Psychobehavioral B-Criteria of Somatic Symptom Disorder Are Associated with Somatic Symptom Reporting in a Large Sample of Psychosomatic Outpatients.

Introduction: Somatic symptom disorder (SSD) as introduced by the DSM-5 is characterized by chronic somatic symptoms not fully explained by underlying pathology and accompanied by psychological factors, the diagnostic B-criteria. These cognitive, affective, and behavioral disturbances are related to increased attention to somatic symptoms. However, there is a lack of empirical evidence regarding the association between the B-criteria and high symptom reporting in clinical settings. Methods: This 12-year retrospective, cross-sectional, observational study examined 6,491 patients from a German psychosomatic outpatient center. The somatoform subscale of HEALTH-49 was used to evaluate somatic symptom reporting. Excessive health concerns and other potential criteria associated with symptom reporting were determined using the ICD-10-Symptom Rating and other HEALTH-49 subscales. Results: Regression analysis revealed that the established B-criteria for SSD were the strongest factors associated with somatic symptom reporting, with a standardized beta-coefficient of ß = 0.31 (R2 = 0.428, df = 24, F = 187.886). Other psychobehavioral factors were clearly less associated with somatic symptom reporting, such as depressive symptoms with ß = 0.15 and impaired activity and participation with ß = 0.12. Sociodemographic factors, such as age (ß = 0.16) and gender (ß = 0.12), were also independently associated with somatic symptom reporting. Conclusion: This study provides evidence for the concept of SSD related to specific B-criteria associated with somatic symptom reporting, based on a large patient sample. These results point to an important role of psychological symptomatology in patients with somatic symptoms. The findings also suggest that additional factors contribute to the reporting of somatic symptoms. Our results may inform future diagnostic criteria for SSD.

This scientific study examines the association between psychobehavioral factors and somatic symptom reporting in a large sample of psychosomatic outpatients. We investigated the association of established and possible additional psychobehavioral criteria for somatic symptom disorder (SSD) as defined in the DSM-V. The study included 6,491 patients from a psychosomatic outpatient center over a 12-year period. The participants completed self-report questionnaires to assess somatic symptom reporting and psychobehavioral factors. The results showed that the B-criteria of SSD were associated with somatic symptom reporting, indicating the validity of these criteria in clinical practice. Other psychobehavioral factors, such as depressive symptoms and impaired activity and participation, as well as sociodemographic factors such as age and gender were also associated with somatic symptom reporting but to a much lesser extent. This study has limitations, including its retrospective and cross-sectional design, reliance on self-report measures, and the need for further research using longitudinal data and clinician-rated assessments to complement self-report data. However, our research highlights the importance of psychological symptomatology in individuals who report somatic symptoms. These findings may inform future diagnostic criteria and treatment approaches for individuals with SSD and improve treatment and patient outcomes.

Evaluation of a new body-focused group therapy versus a guided self-help group program for adults with psychogenic non-epileptic seizures (PNES): a pilot randomized controlled feasibility study.

OBJECTIVE: Psychogenic non-epileptic seizures (PNES), a common phenomenon in neurological settings, are regarded as a paroxysmal type of functional neurological disorder (FND). In a substantial proportion, PNES are disabling with poor long-term outcomes and high economic costs. Despite the clinical and financial consequences of PNES, there is still a lack of controlled clinical trials on the treatment of this challenging disorder. The study aims to evaluate the feasibility and collect first evidence of the efficacy of a group based-intervention in PNES-patients. METHODS: A pilot randomized controlled feasibility study with a parallel-group design was performed in adult outpatients with PNES to evaluate a new body-focused group therapy (CORDIS) versus guided self-help groups. Self-assessment of dissociation (Dissociation Experience Scale-DES-20) and seizure severity (Liverpool Seizure Severity Scale-LSSS) were assessed two weeks before and two weeks after the treatment intervention and also six months after treatment as primary outcome parameters. RESULTS: A total of 53 patients were recruited from a specialized outpatient clinic, and out of those, 29 patients completed either the body-focused group therapy program (n = 15) or a guided self-help group (SHG) therapy (n = 14). When analyzing the ITT sample (n = 22 CORDIS group, n = 20 SHG), both groups showed an effect on seizure severity and level of dissociation. In the per protocol sample (n = 13 CORDIS group, n = 12 SHG), CORDIS was superior to the self-help group for reducing seizure severity 6 months after the treatment. SIGNIFICANCE: CORDIS is a newly developed body-focused group therapy program for adults with PNES. Further studies should include a multicentric design with a higher number of participants.

