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1.
Artigo em Inglês | MEDLINE | ID: mdl-33348794

RESUMO

Chronic pain is common among refugees, and often related to mental health problems. Its management, however, is often challenging. A randomized waitlist-controlled trial was designed to study the effect of group physiotherapy activity and awareness intervention (PAAI) on reducing pain disorders, and secondarily improving mental health, among Syrian refugees. A total of 101 adult Syrian refugees suffering from chronic pain were randomized to either the intervention group or the control group, which thereafter also received PAAI after a waiting period. Pain intensity measured by the Brief Pain Inventory (BPI) was the primary outcome. Scores from the Impact of Events Scale-Revised (IES-R 22) and the General Health Questionnaire (GHQ-12) were secondary outcomes. Intention-to-treat analyses (ITT) showed no effect of the intervention on either pain levels (regression coefficient [B {95% CI} of 0.03 {-0.91, 0.96}], IESR scores [4.8 {-3.7, 13.4}] or GHQ-12 scores [-0.4 {-3.1, 2.3}]). Yet, participants highly appreciated the intervention. Despite the negative findings, our study contributes to the evidence base necessary to plan targeted and effective health care services for refugees suffering from chronic pain and highlights the challenge of evaluating complex interventions adapted to a specific group.


Assuntos
Transtornos Mentais/terapia , Modalidades de Fisioterapia , Refugiados , Transtornos Somatoformes/terapia , Transtornos de Estresse Pós-Traumáticos , Adulto , Humanos , Saúde Mental , Modalidades de Fisioterapia/normas , Inquéritos e Questionários , Síria , Resultado do Tratamento
2.
Orv Hetil ; 161(25): 1050-1058, 2020 06.
Artigo em Húngaro | MEDLINE | ID: mdl-32516123

RESUMO

INTRODUCTION: About 25-30% of patients present themselves in general practice and specialized healthcare with medically unexplained somatic symptoms. The prevalence of these symptoms is the highest among the elderly, children and adolescents. Approximately 20% of patients in primary care and 47% of them in specialized clinics are children between the age of 7-12 who seem to have somatic symptom disorder (SSD). Somatization disorder most frequently occur with symptoms of headache, stomach ache or various kinds of pain in the limbs that show high comorbidity with other mental disorders, predominantly with anxiety. SSDs are always multicausal issues where biological, social-environmental and psychological factors are interconnected in a complex manner. According to our experience, somaziting patients are often drifting in the healthcare system for years, and instead of getting adequate treatment, they only receive medication, thus their symptoms may easily become chronic. Aim, method: Our aim was to review the current literature and guidelines concerning evidence-based treatments for SSD in childhood. Furthermore, to underline the importance of psychotherapy in SSD, we present the cognitive behavior therapy of a 16-year-old adolescent with vertigo, gastrointestinal symptoms and insomnia over a 8-month period. DISCUSSION: The results of effectiveness studies unequivocally recommend cognitive behavioral therapy in the treatment of SSD patients, accompained by family therapy or family consultation. The therapy should focus on reducing psychosocial stressors, health anxiety and catastrophizing thinking style in the family, while developing adequate coping and communication skills as well as maintaining the patient's age-appropriate activity level. CONCLUSION: Cognitive behavior therapy is the treatment of choice in SSD for children and young people. Applying the biopsychosocial approach is a key issue in the assessment of predisposing and maintaining factors, ensuring that only methods based on scientific evidence will be applied to help these children. Orv Hetil. 2020; 161(25): 1050-1058.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Sintomas Inexplicáveis , Transtornos Somatoformes/psicologia , Transtornos Somatoformes/terapia , Adolescente , Idoso , Transtornos de Ansiedade/terapia , Medicina Baseada em Evidências , Humanos , Psicoterapia , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/terapia , Transtornos Somatoformes/diagnóstico , Resultado do Tratamento , Vertigem/diagnóstico , Vertigem/terapia
3.
Neurology ; 94(23): 1028-1031, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32467130

RESUMO

Treatment of functional symptoms has a long history, and interventions were often used in soldiers returning from battle. On the 75th anniversary of the end of the Second World War, I review the portrayal of neurology in documentary film. Two documentaries were released in 1946 and 1948 (Let There Be Light and Shades of Gray, respectively), which showed a number of soldiers with functional neurology including paralysis, stuttering, muteness, and amnesia. The films showed successful treatments with hypnosis and sodium amytal by psychoanalytic psychiatrists. These documentaries link neurology with psychiatry and are remarkable examples of functional neurology and its treatment on screen.


