Diagnostic Criteria For Psychosomatic Research Syndromes Research Articles

Psychosomatic syndromes are associated with IL-6 pro-inflammatory cytokine in heart failure patients.

Psychosomatic syndromes have emerged as an important source of comorbidity in cardiac patients and have been associated with increased risk for adverse outcomes in patients with heart failure (HF). Understanding of the mechanisms underlying this connection is limited, however immune activity represents a possible pathway. While there have been numerous studies connecting immune activity to psychosomatic psychopathology, there is a lack of research on patients with HF. We examined forty-one consecutive outpatients affected by HF. We assessed psychosomatic psychopathology using the Diagnostic Criteria for Psychosomatic Research (DCPR) and the Patient Health Questionnaire-15 (PHQ-15). The Psychosocial Index (PSI) was used for assessing stress and psychosocial dimensions. Depression was evaluated with Beck Depression Inventory-II (BDI-II). Circulating levels of proinflammatory cytokines IL-6 and TNF-alpha were ascertained. Univariate and multivariable regression models were used to test for associations between inflammatory cytokines and psychosomatic psychopathology (i.e., DCPR syndromes, PHQ-15) and psychological dimensions (i.e., BDI-II, PSI). A significant positive correlation was found between IL-6 levels and psychosomatic psychopathology even when controlling for any confounding variables (i.e., Body-mass index (BMI), New York Heart Association (NYHA) class, smoking habits, alcohol consumption, statin use, aspirin use, beta blockers use, age, and gender). In contrast, the associations between TNF-alpha levels were non-significant. These findings can contribute to research in support of a psychoneuroimmune connection between psychosomatic psychopathology and HF. Findings also suggest the possibility that elevated IL-6 levels are more relevant for the pathogenesis of psychosomatic syndromes than for depression in patients with HF.

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.

Psychosomatic syndromes and anorexia nervosa

BackgroundIn spite of the role of some psychosomatic factors as alexithymia, mood intolerance, and somatization in both pathogenesis and maintenance of anorexia nervosa (AN), few studies have investigated the prevalence of psychosomatic syndromes in AN. The aim of this study was to use the Diagnostic Criteria for Psychosomatic Research (DCPR) to assess psychosomatic syndromes in AN and to evaluate if psychosomatic syndromes could identify subgroups of AN patients.Methods108 AN inpatients (76 AN restricting subtype, AN-R, and 32 AN binge-purging subtype, AN-BP) were consecutively recruited and psychosomatic syndromes were diagnosed with the Structured Interview for DCPR. Participants were asked to complete psychometric tests: Body Shape Questionnaire, Beck Depression Inventory, Eating Disorder Inventory–2, and Temperament and Character Inventory. Data were submitted to cluster analysis.ResultsIllness denial (63%) and alexithymia (54.6%) resulted to be the most common syndromes in our sample. Cluster analysis identified three groups: moderate psychosomatic group (49%), somatization group (26%), and severe psychosomatic group (25%). The first group was mainly represented by AN-R patients reporting often only illness denial and alexithymia as DCPR syndromes. The second group showed more severe eating and depressive symptomatology and frequently DCPR syndromes of the somatization cluster. Thanatophobia DCPR syndrome was also represented in this group. The third group reported longer duration of illness and DCPR syndromes were highly represented; in particular, all patients were found to show the alexithymia DCPR syndrome.ConclusionsThese results highlight the need of a deep assessment of psychosomatic syndromes in AN. Psychosomatic syndromes correlated differently with both severity of eating symptomatology and duration of illness: therefore, DCPR could be effective to achieve tailored treatments.

Clinical configuration of cyclothymic disturbances

While there is an increasing recognition of the role of subthreshold symptomatology in bipolar disorder, little attention has been dedicated to its only formally acknowledged subtype, cyclothymic disorder. The aim of this investigation was to provide a controlled evaluation of DSM-IV cyclothymic disorder by using a broad assessment strategy geared to subclinical signs. Sixty-two patients who met the DSM-IV criteria for cyclothymic disorder and did not present comorbidity with other mood disorders, alcohol and drug abuse, and borderline personality disorder and 62 control subjects matched for sociodemographic variables were administered the Structured Interview for Diagnostic Criteria for Psychosomatic Research (DCPR), the Clinical Interview for Depression (CID) and the Mania Scale (MAS). In DSM-IV terms, there was an overlap with anxiety disorders in more than half of the cases. About 3 patients out of 4 were found to present with at least one DCPR syndrome (particularly demoralization and irritable mood). Cyclothymic patients displayed significantly higher levels of depressive and anxiety disturbances on the CID, with particular reference to reactivity to social environment. They also had significantly higher scores on the MAS. The study was cross-sectional and the sample, because of the exclusion criteria, may not be representative of the clinical populations in psychiatric settings. In our patients with cyclothymia, without comorbidity with major mood disorders, DSM-IV anxiety disorders, psychosomatic clinical syndromes (irritable mood, demoralization) and subclinical symptoms such as reactivity to social environment resulted to be more frequent than in controls. The use of a broad assessment strategy aimed at subclinical symptomatology may help identifying clinical phenomena that cut across the current definition of subthreshold forms of bipolar disorder.

