Common Somatic Symptoms Research Articles

Chest pain and breathlessness: Relationship to psychiatric illness

Chest pain and breathlessness are common somatic symptoms of emotional disorder in ambulatory care. Chronic chest pain has a prevalence of 12% and is associated with high utilization of health care. Of patients with chest pain and breathlessness who are referred to a cardiac clinic but subsequently shown not to have heart disease, the majority continue to report symptoms. Those patients with the worst outcome, in terms of continuing limitation of activity and use of medical resources, are those with chest pain but normal coronary arteries. A number of studies that fail to support a unitary theory of causation of noncardiac chest pain are described. A multifactorial, interactive model is proposed, with contributions from physical factors, such as palpitations and intercostal muscle pain; psychologic factors, which include enhanced awareness of and selective attention to bodily sensation; and environmental factors, such as previous exposure to cardiorespiratory disease in first-degree relatives or significant others. Although there have been few controlled intervention studies in patients with unexplained cardiorespiratory symptoms, there is evidence for the efficacy of both drug treatments and psychologic treatment. The results of intervention studies in patients with chest pain and normal coronary arteries are eagerly awaited. Atypical chest pain and breathlessness are common causes of office consultations and/or functional disability. The diagnoses should be established on the basis of positive evidence of psychiatric illness rather than by exclusion. The etiology is multifactorial, and management is aimed at treating the underlying psychosocial problems and/or psychiatric illness. Cognitive-behavioral treatments are probably as effective as drug treatments in the shortterm, and the care of these patients would be improved by a more detailed explanation of noncardiac causes and a greater opportunity for patients to discuss their fears.

Attributions of common somatic symptoms

Three studies explored the causal attributions of common somatic symptoms. The first two studies established the reliability and validity of a measure of attributional style, the Symptom Interpretation Questionnaire (SIQ). Three dimensions of causal attribution were confirmed: psychological, somatic and normalizing. The third study examined the antecedents and consequences of attributional style in a sample of family medicine patients. Medical and psychiatric history differentially influenced attributional style. Past history and attributional style independently influenced clinical presentations over the subsequent 6 months. Symptom attributional style may contribute to the somatization and psychologization of distress in primary care.

Illness behaviour in mental ill-health in Kuwait

Two hundred and eight individuals were interviewed in order to study the behaviour they adopt in relation to the most common somatic and emotional symptoms of mental ill-health. Illness behaviour included ignoring, brooding, self-help and consultation of others. Older individuals tended more frequently to resort to meditation, native healers and doctors. Males consulted doctors more than females. Brooding was more frequent in well educated subjects. A group of married expatriates who left their wives in their original countries were the most likely to consult doctors. Education and marital status were the most predictive of brooding and self-help behaviour. Self-help was the most commonly adopted illness behaviour. The results are explained in terms of the social and cultural background of the individuals studied because this influences their methods of expressing distress and their action in relation to symptoms.

Clinical and Psychological Correlates of Somatic Symptoms in Patients on Dialysis

Somatic symptoms are common in patients on dialysis. Their causes are largely unknown and their therapy is unsatisfactory. To examine the relationship of psychological and clinical factors to these symptoms, 191 interviews were done in patients on hemo- and peritoneal dialysis. The severity of 8 somatic symptoms (tiredness, sleep disturbance, cramps, pruritus, headache, nausea, dyspnea, joint pain) of importance in dialysis patients was measured using previously validated scales. Indices of affect and quality of life were obtained, as was demographic, clinical and laboratory information. The severity of each symptom was significantly related to the indices of affect and quality of life. Using multiple logistic regression, poor affect score was the strongest correlate of each of the following somatic symptoms, tiredness, pruritus, sleep disturbance and cramps. It was ahead of any clinical or demographic variable and was also significantly correlated with the severity of the other symptoms. Indices of hyperparathyroidism were significantly associated with headache, joint pain, dyspnea and nausea. We conclude that the strongest correlate of common somatic symptoms in dialysis patients is affect disturbance, and that therapy aimed at improving the affect may improve the symptoms.

PSYCHOSOMATIC PROBLEMS IN CHILDHOOD1

Since this paper is presented as part of a discussion of Biological Factors in Personality Formation, I shall center my comments about the intimate relationships between common somatic symptoms and disturbances encountered in infancy and childhood and disturbance or deviation of the developing personality of the child. These relationships are more readily observed in small children than in adults because of the more obvious vulnerability of the child in his exposure to a healthy or to a disturbing physical and social environment. In childhood, the nature of the disturbances that may be designated as psychosomatic are dependent upon the biological maturity of the organism (I), and the nature of the nursing and training care to which the child is exposed (2). In the very young infant, the state of physiological maturity and susceptibility to the particular kind of care offered are reflected most commonly in the gastro-intestinal behavior. Appetite disturbances ranging from those that are mild to anorexia that threatens life, reflect errors on the part of the mother in meeting the child's initial need. For the growing infant and child, maternal love and care are essential for the development of security in all life relationships. The feeding situation is, for the child, an experience that initially secures for him comfort and a sense of well-being. When a good nursing or feeding regime and satisfying initial relationship between mother and child are not established, deep discomfort for both follows. There centers about the gastro-intestinal system and its functioning an essential expression of child's need, mother's readiness or capacity to meet that need, and all the possibilities of fundamental gratification or deepest deprivation for the child. Throughout life, the gastro-intestinal system continues to mirror the emotions better than any other body system. Menninger (2) remarks that this in part may be because it is partially under voluntary control, and adds, Next to the skin, the gastro-intestinal system has more contact with the external world than any other part of the personality. It receives more direct demands for adjustment and accommodation, more insults and abuses, and a greater variety of opportunities for gratification than any other set of organs suffers or enjoys. In early life when there is adequate gratification through establishment of a healthy nursing or feeding regime by a stable mother, the clinical picture of a normal infant who thrives physically and gives evidence of comfortable adjustment to his protective environment is usually presented. The implications of such a favorable situation for the healthy personality development of the infant need not be stressed here, and is abundantly