Assuntos
Distúrbios de Guerra/história , Medicina Militar/história , Filmes Cinematográficos/história , Neurologia/história , Transtornos Somatoformes/história , Transtornos de Estresse Pós-Traumáticos/história , II Guerra Mundial , Adulto , Amobarbital/uso terapêutico , Distúrbios de Guerra/psicologia , Distúrbios de Guerra/reabilitação , Distúrbios de Guerra/terapia , Diagnóstico Diferencial , Seguimentos , História do Século XX , História do Século XXI , Humanos , Hipnose/história , Histeria/história , Masculino , Simulação de Doença/diagnóstico , Militares , Neurologia/educação , Transtornos Somatoformes/psicologia , Transtornos Somatoformes/reabilitação , Transtornos Somatoformes/terapia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/reabilitação , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos
4.
Nervenarzt ; 91(7): 651-661, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32435873

RESUMO

Somatic symptoms including pain are everyday human experiences. They usually result from a complex interaction of stimuli, interpretation and reaction, and are not necessarily proportional to structural damage. Persistent functional somatic symptoms can be associated with a significant impairment of quality of life and functioning, even without mental or somatic comorbidity. Dysfunctional experiences, expectancies and behavior, not only by patients but also by physicians, can increase the risk of chronification. From the outset, management should be graded with respect to the severity and biopsychosocial aspects, with thorough but cautious diagnostics and with psychoeducative, active and coping-oriented treatment.


Assuntos
Dor Crônica , Sintomas Inexplicáveis , Dor Crônica/diagnóstico , Dor Crônica/terapia , Humanos , Qualidade de Vida , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/terapia , Síndrome
5.
Adv Mind Body Med ; 34(1): 17-21, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32277750

RESUMO

Medically unexplained physical symptoms (MUPS) is a common, yet neglected disease with a prevalence of around 25% in primary care setting. These patients present with multiple physical and psychological symptoms, without an underlying diagnosis, hampering their functional and mental wellbeing. The management of these undiagnosed symptoms through conventional treatment has not been encouraging. Patients shuttle between different specialities, seeking a diagnosis for their symptoms, making them dissatisfied and increasing healthcare burden. Yoga, as an adjunct therapy has shown to be effective in the management of MUPS related disorders such as somatoform disorder, irritable bowel syndrome (IBS) and depression and anxiety. Thus, we suggest an integrated yoga module which might help in improving both physical and psychological variable in MUPS patients and improving their overall quality of life. Furthermore, the gap in the literature on the efficacy of yoga in improving MUPS, can be addressed by planning a randomised controlled trial based on the suggested yoga module.


Assuntos
Sintomas Inexplicáveis , Ioga , Transtornos de Ansiedade/terapia , Humanos , Qualidade de Vida , Transtornos Somatoformes/terapia
6.
BMC Med ; 18(1): 34, 2020 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-32122350

