Multiple Functional Somatic Syndromes Research Articles

The role of illness perception and behaviour in the treatment of adolescents with multiple functional somatic syndromes: A mediation analysis of AHEAD

The role of illness perception and behaviour in the treatment of adolescents with multiple functional somatic syndromes: A mediation analysis of AHEAD

Patient-tailored modular treatment of multiple functional somatic syndromes (STreSS-5): Observational cohort study of 174 consecutive patients

Patient-tailored modular treatment of multiple functional somatic syndromes (STreSS-5): Observational cohort study of 174 consecutive patients

Group-based Acceptance and Commitment Therapy (AHEAD) for adolescents with multiple functional somatic syndromes: A randomised trial.

Evidence for treatment of adolescents with multiple functional somatic syndromes (FSS) is sparse. This study examined the efficacy of 'Acceptance and Commitment Therapy for Health in Adolescents' (AHEAD), a generic group-based treatment for adolescents with co-occurrence of multiple FSS. A randomized trial was conducted at a specialized university hospital clinic. Adolescents (15-19years) with multiple FSS of at least 1year's duration were randomly assigned to AHEAD or enhanced usual care (EUC). AHEAD consisted of nine modules (i.e., 27h) and one follow-up meeting. Primary outcome was physical health (SF-36). Various secondary outcomes and treatment targets were included (e.g., symptom severity, symptom impact, and illness perception). A linear mixed-effects model was used for analysis. Trial-registration: ClinicalTrials.gov NCT02346071. Ninety-one patients were included. At 12months, no significant difference in physical health was identified between groups (mean adjusted difference 1.2 [95% CI -1.6 to 4.0], p=.404). However, different developments over time were seen with an interaction effect between intervention arm and time (χ2(5)=14.1, p=.0148). AHEAD patients (n=44) reported a clinically relevant improvement at end of treatment and at 8 and 12months, while EUC patients (n=47) displayed a clinically relevant improvement at 12months. Furthermore, AHEAD patients showed a faster improvement on symptom severity, symptom impact and illness perception. EUC patients received more psychological treatment outside the trial (p≤.001) than AHEAD patients. Treatment satisfaction with AHEAD was high in contrast to EUC. Compared with EUC, AHEAD had no additional advantage on the improvement of physical health at the primary endpoint of 12months. However, a faster improvement of physical health was seen in AHEAD and considerably more psychological treatment was received outside the trial in EUC with clinically meaningful improvements in both groups. The results underpin the importance of an organised and systematic treatment offer for the most severely affected youth.

P.0445 Group-based Acceptance and Commitment Therapy (AHEAD) for adolescents with multiple functional somatic syndromes: a randomised trial

P.0445 Group-based Acceptance and Commitment Therapy (AHEAD) for adolescents with multiple functional somatic syndromes: a randomised trial

Adolescents with functional somatic syndromes: Symptom profiles, illness perception, illness worry and attachment orientation

ObjectiveTo describe patterns of somatic symptoms, illness perception, illness worries and attachment in adolescents with functional somatic syndromes (FSS) in comparison with a population-based sample of adolescents. MethodsSelf-reported and clinical data were collected from two studies: 1) Adolescents aged 15-19 with multiple FSS of at least 1 year's duration (n = 91) from the trial AHEAD (Acceptance and Commitment Therapy for Health in Adolescents). 2) A sex-matched population-based sample of adolescents (n = 1573) derived from the 16-17-year follow-up of the Copenhagen Child Cohort 2000 (CCC2000), including a subgroup with high somatic symptom-load (n = 155). ResultsSymptom patterns were similar across groups, but somatic symptoms were approximately 2-3-fold more common in AHEAD compared to CCC2000, with the exception of neurological symptoms, i.e. ‘moving pain’, ‘unpleasant numbness or tingling sensation’ and ‘feeling of paresis’ which were 6.5-9.0 times higher in AHEAD. Adolescents from AHEAD reported considerably more negative illness perception and illness worry compared to both the CCC2000 sample and the high symptom subgroup. Levels of attachment avoidance and anxiety, respectively, were similar in AHEAD as compared with CCC2000 but lower compared to the high symptom subgroup of CCC2000. ConclusionSimilar symptom profiles in AHEAD and CCC2000 support the concept of a general (i.e. not syndrome-specific) factor for symptom development in FSS. Functional neurological symptoms may be useful indicators of clinical impairment. A high degree of negative illness perception and illness worry in youth may lead to healthcare seeking and should have a specific focus in assessment and treatment of youth with FSS.

