Validation of the Spanish version of the SCOFF questionnaire for the screening of eating disorders in primary care.

OBJECTIVE: To assess the performance of the Spanish version of a new screening tool (the SCOFF) for the detection of eating disorders (EDs) in primary care. DESIGN: validation study. The psychiatric interview Schedules for Clinical Assessment in Neuropsychiatry (SCAN) was used as the "gold standard." Blinding was applied to administration of the SCOFF and the clinical interview. SETTING: six primary health care centers in Zaragoza and Huesca, Spain. PARTICIPANTS: 203 female patients, between the ages of 15 and 53 years, with a probable diagnosis of ED. MAIN OUTCOME MEASURE: validity as assessed by sensitivity, specificity, positive predictive value and negative predictive value. In addition, test-retest reliability and the receiver operating characteristics (ROC) curve were calculated. RESULTS: The best threshold point in the Spanish version was 2+ positive answers, the same as that recommended in the original British study. This cutoff point provided 97.7% sensitivity and 94.4% specificity for the detection of EDs in primary care. For each specific ED, sensitivity and specificity with this threshold point were, respectively, the following: bulimia, 97.8% and 94.4%; anorexia, 93.1% and 94.4%; and ED not otherwise specified (EDNOS), 100% and 94.4%. CONCLUSIONS: The Spanish version of the SCOFF questionnaire shows excellent psychometric properties for the early detection of EDs in primary settings.

Validation of the Spanish version of the Perceived Stress Questionnaire.

OBJECTIVE: To validate in Spanish the Perceived Stress Questionnaire (PSQ), a questionnaire to assess stress for research purposes in psychosomatic patients. METHOD: The test was administered to a healthy population (N=174) of nursing students and health workers and to a clinical sample (N=80) of patients attending a psychiatric outpatient consultation. RESULTS: Concurrent validity: General and Recent PSQ scores correlated high with trait anxiety (r=.65), moderate with depression (r=.46) and psychological disturbance (r=.51) and poor with state anxiety (r=.22). Predictive validity: PSQ scores were higher in "psychiatric cases" than in "psychiatric noncases" (P<.01), and correlated highly with somatic symptoms of psychological origin (r=.62) in the clinical subsample. Internal consistency was 0.9 for the General and 0.87 for the Recent PSQ. Test-retest reliability of the General PSQ was 0.80. DISCUSSION: The Spanish version of PSQ presents good psychometric properties and it seems to be a valuable instrument for psychosomatic researchers.

SPECT scan in somatization disorder patients: an exploratory study of eleven cases.

OBJECTIVE: There are no previous studies using single photon emission computed tomography (SPECT) scans in somatization disorder (SD) patients. The aim of this paper is to assess SPECT imaging abnormalities in SD patients and study any relation to laterality. METHOD: Eleven SD patients from the Somatization Disorder Unit of Miguel Servet University Hospital, Zaragoza, Spain, not fulfilling criteria for any other psychiatric disorder and showing normal computed tomography (CT) and magnetic resonance imaging (MRI) images were studied with SPECT. Patients with DSM-IV axis I comorbidity were ruled out because it has been demonstrated that SPECT scans can show abnormalities in patients with depression and anxiety disorders. The technique used for SPECT was 99mTc-D,1,hexamethylpropyleneamide-oxime (99mTc-HMPAO) in four patients and 99mTc-bicisate in the other seven. The SPECT scans were evaluated without knowledge of clinical data and entirely by visual inspection. RESULTS: Seven out of 11 (63.6%) SD patients showed hypoperfusion in SPECT imaging. In four cases there was hypoperfusion in the non-dominant hemisphere and the predominance of pain symptoms took place in the contralateral hemibody. In the other three patients hypoperfusion was bilateral. The anatomical regions affected were cerebellum (four cases), frontal and prefrontal areas (three cases), temporoparietal areas (two cases) and the complete hemisphere (one case). CONCLUSIONS: A proportion of SD patients may present hypoperfusion in SPECT images, uni- or bilaterally, in different brain areas. Possible aetiological explanations for this finding are discussed. Controlled studies are necessary to confirm or refute this hypothesis.

