Somatoform Disorder Patients Research Articles

Pattern of Heart Rate Variability in Somatoform Disorder and Its Association with Anxiety level: An Analytical Study

Background: Somatoform disorder (SD), nowadays considered as the most frequent psychiatric diagnosis in general practice has strong association with anxiety. Though there are a handful of studies showing heart Rate variability (HRV) in SD patients, as such no studies according to author’s knowledge had been addressed to the anxiety component hidden in the SD patients applying HRV tests so far. Aims: Aim of the current study was assess the presence and extent of Heart rate variability in SD patients and to find out it’s possible relationship with their anxiety level. Materials and Methods: An analytical observational cross-sectional study was done among fifty newly diagnosed somatoform disorder patients of eighteen to forty years age attending Psychiatry OPD and fifty age and sex matched healthy control. After assessing their anxiety level using State Trait Anxiety Inventory, Short term Heart rate Variability tests were performed. Appropriate Statistical tests were applied using SPSS 20 version. Results: The SD patients showed reduced heart rate variability as SDNN and RMSDD were less, LF and LF/HF ratio were more in them than controls and significant differences were there. Both SAS and TAS scores were more in cases and there was positive correlation of TAS score with LF and LF/HF ratios. Conclusions: The results of this study actually set an alarm for controlling their symptoms as well as their hidden anxiety underneath, as reduced HRV poses the risk of developing cardiovascular disease and hidden anxiety has influence on heart rate variability.

Higher cardiovascular activation, but normal heartbeat-evoked potentials and cardiac interoceptive accuracy in somatoform disorders and major depressive disorder

The perception-filter model posits that the generation of medically-unexplained symptoms is associated with (I.) more intense afferent bodily signals, (II.) impaired filter system activity to differentiate relevant from irrelevant signals, and (III.) altered perception of bodily signals. We tested these assumptions for cardiac perception in patients with somatoform disorders (SFD), patients with major depressive disorder (MDD) and healthy control (HC) individuals. Heart rate (variability; HR/HRV) and blood pressure served as indicators of bodily signals (I.); heartbeat-evoked potentials (HEPs) assessed during a heartbeat counting task (HCT) and a distraction task indicated filter system activity (II.); interoceptive accuracy (IAc) in the HCT was interpreted as an index of perception (III.). All indicators were assessed before and after a socially-evaluated cold pressor stress task (SECPT) and a control intervention. SFD patients (n ​= ​24) showed higher average HR and diastolic blood pressure, as well as lower HRV than HC individuals (n ​= ​22), but there were no differences in HEPs or IAc. Neither were there significant differences between the SFD and the MDD groups (n ​= ​24), nor any stress effect on HEPs or IAc. Our findings suggest that increased intensity of bodily signals (I.) is the only model assumption that could be supported for patients with fully-developed SFD. • We investigated interoception in somatoform disorders (SFD) and depression (MDD). • SFD and MDD patients had higher heart rate (HR) and blood pressure than controls. • Heartbeat-evoked potentials did not differ between SFD, MDD patients and controls. • Cardiac interoception did not differ between SFD, MDD patients and controls. • Acute stress did not affect heartbeat-evoked potentials and cardiac interoception.

Somatoform disorders. Models of personification oriented therapy

IntroductionContemporary in Ukraine the special priority has been the somatoform disorders increase. The most significant complications belong to the patient’s self-evaluation of the influence of the disease on their social functioning, influence essential part of the self-evaluation of the disease and the important point of therapeutic personality accomodate intervention.ObjectivesDevelop the stages of personalized models of psychotherapyMethodsOn the basis of the examined 270 somatoform disorders patients and 190 ischemic cardial disease patients we have elaborated a formal test that allows to evaluate quantitatively the influents of the disease on various spheres of patients´ social status.ResultsIt was absolutely unrespectable the common for ischemic cardial and somatoform disorders patients rise of significance of personal individual, common life factors in cases of aggravation of the main disease course. We created the personification accomodate psychotherapy system consist with CBT, suggestive and autosuggestive implementations. Elucidation of peculiarity of personal perception of the disease served as basis of elaboration of psychotherapy system, consulting, psychological support for patients with high-effectiveness 1,5 - 3 years catamnes in 85% patients.ConclusionsThe retrospective results showed the necessity the personification oriented models of psychotherapy, parted on stages. On the first stage - sedative-adapting the receptions of CBT and suggestive psychotherapy are used. There is group therapy on second stage. On the third stage-supportive elements of the autogenic training mastered.DisclosureNo significant relationships.

