Somatoform Research Articles

Comparison of death anxiety symptoms between generalized anxiety disorder and somatization disorder in geriatric patients attending a psychiatric outpatient clinic for the first time

Somatic complaints are among the important complaints frequently seen in Generalized Anxiety Disorder (GAD) and Somatic Symptom Disorder (SSD). Death anxiety has also increased significantly with the Covid-19 pandemic, especially in the elderly population. In this study, we compared the difference of the death anxiety level among patients with GAD, SSD and healthy controls.This cross-sectional study which was carried out in Artvin State Hospital's Psychiatric Outpatient Clinic included 59 participants (GAD = 21, SSD = 18, HC = 20). Three groups were subjected to detailed psychiatric examination by the same psychiatrist. Subsequently, anxiety, somatic symptoms and death anxiety were assessed using standardized tools (GAD-7, Templer Death Anxiety Scale, Somatic Symptom Scale).The GAD-7 Scale mean of the GAD group was significantly higher than SSD (p = 0.001) and Healthy Control (HC) (p = 0.001) groups. Death anxiety and Somatic Symptom levels in GAD and SSD groups were significantly higher than in healthy controls. (GAD, p = 0.001; SSD, p = 0.001) with no significant difference between GAD and SSD groups (p = 1). Healthy controls exhibited significantly lower scores in the three scales mean scores compared to the SSD and GAD groups (p = 0.001).Irrespective of specific psychiatric diagnoses, these findings highlight elevated death anxiety in the elderly, underscoring the need for tailored mental health interventions.

Integrative group psychotherapy for patients with somatic symptom disorder: A randomized controlled trial

Integrative group psychotherapy for patients with somatic symptom disorder: A randomized controlled trial

Frequency Of Psychological Stress And Barriers To Accessing Mental Health Services For Leipzig Citizens Of Afghan And Iraqi Citizenship

Aim of the study was to report evidence on mental health needs and access to mental health and psychosocial support for Leipzig citizens of Afghan and Iraqi citizenship in the presence of mental stress and, above all, to identify barriers to access to care. All adults in Leipzig with Iraqi or Afghan citizenship, who were not born in Germany were contacted. Various instruments (PHQ-9, GAD-7, SSS-8, PCL-5/LEC-5) to screen for symptoms of depression, anxiety, somatization disorder or PTSD and one item for self-reported emotional problems were used. Questions on health care utilization and barriers to care followed. 51.4% screened positive in at least one of the tests and self-reported emotional problems. 38.2% of those in need of treatment did not seek help. Frequent reasons for not seeking help were, that the people wanted to solve the problem on their own or that the problem did not bother them very much. A lack of trust and understanding regarding the healthcare system and fear of discrimination and stigmatisation were also perceived as additional barriers to care. The study revealed a high percentage of mental health needs. This could be due to the high number of traumatic events and post-migration stressors. A longer period of residence in Germany and easier access to the public health system through the health insurance card could have encouraged the health care utilization. The treatment gap was caused by barriers to care such as a lack of knowledge or trust of the German health care system and fear of stigmatisation and discrimination. More information about access to care structures and more low-threshold services need to be implemented. These should be organised on an interdisciplinary basis and focus on culturally and racially sensitive care. Mental health awareness should be strengthened and under no circumstances should the access to care be restricted any further.

Body sensation maps of emotions in patients with somatoform and related disorders

Body sensation maps of emotions in patients with somatoform and related disorders

Risk of somatic symptom disorder in patients with somatic diseases from the population-based Hamburg City Health Study

Risk of somatic symptom disorder in patients with somatic diseases from the population-based Hamburg City Health Study

Assessing the criteria of somatic symptom disorder in general hospital patients (NCT04269005)

Assessing the criteria of somatic symptom disorder in general hospital patients (NCT04269005)

Somatoform Disorders (SD)

Somatoform Disorders (SD)

Characteristics and dynamics of the emotional condition and mental health of women during pregnancy and after childbirth in the COVID-19 pandemic

