sobre todo de intervenir sobre las personas que los consultan con este tipo de síntomas.

Investigação categorial e dimensional sobre sintomas físicos e síndromes somatoformes na população geral / Categorical and dimensional investigation on physical symptoms and somatoform syndromes in the general population

Discutir sobre o conceito dos fenômenos somatoformes; investigar as relações categoriais e dimensionais entre sintomas físicos, somatoformes ou não, variáveis demográficas, síndromes psiquiátricas e o uso de serviços de saúde, em uma amostra domiciliar. 1.464 entrevistas realizadas com o Composite International Diagnostic Interview (CIDI), cujos dados foram analisados categorial e dimensionalmente. Associação de sintomas físicos com transtornos psiquiátricos e com certas características demográficas; adequação de modelo unidimensional para sintomas somatoformes na população geral; associação entre sintomas somatoformes e maior uso de serviços de saúde / To discuss the concept of somatoform phenomena and to investigate the categorical and dimensional relationship of physical symptoms – whether somatoform or not, demographic variables, psychiatric syndromes and health services utilization in a household sample. Data from 1,464 subjects interviewed by the Composite International Diagnostic Interview (CIDI) were categorically and dimensionally analyzed. Physical symptoms are associated with psychiatric syndromes and certain demographic features; general population somatoform symptoms are compatible with unidimentional modeling; somatoform symptoms are associated with higher health services utilization...

Factores asociados a síntomas depresivos y síntomas somáticos en mujeres climatéricas de la ciudad de Temuco / Associated factors to depressive symptoms and somatic symptoms in climacteric women in the city of Temuco

BACKGROUND: Depression is an important mental health problem. The Chilean Ministry of Health has considered depression in women as one of the health priorities for the country. AIM: To assess the prevalence of depressive and somatic symptoms and their risk factors in climacteric women. MATERIAL AND METHODS: A special questionnaire was applied to 171 women (45 to 55 years of age), coming from a community organization (PRODEMU) and a private health institution (ISAPRE Banmedica). Risk factors for depression were determined using multiple logistic regression. RESULTS: The prevalence of depressive symptoms was 43 per cent. Women with primary education had an odds ratio for depression of 2.49, compared with women with high school or university education. Other risk factor for depression was the lack of a renumerated job (Odds ratio 1.9). The risk factors for somatic symptoms were the presence of depressive symptoms (OR 3.2), lack of secondary or university education (OR 2.4), low income (OR 1.9) and having a current partner (OR 3.6). CONCLUSIONS: There is a high prevalence of depressive symptoms in the studied population of climacteric women. Lack of education and of a renumerated job are important risk factors for the presence of such symptoms. Women with a low level of education and with depressive symptoms have also a high risk of presenting somatic symptoms.

Comorbilidad de enfermedades médicas crónicas y transtornos psiquiátricos en una población de consultantes en el nivel primario de atención / Association of chronic diseases and psychiatric disorders among patients attending public primary care clinics

Background: As a part of the World Health Organization multicentric study of emotional disorders in general medical care, we studied patients who had a chronic medical ailment and a psychiatric disorder, according to ICD-10. Aim: To report the prevalence of patients with coexisting medical and psychiatric disorders. Patients and methods: All patients, aged 15 to 65 years old, consulting in primary care outpatient clinics, were interviewed using a general health questionnaire. In a second phase, patients with chronic medical disorders were subjected to the World Health Organization Composite International Diagnostic Instrument. Results: Sixty nine percent of interviewed Chilean patients had a medical condition, compared to 60,3 percent of the global study group. Of these, 66 percent had a coexisting psychiatric diagnosis, compared to 31 percent of the global study group. The most frequent diagnoses in the Chilean sample were somatization disorders in 25 percent, harmful alcohol use in 14 percent, depression in 35 percent and hypocondriasis in 6 percent. There was a higher prevalence and odds ratio for psychiatric diagnoses among Chilean women. Conclusions: Patients with chronic medical disorders should be considered a high risk group for the coexistence of psychiatric disturbances

Somatización en estudios de campo / Somatization in field study

A partir de un estudio epidemiológico psiquiátrico previo, se profundiza en las características de los sintomas somatomorfos y trastornos somatomorfos de la muestra original

Depression in general clinical practice--a diagnostic problem.

The study was conducted on 100 patients suffering from depression with the aim to highlight the common manifestations of depression in people belonging to a developing country like India, and to apprise the general practitioners and medical specialists of various disciplines, of various manifestations of depression to help early detection and timely treatment of the problem. It was observed that depression had varied manifestations like depressed mood, anxiety, somatic features, insomnia, lack of interest, paranoid ideas, obsessions, etc. Although 100% of patients had depressed mood but only 22% actually complained of it. Most patients often selectively highlighted somatic manifestations and overtly suppressed the mood component, thereby posing a diagnostic problem to the physician.

