Somatic Illness Research Articles

The Boundaries of Medicine

A valid concern regarding medicine in society is the medicalization of social deviance as a form of social control. Peter Conrad writes about this concern as we become more dependent on physician judgement of what is and isn’t illness. We are faced with determining what is inside and outside the realm of medicine, and what the limits of medical involvement should be. I explore two instances that reveal that medicine should be involved in cases of human suffering, though should never carry all the societal burdens of alleviating suffering. Whether or not medicine should be involved in mental illness is a view contested by Thomas Szasz in an argument that aims to establish that mental illness is outside the realm of medicine. His argument relies on the clear separation between somatic and mental illnesses, which I show are not clearly separated at all. Ultimately, I argue that as complex—and undoubtedly human—as the practice of medicine is, it is a discipline with a wide array of applications that are critically important for treating mental illness.

Satisfaction of 30 402 callers to a medical helpline of the Emergency Medical Services Copenhagen: a retrospective cohort study

ObjectivesTo keep healthcare systems sustainable for future demands, many countries are developing a centralised telephone line for out-of-hours primary care services. To increase the quality of such services, more information...

A Qualitative Study of Caregivers\u2019 Experiences, Motivation and Challenges Using a Web-Based Mindfulness Intervention

Caregivers report experiences of stress and burden that can affect their health negatively. Web-based mindfulness interventions have shown beneficial health effects in clinical and non-clinical populations, including caregivers. The study’s aim was to explore the experiences of a web-based mindfulness program, including motivation and challenges to use, in caregivers of a person with somatic illness. Ten participants were interviewed. Data was analyzed with content analysis, resulting in four categories illustrating the participants’ experiences of the program, including motivations and barriers to training: A timely or untimely intervention; Mainly positive effects even at low levels of training; Relationship to the patient; and Creating a routine and maintaining motivation. Qualitative studies can contribute to enrich our understanding of the value of such interventions, which may be a flexible supportive tool for caregivers. The findings illuminate the importance of supporting motivation and adherence to such interventions, with the potential for enhanced beneficial outcomes.

Anxiety disorders and medical illness comorbidity and treatment implications.

To review recent studies which assess comorbidity, that is, prevalence of co-occurrence, relationships and treatment implications between anxiety disorders and various medical illnesses. The prevalence rates of anxiety disorders in patients with medical illnesses are high, with percentage up to 29% in patients with epilepsy, 48.9% in patients with multiple sclerosis, 30.1% in patients with Parkinson's disease, 30% in patients with cardiovascular disease, 47.0% in patients with diabetes mellitus, and so on. The most prevalent anxiety disorders among individuals with somatic illnesses are generalized anxiety disorder and panic disorder. In addition, various medical illnesses are highly prevalent in samples of patients with anxiety disorders. Anxiety disorders co-occurring with medical illnesses have a number of clinical implications, including a greater severity and negative impact on treatment outcome of both medical illnesses and anxiety disorders. It is important for clinicians to look for possible anxiety disorders among patients with medical illnesses. Further studies need to ascertain how to best treat individuals suffering from both anxiety disorders and medical illnesses, and focus on the issue of causality when these conditions co-occur.

Supporting elderly people with cognitive impairment during and after hospital stays with intersectoral care management: study protocol for a randomized controlled trial

