Diagnostic Criteria For Psychosomatic Research Diagnosis Research Articles

Clinical utility of the Diagnostic Criteria for Psychosomatic Research for a comprehensive assessment of the elderly.

According to the revised version of the Diagnostic Criteria for Psychosomatic Research (DCPR-R), this study explored the prevalence and clinical correlates of DCPR-R psychosomatic syndromes in the elderly and tested whether DCPR-R provide an incremental contribution to the prediction of psychosocial functioning over and above DSM-5. One hundred seven elderly subjects were recruited. Participants received a clinical assessment, which included the DCPR-Revised Semi-Structured Interview (DCPR-R SSI), the Structured Clinical Interview for DSM-5-Clinician Version (SCID-5-CV), the Psychological Well-Being (PWB) Scales, the Geriatric Anxiety Scale (GAS)and the Geriatric Depression Scale (GDS). Analyses of covariance (ANCOVA) and hierarchical regression analyses were run. Twenty-two (20.6%) subjects had at least one DSM-5 diagnosis, and 62 (57.9%) reported at least one DCPR-R diagnosis. Subjects with at least one DCPR-R diagnosis showed lower PWB Personal Growth and PWB Purpose in Life than those without DCPR-R diagnoses. When the incremental validity of the DCPR-R was tested using PWB Personal Growth, PWB Purpose in Life, PWB Self-acceptance, GAS Cognitive symptoms and GAS affective symptoms subscales as criterion variable, the DCPR-R increased up to 0.135-0.263 the explained variance. The DCPR-R might be implemented together with the DSM-5 to have a comprehensive assessment of elderly subjects.

Psychosocial Dimensions in Hemodialysis Patients on Kidney Transplant Waiting List: Preliminary Data

Although the donation rate for deceased and living kidneys has been increasing, the donor organ availability meets only the 30% of kidney needs in Italy. Consequently, hemodialysis patients stay for a long time, an average of 3.2 years, on a waiting list for a kidney transplant with consequent relevant psychological distress or even full-fledged psychiatric disorders, as diagnosed with traditional psychiatric nosological systems. Recent studies report, however, a higher prevalence of other psychosocial syndromes, as diagnosed by using the Diagnostic Criteria for Psychosomatic Research (DCPR) in medically ill and kidney transplant patients. Nevertheless, no data regarding DCPR prevalence are available in patients waitlisted for a renal transplant (WKTs). Thus, the primary aim of this study was to identify sub-threshold or undetected syndromes by using the DCPR and, secondly, to analyze its relationship with physical and psychological symptoms and daily-life problems in WKTs. A total of 30 consecutive WKTs were assessed using the DCPR Interview and the MINI International Neuropsychiatric Interview 6.0. The Edmonton Symptom Assessment System (ESAS) and the Canadian Problem Checklist were used to assess physical and psychological distress symptoms and daily-life problems. A total of 60% of patients met the criteria for at least one DCPR diagnosis; of them, 20% received one DCPR diagnosis (DCPR = 1), and 40% more than one (DCPR > 1), especially the irritability cluster (46.7%), Abnormal Illness Behavior (AIB) cluster (23.3%) and somatization cluster (23.3%). Fifteen patients met the criteria for an ICD diagnosis. Among patients without an ICD-10 diagnosis, 77.8% had at least one DCPR syndrome (p < 0.05). Higher scores on ESAS symptoms (i.e., tiredness, nausea, depression, anxiety, feeling of a lack of well-being and distress), ESAS-Physical, ESAS-Psychological, and ESAS-Total were found among DCPR cases than DCPR non-cases. In conclusion, a high prevalence of DCPR diagnoses was found in WKTs, including those who resulted to be ICD-10 non-cases. The joint use of DCPR and other screening tools (e.g., ESAS) should be evaluated in future research as part of a correct psychosocial assessment of WKTs.

Screening Performance of Edmonton Symptom Assessment System in Kidney Transplant Recipients.