Understanding Somatoform Disorder through Insecure Attachment Developed by Childhood Trauma

Background: There have been few clinical case studies which explored somatoform disorder patients’ mind, in particular, that they are unaware. Purposes: By analyzing clinical records of a male patient with a somatoform disorder, this study aimed at 1) To examine how the core personality pathology behind the somatoform disorder developed in his early life, 2) To elucidate how his attitudes and behaviors in his interpersonal relationships relate to the pathology, 3) To understand the reason behind his decision to discontinue therapy, and 4) To propose a role for psychiatry when treating patients with somatoform disorder. Methods: The patient’s psychotherapeutic process over three years from initiation to termination was described in three periods, based on changes in the nature of the therapeutic relationship. Results: Somatic symptoms, the attitudes and behaviors in the therapeutic relationship, and his decision to terminate the therapy were understandable in relation to his adversity since infancy. These relations were discussed by attachment theory and a theory of structural dissociation of personality. Conclusion: This study provided a perspective that the core pathology of some somatoform disorder patients has its origin in adversity since infancy.

Epidemiological Features and Clinical Manifestations of Patients With Somatoform Disorder at a Tertiary Medical City in Riyadh, Saudi Arabia.

BackgroundSomatoform disorder (SD), known as the presence of physical symptoms suggesting a physical condition, for which there are no demonstrable organic findings or established physiological mechanisms with positive evidence that the symptoms are related to psychological causes. The aim of this study was to highlight the epidemiological characteristics, demographic features, comorbidities, and clinical presentations of patients with SD.Materials and methodsThis was a retrospective study of SD patients at King Abdulaziz Medical City in Riyadh, Saudi Arabia. We reviewed the patients' electronic health records from January 2015 to December 2020 for collecting the patients’ demographic information, including gender, age, marital status, and occupation. The types of SD, presenting symptoms of each disorder, department to which patients initially presented, comorbidities, and management were also documented. The diagnosis of SD was based on the International Classification of Diseases, Tenth Revision (ICD-10).ResultsIn total, 89 patients were included in the study. The majority (n=50, 56.2%) were female, with a mean age of 42.7±17.1 years. More than half of the sample was married (n=54, 60.7%). The most common subtype of SD was somatization disorder followed by conversion disorder, pain disorder, and hypochondriasis, diagnosed in 69 (77.5%), 12 (13.5%), 5 (5.6%), and three (3.4%) patients, respectively. Neurological symptoms and pain were the most frequent presenting symptoms for all the somatoform patients. More than half of the sample (n=48, 53.9%) initially presented at an outpatient clinic.ConclusionsThe number of SD patients was less than expected, and a third did not receive any treatment. This emphasizes the need for more SD awareness among clinicians in various medical specialties. Appropriate SD and other mental disorders education for physicians may support achieving a better identification of SD and subsequently an improved quality of life for the patients.

Brain changes associated with impaired attention function in chronic pain

Attention function is thought to be important in chronic pain, with the pathology of chronic pain closely associated with cognitive–emotional components. However, there have been few neuroimaging studies of the relationship between attention function and chronic pain. We used the method of functional connectivity analysis for resting-state fMRI (rs-fMRI) data and the Attention Network Test-Revision (ANT-R) to clarify the attention-related pathology of chronic pain. We performed rs-fMRI and ANT-R on a group of 26 chronic pain (somatoform pain disorder) patients and 28 age-matched healthy controls. A significant group difference in validity effects, a component of ANT-R, emerged (F1,46 = 5.91, p = 0.019), and the chronic pain group exhibited slower reaction times. Decreased brain connectivity of the left insula and left frontal regions was confirmed in chronic pain patients (pFWE < 0.05), and connectivity was negatively correlated with validity effects (r = −0.29, permutation test p = 0.033). Further, decreased functional connectivity strength of the right insula and left temporal gyrus in the chronic pain group were confirmed (pFWE < 0.05). We conclude that poor control of attention function results from deficits of functional connectivity in the left insula and left frontal regions in chronic pain.

