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Kurt Kroenke - One of the best experts on this subject based on the ideXlab platform.
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depression anxiety and somatization in primary care syndrome overlap and Functional Impairment
General Hospital Psychiatry, 2008Co-Authors: Bernd Lowe, Robert L Spitzer, Janet B W Williams, Monika Mussell, Dieter Schellberg, Kurt KroenkeAbstract:Objective: To determine diagnostic overlap of depression, anxiety and somatization as well as their unique and overlapping contribution to Functional Impairment. Method: Two thousand ninety-one consecutive primary care clinic patients participated in a multicenter cross-sectional survey in 15 primary care clinics in the United States (participation rate, 92%). Depression, anxiety, somatization and Functional Impairment were assessed using validated scales from the Patient Health Questionnaire (PHQ) (PHQ-8, eight-item depression module; GAD-7, seven-item Generalized Anxiety Disorder Scale; and PHQ-15, 15-item somatic symptom scale) and the Short-Form General Health Survey (SF-20). Multiple linear regression analyses were used to investigate unique and overlapping associations of depression, anxiety and somatization with Functional Impairment. Results: In over 50% of cases, comorbidities existed between depression, anxiety and somatization. The contribution of the commonalities of depression, anxiety and somatization to Functional Impairment substantially exceeded the contribution of their independent parts. Nevertheless, depression, anxiety and somatization did have important and individual effects (i.e., separate from their overlap effect) on certain areas of Functional Impairment. Conclusions: Given the large syndrome overlap, a potential consideration for future diagnostic classification would be to describe basic diagnostic criteria for a single overarching disorder and to optionally code additional diagnostic features that allow a more detailed classification into specific depressive, anxiety and somatoform subtypes.
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the difficult patient prevalence psychopathology and Functional Impairment
Journal of General Internal Medicine, 1996Co-Authors: Steven R Hahn, Robert L Spitzer, Janet B W Williams, Kurt Kroenke, David S Brody, Mark Linzer, Frank V DegruyAbstract:OBJECTIVE: To determine the proportion of primary care patients who are experienced by their physicians as “difficult,” and to assess the association of difficulty with physical and mental disorders, Functional Impairment, health care utilization, and satisfaction with medical care.
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physical symptoms in primary care predictors of psychiatric disorders and Functional Impairment
Archives of Family Medicine, 1994Co-Authors: Kurt Kroenke, Robert L Spitzer, Janet B W Williams, Steven R Hahn, Mark Linzer, Frank V Degruy, David L BrodyAbstract:Objective To examine how the type and number of physical symptoms reported by primary care patients are related to psychiatric disorders and Functional Impairment. Design Outpatient mental health survey. Setting Four primary care clinics. Patients One thousand adult clinic patients, of whom 631 were selected randomly or consecutively and 369 by convenience. Main outcome measures Psychiatric disorders as determined by the Primary Care Evaluation of Mental Disorders procedure; the presence or absence of 15 common physical symptoms and whether symptoms were somatoform (ie, lacked an adequate physical explanation); and Functional status as determined by the Medical Outcomes Study Short-form General Health Survey. Results Each of the 15 common symptoms was frequently somatoform (range, 16% to 33%). The presence of any physical symptom increased the likelihood of a diagnosis of a mood or anxiety disorder by at least twofold to three-fold, and somatoform symptoms had a particularly strong association with psychiatric disorders. The likelihood of a psychiatric disorder increased dramatically with increasing numbers of physical symptoms. The prevalence of a mood disorder in patients with 0 to 1, 2 to 3, 4 to 5, 6 to 8, and 9 or more symptoms was 2%, 12%, 23%, 44%, and 60%, respectively, and the prevalence of an anxiety disorder was 1%, 7%, 13%, 30%, and 48%, respectively. Finally, each physical symptom was associated with significant Functional Impairment; indeed, the number of physical symptoms was a powerful correlate of Functional status. Conclusions The number of physical symptoms is highly predictive for psychiatric disorders and Functional Impairment. Multiple or unexplained symptoms may signify a potentially treatable mood or anxiety disorder.
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Psychiatric disorders and Functional Impairment in patients with persistent dizziness.