The use of alternative medicines by somatoform disorder patients in Spain.

Somatisation disorder patients show a high rate of alternative medicine consultations but most of them do not disclose this fact to the doctor owing to fear of reprisals. The reasons given for using these medicines do not equate to sociodemographic characteristics, psychiatric diagnosis or personality traits but instead to dissatisfaction with medical care and with diagnosis. These patients appreciate the longer and more frequent consultations as well as the better doctor-patient relationship of alternative medicines.

[Effectiveness of group psychoanalytic therapy in somatizing patients]. / Eficacia de la psicoterapia analítica grupal en enfermos somatizadores.

Somatizers are a kind of patients very prevalent, expensive for the health system and difficult to treat. In recent years, several treatment approaches, such as cognitive, psychodynamic or educative therapy, have demonstrated effectiveness for the management of these patients. This paper aims to analyze the research studies on group psychotherapy for the treatment of somatizers. Most of these studies are not solid from a methodological point of view. Based on these data, the authors summarize the indications, methodology, limitations and effectiveness of group psychotherapy in the treatment of somatizing patients.

Eficacia de la psicoterapia analítica grupal en enfermos somatizadores / Effectiveness of group psychoanalytic therapy in somatizing patients

Los somatizadores constituyen un grupo de pacientes muy prevalentes, costosos para el sistema sanitario y difíciles de tratar. En los últimos años, varios tipos de tratamiento como las terapias cognitivas, psicodinámicas o educativas han demostrado su efectividad en el manejo de estos enfermos.Este artículo tiene como objetivo analizar los estudios de investigación llevados a cabo sobre el tratamiento de los pacientes somatizadores con técnicas de psicoterapia de grupo. La mayoría de estos estudios presentan severos problemas metodológicos. No obstante, basados en estos datos, los autores resumen las indicaciones, metodología, limitaciones y efectividad de la psicoterapia de grupo en el tratamiento de los somatizadores. (AU)

A review of the differences between somatizing and psychologizing patients in primary care.

OBJECTIVE: This article reviews all published studies on somatizing and psychologizing patients in primary care, according to Bridges and Goldberg's criteria [1]. METHOD: A review of the Medline base from 1985 to 1998 was carried out. RESULTS: Somatization is a concept valid, reliable, and stable over time. There are no differences between somatizers and psychologizers in sociodemographics, social problems or past medical and psychiatric history. The main clinical and diagnostic difference is a predominance of depressive symptoms and disorders in psychologizers. Finally, the most remarkable differences between somatizers and psychologizers are found in personality traits, such as attribution of somatic symptoms. However, some traits considered important in the outcome of somatizers, such as hypochondriasis or locus of control, show no differences between both groups of patients. CONCLUSION: Contrary to what was expected, the comparison between these two groups of patients give few clues for the etiology and treatment of somatization. Follow-up studies should be the main source of data to answer these questions.

Management of somatisers in primary care: are family doctors motivated?

OBJECTIVE: The aim of this paper is to assess the attitudes of Spanish general practitioners towards somatisers and the degree of involvement that family doctors are ready to adopt in the care of these patients. METHOD: A postal questionnaire on attitudes was sent to a representative sample (n = 135) of general practitioners from two health districts of the region of Aragon. Seventy (51.8%) of them returned usable questionnaires. RESULTS: Most of the general practitioners were interested in the treatment of somatisers and considered that they should be treated at primary care level. However, when specific treatment tasks were proposed, they only accepted to act as a filter to specialised care and to care for patients with chronic functional syndromes. Additionally, they refuse to detect presenting somatisers, to prescribe psychotropic drugs or offer any psychological approach, and to avoid reinforcing abnormal illness behaviour in these patients and their families. These findings can be explained because the main emotions somatisers produce in doctors are frustration and anger. CONCLUSIONS: Family doctors need a lot more help, education and support in the management of somatisers, and psychiatrists need to provide it. Any management program for the treatment of somatisers in primary care should include methods to modify general practitioners' attitudes towards these patients.