BACKGROUND: The coronavirus pandemic has been a powerful and long-term stressor, and pregnant women are among the most vulnerable groups in the population. Modern foreign studies have shown an increase in the level of anxiety, depression, and post-traumatic stress disorder in women during pregnancy and after childbirth in the COVID-19 coronavirus pandemic, which, in turn, can affect both the course of pregnancy and childbirth and the development of the child. Meanwhile, there are currently very few domestic studies of these characteristics and their dynamics in women in the pre- and postnatal period. AIM: The aim of this study was to assess the characteristics and dynamics of the emotional condition and mental health of women during pregnancy and after childbirth in the COVID-19 coronavirus pandemic. MATERIALS AND METHODS: In this study, we used the State-Trait Anxiety Inventory by Ch.D. Spilberger, adapted by Yu.L. Khanin; the Achenbach System of Empirically Based Assessment (Adult Self-Report 18–59) by T. Achenbach and L. Rescorla, adapted by E.R. Slobodskaya; the Impact of Event Scale-Revised by D.S. Weiss and C.R. Marmar, adapted by N.V. Tarabrina; socio-biographical questionnaire during pregnancy and after childbirth; and postpartum interview. At the I stage, the study included 248 pregnant women, with the average age of 30.7 (18–44) years and the average gestational age of 31.1 (4–40) weeks. At the II stage, we enrolled 98 women from the initial sample four to six months after childbirth. RESULTS: Our study showed the presence of predominantly average levels of anxiety, a high frequency of depressive disorder and avoidance, cognitive problems and withdrawal, as well as somatic problems during pregnancy. Pandemic-related post-traumatic stress disorder was identified in 7.7% of pregnant women and 6% of women after childbirth. Analysis of the dynamics of the emotional condition and mental health disorders in women before and after childbirth revealed a significant decrease in the levels of post-traumatic stress disorder (p 0.01), depressive (p 0.05) and somatic (p 0.01) disorders, and avoidance disorder (p 0.05). Predictors of the emotional condition, post-traumatic stress disorder and mental health disorders in women after childbirth are the same as those during pregnancy. CONCLUSIONS: The study showed a high incidence of post-traumatic stress disorder, depression and avoidance disorders with an average level of anxiety in pregnant women during the pandemic. After childbirth, patients experienced a decrease in depressive, somatic and avoidance disorders, as well as post-traumatic stress disorder.

Rehabilitation success after psychosomatic rehabilitation as afunction of psychotherapy dose

Increasing the effectiveness of psychosomatic rehabilitation by prolonging the treatment is a subject of controversial debate. The number of sessions over time defines the dosage in psychotherapy. While the dose-response model assumes an optimal therapy dose, the good-enough level model assumes acorrelation of the rate of change with the total sessions. Arandomized control group study was conducted to investigate the extent to which an adaptive therapy concept with atwo-week intensive phase and early intervention could increase rehabilitation success. A total of 494 rehabilitants between the ages of 21 and 64 (47% women) who completed aclassical or an integrative psychosomatic rehabilitation at the Rehazentrum Oberharz between 2020 and 2022 were analysed. Rehabilitation success was mapped by the Reliable Change Index of individual symptom reduction (depression severity or psychological and somatoform disorders) and as asocio-medical parameter (physician's assessment of potential work ability (WA) after twoweeks). Two-factorial ANOVAs and hierarchical binary logistic regressions were calculated, and sick leave before rehabilitation was statistically controlled. Dosage showed no effect on symptom reduction (p = 0.29) and potential WA after twoweeks (p = 0.90). However, when stratified by disease severity, there was amean effect of dosage (p = 0.05) and twice the probability of WA after twoweeks (odds 2.13; p = 0.01) for those with mild disease at the start of measure (p = 0.05). In the early stages of an affective disorder, early and intensified intervention can counteract the chronification of mental disorders.

