Current Somatic Symptoms Research Articles

Structural brain correlates of serum and epigenetic markers of inflammation in major depressive disorder

Inflammatory processes are implicated in the aetiology of Major Depressive Disorder (MDD); however, the relationship between peripheral inflammation, brain structure and depression remains unclear, partly due to complexities around the use of acute/phasic inflammatory biomarkers.Here, we report the first large-scale study of both serological and methylomic signatures of CRP (considered to represent acute and chronic measures of inflammation respectively) and their associations with depression status/symptoms, and structural neuroimaging phenotypes (T1 and diffusion MRI) in a large community-based sample (Generation Scotland; NMDD cases = 271, Ncontrols = 609).Serum CRP was associated with overall MDD severity, and specifically with current somatic symptoms- general interest (β = 0.145, PFDR = 6 × 10−4) and energy levels (β = 0.101, PFDR = 0.027), along with reduced entorhinal cortex thickness (β = −0.095, PFDR = 0.037). DNAm CRP was significantly associated with reduced global grey matter/cortical volume and widespread reductions in integrity of 16/24 white matter tracts (with greatest regional effects in the external and internal capsules, βFA= −0.12 to −0.14). In general, the methylation-based measures showed stronger associations with imaging metrics than serum-based CRP measures (βaverage = −0.15 versus βaverage = 0.01 respectively).These findings provide evidence for central effects of peripheral inflammation from both serological and epigenetic markers of inflammation, including in brain regions previously implicated in depression. This suggests that these imaging measures may be involved in the relationship between peripheral inflammation and somatic/depressive symptoms. Notably, greater effects on brain morphology were seen for methylation-based rather than serum-based measures of inflammation, indicating the importance of such measures for future studies.

Associations of somatic symptom attribution in Turkish patients with major depression

Background: There are differences across ethno-cultural groups in the degree of somatization among patients with major depressive disorder (MDD). Studies showed that the attribution style of somatic symptoms is an important predictor of health outcome in depressed patients. Aims: The aims of this study were to investigate associations of psychologizing, normalizing and somatizing attribution styles as measured by the Symptom Interpretation Questionnaire (SIQ) in Turkish patients with MDD. Methods: Ninety patients who were diagnosed with a major depressive episode using a semi-structured interview were administered the SIQ to assess attribution styles, each of which was regressed on age, gender, educational level, depressive symptom severity, tendency for somatosensory amplification, current somatic symptoms and alexithymia. Results: Scores on somatizing, psychologizing and normalizing attribution subscales of the SIQ were strongly correlated with each other. Somatosensory amplification and alexithymia were independent correlates of somatizing attributions. Higher levels of psychologizing and normalizing attributions were both related to more severe symptoms of depression and to somatosensory amplification. Conclusions: These results suggested that patients with higher levels of depressive symptoms were more likely to engage in a greater diversity of attribution styles as measured by the SIQ in our sample. Independent correlates of somatic symptom attribution in patients with MDD were found to be different from Western countries, suggestive of disparate cultural characteristics and help-seeking pathways and behaviour in Turkey.

History of attempted suicide and the medical review of systems

Previous studies indicate relationships between borderline personality disorder, characterized by chronic selfharm behaviour, and somatic preoccupation. 1 Therefore, we hypothesized a relationship between a history of suicide attempts and multiple somatic symptoms in the context of a medical review of systems (ROS). Participants were male and female outpatients, aged 18 or older, seen in a resident-provider internal medicine clinic. We excluded individuals with medical or other symptoms that would preclude their ability to complete a survey. Of 471 individuals approached, 417 (88.5%) agreed to participate; 367 completed all study measures – 124 male and 243 female, aged 19–97 years (M = 50.13, SD = 15.46). Most (88.0%) were White (African American, 7.9%; Other, 2.2%; Hispanic, 1.1%; Asian, 0.8%), with 6.6% reporting less than a high school diploma and 28.7% a bachelor’s degree or higher. One author positioned in the clinic lobby, approached incoming patients, assessed exclusion criteria, reviewed the project and invited each to complete an anonymous survey. The survey consisted of: (i) a demographic query; (ii) a query about a past history of suicide attempts (‘Have you ever intentionally, or on purpose, attempted suicide?’) and (iii) the presence or not of 35 general medical symptoms (i.e. one clinical version of a ROS) adapted from Sinsky; 2 items were preceded by the statement, ‘Have you experienced any of the following symptoms in the past week?’, with yes/no response options. The project was approved by two institutional review boards and completion of the survey was assumed to be implied consent (clarified on the survey cover page). Forty-nine (13.4%) participants indicated suicide attempts. The number of endorsed ROS symptoms ranged 0–32 (M = 6.87, SD = 5.95), with 89.9% endorsing at least one symptom. The mean number of such symptoms was greater for those who indicated a history of attempted suicide (M = 10.29, SD = 7.40) compared with those who denied such a history (M = 6.35, SD = 5.53), [F(1,365) = 19.50, P < 0.001]. Age was inversely related to the total number of symptoms endorsed (r = -0.12, P < 0.05), and those who indicated a history of attempted suicide were younger (M = 41.83, SD = 13.15) compared with those who denied such a history (M = 51.40, SD = 15.41), [F(1,361) = 16.63, P < 0.001]. However, history of attempted suicide remained a statistically significant predictor [F(1,360) = 15.84, P < 0.001] of the total number of symptoms endorsed even when age was entered as a covariate. In this sample of internal medicine outpatients, past suicide attempts were associated with a greater number of current physical symptoms – a finding that we believe is unique to the current literature. If valid, multiple current somatic symptoms might be an indistinct marker for past suicide attempts.