RESUMO

BACKGROUND: Functional somatic symptoms and disorders are common and complex phenomena involving both bodily and brain processes. They pose major challenges across medical specialties. These disorders are common and have significant impacts on patients' quality of life and healthcare costs. MAIN BODY: We outline five problems pointing to the need for a new classification: (1) developments in understanding aetiological mechanisms; (2) the current division of disorders according to the treating specialist; (3) failure of current classifications to cover the variety of disorders and their severity (for example, patients with symptoms from multiple organs systems); (4) the need to find acceptable categories and labels for patients that promote therapeutic partnership; and (5) the need to develop clinical services and research for people with severe disorders. We propose 'functional somatic disorders' (FSD) as an umbrella term for various conditions characterised by persistent and troublesome physical symptoms. FSDs are diagnosed clinically, on the basis of characteristic symptom patterns. As with all diagnoses, a diagnosis of FSD should be made after considering other possible somatic and mental differential diagnoses. We propose that FSD should occupy a neutral space within disease classifications, favouring neither somatic disease aetiology, nor mental disorder. FSD should be subclassified as (a) multisystem, (b) single system, or (c) single symptom. While additional specifiers may be added to take account of psychological features or co-occurring diseases, neither of these is sufficient or necessary to make the diagnosis. We recommend that FSD criteria are written so as to harmonise with existing syndrome diagnoses. Where currently defined syndromes fall within the FSD spectrum - and also within organ system-specific chapters of a classification - they should be afforded dual parentage (for example, irritable bowel syndrome can belong to both gastrointestinal disorders and FSD). CONCLUSION: We propose a new classification, 'functional somatic disorder', which is neither purely somatic nor purely mental, but occupies a neutral space between these two historical poles. This classification reflects both emerging aetiological evidence of the complex interactions between brain and body and the need to resolve the historical split between somatic and mental disorders.


Assuntos
Transtornos Psicóticos/classificação , Transtornos Somatoformes/classificação , Humanos , Transtornos Somatoformes/psicologia , Transtornos Somatoformes/terapia
7.
Psychol Health ; 35(9): 1033-1048, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32064931

RESUMO

Objective: We developed and validated a drawing test version of the Pictorial Representation of Illness and Self Measure (PRISM), a visual method to assess the perceived burden of illness and illness perception. Our aim was to test whether the drawing version would allow patients more freedom to deliberately vary both the size and position of circles symbolizing illness and individual coping resources, as well as gain more information about illness representations and available resources. Design and Main Outcome Measures: We applied the PRISM-D test to 500 patients with severe somatic diseases under active hospital treatment. We used Spielberger's State and Trait Anxiety Inventory and Beck's Depression Inventory to assess convergent validity. Results: The PRISM-D test is applicable for inpatients and it can be used to explore their subjective representations. The modifications did not cause any loss in convergent validity as the Self-Illness Separation and the Illness Perception Measure are significantly correlated with levels of depression and anxiety. Conclusion: The drawing test enables more detailed measurement of suffering caused by illness, illness perception and more complex assessment of important factors in a patient's life. The test is adequate for clinical use as well as research among a wide range of somatic inpatients.


Assuntos
Atitude Frente a Saúde , Efeitos Psicossociais da Doença , Obras Pictóricas como Assunto , Testes Psicológicos , Transtornos Somatoformes/psicologia , Adaptação Psicológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Transtornos Somatoformes/terapia , Adulto Jovem
8.
J Neuropsychiatry Clin Neurosci ; 32(2): 125-131, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31466516

RESUMO

Psychogenic nonepileptic seizures (PNES) are a highly disabling disorder frequently encountered by neurologists, psychiatrists, and emergency medicine physicians. There is accumulating evidence for the efficacy of psychological therapies, yet the majority of patients do not complete treatment. A range of health care system-based, clinician-based, and patient-based barriers to treatment exists, including stigma, poor clinician-patient communication, and patient ambivalence about the diagnosis and treatment of PNES. These barriers frequently lead to treatment nonadherence. Motivational interviewing (MI) is a patient-centered counseling style targeting ambivalence about behavior change, which has been shown to be effective in improving psychotherapy adherence and outcomes among patients with PNES. The authors review MI processes and techniques that may be useful to health care providers helping patients with PNES and other functional neurological disorders to engage in psychotherapy. The authors examine common challenges arising during MI for patients with PNES, including somatic symptoms distracting from clinician-patient communication, ambivalence about making concrete plans for treatment, and psychiatric comorbidities. Strategies for overcoming these obstacles are reviewed, including the use of complex reflections to enhance patient engagement; the use of an ask-tell-ask format and specific, measurable, achievable, relevant, and time-limited (SMART) goals to facilitate treatment planning; and close collaboration between the neurology and psychotherapy teams.