[Pilot Data from the Evaluation of an Integrative Body Psychotherapy Program for Patients with Psychogenic Non-Epileptic Seizures]. / Pilotäre Zwischenergebnisse zur Evaluation eines störungsspezifischen, körperpsychotherapeutisch orientierten Gruppenbehandlungsprogramms für Menschen mit psychogenen Anfällen.

Psychogenic non-epileptic seizures (PNES) occur in the context of various diseases. Therefore, PNES patients represent a heterogeneous group with different causative disorders. The etiology is still poorly understood. Previous concepts assume an increased rate of trauma disorders in PNES, which has been proven several times by previous studies 1 2. The clinical picture is threatening, which means that those affected often receive intensive care measures without benefiting from them 3. PNES patients accumulate especially in epilepsy centers, since a diagnostic differentiation from epileptic seizures is possible at those specialized centers. Often, the transition from making the diagnosis in epilepsy centers to follow-up treatment in psychosomatic/psychiatric settings is difficult. A reason could be that patients and practitioners are often involved in somatic disease concepts, which might be caused by the threatening clinical picture of PNES 28. Due to this difficulties, a special outpatient clinic was set up at the Charité Berlin for people with dissociative seizures, which settles in the transition from neurology to psychosomatics and works as a cooperation project 27. Out of the ambulance, a group treatment program (CORDIS) was developed, which aims at a better care of PNES patients at the interface between neurology and psychosomatic medicine. This modularized 10-week treatment program will be presented in this article and is the subject of a currently ongoing randomized, controlled evaluation study. The pilot data from the ongoing RCT study presented here showed significant effects in the effectiveness of the program, in particular the primary and secondary outcome measures.

Functional pain disorders - more than nociplastic pain.

BACKGROUND: Nociplastic pain has been recently introduced as a third mechanistic descriptor of pain arising primarily from alterations of neural processing, in contrast to pain due to tissue damage leading to nociceptor activation (nociceptive) or due to lesion or disease of the somatosensory nervous system (neuropathic). It is characterized by hyperalgesia and allodynia, inconsistency and reversibility, as well as dynamic cross-system interactions with biological and psychobehavioral factors. Along with this renewed understanding, functional pain disorders, also classified as chronic primary pain, are being reframed as biopsychosocial conditions that benefit from multimodal treatment. OBJECTIVE: To summarize the current understanding of nociplastic pain and functional pain disorders, with a focus on conditions that are common in neurology practice. METHODS: This was a narrative literature review. RESULTS: Chronic back pain, fibromyalgia syndrome and complex regional pain syndrome are best understood within a biopsychosocial framework of pain perception that considers structural factors (predispositions and sequelae) and psychobehavioral mechanisms. Although pain is often the primary complaint, it should not be the only focus of treatment, as accompanying symptoms such as sleep or mood problems can significantly impact quality of life and offer useful leverage points for multimodal treatment. Analgesic pharmacotherapy is rarely helpful on its own, and should always be imbedded in a multidisciplinary setting.

[Turning an addictive drug into a remedy--the assessment of sedatives at the Charité Nervenklinik from 1962-75]. / Von der Suchtdroge zum Therapeutikum--Zur Bewertung von Beruhigungsmitteln an der Charité Nervenklinik von 1962-75.

On which evidence did psychiatrists at the East-Berlin Charité Hospital base the diagnosis of substance abuse? This article aims to reconstruct criteria of abuse, dependency and misuse of pharmaceuticals, drawing on patient files from the Psychiatric Clinic from 1962-1975. To assess preclinical sedative use, a quantitative and qualitative analysis is carried out. It shows how sedative consumption was less and less seen as misuse. The article argues that Karl Leonhard's retirement from his position as the director of the clinic in 1970 gave way to a substantial restructuring of clinical practice which changed the understanding of substance abuse. Where Leonhard focused on prognosis based on diagnostic evaluation, next-generation psychiatrists concentrated on psychotropic substances and made them an essential and legitimate element of psychiatric therapy.

East-Side story: the standardisation of psychotropic drugs at the Charité Psychiatric Clinic, 1955-1970.

The present article illustrates the history of psychotropic drugs introduced in the German Democratic Republic (GDR) from 1945 onwards. We begin by examining the introduction of an anti-depressant and a tranquilizer at the university psychiatric clinic, Charité, in East Berlin. On the basis of patient files, we consider the monitoring routines, altered by the use of psychotropic drugs, and the difficulties that arose when these routines were translated into existing research programs. In the 1960s, attempts to evaluate the psychiatric practice were based on psychopathology whereas at the end of the 1960s there was a shift to "target symptoms".