Somatization in the community.

We examined the prevalence of somatization disorder symptoms elicited with the Diagnostic Interview Schedule in 3132 community respondents interviewed in Los Angeles by the Epidemiologic Catchment Area program. The variables age, gender, ethnic background, and the presence of a psychiatric diagnosis significantly influenced the number of somatization symptoms reported. An introductory review on conceptual and nosological aspects of somatization phenomena led to the formulation of a less-restrictive operational definition of the somatizer. We found that 4.4% of the respondents met criteria for this abridged cutoff score of somatization, whereas only 0.03% of the respondents met criteria for the full DSM-III somatization disorder diagnosis. This abridged cutoff score was associated with sociodemographic factors and psychiatric diagnosis in the direction predicted.

Development of the Spanish-language version of the National Institute of Mental Health Diagnostic Interview Schedule.

The use of the National Institute of Mental Health Diagnostic Interview Schedule (DIS) to elicit DSM-III-defined mental disorders among Hispanic respondents in the Los Angeles site of the Epidemiologic Catchment Area project required development of a Spanish translation of the instrument that would be understood readily by persons of Mexican, Puerto Rican, and Cuban origin. The translation was carried out using back translation, bilingual test respondents, a bilingual translation staff, an extensive committee of experienced bilingual clinicians as translation consultants, and revision following clinical evaluation. A study of its reliability and comparison with clinical diagnoses obtained with Spanish-speaking psychiatric outpatients indicated satisfactory equivalence of the Spanish DIS to the English version. Early international use of the Spanish DIS promises new data on the cross-cultural validity and prevalence rates of DSM-III-diagnosed disorders.

The Spanish Diagnostic Interview Schedule. Reliability and comparison with clinical diagnoses.

The National Institute of Mental Health Diagnostic Interview Schedule (DIS) was translated into Spanish. The reliability of the Spanish instrument, its equivalence to the English version, and its agreement with clinical diagnoses were examined in a study of 90 bilingual (English-and Spanish-speaking) and 61 monolingual (Spanish-speaking only) patients from a community mental health center. The study design involved two independent DIS administrations and one independent clinical evaluation of each subject.

Six-month prevalence of specific psychiatric disorders among Mexican Americans and non-Hispanic whites in Los Angeles.

The current prevalence of DSM-III psychiatric disorders was assessed using the Diagnostic Interview Schedule (DIS) as part of a Los Angeles household population survey. The Los Angeles prevalence estimates were compared with sex- and age-adjusted estimates from four other US field sites, all of which were part of the Epidemiologic Catchment Area (ECA) program. Overall, few significant differences in household population rates were found between Los Angeles and the other ECA sites. Within the Los Angeles household sample, the current prevalence of disorder among Mexican Americans was compared with that among non-Hispanic whites. Non-Hispanic whites had higher rates of drug abuse/dependence than Mexican Americans; the rates among non-Hispanic whites in Los Angeles were also higher than those found at other ECA sites. Mexican Americans displayed higher rates of severe cognitive impairment, a finding that likely reflects ethnic and educational bias in the measurement of cognitive impairment. Another ethnic difference was found only for one specific age and sex group: Mexican-American women 40 years of age or older had strikingly high rates of phobia.

Lifetime prevalence of specific psychiatric disorders among Mexican Americans and non-Hispanic whites in Los Angeles.

The lifetime prevalence of specific DSM-III-defined psychiatric disorders among 1243 Mexican-American and 1309 non-Hispanic white residents of two Los Angeles communities is reported from the Los Angeles site of the Epidemiologic Catchment Area (ECA) research study. Results from household interviews in response to the National Institute of Mental Health Diagnostic Interview Schedule revealed overall rates of disorders for the total Los Angeles sample and ethnic subsamples that were similar to rates reported from the initial three ECA sites. Non-Hispanic whites reported far more drug abuse/dependence and more major depressive episodes than Mexican Americans. Young non-Hispanic white women reported high rates of major depressive episodes and drug abuse/dependence. Alcohol abuse/dependence is highly prevalent among Mexican-American and non-Hispanic white men of any age. Mexican-American women infrequently abuse or become dependent on drugs or alcohol at any age. Dysthymia, panic disorder, and phobia are somewhat more prevalent among Mexican-American women over 40 years of age compared with both non-Hispanic white women over and Mexican-American women under 40 years of age. Antisocial personality is predominantly a disorder of young men of both ethnic groups.

