Posttraumatic stress disorder in a psychosomatic outpatient clinic. Gender effects, psychosocial functioning, sense of coherence, and service utilization.

BACKGROUND: The lifetime prevalence of DSM-IV traumatic events and posttraumatic stress disorder (PTSD) was assessed in outpatients of a tertiary referral mental health center; differences in psychopathology and service utilization between PTSD and non-PTSD patients were evaluated. METHODS: Five hundred eighty-three outpatients (35.3 years, S.D.=12.5; 74.3% women and 25.7% men), who had been initially examined by clinically experienced medical and psychological psychotherapists, were investigated by means of standardized trauma-specific questionnaires. RESULTS: Of the patients, 61.1% reported at least one traumatic event during their lifetime, but only 34.3% of the total sample met the DSM-IV (A1 and A2) criteria. The lifetime prevalence of PTSD-positive screening was 10.1%. In 2.7% of these patients, PTSD had been diagnosed in clinical routine (ICD-10: F43.1); 6.6% of the men and 11.3% of the women met the diagnostic criteria for lifetime prevalence of PTSD. All in all, patients with PTSD had higher levels of depression and anxiety and lower levels of sense of coherence (P < .001) than did patients without PTSD (all P < .001). In addition, PTSD patients reported significantly higher rates of medical consultations (P < .001), psychotropic medication (P < .001), and psychotherapy (P < .001). CONCLUSIONS: About one third of the outpatients suffered from DSM-IV traumas, and 10%, from PTSD. However, PTSD had been diagnosed only in very few patients within the routine diagnostic procedure. These findings suggest that PTSD is frequently overlooked not only in primary but also in tertiary care settings. Finally, our study supports previous results that PTSD patients use more service utilization and are more affected by psychopathology symptoms.

Clinical presentation and personality factors are predictors of the response to treatment in patients with functional dyspepsia; a randomized, double-blind placebo-controlled crossover study.

The role of psychological factors or symptom pattern for the response to treatment in patients with unexplained (functional) dyspepsia is unknown. We hypothesized that patients with reflux- and ulcer-like symptoms would be more likely to respond to acid-lowering therapy, while psychological disturbances would be associated with a less favorable response to treatment. Seventy-eight patients with a diagnosis of functional dyspepsia were recruited and 75 completed the trial. Patients were treated for 4 weeks in a double-blind, placebo-controlled crossover trial starting in random order with either active drug (ranitidine, 150 mg b.d.) or placebo. Every 7 days, medication was switched from active drug to placebo, or vice versa. At entry, patient characteristics were assessed utilizing a semistructured standardized interview and standardized questionnaires, and weekly intensity of symptoms was assessed utilizing a visual analogue scale. Patients with a greater reduction of the symptom score during active treatment and an overall reduction of the global symptom score by more than 50% at the end of the study period were categorized as responders. Logistic regression analysis was utilized to assess the influence of symptom type and presence of psychological disturbances on the treatment response. During treatment the symptom score decreased significantly, from 32.1 +/- 1.44 (SD) to 21.3 +/- 1.9 at the end of the trial (P < 0.001). Twenty of 75 were responders. High scores for somatization (OR, 3.6; 95% Cl, 1.2-11.4), anxiety (OR, 3.3; 95% Cl, 0.9-11.8), and reflux-like symptoms (OR, 5.3; 95% Cl, 1.7-16.7) were associated with response to treatment, while dysmotility-like symptoms were associated with an unfavorable response (OR, 0.3; 95% Cl, 0.1-0.9). Symptom pattern and psychological disturbances are independent predictors of treatment response. Patients with reflux-like symptoms and greater psychological disturbances are more likely to respond to an acid-lowering compound.

G-protein beta 3 subunit 825 CC genotype is associated with unexplained (functional) dyspepsia.

BACKGROUND & AIMS: In patients with functional dyspepsia, altered alpha-adrenoreceptor function and depression are prevalent, features that are linked to a G-protein beta 3 (GNB3) subunit gene polymorphism (C825T). We aimed to assess the association of specific G-protein beta 3 subunit genotypes with functional dyspepsia. METHODS: In study A, abdominal symptoms were assessed in 67 patients with unexplained, upper abdominal symptoms and 259 consecutive blood donors with and without abdominal symptoms. In study B, a further 56 patients with functional dyspepsia and 112 age- and sex-matched healthy controls from a blood donor population study were evaluated. Genomic DNA was isolated from buccal swabs and genotyping of the C825T polymorphisms was performed by polymerase chain reaction and restriction analysis. RESULTS: In the blood donors with no abdominal symptoms in study A (controls, n = 161), genotype distribution was 17 TT, 77 TC, and 67 CC. In blood donors and patients with unexplained abdominal symptoms, genotype distribution was 22 TT, 54 TC, and 89 CC (P = 0.007 vs. controls). In study B, the genotype distribution in functional dyspepsia patients was 4 TT, 18 CT, and 34 CC compared with 4 TT, 62 CT, and 46 CC in the controls (P < 0.02). Combining studies A and B, the odds ratio (OR) adjusted for age and sex for upper abdominal symptoms associated with the CC genotype was 2.2 (95% confidence interval [CI]: 1.4-3.3), compared with subjects with TC and TT genotype carrying an allele. CONCLUSIONS: Homozygous GNB3 825C carrier status is associated with unexplained predominantly upper abdominal symptoms.

[Trauma, post-traumatic stress disorder and somatization]. / Trauma, posttraumatische Belastungsstörung und Somatisierung.

In a cross-sectional study, 483 patients (age: 35.8 +/- 13.2 years) of an outpatient psychosomatic university clinic were investigated using a standardized disorder-specific set of tests. 63.1 % of the patients reported to have experienced at least one traumatic event in their life. Test-psychometrically, a posttraumatic stress disorder (PTSD) could be assumed in 10.1 %. Compared to non-traumatized patients, patients with a PTSD reported significantly more frequently somatoform symptoms; even the comparison of traumatized patients with and without PTSD demonstrated a pronounced tendency to somatize in PTSD patients. Neurologic, gastrointestinal and cardiopulmonary symptoms, as well as pain sensations and sexual dysfunctioning were predominantly reported as somatoform complaints. The results emphasize the close connection between somatization and PTSD symptoms; this should be increasingly taken into consideration in the diagnostic process within psychotraumatology.