Diagnostic Criteria For Psychosomatic Research Research Articles

Cognitive functioning and psychosomatic syndromes in a subjective tinnitus sample.

Tinnitus is the perception of a sound in the absence of any corresponding external sound source. Current research suggests a relationship among emotional, cognitive, and psychosomatic symptoms and the occurrence or maintenance of chronic tinnitus. This study aimed to detect the prevalence and role of psychosomatic conditions, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR), and cognitive functioning in a group of patients with tinnitus. Sixty-two patients with subjective tinnitus and 62 non-tinnitus controls were recruited from the Otorhinolaryngology Unit of the University of Bari. Pure-tone audiometry was performed in all tinnitus subjects, and sound level tolerance was evaluated. Additionally, tinnitus handicap (Tinnitus Handicap Inventory [THI]), psychopathological symptoms (Symptom Checklist-90, Revised [SCL-90-R]), anxiety (State-Trait Anxiety Inventory [STAI-Y1/2]), depression (Beck Depression Inventory [BDI]), cognitive impairment (Mini-Mental State Examination [MMSE]), executive functions (Frontal Assessment Battery [FAB]), and psychosomatic syndromes (DCPR) were evaluated. Parametric and non-parametric tests were used to detect cognitive and symptomatological differences between patients and controls. The predictivity of these factors for tinnitus severity was studied using multiple regression (Backward Elimination). All tests were considered significant at p < 0.05 (family wise error corrected for each comparison). 69.4% tinnitus patients met multiple DCPR criteria, compared to 32.3% of controls. Tinnitus patients exhibited elevated rates of illness denial (ꭓ2 = 9.02; p < 0.009), demoralization (ꭓ2 = 8.05; p < 0.018), somatization (ꭓ2 = 4.92; p < 0.063) and functional symptoms (ꭓ2 = 5.21; p < 0.06) scoring significantly higher on the BDI, STAI-Y1, and STAI-Y2, and SCL-90-R compared to controls. Patients with tinnitus showed lower MMSE scores, compared to controls (t = -2.282; p < 0.001). No association between tinnitus severity and global cognitive impairment emerged. Conversely, executive function deficits were associated to tinnitus severity. Among the cognitive and psychological factors, only trait anxiety, one or more psychosomatic syndromes, and somatization clusters were strongly correlated with tinnitus severity. Our findings suggest a relationship between tinnitus severity, psychological, psychosomatic symptoms, and frontal impairment. Additionally, the influence of tinnitus on cognitive functions paves the way for integrated, multidisciplinary diagnostic and treatment options for patients. Although preliminary, our findings highlight the importance of early cognitive and psychological screening to improve patients' quality of life.

Evaluation Criteria for Psychosomatic Practice

To diagnose and treat somatic disorders while considering psychosocial factors, medical and psychological practices require a comprehensive and operationalized list of criteria. The Evaluation Criteria for Psychosomatic Practice (ECPP) has been developed to address this need. It builds upon the updated version of the Diagnostic Criteria for Psychosomatic Research (DCPR) by incorporating significant psychodynamic factors and restructuring its framework to better cater to the practical demands of clinical assessment, diagnosis, treatment planning, and outcome monitoring. It offers four axes for clinical evaluation that can be used together or separately, depending on the needs of diagnostic process, treatment, informing the patient, or research: psychosomatic symptoms and complaints, risk factors related to personality structure, triggers, and secondary risk factors. By utilizing the ECPP’s four axes, clinicians can gain a deeper understanding of how psychosocial factors impact the clinical picture and dynamics of somatic disorders and then effectively communicate this knowledge to patients, improving compliance and collaboration in treatment. Additionally, the ECPP’s framework allows for a balance of psychological, physical, and social treatment interventions that can be tailored to the specific needs of the patient, ultimately leading to better treatment outcomes.

Clinimetric properties of the diagnostic criteria for psychosomatic research among the elderly.