Utilization of health and mental health services by Los Angeles Mexican Americans and non-Hispanic whites.

Utilization of general medical and mental health services by respondents in the Los Angeles Epidemiologic Catchment Area (ECA) site was compared with that in three ECA sites studied previously (New Haven, Conn, Baltimore, and St Louis). Within the Los Angeles sample, Mexican-American patterns of utilization were compared with those for non-Hispanic whites. Los Angeles respondents were less likely than those at other ECA sites to make ambulatory health care visits and to be hospitalized for physical or mental health reasons. Mexican Americans were less likely than non-Hispanic whites to report ambulatory health care but were as likely to have been hospitalized. Six percent of Los Angeles respondents reported a recent mental-health-care visit as compared with 6% to 7% of respondents at the other ECA sites. However, among respondents with Diagnostic Interview Schedule DSM-III disorders diagnosed within the six months prior to the interview, a lower proportion made a mental health visit in Los Angeles (14%) compared with the other sites (16% to 20%). Of those who made a mental-health-care visit, Los Angeles respondents with a recently diagnosed disorder were more likely than comparable respondents at the other ECA sites to visit a mental health specialist rather than a general medical care provider. Mexican Americans with a recently diagnosed mental disorder were only half as likely as non-Hispanic whites (11% vs 22%, respectively) to have made a mental health visit. However, when Mexican Americans with Diagnostic Interview Schedule/DSM-III did make a mental health visit, they were as likely as non-Hispanic whites to see a mental health specialist.

Depressive phenomenology in North and South American patients.

The authors assessed patients newly admitted to two North American health centers and one South American (Colombian) center according to a standardized protocol, with a structured interview, a symptom checklist, and a depression scale. The patients were suffering from major depressive disorders with endogenous features. There was an impressive similarity in symptoms of depression across cultures, supporting the idea of a universal core depressive syndrome. However, somatization indexes, psychomotor components of depression, and levels of psychopathology differed between U.S. and Colombian samples. The authors offer a general discussion of potential determinants of these cross-cultural differences.

Somatic symptoms after a natural disaster: a prospective study.

The authors prospectively examined the prevalence of somatization symptoms among community respondents after a natural disaster in Puerto Rico. Exposure to the disaster was related to a higher prevalence of medically unexplained physical symptoms, particularly gastrointestinal ones (abdominal pain, vomiting, nausea, excessive gas) and pseudoneurological ones (amnesia, paralysis, fainting, unusual spells/double vision).

Lithium carbonate in the treatment of tardive dyskinesia.

Six patients with tardive dyskinesia were treated with lithium carbonate in an open clinical trial. Evaluations using a new tardive dyskinesia rating scale showed statistically significant improvement in dyskinetic movements while the patients received lithium. This improvement was consistently observed in all patients but was relatively small when compared to the amount of pathology present.

Loxapine versus chlorpromazine in paranoid schizophrenia: a double-blind study.

Newly admitted paranoid schizophrenic patients (N = 68) were treated with either loxapine or chlorpromazine for up to 4 weeks. Mean maximum dosages were 84 mg/day of loxapine and 820 mg/day of chlorpromazine. Loxapine showed efficacy superior to that of chlorpromazine, confirming earlier retrospective findings. Adverse reactions were also less troublesome with loxapine.

Comparison of injectable molindone and haloperidol followed by oral dosage forms in acutely ill schizophrenics.