Criteria for Psychosomatic Research (DCPR) in the Medical Setting

The Diagnostic Criteria for Psychosomatic Research (DCPR) represent a diagnostic and conceptual framework that aims to translate psychosocial variables derived from psychosomatic research into operational tools whereby individual patients can be identified. A set of 12 syndromes was developed: disease phobia, thanatophobia, health anxiety, illness denial, persistent somatization, functional somatic symptoms secondary to a psychiatric disorder, conversion symptoms, anniversary reaction, irritable mood, type A behavior, demoralization, and alexithymia. The aim of this article is to survey the research evidence that has accumulated on the DCPR in several clinical settings (cardiology, oncology, gastroenterology, endocrinology, primary care, consultation psychiatry, nutrition, and community), to examine prevalence and specific diagnostic clusters of the more prevalent DCPR syndromes, and to review their clinical utility in terms of clinical decision, prediction of psychosocial functioning, and treatment outcomes. The implications for classification purposes (DSM-V) are also discussed.

Psychosocial Functioning in Consultation-Liaison Psychiatry Patients: Influence of Psychosomatic Syndromes, Psychopathology and Somatization

Background:This study investigated whether the Diagnostic Criteria for Psychosomatic Research (DCPR) were able to predict psychosocial functioning in addition to psychiatric diagnoses and somatization in consultation-liaison psychiatry (CLP) patients. Method: A consecutive sample of 208 CLP patients were recruited and assessed for sociodemographic and medical data, psychopathology (SCID), psychosomatic syndromes (DCPR structured interview) and somatization (SCL-90-R SOM scale and multisomatoform disorder, MSD). The main endpoints were the mental and physical components of psychosocial functioning (SF-36). Results: A total of 185 (89%) patients had any psychiatric diagnosis, 51 (25%) had MSD positive criteria, 176 (85%) had any DCPR syndrome, and 105 (51%) had multiple DCPR syndromes. Although psychiatric and psychosomatic syndromes were variously associated with psychosocial functioning, hierarchical regression and effect size analyses showed that only DCPR syndromes, particularly demoralization and health anxiety, with somatization but not DSM-IV psychopathology independently predicted poor psychosocial functioning. Conclusions:The presence of psychosomatic syndromes, assessed with DCPR criteria, and high levels of somatization had larger effect size and were independent predictors of the mental and physical components of psychosocial dysfunction, over and above psychopathology. The DCPR classification can provide CLP professionals with a set of sensitive diagnostic criteria for a comprehensive clinical evaluation of psychosomatic syndromes that might play a significant mediating role in the course and the outcome of medical patients referred for psychiatric consultation.

Psychosomatic characterization of adjustment disorders in the medical setting: Some suggestions for DSM-V

Background Adjustment disorders have been found to be the most frequent psychiatric diagnosis in the medically ill. Problems have been raised, however, as to their clinical value. The aim of the study was to characterize the psychosomatic features of adjustment disorders. Methods One hundred patients with medical illness and a diagnosis of adjustment disorder according to DSM-IV criteria were interviewed according to the Diagnostic Criteria for Psychosomatic Research (DCPR) system, consisting of 12 clusters. Results A considerable overlap was shown between adjustment disorders and DCPR clusters related to abnormal illness behavior (health anxiety, tanatophobia, nosophobia and illness denial) (54%), somatization (functional somatic symptoms secondary to a psychiatric disorder, persistent somatization, conversion symptoms and anniversary reaction) (37%) and demoralization (33%). Only 13 of the patients with adjustment disorders did not present any DCPR syndromes. Limitations The study is cross-sectional and does not allow to determine the prognostic features of DCPR categorization. Conclusion The clinical information which derives from the concomitant application of the DCPR might improve and make more specific the treatment of patients with adjustment disorders.

Use of the Diagnostic Criteria for Psychosomatic Research (DCPR) in a Community Sample

The authors assessed the prevalence of Diagnostic Criteria for Psychosomatic Research (DCPR) clusters in a community sample and the association between these syndromes and psychosocial variables. A group of 347 consecutive subjects from the general population were administered the semistructured interview for DCPR and a self-rating scale (the Psychosocial Index). A DCPR syndrome was identified in 59% of subjects. These subjects showed more stress and distress and less well-being than those without a DCPR syndrome. Some DCPR syndromes (alexithymia, Type A behavior, irritable mood) are frequently encountered in a community sample and are associated with impairment in quality of life. Other syndromes (demoralization, persistent somatization) that have been frequently found in medically ill persons were uncommon in this general-population sample.

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.

Interrater Reliability, Prevalence, and Relation to ICD-10 Diagnoses of the Diagnostic Criteria for Psychosomatic Research in Consultation-Liaison Psychiatry Patients

The Diagnostic Criteria for Psychosomatic Research (DCPR) have been proposed by an international group of psychosomatic investigators as an operationalized tool for the assessment of psychological distress in medical patients. The aims of the present study were to evaluate interrater reliability, the distribution of DCPR syndromes, and their relationship with ICD-10 diagnostic categories. One hundred consecutive patients who were referred for psychiatric consultation in a university general hospital consented to assessment for DCPR syndromes as elicited in a joint interview conducted by two researchers. The results showed excellent interrater agreement, with kappa values for the 11 DCPR syndromes ranging from 0.69 to 0.97. More patients met criteria for one or more of the DCPR (87%) than for an ICD-10 diagnosis (75%). Four DCPR syndromes were particularly prevalent: demoralization, alexithymia, illness denial, and type A behavior. DCPR criteria appear to be a useful, reliable, and promising approach in the assessment and description of psychological distress in medical patients. They may serve as a focus of intervention studies in this population.