BackgroundThe sectorization of health-care systems leads to inefficient treatment, especially for elderly people with cognitive impairment. The transition from hospital care to primary care is insufficiently coordinated, and communication between health-care providers is often lacking. Consequences include a further deterioration of health, higher rates of hospital readmissions, and institutionalization. Models of collaborative care have shown their efficacy in primary care by improving patient-related outcomes. The main goal of this trial is to compare the effectiveness of a collaborative care model with usual care for people with cognitive impairment who have been admitted to a hospital for treatment due to a somatic illness. The aim of the intervention is to improve the continuity of treatment and care across the transition between the in-hospital and adjoining primary care sectors.Methods/designThe trial is a longitudinal multisite randomized controlled trial with two arms (care as usual and intersectoral care management). Inclusion criteria at the time of hospital admission due to a somatic illness are age 70+ years, cognitive impairment (Mini Mental State Examination, MMSE ≤26), living at home, and written informed consent. Each participant will have a baseline assessment at the hospital and two follow-up assessments at home (3 and 12 months after discharge). The estimated sample size is n = 398 people with cognitive inmpairement plus their respective informal caregivers (where available).In the intersectoral care management group, specialized care managers will develop, implement, and monitor individualized treatment and care based on comprehensive assessments of the unmet needs of the patients and their informal caregivers. These assessments will occur at the hospital and in participants’ homes. Primary outcomes are (1) activities of daily living, (2) readmission to the hospital, and (3) institutionalization. Secondary outcomes include (a) frailty, (b) delirium, (c) quality of life, (d) cognitive status, (e) behavioral and psychological symptoms of dementia, (f) utilization of services, and (g) informal caregiver burden.DiscussionIn the event of proving efficacy, this trial will deliver a proof of concept for implementation into routine care. The cost-effectiveness analyses as well as an independent process evaluation will increase the likelihood of meeting this goal. The trial will enable an in-depth analysis of mediating and moderating effects for different health outcomes at the interface between hospital care and primary care. By highlighting treatment and care, the study will provide insights into unmet needs at the time of hospital admission, and the opportunities and barriers to meeting those needs during the hospital stay and after discharge.Trial registrationClinicalTrials.gov, NCT03359408; December 2, 2017.

The value of distinct depressive symptoms (PHQ-9) to differentiate depression severity in cancer survivors: An item response approach.

The value of distinct depressive symptoms (PHQ-9) to differentiate depression severity in cancer survivors: An item response approach.

Is the exclusion of psychiatric patients from access to physician-assisted suicide discriminatory?

Advocates of physician-assisted suicide (PAS) often argue that, although the provision of PAS is morally permissible for persons with terminal, somatic illnesses, it is impermissible for patients suffering from psychiatric...

The mediating effect of health anxiety in the relationship between functional somatic symptoms and illness behavior in Chinese inpatients with depression

BackgroundFunctional somatic symptoms in depression disorder may cause inappropriate illness behavior hindering the treatment process. Health anxiety may play a role in this relationship, but few studies have examined it. The current study aimed to investigate the role of health anxiety in the relationship between functional somatic symptoms and illness behavior in patients with depression.MethodsThe present study recruited 323 hospitalized patients with depression to complete the Patient Health Questionnaire-15, Whiteley-Index-7, and Scale for the Assessment of Illness Behavior, then constructed a structural equation model to examine whether health anxiety mediated the relationship between functional somatic symptoms and illness behavior.ResultsThe results showed significant correlations between any two of the three variables of interest. More importantly, health anxiety played a partially mediating role (42.86%) in the relationship between functional somatic symptoms and illness behavior. Further analysis suggested that elderly patients reached higher health anxiety than younger patients when their functional somatic symptoms were mild.ConclusionsThese results highlight that health anxiety may mediate the influence of functional somatic symptoms on illness behavior. The implications of assessing and intervening in health anxiety in patients with depression were discussed.

Internet-Based Cognitive Behavioral Therapy Among Psychologists in a Medical Setting: A Survey on Implementation.

