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Per Fink - One of the best experts on this subject based on the ideXlab platform.
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The outcome of health anxiety in primary care. A two-year follow-up study on health care costs and self-rated health. PLoS One
2016Co-Authors: Per Fink, Eva Ornbol, Kaj Sparle ChristensenAbstract:Background: Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety’s impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs. Methodology/Principal Findings: 1785 consecutive primary care patients aged 18–65 consulting their family physicians (FPs) for a new illness were followed-up for two years. A stratified subsample of 701 patients was assessed by the Schedules for Clinical Assessment in Neuropsychiatry interview. Patients with mild (N = 21) and severe Health anxiety (N = 81) and Hypochondriasis according to the DSM-IV (N = 59) were compared with a comparison group of patients who had a well-defined medical condition according to their FPs and a low score on the screening questionnaire (N = 968). Self-rated health was measured by questionnaire at index and at three, 12, and 24 months, and health care use was extracted from patient registers. Compared with the 968 patients with well-defined medical conditions, the 81 severe Health anxiety patients and the 59 DSM-IV Hypochondriasis patients continued during follow-up to manifest significantly more Health anxiety (Whiteley-7 scale). They also continued to have significantly worse self-rated functioning related to physical and mental health (component scores of the SF-36). The severe Health anxiety patients used about 41–78 % more health care per year i
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the outcome of health anxiety in primary care a two year follow up study on health care costs and self rated health
PLOS ONE, 2010Co-Authors: Per Fink, Eva Ornbol, Kaj Sparle ChristensenAbstract:BACKGROUND: Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs. METHODOLOGY/PRINCIPAL FINDINGS: 1785 consecutive primary care patients aged 18-65 consulting their family physicians (FPs) for a new illness were followed-up for two years. A stratified subsample of 701 patients was assessed by the Schedules for Clinical Assessment in Neuropsychiatry interview. Patients with mild (N = 21) and severe Health anxiety (N = 81) and Hypochondriasis according to the DSM-IV (N = 59) were compared with a comparison group of patients who had a well-defined medical condition according to their FPs and a low score on the screening questionnaire (N = 968). Self-rated health was measured by questionnaire at index and at three, 12, and 24 months, and health care use was extracted from patient registers. Compared with the 968 patients with well-defined medical conditions, the 81 severe Health anxiety patients and the 59 DSM-IV Hypochondriasis patients continued during follow-up to manifest significantly more Health anxiety (Whiteley-7 scale). They also continued to have significantly worse self-rated functioning related to physical and mental health (component scores of the SF-36). The severe Health anxiety patients used about 41-78% more health care per year in total, both during the 3 years preceding inclusion and during follow-up, whereas the DSM-IV Hypochondriasis patients did not have statistically significantly higher total use. A poor outcome of Health anxiety was not explained by comorbid depression, anxiety disorder or well-defined medical condition. Patients with mild Health anxiety did not have a worse outcome on physical health and incurred significantly less health care costs than the group of patients with a well-defined medical condition. CONCLUSIONS/SIGNIFICANCE: Severe Health anxiety was found to be a disturbing and persistent condition. It is costly for the health care system and must be taken seriously, i.e. diagnosed and treated. This study supports the validity of recently introduced new criteria for Health anxiety.
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the outcome of health anxiety in primary care a two year follow up study on health care costs and self rated health
PLOS ONE, 2010Co-Authors: Per Fink, Eva Ornbol, Kaj Sparle ChristensenAbstract:Background Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs.
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screening for somatization and Hypochondriasis in primary care and neurological in patients a seven item scale for Hypochondriasis and somatization
Journal of Psychosomatic Research, 1999Co-Authors: Per Fink, Henrik Ewald, Jorgen Jensen, L Sorensen, Marianne Engberg, Martin Holm, Povl MunkjorgensenAbstract:The aim of this study was to investigate the internal and external validity of the Whiteley Index as a screening instrument for somatization illness. A 14-item version of the Whiteley Index for hypochondriacal traits was given to 99 of 191 consecutive primary care patients, aged 18-65 years, and to 100 consecutive patients, aged 18-60 years, admitted for the first time to a neurological ward. The primary care sample was, in addition, interviewed by means of the SCAN (Schedules for Clinical Assessment in Neuropsychiatry) psychiatric interview. The GPs and the neurologists were asked to rate various characteristics of the patients that might indicate somatization. The internal validity of the Whiteley Index was tested by means of latent structure analysis. On this basis, a reduced seven-item scale (Whiteley-7 scale) and two subscales (i.e., an Illness Conviction and Illness Worrying scale, each with three items) were constructed. All three had a high internal validity fitting into the very restricted Rasch statistical model (p>0.05) and an acceptable transferability between most of the subpopulations investigated. In the primary care population, the Whiteley-7 and the Illness Conviction scales at cut-point 0/1 showed 1.00 and 0.87 sensitivity and 0.65 and 0.87 specificity, respectively, using as "gold standard" the fulfillment of criteria for at least one ICD-10 somatoform disorder, and 0.71 and 0.63 sensitivity and 0.62 and 0.87 specificity, respectively, as gold standard for the fulfillment of criteria for at least one DSM-IV somatoform disorder, excluding the NOS diagnostic group. The Illness Worrying subscale showed less impressive performance in this respect. The agreement between the Whiteley-7 scale including the two subscales and neurologists' rating and the GPs' rating and the somatization subscale on the SCL-90 was modest or worse. It may be concluded that the Whiteley-7 scale and the Illness Conviction subscale had acceptable psychometric profiles, and both seem to be promising screening tools for not only Hypochondriasis but also for somatoform disorders in general.