Assuntos
Entrevista Motivacional , Cooperação do Paciente , Psicoterapia , Convulsões/terapia , Transtornos Somatoformes/terapia , Humanos , Cooperação do Paciente/psicologia , Convulsões/fisiopatologia , Convulsões/psicologia , Transtornos Somatoformes/fisiopatologia , Transtornos Somatoformes/psicologia
9.
Clin Exp Dermatol ; 45(1): 20-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31468592

RESUMO

Functional disorders within dermatology present as various constellations of skin symptoms, but without evidence of organic pathology. Examples can include mucocutaneous pain syndromes, functional pruritus, somatoform pain disorder and rarer entities, such as undifferentiated somatoform idiopathic anaphylaxis and multiple chemical sensitivity syndrome. These conditions can have a significant impact on a patient's quality of life, and can present challenges in communication, investigation and management. The aetiology of functional disorders is not fully understood, but with an effective collaborative approach, a psychological explanation for these symptoms is often found. A structured approach to assessment can lead to a confident diagnosis, and understanding a patient's belief system and the impact of symptoms on their functioning can give better grounding for successful management. Treatment is dependent on the level of the patient's engagement with healthcare professionals, and often takes a measured and rehabilitative approach. Psychological therapies have been shown to be effective, often alongside both psychopharmacological and topical medications.


Assuntos
Anafilaxia , Dor Crônica , Doença Ambiental , Prurido , Transtornos Somatoformes , Anafilaxia/diagnóstico , Anafilaxia/terapia , Dor Crônica/diagnóstico , Dor Crônica/terapia , Doença Ambiental/diagnóstico , Doença Ambiental/terapia , Humanos , Prurido/diagnóstico , Prurido/terapia , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/terapia
10.
Clin Child Psychol Psychiatry ; 25(1): 273-290, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31232094

RESUMO

BACKGROUND: Medically unexplained symptoms affect between 4% and 20% of children and adolescents; 30-60% of these children also experience mental health difficulties. Trials and reviews have focussed on physical gains in this population, often overlooking mental health outcomes. OBJECTIVES: To use a systematic review methodology guided by the PRISMA checklist to (1) investigate the effectiveness of psychological interventions for mental health difficulties in children and adolescents with medically unexplained symptoms and (2) identify aspects of interventions associated with their success. METHODS: Randomised controlled studies investigating the impact of psychological interventions on mental health in children and adolescents with medically unexplained symptoms were included. Systematic searches of PsycINFO, MEDLINE and CINAHL were undertaken from inception to January 2018. Studies were appraised using the quality appraisal checklist. A qualitative synthesis of studies was completed. RESULTS: In all, 18 studies were identified. Interventions targeting parental responses to illness and family communication appeared to have the best outcomes. CONCLUSIONS: Psychological interventions may be effective in improving mental health outcomes within this population; however, evidence for the efficacy of these interventions is limited due to a high risk of bias within the majority of reviewed studies. Future research using rigorous methodology and non-cognitive behavioural therapy interventions is recommended.


Assuntos
Sintomas Inexplicáveis , Saúde Mental , Psicoterapia , Transtornos Somatoformes/terapia , Adolescente , Criança , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos Somatoformes/psicologia
11.
Clin Child Psychol Psychiatry ; 25(1): 45-61, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31079473