Among the elderly, the availability of tool assessing psychosomatic syndromes is limited. The present study aims at testing inter-rater reliability and concurrent validity of the semi-structured interview for the Diagnostic Criteria for Psychosomatic Research (DCPR-R-SSI) in the elderly of the general population. One hundred eight subjects were recruited. Participants received a clinical assessment which included the DCPR-R-SSI, the Illness Attitude Scale (IAS), the Geriatric Depression Scale (GDS), the Psychosocial Index (PSI), the Toronto Alexithymia Scale-20 (TAS-20). Analyses of inter-rater reliability of DCPR-R-SSI and concurrent validity between DCPR-R-SSI and self-administered questionnaires were conducted. DCPR-R-SSI showed excellent inter-rater reliability with a percent of agreement of 90.7% (K Cohen: 0.856 [SE = 0.043], 95% CI: 0.77-0.94). DCPR-R demoralization showed fair concurrent validity with GDS; concurrent validity was also fair between DCPR-R Alexithymia and TAS-20, and between DCPR-R allostatic overload and PSI allostatic load, while the concurrent validity between DCPR-R Disease Phobia and IAS was moderate. DCPR-R-SSI represents a reliable and valid tool to assess psychosomatic syndromes in the elderly. DCPR-R is in need of being implemented in the elderly clinical evaluation.

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.

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.

Efficacy of group biofeedback treatment on hyperemesis gravidarum with psychosomatic symptoms diagnosed with the revised version of Diagnostic Criteria for Psychosomatic Research (DCPR-R): study protocol for a randomised controlled trial

IntroductionHyperemesis gravidarum (HG) is a condition characterised by dehydration, electrolyte imbalance, lack of nutrition and at least 5% loss in body weight, occurring in the first half of pregnancy. The...

Validation of Self-Assessed Form of Diagnostic Criteria for Psychosomatic Research Adapted from Diagnostic Criteria for Psychosomatic Research - Structured Interview.

Background:As the diagnostic criteria for psychosomatic research-structured interview (DCPR-SI) is a rater-assessed questionnaire, it has not been used vastly in community-based studies and clinics. Describing and investigating self-assessed form of DCPR are an attempt to apply it easier and more worthwhile for medical settings. The aim of this study was to describe and present self-assessed form of DCPR self-assessed (DCPR-SA) and test its validity and reliability.Materials and Methods:The DCPR-SI was translated to Persian according to the best practice methodology and the guideline for adaptation of self-report measures. In this cross-sectional study, 540 patients and healthy individuals were recruited and answered DCPR-SA and some related questionnaires. Inter-rater (test–interview) and test–retest reliability were determined. Construct, concurrent, discriminant, and known-group validity were tested.Results:The kappa coefficients were expressed substantial and almost perfect agreement (0.617–0.784, P ≤ 0.05). In addition, phi correlation coefficients were indicated adequate test–retest reliability for each cluster (0.548–0.754, P ≤ 0.05). Three domains (anxiety-related symptoms, functional symptoms, and dysfunctional traits and emotional patterns) were confirmed by factor analysis. The results of the discriminate validity analysis were promising.Conclusion:The findings show that the DCPR-SA is valid and reliable and can be used by medical professionals as a psychosomatic screening tool and can be used properly in Persian-speaking population.

Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis.

