Persistence rate of DSM-5 somatic symptom disorder: 4-year follow-up in patients from a psychosomatic outpatient clinic.

BACKGROUND: Somatic Symptom and Related Disorders (SSD) were introduced by DSM-5 in order to improve the classification of somatoform disorders. There is a lack of longitudinal studies on course and predictors of SSD. The present study investigates the natural course of SSD in a four-year follow-up study in patients from a psychosomatic outpatient clinic. MATERIAL AND METHODS: At baseline, n = 360 outpatients completed a semi-structured clinical interview to assess SSD, and additional self-report questionnaires (SSS-8, SSD-12, PHQ-8, GAD-7, SF-12). 112 patients were re-assessed after four years. Persistence rate and predictors for persisting SSD were evaluated. RESULTS: The prevalence rate of SSD at baseline was 51.8%, and 47.3% at follow-up. We found a persisting SSD in 30.4% (n = 34) of the patients, a remission rate of 21.4% (n = 24) and an incidence rate of 16.9% (n = 19). 31.3% (n = 35) of the sample never received a SSD diagnosis. Significant predictors for persistence were a high psychological burden through somatic symptoms (OR: 1.13, 95% CI: 1.01-1.26) and general anxiety (OR: 1.38, 95% CI: 1.01-1.88) at baseline. CONCLUSION: This study indicates that SSD is highly prevalent and persistent in patients from a psychosomatic setting. Our findings indicate that psychological and behavioral factors contribute to the maintenance of SSD and present potential targets for interventions. Future interventions for SSD could potentially be optimized by addressing psychological processes such as catastrophic thinking styles and symptom focusing.

Clinical and psychobehavioral features of outpatients with somatic symptom disorder in otorhinolaryngology clinics.

OBJECTIVE: In the Otorhinolaryngology Department, patients exhibiting somatic symptoms without a medical cause are frequently neglected and left untreated. The aim of this study was to characterize the psychosomatic features of outpatients with somatic symptom disorder (SSD) to better identify patients needing treatment. METHODS: This cross-sectional study enrolled 883 consecutive patients with medically unexplained symptoms. A semistructured clinical interview was employed to confirm the diagnosis of SSD. Data, including sociodemographic and clinical measures, were collected. The Patient Health Questionnaire-15 (PHQ-15) and Somatic Symptom Scale-China (SSS-CN) were used to assess the severity of somatic symptoms; the Patient Health Questionnaire-9 (PHQ-9) was used to assess depression; the General Anxiety Disorder-7 (GAD-7) was used to assess anxiety; and the 12-item Short-form Health Survey (SF-12) was used to assess quality of life (QoL). RESULTS: Based on the DSM-5 criteria, 641 patients were placed in the SSD group, and 212 were placed in the normal group. Compared with the normal group, the SSD group had significantly more doctor visits, longer symptom durations, higher GAD-7 and PHQ-9 scores, and lower physical composite scores (PCSs) and mental composite scores (MCSs). Spearman's correlation analysis and multiple linear regression analyses showed that the SSS-CN score, PHQ-15 score and the patient's subjective feeling that his or her daily life was affected by the disorder were significant risk factors for low PCSs; the SSS-CN, PHQ-15, PHQ-9, and GAD-7 scores were independent risk factors for low MCSs. CONCLUSION: Our findings demonstrated that SSD patients are not rare in otorhinolaryngology clinics in China and that their QoL is significantly affected by SSD. Otolaryngologists should thoroughly evaluate these patients from the perspective of psychosomatic medicine.

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.

Prevalence of DSM-5 somatic symptom disorder in Chinese outpatients from general hospital care.