Feasibility of group-based acceptance and commitment therapy for adolescents (AHEAD) with multiple functional somatic syndromes: a pilot study

BackgroundRecurrent and impairing functional somatic syndromes (FSS) are common in adolescents. Despite a high need for care, empirically supported treatments are lacking for youth. The aim of this uncontrolled pilot study was to assess feasibility and treatment potential of a new intervention with group-based Acceptance and Commitment Therapy (ACT) in a generic treatment approach for adolescents with multiple FSS.MethodsTwenty-one patients received ‘ACT for Health in Adolescents’ (AHEAD) (30 h), specifically developed for adolescents (aged 15–19 years) with moderate to severe FSS. Close relatives attended an information meeting to facilitate support of the patients throughout treatment. Treatment satisfaction was evaluated by means of self-report and relatives’ impressions. Self-reported physical health at 3 months follow-up (FU) after end of treatment was the primary outcome whereas secondary outcomes included symptom burden, limitation due to symptoms, illness worry, emotional distress and physical and emotional symptoms. Treatment targets were assessed by measures on illness behaviour, illness perception and psychological inflexibility.ResultsNineteen patients (90.5%) completed the treatment with a high overall attendance rate of 93%. All would recommend the treatment to a friend with similar problems. Close relatives rated it valuable to participate in an information meeting. Patients’ physical health improved significantly from assessment to FU with a clinically relevant mean change of 8.9 points (95% CI [5.4; 12.4]; SRM 0.91 [0.26;1.57]). Improvement was also seen on all secondary outcome measures, from assessment to FU. Maladaptive illness behaviours and perceptions as well as psychological inflexibility showed a significant decline from assessment to FU.ConclusionAHEAD was feasible and potentially efficacious and warrants testing in a larger clinical trial.Trial registrationClinical Trials gov NCT04464447, registration date July 9th, 2020. Retrospectively registered.

Prevalence of functional somatic syndromes and bodily distress syndrome in the Danish population: the DanFunD study.

Aims: Little is known about the prevalence and characteristics of functional somatic syndromes (FSS) such as irritable bowel syndrome (IBS), fibromyalgia (FM), chronic fatigue syndrome (CFS), whiplash associated disorders (WAD), multiple chemical sensitivity (MCS), and bodily distress syndrome (BDS) in the general population when they are investigated simultaneously. Method: This cross-sectional study is based on the Danish Study of Functional Disorders (DanFunD) cohort consisting of 9656 adults from the general population. FSS and BDS were identified by questionnaires and characterized by age, sex, vocational training, physical health and comorbidity with physical and psychiatric disease. Results: In total, 16.3% (95% CI: 15.6-17.1) of the participants fulfilled the criteria for at least one FSS, ranging from 1.7% for WAD to 8.6% for CFS, and 16.1% (95% CI: 15.4-16.9) fulfilled the criteria for BDS. Cases had a high risk of poor self-perceived health, limitations in daily activities, and a high psychiatric comorbidity, all increasing with the number of syndromes in each individual. However, the associations differed across the various FSS. Mutual overlaps of IBS, FM and CFS were greater than could be expected by chance. Conclusions: FSS and BDS are prevalent in the adult Danish population, and cases have high risk of poor self-perceived health, limitation in daily activities, and psychiatric comorbidity. These associations were particularly strong for cases with multiple FSS and multi-organ BDS.

“Understand your illness and your needs”: Assessment-informed patient education for people with multiple functional somatic syndromes

ObjectivesPatients suffering from multiple functional somatic syndromes (FSS) such as fibromyalgia, chronic fatigue syndrome, or irritable bowel syndrome, often lack both a clear diagnosis and tangible illness explanations, which is a barrier for treatment engagement. We tested a short-term intervention taking the unifying concept of Bodily Distress Syndrome (BDS) as a point of departure. The intervention consisted of a clinical assessment, group-based patient education, and one follow-up consultation. Methods174 patients were included and received questionnaires at baseline, after clinical assessment, after patient education, and median 19 weeks after baseline. Data were analyzed using random effects models and simple t-tests. Qualitative data were thematically analyzed. ResultsWe found small reductions in symptom levels, considerable reductions in illness worry, and improvement of illness perceptions and illness-related behaviors. Overall, patients evaluated the intervention positively and expressed high expectations for further treatment. Qualitative results mainly supported these findings. ConclusionTargeting illness perceptions through patient education is crucial to obtain patient engagement in self-help management or further treatment. This may lead to improved outcomes. Practical implicationsPhysicians in primary and secondary care should strive to give patients with multiple FSS a clear understanding that their various FSS diagnoses are related and provide tangible illness explanations.

Acceptance and Commitment group Therapy for patients with multiple functional somatic syndromes: a three-armed trial comparing ACT in a brief and extended version with enhanced care - CORRIGENDUM.