Journal of General Internal Medicine, 1993Co-Authors: Kurt Kroenke, Christine A. Lucas, Michael L. Rosenberg, Barbara ScherokmanAbstract:Objective: To determine the prevalence and predictors of psychiatric dizziness and to measure Functional Impairment associated with dizziness.
Robert L Spitzer - One of the best experts on this subject based on the ideXlab platform.
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depression anxiety and somatization in primary care syndrome overlap and Functional Impairment
General Hospital Psychiatry, 2008Co-Authors: Bernd Lowe, Robert L Spitzer, Janet B W Williams, Monika Mussell, Dieter Schellberg, Kurt KroenkeAbstract:Objective: To determine diagnostic overlap of depression, anxiety and somatization as well as their unique and overlapping contribution to Functional Impairment. Method: Two thousand ninety-one consecutive primary care clinic patients participated in a multicenter cross-sectional survey in 15 primary care clinics in the United States (participation rate, 92%). Depression, anxiety, somatization and Functional Impairment were assessed using validated scales from the Patient Health Questionnaire (PHQ) (PHQ-8, eight-item depression module; GAD-7, seven-item Generalized Anxiety Disorder Scale; and PHQ-15, 15-item somatic symptom scale) and the Short-Form General Health Survey (SF-20). Multiple linear regression analyses were used to investigate unique and overlapping associations of depression, anxiety and somatization with Functional Impairment. Results: In over 50% of cases, comorbidities existed between depression, anxiety and somatization. The contribution of the commonalities of depression, anxiety and somatization to Functional Impairment substantially exceeded the contribution of their independent parts. Nevertheless, depression, anxiety and somatization did have important and individual effects (i.e., separate from their overlap effect) on certain areas of Functional Impairment. Conclusions: Given the large syndrome overlap, a potential consideration for future diagnostic classification would be to describe basic diagnostic criteria for a single overarching disorder and to optionally code additional diagnostic features that allow a more detailed classification into specific depressive, anxiety and somatoform subtypes.
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the difficult patient prevalence psychopathology and Functional Impairment
Journal of General Internal Medicine, 1996Co-Authors: Steven R Hahn, Robert L Spitzer, Janet B W Williams, Kurt Kroenke, David S Brody, Mark Linzer, Frank V DegruyAbstract:OBJECTIVE: To determine the proportion of primary care patients who are experienced by their physicians as “difficult,” and to assess the association of difficulty with physical and mental disorders, Functional Impairment, health care utilization, and satisfaction with medical care.
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physical symptoms in primary care predictors of psychiatric disorders and Functional Impairment
Archives of Family Medicine, 1994Co-Authors: Kurt Kroenke, Robert L Spitzer, Janet B W Williams, Steven R Hahn, Mark Linzer, Frank V Degruy, David L BrodyAbstract:Objective To examine how the type and number of physical symptoms reported by primary care patients are related to psychiatric disorders and Functional Impairment. Design Outpatient mental health survey. Setting Four primary care clinics. Patients One thousand adult clinic patients, of whom 631 were selected randomly or consecutively and 369 by convenience. Main outcome measures Psychiatric disorders as determined by the Primary Care Evaluation of Mental Disorders procedure; the presence or absence of 15 common physical symptoms and whether symptoms were somatoform (ie, lacked an adequate physical explanation); and Functional status as determined by the Medical Outcomes Study Short-form General Health Survey. Results Each of the 15 common symptoms was frequently somatoform (range, 16% to 33%). The presence of any physical symptom increased the likelihood of a diagnosis of a mood or anxiety disorder by at least twofold to three-fold, and somatoform symptoms had a particularly strong association with psychiatric disorders. The likelihood of a psychiatric disorder increased dramatically with increasing numbers of physical symptoms. The prevalence of a mood disorder in patients with 0 to 1, 2 to 3, 4 to 5, 6 to 8, and 9 or more symptoms was 2%, 12%, 23%, 44%, and 60%, respectively, and the prevalence of an anxiety disorder was 1%, 7%, 13%, 30%, and 48%, respectively. Finally, each physical symptom was associated with significant Functional Impairment; indeed, the number of physical symptoms was a powerful correlate of Functional status. Conclusions The number of physical symptoms is highly predictive for psychiatric disorders and Functional Impairment. Multiple or unexplained symptoms may signify a potentially treatable mood or anxiety disorder.