Clinical implications of panic attack in Chinese patients with somatoform disorders

ObjectiveSomatoform disorders are frequently accompanied by panic attack and causes many clinical symptoms. This study aimed to compare clinical features between patients with and without panic attack in somatoform disorder. MethodsIn this cross-sectional study, 341 patients with somatoform disorder according to the MINI-International Neuropsychiatric Interview (M.I.N·I.) were divided into two groups depending on with or without comorbidity of a panic attack, somatoform disorder with a panic attack (SPA, n = 88) and those without panic attack (SNPA, n = 253). Patient Health Questionnaire (PHQ-15), Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder (GAD-7) scale was used to identify correlations between SPA group and SNPA group, respectively. Correlation analysis and multivariate regression analysis were used to determine the effects of demographic factors and psychiatric diagnoses on somatic, depressive and anxiety symptoms separately. ResultsThe SPA group's PHQ-15, PHQ-9 and GAD-7 scores were significantly higher than those of the SNPA group. Multiple linear regression analyses revealed that the associated factors for PHQ-15 were gender and panic disorder. PHQ-9 was just significantly associated with panic disorder. GAD-7 was significantly associated with education degree and panic disorder. ConclusionsOur results suggest that somatoform disorder patients with panic attack suffered more severe clinical symptoms than those without a panic attack.

Changes in brain glucose metabolism and connectivity in somatoform disorders: an 18F-FDG PET study.

Somatoform disorders (SFD) are defined as a syndrome characterized by somatic symptoms which cannot be explained by organic reasons. Chronic or recurrent forms of somatization lead to heavy emotional and financial burden to the patients and their families. However, the underlying etiology of SFD is largely unknown. The purpose of this study is to investigate the changed brain glucose metabolic pattern in SFD. In this study, 18 SFD patients and 21 matched healthy controls were enrolled and underwent an 18F-FDG PET scan. First, we explored the altered brain glucose metabolism in SFD. Then, we calculated the mean 18F-FDG uptake values for 90 AAL regions, and detected the changed brain metabolic connectivity between the most significantly changed regions and all other regions. In addition, the Pearson coefficients between the neuropsychological scores and regional brain 18F-FDG uptake values were computed for SFD patients. We found that SFD patients showed extensive hypometabolism in bilateral superolateral prefrontal cortex, insula, and regions in bilateral temporal gyrus, right angular gyrus, left gyrus rectus, right fusiform gyrus, right rolandic operculum and bilateral occipital gyrus. The metabolic connectivity between right insula and prefrontal areas, as well as within prefrontal areas was enhanced in SFD. And several brain regions were associated with the somatic symptoms, including insula, putamen, middle temporal gyrus, superior parietal gyrus and orbital part of inferior frontal gyrus. Our study revealed widespread alterations of the brain glucose metabolic pattern in SFD patients. Those findings might elucidate the neuronal mechanisms with glucose metabolism and shed light on the pathology of SFD.