Acceptance and Commitment group Therapy for patients with multiple functional somatic syndromes: a three-armed trial comparing ACT in a brief and extended version with enhanced care - CORRIGENDUM - Volume 48 Issue 16

The use of prescription medication in 239 patients with multiple functional somatic syndromes.

To describe the use of prescription drugs and their association with patient characteristics in patients with multiple functional somatic syndromes (FSS) focusing on drugs generally recommended and not recommended in FSS treatment. Using data from a national prescription registry, we describe the drug use during a two-year period for 239 trial participants. Using regression models, we analyse the associations of patient characteristics with the patterns of use of antidepressants, anticonvulsants, opioids and sedatives. The use of prescription drugs was highly heterogeneous. Antidepressants were used at least temporarily by 34% (88/239), anticonvulsants by 7% (16/239), opioids by 26% (61/239) and sedatives by 20% (47/239) of the patients. Severe impairment due to multiple FSS was associated with use of opioids or sedatives (OR 6.49 (95% CI 2.68-15.68; p < 0.001)) but also with use of antidepressants or anticonvulsants (OR 3.42 (95% CI 1.35-8.65; p = 0.009)). Poor self-reported physical health, additional physical comorbidities and low socioeconomic status were associated with use of opioids or sedatives only. Antidepressants and anticonvulsants were modestly used. Opioids and sedatives were especially used by the severely affected patients. Balancing treatment expectations and enhancing patients' understanding of FSS may direct treatments towards more generally recommended drugs.

Physical comorbidity in patients with multiple functional somatic syndromes. A register-based case-control study

BackgroundPatients with multiple functional somatic syndromes show markedly reduced functioning and numerous somatic symptoms that cannot be explained by conventionally-defined physical disease. Whilst the comorbidity of functional somatic syndromes with mental disorders is well-known, knowledge about physical comorbidity and mortality is scarce. AimTo compare number of physical diseases between patients with multiple functional somatic syndromes (operationalized as multi-organ bodily distress syndrome) and the general population with regard to: 1) All conventionally-defined physical diseases, and 2) Severe mortality-associated physical diseases. Materials and methodsPatients with multiple functional somatic syndromes (n=239) were compared with age- and gender-matched population-based controls (n=5975). The number of physical diseases during a four-year period was estimated by means of registered ICD-10 codes in relation to hospital admissions and ambulatory care. We counted individual diagnoses indicating conventionally-defined physical disease based on a previously developed diagnosis sorting algorithm and an additional clinical evaluation, excluding unspecific (symptom) diagnoses and functional somatic syndromes. An updated version of Charlson Comorbidity Index (CCI12) was used to estimate severe, mortality-associated physical diseases. ResultsPatients with multiple functional somatic syndromes had an increased number of conventionally-defined physical disease compared to controls (Ratio: 2.17, 95% CI: 1.96–2.41). Groups were similar as regards CCI12 (P=0.55). ConclusionsPatients with multiple functional somatic syndromes showed substantial physical comorbidity. Their burden of severe, mortality-associated physical diseases was comparable to the general population. Further research is needed to clarify the nature, clinical significance, and long-term consequences of the comorbid physical diseases.

Imipramine versus placebo for multiple functional somatic syndromes (STreSS-3): a double-blind, randomised study

Functional somatic syndromes, including chronic fatigue syndrome or irritable bowel syndrome, often co-exist. Treatment guidelines supported by high quality evidence exist for most functional somatic syndromes, but are lacking for multiple comorbid functional somatic syndromes. We aimed to assess the effect of the tricyclic antidepressant, imipramine, in patients with multiple functional somatic syndromes defined by the criteria for multiorgan bodily distress syndrome, a unifying diagnosis that encompasses most functional somatic syndromes and somatoform disorders. In this single-centre, double-blind, randomised trial done in a Danish university hospital setting, participants were patients consecutively referred (age 20-50 years) fulfilling criteria for multiorgan bodily distress syndrome with no concurrent comorbid depression or anxiety disorder. Participants were randomly assigned (1:1) to receive either 10 weeks of low-dose imipramine or placebo (oral daily doses of 25-75 mg). The hospital pharmacy handled randomisation (computer-generated) and masking, providing sequentially numbered packs of study drug that were given serially to the participants. All others involved were masked to allocation. Primary outcome was patient-rated overall health improvement on a 5-point clinical global improvement scale. Improvement was defined as patients responding "better" or "much better" as opposed to "unchanged" and "worse" or "much worse" when rating their overall health status after 10 weeks of minimum 25 mg study drug. Analyses included patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT01518634. Between Jan 30, 2012, and Nov 24, 2014, 138 patients were randomly assigned; 70 to receive imipramine and 68 to receive placebo. The study was completed on May 1, 2015. 125 patients received at least one dose of study drug: 65 received imipramine and 60 received placebo. Treatment was terminated prematurely for eight (12%) patients receiving imipramine and seven (12%) patients receiving placebo. Data were missing for two (3%) patients receiving imipramine and three (5%) patients receiving placebo. Of the 120 patients (96%) who provided primary outcome data, 33 (53%) receiving imipramine reported their overall health status as "better" or "much better" compared with 14 patients (25%) receiving placebo. The improvement after imipramine was significantly greater than after placebo (odds ratio 3·3 [95% CI 1·6-6·8]; p=0·001). Number needed to treat was 3·6 (95% CI 2·3-8·9). Analysis of the worst-case scenario for patients with missing outcome did not change the interpretation of the results. 32 patients (49%) receiving imipramine and 10 patients (17%) receiving placebo had at least one adverse event of moderate intensity (p=0·0001); eight patients (12%) receiving imipramine and three patients (5%) receiving placebo had at least one adverse event of severe intensity (p=0·1496). One patient (1%) receiving placebo experienced a serious adverse event (a subdural haematoma sustained after an accident). Adverse events caused dropout in four patients (6%) receiving imipramine and three patients (5%) receiving placebo. Imipramine treatment compared with placebo significantly improved overall health in patients with multiple functional somatic syndromes when both treatments were supported by regular contacts with clinicians. Adverse events were more common in the imipramine group, but only rarely led to discontinuation of treatment. The Danish Foundation, Trygfonden.