Although kidney transplant can lead to psychiatric disorders, psychosocial syndromes and demoralization, a positive post-traumatic growth (PTG) can occur in kidney transplant recipients (KTRs). However, the PTG-Inventory (PTGI), a reliable tool to measure PTG is scarcely used to explore the effect of this stressful event in KTRs. Thus, the purpose of our study was to assess the level of PTG and its correlation with demoralization, physical and emotional symptoms or problems via network analysis in KTRs. Additionally, we aimed at exploring the association of PTG with psychiatric diagnoses, Diagnostic Criteria for Psychosomatic Research (DCPR) conditions, and medical variables. A total of 134 KTRs were tested using MINI International Neuropsychiatric Interview 6.0 (MINI 6.0), DCPR interview, PTGI, Edmonton Symptom Assessment System (ESAS), Canadian Problem Checklist (CPC) and Demoralization scale (DS-IT). PTGI was used to investigate the positive psychological experience of patients after KT. It consists of 21 items divided in five factors. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. A symptom network analysis was conducted among PTGI, ESAS and DS-IT. Mean score of PTGI total of sample was 52.81 ± 19.81 with higher scores in women (58.53 ± 21.57) than in men (50.04 ± 18.39) (p < 0.05). PTGI-Relating to Others (16.50 ± 7.99) sub-score was markedly higher than other PTGI factor sub-scores. KTRs with DCPR-alexithymia or International Classification of Diseases, tenth revision (ICD-10) anxiety disorders diagnosis had lower PTGI total score and higher PTGI-Personal Strength sub-score, respectively (p < 0.05). The network analysis identified two communities: PTGI and ESAS with DS-IT. DS-IT Disheartenment, DS-IT Hopelessness and PTGI Relating to Others were the most central items in the network. After 1000 bootstrap procedures, the Exploratory graph analysis revealed the presence of a median of two communities in the network in 97.5% of the bootstrap iterations. A more extensive use of PTGI should be encouraged to identify and enhance the positive psychological changes after KT.

Diagnostic Criteria for Psychosomatic Research – revised version by Giovanni A. Fava and his research team

Diagnostic Criteria for Psychosomatic Research (DCPR), developed by a team of Italian and American researchers at the end of the 20th century, was elaborated and then revised based on observations and studies conducted by clinicians. In this paper, we present their current version known as DCPR-R. This classification system departs from the functional/organic dichotomy of disorders. The new criteria allow for the assessment of the role of multiple emotional/behavioural dimensions and responses in the functioning of an affected person. The revised version has four diagnostic modules, i.e., stress, illness behaviour, psychological manifestation, and personality. The authors introduced an additional factor to describe life experiences that contribute to stress (allostatic overload). Illness behaviours include health anxiety, disease phobia, hypochondriasis, thanatophobia, illness denial, persistent somatisation, conversion, and anniversary reaction. Irritable mood, somatic symptoms secondary to a psychiatric disorder and demoralisation are psychological manifestations. Type A behaviour pattern and alexithymia are considered personalityrelated factors. The authors of DCPR-R proposed a certain number of criteria to be met in order to diagnose each of these syndromes. The system makes it possible to clearly determine the presence of a given syndrome, but it does not allow to assess its severity. Psychosomatic syndromes play an important role in the development and/or course of somatic diseases. Inclusion of these syndromes in clinical diagnosis has made it possible to expand the spectrum of information about patient’s functioning, and, once they are diagnosed, offer appropriate psychological assistance, which will translate into an improvement in the quality of life.

Evaluation of Diagnostic Criteria for Psychosomatic Research (DCPR) and Type D personality in a psychiatric inpatient clinic

