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Follow-up study on health care use of patients with somatoform, anxiety and depressive disorders in primary care
Margot WM de Waal, Ingrid A Arnold, Just AH Eekhof, Willem JJ Assendelft, Albert M van Hemert
BMC Family Practice , 2008, DOI: 10.1186/1471-2296-9-5
Abstract: In eight family practices 1046 consulting patients (25–79 yrs) were screened and a stratified sample of 473 was interviewed. Somatoform disorders, anxiety and depressive disorders were diagnosed (DSM IV) using SCAN 2.1. The electronic records of 400 participants regarding somatic diseases, medication and healthcare use were available through their family physicians (FP).In the follow-up year patients with psychiatric disorders had more face-to-face contacts with the FP than patients who had no psychiatric disorder: average 7–10 versus 5. The impact on the use of primary care by patients with somatoform disorders was comparable to patients with depressive or anxiety disorders. Undifferentiated somatoform disorders had an independent impact on the use of primary care after adjustment for anxiety and depressive disorders, resulting in 30% more consultations (IRR 1.3 (95% CI: 1.1–1.7)). Anxiety disorders had no independent effect.Health care planning should focus on the recognition and treatment of somatoform as well as affective disorders.Psychiatric disorders may have a significant impact on consultation rates in primary care. Patients with anxiety and depressive disorders report more use of health care than patients without these disorders [1,2]. A similar assumption can be made for somatoform disorders, considering the predominant presentation of physical symptoms [3-5]. Additionally, hypochondriacal beliefs and a high somatic concern have found to be related to a high utilization of health care [6,7].With an estimated prevalence rate between 13% and 27%, undifferentiated somatoform disorder is the most prevalent somatoform disorder in primary care [8,3]. Somatization disorder and hypochondriasis are encountered less, with prevalence rates below 5% [9]. In DSM-IV the diagnosis of undifferentiated somatoform disorder (USD) can be made when at least one medically unexplained physical symptom leads to substantial impairment for a minimum of 6 months [10]. Hence, health
Defense mechanisms in patients with fibromyalgia and major depressive disorder
Landmark,Tormod; Stiles,Tore C.; Fors,Egil A.; Holen,Are; Borchgrevink,Petter C.;
The European Journal of Psychiatry , 2008, DOI: 10.4321/S0213-61632008000400001
Abstract: background and objectives: fibromyalgia (fm) and depression has been suggested to share a common underlying etiology. few studies have investigated the role of emotional regulation processes in fm compared to depressive disorders.the purpose of the current study was to explore the use of defense mechanisms in fm patients with and without comorbid lifetime depressive disorder (ldd), and to compare their use of defenses to healthy control subjects and patients with major depressive disorder (mdd). methods: a total of 91 participants were included (17 with fm and ldd, 25 with fm but not ldd, 24 with mdd, and 25 healthy controls). depressive disorders were identified by using the structured clinical interview for dsm axis i disorders (scid-i). all diagnosis of fm were confirmed to meet the american college of rheumatology's criteria for fm. the life style index (lsi) was used to measure defense mechanisms. results and conclusions: group comparisons indicated that mdd patients and fm patients with ldd made significantly more use of defenses than healthy controls, whereas fm patients without ldd made significantly less use of defenses than both mdd patients and fm patients with ldd, but did not differ from healthy controls. follow up analyses indicated significant main effects for the defense mechanisms of regression, compensation and displacement. this study suggests that fm and depression do not share common risk factors in terms of restricted affects or avoidance of conflicted feelings.
Defense mechanisms in patients with fibromyalgia and major depressive disorder  [cached]
Tormod Landmark,Tore C. Stiles,Egil A. Fors,Are Holen
The European Journal of Psychiatry , 2008,
Abstract: Background and objectives: Fibromyalgia (FM) and depression has been suggested to share a common underlying etiology. Few studies have investigated the role of emotional regulation processes in FM compared to depressive disorders.The purpose of the current study was to explore the use of defense mechanisms in FM patients with and without comorbid lifetime depressive disorder (LDD), and to compare their use of defenses to healthy control subjects and patients with Major Depressive Disorder (MDD). Methods: A total of 91 participants were included (17 with FM and LDD, 25 with FM but not LDD, 24 with MDD, and 25 healthy controls). Depressive disorders were identified by using the Structured Clinical Interview for DSM Axis I disorders (SCID-I). All diagnosis of FM were confirmed to meet the American College of Rheumatology's criteria for FM. The Life Style Index (LSI) was used to measure defense mechanisms. Results and Conclusions: Group comparisons indicated that MDD patients and FM patients with LDD made significantly more use of defenses than healthy controls, whereas FM patients without LDD made significantly less use of defenses than both MDD patients and FM patients with LDD, but did not differ from healthy controls. Follow up analyses indicated significant main effects for the defense mechanisms of regression, compensation and displacement. This study suggests that FM and depression do not share common risk factors in terms of restricted affects or avoidance of conflicted feelings.