Multisensory mechanisms of body perception in somatoform disorders

ObjectiveAccording to one of the hypotheses, somatoform disorders (SD) are related to disturbed perception of bodily signals. We suspect that the disturbances and abnormalities of multisensory integration dynamics may be an additional SD mechanism. The objective of the research was to investigate multisensory bodily illusion dynamics in SD patients. MethodsA clinical group of SD patients (n = 16) and a control group (n = 17) participated in experiments aimed at eliciting a visual-tactile rubber hand illusion (RHI) and a visual-kinesthetic virtual hand illusion (VHI). ResultsFor both illusions studied, the illusion dynamics in SD patients differed from those of healthy subjects. The visual-tactile illusion on the subjective level appeared to be less strong in SD patients, and no proprioceptive drift (PD) was detected. The subjective dynamics of the visual-kinesthetic illusion in patients were similar to those of the control group, but the PD dynamics were different: after the termination of stimuli from the artificial limb, the proprioceptive system did not return to its initial state; on the contrary, PD continued to increase. ConclusionIn comparison with the norm, patients with somatoform disorders display differences in multisensory mechanisms underlying the development of body perception. The results suggest that the disturbance of visual-tactile integration of the stimuli represents one of the mechanisms of body perception distortion in somatoform disorders. It may be assumed that one of the reasons for persistent symptom perception in SD patients is the rigidity of multisensory stimuli perception, at least in the visual-motor domain.

Effectiveness of Duloxetine in Treating Early Stage of Somatoform Disorder at Koshi Zonal Hospital

Introduction: Somatoform disorder (SD)is group of psychiatric disorders that disrupt multiple physical symptoms, accompanied by disturbance in thoughts, impairing activities of daily living due to muscle and joint pain, low back pain, headache, chronic tiredness, palpitation, stomach upset, dizziness and sleeplessness which may cause occupational and social dysfunction.&#x0D; Objective: Evaluation of patients by Numeric Pain Rating Scale (NPRS), Pain Disability Scale (PDS) and complications duloxetine medication during treating of patients with somatoform disorder at Koshi Zonal Hospital.&#x0D; Methodology: A total of 50 patients with first time diagnosis of SD were selected by in this cross sectional study on the basis of diagnostic and statistical manual (DSM-5), pain and other symptoms, were treated with Duloxetine medication in early stage of Somatoform Disorder and results were evaluated at 2nd week, 6th week and 12th week. The study was conducted from March 2016 to July 2017 at Koshi Zonal Hospital.&#x0D; Results: Out of 50 early SD patients, total mean age was 41.38 years (range 20-60), 21 patients recovered at 6th week and 22 patients recovered at 12th week but 7 patients needed other medications after 12 weeks. Duloxetine was well tolerated with nausea and headache being the most common complaint following use of duloxeting.&#x0D; Conclusion: Duloxetine can be both effective and well tolerated in the treatment of early stage of somatoform disorder.

Stressful life events and quality of life in patients with somatoform disorders

Background: Stressful life events are associated with somatoform disorders. Somatoform disorders can influence the quality of life (QOL). These factors are culture-specific and less studied in the Indian population. Objective: The objective of this study was to evaluate the stressful life events and QOL in patients with somatoform disorders. Materials and Methods: This cross-sectional observational study was done by examining the life events and QOL of 112 consecutive patients who were diagnosed with somatoform disorders. Mini Neuropsychiatric Interview Plus, Presumptive Stressful Life Events Scale (PSLES), and WHO Quality of Life-Bref scales were administered. Results: The study sample had undifferentiated somatoform disorder (32.1%), persistent somatoform pain disorder (26.7%), and somatization disorder (25.9%). The common stressful life events experienced by somatoform disorder patients were financial issues (27.7%), marital conflicts (20.5%), family conflicts (18.7%), and illness in family members (16%). Males reported predominantly financial and job-related stressors, whereas females reported stress in family and interpersonal domain. The mean stress score using PSLES among the participants was 114.9, and the score of mean life events experienced by the participants was 2.03. QOL scores in domains such as physical, psychological, social relationship, and environment were 44.3, 41.4, 46.6, and 47.7, respectively. These were low when compared to population norms. There was a significant positive correlation between the duration of the somatoform disorder and the stress scores and a negative correlation which was not significant between the duration of illness and QOL. Conclusions: There is a difference between stressors experienced between the two genders, the knowledge of which would help in tailoring individual needs in management. There is significant impairment in the QOL in people with somatoform disorder.