The number of existing functional somatic syndromes (FSSs) is an important risk factor for new, different FSSs

ObjectiveThe objective of this study is to test the hypothesis that the number of functional somatic syndromes (FSSs) predicts new, additional FSSs. MethodsIn a recent case–control study of interstitial cystitis/painful bladder syndrome (IC/PBS), we used symptom-based consensus definitions to identify these FSSs: fibromyalgia (FM), chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), chronic pelvic pain, migraine, sicca syndrome and panic disorder. Those present before the incidence year were called antecedent FSSs; those with onset during the incidence year were called incident FSSs. In each of two groups, 312 IC/PBS cases and 313 controls, rates of incident FSSs were compared among those with 0, 1, 2, or ≥3 antecedent FSSs. Confounding was assessed using logistic regression analyses that included the individual antecedent FSSs, published correlates of these FSSs, and demographic variables. ResultsThe incidence of a new FSS increased with the number of antecedent FSSs, as did that of incident FM, CFS and IBS studied separately. These findings were not confounded by other variables. The presence of multiple antecedent FSSs generally had the highest odds ratio for new, different, incident FSSs. ConclusionsThis study revealed that the number of antecedent FSSs was among the strongest risk factors for other FSSs, especially incident FM, CFS and IBS. This suggests that the FSSs are linked through a polysyndromic phenotype. If each FSS is heterogeneous, to seek a pathogenesis common to all FSSs, individuals with multiple FSSs should be sought; to seek a pathogenesis unique to a specific FSS, mature persons who have only that FSS should be studied.

Assessment of somatization in temporomandibular disorders patients with functional somatic syndromes

PURPOSE: The present study addressed the prevalence of functional somatic syndromes (FSS) in temporomandibular disorders (TMD) patients and in control patients. We also investigated the overlap between history of FSS and psychometric data. PATIENTS AND METHODS: We evaluated sociodemographic characteristics, reports of previous FSS, and measures of depression and somatization as determined by the psychometric scales of the Symptom Checklist-90-Revised (SCL-90-R). Samples comprised 56 TMD patients and 103 controls who were routine dental patients. RESULTS: The reports of at least one FSS were significantly more prevalent in TMD patients than in control patients. The former group also reported significantly more frequent occurrences of multiple FSS. The median depression and somatization scores on the SCL-90-R were higher in TMD patients. TMD patients were significantly more frequently classified in the moderate and severe classes of the SCL-90-R somatization scale. The depression and somatization scores were significantly correlated. A significant and positive relationship between the number of reports of FSS and the somatization score was found in both TMD patients and in control patients. The depression score was significantly and positively linked with the incidence of FSS in the control group. CONCLUSION: TMD patients more frequently report FSS and multiple FSS than routine dental patients. Somatization of TMD patients can be assessed by inquiring as to their history of FSS.

Anxiety Disorder Presentations in Asian Populations: A Review

This article reviews typical anxiety presentations in Asia, and among Asian refugees. In Asia, there are multiple functional somatic syndromes that are common anxiety presentations. These distress syndromes often produce catastrophic cognitions about anxiety-type somatic and psychological symptoms. These functional somatic syndromes should be understood, and specifically assessed and addressed, in order to optimize the evaluation and treatment of anxiety disorders among Asian individuals.