An average prevalence of 35% for psychiatric comorbidity has been reported in kidney transplant recipients (KTRs) and an even higher prevalence of other psychosocial syndromes, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR), has also been found in this population. Consequently, an easy, simple, rapid psychiatric tool is needed to measure physical and psychological symptoms of distress in KTRs. Recently, the Edmonton Symptom Assessment System (ESAS), a pragmatic patient-centred symptom assessment tool, was validated in a single cohort of KTRs. The aims of this study were: to test the screening performances of ESAS for the International Classification of Diseases-10th Revision (ICD-10) psychiatric diagnoses in KTRs; to investigate the optimal cut-off points for ESAS physical, psychological and global subscales in detecting ICD-10 psychiatric diagnoses; and to compare ESAS scores among KTR with ICD-10 diagnosis and DCPR diagnosis. 134 KTRs were evaluated and administered the MINI International Neuropsychiatric Interview 6.0 and the DCPR Interview. The ESAS and Canadian Problem Checklist (CPC) were given as self-report instruments to be filled in and were used to examine the severity of physical and psychological symptoms and daily-life problems. The physical distress sub-score (ESAS-PHYS), psychological distress sub-score (ESAS-PSY) and global distress score (ESAS-TOT) were obtained by summing up scores of six physical symptoms, four psychological symptoms and all single ESAS symptoms, respectively. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. Receiving Operating Characteristic (ROC) analysis was used to examine the ability of the ESAS emotional distress (DT) item, ESAS-TOT, ESAS-PSY and ESAS-PHYS, to detect psychiatric cases defined by using MINI6.0. The area under the ROC curve for ESAS-TOT, ESAS-PHYS, ESAS-PSY and DT item were 0.85, 0.73, 0.89, and 0.77, respectively. The DT item, ESAS-TOT and ESAS-PSY optimal cut-off points were ≥4 (sensitivity 0.74, specificity 0.73), ≥20 (sensitivity 0.85, specificity 0.74) and ≥12 (sensitivity 0.85, specificity 0.80), respectively. No valid ESAS-PHYS cut-off was found (sensitivity <0.7, specificity <0.7). Thirty-nine (84.8%) KTRs with ICD-10 diagnosis did exceed both ESAS-TOT and ESAS-PSY cut-offs. Higher scores on the ESAS symptoms (except shortness of breath and lack of appetite) and on the CPC problems were found for ICD-10 cases and DCRP cases than for ICD-10 no-cases and DCPR no-cases. This study shows that ESAS had an optimal screening performance (84.8%) to identify ICD-10 psychiatric diagnosis, evaluated with MINI; furthermore, ESAS-TOT and ESAS-PSY cut-off points could provide a guide for clinical symptom management in KTRs.

Subsyndromal psychosomatic concepts and personality traits in community adults

ObjectiveTo investigate the prevalence of features of the Diagnostic Criteria for Psychosomatic Research (DCPR) in the Taiwanese community and to explore their relationships with psychological states and personality traits. MethodThe participants were 153 individuals without a DSM-5 psychiatric diagnosis who were grouped according to whether they had a DCPR diagnosis (at least one DCPR diagnosis, DCPR(+): n=66; no DCPR diagnosis, DCPR(−): n=87). The groups were compared with respect to psychological states (measured with Patient Health Questionnaire-15 [PHQ-15], Health Anxiety Questionnaire [HAQ], Beck Depression Inventory-II [BDI-II], Beck Anxiety Inventory [BAI)]) and personality (measured with Tridimensional Personality Questionnaire). Multiple logistic and linear regressions were used to examine associations among demographic, personality, DCPR, and psychological states. ResultsThe DCPR(+) group had higher BDI-II, BAI, PHQ-15 and HAQ scores than the DCPR(−) group and also had a higher anticipatory worry. The most common DCPR diagnoses were health anxiety (42.42%) and alexithymia (37.88%). Anticipatory worry was the variable most closely associated with all the DCPR diagnoses. Health anxiety was related to anticipatory worry and age, whereas alexithymia was associated with dependence and fatiguability. PHQ-15, HAQ, and BDI-II scores were related to health anxiety but not alexithymia. ConclusionDCPR has clinical utility in the community samples without DSM-5 diagnoses. DCPR may be a valid mediator between psychological trait and state.