Prevalence and correlates of psychiatric comorbidity in chronic pain patients: A hospital-based study

Background: There is a paucity of information on psychiatric comorbidity in chronic pain patients in developing countries like India. The present study was undertaken in this context. Aim: The aim of this study is to assess the psychiatric comorbidity in chronic pain patients. Materials and Methods: Fifty adult chronic pain patients without organic cause of more than 6 months duration attending outpatient departments were included in the study with their informed consent. Psychiatric comorbidity was assessed by the Schedules for Clinical Assessment in Neuropsychiatry. Results: Majority (80%) of patients was between 18 and 50 years of age, came from nuclear families (88%), and was married (82%). Majority (76%) of patients had pain <2 years; 56% had moderate pain severity and 54% had moderate functional impairment due to pain. In chronic pain patients, 78% had psychiatric comorbidity; the most common disorder was depression (36%) followed by generalized anxiety disorder (18%), somatoform disorder (16%), and panic disorder (8%) patients indicating that patients with chronic pain are more likely to have mood disorder than other psychiatric disorders. A significant association was seen between psychiatric comorbidity and pain severity but not with sociodemographic characteristics. Psychiatric comorbidity was associated with severity of pain. Head and neck and back pain patients reported high prevalence of depression (39.5% and 36%), while chest pain and limb pain patients had high prevalence of generalized anxiety disorder (45.5% and 33.3%). There was high prevalence of nonspecific symptoms such as localized tension pain (90%) and worry (82%) in chronic pain patients. Conclusion: The high prevalence of psychiatric comorbidity in patients suffering from chronic pain disorders emphasize the need to screen these patients for psychiatric disorders, particularly depression and anxiety. Diagnosis and treatment of comorbid psychiatric disorders will greatly improve the management of chronic pain patients.

The Neuroanatomy of Somatoform Disorders: A Magnetic Resonance Imaging Study

Somatoform disorders (SDs) are a heterogeneous group of psychiatric syndromes characterized by common symptoms, which may mimic a physical condition but they are not explained by a medical condition. Although the biologic nature of this disorder has been widely accepted, the neuroanatomical correlates characterizing SDs are still inconclusive. This study aims to explore gray matter (GM) volume alterations in SD patients compared to healthy controls and their possible association with clinical and cognitive measures. We used voxel-based morphometry to examine regional GM volumes in 20 inpatients with SDs and 24-matched healthy controls. Only for SD patients, we employed multiple instruments to assess psychopathology and cognitive functioning, which were then used to explore their association with GM volume deficits. Compared to healthy controls, SD patients showed GM volume reductions in the hypothalamus, left fusiform gyrus, right cuneus, left inferior frontal gyrus, left posterior cingulate, and right amygdala (p < 0.05, cluster Family Wise Error corrected). Additionally, in SD, Symptom Checklist-90-Phobia and Hamilton Depressive Rating Scale scores negatively correlated with specific fronto-temporoparietal regions whereas Symptom Checklist-90-Sleep scores positively correlated with anterior cingulate cortex. Lastly, the Boston Naming Test negatively correlated with fronto-temporoparietal and striatal volumes whereas Free and Cued Selective Reminding Test and Stroop scores positively correlated with superior temporal gyrus and cuneus, respectively (all p < 0.05, cluster Family Wise Error corrected). Our results suggest that SDs might be characterized by selective impairments in specific cortico-limbic regions associated to two overlapping circuits, the neuromatrix of pain and the emotion regulation system.

Stability of Cellular Immune Parameters over 12 Weeks in Patients with Major Depression or Somatoform Disorder and in Healthy Controls