Janet B W Williams - One of the best experts on this subject based on the ideXlab platform.
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depression anxiety and somatization in primary care syndrome overlap and Functional Impairment
General Hospital Psychiatry, 2008Co-Authors: Bernd Lowe, Robert L Spitzer, Janet B W Williams, Monika Mussell, Dieter Schellberg, Kurt KroenkeAbstract:Objective: To determine diagnostic overlap of depression, anxiety and somatization as well as their unique and overlapping contribution to Functional Impairment. Method: Two thousand ninety-one consecutive primary care clinic patients participated in a multicenter cross-sectional survey in 15 primary care clinics in the United States (participation rate, 92%). Depression, anxiety, somatization and Functional Impairment were assessed using validated scales from the Patient Health Questionnaire (PHQ) (PHQ-8, eight-item depression module; GAD-7, seven-item Generalized Anxiety Disorder Scale; and PHQ-15, 15-item somatic symptom scale) and the Short-Form General Health Survey (SF-20). Multiple linear regression analyses were used to investigate unique and overlapping associations of depression, anxiety and somatization with Functional Impairment. Results: In over 50% of cases, comorbidities existed between depression, anxiety and somatization. The contribution of the commonalities of depression, anxiety and somatization to Functional Impairment substantially exceeded the contribution of their independent parts. Nevertheless, depression, anxiety and somatization did have important and individual effects (i.e., separate from their overlap effect) on certain areas of Functional Impairment. Conclusions: Given the large syndrome overlap, a potential consideration for future diagnostic classification would be to describe basic diagnostic criteria for a single overarching disorder and to optionally code additional diagnostic features that allow a more detailed classification into specific depressive, anxiety and somatoform subtypes.
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the difficult patient prevalence psychopathology and Functional Impairment
Journal of General Internal Medicine, 1996Co-Authors: Steven R Hahn, Robert L Spitzer, Janet B W Williams, Kurt Kroenke, David S Brody, Mark Linzer, Frank V DegruyAbstract:OBJECTIVE: To determine the proportion of primary care patients who are experienced by their physicians as “difficult,” and to assess the association of difficulty with physical and mental disorders, Functional Impairment, health care utilization, and satisfaction with medical care.
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physical symptoms in primary care predictors of psychiatric disorders and Functional Impairment
Archives of Family Medicine, 1994Co-Authors: Kurt Kroenke, Robert L Spitzer, Janet B W Williams, Steven R Hahn, Mark Linzer, Frank V Degruy, David L BrodyAbstract:Objective To examine how the type and number of physical symptoms reported by primary care patients are related to psychiatric disorders and Functional Impairment. Design Outpatient mental health survey. Setting Four primary care clinics. Patients One thousand adult clinic patients, of whom 631 were selected randomly or consecutively and 369 by convenience. Main outcome measures Psychiatric disorders as determined by the Primary Care Evaluation of Mental Disorders procedure; the presence or absence of 15 common physical symptoms and whether symptoms were somatoform (ie, lacked an adequate physical explanation); and Functional status as determined by the Medical Outcomes Study Short-form General Health Survey. Results Each of the 15 common symptoms was frequently somatoform (range, 16% to 33%). The presence of any physical symptom increased the likelihood of a diagnosis of a mood or anxiety disorder by at least twofold to three-fold, and somatoform symptoms had a particularly strong association with psychiatric disorders. The likelihood of a psychiatric disorder increased dramatically with increasing numbers of physical symptoms. The prevalence of a mood disorder in patients with 0 to 1, 2 to 3, 4 to 5, 6 to 8, and 9 or more symptoms was 2%, 12%, 23%, 44%, and 60%, respectively, and the prevalence of an anxiety disorder was 1%, 7%, 13%, 30%, and 48%, respectively. Finally, each physical symptom was associated with significant Functional Impairment; indeed, the number of physical symptoms was a powerful correlate of Functional status. Conclusions The number of physical symptoms is highly predictive for psychiatric disorders and Functional Impairment. Multiple or unexplained symptoms may signify a potentially treatable mood or anxiety disorder.
