Role of history of traumatic life experiences in current psychosomatic manifestations.

OBJECTIVES: Although the relationship between traumatic experiences (TEs) and psychosomatic manifestations (pain, somatization, somatosensory amplification [SSA], and alexithymia) has been widely described, very few studies have investigated how these variables correlate with each other and with a history of TEs. The aim of this study was to investigate whether and how current psychosomatic manifestations are correlated with major and minor adult- and childhood TEs. METHODS: One hundred and forty-six patients (91 with pain) from the Pisa Gift Institute for Integrative Medicine Psychosomatics Lab., Italy, were assessed for pain, history of TEs (divided into major and minor based on whether or not they meet the DSM-5 Criterion A for post-traumatic stress disorder), alexithymia, somatization, and SSA. RESULTS: TEs were positively correlated with age, the sensorial dimension and intensity of pain, somatization, psychopathology index, SSA, and alexithymia. Using the somatization score (controlled for age) as a covariate, the previous correlations between psychosomatic dimensions and TEs lost their statistical significance: SSA (total TEs: from r = 0.30, p = 0.000 to r = -0.04, p = 0.652); alexithymia (total TEs: from r = 0.28, p = 0.001 to r = 0.04, p = 0.663); sensorial dimension of pain (total TEs: from r = 0.30, p = 0.015 to r = 0.12, p = 0.373); and pain intensity (total TEs: from r = 0.38, p = 0.004 to r = -0.15, p = 0.317). Interestingly, the tendency to report more intense pain was mainly predicted by minor TEs in childhood (ß = 0.28; p = 0.030). CONCLUSIONS: The number of lifetime TEs is positively correlated with the sensorial dimension and intensity of pain but not its affective and cognitive dimensions. However, the former relationship depends on the presence of somatization. The intensity of pain is associated with minor rather than major TEs, especially when they occur in childhood.

What Kind of Patients Receive Inpatient and Day-Hospital Treatment in Departments of Psychosomatic Medicine and Psychotherapy in Germany?

INTRODUCTION: Germany is one of the few countries with a medical specialty of psychosomatic medicine and psychotherapy and many treatment resources of this kind. OBJECTIVE: This observational study describes the psychosomatic treatment programs as well as a large sample of day-hospital and inpatients in great detail using structured diagnostic interviews. METHODS: Mental disorders were diagnosed according to ICD-10 and DSM-IV by means of Mini-DIPS and SCID-II. In addition to the case records, a modified version of the CSSRI was employed to collect demographic data and service use. The PHQ-D was used to assess depression, anxiety, and somatization. RESULTS: 2,094 patients from 19 departments participated in the study after giving informed consent. The sample consisted of a high proportion of "complex patients" with high comorbidity of mental and somatic diseases, severe psychopathology, and considerable social and occupational dysfunction including more than 50 days of sick leave per year in half of the sample. The most frequent diagnoses were depression, somatoform and anxiety disorders, eating disorders, personality disorders, and somato-psychic conditions. CONCLUSIONS: Inpatient and day-hospital treatment in German university departments of psychosomatic medicine and psychotherapy is an intensive multimodal treatment for complex patients with high comorbidity and social as well as occupational dysfunction.

[Early Detection of Psychological Comorbidity in Patients Admitted to Dermatological and Internal Medicine Wards: A New Care Model for Psychosomatic Consultation Service]. / Früherkennung von psychischer Komorbidität in der stationären dermatologischen und internistischen Versorgung: Darstellung eines neuen Versorgungskonzeptes.

This article explains the development and implementation of a psychosomatic screening and consultation service for inpatient somatic care. Approximately one in six somatic inpatients has a mental disorder. It is estimated that only half of these cases are properly identified. Consequently, a large proportion of patients remains untreated. To address this gap in care, a psychosomatic early detection programme was developed by an interdisciplinary working group. This programme is based on the Patient Health Questionnaire-4 (PHQ-4), a psychometrically very well evaluated ultra-short screening questionnaire for the detection of depressive and anxiety disorders. For implementation in routine inpatient care, the PHQ-4 was programmed as a form in the electronic medical record and administered by nursing staff during the admission interview. If the PHQ-4 screening result indicates the presence of a mental comorbidity and the patient expresses a wish for assessment of this disorder, a psychosomatic consultation is automatically ordered. The PHQ-4 was implemented into the clinical routine in four internal medicine and three dermatology wards of the University Medical Center Hamburg-Eppendorf. Documentation of the early diagnosis in the electronic patient record is a minimally costly, less time-consuming and practicable method of providing patients with holistic care through rapid interdisciplinary referral. An evaluation of cost-effectiveness, clinical efficiency, and acceptance is still pending.