Objective: Cellular immune status in major depression (MD) patients differs from that in somatoform disorder (SFD) patients and healthy controls (HC). It is still questionable whether the patterns of immune parameters remain stable over time. Therefore, we studied lymphocyte and monocyte cell counts and neopterin levels in peripheral blood of MD and SFD patients and HC over 12 weeks and tested for correlations between biochemical and psychometric parameters. Methods: Thirty-nine patients with MD, 27 with SFD, and 51 HC were recruited. Peripheral blood was drawn at four visits, at 4-week intervals. We assessed the total cell count of B lymphocytes, natural killer (NK) cells, T lymphocyte subpopu­lations, and monocytes by flow cytometry, and neopterin serum levels by ELISA. Psychometric parameters were measured with questionnaires. Results: Counts of lymphocytes, monocytes, and neopterin were stable in the SFD and HC groups. In the MD group, total CD3⁺, CD3⁺CD8⁺, NK cells, and CD3⁺CD25⁺ T cells showed inhomogeneous variances in Friedman tests, particularly in females. Neopterin correlated with depressed mood in MD patients, and with body mass index in HC. Conclusions: Cellular immune parameters are stable in HC and SFD. Our results may indicate influences of MD and gender on some cellular immune parameters. This may need to be considered in future immunological studies.

Relationship between theory of mind functions with attachment styles and alexithymia in Somatoform Pain Disorder

There is sparse information available in the literature regarding attachment styles and theory of mind functions with somatoform pain disorder. Thus, the aim of the present study is to investigate the relation between somatoform pain disorder and attachment styles, theory of mind functions and alexithymia. Thirty consecutive somatoform pain disorder patients and age, education level and gender ratio matched 30 controls enrolled for the study. SCID-I Structured Clinical Therapy Patient Form, Adult Attachment Scale (AAS), Toronto Alexithymia Scala (TAS-20) Reading Mind from the Eyes Turkish Form (Eyes Test) procedures were applied to the somatoform pain disorder patients that are investigated. According to results; scores of somatoform pain disorder patients with regards to AAS avoidant subscale score, Difficulty Describing Feelings subscale, Difficulty Identifying Feeling subscale, Externally-Oriented Thinking subscale, total Alexithymia Scale scores have been found significantly higher than that of controls (p

Changes in resting-state brain networks after cognitive–behavioral therapy for chronic pain

Cognitive-behavioral therapy (CBT) is thought to be useful for chronic pain, with the pathology of the latter being closely associated with cognitive-emotional components. However, there are few resting-state functional magnetic resonance imaging (R-fMRI) studies. We used the independent component analysis method to examine neural changes after CBT and to assess whether brain regions predict treatment response. We performed R-fMRI on a group of 29 chronic pain (somatoform pain disorder) patients and 30 age-matched healthy controls (T1). Patients were enrolled in a weekly 12-session group CBT (T2). We assessed selected regions of interest that exhibited differences in intrinsic connectivity network (ICN) connectivity strength between the patients and controls at T1, and compared T1 and T2. We also examined the correlations between treatment effects and rs-fMRI data. Abnormal ICN connectivity of the orbitofrontal cortex (OFC) and inferior parietal lobule within the dorsal attention network (DAN) and of the paracentral lobule within the sensorimotor network in patients with chronic pain normalized after CBT. Higher ICN connectivity strength in the OFC indicated greater improvements in pain intensity. Furthermore, ICN connectivity strength in the dorsal posterior cingulate cortex (PCC) within the DAN at T1 was negatively correlated with CBT-related clinical improvements. We conclude that the OFC is crucial for CBT-related improvement of pain intensity, and that the dorsal PCC activation at pretreatment also plays an important role in improvement of clinical symptoms via CBT.

System of integrative psychotherapy of somatoform and psyhosomatic disorders patients

The main goal of the investigation was the integrative psychotherapy system established. On the basis of the examined 350 patients with somatoform disorders and 250 patients with chronic psychosomatic diseases, we have elaborated a test that allows to evaluate quantitatively the influence of the disease on patients’ social functions. We created the integrative psychotherapy system with cognitive-oriented, suggestive and autosuggestive implementations. Elucidation of peculiarity of personal perception of the disease served as basis of elaboration of purposeful system of psychotherapy, consulting, and psychological support for psychosomatic patients with high-effectiveness 1.5–3 years catamnesis in 85% patients. Psychotherapy should be used first of all as a target-oriented. Our experience showed the necessity of the use the integrative models of psychotherapy, parted on stages. On the first stage, the receptions of cognitive and suggestive psychotherapy are used. There is group therapy on second stage. On the third stage elements of the autogenic training mastered. The system examination high efficacy was shown.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Collaboration Is Key to Improving Hospital Care for Patients With Medical and Psychiatric Comorbidity.