Somatizaçöes cardíacas: estudo epidemiológico de pacientes atendidos nos ambulatórios de cardiologia do PAM-Centro de Cuiabá, no período de janeiro de 1995 / Cardiac somatizations: epidemiology study in the cardiology clinic outpatients

Há grande desacordo no meio médico, quanto ao conceito operaciolnalizaçäo ao diagnóstico de somatizaçäo, em especial entre as näo psiquiátricas. Para muitos médicos o termo somatizaçäo näo significa categoria diagnóstica e sim uma denominaçäo para a ignorância médica. Mas a realidade se impöe; há uma prevalência ambulatorial de cerca de 15 por cento de pacientes com queixas corporais, para as quais näo se encontra substrato anatomopatológico. Na grande maioria das vezes as queixas säo: dor toráxica (96,4 por cento), dispnéia 82,1 por cento), palpitaçöes (82,1 por cento), tonteira (78,5 por cento) e debilidade (64,2 por cento). Outros sintomas ocorrem e, na nossa série, observamos um sinal objetivo: manchas cutâneas vinhosas migratórias. Este síndrome clínico está inserido no grupo F45 da Classificaçäo Internacional de Doenças da Organizaçäo Mundial de Saúde, CID-10, dos transtornos somatoformes, e o seu diagnóstico é firmado pela presença de pelo menos 12 (para os homens) e 14 (para as mulheres) numa lista de 37 sintomas que compöe o CIDI, uma entrevista estruturada seguindo normas da CID-10 e do Diagnostic and Statistical Manual of Mental Disorders da Associaçäo Americana de Psiquiatria, a DSM-III. Trabalhos recentes têm advogado um critério diagnóstico mais liberal, proposto icialmente por Escobar e cols: o número mínimo de sintomas requeridos reduzem-se para 4 e 6, respectivamente nos homens e mulheres. Corroba a utilidade desse critério encurtado, uma vez que o mesmo reflete em boa medida o que se chama de somatizaçäo cardíaca na prática clínica cardiológica. Frente a ela a concordância do diagnóstico dos cardiologistas, medida pelo índice Kappa, aumentou de 9 por cento para 60 por cento, quando comparado com critério de diagnóstico mais rígido, näo encurtado. Compara várias características dos somatizadores, classificados segundo os critérios de Escobar. Verificou-se a associaçäo significativa do síndrome com o sexo feminino, corroborada por extensa literatura sobre somatizaçäo. Houve também uma associaçäo significativa fronteiriça (pv=0,05) com a presença de dificuldades ou insatisfaçöes, medida pelo questionário de problemas sociais de Corney & Clare.

Programa de Ansiedade e Depressäo - UFRJ. Sèrie Psicofarmacologia - 16: O sofrimento da feiúra imaginária: transtorno dismórfico do corpo / The distress of imagined ugliness: body dysmorphic disorder

O transtorno dismórfico do corpo - preocupaçäo excessiva com um defeito imaginário da aparência - tem sido pouco investigado empiricamente. Entretanto, parece ser um transtorno crônico, com significativa morbidade e alta associaçäo com outros transtornos psiquiátricos, principalmente transtornos do humor, de ansiedade e de personalidade. Vem sendo descrito na literatura há mais de um século, com vários relatos de casos atestando potenciais complicaçöes tais como sucessivas cirurgias plásticas, hospitalizaçäo e tentativas de suicídio. Há um viés da literatura americana recente ao sugerir uma maior ligaçäo do transtorno dismórfico do corpo com o transtorno obsessivo-compulsivo do que com outros transtornos psiquiátricos. Mostramos que ele pode ocorrer em outros transtornos, através da descriçäo de três casos clínicos de transtorno dismórfico do corpo associado à fobia. Realizamos revisäo da literatura sobre o transtorno dismórfico do corpo abarcando os tópicos: diagnóstico, demografia, curso, comprometimento e complicaçöes, etiologia, tratamento e relaçäo com outros transtornos psiquiátricos. Notamos que sistemas como o DSM-III-R näo incluem dentre os critérios diagnósticos para transtorno dismórfico do corpo "pontos-de-corte" para diferenciar "casos" de "näo-casos" com base em sofrimento e/ou comprometimento funcional. Propostas recentes de tratamento farmacológico ressaltam os antidepressores bloqueadores da recaptaçäo da serotonina como opçöes promissoras. Salientamos a importância da detecçäo das síndromes comórbidas com o transtorno dismórfico do corpo para o planejamneto de uma estratégia terapêutica mais flexível e eficiente