The comparative efficacy of molindone and haloperidol, given by injection for the first 2-3 days of hospitalization and then continued orally for up to 4 weeks, is reported from an ongoing double-blind study. Efficacy and side effects were assessed by the Brief Psychiatric Rating Scale, Clinical Global Impressions, Treatment Emergent Symptom Scale, and Target Symptom Ratings. Analyses based on the first 35 patients who entered the study indicate that both drugs were effective and well tolerated. There were slight advantages for molindone early during the injectable phase of treatment and for haloperidol late during the oral portion of the study, but these differences were not clinically significant. No significant differences in side effects were found between the two drugs.

The NIMH-DIS in the assessment of DSM-III schizophrenic disorder.

The National Institute of Mental Health Diagnostic Interview Schedule (NIMH-DIS) was administered by trained lay interviewers to a sample of 82 outpatients with clinical diagnoses of DSM-III schizophrenic disorder. Of these subjects, 77 percent were also diagnosed as suffering from DSM-III schizophrenic disorder according to the structured interview (NIMH-DIS) administered by a lay interviewer. The DIS interviews were scrutinized to find the reasons for their discrepancy with the clinical diagnoses. A majority of the DIS-negative schizophrenic subjects acknowledged significant psychopathology in the DIS and missed only one of the six DSM-III criteria items for schizophrenia. Test-retest results showed consistency in the subjects' reporting of lifetime schizophrenic symptoms.

Transcultural aspects of dissociative and somatoform disorders.

A brief review of the cross-cultural literature on dissociative and somatoform disorders with emphasis on US Hispanic populations has been provided. A brief description of the psychopathology of somatizing syndromes has been given as have some critiques of current nosologic systems. Cultural influences that may color the expression of somatic manifestations have been outlined. Although it is often difficult to disentangle the contribution of ethnicity from other demographic factors, and although there are plenty of methodologic shortcomings, most studies reinforce the view that culture exerts a powerful influence in shaping symptom presentation and determining health-related attitudes. Future work using instruments such as the Composite International Diagnostic Interview (CIDI) (Rubio-Stipec M: The somatization schedule of the Composite International Diagnostic Interview: The use of the probe in 17 different countries; unpublished manuscript) that include a more culturally congruent list of somatizing symptoms may shed new light on the international distribution and mechanisms at play in these symptom presentations.

Antidepressants in chronic pain: a review of efficacy.

Antidepressant drugs have gained widespread clinical usage alone or as adjuncts in the treatment of chronic pain disorders. Of 17 controlled studies of antidepressants in chronic pain, 13 demonstrated significant pain relief with antidepressants compared to placebo. These studies were too different from one another to allow any general conclusions concerning efficacy, however. Five studies of either migraine or chronic tension headache all demonstrated superior efficacy of antidepressants versus placebo, while those of back and arthritic pain yielded mixed results. Of 3 studies of pain of several etiologies, 2 failed to demonstrate efficacy of antidepressants over placebo. These studies do not provide answers to many clinical questions on the use of antidepressants for chronic pain, such as drug of choice or appropriate dosage. Rather, they suggest that these agents may be beneficial in some patients with chronic pain.

Screening for somatization disorder in patients with chronic fatigue.

The current definition of Somatization Disorder requires the assessment of each of 35 symptoms, 13 of which have to be scored as meeting special criteria (e.g., not due to medical reasons) in order to make the diagnosis. The detailed questioning and probing about each symptom can be quite elaborate--hence the interest in developing briefer screening indexes. This study evaluated two sets of screening indexes for Somatization Disorder (those of Othmer and DeSouza and Swartz and colleagues) that had been previously developed in psychiatric and community samples. One hundred medical outpatients with chronic fatigue constituted the study sample. The patients underwent thorough medical evaluations and were administered the Diagnostic Interview Schedule (DIS) to make the psychiatric diagnoses. Of the two screening sets, the one developed in a psychiatric outpatient sample (Othmer and DeSouza's) had the best sensitivity. Although a screening index derived from the DIS interviews of this group of patients also had excellent sensitivity, we support the use of Othmer and DeSouza's index in medical outpatients with a chief complaint of chronic fatigue.

DSM-IV hypochondriasis in primary care.