RESUMO

BACKGROUND: Functional disorders, defined as disorders with no clear medical explanation, are common and impose a significant burden on youths, their families, healthcare services and society as a whole. Currently, the literature describes resistance among patients and their families towards psychological symptom explanations and treatments. More knowledge about the thoughts and understandings of youths with functional disorders and their parents is needed. The aim of this study was to explore the illness perceptions of youths with severe functional disorders and their parents. METHODS: A qualitative interview study using interpretative phenomenological analyses. The study included 11 youths aged 11-15 years with functional disorders and their parents, where interviews were performed at the point of referral from a somatic to a psychiatric treatment setting. RESULTS: Analyses identified three main themes. Themes 1(Ascribing identity to the disorder) and 2 (Monocausal explanations) explore key elements of the participants' illness perceptions, and theme 3 (Mutable illness perceptions) explores how illness perceptions are influenced by experiences from healthcare encounters. CONCLUSIONS: The label 'functional disorder' was poorly integrated in the illness perceptions of the youths and their parents. Participants used a monocausal and typically physical explanation rather than a multicausal biopsychosocial explanation for their symptoms.


Assuntos
Sintomas Inexplicáveis , Transtornos Somatoformes/psicologia , Estresse Psicológico/psicologia , Adolescente , Adulto , Criança , Terapia Familiar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pais , Pesquisa Qualitativa , Transtornos Somatoformes/terapia , Estresse Psicológico/terapia
12.
Internist (Berl) ; 61(1): 44-50, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31853579

RESUMO

Somatoform disorders are encountered in primary medical care with above-average frequency but are too rarely named as such in the differential diagnostics. The prevalence is approximately 30 % with a predominance of female patients. This patient group puts the physician-patient relationship to the acid test from the very beginning due to the fixation on organ-related symptoms, the expectations of repeated instrumental diagnostics and the special way of acting. The consequences are frequent changes of physicians, chronification and disappointment on both sides; however, a workable physician-patient relationship can be developed through an empathic but critically distanced fundamental attitude of the general internist based on a biopsychosocial illness concept. In the further course corrections in the understanding and expression of the illness on the part of the patient can be achieved with a pacing and leading strategy and with psychoeducative measures. The primary psychologization of functional complaints will not satisfy the affected person but outpatient psychotherapy should be initiated only after the patient has been well-prepared. Measures with medications mostly remain unspecific and serve only for relief of symptoms. For comorbidities with anxiety and/or depressive disorders the use of selective serotonin reuptake inhibitors should be considered.


Assuntos
Transtorno Depressivo/diagnóstico , Medicina Interna , Medicina Psicossomática/métodos , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/terapia , Assistência Ambulatorial , Assistência à Saúde , Transtorno Depressivo/psicologia , Feminino , Humanos , Pacientes Ambulatoriais , Relações Médico-Paciente , Transtornos Somatoformes/psicologia
13.
Epilepsy Behav ; 102: 106814, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31805511

RESUMO

There is an unmet need to improve therapy for neuropsychiatric comorbidities that are highly prevalent in persons with epilepsy (PWE). However, diagnosing and monitoring the neurobehavioral symptoms is challenging as their presentation can overlap with seizures. In this retrospective study, we report the advantage of chronic ambulatory electrocorticography (ECoG) from implanted Responsive Neurostimulator System (RNS®) in characterizing these psychosomatic paroxysms as a possible ictal, postictal, or interictal phenomenon and how the diagnosis guided the therapy choices. Five out of 21 patients with RNS had neuropsychiatric symptoms (panic attack, psychosis, conversion, and somatization disorders) that overlapped with their seizure semiology and were found to benefit from the use of RNS ECoG data by timely diagnosing and titrating targeted therapies. The cases illustrate the use of RNS ECoG data in diagnosing and improving the management of comorbidities in PWE. The ability to access RNS ECoG data and correlate it with patient symptoms is unique among available therapeutic options for PWE.