School Absenteeism Longer Than Two Weeks Is a Red Flag of Somatic Symptom and Related Disorders in Hospitalised Children and Adolescents: A Matched Cohort Study.

Chronic school absenteeism is a common problem in childhood and adolescence, and it is frequently observed in patients with somatic symptom and related disorders (SSRDs). This study aimed to determine whether and to what extent the presence of school absenteeism may be a risk factor for the diagnosis of SSRDs in hospitalised patients. This matched cohort study included children and adolescents aged between 8 and 17 years, admitted to the paediatric ward of the IRCCS Burlo Garofolo in Trieste from 2021 to 2023, who were divided into two groups, the first including children with at least 15 days of absence from school for medical reasons and the second including children with regular school attendance, matched to the former group by age and sex. We consecutively enrolled 70 patients, 35 in the absentee group and 35 in the control group. In the absentee group, 30/35 (85.7%) patients were diagnosed with an SSRD, while in the control group, 1/35 (2.9%) was diagnosed with an SSRD. The absentee group had a 30-fold higher risk of being diagnosed with SSRDs than the control group (RR = 30 [95% CI = 4.3-208]; p < 0.001). This study shows that in hospitalised children, a history of school absenteeism of more than two weeks is an important risk factor for the diagnosis of SSRDs.

NOSOLOGICAL STRUCTURE OF IN-PATIENT PSYCHIATRIC CARE PROVISION IN THE POLTAVA REGION IN 2023

Introduction. The importance of safeguarding mental health and providing high-quality psychiatric care became increasingly urgent following the onset of full-scale war in Ukraine. Currently, a strategy to transfer psychiatric care from specialized institutions to primary care is being implemented. Therefore, analyzing the nosological distribution of referrals to a psychiatric hospital during martial law is an extremely urgent issue. The aim of this study is to investigate the nosological structure of hospitalizations at the Communal Enterprise “Regional Institution of Mental Psychiatric Care of the Poltava Regional Council” in 2023. Results and their discussion. Schizophrenia remains the leading diagnosis among patients receiving inpatient psychiatric care. The second place is taken by neurotic, stress-related, and somatoform disorders. In third place are organic, including symptomatic, mental disorders, with vascular dementia being the leading primary diagnosis among patients with organic, including symptomatic, mental disorders. Among the substances causing mental and behavioral disorders due to the use of psychoactive substances, alcohol ranks first. Paranoid schizophrenia is the leading diagnosis in patients with schizophrenia, schizotypal states, and delusional disorders. Recurrent depressive disorder is the most common among affective disorders. Adjustment disorders occupy the first place in the structure of the incidence of neurotic, stress-related, and somatoform disorders. Among the behavioral syndromes associated with physiological disturbances and physical factors, anorexia nervosa is the most common. Emotionally unstable personality disorder is most common among patients with disorders of adult personality and behavior. Mild mental retardation is more common than others. Childhood autism has the largest share in the incidence structure of disorders of psychological development. Among behavioral and emotional disorders with onset usually occurring in childhood and adolescence, the most common are mixed disorders of conduct and emotions. Conclusion. The obtained results can be used in planning and forecasting the provision of inpatient psychiatric care to patients during the wartime.

Changes in interoceptive accuracy related to emotional interference in somatic symptom disorder

ObjectiveThe somatic symptom disorder (SSD) is characterized by one or more distressing or disabling somatic symptoms accompanied by an excessive amount of time, energy and emotion related to the symptoms. These manifestations of SSD have been linked to alterations in perception and appraisal of bodily signals. We hypothesized that SSD patients would exhibit changes in interoceptive accuracy (IA), particularly when emotional processing is involved.MethodsTwenty-three patients with SSD and 20 healthy controls were recruited. IA was assessed using the heartbeat perception task. The task was performed in the absence of stimuli as well as in the presence of emotional interference, i.e., photographs of faces with an emotional expression. IA were examined for correlation with measures related to their somatic symptoms, including resting-state heart rate variability (HRV).ResultsThere was no significant difference in the absolute values of IA between patients with SSD and healthy controls, regardless of the condition. However, the degree of difference in IA without emotional interference and with neutral facial interference was greater in patients with SSD than in healthy controls (p = 0.039). The IA of patients with SSD also showed a significant correlation with low-frequency HRV (p = 0.004) and high-frequency HRV (p = 0.007).ConclusionSSD patients showed more significant changes in IA when neutral facial interference was given. These results suggest that bodily awareness is more affected by emotionally ambiguous stimuli in SSD patients than in healthy controls.