Kaj Sparle Christensen - One of the best experts on this subject based on the ideXlab platform.
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The outcome of health anxiety in primary care. A two-year follow-up study on health care costs and self-rated health. PLoS One
2016Co-Authors: Per Fink, Eva Ornbol, Kaj Sparle ChristensenAbstract:Background: Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety’s impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs. Methodology/Principal Findings: 1785 consecutive primary care patients aged 18–65 consulting their family physicians (FPs) for a new illness were followed-up for two years. A stratified subsample of 701 patients was assessed by the Schedules for Clinical Assessment in Neuropsychiatry interview. Patients with mild (N = 21) and severe Health anxiety (N = 81) and Hypochondriasis according to the DSM-IV (N = 59) were compared with a comparison group of patients who had a well-defined medical condition according to their FPs and a low score on the screening questionnaire (N = 968). Self-rated health was measured by questionnaire at index and at three, 12, and 24 months, and health care use was extracted from patient registers. Compared with the 968 patients with well-defined medical conditions, the 81 severe Health anxiety patients and the 59 DSM-IV Hypochondriasis patients continued during follow-up to manifest significantly more Health anxiety (Whiteley-7 scale). They also continued to have significantly worse self-rated functioning related to physical and mental health (component scores of the SF-36). The severe Health anxiety patients used about 41–78 % more health care per year i
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the outcome of health anxiety in primary care a two year follow up study on health care costs and self rated health
PLOS ONE, 2010Co-Authors: Per Fink, Eva Ornbol, Kaj Sparle ChristensenAbstract:Background Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs.
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the outcome of health anxiety in primary care a two year follow up study on health care costs and self rated health
PLOS ONE, 2010Co-Authors: Per Fink, Eva Ornbol, Kaj Sparle ChristensenAbstract:BACKGROUND: Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs. METHODOLOGY/PRINCIPAL FINDINGS: 1785 consecutive primary care patients aged 18-65 consulting their family physicians (FPs) for a new illness were followed-up for two years. A stratified subsample of 701 patients was assessed by the Schedules for Clinical Assessment in Neuropsychiatry interview. Patients with mild (N = 21) and severe Health anxiety (N = 81) and Hypochondriasis according to the DSM-IV (N = 59) were compared with a comparison group of patients who had a well-defined medical condition according to their FPs and a low score on the screening questionnaire (N = 968). Self-rated health was measured by questionnaire at index and at three, 12, and 24 months, and health care use was extracted from patient registers. Compared with the 968 patients with well-defined medical conditions, the 81 severe Health anxiety patients and the 59 DSM-IV Hypochondriasis patients continued during follow-up to manifest significantly more Health anxiety (Whiteley-7 scale). They also continued to have significantly worse self-rated functioning related to physical and mental health (component scores of the SF-36). The severe Health anxiety patients used about 41-78% more health care per year in total, both during the 3 years preceding inclusion and during follow-up, whereas the DSM-IV Hypochondriasis patients did not have statistically significantly higher total use. A poor outcome of Health anxiety was not explained by comorbid depression, anxiety disorder or well-defined medical condition. Patients with mild Health anxiety did not have a worse outcome on physical health and incurred significantly less health care costs than the group of patients with a well-defined medical condition. CONCLUSIONS/SIGNIFICANCE: Severe Health anxiety was found to be a disturbing and persistent condition. It is costly for the health care system and must be taken seriously, i.e. diagnosed and treated. This study supports the validity of recently introduced new criteria for Health anxiety.
Arthur J Barsky - One of the best experts on this subject based on the ideXlab platform.