OBJECTIVE: We aimed to explore the prevalence of somatic symptom disorder (SSD) according to DSM-5 criteria in Chinese outpatients from general hospital departments. METHODS: This multicentre cross-sectional study enrolled 699 patients from outpatient departments, including the neurology, gastroenterology, Traditional Chinese Medicine [TCM] and psychosomatic medicine departments, in five cities in China. The structured clinical interview for DSM-5 (SCID-5) for SSD was administered by trained clinical professionals to diagnose SSD. RESULTS: SSD was diagnosed in 33.8% (236/697) of all enrolled patients. The prevalence of SSD differed significantly among the departments (χ2 = 34.049, df = 2, p ≤0.001). No differences were found between SSD patients and non-SSD patients in terms of gender, residence, marital and living statuses, family income, education, employment status and lifestyle factors. However, patients with SSD reported higher levels of depression, health-related and general anxiety, lower physical and mental quality of life, higher frequency of doctor visits, increased time devoted to physical symptoms and longer duration of somatic symptoms. In a binary linear regression analysis, SSD was significantly associated with an increase in health-related anxiety, time devoted to symptoms and impact of somatic symptoms on daily life. The explained variance was Nagelkerke R2 = 0.45. CONCLUSION: There is a high prevalence of SSD in Chinese general hospital outpatient clinics. The diagnosis is associated with high levels of emotional distress and low quality of life. There is a danger of over-diagnosis if we include the mild and moderate forms of SSD. Future studies are warranted to investigate the prevalence of SSD in inpatient departments and the development of psychological interventions for these patients.

Depression profile in cancer patients and patients without a chronic somatic disease.

BACKGROUND: To investigate whether depressed oncology patients show a specific depressive symptom profile, we compared depression symptoms in depressed cancer patients (CANCER-DEP) and depressed patients without a chronic somatic disease (NONCANCER-DEP). METHODS: Of a total of 2493 outpatients from a comprehensive cancer center and a center for psychosocial medicine, 1054 (42.3%) met the DSM-5 criteria for depression, measured with the Patient Health Questionnaire 9. Based on the Patient Health Questionnaire 9 scores, differences in severity of each of the 9 individual DSM-5 depression symptoms between CANCER-DEP (n = 542) and NONCANCER-DEP (n = 512) were examined. Non-depressed cancer patients (CANCER-NONDEP; n = 1216) served as a comparison group for somatic symptoms independent of depression in cancer. To control for depression severity, group comparisons were performed separately for patients with major depression and any depressive disorders. RESULTS: Depressed cancer patients reported significantly lower levels of the cognitive-emotional depression symptoms "worthlessness" and "suicidal thoughts" than NONCANCER-DEP. Only 1 out of 5 somatic depression symptoms ("changes in appetite") was more pronounced in CANCER-DEP than in NONCANCER-DEP. Confirming previous research, somatic depression symptoms occurred more frequently in CANCER-DEP than in CANCER-NONDEP. CONCLUSIONS: The lower level of cognitive-emotional symptoms in CANCER-DEP than in NONCANCER-DEP is discussed in relation to different psychosocial phenomena. Our results indicate that somatic depression symptoms are similarly pronounced in CANCER-DEP and NONCANCER-DEP, and that CANCER-DEP show greater somatic depression symptoms than CANCER-NONDEP. The presence of high levels of somatic symptoms should alert clinicians to investigate for a potential comorbid depression in cancer patients.

Psychological characteristics of dissociation in general population / Características psicológicas de la disociación en la población general

Dissociation is defined as the separation of those processes that should be accessible, considering that both somatoform and conversion symptoms may be understood as dissociative. In recent decades, psychological variables have been related to dissociation, such as suggestibility, fantasy, alexithymia, abnormal emotional processes, and also a particular personality profile. The aim of this paper is to study the profile associated with psychoform and somatoform dissociation. The sample consisted of 355 participants. University students employed the snowball sampling. The following instruments were used: the Dissociative Experiences Scale-II (DES-II), the Questionnaire Somatoform Dissociation (SDQ-20), the Inventory Suggestibility (IS), the Alexithymia Scale Toronto (TAS-20), the Scale Difficulties in Emotion Regulation (DERS), the revised NEO Personality Inventory (NEO-PI), and some ad hoc questions to evaluate sleep-related experiences. The results indicated that high dissociators showed higher scores on suggestibility, alexithymia, sleep- related experiences, neuroticism, openness to experience, and lower conscientiousness than low dissociators, the results being similar to those obtained by high somatizers. As a conclusion, the profile found in both types of dissociation indicated their existing relationship, and pointed out possible lines of future research and treatment