Amaç: Bu çalışma psikiyatri servisinde tedavi gören psikotik olan ve olmayan hasta gruplarını DCPR sendromları ve Tip D kişilik açısından karşılaştırmayı, hastalık şiddeti ile Psikosomatik Araştırmalar için Tanı Ölçütleri(DCPR) sendromları ve Tip D kişilik arasında anlamlı bir ilişki olup olmadığını araştırmayı amaçlamıştır.&#x0D; Gereç ve Yöntem: Çalışmaya Gazi Üniversitesi Tıp Fakültesi Psikiyatri servisinde yatmakta olan 200 erişkin hasta alınmıştır. Hastalar psikotik olan (n:98) ve olmayan (n:102) şeklinde gruplandırılmıştır. Katılımcılara Sosyodemografik Veri Formu, Kısa Psikiyatrik Değerlendirme Ölçeği(KPDÖ), Tip D kişilik ölçeği ve DCPR Sendromları için yarı yapılandırılmış klinik görüşme uygulanmıştır.&#x0D; Bulgular: Ölüm Korkusu ve Süreğen Somatizasyon sendromlarının psikotik olmayan grupta anlamlı oranda yüksek olduğu saptanmıştır. Tip D kişiliği oluşturan alt bileşenler gruplar arasında ayrı ayrı değerlendirildiğinde, Olumsuz Duygulanım puanlarının psikotik bozukluğu olmayanlarda anlamlı düzeyde yüksek olduğu görülmüştür. Psikotik bozukluğu olanlarda KPDÖ puanları ile Ölüm Korkusu, Psikiyatrik Bozukluğa İkincil İşlevsel Somatik Belirtiler, Demoralizasyon ve Tip D kişilik varlığı arasında anlamlı bir ilişki saptanmıştır. &#x0D; Sonuç: DCPR ile değerlendirilen hastalar psikotik olup olmamalarına göre farklı DCPR sendromları tanılarını daha fazla oranda almışlardır. Psikotik Bozukluğu olanlarda DCPR sendromları hastalığın şiddetini göstermede bir yordayıcı olabilir.

PSYCHOLOGICAL DISTRESS, PSYCHOSOMATIC SYNDROMES AND PSYCHOLOGICAL WELL-BEING IN MASKED HYPERTENSION

Objective: In patients affected by masked hypertension psychological variables have been poorly investigated so far. Some authors found an association of masked hypertension with hypochondria and/or depression. Studies on the relationship between masked hypertension and stress focused on stressors at work ignoring chronic/acute stressful life events related to other contexts. This research aims to understand psychological, psychosomatic and well-being characteristics among patients with masked hypertension. Design and method: 10 patients with masked hypertension, enrolled at the Division of Internal Medicine, were assessed. They were administered both observer- (interviews on clinical psychological distress and psychosomatic syndromes) and self-rated (questionnaires on subclinical distress and well-being) measures. Results: 40% of patients reported at least one depressive disorder (30% past major depressive episode and 20% persistent depressive disorder) and 40% at least one anxiety disorder (30% generalized anxiety, 10% panic and 10% social anxiety). 50% showed illness behaviour, 20% psychological manifestations and 20% personality syndrome. Only 30% of patients did not report a diagnosis of either Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or Diagnostic Criteria for Psychosomatic Research (DCPR). 20% of the sample reported only one psychosomatic syndrome (somatization and conversion syndromes). The mean levels of psychological well-being were significantly lower in masked hypertension patients than those of the general population: autonomy (29.9 ± 6.87 versus 37.14 ± 6.96), environmental mastery (26.70 ± 2.75 versus 38.15 ± 7.41), personal growth (32.10 ± 3.93 versus 38.40 ± 6.93), positive relations (31.20 ± 4.92 versus 40.57 ± 6.96), purpose in life (26.72 ± 5.32 versus 38.40 ± 6.98) and self-acceptance (25.80 ± 5.37 versus 38.12 ± 8.20). The mean scores Psychosocial Index subscales were significantly higher than those reported by the general population: psychological distress (13 ± 6.43 versus 5.54 ± 3.60), abnormal illness behavior (1.10 ± 1.20 versus 0.50 ± 0.82) and stress (4.40 ± 1.51 versus 2.30 ± 1.81). On the contrary, the mean scores of well-being dimension were significantly lower (6 ± 1.33 versus 7.42 ± 1.64). Conclusions: A high percentage of patients with masked hypertension showed high levels of psychological and psychosomatic distress. A psychosomatic assessment including both distress and psychological well-being impairments should be implemented in patients with masked hypertension in order to recognize potential vulnerability factors for both medical and psychiatric syndromes.