Psychological inflexibility and somatization in nonepileptic attack disorder.

BACKGROUND: There is no clear understanding of what causes and maintains nonepileptic attack (NEA) disorder (NEAD), or which psychological therapies may be helpful. The relationships between variables of psychological inflexibility: experiential avoidance (EA), cognitive fusion (CF), mindfulness, and key outcome variables in NEAD: somatization, impact upon life, and NEA frequency were investigated. METHOD: Two hundred eighty-five individuals with NEAD completed validated measures online. Linear regression was used to explore which variables predicted somatization and impact upon life. Ordinal regression was used to explore variables of interest in regard to NEA frequency. RESULTS: Mindfulness, EA, CF, somatization, and impact upon life were all significantly correlated. Mindfulness uniquely predicted somatization when considered in a model with EA and CF. Higher levels of somatization increased the odds of experiencing more NEAs. Individuals who perceived NEAD as having a more significant impact upon their lives had more NEAs, more somatic complaints, and more EA. CONCLUSIONS: Higher levels of CF and EA appear to be related to lower levels of mindfulness. Lower levels of mindfulness predicted greater levels of somatization, and somatization predicted NEA frequency. Interventions that tackle avoidance and increase mindfulness, such as, acceptance and commitment therapy, may be beneficial for individuals with NEAD. Future directions for research are suggested as the results indicate more research is needed.

Clinical spectrum of psychogenic non epileptic seizures in children; an observational study.

PURPOSE: The current study was designed to analyze the clinical spectrum of Psychogenic non-epileptic seizures (PNES) in children. METHODS: Children aged 6-16years with clinically suspected PNES, confirmed by short-term VEEG (STVEEG{video electroencephalogram}) and induction were classified as per Seneviratne classification. Stressors, associated co morbidities, Verbal IQ (Intelligence Quotient) and behavioral abnormalities were assessed using HTP(House tree person) test, DSM IV (Diagnostic and statistical manual of mental disorders) TR criteria, MISIC (Malin intelligence scale for Indian children) and CBCL (Child behaviour checklist). RESULTS: Eighty children with PNES {45 boys; mean age: 10.5 (±1.6) years} were enrolled. Median delay in diagnosis was 5 months {IQR(interquartile range)- 0.5 to 48 months}) and 45% patients were already on AEDs (antiepileptic drugs). Commonest semiology was dialeptic (42.5%), followed by mixed (28.8%), motor (15%) and nonepileptic aura (13.8%). Family stressors were the commonest followed by school related issues. The most common psychiatric comorbidity was adjustment disorder. Somatic complaints were observed in 50% children. CONCLUSIONS: Dialeptic PNES is commonest in children. In resource constrained settings, STVEEG along with induction is a reliable method to diagnose PNES. A comprehensive assessment protocol (including assessment of stressors) is needed for holistic management of pediatric PNES.

[Models of Mental Health Care for Vulnerable Refugees in the Community]. / Modelle zur regionalen Versorgung psychisch vulnerabler Flüchtlinge.

A non-neglectable portion of people that have fled to Germany have been subjected to expulsion, violence, torture and grave human loss. In some of them, signs of secondary mental problems are obvious. In the light of the efforts at integration, these diseases must not be neglected. Outlined are the federal legal requirements and how the cost coverage, as well as the admission to health care system, is structured. Additionally, 2 exemplary regional models for psychosomatic health care are being introduced: Dresden's "Stepped Care Model for Psychologically Vulnerable Refugees" includes phased offers for prevention and treatment of acute mental crises, as well as somatoform disorders in refugees and their volunteer helpers. The PSZ in Bielefeld unites already existing expertise of social work and trauma therapy to form a shared project and favors, among other things, training courses and the instruction of language mediators. The local circumstances and differences lead to individual, sometimes totally new solutions. Already existing clinical care offers as well as concepts of trauma therapy are focal points for the development of a comprehensive health care provision. Most effective is a combination of medicinal care, psychosocial networking and psychosomatic treatment. For a working health care provision without parallel structures it is indispensible to use expertise in trauma therapy that is already in place. While being very resource-saving psychosomatic centers offer targeted applications in the network of all actors in refugee care especially when combined with well-trained volunteers and language mediators, informed on the issue of trauma.

Somatic Comorbidity in Women with Overactive Bladder Syndrome.