Assuntos
Eletrocorticografia , Epilepsia , Neuroestimuladores Implantáveis , Monitorização Ambulatorial , Monitorização Neurofisiológica , Transtorno de Pânico , Transtornos Psicofisiológicos , Transtornos Somatoformes , Adulto , Comorbidade , Epilepsia/diagnóstico , Epilepsia/epidemiologia , Epilepsia/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/epidemiologia , Transtorno de Pânico/terapia , Transtornos Psicofisiológicos/diagnóstico , Transtornos Psicofisiológicos/epidemiologia , Transtornos Psicofisiológicos/terapia , Estudos Retrospectivos , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/epidemiologia , Transtornos Somatoformes/terapia
14.
Clin Child Psychol Psychiatry ; 25(1): 62-77, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30818976

RESUMO

BACKGROUND: Medically unexplained symptoms (MUS) are common among children and adolescents and may be highly impairing. Even after long diagnostic and/or therapeutic trajectories, many of these children and their parents feel dissatisfied with the advice and therapies they were given. OBJECTIVES: After a 2-week hospitalisation for somatic and psychiatric reassessment, children and their families were given recommendations for further treatment. This study evaluates which of these recommendations were carried out (primary outcome measure) and which factors influenced the (non-)adherence to therapeutic advice. METHODS: Parents of 27 children aged 7-17 with impairing MUS took part in a structured telephone survey to assess adherence to and perceived effectiveness of therapeutic recommendations (cross-sectional study). Influencing factors were analysed retrospectively. RESULTS: Psychotherapy was recommended to all 27 patients and their families; 19 of them (70.4%) carried out this advice. When physiotherapy was recommended, adherence proved lower (6/22 children; 27.3%). No influencing factors were found to have a statistically significant correlation with adherence. Effect sizes may be indicative of clinically relevant influential factors, but should be considered cautiously. CONCLUSION: Results suggest that more efforts need to be made to ensure adherence to therapeutic recommendations. Known risk factors for non-adherence to treatments for chronic somatic disorders may not apply for children with somatoform disorders.


Assuntos
Sintomas Inexplicáveis , Cooperação do Paciente/psicologia , Satisfação do Paciente , Transtornos Somatoformes/terapia , Adolescente , Criança , Estudos Transversais , Terapia Familiar , Feminino , Humanos , Masculino , Pais , Psicoterapia/métodos , Estudos Retrospectivos , Transtornos Somatoformes/psicologia , Resultado do Tratamento
15.
Trials ; 20(1): 784, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881990

RESUMO

BACKGROUND: There is a high prevalence of pain and post-traumatic symptoms among refugees and feasible interventions to manage these are needed. However, knowledge about the effect of physiotherapy and psychological group interventions among refugees is scarce. Our aim is to determine whether two different interventions, the Physiotherapy Activity and Awareness Intervention (PAAI) and Teaching Recovery Techniques (TRT), reduce pain and post-traumatic symptoms among refugees from Syria living in Norway. METHODS/DESIGN: Syrian adults with either pain disorders or post-traumatic symptoms, or both, will be recruited to this randomized control trial. The trial will include two separate interventions: participants with dominating pain symptoms will be assigned to the PAAI; and those with a predominance of post-traumatic symptoms will be assigned to the TRT intervention. Participants will be randomized to either the immediate intervention group or the delayed intervention group, for each of the interventions (PAAI and TRT). A minimum of 68 participants will be recruited for the PAAI and 78 participants for TRT, in order to detect clinically and statistically significant symptom improvement, assuming 25-30% attrition after recruitment. The main outcomes for the analyses will be pain intensity measured by the Brief Pain Inventory questionnaire and the scores of the Impact of Events Scale - Revised. The effect will be evaluated at the end of interventions lasting 8 weeks (PAAI) and 6 weeks (TRT) using the same instruments after the end of the intervention, and again 4-6 weeks later. Additionally, a qualitative evaluation will be conducted through an embedded process evaluation and personal interviews with participants after each of the interventions is finished. DISCUSSION: Our study will determine the feasibility of the implementation of two different interventions and the effect of these interventions among refugees from Syria with pain disorders and/or post-traumatic symptoms. TRIAL REGISTRATION: Clinical Trials.gov, NCT03951909. Retrospectively registered on 19 February 2019.