Epilepsi Hastalarında Yaşam Kalitesine Psikosomatik Açıdan Yaklaşım

Aim: The aim of this study was to evaluate psychosocial functionality in patients with epilepsy using the Diagnostic Criteria for Psychosomatic Research (DCPR) classification system that aims to identify patients with clinically significant and relatively weighted psychological factors and to compare it with the Diagnostic and Statistical Manual of Mental Disorders (DSM). In addition, it was aimed to validate the DCPR system by investigating the effects of psychosomatic diagnoses on the quality of life in the disease process. Materials and Methods: One hundred consecutive patients with epilepsy who were referred to the Epilepsy special branch outpatient clinic were included in the study. The control group consisted of 53 healthy volunteers. All participants underwent structured DCPR and SCID-I interviews and were investigated using the Short Form-36 (SF-36) and a Sociodemographic Data Form. Results: Eighty-seven percent of the patients met the diagnostic criteria with the DCPR system while 82% of the patients met the diagnostic criteria with DSM (χ2(1, N =100) = 4.539, p = 0.04). Examination of the effect of diagnostic systems on SF-36 scores in patients with epilepsy with the hierarchical regression model showed that diagnoses in the DCPR system predicted most of the SF-36 subscale scores better. Conclusion: The DCPR system could detect psychological distress at a higher rate than DSM in patients with epilepsy. Syndromes in the DCPR classification were associated with poor quality of life in the patients. The DCPR classification is therefore valid in patients with epilepsy and may have advantages in a more comprehensive evaluation of patients.

Therapeutic approaches in psychosomatic medicine from a biopsychosocial perspective

Psychosomatic medicine is an interdisciplinary field of medicine that focuses on the interaction of biological, psychological, social and behavioral factors in the genesis of a disorder. A key element of the psychosomatic view is the effect of stress on the homeostatic dysregulation and the consequent emergence of symptomatology. The fields of intervention in psychosomatic medicine include health behavior modifications, a general psychosomatic approach, psychotherapy and pharmacotherapy. Assessment strategies include the Diagnostic Criteria for Psychosomatic Research. Psychotherapeutic strategies, such as cognitive-behavioral therapy, wellbeing therapy, mindfulness-based stress reduction as well as other therapeutic interventions, such as biofeedback, have several indications with regards to psychosomatic illnesses. According to various literature reports, most of these interventions have a positive effect on brain neuroplasticity and the reduction of allostatic load, often through epigenetic mechanisms. Psychotherapy has also been shown to bring on structural and functional changes to the brain through learning mechanisms and long-term potentiation (LPT). Epigenetic mechanisms may be potential targets of psychotherapeutic interventions. Psychopharmacology is also a frequently used intervention in the psychosomatic field. However, we should be aware of the fact that psychopharmacological interventions may produce adverse effects that may in turn exacerbate physical illness, and also somatic pharmacological interventions may cause psychiatric side effects. The beneficial roles of the social support network and eudaemonic well-being are also highlighted. Moreover, the recent emergence of epigenetic drugs has shown promising results in preclinical studies of idiopathic mental disorders. The goal of the biopsychosocial approach is to promote a humanitarian, holistic care and improve the health of the individual. The cornerstone of the implementation of this holistic approach is the presence of an interdisciplinary team that should collaborate with the patient in order to provide thorough information on diagnosis, therapy and prognosis of psychosomatic illness.

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 &gt; 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 &lt; 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 Symptom Severity in Chronic Psoriasis.