Адаптация русскоязычной версии детского опросника соматических симптомов на выборке детей-сирот и детей, оставшихся без попечения родителей

&lt;p&gt;This study was aimed to adapt the Russian version of the Children&amp;rsquo;s Somatic Symptoms Inventory-8 (CSSI-8). The participants were 160 orphans and children and adolescents left without parental care, including 80 girls and 80 boys aged 9 to 17 years (M=14,51; Me=15 years; SD=1,79). All participants completed CSSI-8 and the Revised Child Anxiety and Depression Scale-30 (RCADS-30). The Russian version of the inventory was reliable and valid: firstly, it has a high Cronbach&amp;rsquo;s &amp;alpha;, showing its internal reliability; secondly, it has a one-factor structure, indicating its factor validity; thirdly, the relationship of somatic symptoms with anxiety and depressive symptoms proves convergent validity. Thus, 76,2% of children and adolescents had at least one specific somatic symptom, 44,4% complained of pain in stomach or abdomen, 58,7% of headaches, 30,6% of pain in lower back, 19,4% of faintness or dizziness, 29,4% of pain in arms or legs, 28,7% of heart palpitations, nausea or upset stomach, 47,5% of weakness in some parts of the body. In conclusion, it is important to make future psychometric examinations of the adapted questionnaire, which allow us to recommend it for school diagnosis and psychological counseling of children and adolescents, as well as screening and monitoring of somatoform disorders.&lt;/p&gt;

Illness Anxiety Disorder: A Review of the Current Research and Future Directions

Purpose of ReviewWe review recent evidence on Illness Anxiety Disorder (IAD), including risk factors and precipitants, diagnostic classification, clinical characteristics of the disorder, and assessment and treatment in both children and adults.Recent FindingsIAD places a substantial burden on both individuals and society. Despite its impact, understanding of the disorder is lacking and debates remain about whether IAD should be classified as an anxiety disorder and whether it is distinct from Somatic Symptom Disorder. Cognitive behavioural therapy (CBT) is an effective treatment for IAD and there are multiple validated measures of health anxiety available. However, research on health anxiety in children and youth is limited.SummaryIAD is chronic, and debilitating, but when identified, it can be effectively treated with CBT. Research using DSM-5 IAD criteria is lacking, and more research is needed to better understand the disorder, particularly in children and youth.

Cannabinoid Drugs in the Treatment of Psychiatric Disorders - Data from the German Federal Institute for Drugs and Medical Devices

Since 2017 physicians in Germany can prescribe cannabis based medicines or medical cannabis with subsequent funding by the statutory health insurance system. Physicians prescribing cannabinoid drugs were legally required to take part in a survey conducted by the Federal Institute for Drugs and Medical Devices. This study analyses data from 16.809 case reports that were collected from 30.3.2017 to 31.12.2021. There were 5582 cases documenting the use of cannabinoid drugs in psychiatric disorders. More than half of the prescriptions were Dronabinol. 80% of the treatments concerned somatoform disorders. Most of the treatments for other psychiatric disorders also targeted pain. Doctors reported a positive effect on symptoms in at least 75% of the cases. Most patients with psychiatric disorders received cannabinoid drugs for pain. The evidence from randomized controlled clinical trials for the use of cannabinoid drugs in psychiatric indications is weak.