Christopher D Graham - One of the best experts on this subject based on the ideXlab platform.
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a preliminary investigation of sleep quality in Functional neurological disorders poor sleep appears common and is associated with Functional Impairment
Journal of the Neurological Sciences, 2017Co-Authors: Christopher D Graham, Simon D KyleAbstract:Abstract Purpose Functional neurological disorders (FND) are disabling conditions for which there are few empirically-supported treatments. Disturbed sleep appears to be part of the FND context; however, the clinical importance of sleep disturbance (extent, characteristics and impact) remains largely unknown. We described sleep quality in two samples, and investigated the relationship between sleep and FND-related Functional Impairment. Methods We included a sample recruited online via patient charities (N = 205) and a consecutive clinical sample (N = 20). Participants completed validated measures of sleep quality and sleep characteristics (e.g. total sleep time, sleep efficiency), mood, and FND-related Functional Impairment. Results Poor sleep was common in both samples (89% in the clinical range), which was characterised by low sleep efficiency (M = 65.40%) and low total sleep time (M = 6.05 h). In regression analysis, sleep quality was negatively associated with FND-related Functional Impairment, accounting for 16% of the variance and remaining significant after the introduction of mood variables. Conclusions These preliminary analyses suggest that subjective sleep disturbance (low efficiency, short sleep) is common in FND. Sleep quality was negatively associated with the Functional Impairment attributed to FND, independent of depression. Therefore, sleep disturbance may be a clinically important feature of FND.
Frank V Degruy - One of the best experts on this subject based on the ideXlab platform.
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the difficult patient prevalence psychopathology and Functional Impairment
Journal of General Internal Medicine, 1996Co-Authors: Steven R Hahn, Robert L Spitzer, Janet B W Williams, Kurt Kroenke, David S Brody, Mark Linzer, Frank V DegruyAbstract:OBJECTIVE: To determine the proportion of primary care patients who are experienced by their physicians as “difficult,” and to assess the association of difficulty with physical and mental disorders, Functional Impairment, health care utilization, and satisfaction with medical care.
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physical symptoms in primary care predictors of psychiatric disorders and Functional Impairment
Archives of Family Medicine, 1994Co-Authors: Kurt Kroenke, Robert L Spitzer, Janet B W Williams, Steven R Hahn, Mark Linzer, Frank V Degruy, David L BrodyAbstract:Objective To examine how the type and number of physical symptoms reported by primary care patients are related to psychiatric disorders and Functional Impairment. Design Outpatient mental health survey. Setting Four primary care clinics. Patients One thousand adult clinic patients, of whom 631 were selected randomly or consecutively and 369 by convenience. Main outcome measures Psychiatric disorders as determined by the Primary Care Evaluation of Mental Disorders procedure; the presence or absence of 15 common physical symptoms and whether symptoms were somatoform (ie, lacked an adequate physical explanation); and Functional status as determined by the Medical Outcomes Study Short-form General Health Survey. Results Each of the 15 common symptoms was frequently somatoform (range, 16% to 33%). The presence of any physical symptom increased the likelihood of a diagnosis of a mood or anxiety disorder by at least twofold to three-fold, and somatoform symptoms had a particularly strong association with psychiatric disorders. The likelihood of a psychiatric disorder increased dramatically with increasing numbers of physical symptoms. The prevalence of a mood disorder in patients with 0 to 1, 2 to 3, 4 to 5, 6 to 8, and 9 or more symptoms was 2%, 12%, 23%, 44%, and 60%, respectively, and the prevalence of an anxiety disorder was 1%, 7%, 13%, 30%, and 48%, respectively. Finally, each physical symptom was associated with significant Functional Impairment; indeed, the number of physical symptoms was a powerful correlate of Functional status. Conclusions The number of physical symptoms is highly predictive for psychiatric disorders and Functional Impairment. Multiple or unexplained symptoms may signify a potentially treatable mood or anxiety disorder.