Dissociative disorders and other psychopathological groups: exploring the differences through the Somatoform Dissociation Questionnaire (SDQ-20)
Santo, Helena Maria Amaral do Espirito;Pio-Abreu, José Luís;
Revista Brasileira de Psiquiatria , 2007, DOI: 10.1590/S1516-44462006005000039
Abstract: objective: the somatoform dissociation questionnaire is a self-report questionnaire that has proven to be a reliable and valid instrument. the objectives of this study were to validate the portuguese version and to determine its capability to distinguish patients with dissociative disorders from others with psychopathological disorders. method: 234 patients answered the translated version of somatoform dissociation questionnaire. the portuguese dissociative disorders interview schedule was used to validate clinical diagnosis. patients with dissociative disorder (n = 113) were compared to a control group of 121 patients with various anxiety and depression disorders. results: reliability measured by cronbach's a was 0.88. the best performance of the portuguese form was at a cut-off point of 35, which distinguishes between dissociative disorder and neurotic disorders with a good diagnostic efficacy (sensitivity = 0.73). the somatoform dissociation was significantly more frequent in dissociative disorder patients, conversion disorder patients and post-traumatic stress disorder patients. conclusions: these findings suggest that dissociative disorders can be differentiated from other psychiatric disorders through somatoform dissociation. the portuguese version of the somatoform dissociation questionnaire has fine psychometric features that sustain its cross-cultural validity.
Persistent Depressive Disorder or Dysthymia: An Overview of Assessment and Treatment Approaches  [PDF]
Sherri Melrose
Open Journal of Depression (OJD) , 2017, DOI: 10.4236/ojd.2017.61001
Abstract: Persistent depressive disorder or dysthymia is a recurrent depressive disorder with no clearly demarcated episodes. Onset is insidious and can occur in adolescence or adulthood. Dysthymia frequently remains unrecognized and undiagnosed for years. Co-morbid major depression, anxiety, personality, somatoform and substance abuse disorders are common. Symptoms center on sad mood, pessimism and hopelessness. Sufferers experience significant functional impairment and are at risk of death by suicide. Those most at risk are female, unmarried, live in high income countries and have family histories of depression. Screening instruments include the Cornell Dysthymia Rating Scale (CDRS). Typical treatments are antidepressant medications and cognitive behavioral analysis system of psychotherapy (CBASP). This paper provides health professionals with an overview of assessment and treatment approaches in dysthymia.
Do defense mechanisms vary according to the psychiatric disorder?
Blaya, Carolina;Dornelles, Marina;Blaya, Rodrigo;Kipper, Letícia;Heldt, Elizeth;Isolan, Luciano;Bond, Michael;Manfro, Gisele Gus;
Revista Brasileira de Psiquiatria , 2006, DOI: 10.1590/S1516-44462006000300007
Abstract: objective: the aim of this study was to evaluate the defense mechanisms used by depressive and anxious patients without comorbidities compared to those used by controls and to determine whether these patterns differ between diagnoses. method: the sample was composed of 167 psychiatric patients and 36 controls that were evaluated using the defense style questionnaire 40. all subjects were evaluated through a clinical interview, and each evaluation was confirmed through the application of the mini international neuropsychiatric interview, a structured psychiatric interview. we used anova and discriminant analysis to assess differences between groups. results: neurotic defense mechanisms discriminated controls from all patients except those with social anxiety. immature defense mechanisms differentiated controls from all patients, as well as distinguished depressive patients from panic disorder and obsessive disorder patients. the discriminant analysis indicated that depressive patients are characterized by projection, panic disorder patients by sublimation and obsessive-compulsive patients by acting out. conclusions: depressive and anxious patients differ from other individuals in their use of defense mechanisms, and each diagnosis has a particular pattern. these findings could lead to the development of specific psychotherapeutic interventions.
Do defense mechanisms vary according to the psychiatric disorder?