PURPOSE: We explore the influence of co-occurring somatic illnesses on prevalent overactive bladder in women of premenopausal age. MATERIALS AND METHODS: Data for the present study were derived from a nationwide survey on complex diseases among all twins in the Swedish Twin Registry born 1959 to 1985. The present study was limited to female twins participating in the survey (12,850). Generalized estimating equations were used to estimate odds ratios with 95% CIs. Environmental and genetic influences were assessed in co-twin control analysis. RESULTS: Generalized estimating equations analysis showed a significant association between overactive bladder and migraine (OR 1.34, 95% CI 1.15-1.57), fibromyalgia (1.83, 1.54-2.18), chronic fatigue (1.81, 1.49-2.19) and eating disorders (1.56, 1.24-1.96). There was also a significant association with allergic disorders including asthma (1.24, 1.01-1.52) and eczema (1.22, 1.04-1.43). Among reproductive disorders, urinary tract infections (1.60, 1.40-1.84), dysmenorrhea (1.53, 1.33-1.76) and pelvic pain (1.60, 1.31-1.94) showed the strongest association with overactive bladder. Results from co-twin control analysis indicated that the significant associations observed in generalized estimating equations analysis were influenced by environmental and genetic factors without a common pathway model. CONCLUSIONS: Our results suggest a multifactorial and complex pathogenesis of overactive bladder in which associations between various somatic illnesses and overactive bladder may be affected by environmental and genetic factors.

Clinical Characteristics and Referral Patterns of Outpatients Visiting a Japanese Psychosomatic Medicine Clinic.

BACKGROUND: The definition of psychosomatic medicine is not consistent across countries. PURPOSE: The study purpose was to clarify the applicability of the definition of psychosomatic illness issued by the Japanese Society of Psychosomatic Medicine to different types of referral in a university hospital. METHODS: The sample consisted of 1067 outpatients visiting a psychosomatic clinic. Participants completed questionnaires to assess degrees of somatization, depression, anxiety, and psychosocial stress after completing clinical interviews based on the Diagnostic and Statistical Manual, Fourth Edition, Text Revision. All subjects were classified into psychosomatic and non-psychosomatic groups, and the non-psychosomatic group was further divided into three additional groups: depression, anxiety, and other. RESULTS: In total, 398 (37 %) of the subjects were placed in the psychosomatic group. The percentage of the psychosomatic group was 46 % in those referred within the hospital, 37 % in those referred outside the hospital, and 28 % in those without referral from physicians. Concerning the non-psychosomatic group, 269 (25 %) were placed in the depression group, 229 (22 %) in the anxiety group, and 171 (16 %) in the other group. Membership in the psychosomatic group was positively associated with age and the severity of somatosensory amplification (both p < 0.05), but negatively associated with the severity of depression and anxiety as well as the classification of non-referral (all p < 0.05). CONCLUSIONS: Although patients with psychiatric disorders, including depressive and anxiety disorders, are frequently seen in the Japanese psychosomatic clinic, patients who are diagnosed with psychosomatic illnesses tend to have been referred by physicians within the hospital. The concept of psychosomatic medicine needs to be further developed to assist both clinical practitioners and patients.

Outbreak of Mysterious Illness Among Hospital Staff: Poisoning or Iatrogenic Reinforced Mass Psychogenic Illness?

BACKGROUND: Hospitals are rarely reported as settings for mass psychogenic illness (MPI). The present report scrutinizes an outbreak of probable MPI among hospital staff, with medical intervention reinforcing the course of the illness. CASE REPORT: Four of seven staff members in an emergency department became acutely ill with nonspecific symptoms. After uneventful observation they were discharged, but symptoms worsened at reassembly for debriefing. Poisoning with hydrogen sulfide was suspected, and the victims were transferred by helicopter for hyperbaric oxygen (HBO) treatment. During the following 9 days, 14 possible poisoning victims were identified, 6 of whom were transferred for HBO. After hospital stays with repeated HBO treatment and examinations without identification of significant physical disease, the majority of the 10 HBO-treated victims remained symptomatic, some on prolonged sick leave. The ward was closed for several weeks during comprehensive but negative investigations for toxic chemicals. Clinical data and lack of indication of chemical exposure, together with an attack pattern with only some individuals becoming ill in a shared environment, suggest MPI. Iatrogenic influence from dramatic intervention was probably a strong driving force in the outbreak. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Awareness of MPI may prevent unnecessary and potentially harmful treatment as well as improve health care resilience, particularly with respect to preparedness. Outbreaks of illness in a group of symptomatic victims without indication of significant physical disease should be managed by observation and limited intervention.