BackgroundInternet-based cognitive behavioral therapy (iCBT) is an effective treatment for patients with a chronic somatic illness to improve self-management skills and to learn to adjust to their chronic disease and its impact on daily life. However, the implementation of iCBT in clinical practice is challenging.ObjectiveThis study aimed to examine the current degree of implementation of iCBT among psychologists in a medical setting and discover determinants influencing the implementation of iCBT among nonusers.MethodsA Web-based survey, based on the Unified Theory of Acceptance and Use of Technology (UTAUT), was distributed among psychologists in a medical setting. The survey included questions regarding the current use of iCBT, intention to use iCBT in the future, and operationalized concepts of the UTAUT constructs, that is, performance expectancy (PE), effort expectancy (EE), social influence (SI), and facilitating conditions (FC).ResultsIn total, 107 (24.8%) psychologists completed the survey. Of them, 16.8% have access to iCBT, 15.9% currently use iCBT, and 21.5% are expected to use iCBT within the next year. The constructs PE, EE, and SI together significantly influenced behavioral intention (BI; mean 3.9 [SD=0.8]) among nonusers (R2=0.490; F4.85=20.405; P<.001).ConclusionsIn spite of an average to high BI, the current implementation of iCBT is rather low among psychologists in a medical setting. Further research should focus on reducing the gap between intention to use and actual use by focusing on influencing the predictive UTAUT constructs.

Schizophrenia and attendance in primary healthcare: a population-based matched cohort study

Objective: Schizophrenia is associated with high mortality, somatic comorbidity and reduced life expectancy. The general practitioner (GP) plays a key role in the treatment of mental and physical multimorbidity. Nevertheless, it is unclear how much individuals with schizophrenia use primary healthcare. This study aims to investigate the yearly numbers of consultations in general practice for individuals with schizophrenia.Design and Setting: We performed a population-based matched cohort study of 21,757 individuals with schizophrenia and 435,140 age- and gender-matched references from Danish National Registers. Monthly general practice consultations were analysed using a generalized linear model with log link and assuming negative binomial distribution.Main outcome measures: Consultation rates in general practice up to17 years after index diagnosis.Results: Individuals with schizophrenia attended their GP more than references throughout the study period. The cases had 82% (95% CI: 78-87) and 76% (95% CI: 71-80) more consultations in primary care after 1 year and 5 years, respectively. Individuals with both schizophrenia and comorbid somatic illness attended even more.Conclusion: Individuals with schizophrenia are in regular contact with their GP, especially if they have comorbid illnesses. Whether an average of six consultations per year for individuals with schizophrenia is sufficient is up for debate. The study demonstrates a potential for an increased prevention and treatment of individuals with schizophrenia in general practice.KEY POINTSSchizophrenia is associated with high mortality, somatic comorbidity and reduced life expectancy. Little is known about the attendance pattern in primary care for individuals with schizophrenia.•We found high attendance rates in primary care for individuals diagnosed with schizophrenia from index diagnosis and at least 17 years after diagnosis, which suggests opportunities for earlier intervention to improve their somatic health.•We found an association between high illness comorbidity and increased risk of not attending the general practitioner. The most severely somatically and mentally ill individuals may thus be difficult to reach and support in the current healthcare system.

Childhood obesity: when do you stop testing and start talking?

Obese children often present with somatic illness such as headache and pain. However, less well documented are the associated psychological comorbidities. The authors describe a case of a 12‐year‐old severely obese boy that highlights the need for an holistic approach to address psychiatric as well as physical needs.

Morbidity and Mortality in the Children and Young Adult Offspring of Parents With Schizophrenia or Affective Disorders-A Nationwide Register-Based Cohort Study in 2 Million Individuals.

The offspring of parents with severe mental illness (SMI) are at higher risk of mortality and of developing certain somatic diseases. However, across the full spectrum of somatic illness, there remains a gap in knowledge regarding morbidity. We conducted a register-based nationwide cohort study of all 2 000 694 individuals born in Denmark between 1982 and 2012. Maximum age of offspring at follow-up was 30 years. Information on parents' psychiatric diagnoses of schizophrenia, bipolar disorder, and unipolar depression was retrieved from the Psychiatric Central Register. We estimated incidence rate ratio (IRR), cumulative incidence percentage and mortality rate ratio of first hospital contact for a broad spectrum of somatic illnesses according to the International Statistical Classification of Diseases and Related Health Problems. Analyses were adjusted for important confounders. Offspring of individuals with SMI had higher risk of somatic hospital contacts IRR: 1.17 (95% CI: 1.16-1.18) with maternal depression being associated with the highest IRR (1.22, 95% CI: 1.20-1.24). Offspring of parents with SMI had higher risk within most broad diagnostic categories with highest IRRs for unclassified somatic diagnoses, infections and endocrine diseases ranging from 1.27 (95% CI: 1.25-1.28) to 1.26 (95% CI: 1.23-1.29) (all P < .0001). Morbidity was particularly increased in children aged 0-7 years. The mortality rate ratio associated with parental SMI was 1.31 (95% CI: 1.21-1.41) with excess mortality mainly due to unnatural causes. Our findings indicate that offspring of parents with SMI experienced increased mortality and somatic morbidity warranting heightened vigilance and support for this population.