Assuntos
Manejo da Dor , Modalidades de Fisioterapia , Psicoterapia de Grupo/métodos , Refugiados/psicologia , Transtornos Somatoformes , Transtornos de Estresse Pós-Traumáticos , Adulto , Humanos , Noruega , Avaliação de Resultados em Cuidados de Saúde , Manejo da Dor/métodos , Manejo da Dor/psicologia , Medição da Dor/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos Somatoformes/psicologia , Transtornos Somatoformes/terapia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/terapia , Síria/etnologia
16.
PLoS One ; 14(11): e0225404, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31756195

RESUMO

BACKGROUND: Urethral Pain Syndrome (UPS) in women is a recurrent urethral pain without any proven infection or other obvious pathology. There are few studies on UPS, and evidence-based treatment is lacking. The primary aim was to study what treatments are used, and to compare the treatment tradition of UPS in Sweden in 2018, with what was used in 2006. METHODS: A questionnaire on the treatment of women with UPS was sent to all public gynecology, urology, gynecologic oncology and venereology clinics, and one public general practice in each county in Sweden in 2018. Private practice clinics in gynecology responded to the survey in 2017. Comparisons were made with the same survey sent to gynecology and urology clinics in 2006. FINDINGS: Of 137 invited clinics in 2018, 99 (72.3%) responded to the survey. Seventy-seven (77.8%) of them saw women with UPS and 79.2% (61/77) of these clinics treated the patients using 19 different treatment methods. Local corticosteroids and local estrogens were the methods most used. Treatments were similar in gynecology and urology clinics in 2006 and 2018, although strong corticosteroids had increased in use in the treatment regimens of 2018. More than half of the clinics used antibiotics. INTERPRETATION: Since there is no evidence-based treatment of UPS, a wide spectrum of treatments is used, and different specialties use different treatment strategies. Despite the lack of proven infection, a large number of clinics also treated the syndrome with antibiotics. There is thus a need for well-designed randomized controlled clinical trials to find evidence-based treatments of UPS.


Assuntos
Hormônios/uso terapêutico , Transtornos Somatoformes/epidemiologia , Transtornos Somatoformes/terapia , Doenças Uretrais/tratamento farmacológico , Doenças Uretrais/epidemiologia , Corticosteroides/uso terapêutico , Gerenciamento Clínico , Estrogênios/uso terapêutico , Medicina Baseada em Evidências , Feminino , Ginecologia , Humanos , Dor Pélvica , Instalações Privadas , Prática Privada , Inquéritos e Questionários , Suécia , Urologia
17.
BMC Psychiatry ; 19(1): 307, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640632

RESUMO

BACKGROUND: Persistent physical symptoms (PPS), also known as medically unexplained symptoms (MUS), affect approximately 50% of patients in secondary care and are often associated with disability, psychological distress and increased health care costs. Cognitive behavioural therapy (CBT) has demonstrated both short- and long-term efficacy with small to medium effect sizes for PPS, with larger treatment effects for specific PPS syndromes, including non-cardiac chest pain, irritable bowel syndrome (IBS) and chronic fatigue syndrome (CFS). Research indicates that PPS conditions share similar cognitive and behavioural responses to symptoms, such as avoidance and unhelpful beliefs. This suggests that a transdiagnostic approach may be beneficial for patients with PPS. METHODS: A randomised controlled trial (RCT) will be conducted to evaluate the efficacy and cost-effectiveness of a transdiagnostic CBT-based intervention for PPS. 322 participants with PPS will be recruited from secondary care clinics. Participants stratified by clinic and disability level will be randomised to CBT plus standard medical care (SMC) versus SMC alone. The intervention consists of 8 CBT sessions delivered by a qualified therapist over a period of 20 weeks. Outcomes will be assessed at 9, 20, 40- and 52-weeks post randomisation. Efficacy will be assessed by examining the difference between arms in the primary outcome Work and Social Adjustment Scale (WSAS) at 52 weeks after randomisation. Secondary outcomes will include mood, symptom severity and clinical global impression at 9, 20, 40 and 52 weeks. Cost-effectiveness will be evaluated by combining measures of health service use, informal care, loss of working hours and financial benefits at 52 weeks. DISCUSSION: This trial will provide a powered evaluation of the efficacy and cost-effectiveness of a transdiagnostic CBT approach versus SMC for patients with PPS. It will also provide valuable information about potential healthcare pathways for patients with PPS within the National Health Service (NHS). TRIAL REGISTRATION: ClinicalTrials.gov NCT02426788. Registered 27 April 2015. Overall trial status: Ongoing; Recruitment status: No longer recruiting.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Atenção Secundária à Saúde/métodos , Transtornos Somatoformes/terapia , Adulto , Terapia Cognitivo-Comportamental/economia , Análise Custo-Benefício , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Atenção Secundária à Saúde/economia , Transtornos Somatoformes/economia , Transtornos Somatoformes/psicologia , Medicina Estatal , Resultado do Tratamento
18.
Endocrinol Metab Clin North Am ; 48(4): 751-764, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31655774