[Normative-empirical determination of personnel requirements in psychosomatic medicine and psychotherapy]. / Normativ-empirische Bestimmung des Personalbedarfs in der Psychosomatischen Medizin und Psychotherapie.

OBJECTIVES: There is a high degree of misallocated medical care for patients with somatoform disorders and patients with concomitant mental diseases. This complex of problems could be reduced remarkably by integrating psychosomatic departments into hospitals with maximum medical care. Admitting a few big psychosomatic specialist clinics into the calculation basis decreased the Day-Mix Index (DMI). The massive reduction of the calculated costs per day leads to a gap in funding resulting in a loss of the necessary personnel requirements - at least in university psychosomatic departments. The objective of this article is therefore to empirically verify the reference numbers of personnel resources calculated on the basis of the new German lump-sum reimbursement system in psychiatry and psychosomatics (PEPP). METHODS: The minute values of the reference numbers of Heuft (1999) are contrasted with the minute values of the PEPP reimbursement system in the years 2013 and 2014, as calculated by the Institute for Payment Systems in Hospitals (InEK). RESULTS: The minute values derived from the PEPP data show a remarkable convergence with the minute values of Heuft's reference numbers (1999). CONCLUSIONS: A pure pricing system like the PEPP reimbursement system as designed so far threatens empirically verifiable and qualified personnel requirements of psychosomatic departments. In order to ensure the necessary therapy dosage and display it in minute values according to the valid OPS procedure codes, the minimum limit of the reference numbers is mandatory to maintain the substance of psychosomatic care. Based on the present calculation, a base rate of at least 285 e has to be politically demanded. Future developments in personnel costs have to be refinanced at 100 %.

[Emotional and psychosomatic disorder among female patients undergoing breast cancer diagnosis]. / Emotional and psychosomatic disorder among female patients undergoing breast cancer diagnosis.

UNLABELLED: Basics of psychoneuroimmunology indicate factors such as emotions, behaviour, personality and cognitive functions to have impact on weakening of immunological system and worsening the risk to develop medical conditions, including breast cancer. AIM: The aim of research was to attempt a coping of emotional and psychosomatic disorders among women undergoing breast tumor diagnostic process. MATERIALS AND METHODS: 145 female patients were included in the the research, among which 99 belonged to the research group (RG) and 46 belonged to the control group (CG). The average age in GB 49, 67 (± 9,47) i GK 46,43 (± 11,2). The research group members were undergoing diagnosis process for suspected breast cancer. The subjects filled out a survey and Symptom Questionnaire S-II, and were subject to mammographic and ultrasound examination, as well as aspiration biopsy was performed on them. 99 individual subjects were positively diagnosed with breast cancer, and 46 were negatively diagnosed. RESULTS: One in three women belonging to RG displayed emotional disorders. In CG only one in ten displayed symptoms of such disorders. Anxiety was the most common disorder mentioned by both RG and CG. There is however statistically relevant difference in anxiety intensity between the two groups. A statistically relevant corelation has been observed among members of the research group between certain psychosomatic disorders and a number of sociodemographic and medical variables' levels. CONCLUSIONS: Stress-related and formed psychophysiological and psychosomatic reactions are likely to play the role of psychosomatic and emotional factors leading to breast cancer development.

Trastornos de síntomas somáticos y trastornos relacionados / No disponible

En esta mesa se comentan las perspectivas epistemológicas, diagnósticas, explicativas y etiopatogénicas, así como una pauta general de actuación ante los trastornos de síntomas somáticos y trastornos relacionados (AU)

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Dysfunctional illness perception and illness behaviour associated with high somatic symptom severity and low quality of life in general hospital outpatients in China.

