Somatic Symptomatology Research Articles

Depression--a diagnosis sometimes missed and sometimes mistaken.

A short description of the clinical picture of the major depression is given. Different forms of missed diagnosis in depression are discussed. Beside somatic symptomatology there are behavioural disturbances and disorders of a psychopathological type. Attention is paid to sexuality, anxiety and compulsion. The depression as a mistaken diagnosis is considered in relationship with endocrinopathy and with pharmacotherapy. In this respect reference is made to Cushing's disease, psychotropic drugs and oral contraceptives.

Munchausen Syndrome by Proxy

The etiology of somatic symptomatology in children is occasionally difficult to ascertain in spite of vigorous investigative efforts. This paper explores a case of illness in a child in which psychological and somatic factors in both parent and child interact in a complex, pathological way. The case is one of Munchausen syndrome by proxy which is unique in its presentation in that the child's mother has Munchausen syndrome. A literature review of Munchausen syndrome and Munchausen syndrome by proxy is included.

Mental Health and the Elderly: Factors in Stability and Change Over Time

Data from the Cleveland GAO Study reveal that, over one year, more elderly persons improved or remained stable than declined in self-assessed mental health and psychiatric symptoms. This pattern is contrary to findings that mental impairment increases with age. Factor analysis of a commonly used psychiatric symptom checklist identified two subscales, one a measure of psychological symptoms and the other of somatic symptoms; both of these are analyzed in this report. Secondary analysis of the 1,332 persons for whom data from both Ti (1975) and T2 (1976) are available evaluates this unexpected stability and improvement. Good physical health at T2 and less illness during the year emerged as the most powerful explanands for gains in all mental health measures, with higher educational levels also contributing to such gains. Improvement in self-assessed mental health was more likely for blacks than for whites, and males were more likely than females to show improvement in somatic symptomatology. Implications offindings for measurement of mental health and for the quality of life among the elderly are discussed.

Health beliefs and physician identified "worried well".

Health belief variables of the frequent and inappropriate user of medical services, or "worried well," were examined in two studies. Study 1 showed the physician identified "worried well" to be concerned about both general and mental health issues and to perceive typically minor symptoms as more serious than other frequent appropriate users, infrequent users, and mental health comparison groups. Study 2, a prospective study, measured beliefs and subsequent use for one year. Ratings of inappropriateness of use and psychosomatic involvement made by medical providers were predicted by high degrees of self reported somatic symptomatology, mental health concern, belief in self responsibility for health care, belief that one should handle one's own problems, and a limited belief in the responsibility of powerful others for health care.

Hypochondriasis and tendency to adopt the sick role as moderators of the relationship between life-events and somatic symptomatology.

The relationship between measures of hypochondriasis and the tendency to adopt a sick role, life-events and somatic symptomatology was explored. A sample of 85 married couples drawn from the community (n = 170) completed mailed questionnaires about the past year's events and symptoms and about hypochondriasis and sick-role tendency. Life-events were related to symptoms (r = 0.17) as were hypochondriasis, sick-role tendency, and subjects' sex (rs = 0.23, 0.16, 0.22, respectively). Hierarchical multiple regression analyses demonstrated that hypochondriasis and sick-role tendency were also related to the association between events and symptoms, such that subjects with high scores on the former measures showed a reduced event-symptoms correlation compared with low and moderate scorers. Low scorers on hypochondriasis and sick-role tendency had a considerably stronger relationship between events and symptoms compared to those typically reported in the literature. It was suggested that hypochondriasis and sick-role tendency may be moderators of the life-event-symptom relationship and as such deserve more widespread use in life-events research.

Personality Correlates of Conventional and Unconventional Glossolalia

Summary An investigation was made of the personality characteristics of Christians who had been divided along two bipolar dimensions: glossolalianonglossolalia, and conventional-unconventional. There was homogeneity among the groups with respect to age, sex, sample size, and socioeconomic status. One hundred and sixty-one men and women from several religious groups were administered the MMPI, the Shipley Institute of Living Scale, and a demographic questionnaire constructed by the authors. The results suggest glossolalics are more anxious but less neurotic than nonglossolalics; glossolalics tend to externalize anxiety into physical and vocal behavior, while nonglossolalics tend to internalize anxiety into somatic and depressive symptomatology; nonglossolalics tend to be more intelligent and dependent than glossolalics, while the latter have experienced more personal tragedy.

Responders and nonresponders to chlordiazepoxide and placebo: A discriminant function analysis

1. 1. Data from 356 anxious outpatients treated with either chlordiazepoxide or placebo in 4 week double-blind drug trials were analyzed in an attempt to determine predictors of treatment response using extreme groups and discriminant function analysis. 2. 2. Chlordiazepoxide response was found to be greater in younger female patients with lower levels of initial depression and a more favorable prognosis. 3. 3. Placebo response was found to be greater in younger, black, previously untreated or favorably drug treated patients and patients with lower initial somatization and depression. 4. 4. Discriminators between drug and placebo response included age, previous drug treatment, race, and initial level of somatic symptomatology.