RESUMO

Pseudopheochromocytoma manifests as severe, symptomatic paroxysmal hypertension without significant elevation in catecholamine and metanephrine levels and lack of evidence of tumor in the adrenal gland. The clinical manifestations are similar but not identical to those in excess circulating catecholamines. The underlying symptomatic mechanism includes augmented cardiovascular responsiveness to catecholamines alongside heightened sympathetic nervous stimulation. The psychological characteristics are probably attributed to the component of repressed emotions related to a past traumatic episode or repressive coping style. Successful management can be achieved by strong collaboration between a hypertension specialist and a psychiatrist or psychologist with expertise in cognitive-behavioral panic management.


Assuntos
Neoplasias das Glândulas Suprarrenais , Hipertensão , Transtorno de Pânico , Feocromocitoma , Transtornos Somatoformes , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/terapia , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Hipertensão/terapia , Transtorno de Pânico/complicações , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/terapia , Feocromocitoma/complicações , Feocromocitoma/diagnóstico , Feocromocitoma/terapia , Transtornos Somatoformes/complicações , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/terapia
19.
Fortschr Neurol Psychiatr ; 87(9): 512-525, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31519027

RESUMO

Somatoform disorders in the gastrointestinal tract are associated with a high level of suffering for the patients. Often the diagnosis is difficult or is made late. This article gives a clearer picture of these syndromes and sheds light on the diagnostics and treatment options. The revised AWMF guideline from 2018 also takes somatoform gastrointestinal disorders into account.


Assuntos
Trato Gastrointestinal/fisiopatologia , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/terapia , Humanos , Transtornos Somatoformes/fisiopatologia
20.
Complement Ther Clin Pract ; 37: 68-72, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31491603

RESUMO

BACKGROUND AND PURPOSE: Somatic symptom disorder (SSD) refers to a significant impairment in daily activities due to a dysfunctional preoccupation with one or more physical symptoms. This study reports the effectiveness of herbal medicine (HM) on SSD patient. MATERIALS AND METHODS: A 58-year-old woman had somatic atypical gastrointestinal symptoms for 5 years; i.e., an uncomfortable feeling going from the stomach to the ear as well as related severe anxiety. A Korean medicine (KM) doctor presumed she had SSD and phlegm-dampness syndrome, consequently, Xiao Ban Xia Jia Fu Ling Tang was administered. Her anxiety symptoms were rated using the numerical rating scale and the Beck anxiety inventory. RESULTS: The somatic symptoms originating in the stomach and chest, as well as the severe anxiety, improved markedly after 2 months of KM treatment. CONCLUSION: HMs used for treating phlegm-dampness syndrome may be effective in treating conditions involving somatic symptoms and related anxiety.


Assuntos
Ansiedade/terapia , Preparações de Plantas/administração & dosagem , Plantas Medicinais/química , Transtornos Somatoformes/terapia , Feminino , Gastroenteropatias/psicologia , Gastroenteropatias/terapia , Humanos , Sintomas Inexplicáveis , Pessoa de Meia-Idade
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