La disociación se define como la separación de procesos que deberían ser accesibles, considerándose que los síntomas somatomorfos y conversivos pueden entenderse como disociativos. En las últimas décadas se han encontrado variables psicológicas relacionadas con la disociación, como la sugestionabilidad, la fantasía, alexitimia, alteraciones en los procesos emocionales y un perfil concreto de personalidad. El objetivo de este trabajo es estudiar el perfil asociado a la disociación psicoforme y somaforme. La muestra estuvo compuesta por 355 participantes. El muestreo consistió en la bola de nieve por parte de estudiantes universitarios. Para su realización se utilizó la Escala de Experiencias Disociativas-II (DES-II), el Cuestionario de Disociación Somatoforme (SDQ-20), el Inventario de Sugestionabilidad (IS), la Escala de Alexitimia de Toronto (TAS-20), la Escala de Dificultades en la Regulación Emocional (DERS), el Inventario de Personalidad NEO revisado (NEO-PI) y preguntas elaboradas ad hoc para evaluar experiencias relacionadas con el sueño. Los sujetos con elevada disociación mostraron mayores puntuaciones en sugestionabilidad, alexitimia, experiencias de sueño, neuroticismo y apertura y menores en responsabilidad, de forma muy similar al grupo de sujetos de elevada somatización. Puede concluirse que el perfil hallado en ambos tipos de disociación refleja la relación existente entre ambas y señala posibles líneas de investigación y tratamiento futuros

Multisensory temporal function and EEG complexity in patients with epilepsy and psychogenic nonepileptic events.

Cognitive and perceptual comorbidities frequently accompany epilepsy and psychogenic nonepileptic events (PNEE). However, and despite the fact that perceptual function is built upon a multisensory foundation, little knowledge exists concerning multisensory function in these populations. Here, we characterized facets of multisensory processing abilities in patients with epilepsy and PNEE, and probed the relationship between individual resting-state EEG complexity and these psychophysical measures in each patient. We prospectively studied a cohort of patients with epilepsy (N=18) and PNEE (N=20) patients who were admitted to Vanderbilt's Epilepsy Monitoring Unit (EMU) and weaned off of anticonvulsant drugs. Unaffected age-matched persons staying with the patients in the EMU (N=15) were also recruited as controls. All participants performed two tests of multisensory function: an audio-visual simultaneity judgment and an audio-visual redundant target task. Further, in the cohort of patients with epilepsy and PNEE we quantified resting state EEG gamma power and complexity. Compared with both patients with epilepsy and control subjects, patients with PNEE exhibited significantly poorer acuity in audiovisual temporal function as evidenced in significantly larger temporal binding windows (i.e., they perceived larger stimulus asynchronies as being presented simultaneously). These differences appeared to be specific for temporal function, as there was no difference among the three groups in a non-temporally based measure of multisensory function - the redundant target task. Further, patients with PNEE exhibited more complex resting state EEG patterns as compared to their patients with epilepsy, and EEG complexity correlated with multisensory temporal performance on a subject-by-subject manner. Taken together, findings seem to indicate that patients with PNEE bind information from audition and vision over larger temporal intervals when compared with control subjects as well as patients with epilepsy. This difference in multisensory function appears to be specific to the temporal domain, and may be a contributing factor to the behavioral and perceptual alterations seen in this population.

[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.

Improvements in Somatic Complaints Among Individuals With Serious Mental Illness Receiving Treatment in a Psychiatric Hospital.