OBJECTIVE: In primary care populations in Western countries, high somatic symptom severity (SSS) and low quality of life (QoL) are associated with adverse psychobehavioural characteristics. This study assessed the relationship between SSS, QoL and psychobehavioural characteristics in Chinese general hospital outpatients. METHODS: This multicentre cross-sectional study enrolled 404 patients from 10 outpatient departments, including Neurology, Gastroenterology, Traditional Chinese Medicine [TCM] and Psychosomatic Medicine departments, in Beijing, Shanghai, Chengdu and Kunming. A structured interview was used to assess the cognitive, affective and behavioural features associated with somatic complaints, independent of their origin. Several standard instruments were used to assess SSS, emotional distress and health-related QoL. Patients who reported low SSS (PHQ-15<10, n=203, SOM-) were compared to patients who reported high SSS (PHQ-15≥10, n=201, SOM+). RESULTS: As compared to SOM- patients, SOM+ patients showed significantly more frequently adverse psychobehavioural characteristics in all questions of the interview. In hierarchical linear regression analyses adjusted for anxiety, depression, gender and medical conditions (SSS additionally for doctor visits), high SSS was significantly associated with "catastrophising" and "illness vulnerability"; low physical QoL was associated with "avoidance of physical activities" and "disuse of body parts"; low mental QoL was associated with "need for immediate medical help." CONCLUSION: In accordance with the results from Western countries, high SSS was associated with negative illness and self-perception, low physical QoL with avoidance behaviour, and low mental QoL with reassurance seeking in Chinese general hospital outpatients.

The association of interpersonal trauma with somatic symptom severity in a primary care population with chronic pain: exploring the role of gender and the mental health sequelae of trauma.

OBJECTIVE: Female trauma survivors develop somatic symptoms more frequently than males. We propose a model for somatic symptom development among trauma survivors, focusing on gender. METHODS: Among 597 urban primary care patients with chronic pain, we examined the association between somatic symptom severity and three interpersonal trauma types: 1) sexual trauma (ST), 2) intimate partner violence (IPV), and 3) childhood trauma history (≥3 adverse childhood experiences (3+ACE)). We developed a structural equation model in which PTSD, depression, and substance abuse were evaluated as potential mediators of the path between trauma exposure and somatic symptom severity, and explored the role of gender in this model. RESULTS: 350 (59%) respondents were female; the mean age was 47. Women reported significantly more somatic symptoms than men, although somatic symptoms were increased among all interpersonal trauma survivors. In models in which the potential intervening variables are considered in aggregate, we did not find a signficant interaction between gender and trauma on somatic symptom severity, with the exception of 3+ACEs. A structural equation model showed depression and substance abuse, for men, and depression, for women, were associated with somatic symptom severity. PTSD was not associated with somatic symptom severity. Paths from trauma exposures to mental health sequelae were stronger for men. CONCLUSIONS: Women have more severe somatic symptoms. With the exception of 3+ACEs, the association between trauma and somatic symptoms is amplified in both genders. Structural equation models showed the pathways differed by gender in function and strength of association.

[Psychosomatic and psychotherapeutic outpatient care in Germany - Capacity profile based on data from the National Association of Statutory Health Insurance Physicians]. / Ambulante psychosomatische und psychotherapeutische Versorgung in Deutschland - Versorgungsprofile abgebildet durch Daten der Kassenärztlichen Bundesvereingung (KBV).

OBJECTIVES: At the centre of the study lay a representation of outpatient psychosomatic and psychotherapeutic care with a focus on different groups of medical and psychological therapists. METHODS: The routine data of the National Association of Statutory Health Insurance Physicians (KBV) from the year 2008 were analyzed based on a systematic literature review (Medline, ISI, to November 2010). RESULTS: Neurologists and psychiatrists see the most patients (n = 3,172 vs n = 1,347 cases per practice), but they rarely provide services according to the directives for psychotherapy (4,4 %). However, specialists for psychosomatic medicine and psychotherapy (65 %), physicians providing only psychotherapy (66 %) and psychological psychotherapists (73 %) provide care mainly according to the directives for psychotherapy and therefore see fewer patients (170-190 cases per practice).Medical psychotherapists work more often on a psychodynamic basis, while psychological psychotherapists perform more often behavioral therapy. CONCLUSIONS: The treatment of patients with mental and psychosomatic disorders is based on three columns of care, which differ in their supply profile and each make a specific contribution to the treatment.

Forgiveness and health: assessing the mediating effect of health behavior, social support, and interpersonal functioning.

Religiousness and spirituality are important to most Americans and while beneficial associations between forgiveness and health are consistently observed, little is known regarding the mechanism of association. Cross-sectional multiple mediation-based analyses of associations between dimensions of forgiveness and physical and mental health were conducted using a sample of 363 undergraduate students from rural Southern Appalachia. Controlling for demographic variables (i.e., gender, age, education, ethnicity, and marital status) and lifetime religiousness, multivariable analyses reflected associations of forgiveness of self and forgiveness of others, but not feeling forgiven by God, with physical health status, somatic symptoms, mental health status, and psychological distress. All such associations operated through health behavior and/or social support; however, only in the context of forgiveness of self did such associations also operate through interpersonal functioning (problems). While forgiveness of self and forgiveness of others each appear to have a robust indirect relationship with health, mediation-based associations involving forgiveness of self were nearly twice as frequent. It may be that forgiveness of self is relatively more important to health-related outcomes.