HADStress screen for posttraumatic stress: replication in ethiopian refugees.

Purpose was to assess whether a 4-symptom somatic screen, shown to correlate with current post-traumatic stress symptoms in 1 refugee group, could function as a screening instrument in another group of refugees. Sample consisted of 512 community-dwelling refugees from Ethiopia. Data collection included demography, types of torture and nontorture trauma experienced a decade earlier in Africa, and current posttraumatic stress symptoms. Somatic symptoms included headaches (H), appetite change (A), dizziness and faintness (D), and sleep problems (S), added with equal weighting into the HADStress Screen, ranging from 0 to 4. Results showed that age, gender, torture, and other trauma experiences from a decade ago, and current posttraumatic stress symptoms predicted current somatic symptoms on univariate analyses. On a negative binomial regression model, current posttraumatic stress symptoms, male gender, and number of torture types predicted a high HADStress score. Post hoc tests supported cut-off levels at 3 and at 4 symptoms. Conclusion is that the HADStress Screen can serve as an efficient, nonthreatening screen for posttraumatic stress symptoms among refugees.

High Somatic Symptom Burdens and Functional Gastrointestinal Disorders

Unexplained, multi-system somatic symptoms and syndromes, the hallmark features of somatization, are prevalent in patients with functional gastrointestinal disorders (FGIDs). We studied outpatients attending a gastroenterology clinic to see whether current somatic symptom burdens (a somatization state measure) or number of prior functional diagnoses (a somatization trait measure) could predict the presence of an FGID over structural gastrointestinal disease, and whether the predictive value was dependent on comorbid depression or anxiety disorders. Clinical data from 327 consecutive new referrals to an outpatient gastroenterology practice were reviewed, 187 with an FGID and 140 with a structural illness. Somatization state and trait were measured by using self-reported current symptoms and functional diagnoses recorded in the medical history, respectively. Psychiatric comorbidity (depression or anxiety disorders) was extracted from chart review. FGID subjects endorsed more somatization state symptoms, had more somatization trait diagnoses, and had greater likelihood of psychiatric comorbidity (P < .001 for each). Logistic regression analysis adjusting for age and sex differences showed that each of these features independently predicted the likelihood of an FGID over structural disease (P < .05 for each). When high ratings on the somatization measures were present together with psychiatric comorbidity, the positive predictive value exceeded 0.95. Higher burdens of either current somatic symptoms or functional diagnoses in the medical history are strong predictors of an FGID in outpatients presenting with gastrointestinal complaints. The mechanism is not solely dependent on a relationship with affective disorders, which independently predicts FGID, at least in part, through another path.

Prevalence and sources of patients' unmet expectations for care.

Patients' expectations and the role they play in medical care are increasingly considered to be important, but the factors that influence these expectations have not been well studied. To examine the factors that influence patients' expectations for care in office practice. Qualitative inquiry nested within a large clinical survey. Three general internal medicine practices in one mid-sized city in northern California. 688 patients visiting their internists' offices were surveyed (response rate, 86%); 88 patients who reported one or more omissions of care on a post-visit questionnaire and were available for a telephone interview 1 to 7 days after the visit were included in the qualitative inquiry. Proportion of surveyed patients who reported one or more omissions of care, and qualitative analysis of the sources of patients' expectations, as determined from the telephone interviews. Interviews focused on the sources of expectations and perceptions of omission. Using an iterative process and working by consensus, investigators developed coding categories on a randomly selected 50% of the transcripts. The other 50% of the sample was used for validation. The 125 patients who had unmet expectations perceived omissions that were related to physician preparation for the visit (23%), history taking (26%), physical examination (30%), diagnostic testing (28%), prescription of medication (19%), referral to specialists (26%), and physician-patient communication (15%). Unmet expectations were shaped by patients' current somatic symptoms (intensity of symptoms, functional impairment, duration of symptoms, and perceived seriousness of symptoms) (74%); perceived vulnerability to illness (related to age, family history, personal lifestyle, or previously diagnosed conditions) (50%); past experiences (personal or familial) with similar illnesses (42%); and knowledge acquired from physicians, friends, family, or the media (54%). Patients' expectations for care are derived from multiple sources; their complexity should discourage simple schemes for "demand management." Nevertheless, the results of this study may help physicians to take a more empathetic stance toward their patients' requests and to devise more successful strategies for clinical negotiation.