OBJECTIVE: Individuals with serious mental illness (SMI) experience significant comorbid somatic complaints. Little is known about response to integrated inpatient care that addresses psychiatric and general medical needs among individuals with SMI. METHODS: Latent growth curve analyses were used to model somatic symptom trajectories across adult inpatients with SMI (n = 989). The Patient Health Questionnaire-15 (PHQ-15) was administered at admission, every 14 days, and at discharge. RESULTS: Patients evidenced substantial reduction in somatization from admission (mean [standard deviation] = 9.0 [5.2]) to discharge (mean [standard deviation] = 5.2 [4.4]), with large effects (d = 0.83, 95% confidence interval = 0.76-0.90). Results indicate nonlinear improvement in somatic symptoms for 8 weeks of treatment, with greatest symptom reduction occurring during the first weeks of treatment with continued, albeit slowed, improvement until discharge. Initial PHQ-15 scores were lower among men and those who reported regular exercise in the 30 days preceding this hospitalization. In addition, presence of an anxiety disorder or personality disorder at admission; history of trauma, a gastrointestinal disorder, or major medical illness (within the past 3 months); and significant sleep disturbance independently contribute to higher PHQ-15 scores at admission. A substance use disorder and sleep disturbance were associated with greater immediate symptom reduction. CONCLUSIONS: Somatic complaints can be managed in the context of inpatient psychiatric care integrated with 24-hour nursing and internal medicine specialists. Addressing psychiatric impairments, improving sleep, and ensuring abstinence from drugs and alcohol are associated with significant improvement in somatic complaints.

Fibromyalgia syndrome: Basic knowledge, diagnosis and treatment. / Fibromyalgiesyndrom Basiswissen, Diagnostik und Therapie.

Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain, unrefreshing sleep and mental/physical fatigue. Most patients report additional somatic and psychological symptoms. Fibromyalgia is a heterogeneous condition. The definite aetiology of this syndrome remains unknown. A model of interacting biological and psychosocial variables in the predisposition, triggering, and development of the chronicity of fibromyalgia symptoms has been suggested. Depression, genetics, obesity combined with physical inactivity, physical and sexual abuse in childhood, sleep problems, and smoking predict future development of fibromyalgia. Psychosocial stress (working place and family conflicts) and physical stress (infections, surgery, accidents) might trigger the onset of chronic widespread pain and fatigue. Mental disorders have a negative impact on the clinical outcome. Several factors are associated with the pathophysiology such as alteration of sensory processing in the brain, reduced reactivity of the hypothalamus-pituitary-adrenal axis to stress, increased pro-inflammatory and reduced anti-inflammatory cytokine profiles, disturbances in neurotransmitters such as dopamine and serotonin, and small fiber pathology. Prolonged exposure to stress, as outlined above, may contribute to these functional changes in predisposed individuals. The prevalence in the general German population is about 2 %. The clinical diagnosis is established by the history of the key symptoms and the exclusion of somatic diseases sufficiently explaining chronic widespread pain. For management, the German evidence and consensus based guideline recommends a stepwise approach according to the severity of FMS. All patients should receive adequate education about the disorder and its management. Non-pharmacological therapies such as low intensity aerobic exercise and meditative movement therapies such as Qi-Gong and Yoga are highly recommended for long-term self-management. Drug therapy is not mandatory. Recommended drugs are the antidepressants amitriptyline and duloxetine and the anticonvulsant pregabalin which act as pain modulators.

¿Podemos descartar que la fibromialgia, el síndrome de fatiga crónica y la sensibilidad química múltiple sean enfermedades psicosomáticas? / Can we rule out that fibromyalgia, chronic fatigue syndrome and multiple chemical sensitivity are psychosomatic diseases?

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Familial and socio-economic correlates of somatisation disorder.

BACKGROUND: Somatisation disorder can result from an interplay between suboptimal family environment and socio-economic deprivation, which enhances the underlying cognitive tendency for this disorder. There are pertinent familial and socio-economic factors associated with this disorder, but research addressing this is sparse. AIM AND SETTING: The study aims to evaluate family and socio-economic factors that are associated with somatisation disorder amongst patients presenting to the Family Medicine clinic, University College Hospital, Ibadan, Nigeria. METHODS: This is an observational case-control study of 120 participants who presented to the clinic between May and August 2009. Data collection was by interviewer-administered structured questionnaire using the World Health Organization Screener for Somatoform Disorder and Somatoform Disorder Schedule to ascertain somatisation in 60 patients who were then matched with 60 controls. The respondents' demographic and family data were also collected and their interpersonal relationships were assessed with the Family Relationship Index. RESULTS: The somatising patients were mostly females (70%), with a female to male ratio of 2.3:1 and mean age of 43.65 ± 13.04 years.Living in a polygamous family (as any member of the family) was significantly related to somatisation (p = 0.04). Somatisation was also more common in people who were separated, divorced or widowed (p = 0.039). Somatisers from a lower social class or those earning below a dollar a day experienced poorer cohesion (p = 0.042) and more conflicts (p = 0.019) in their interpersonal relationship. CONCLUSION: This study was able to demonstrate that a polygamous family setting, disrupted marriage, low social status and financial constraints are correlates of somatisation. It is of essence to identify these factors in holistic management of somatising patients.