АНАЛИЗ НЕЙРОФИЗИОЛОГИЧЕСКИХ И НЕЙРОХИМИЧЕСКИХ МЕХАНИЗМОВ СУБСИНДРОМОВ ПОВЕДЕНЧЕСКОГО ДЕПРЕССИВНОГО СИНДРОМА

Депрессивный синдром наблюдается при ряде психических, неврологических и соматических заболеваний. Столь широкое распространение синдрома указывает на гетерогенность составляющих его субсиндромов. Нейрофизиологическая и нейрохимическая гетерогенность заболевания затрудняет его лечение. В этом обзоре рассмотрены патофизиологические механизмы развития тех субсиндромов депрессивного расстройства, которые можно моделировать на животных. Это касается снижения мотиваций, определяющих парадигму поведения, ангедонии, повышения уровня тревожности, нарушений сна и аппетита. Приведены данные литературы, что в основе этих субсиндромов лежит ослабление возбуждающей нейропередачи и функциональных связей в лимбических структурах мозга – префронтальной коре, прилежащем ядре, миндалинах, гиппокампе и др.

Gun Violence and Cardiovascular Health.

Gun Violence and Cardiovascular Health.

Alternative or complementary attitudes toward alternative and complementary medicines

BackgroundIntegrative and complementary health approaches (ICHA) are often pursued by patients facing chronic illnesses. Most of the studies that investigated the factors associated with ICHA consumption have considered that the propensity to use ICHA is a stable or fixed characteristic of an individual. However, people may prefer using ICHA in some situations and not in others, depending on the characteristics of the illness to face. Moreover, the attitude toward ICHA may differ within a single individual and between individuals so that ICHA can be used either in addition to (i.e., complementary attitude) or in place of (i.e., alternative attitude). The present study aimed at examining distinct patterns of attitudes toward ICHA in people hypothetically facing chronic illnesses that differed according to severity and clinical expression.MethodsWe conducted a web-based study including 1807 participants who were asked to imagine that they had a particular chronic illness based on clinical vignettes (mental illnesses: depression, schizophrenia; somatic illnesses: rheumatoid arthritis, multiple sclerosis). Participants were invited to rate their perceived distress and social stigma associated with each illness as well as its perceived treatability. They also rated their belief in treatment effectiveness, and their treatment preference. Four patterns of treatment choice were determined: strictly conventional, weak or strong complementary, and alternative. Bayesian methods were used for statistical analyses.ResultsICHA were selected as complementary treatment option by more than 95% of people who hypothetically faced chronic illness. The complementary attitude towards ICHA (in addition to conventional treatment) was more frequent than the alternative one (in place of conventional treatment). Factors driving this preference included employment status, severity of illness, age and perceived distress, social stigma and treatability of the illness. When the label of illnesses was included in the vignettes, patterns of treatment preference were altered.ConclusionsThis study provides evidence that “medical pluralism” (i.e., the integration of ICHA with conventional treatment) is likely the norm for people facing both mental or somatic illness. However, our result must be interpreted with caution due to the virtual nature of this study. We suggest that taking attitudes toward ICHA into account is crucial for a better understanding of patients’ motivation to use ICHA.