[The reason for medical consultations in patients with psychiatric diseases: somatization phenomena and suicide attempts]. / Motivo de consultas médicas en pacientes con enfermedades psiquiátricas: fenómenos de somatización e intentos de autólisis.

BACKGROUND: The objectives of the study are to document the frequency of use of the general medical services by psychiatric patients, to measure how many consultations are due to somatization and suicide attempts and to know the existence of possible differences between psychiatric inpatients and outpatients in relation to the reason of medical consultation. DESIGN: retrospective study. Site: Manchester Royal Infirmary, a university third level hospital in Manchester (United Kingdom). PATIENTS: patients from the psychiatric department seen during the period from July 1st to December 31st in 1992 (n = 1,012 patients). RESULTS: The percentage of patients that consults a medical/surgical department in one year is 27.5%, 25.2% of outpatients and 36.3% of inpatients. Non-medical reasons are 42.3% of these consultations: 30.4% somatization phenomena and 10.8% suicide attempts. The frequency of somatization in psychiatric patients (30.4%) is similar to that described in non-psychiatric patients. The psychiatric inpatients that are referred to a medical department as inpatients show a significant lower rate of somatization (2.2%) and a higher rate of suicide (35.5%). CONCLUSIONS: On fourth of psychiatric patients consult a medical department in one year and more than 40% of these consultations are not due to somatic diseases. The frequency of somatization in psychiatric patients is similar to the observed in other patients. Psychiatric inpatients that are also medical inpatients in one year constitute a specific high risk group.

Screening of somatization disorder: validation of the Spanish version of the Othmer and DeSouza test.

The objective of this study was to validate the Spanish version of the Othmer and DeSouza Screening Test for Somatization Disorder. We have designed a validity study using the Standardized Polyvalent Psychiatric Interview, an instrument specifically designed to diagnose psychiatric morbidity in medical settings as the 'golden rule'. The control group displayed 'functional' and 'presenting' somatization. The Othmer and DeSouza Screening Test, with a threshold of three symptoms, shows 88% sensitivity, 78% specificity and a misclassification rate of 17%. It is concluded that Othmer and DeSouza's screening test, with a threshold of three symptoms, is a useful tool for the diagnosis of somatization disorder in medical and primary care settings in Spain. Discrepancies with US findings are discussed on a cross-cultural basis.

[Somatization disorders in primary care: differential clinical aspects. Study Group of Psychic and Psychosomatic Morbidity of Zaragoza, Primary Care Section]. / Trastorno por somatización en atención primaria: aspectos clínicos diferenciales. Grupo de Estudio de la Morbilidad Psíquica y Psicosomática de Zaragoza, Sección de Atención Primaria (GEMPPZ, AP).

BACKGROUND: To identify specific sociodemographic and psychopathological features of somatization disorder (SD) patients in relation to other patients with psychiatric and organic morbidity in primary care (PC) setting. METHODS: A group of SD patients from PC was compared with other two control groups: the first one made of patients with psychiatric morbidity (with or without organic disease) and the second group of patients with only organic disease without psychiatric morbidity. Polivalent standardized psychiatric interview (PSPI), a specific psychiatric interview for PC settings, was used as diagnostic instrument. RESULTS: 1) there is a female predominance in SD statistically significant compared with organic patients and with a trend to significance in relation to psychiatric patients. Age, marital status and educational level show no significant differences among the groups; 2) in relation to psychopathology, SD patients show, in relation with organic patients, statistically higher levels in all items measured by PSPI. On the contrary, SD overwhelmed psychiatric patients in just four items: somatic symptoms, fatigue, reported anxiety and hystrionism as well as sexual problems and lack of social support, and 3) high psychiatric morbidity (85%) in SD, most of them affective and anxiety diagnosis, make it difficult to differentiate from the other patients suffering from psychiatric morbidity in PC. CONCLUSION: Patients with SD show a very different profile compared with those with organic disease in relation to psychiatric symptoms and social problems. On the other hand, when compared with patients with psychiatric disorders, differences are rather scarce. In addition, affective and anxiety comorbidity associated make it difficult the diagnosis. For this reason, the use of screening instruments for SD seems mandatory.