Psychosocial, musculoskeletal and somatoform comorbidity in patients with chronic low back pain: original results from the Dutch Transition Project.

BACKGROUND: Better insight into frequent comorbidities in patients with chronic (≥ 3 months) low back pain (LBP) may help general practitioners when planning comprehensive care for these patients. OBJECTIVE: To prospectively study the prevalence of psychological, social, musculoskeletal and somatoform disorders in patients presenting with chronic non-specific LBP to general practitioners, in comparison to a contrast group of patients consulting in the same setting. METHODS: This case-control study is embedded in a historical cohort, based on a primary care practice-based research network. All the health problems presented by the patients were prospectively coded according to the international classification of primary care between 1996 and 2013. The prevalence of psychological, social, musculoskeletal and somatoform disorders presented by the adult patients from 1 year before the onset of chronic LBP to 2 years after onset was compared to that of matched patients consulting without LBP, using conditional logistic regressions. RESULTS: The 1511 patients with chronic LBP more often presented musculoskeletal disorders than the contrast group during the year before the onset of LBP and during the second year after it, with odds ratios (95%confidence intervals) of 1.39 (1.20-1.61) and 1.56 (1.35-1.81), respectively. They did not more often present psychological, social or non-musculoskeletal somatoform disorders. CONCLUSIONS: General practitioners should consider all the musculoskeletal symptoms when caring for patients with chronic LBP. Rather than systematically screening for specific psychological, social or somatoform disorders, they should consider with the patient how LBP and any type of potential comorbidity interfere with his/her daily functioning.

[Psychotherapy for pregnant women with psychiatric disorders]. / Psychoterapia ciezarnych kobiet cierpiacych na zaburzenia psychiczne.

Pregnancy is a major life change for many women. The related biological changes, especially complications in its course and in the course of delivery, carry a risk of developing a variety of psychological problems and mental disorders. However, their treatment is challenging due to the teratogenic effects of most psychoactive drugs and specific requirements for entering different psychotherapeutic programs. Mental disorders during pregnancy are undoubtedly an important issue for both gynecology and psychiatry. There is still a discussion considering the question whether psychotherapy during pregnancy is safe, although no scientifically valid data contradicting the safety of psychotherapy during pregnancy has been published so far. Together with psychotherapy - as a treatment of choice - clinicians approve some other relatively safe treatment methods for psychiatric disorders in pregnant women. Light therapy, limited pharmacotherapy, ECT are included. The goal of this paper is to review current opinions of clinicians and researches concerning possibilities, indications and outcome of psychological treatments as a way to help pregnant women who suffer from different psychiatric conditions, and also because this subject is not yet present in Polish psychiatric journals.

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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The impact of psychiatric and extraintestinal comorbidity on quality of life and bowel symptom burden in functional GI disorders.

