Anxiety, depression, and somatization in DSM-III hypochondriasis.

To assess the severity of distress and of somatization in hypochondriasis, the authors administered several validated self-rating scales of depression, anxiety, somatic symptoms, and anger/hostility to 21 psychiatric outpatients with the DSM-III diagnosis of hypochondriasis and to matched groups of other nonpsychotic psychiatric patients, family practice patients, and employees. Anxiety and somatic symptoms were highest in hypochondriacal patients; depression and anger/hostility did not differ from those of other psychiatric patients but were higher than in the other groups. The findings do not support the theory that hypochondriasis is a defense against anxiety or that it is a masked depression or depressive equivalent. The findings are consistent with the view that the interaction of severe anxiety and severe somatic symptoms is a common feature of the psychopathology of hypochondriasis.

Nonpsychotic patients referred to a consultation service.

In order to examine characteristics of nondangerous and nonpsychotic patients referred to a consultation service, the authors administered self-rating scales and questionnaires to fifty referred medical patients and nonreferred controls. Recalled abuse in childhood appeared a stronger predictor for referral than some other commonly researched ones such as parental death, divorce or separation in childhood or recent losses. Anxiety, hostility and depression were significantly higher in referred patients, whereas hypochondriacal attitudes did not differ between the two groups. The findings appear to have implications for treatment.

Fears, beliefs, and attitudes in DSM-III hypochondriasis.

In order to explore fears, beliefs, and attitudes of patients with DSM-III hypochondriasis, the authors administered the self-rated Illness Attitude Scales to 21 patients with hypochondriasis, matched family practice patients, nonpatient employees, and nonhypochondriacal psychiatric patients. Hypochondriacal patients reported more fears of and false beliefs about disease; they attended more to bodily sensations, had more fears about death, and distrusted physicians' judgments more, yet sought more medical care than other subjects. They did not take better precautions about their health. The self-report of overt attitudes suggests a characteristic syndrome, consistent with the DSM-III description of hypochondriasis. Two of the subscales of the Illness Attitude Scales yielded characteristic responses in hypochondriasis.

Hostility, somatic symptoms, and hypochondriacal fears and beliefs.

The authors administered self-rating scales of anger-hostility, somatic symptoms, and hypochondriacal fears and beliefs to seven groups of patients and nonpatients. Somatic symptoms were positively correlated with anger-hostility and were negatively correlated with feelings of friendliness; the correlation coefficients ranged from low to moderately high and were significant in most groups. Somatic symptoms tended to be associated more strongly with symptoms of anxiety and depression than with those of hostility. The associations of hypochondriacal fears and beliefs with hostility were inconsistent, varied between groups and with the concern measured. The findings do not support the view that anger or hostility are main or specific etiological factors either in somatization or in hypochondriacal fears or beliefs.

Life events and hypochondriacal concerns.

In a study of 165 employees of a retail firm, life events were associated with several hypochondriacal concerns and with most of the self-rating distress scales. Life events related to illness and death were associated with fear of disease and showed weak associations with somatic symptoms and anxiety. Life events unrelated to illness and death were associated with hypochondriacal beliefs, bodily preoccupations, fear of death, and most of the distress scales. Illness and death do not appear to be common recent precipitants of hypochondriacal concerns in a normal population. One of the reasons for the observed associations appears to be that preoccupation with illness and death can occur at times of distress, regardless of the nature of the recent stressful life events.

Hypochondriacal beliefs and attitudes in family practice and psychiatric patients.

Beliefs and attitudes which can be responsible for hypochondriacal behavior were explored by administering the Illness Attitude Scales and two distress scales to patients attending a family practice clinic, nonpsychotic psychiatric outpatients and a random group of employees. Family practice patients were more distressed, had more hypochondriacal concerns and had more bodily preoccupations than employees and took more precautions about their health. Psychiatric patients were more distressed and had more fears about illness and death than family practice patients, yet took fewer precautions about their health. The findings appear to have implications for treatment.

Changing trends in CMHCs: keys to survival in the eighties.

Since 1970 community mental health centers have been seeing greater percentages of less seriously ill patients in spite of the growing numbers of seriously and chronically ill patients in the community. CMHC staffs are composed of less highly trained individuals at all levels, centers appear to be used less for psychiatric training, and federal funds have decreased substantially. To survive the 1980s, centers must make some drastic adjustments, the author believes. They must develop closer relationships with other health facilities, including state hospitals, and they must reprofessionalize their staffs, offering incentives that attract and retain more psychiatrists and doctoral-level psychologists. Centers must market their services more competitively to consumers in the private sector. They must continue to care for the indigent, becoming more adept at participating in third-party insurance programs.

Staffing patterns in community mental health centers.

Staffing patterns of federally funded community mental health centers were examined in a survey of 512 centers conducted in 1977. A total of 275 usable responses were received. The findings showed that rural centers had significantly fewer trainees in three of the major mental health disciplines (psychiatry, psychology, and soical work) and fewer affiliations with training institutions, factors that contribute to the maldistribution of mental health professionals in rural areas. The survey also showed that center directors tended to hire more staff of their own professional background.

The changing role of psychiatrists in community mental health centers.

The community mental health center (CMHC) movement, largely conceived by psychiatrists to improve standards of mental health care nationally, appears to be going through an evolutionary phase in which there is decreasing utilization of psychiatrists and increasing utilization of other mental health professionals. The author discusses some factors that may have influenced this trend. In order to counter it CMHCs must become a recognized, essential, and respectable part of a pluralistic system of mental health care, and psychiatrists must be willing to assume their responsibility for involvement in all segments of mental health care, including the private and public sectors, in both leadership and clinical positions.

The effects of one-day treatment of anxiety with high doses of halazepam.

The main purposes of this study were to examine the effects of one-day treatment of anxiety and to test whether significant relief of anxiety can be achieved in a short time period by frequency individual adjustment of doses. A double-blind crossover study of halazepam and placebo was carried out with 22 patients, 20 completing the study. Each treatment lasted for one day. Oral medication was administered starting with a dose of 40 mg and the dose adjusted every 2 hours. The total daily dose did not exceed 600 mg. Several rating and self-rating scales were used. All observer rating scales and several self-rating scales discriminated at a significant level. The design appeart to be suitable for the rapid screening for anti-anxiety properties of new drugs.