Psychological Aspects of Primary Aldosteronism

Background: Except for 3 case reports of Conn’s syndrome presenting as depression, psychosocial factors have not been explored in primary aldosteronism. We investigated psychological correlates in primary aldosteronism using methods that were found to be sensitive and reliable in psychosomatic research. Method: Ten consecutive newly diagnosed patients with primary aldosteronism were studied: 5 males/5 females; mean age (±SD) 45.5 ± 6.6 years, age range 34–54 years; 4 with an aldosterone-producing adenoma and 6 with idiopathic aldosteronism; systolic/diastolic blood pressure 189 ± 20/111 ± 7.7 mm Hg; upright plasma aldosterone 40.0 ± 18.3 ng/dl; upright plasma renin activity (PRA) 0.2 ± 0.1 ng/ml/h; aldosterone/PRA ratio 229.2 ± 191.0; serum K⁺ 3.5 ± 0.5 mmol/l. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for eliciting psychiatric diagnoses, and a shortened version of the structured interview for subclinical psychological syndromes, the Diagnostic Criteria for Psychosomatic Research (DCPR), were administered. Results: Seven patients (2 with aldosterone-producing adenoma and 5 with idiopathic hyperaldosteronism) received both DSM-IV and DCPR diagnoses, while 3 had neither. As to DSM-IV, generalized anxiety disorder was detected in 6 cases (in 1 it was associated with panic disorder and in 1 with major depression) and obsessive-compulsive disorder in 1. The most frequent DCPR cluster was demoralization (5 cases), while persistent somatization occurred in 2 cases (associated with demoralization in 1) and irritable mood in 1. Conclusions: The occurrence of anxiety disorders in patients with primary aldosteronism was much higher than that found in the general population and in primary care. Since an association between hyperaldosteronism and anxiety has also been suggested in previous animal studies, it seems worthwhile to gain further knowledge on clinical aspects by larger population studies.

Integration of Multiple Criteria for Psychosomatic Assessment of Dermatological Patients

Psychological distress has been frequently reported in the setting of skin disorders. The Diagnostic Criteria for Psychosomatic Research (DCPR) have been found to yield valuable integrative information, in addition to DSM-IV nosology, in a variety of medical diseases. The aim of this study was to verify whether this integration could also be helpful in dermatology. A consecutive series of 539 inpatients with various skin conditions was evaluated by means of structured interviews for DSM-IV and DCPR diagnoses. The prevalence of DSM-IV conditions was 38% (mostly depressive disorders and anxiety disorders), whereas that of DCPR clusters (mostly demoralization and somatization secondary to psychopathology) was 48%. Overall, DCPR diagnoses were significantly more frequent than DSM-IV categories, regardless of the presence or absence of a psychiatric disorder. Psychological assessment of patients with skin diseases needs to incorporate both clinical (DSM-IV) and subclinical (DCPR) methods of classification. The health status of these patients can be improved if their psychological problems are appropriately assessed and recognized.

Prodromal Symptoms in Myocardial Infarction

Background: Little is known about the prodromal phase of myocardial infarction (MI). The aim of this study was to explore this phase with methodologies which have been standardized in affective disorders. The psychological evaluation of patients with MI diagnosis is currently based on DSM-IV criteria. An alternative diagnostic and conceptual framework has been proposed by an international group of psychosomatic investigators. In this study, we are going to compare these new criteria, i.e. the Diagnostic Criteria for Psychosomatic Research (DCPR), with DSM-IV in a population where a high prevalence of psychological problems is expected. Methods: A semistructured research interview based on Paykel’s Clinical Interview for Depression for eliciting prodromal symptoms was administered to a consecutive series of 92 patients with a first episode MI diagnosis. Two interviews for the evaluation of psychological problems were administered according to DSM-IV and DCPR criteria. Results: Most of the patients reported prodromal symptoms. Irritability, depressed mood and somatic anxiety were the most common prodromal symptoms. The results also show that the number of DCPR diagnoses was higher than the number of DSM-IV diagnoses. At least one DCPR diagnosis was found in all patients, whereas at least one DSM-IV diagnosis was present in 42 (46%) patients. Conclusions: The prodromal phase of MI was found to be characterized by prodromal symptoms of affective type. The joint use of DSM-IV and DCPR criteria was found to improve the identification of psychological factors which could affect this phase. The results should alert the physician to the fact that patients presenting with irritability, depressed mood (including demoralization), anxiety and insomnia may be at risk of developing coronary artery disease.