Obstetric complications in bipolar disorder: The role of mental health disorders in the risk of caesarean section

Background: Women with Bipolar Disorder (BD) during pregnancy present a negative impact on them and their babies’ health. Caesarean Section (C-Section) is an intervention to reduce complications associated with childbirth, but it also has risks, including maternal infections, anaesthetic and psychological complications. There are few studies that analyse the C-Section rates in women with BD compared to the general population. Methods: A case–control study was conducted in a general university hospital. 100 pregnant women with BD matched with 100 controls without psychiatric illness who were attending the same hospital at delivery. We compared obstetrical outcomes during pregnancy, Pre/During Labour, onset of labour and mode of delivery specifying the type of C-Section. Results: Rate of C-Section was significantly higher in BD group compared to the control group (OR=2, 95% CI 1,4–1,6). Case group had more somatic illness (SI) without treatment (P<, 001). BD (P=,021), primiparity (P=, 003), obstetric complications during pregnancy (P<, 001), obstetric complications during labour (P<,001), and SI with and without treatment (P<,001 and P=,007, respectively) were higher in women that required C- section. Conclusion: Women with Bipolar Disorder have near two-fold increased risk of C-section than women without Bipolar Disorder of similar age, gestational age and parity. Somatic illness was more prevalent in BD group that required C-section and this relation probably is related to high probability of having somatic comorbidities in patients with BD.

Impacts of early marriage and adolescent pregnancy on mental and somatic health: the role of partner violence

Researchers agree that early marriage (EM) and adolescent pregnancy (AP) can form severe risks for women’s somatic, mental, and reproductive health, as well as on educational and social status. Yet, less is known about factors that may moderate or mediate these associations. This study examined, first, retrospectively the impacts of EM and AP on self-reported mental and somatic health among multicultural group of women living in Eastern Anatolia, Turkey. Second task was to analyze whether and how the partner violence would mediate and/or moderate between EM and AP and mental health problems. The participants were 1569 women (16–72 years of age), who reported their age of being married, first pregnancy, and demographic characteristics. They described their mental health status through General Health Questionnaire (GHQ-28: depressive, anxiety, social dysfunction, and somatization symptoms) and symptoms of posttraumatic stress disorder (PTSD; DSM-5). Women’s reports of somatic illnesses were classified according to WHO-ICD-10. The revised conflict tactics scale, short form was used as a proxy to partner violence. Women who gave birth at 13–19 years of age reported more anxiety and somatization symptoms than later delivered, and those married younger than 25 showed a higher level of depressive symptoms than later married. Both AP and EM formed a heightened risk for somatic illnesses. The partner violence functioned as a moderator; AP was associated with especially high levels of depressive and anxiety symptoms among women exposed to sexual coercion in their marriage. Non-significant mediation analysis indicates that partner violence did not explain the severe impacts of the AP and EM on women’s mental health. Yet, the AP and EM were associated with heightened level of partner violence. Adolescent pregnancy forms a comprehensive mental health risk, and both AP and EM were risks for somatic illnesses, such as cardiovascular problems. The mental health risk of AP further intensified if women experienced sexual coercion in their partnership. Our fundamental work is to abolish these patriarchal phenomena.