ObjectiveTo investigate whether and the extent to which psychosomatic syndromes and psychopathology are associated to psoriasis severity.MethodConsecutive 282 outpatients with chronic psoriasis were assessed for psychopathology (with the Mini International Neuropsychiatric Interview), psychosomatic conditions (with the Diagnostic Criteria for Psychosomatic Research, DCPR), severity of psoriatic symptoms (with the Psoriasis Area and Severity Index, PASI), and illness-related quality of life (with the Dermatology Life Quality Index, DLQI).ResultsPsychopathology was diagnosed in 26.6% patients while at least one DCPR syndrome in 67% of them and higher psychosomatic severity (>1 DCPR syndrome) in 29.1%. Higher symptom severity (PASI>20) was significantly more prevalent in patients with greater psychosomatic severity (29.1%) (d=1.25) – particularly, alexithymia (29.4%; d=0.83) – and poorer quality of life (DLQI>10) (d=0.86). Furthermore, after controlling for psychopathology, psychosomatic severity, and alexithymia, together with lower illness-related quality of life, independently predicted severity of symptoms, with large effect size (d=0.78 and d=1.75, respectively).ConclusionsDCPR clusters can be suggested as a useful tool for identifying psychological distress in psoriasis, significantly linked to both subjective (quality of life) and objective factors (severity of lesions and extension of affected skin areas) of the illness experience.

Incremental Validity Of The Diagnostic Criteria For Psychosomatic Research – Revised (DCPR-R) To Clinical Assessment In Primary Care

Psychosocial problems are highly prevalent among primary care (PC) patients, but they often remain undetected using traditional classification systems. The aim of the present study was to test the incremental validity of the revised version of the Diagnostic Criteria for Psychosomatic Research (DCPR-R), in addition to standard psychiatric assessment based on DSM-5, with regard to the prediction of psychosocial functioning of PC patients. Two-hundred PC patients were consecutively recruited. A comprehensive assessment was performed using two clinical interviews and three self-rating questionnaires (the PsychoSocial Index [PSI], the Short-Form Health Survey [SF-12] and the Illness Attitude Scales [IAS]) for the assessment of psychopathology and psychosocial functioning. Adding the DCPR-R to DSM-5, the amount of explained variance significantly increased by 9% to 16% in the PSI subscales, by 13% in the SF-12 mental component summary, and by 2% to 6% in the IAS scales. The joint use of DCPR-R and DSM-5 thus significantly increased the prediction of psychosocial functioning of primary care patients. These findings further support the use of the DCPR-R in PC settings, particularly in patients who do not satisfy DSM-5 criteria and yet present with high psychological distress, maladaptive illness behavior, impaired psychological well-being and quality of life.

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.

Suicidal risk and demoralization in Parkinson disease.

We aimed to determine suicide risk and lifetime suicidal ideation in Parkinson disease (PD) patients versus controls and how depression, demoralization, and insomnia are associated with suicidality. In this case-control study, PD patients and matched controls were recruited from movement disorder clinics, Michael J. Fox Foundation, and Research Match websites. Suicide risk and suicidal ideation were assessed using the Suicidal Behavior Questionnaire-revised (SBQ-R) and Columbia-Suicide Severity Rating Scale. Lifetime depression was assessed using the Brief Lifetime Depression Scale, sleep using Insomnia Severity Index (ISI), demoralization using Diagnostic Criteria for Psychosomatic Research and Kissane Demoralization Scales, and non-motor symptoms using UPDRS Non-Motor Aspects of Experiences of Daily Living scale (nM-EDL). 186 PD participants and 177 controls were matched for age (64.2 ± 7.7years), sex (48.8% female), and socioeconomics. PD participants were not more likely than controls to have high suicide risk (SBQ-R ≥ 7) (7.5% vs. 11.3%; p = 0.22) or to have had a lifetime suicide plan or attempt (2.7% vs. 5.1%; p = 0.24), but were less likely to have had lifetime suicidal ideation (23.1% vs. 35.0%; p = 0.01). PD participants were more likely than controls to have lifetime depression history (34.4% vs. 20.9%; p = 0.004), and demoralization (19.9% vs. 10.7%; p = 0.02), and had higher ISI scores (8.7 ± 5.8 vs. 5.1 ± 4.5; p < 0.0001). PD patients with high versus normal suicide risk had higher nM-EDL scores (16.5 ± 6.8 vs. 10.7 ± 5.9; p = 0.002), and more demoralization (71.4% vs. 21.5%; p < 0.0001). Suicide risk is not elevated and suicidal ideation is uncommon in PD, despite the high prevalence of depression and demoralization.

