Chronic Physical Complaints Research Articles

Somatic symptom disorder should be suspected in children with alleged chronic Lyme disease

We report a case series of seven children admitted to a tertiary level pediatric ward for long-lasting physical symptoms with a previous diagnosis of chronic Lyme disease. In these children, medical history and clinical features were strongly suggestive of a psychopathological disorder, mainly a somatic symptom disorder. What is Known: • There is an increasing number of diagnoses of chronic Lyme disease both in North America and in Europe. Adults receive this diagnosis to explain chronic physical complaints often with negative history and serology. What is New: • Somatic symptom disorder should be suspected in children and adolescents with non-specific symptoms diagnosed with chronic Lyme disease.

Personality Traits and Physical Complaints in Patients With Acromegaly: A Cross Sectional Multi-Center Study With Analysis of Influencing Factors.

Objective: Acromegalic patients display a distinct neuropsychological profile and suffer from chronic physical complaints. We aimed to investigate in more detail these aspects in acromegalic patients, dependent on influencing factors like disease activity, age, sex, chronic medication, surgery, pituitary radiation, pituitary insufficiency and comorbidities.Design: Cross sectional, multicentric.Methods: 129 patients (M/W 65/64, 58.3 ± 12.7 years, 53/76 with active/controlled disease). Acromegalic patients completed the following inventories: NEO-FFI, IIP-D, and the Giessen Complaints List (GBB-24), after written informed consent. Age, sex, IGF-1 concentrations, comorbidities, treatment modalities and pituitary insufficiency were documented.Results: Acromegalic patients or specific patient-subgroups were more agreeable, neurotic, exploitable/permissive, introverted/socially avoidant, non-assertive/insecure, nurturant and less open to experience, cold/denying, domineering, compared to normal values from the healthy population (controls). Multivariable analysis demonstrated that these overall results were due to the specific patient subgroups as patients on chronic medication, with arthrosis and pituitary insufficiency. Disease activity was only associated with the trait nurturant. Higher scores for introversion were associated with arthrosis. Lower domineering was independent of any disease- or treatment related variable or comorbidity. The GBB inventory showed overall higher scores in patients, with higher scores for exhaustion and general complaints being associated with pituitary insufficiency, coronary heart disease and history of malignancy in the multivariable analysis. Joint complaints were independent of any disease- or treatment- related variable.Conclusions: We define new aspects of a distinct neuropsychological profile in patients with acromegaly, which are largely independent of disease activity. Chronic physical complaints are more pronounced in patients than in controls, with exhaustion and general complaints showing no association with disease activity.

Psychogenic Explanations of Physical Illness

In some patients with chronic physical complaints, detailed examination fails to reveal a well-recognized underlying disease process. In this situation, the physician may suspect a psychological cause. In this review, we critically evaluated the evidence for this causal claim, focusing on complaints presenting as neurological disorders. There were four main conclusions. First, patients with these complaints frequently exhibit psychopathology but not consistently more often than patients with a comparable “organic” diagnosis, so a causal role cannot be inferred. Second, these patients report a high incidence of adverse life experiences, but again, there is insufficient evidence to indicate a causal role for any particular type of experience. Third, although psychogenic illnesses are believed to be more responsive to psychological interventions than comparable “organic” illnesses, there is currently no evidence to support this claim. Finally, recent evidence suggests that biological and physical factors play a much greater causal role in these illnesses than previously believed. We conclude that there is currently little evidential support for psychogenic theories of illness in the neurological domain. In future research, researchers need to take a wider view concerning the etiology of these illnesses.

Cognitive Alexithymia Mediates the Association Between Avoidant Attachment and Interpersonal Problems in Patients With Somatoform Disorder

ABSTRACTPatients with somatoform disorder (SFD) are characterized by the presence of chronic physical complaints that are not fully explained by a general medical condition or another mental disorder. Insecure attachment patterns are common in this patient group, which are often associated with interpersonal difficulties. In the present study, the mediational role of two types of alexithymia and negative affectivity (NA) was examined in the association between attachment styles and interpersonal problems in a group of 120 patients with SFD. Patients were requested to fill out several self-report questionnaires for the assessment of attachment strategies, alexithymia, NA, and interpersonal problems. Cognitive alexithymia (i.e., the inability to identify and verbalize emotions) mediated the relationship between avoidant attachment patterns and interpersonal problems, even after controlling for NA. Preliminary findings also suggested that NA acted as a moderator of the mediator cognitive alexithymia. These results have important implications for clinical practice, as this study clearly shows that interpersonal problems do not automatically follow from insecure attachment strategies, but are contingent upon alexithymic features. It is recommended to target alexithymic features in patients with SFD, particularly in the context of negative emotions. Therefore, cognitive alexithymia may be an important therapeutic focus, specifically in the treatment of avoidant ptients with SFD.