ОСОБЕННОСТИ ВЗАИМОСВЯЗЕЙ МАТЕРИНСКОГО ОТНОШЕНИЯ И МЕЛКОЙ МОТОРИКИ ЧАСТО БОЛЕЮЩИХ ДЕТЕЙ РАННЕГО ВОЗРАСТА

Problem and purpose. In the world the interest in the issues of proper development of frequently-ill children is steadily growing because statistic data sources point at a constant increase in the number of somatic illnesses among children, including the children of babyhood and preschool age. There is an urgent necessity to look for the determinants of the parents’ attitude that designates the development of a frail child. The purpose of the article is to study the peculiarities of interrelations among various types of motherly attitude to sickly children and the development of fine motor skills in frequently-ill children of babyhood and preschool age. The methodology of the research is based on the activity approach (M.Ya. Basov, S.L. Rubinstein, A.N. Leontyev) and psychosomatic approach that presupposes the research of psychic and somatic interrelations, which are connected with micro and macro-social environment of a human being (M. Yacobi, F. Alexander, F. Danbar). Methods. The methods of the research consist in the analysis of empiric data, the analysis of medical charts of the children to assess their health condition. In order to diagnose the attitude of the parents to their child, a check-list suggested by A.Ya. Varga and V.V. Stolin was used. Specific features of fine motor skills formation were assessed using the methods developed by N.O. Ozeretskiy and N.I. Gurevich. Statistical processing of data was performed making use of U-criterion by Mann – Wittney and correlation coefficient by Spirman. 24 children of two -three years of age, as well as their mothers, participated in the experiment. 12 children were healthy and 12 – sickly. Results. The prevalence in motherly attitude of “symbiosis” and authoritarian “hypersocialization” towards a frequently-ill child was revealed. In this case the parent feels as if she is an integral whole with her child and is eager to control all the sphere of the child’s activity. It was discovered that the indices of fine motor skills of a healthy child were equal to those of a frequently-ill child when they fulfill the following assignments: “Copy the position of the other arm”. “Perform the given motor repertoire”. “Position correctly your postural pose in space”. However, in the group of frequently-ill children a decrease of correctness in performing the tasks: “Switch over to the next pose”. “Copy this pose” was observed. Making use of motherly attitude of “cooperation” in the family with healthy children exerts positive influence on the development of fine motor skills, and in a group of frequently-ill children resorting to motherly attitude of “a little lame duck” negatively affects the development of their fine motor skills. Conclusion. Implementation of partnership relations with children, encouraging their independence positively influences the development of fine motor skills in healthy children of two – three years of age. And as for frequently-ill children, among them difficulties in the development of fine motor skills can be observed in cases of their infantilization, the absence of trust in them, the presence of the idea of their awkwardness and unsuccessfulness.

Somatic comorbidity in children and adolescents with psychiatric disorders

In the adult population, psychiatric disorders are associated with somatic illness. Explanatory life style factors have been found, but also a failure to recognize somatic illness in this group. Another factor is side effects from long-term use of antipsychotic drugs. Given the psychiatric-somatic comorbidity in the adult population, it is of interest to investigate whether an association exists already during childhood. The aim of the present study was to investigate the frequency of somatic illness in children and adolescents with a psychiatric diagnose. Data were obtained from the regional health care database Vega, Sweden. Psychiatric and somatic diagnoses obtained during 2011–2013 for individuals aged 3–18 years were extracted. Descriptive statistics were used to examine difference in somatic morbidity between children with and without psychiatric diagnoses. Logistic regression was used in age-stratified models to test the association between psychiatric and somatic diagnoses. Anxiety and behavioral disorders were associated with all somatic conditions investigated at nearly all ages. The same applied to substance use, investigated at age 9–18 years. Affective disorders were associated with all somatic conditions at age 12–18 years. Psychotic conditions were associated with asthma, bowel disorders and myalgia in adolescents. Children with psychiatric disorders are at remarkably high risk for concurrent somatic illness. The associations span across many types of conditions and across all ages. The results support the need for awareness of somatic morbidity in child and adolescent psychiatric clinical settings, and the need for coordinated health care for children with comorbid states.

Re-creating self-identity and meaning through occupations during expected and unexpected transitions in life

ABSTRACTThe present study explores occupational engagement during expected and unexpected transitions in life, and how self-identity and meaning, situated in the context, is created and re-created through the daily occupations. We use case examples of children with disabilities, adults with acquired brain injury, older adults with stroke, and people with serious somatic illness who are undergoing rehabilitation. The cases are drawn from previous studies by each of the authors. In the present study, a secondary analysis of data was conducted based on an abductive approach and theories of self-identity and transaction, to illustrate how changes in everyday life occupations made sense. Three themes emerged that structure the discussion; Disruption of a former self, Pursuing normality, and Re-constructing daily occupations and routines. Our discussion illustrates how different life transitions can be demanding and how people, situated in the context, revise and create new meaning and self-identity through their occupations.