BACKGROUND: Functional gastrointestinal disorders (FGID) patients report poor health-related quality of life (HRQOL) and experience high rates of psychiatric and extraintestinal functional disorder (EIFD) comorbidity. The independent influence of these comorbidities on HRQOL and symptom burden remains unknown. We sought to determine whether FGID with mood or EIFD comorbidity have poorer HRQOL and greater GI symptom burdens; to determine the influence of comorbidities on HRQOL in FGID independent of bowel symptoms. METHODS: Subjects reported on comorbidities (anxiety, depression, somatization, EIFD), FGID criteria (irritable bowel syndrome, IBS; functional dyspepsia, FD) using ROME III Research questionnaire, GI symptom burden, and HRQOL. Differences in measures were assessed between subjects with and without ROME III criteria. Multiple regression determined the relative contribution of comorbidities to HRQOL, and mediation analysis explored whether comorbidity influences HRQOL. KEY RESULTS: In a cohort of 912 GI outpatients (47.2 ± 1.5 years, 75.8% female), 606 (66.4%) met Rome III IBS and/or FD criteria. Comorbidities were common in FGID (≥1 in 77.4%), leading to lower HRQOL and greater GI symptom burden (each p < 0.05). Poorer HRQOL was predicted by both psychiatric and EIFD comorbidity (each p < 0.05) independent of GI symptoms (p < 0.001). Comorbidities together exerted a greater effect on predicted variation in HRQOL (70.9%) relative to GI symptoms (26.5%). CONCLUSIONS & INFERENCES: Psychiatric and EIFD comorbidities are common in FGID, decrease HRQOL and are associated with greater GI symptom burdens; these factors were stronger predictors of HRQOL than GI symptoms in FGID patients.

[Comorbidity of hysterical pathologies associated with gynecological diseases: historical perspectives and current evidence]. / Comorbilità di patologie dello spettro isterico con patologie dell'apparato ginecologico: nozioni storiche ed evidenze attuali.

BACKGROUND: In spite of a large amount of observations made in Psychiatric Day-Hospital of Sapienza University of Rome relating to comorbidity between sexual and gynecological disorders and hysteria, we have attempted to quantify the incidence of this phenomenon in order to assess their significance. METHODS: A retrospective study was conducted on medical records of patients hospitalized at the Day-Hospital of the Policlinico Umberto I in Rome between 1989 and 2009. RESULTS: It seems to be confirmed the hypothesis of a high frequency of correlating these disorders, although the results lead to a number of critical reflections on its significance and the method adopted. CONCLUSIONS: This research needs larger and more accurate future investigations, cause the type of study was made without direct information.

Somatoform disorders in patients with chronic pain.

OBJECTIVE: To assess the frequency and characteristics of somatoform disorders in patients with chronic pain. METHOD: The study took place in the psychiatric outpatient clinic of a rehabilitation hospital. Participants were interviewed using the World Health Organization Somatoform Disorders Schedule (WHO-SDS) version 2.0. Thirty new and 30 current attendees to the clinic were interviewed following referral by pain medicine specialists. RESULTS: Somatoform disorders were commonly co-morbid with chronic pain in the study population. Persistent somatoform pain disorder (PSPD) was the commonest somatoform disorder. There was a significant difference between women and men suffering from somatic autonomic dysfunction (SAD). CONCLUSIONS: The findings of this study confirm that somatoform disorders are common co-morbid diagnoses in patients with chronic pain. Combining psychological treatments with medication, appropriate physical treatments and attending to social issues, may indeed improve the well-being of such patients.

GP consultations for medically unexplained physical symptoms in parents and their children: a systematic review.

BACKGROUND: There is evidence of an association of medically unexplained physical symptoms (MUPS) between parents and children, but it is unclear whether this association is also present for GP consultations. AIM: To review the literature investigating the association of GP consultations for MUPS between parents and children. DESIGN OF STUDY: Systematic review. METHOD: Systematic search of MEDLINE(®), Embase, CINAHL, and PsycINFO databases from their inception to October 2012. Observational studies examining the association of GP consultations for MUPS between parents and children were included. RESULTS: Eight studies were included in the review. Three studies found significant associations between GP consultations for multiple MUPS between parents and children. Two studies reported significant associations between irritable bowel syndrome diagnosis in parents and multiple MUPS in children. One study showed no significant associations between multiple MUPS in mothers and functional abdominal pain in children. Two studies investigated the association of non-specific low back pain in parents and children; one study showed a significant association, whereas the other study found no significant association. Formal pooling of the results was not performed owing to a high degree of study heterogeneity. CONCLUSION: This review provides evidence of an association between GP consultations for MUPS in parents and children, although the evidence is limited by some potential biases and study heterogeneity. GPs need to be aware of this association, which has implications for management of children presenting with MUPS. More longitudinal research focusing on all common MUPS in children, which relies on more precise sources of data, is needed to further investigate this association.