Longitudinal Outcomes for Victims of Child Abuse

Childhood abuse and neglect (child maltreatment) represent a common and significant public health burden. The consequences of maltreatment can be seen immediately, in the short term and in the long term. Determination of the exact prevalence of childhood maltreatment is difficult, as many cases go unreported; however in reported cases there is an estimated $124 billion annual burden on the US health-care system. The evaluation of potential maltreatment is difficult as many of the initial symptoms are subtle and can be explained with alternative illnesses or injuries. Potential immediate and short-term effects include brain injury, shaken baby syndrome and behavioral regression. The potential long-term sequelae of child maltreatment are explored in detail here and include increased risks of the development of mental health disorders, substance use disorders and chronic physical complaints during development and adulthood. Lastly, the review provides an overview of current treatment approaches for victims of childhood maltreatment.

Deciphering emotional aches and physical pains in children.

Pain syndromes in children are common and can often be associated with stress, which can have biological as well as psychiatric concomitants. After a comprehensive evaluation is performed, an overall intervention plan should be presented to the child and family. Pediatricians need to be sensitive to the negative stigma attached to treatment directed at mood and behavior, and nonpharmacologic interventions should be considered before any psychopharmacologic intervention is instituted. Finally, pediatricians should always regard pain as "real," and the child psychiatrist can play an important role in integrating care of patients with chronic physical complaints.

Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor–patient communication in general practice

Mishler (The discourse of medicine. The dialectics of medical interviews. Norwood, NJ: Ablex), applying Habermas's theory of Communicative Action to medical encounters, showed how the struggle between the voice of medicine and the voice of the lifeworld fragmented and suppressed patients’ multi-faceted, contextualised and meaningful accounts. This paper investigates and critiques Mishler's premise that this results in inhumane, ineffective medical care. Using a more complex data collection strategy, comprising patient interviews, doctor interviews and transcribed consultations we show more complex relations than emerged from Mishler's analysis. We found four communication patterns across 35 general practice case studies. When doctor and patient both used the voice of medicine exclusively (acute physical complaints) this worked for simple unitary problems (Strictly Medicine). When both doctor and patient engaged with the lifeworld, more of the agenda was voiced ( Mutual Lifeworld) and patients were recognised as unique human beings (psychological plus physical problems). Poorest outcomes occurred where patients used the voice of the lifeworld but were ignored ( Lifeworld Ignored) or blocked ( Lifeworld Blocked) by doctors’ use of voice of medicine (chronic physical complaints). The analysis supports the premise that increased use of the lifeworld makes for better outcomes and more humane treatment of patients as unique human beings. Some doctors switched communication strategies in different consultations, which suggests that their behaviour might be open to change. If doctors could be sensitised to the importance of dealing with the concerns of the lifeworld for patients with chronic physical conditions as well as psychological conditions, it might be possible to obtain better care for patients. This would require attention to structural aspects of the healthcare system to enable doctors to work fully within the patient-centred model.

A Cross-Sectional Study of Health Complaints Among 79 Data Entry Operators Using Video Display Terminals

This paper reports on the findings of a cross-sectional study of 79 data entry clerks employed by an Ontario-based organization in five separate offices. The study was conducted to identify factors associated with physical complaints experienced by these office workers. A large percentage of the data entry clerks reported chronic physical complaints (eyestrain, musculo-skeletal pains, headache) as well as emotional or mental stress which they felt were associated with their occupation. Poorly designed overhead lighting systems in all offices contributed to both eyestrain and headache. Duration of employment as a data entry operator within the organization was not associated with stress or physical health complaints. The presence of an adjustable workstation did not in itself guarantee any protection from these conditions. Highly significant associations between occupational stress levels and some physical complaints were observed. The presence of these associations indicated that the management of both physical and stress complaints within these office environments should be tackled simultaneously.

Sex differences in problems related to depression

The study investigated possible sex differences in the types of problems that are correlated with Beck Depression Inventory (BDI) scores, using a sample of college students. Problems related to assertiveness and feeling ill at ease were positively correlated with BDI scores for males, but not for females. In contrast, conflicts with parents, feelings of being boxed in and of boredom, lack of money, and chronic physical complaints were positively related to BDI scores for females, but not for males.

Family structure, marital adjustment, and intimacy in patients referred to a consultation-liaison service

Patients with chronic physical symptoms of obscure etiology who are referred to a psychiatric consultation service demonstrated characteristic differences in their marital adjustment and family structure when compared with nonpatient controls. Although marital adjustment, as perceived by patient and spouse, was similar to that of nonpatient couples and an absence of overt conflict was demonstrated, the marriages of patients were characterized by specific incompatibilities in intimacy, socializing, and initiative. The family structure also demonstrated a preoccupation with relationships within the family, with resultant isolation from extrafamilial social contacts, and a lack of problem solving ability. The study suggests that the level of intimacy in a marriage may be a predisposing vulnerability risk factor and an influence on illness behavior, or a perpetuating factor in the sick role assumed by at least some hospitalized patients. Finally, the study suggests that marital assessment may have value in the evaluation of patients with chronic physical complaints of obscure etiology.