Use of the Diagnostic Criteria for Psychosomatic Research in Oncology

Background: Psycho-oncology literature has shown that 30–50% of cancer patients meet the criteria for a psychiatric diagnosis, according to the usual nosographic classification (e.g. DSM). The Diagnostic Criteria for Psychosomatic Research (DCPR) have been shown to be useful in identifying psychological constellations in patients with medical illness. The aims of the study were to compare the DSM-IV and the DCPR in their application to cancer patients. Method: One hundred and forty-six patients with cancer underwent semistructured interviews to assess psychiatric morbidity and psychosocial syndromes according to the DSM-IV and the DCPR, respectively. The Brief Symptom Inventory (BSI) was also used to assess psychological stress symptoms. Results: Sixty-five subjects (44.5%) met the criteria for a DSM-IV diagnosis (DSM cases), while 104 patients (71.2%) presented symptoms meeting the criteria for at least one DCPR syndrome. Three DCPR dimensions were more frequent than others, specifically Health Anxiety (37.7%), Demoralization (28.8%) and Alexithymia (26%). Among the subjects with no formal DSM-IV diagnosis (n = 81), 58% had at least one DCPR syndrome. DSM-IV cases had higher scores on several BSI subscales in comparison with patients with only one DCPR syndrome, while no difference was found in patients with more than one DCPR diagnosis. Conclusions: The DCPR system was found to be useful in oncology in investigating psychological conditions which are not identified by the DSM-IV alone. Assessment of more specific constructs, other than intensity of general stress symptoms, may give more specific information and help in tailoring psychological intervention for patients with cancer.

Diagnostic Criteria for Psychosomatic Research and Psychosocial Variables in Breast Cancer Patients

The aim of the study was to examine the relationship of the Diagnostic Criteria for Psychosomatic Research (DCPR) with psychosocial variables and quality of life among cancer patients. Of 105 women with breast cancer who participated in the study, 40 (38.1%) had symptoms meeting the criteria for at least one DCPR syndrome, and 30 (28.6%) had more than one DCPR syndrome. Health anxiety, demoralization, and alexithymia were the most frequent DCPR syndromes. Patients who were diagnosed with DCPR syndromes reported higher levels of cancer-related worries and poorer quality of life than those without a DCPR diagnosis. Analysis of the single DCPR clusters and coping with cancer indicated that health anxiety was related to higher scores on the Mini-Mental Adjustment to Cancer (Mini-MAC) anxious preoccupation subscale, DCPR demoralization was related to higher scores on the Mini-MAC hopelessness subscale, and DCPR alexithymia was related to higher scores on the Mini-MAC avoidance subscale. The study indicates the usefulness of the application of the DCPR in breast cancer, although further research is needed to improve the feasibility and internal validity of DCPR constructs.

Prediction of Treatment Outcome of Patients with Functional Gastrointestinal Disorders by the Diagnostic Criteria for Psychosomatic Research

Background: The Diagnostic Criteria for Psychosomatic Research (DCPR) have been demonstrated to be useful in identifying specific psychological conditions of medical patients. The aim of this study was to evaluate the clinical utility of the DCPR in predicting the treatment outcome of patients with functional gastrointestinal disorders (FGID). Methods: FGID outpatients were allocated to improved (n = 65) and unimproved (n = 40) groups on the basis of preestablished criteria following 6 months of treatment. Patients were administered the structured interview for DCPR at baseline and the Gastrointestinal Symptom Rating Scale both at baseline and follow-up. Results: In the unimproved patients, the prevalence of the DCPR categories of alexithymia (82.2%) and persistent somatization (72.5%) was significantly higher while health anxiety was more prevalent in improved patients (21.5%). No unimproved patient lacked a DCPR diagnosis while multiple DCPR diagnoses were significantly higher in the unimproved group (90%). In the regression analysis, alexithymia, persistent somatization, a higher number of DCPR diagnoses for each patient and, to a lesser extent, greater symptom severity at baseline were significant predictors of unimprovement. Health anxiety, even after controlling for gastrointestinal symptoms, was a significant predictor of improvement. Conclusion: The ability to predict treatment outcome indicates the clinical utility of the DCPR. Clinicians may improve treatment outcome for FGID patients by identifying particular psychosomatic syndromes (alexithymia, persistent somatization, and health anxiety) and patients with multiple DCPR clusters, and attempting to address specific therapeutic interventions.