The object of this study was to assess the prevalence and correlates of the DSM-IV diagnosis of hypochondriasis in a primary care setting. A large sample (N = 1456) of primary care users was given a structured interview to make diagnoses of mood, anxiety, and somatoform disorders and estimate levels of disability. The prevalence of hypochondriasis (DSM-IV) was about 3%. Patients with this disorder had higher levels of medically unexplained symptoms (abridged somatization) and were more impaired in their physical functioning than patients without the disorder. Of the various psychopathologies examined, major depressive syndromes were the most frequent among patients with hypochondriasis. Interestingly, unlike somatization disorder, hypochondriasis was not related to any demographic factor. Hypochondriasis is a relatively rare condition in primary care that is largely separable from somatization disorder but seems closely intertwined with the more severe depressive syndromes.

A hierarchical classes analysis (HICLAS) of primary care patients with medically unexplained somatic symptoms.

This study used a clustering model, Hierarchical Classes Analysis (HICLAS), to examine patient groupings in a multiethnic sample of 1456 patients using primary care services at a university-affiliated community clinic in southern California. Somatic symptoms, psychiatric diagnoses and disability were studied using a survey instrument that included portions of the Composite International Diagnostic Interview (CIDI), the Diagnostic Interview Schedule (DIS) and the RAND-MOS Short Form Health Survey's (SF-36) 'physical functioning' dimension. HICLAS identified 11 clusters of patients with distinct patterns of medically unexplained somatic symptoms. These patient clusters varied with respect to psychiatric diagnoses and symptoms, gender, immigration status and disability. Results of this study suggest that the type of presenting symptom(s) and their various combinations may have diagnostic and prognostic value in primary care settings. These new findings may lead to further refinement of current diagnostic constructs for somatizing syndromes.

Immigration and mental health: Mexican Americans in the United States.

The Hispanic population in the United States continues to expand rapidly due primarily to a large flow of immigrants from Mexico. Historical observations of disadvantage in the immigrant population, when compared to the native population, had helped to shape prevailing theories on immigration and mental health. However, data emerging from new research on Mexican Americans have come to challenge the old idea that immigrants are necessarily disadvantaged. The goal of this article is to review these new studies critically, to draw conclusions concerning the relationship between immigration and psychopathology, and to offer potential explanations for the major findings. We review five recent large-scale studies that examined the prevalence of mental disorders among Mexican-born immigrants and U.S.-born Mexican Americans in the United States. Results of these studies are inconsistent with traditional tenets on the relationship among immigration, acculturation, and psychopathology. They show that Mexico-born immigrants, despite significant socioeconomic disadvantages, have better mental health profiles than do U.S.-born Mexican Americans. Possible explanations for the better mental health profile of Mexican immigrants include research artifacts such as selection bias, a protective effect of traditional family networks, and a lower set of expectations about what constitutes "success" in America. The elevated rates of psychopathology in U.S.-born Mexican Americans may be related to easier access to abused substances and an elevated frequency of substance abuse among the U.S.-born.

Cognitive behavior therapy for somatization disorder: a preliminary investigation.

Patients diagnosed with somatization disorder have high rates of disability and often prove refractory to treatment. This preliminary investigation examines the effect of a 10-session cognitive behavior therapy (CBT) protocol on the physical discomfort and disability of severely impaired somatizers. The severity of patients' physical discomfort and disability was assessed at baseline, post-treatment, and eight months following treatment. Patients reported significant improvement in symptomatology and physical functioning between baseline and post-treatment as well as between baseline and follow-up. The findings suggest that CBT might benefit patients diagnosed with somatization disorder and should be subjected to a controlled treatment trial.

Functional somatic symptoms: a cross-ethnic comparison.

Type, distribution, and comorbidity of functional somatic symptoms were examined in four community samples, three Hispanic and one non-Hispanic white. Important intergroup and intragroup differences between Hispanic and non-Hispanic white groups were identified. Of the four groups, Puerto Rican respondents reported the highest level of somatic symptoms; this finding was apparently independent of sociodemographic factors.