Over the past 2 decades, hospitals have been increasingly called on to provide stabilization and treatment of pediatric patients with mental health symptoms. At least 1 in 10 hospitalized children >3 years has both a medical and a psychiatric condition,1 and the population of hospitalized patients with significant psychiatric morbidity is growing.2 Patients who have conditions affecting both their mental and physical health are in need of integrated medical and psychiatric treatments, and hospitals report challenges ensuring teams are prepared to care for these patients.3 In this month’s Hospital Pediatrics , Ibeziako et al4 provide a new window into understanding the characteristics of patients with eating disorders and somatoform disorders with an eye toward advancing the quality of their inpatient care. In this single-center, retrospective cohort study of 250 patients, Ibeziako et al4 found that patients hospitalized for eating disorders and somatoform disorders shared similar demographic characteristics, stressors, and coping styles. Nevertheless, a number of their medical and psychiatric symptoms and treatments differed. Eating disorder patients had higher rates of depression, suicidal ideation, and self-injury and required more laboratory testing, whereas somatoform disorder patients had greater fragmentation of their care, more neurologic evaluation, more specialty consults, and higher rates of learning disabilities. The reported findings highlight the value of a team approach to providing hospital care to patients with eating disorders and somatoform disorders. Efforts to use data like those reported by Ibeziako et al4 …

Suicidality in patients with somatoform disorder - the speechless expression of anger?

To identify emotion-associated risk factors for suicidality in patients with somatoform disorders. A sample of 155 consecutive patients diagnosed with somatoform disorders at the Psychosomatic Ambulance of Bonn University Hospital filled in several questionnaires including the Symptom Checklist 90-Revised Version (SCL-90-R), the Toronto Alexithymia Scale (TAS-20), and the State Trait Anger Expression Inventory (STAXI). Our aim was to compare patients with suicide attempts to patients without suicide attempts via a MANCOVA (IV: Group; DV: SCL-90-R, TAS-20, STAXI; covariates: sex, age, depression, borderline personality disorder). Lifetime suicide attempts were documented in 20 patients (12.9%), current active suicidal ideation in 33.6%, and thoughts of death or dying in 55.9%. Patients with lifetime suicide attempts showed significantly more psychological distress, a significantly higher alexithymia sum score, a significantly higher score on trait anger, state anger, and a stronger tendency to express anger. Somatoform disorder patients with lifetime suicide attempts might have greater difficulties in identifying and describing emotions, and a tendency to intensely experience and express anger. Future longitudinal studies should further investigate possible links between difficulties in coping with anger and suicidality to improve prophylaxis and treatment of suicidal behaviour in somatoform disorder patients.

Integrative psychotherapy model on somatoform disorders patients

Last 12years in Ukraine the special priority has the problem of somatoform disorders. The most significant role belongs to the patient's self-evaluation of the influence of the disease on their social functioning, influence essential past of the self-picture of the disease and the important point of therapeutic rehabilitation intervention. On the basis of the examined 300 patients on somatoform disorders and 210 patients on ischemic cordial disease, we have elaborated a formal test that allows evaluating quantitatively the influents of the disease on various spheres of patients' social status. It was absolutely unrespectable the common for ischemic cordial and somatoform disorders patients rise of significance of personal individual, common life factors in cases of aggravation of the main disease course. We created the integrative psychotherapy system with cognitive-behavioral, suggestive and autosuggestive implementations. Elucidation of peculiarity of personal perception of the disease served as basis of elaboration of purposeful system of psychotherapy, consulting, psychological support for patients with high-effectiveness 1.5–3years catamnesis in 85% patients. The retrospective results showed the necessity the target-oriented integrative models of psychotherapy, parted on stages. On the first stage-sedative-adapting the receptions of cognitive and suggestive psychotherapy are used. There is group therapy on second-main-stage. On the third stage-supportive-elements of the autogenic training mastered.