Antidepressant Therapy in Gastrointestinal Conditions: Clinical Evaluation of Desipramine Hydrochloride (Norpramin)

• Somatic symptomatology associated with depression is <Iuite prevalent among general medical patients. Culpan and Davies l cite numerous survPys which report !the inci­ dence of psychiatric illness in a nonpsychi­ atric population as ranging from 12 to 52 percent while patients with concurrpnt organ­ ic and psychiatric conditions account for an additional 10 to 40 percent. Various surgical, psychiatric and medical ilwpstigators have indicated that depression is a factor which is often overlooked and frequently complicates the diagnoses and man­ agement of many surgical and medical con­ ditions. Of 200 surgical patients, Zwerling, ct lIl. reported that 15 percent had neurotic or psychotic depressions. Poe, et aZ. en­ countered depression in 52 percent of 192 patients during routine psychiatric consulta­ tions in a general hospital. In a study of 50 depressed patients, Stone and Burris I frequently encountered the de­ pressin' symptom complex of insomnia, nerv­ ousness. anorexia and weight loss in patients with numerous nwdical conditions. General­ ly, the elapsed time from onset to accurate reeognition of svmptoms ranged from three to 36 months in this group of patients. During this time, the investigators state the patients were frequently treated for other illnesses while the famil~' and financial situations pro­ gressivelv deteriorated and the risk of suicide persistecl.

A Study of the Somatic Symptomatology of Depression in Medical Inpatients

A Study of the Somatic Symptomatology of Depression in Medical Inpatients

Symptomatology and management of acute grief

At first glance, acute grief would not seem to be a medical or psychiatric disorder in the strict sense of the word but rather a normal reaction to a distressing situation. However, the understanding of reactions to traumatic experiences whether or not they represent clear-cut neuroses has become of ever-increasing importance to the psychiatrist. Bereavement or the sudden cessation of social interaction seems to be of special interest because it is often cited among the alleged psychogenic factors in psychosomatic disorders. The enormous increase in grief reactions due to war casualties, furthermore, demands an evaluation of their probable effect on the mental and physical health of our population. The points to be made in this paper are as follows: i. Acute grief is a definite syndrome with psychological and somatic symptomatology. 2. This syndrome may appear immediately after a crisis; it may be delayed; it may be exaggerated or apparently al)sent. 3. In place of the typical syndrome there may appear distorted pictures, each of which represents one special aspect of the grief syndrome. 4. By appropriate techniques these distorted pictures can be successfully transformed into a normal grief reaction with resolution. Our observations comprise tot patients. Included are (i) psychoneurotic patients who lost a relative during the course of treatment, (2) relatives of patients who uied in the hospital, (3) bereaved disaster victims (Cocoanut Grove Fire) and their close relatives, ( ) relatives of members of the armed forces.

Fashions in neurosis.

The textbooks of a hundred years ago considered the conditions we would call psychotic to be largely psychogenic, the conditions we would call neurotic to be associated with organic diseases, and those we would call hysterical to be due to a special sensitivity of the nervous system or to gynaecological disorders. The conditions corresponding to the neuroses as we know them today, apart from “hysterical insanity” do not seem to have been part of the province of the alienist but of the general physician and later the neurologist. Towards the end of the last century, it was suggested that the term neurosis should apply to a disordered physiological state and the term psychosis to a disordered mind. Psychiatric textbooks of a century ago did not concern themselves with neuroses. The medical textbooks described hysteria in great detail, usually manifestations of a gross kind. The idea of hysteria having something to do with the uterus persisted, Cullen ascribing it to amenorrhoea or too great a salacity. Later, when theories of exhaustion of the nervous system in neurasthenia became popular, the exhaustion was held by some to be caused by the “irritation” of the nervous system by gynaecological disorders. Neuroses with somatic symptomatology tended to be classified under a somatic label. Anxiety states with somatization were attributed either to the common diseases of the day, such as gout or dyspepsia, or to dysfunction of the nervous system. The rest therapy popularized by Weir Mitchell in 1875 got its results through suggestion and the anaclitic meaning it carried. Although popular for “neurasthenia” it was widely used for all mental disorders, and in its day was as revolutionary as shock therapy or the tranquilizers. Focal sepsis and auto-intoxication provided theories which led to the surgical treatment of neuroses. Present day fashions in diagnosis of the neuroses vary with the orientation of the diagnostician: in terms of reaction of a personality, in terms of dynamics, or in terms of symptom groupings.

Relation of C.M.I. responses to some social and psychological factors

The C.M.I. responses of 146 adults were related to their childhood experience and marital adjustment. High scores were associated with the recollection of emotionally disturbed childhood homes, and in women with poor marital adjustment. The physical symptoms reported by high scoring women were of a type recognisably “functional” but this did not apply to men. Higher “psychiatric” (M-R) scores were associated with more numerous physical symptoms. No particular pattern of somatic symptomatology was found in association with any of the factors studied. “Functional somatic” symptoms occured in combination with each other more often than would be predicted by chance.