One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders.

BACKGROUND: In order to clarify the classification of physical complaints not attributable to verifiable, conventionally defined diseases, a new diagnosis of bodily distress syndrome was introduced. The aim of this study was to test if patients diagnosed with one of six different functional somatic syndromes or a DSM-IV somatoform disorder characterized by physical symptoms were captured by the new diagnosis. METHOD: A stratified sample of 978 consecutive patients from neurological (n=120) and medical (n=157) departments and from primary care (n=701) was examined applying post-hoc diagnoses based on the Schedules for Clinical Assessment in Neuropsychiatry diagnostic instrument. Diagnoses were assigned only to clinically relevant cases, i.e., patients with impairing illness. RESULTS: Bodily distress syndrome included all patients with fibromyalgia (n=58); chronic fatigue syndrome (n=54) and hyperventilation syndrome (n=49); 98% of those with irritable bowel syndrome (n=43); and at least 90% of patients with noncardiac chest pain (n=129), pain syndrome (n=130), or any somatoform disorder (n=178). The overall agreement of bodily distress syndrome with any of these diagnostic categories was 95% (95% CI 93.1-96.0; kappa 0.86, P<.0001). Symptom profiles of bodily distress syndrome organ subtypes were similar to those of the corresponding functional somatic syndromes with diagnostic agreement ranging from 90% to 95%. CONCLUSION: Bodily distress syndrome seem to cover most of the relevant "somatoform" or "functional" syndromes presenting with physical symptoms, not explained by well-recognized medical illness, thereby offering a common ground for the understanding of functional somatic symptoms. This may help unifying research efforts across medical disciplines and facilitate delivery of evidence-based care.

[Diagnostic value of the SHAPE questionnaire in recognition of the hyperventilation syndrome in children: a pilot study]. / Valeur diagnostique du questionnaire SHAPE pour le syndrome d'hyperventilation de l'enfant : étude pilote.

OBJECTIVE: Determination of a diagnostic scoring method for hyperventilation syndrome (HVS) in children and proposal of a simplified questionnaire. METHOD: We used the main clinical signs of HVS in children and adolescents identified in a previous study and classified them according to their odds ratios (OR). The intensity of each sign, measured using a visual analogic scale in the previous study, led us to analyze several scoring methods, with a breakdown between major and minor signs according to their OR. Building receiver operating characteristics (ROC) curves allowed us to choose the best diagnostic combination. RESULTS: A sample of 85 children and adolescents aged from 7 to 20 years (mean age, 11.9 years) was tested. This sample comprised 45 children with isolated HVS or HVS associated with asthma and 40 controls, with asthma but without HVS or attending our emergency unit after trauma. Seven respiratory signs and 10 nonrespiratory signs were selected. For each scoring method, a significant difference was observed between HVS and non-HVS patients. The most suitable area under the curve (0.934) and the best combination between specificity and sensitivity (Sp=0.90 and Se=0.82) were obtained when the scoring method was 0,3,6 for major signs, and 0,1,2 for minor signs, according to perceived intensity of each sign ("never or almost never", "sometimes" or "often or very often"). CONCLUSION: Since no gold standard is available to confirm the diagnosis of HVS in children, we propose using a simplified questionnaire composed of 17 items to compute a diagnostic score. The questionnaire will be validated shortly in a new prospective study.

Respiratory and cognitive subtypes of panic. Preliminary validation of Ley's model.

A review of the panic disorder literature strongly suggests subtypes of panic attacks, including a respiratory subtype. This study empirically tested several aspects of Ley's panic subtype theory, measuring end-tidal carbon dioxide (ETCO2) levels at baseline, during psychologic and respiratory stressors, and at recovery. As predicted, Type 1 (classic or respiratory) panickers had significantly lower resting ETCO2 compared to Type 3 (cognitive) and to controls. Type 3 panickers did not differ from controls. Physiologic findings support the existence of respiratory and other subtypes of panic attacks in panic disorder. More complex measures of respiration and other physiology are likely required to elicit full subtype profiles. Distinguishing between chronic (compensated) hyperventilators and acute hyperventilators will likely be useful in clarifying the subtypes. Recognizing the need for differential diagnosis of panic attacks can facilitate developing more specific treatment plans and interventions (e.g., restoration of normal ETCO2 in Type 1), improving treatment success rates.

[The hyperventilation syndrome]. / Giperventiliatsionnyi sindrom.

A review of literature comprises the main data on etiological factors, pathogenetic mechanisms, clinical peculiarities and methods of diagnosis of the hyperventilation syndrome. Physicians' insufficient knowledge of this disease is emphasized. Various clinical manifestations are based on the same pathogenetic mechanisms of acute or chronic respiratory disregulation resulting in hypocapnia, a rise of vascular tone, and electrolytic disorders. Of great practical importance is the use of a unified clinical classification, of which a variant is proposed by the authors. The main therapeutic modalities are: 1) psychotherapy, 2) pharmacotherapy, 3) exercise therapy.