[The improvement of the transfer into daily life of progressive relaxation after an inpatient psychosomatic rehabilitation]. / Verbesserung des Transfers von Progressiver Relaxation in den Alltag der Patienten nach stationärer psychosomatischer Rehabilitation.

AIM OF THE STUDY: The aim of the current study was the identification of predictors for a successful transfer of progressive relaxation (PR) into clinical and daily life. Furthermore the development of tension-related symptoms dependening of the frequency of continuous practise was detected. METHODS: 411 patients of a psychosomatic rehabilitation clinic attended a 6-h-course of progressive relaxation and were interviewed at 3 different times by a modified version of the "diagnostisches und evaluatives Instrumentarium für Entspannungstraining und Entspannungstherapie (ET-EVA)": at the beginning of therapy (T1), at discharge (T2) and 3 months after discharge by postal service (T3). After 3 months 274 patients (78.3%) sent the completed questionnaires back. The frequency of exercising by at least once a week was defined as successful. To detect the extent of symptom improvement, difference values between the different measuring times and effect sizes were calculated. To identify predictors of the frequency of daily practise, bivariate correlations and linear regression were used. RESULTS: 69.4% of the patients continued the exercises successfully beyond the course. The improved experience of relaxation directly after the program (r=-0.184; p<0.01) had a positive influence on the frequency of practising during hospital stay. 3 months after discharge 50.4% of the participants were practising at least once a week. The frequency of practise during hospital stay (r=0.558; p<0.01) and the experience of relaxation at T3 (r=-0.356; p<0.01) could be identified as predictors of a successful transfer into daily life of progressive relaxation. In the context of the linear regression the effect of the frequency of practise during hospital stay (Beta=0.506; p<0.01) and the experience of relaxation after 3 months (Beta=-0.275; p<0.01) remained significant predictors and explaines 40.9% of the variance. The items of all 6 symptom scales decreased significantly from T1 to T2 (p<0.01) and the feeling of discomfort after 3 months was significantly below the base level of T1 (p<0.01). The patients who practised at least once a week - compared to the not-practising patients - declared significantly less tension-related symptoms at T3 (p<0.01) and could achieve a significantly stronger change of wellbeing and relaxation experience at T2 and T3 (p<0.01). CONCLUSION: 50.4% of the patient implemented the relaxation training in their daily routine. The experienced alteration in terms of self-efficacy plays a meaningful role concerning the frequency of practise in hospital stay and daily routine. In future courses attention should be paid to the initial experience of relaxation. The frequency of practise once a week turned out to be the most effective.

[Mental disorders in patients with fibromyalgia syndrome: screening in centres of different medical specialties]. / Psychische Störungen beim Fibromyalgiesyndrom: Screening in Einrichtungen verschiedener Fachrichtungen.

BACKGROUND: Systematic reviews have reported a wide range of prevalence rates for depressive, anxiety and posttraumatic stress disorders (PTSD) in patients with fibromyalgia syndrome (FMS) which have been partially explained by setting differences. No data are currently available on the prevalence of potential mental disorders depending on the medical specialty in Germany. MATERIAL AND METHODS: All consecutive FMS patients of 8 study centres (3 rheumatology/orthopaedic surgery, 3 psychosomatic/pain medicine, 2 physical/integrative medicine) were assessed from February 1 to July 31, 2012 with standardised questionnaires. Patients with FMS diagnosed by a study physician were included. Non-German speaking and mentally retarded patients were excluded. The German version of the Patient Health Questionnaire 4 was used to screen for potential depressive and anxiety disorders. Severe life events were assessed by the trauma list of the Munich Composite International Diagnostic Interview and symptom criteria of PTSD of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) using the Posttraumatic Diagnostic Scale. RESULTS: Of 538 patients, 396 patients (93.9 % women, mean age 52.3 years, mean duration since chronic widespread pain 12.8 years, mean duration since FMS diagnosis 4.5 years) were analysed. In all, 65.7 % of patients met the criteria of a potential depressive disorder, 67.9 % of a potential anxiety disorder and 45.5 % of a potential PTSD. Potential depressive disorders were more frequent in the psychosomatic/pain medicine setting than in the rheumatology setting. CONCLUSION: Potential mental disorders were frequent in FMS patients regardless of the medical specialty. All FMS patients of all types of clinical settings should be screened for mental disorders.