Blaya Carolina,Dornelles Marina,Blaya Rodrigo,Kipper Letícia
Revista Brasileira de Psiquiatria , 2006,
Abstract: OBJECTIVE: The aim of this study was to evaluate the defense mechanisms used by depressive and anxious patients without comorbidities compared to those used by controls and to determine whether these patterns differ between diagnoses. METHOD: The sample was composed of 167 psychiatric patients and 36 controls that were evaluated using the Defense Style Questionnaire 40. All subjects were evaluated through a clinical interview, and each evaluation was confirmed through the application of the Mini International Neuropsychiatric Interview, a structured psychiatric interview. We used ANOVA and discriminant analysis to assess differences between groups. RESULTS: Neurotic defense mechanisms discriminated controls from all patients except those with social anxiety. Immature defense mechanisms differentiated controls from all patients, as well as distinguished depressive patients from panic disorder and obsessive disorder patients. The discriminant analysis indicated that depressive patients are characterized by projection, panic disorder patients by sublimation and obsessive-compulsive patients by acting out. CONCLUSIONS: Depressive and anxious patients differ from other individuals in their use of defense mechanisms, and each diagnosis has a particular pattern. These findings could lead to the development of specific psychotherapeutic interventions.
An Instance of Somatoform Disorder  [PDF]
Armando Simon
Open Journal of Medical Psychology (OJMP) , 2013, DOI: 10.4236/ojmp.2013.21004
Abstract: A case study is presented of a prison inmate with Somatoform Disorder, a relatively rare type of mental illness. In this particular case symptomatology revolved around his claim that some of his teeth were rotten, resulting in great pain, in spite of several diagnoses by dentists. When said teeth were extracted, inmate would express satisfaction, whereupon several weeks later the same complaint would resurface and the cycle began anew. Of the various types of mental illnesses listed in the DSM, there are some that are infrequently seen [1,2] One of these is Somatoform Disorder, a category of mental illness for which there is a paucity of research, partly due to diagnostic difficulties and controversies [3,4] and we would like to present a case study of just such an instance.
Pain drawings in somatoform-functional pain  [cached]
Egloff Niklaus,Cámara Rafael JA,von K?nel Roland,Klingler Nicole
BMC Musculoskeletal Disorders , 2012, DOI: 10.1186/1471-2474-13-257
Abstract: Background Pain drawings are a diagnostic adjunct to history taking, clinical examinations, and biomedical tests in evaluating pain. We hypothesized that somatoform-functional pain, is mirrored in distinctive graphic patterns of pain drawings. Our aim was to identify the most sensitive and specific graphic criteria as a tool to help identifying somatoform-functional pain. Methods We compared 62 patients with somatoform-functional pain with a control group of 49 patients with somatic-nociceptive pain type. All patients were asked to mark their pain on a pre-printed body diagram. An investigator, blinded with regard to the patients’ diagnoses, analyzed the drawings according to a set of numeric or binary criteria. Results We identified 13 drawing criteria pointing with significance to a somatoform-functional pain disorder (all p-values ≤ 0.001). The most specific and most sensitive criteria combination for detecting somatoform-functional pain included the total number of marks, the length of the longest mark, and the presence of symmetric patterns. The area under the ROC-curve was 96.3% for this criteria combination. Conclusion Pain drawings are an easy-to-administer supplementary technique which helps to identify somatoform-functional pain in comparison to somatic-nociceptive pain.
Symptom Similarities and Differences in Anxiety and Depressive Disorders  [PDF]
Dilek Sirvanli Ozen,Elif Temizsu
Psikiyatride Guncel Yaklasimlar , 2010,
Abstract: The question if there is a valid distinction between depression and anxiety disorders remains controversial. These two disorders have various overlaps in the symptomatology and sometimes it is difficult to make a clear diagnosis. The difficulty in making a definite diagnosis destined researchers to determine the differences and the similarities between anxiety and depression. The negative affect which has multiple dimensions such as low self-esteem, negative mood and negative cognitions is seen as the common factor in both disorders. The positive affect which has been defined as the harmony and satisfaction with others and milieu, is regarded as the discriminating factor for the diagnosis of depression. Further research has characterized somatic arousal as the third dimension, a candidate to be the discriminating factor for anxiety disorders. Although phenotypic models appear to find a solution for this problem the facts that negative affect dimension is more loaded compared to the other two dimensions and predominance of negative affect on several symptom patterns prevent researchers to reach a conclusive results regarding the differences between these two disorders. In this review article, symptom similarities and differences of anxiety and depressive disorders are discussed within the frame of phenotypic models and some alternative ideas are provided for possible changes in upcoming versions of classification systems.
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