Psychosomatic Rehabilitation: An Overview

Psychosomatic Rehabilitation: An Overview Abstract. Psychosomatic Medicine is based on the shared understanding that physical illnesses can have a multi-factorial aetiology, whereby biological, psychological and social factors interact to cause and maintain physical and mental symptoms and complaints. Commonly implicated aetiological factors in psychosomatic disorders are physical and / or psychological stress, inflammation and degeneration, and the resulting symptoms can manifest themselves in different organ systems, such as: the nervous system, the musculoskeletal system, the cardiovascular system, the respiratory system, the gastrointestinal system and the skin. In order to create a model of psychosomatic symptoms that would allow for a systematic classification of psychosomatic disorders, the Diagnostic Criteria for Psychosomatic Research (DCPR) were developed in 1995. Given that biological, psychological and social factors can interact to cause and maintain physical and mental symptoms and complaints, psychosomatic therapies and rehabilitation are usually provided in multidisciplinary settings, where professionals from different disciplines (physicians, psychologists, osteopaths, physiotherapists and occupational therapists) work as a team. If no interdisciplinary treatment and process organisation close to the patient's home is available for an outpatient setting, psychosomatic rehabilitation is usually carried out in an inpatient setting. The rehabilitation process is organised in several steps: Assessment (1); Conceptualisation (2); Goal planning (3); Interdisciplinary rehabilitation (4); Re-assessment (5); Discharge planning. The clinical effectiveness of inpatient psychosomatic rehabilitation has been documented in several Austrian and German studies. Following discharge, the patient is usually offered a continuation of the rehabilitation as an outpatient.

Emotional Suppression and Oneiric Expression in Psychosomatic Disorders: Early Manifestations in Emerging Adulthood and Young Patients.

BackgroundThe function of emotions, beginning from the proto-emotions, is the adaptation to the environment. This is based on the Homeorhesis, the equilibrium due to the adaptive operation of excitement and the dissipation of emotions. The object relations of the participants foresee the practice of defense mechanisms in a continuum that goes from the consciousness to the oneiric activities. The predominant and maladaptive use of defense mechanisms in the psychosomatic phenomenology, can be identified with deficits in emotional awareness, with the impossibility to manage excitement and dissipation of emotions foreseen by the oneiric phenomena.MethodsThe observation group is composed by 140 participants, 56 males (43%) and 84 females (57%),with pathological-functional disorders of psychosomatic domain. The study had been conducted with the use of measures related to the conscious defense of suppression (Suppression Mental Questionnaire), to the emotional awareness linked to the psychosomatic phenomena (Diagnostic Criteria for Psychosomatic Research Structured Interview-DCPR-SI) and to the states of perturbation and conservation of oneiric activities (The Manheim Dream Questionnaire-MADRE).ResultsSignificant inverse correlations emerged among rationalization, repressive function and illness Denial, as for the suppression mental questionnaire factors and irritable mood, but for Regression in the service of the Ego; inverse and significant correlations emerged among suppression, repressive function, rationalization and gastrointestinal psychosomatic outcomes and among suppression, repression and cardiological psychosomatic outcomes. Regarding alexithymia, a positive correlation emerged with rationalization and inverse with Regression in the service of the Ego. Positive correlations emerged between illness denial and overall emotional tone, for disease phobia and meaningfulness and for cardiological psychosomatic outcomes and nightmare distress and recurring nightmares.ConclusionThe study of such outcomes due to a prevalent defensive style based on suppression, suggest the identification of a key phenomenon, which translates into maladjustment that goes from functional disorders to parasomnia. The bridge established by the obfuscation of conscious contents until the manifestations of disturbance of ancient activities such as oneiric ones, expresses the need to transform an emotional maladaptive style, in line with classic literature and the current state of art.