An integrated mental health video consultations model for patients with somatic symptom disorder in primary care: The randomized VISION pilot trial

ObjectiveSymptoms of somatic symptom disorder (SSD) are one of the most common reasons for consultations in primary care. However, specialized psychological services are mostly unavailable. This pilot trial aimed to determine the feasibility, acceptability, and safety of the integrated mental health video consultations VISION model for patients with SSD in primary care. MethodsWe conducted a parallel group, randomized controlled pilot trial involving fifty-one patients with SSD from ten primary care practices in Germany, who we randomized to the VISION model or enhanced treatment-as-usual (eTAU). The VISION model comprised five video consultations which featured diagnostic clarification, psychoeducation (acknowledging and legitimizing of symptoms), and brief psychological therapy. eTAU included training primary care practice teams on the DSM-5 concept of SSD and on current guideline recommendations for its treatment in primary care. We assessed feasibility as the primary outcome at 6-months, measuring efficiency of recruitment, intervention acceptability, and safety. ResultsRecruitment was efficient reflected in an overall recruitment yield (number randomized per number screened) of 55% (51/92) and a consent rate (number randomized per number eligible) of 94% (51/54). Acceptability of the intervention was high with 98% (123/125) of the video consultations conducted as planned. No serious adverse events were reported in either group. ConclusionAn integrated mental health video consultations VISION model for patients with SSD presenting to primary care is feasible, acceptable, and safe. Potential clinical effectiveness of the model should be evaluated in confirmatory trial implementing the multifaceted approach tailored to the individual patient with SSD directly into primary care practice. Trial registrationThe trial protocol was registered at German Clinical Trials Register (number: DRKS00026075, https://www.drks.de).

Diagnostic problems of unusal somatic disorder - Munchausen syndrome by proxy

Introduction and purpose Munchausen syndrome by proxy is a factitious disorder characterized by the search for and induction of somatic symptoms, the falsification of laboratory results, and even the mutilation of a loved one, usually a child, by a parent or caregiver. Paediatricians often only have information about the child's condition from an interview with the child’s guardian, so it is very important to differentiate feigned disorders from real, sometimes difficult to diagnose, cases of illness. We may suspect them if the parent reports unusual symptoms in the child, insinuates further treatments and hospital stays, has above-average knowledge of medical terminology, and is aggressive towards the staff. Prominent among the causes of Munchausen syndrome by proxy are first and foremost the desire to focus the parent/carer’s attention on themselves and the expectation of recognition for their care and concern for the child. Methods and materials The following review was based on articles from the PubMed and Google Scholar databases. Key search terms included munchausen syndrome, munchausen syndrome by proxy, treatment, diagnosis, paediatric condition falsification, factitious disorder. Conclusions Due to the nature of this disorder, physicians of different specialities may come across it during their practice. Increasing their knowledge on this topic and the effects of Munchausen syndrome by proxy will allow the correct diagnosis to be established and appropriate psychiatric therapy with psychological care to be introduced, as well as protecting children who are victims of the actions of their caregivers.

Health, behavior, and social outcomes among offspring of parents with criminal convictions: a register-based study from Sweden.

There is currently insufficient understanding of the health and behavior of children whose parents engage in criminal behavior. We examined associations between parental criminal convictions and wide range of offspring health, behavioral, and social outcomes by age 18 in a large, national sample, aiming to get a comprehensive picture of the risks among children of offending parents. We studied 1,013,385 individuals born in Sweden between 1987 and 1995, and their parents. Using data from several longitudinal nationwide registers, we investigated parental convictions and 85 offspring outcomes until the end of 2013, grouped into birth-related conditions, psychiatric and somatic disorders, accidents and injuries, mortality, school achievement, violent victimization, and criminality. Cox proportional hazards regression and logistic regression models were used to examine the associations. The role of genetic factors in intergenerational associations was studied in children-of-siblings analyses. We also examined the co-occurrence of multiple outcomes using Poisson regression. A total of 223,319 (22.0%) individuals had one parent convicted and 31,241 (3.1%) had both parents convicted during the first 18 years of their life. The strongest associations were found between parental convictions and offspring behavioral problems, substance use disorders, poor school achievement, violent victimization, and criminality, with an approximately 2 to 2.5-fold increased risk in children with one convicted parent and 3- to 4-fold increased risk in children with two convicted parents. The risks were particularly elevated among children of incarcerated parents with a history of violent convictions. The associations appeared to be at least partly explained by genetic influences. Parental convictions were also associated with an increased likelihood of experiencing multiple outcomes. Our findings help to calibrate the risks of a wide range of adverse outcomes associated with parental convictions and may be used to guide prevention efforts and identify key areas for future research.

Разработка и анализ психометрических свойств новой русскоязычной версии Международного опросника неблагоприятного детского опыта (ACE-IQ)

&lt;p style="text-align: justify;"&gt;Background. Adverse childhood experiences (ACE) is one of the most important risk factors for mental and somatic disorders and needs to be considered and evaluated in clinical and research practice. The aim of this study was to develop, adapt and validate the new Russian version of ACE-IQ. Methods. A total of 123 people (88 women, Me = 25 years) were included, of which about a half (n = 68) of the sample were patients with depression, the rest of the participants had no psychiatric diagnoses based on the results of the diagnostic interview. Results. ACE-IQ showed good reliability and internal consistency (Cronbach's alpha = 0.801). A six&amp;ndash;factor structure of the questionnaire was identified (&amp;laquo;Sexual abuse&amp;raquo;, &amp;laquo;Family violence&amp;raquo;, &amp;laquo;Violence outside the family&amp;raquo;, &amp;laquo;Mental disorders and substance abuse in the family&amp;raquo;, &amp;laquo;Dysfunctional family factors&amp;raquo;, &amp;laquo;Social Cataclysms&amp;raquo;). Conclusions. We developed, adapted and validated the new Russian&amp;ndash;language version of the ACE-IQ, retaining the structure and semantic equivalence of the original version of the questionnaire. Although confirmation of factor structure in other samples is needed, our data allows to recommend the new Russian version of the ACE-IQ for use in clinical and research practice.&lt;/p&gt;

Association of categorical diagnoses and psychopathologies with quality of life in patients with depression, anxiety, and somatic symptoms: A cross-sectional study

ObjectiveMajor depressive disorder (MDD), anxiety disorders, and somatic symptom disorder (SSD) are associated with quality of life (QoL) reduction. This cross-sectional study investigated the relationship between these conditions as categorical diagnoses and related psychopathologies with QoL, recognizing their frequent overlap. MethodsWe recruited a total of 403 clinical patients and healthy individuals, administering diagnostic interviews based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. QoL and psychopathologies were assessed using the WHO Quality of Life-BREF (WHOQOL-BREF) and several self-administered questionnaires, respectively. Multiple linear regression analyses examined the associations between psychiatric diagnoses, psychopathologies, and QoL. ResultsSSD and MDD were independently associated with impaired global (β = −0.318 and − 0.287) and all QoL domains (β = −0.307, −0.150, −0.125, and − 0.133, in physical, psychological, social, and environmental domains respectively for SSD; β = −0.278, −0.344, −0.275, and − 0.268 for MDD). The Beck Depression Inventory-II score showed pervasive associations with QoL (β = −0.390, −0.408, −0.685, −0.463, and − 0.420, in global, physical, psychological, social, and environmental domains). The Patient Health Questionnaire-15 and Health Anxiety Questionnaire scores were associated with global (β = −0.168 and − 0.181) and physical (β = −0.293 and − 0.121) QoL domain, while the Cognitions About Body and Health Questionnaire score was only associated with environmental QoL domain (β = −0.157). ConclusionSSD and MDD were independently associated with QoL impairment. Depressive symptoms were associated with all QoL domains, whereas somatic symptom burden and health anxiety primarily affected the physical QoL domain. Clinicians should consider concomitant psychopathologies when managing patients with depression, anxiety, or somatic symptoms.