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the relationship of Hypochondriasis to anxiety depressive and somatoform disorders
Psychosomatics, 2016Co-Authors: Brian A. Fallon, Arthur J Barsky, Timothy M Scarella, Johannes A C Laferton, David K AhernAbstract:Background Though the phenotype of anxiety about medical illness has long been recognized, there continues to be debate as to whether it is a distinct psychiatric disorder and, if so, to which diagnostic category it belongs. Objective Our objective was to investigate the pattern of psychiatric comorbidity in Hypochondriasis (HC) and to assess the relationship of health anxiety to anxiety, depressive, and somatoform disorders. Methods Data were collected as part of a clinical trial on treatment methods for HC. In all, 194 participants meeting criteria for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) HC were assessed by sociodemographic variables, results of structured diagnostic interviews, and validated instruments for assessing various symptom dimensions of psychopathology. Results Most of the individuals with HC had comorbid psychiatric illness; the mean number of comorbid diagnoses was 1.4, and 35.1% had HC as their only diagnosis. Participants were more likely to have only comorbid anxiety disorders than only comorbid depressive or somatoform disorders. Multiple regression analysis of continuous measures of symptoms revealed the strongest correlation of health anxiety with anxiety symptoms, and a weaker correlation with somatoform symptoms; in multiple regression analysis, there was no correlation between health anxiety and depressive symptoms. Conclusion Our findings suggest that the entity of health anxiety (HC in DSM-IV and illness anxiety disorder in DSM-5) is a clinical syndrome distinct from other psychiatric disorders. Analysis of comorbidity patterns and continuous measures of symptoms suggest that its appropriate classification is with anxiety rather than somatoform or mood disorders.
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anxiety as a predictor of improvements in somatic symptoms and health anxiety associated with cognitive behavioral intervention in Hypochondriasis
Psychotherapy and Psychosomatics, 2011Co-Authors: Mutsuhiro Nakao, David K Ahern, Yasuko Shinozaki, Arthur J BarskyAbstract:Background: Cognitive-behavioral therapy (CBT) has been shown to be beneficial in the treatment of Hypochondriasis. In this study, we sought to determine whether there was a differe
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mindfulness based cognitive therapy for Hypochondriasis or severe health anxiety a pilot study
Journal of Anxiety Disorders, 2010Co-Authors: David A Lovas, Arthur J BarskyAbstract:Abstract In spite of the existence of evidence-based treatments for Hypochondriasis, or severe health anxiety, recovery rates are low and morbidity is high. Therefore, more treatment options are needed for this prevalent condition. Mindfulness-based cognitive therapy (MBCT) interventions have been gaining research and clinical attention for the treatment of mood, and more recently anxiety disorders. A small, uncontrolled pilot study of an 8-week group MBCT intervention for Hypochondriasis was conducted. Ten subjects (five females and five males) with a mean age of 35.6 (range = 25–59) recruited from an academic community health network met criteria and completed the study. There were significant improvements in measures of health anxiety, disease-related thoughts, somatic symptoms, and mindfulness at the end of treatment, and these benefits were sustained at 3-month follow-up. Participants evidenced high treatment satisfaction, with no drop-outs or adverse events. These findings provide the basis for a larger, more rigorous, controlled trial of this promising treatment approach.
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cognitive behavior therapy for Hypochondriasis a randomized controlled trial
JAMA, 2004Co-Authors: Arthur J Barsky, David K AhernAbstract:ContextHypochondriasis is a chronic, distressing, and disabling condition that is prevalent in ambulatory medical practice. Until recently, no specific treatment has been clearly demonstrated to be effective.ObjectiveTo assess the efficacy of a cognitive behavior therapy (CBT) for Hypochondriasis.DesignA randomized, usual care control group design, conducted between September 1997 and November 2001. The individual primary care physician was the unit of randomization, and all patients clustered within each physician's practice were assigned to the experimental treatment (individual CBT and a consultation letter to the primary care physician) or to the control condition. Subjects were assessed immediately before and 6 and 12 months after the completion of treatment.Setting and ParticipantsParticipants were 80 patients from primary care practices and 107 volunteers responding to public announcements, all of whom exceeded a predetermined cutoff score on a Hypochondriasis self-report questionnaire on 2 successive occasions.InterventionA scripted, 6-session, individual CBT intervention was compared with medical care as usual. The CBT was accompanied by a consultation letter sent to the patient's primary care physician.Main Outcome MeasuresHypochondriacal beliefs, fears, attitudes, and somatic symptoms; role function and impairment.ResultsA total of 102 individuals were assigned to CBT and 85 were assigned to medical care as usual. The sociodemographic and clinical characteristics of the 2 groups were similar at baseline. Using an intent-to-treat analytic strategy, a consistent pattern of statistically and clinically significant treatment effects was found at both 6- and 12-month follow-up, adjusting for baseline covariates that included educational level, generalized psychiatric distress, and participant status (patient vs volunteer). At 12-month follow-up, CBT patients had significantly lower levels of hypochondriacal symptoms, beliefs, and attitudes (P<.001) and health-related anxiety (P = .009). They also had significantly less impairment of social role functioning (P = .05) and intermediate activities of daily living (P<.001). Hypochondriacal somatic symptoms were not improved significantly by treatment.ConclusionThis brief, individual CBT intervention, developed specifically to alter hypochondriacal thinking and restructure hypochondriacal beliefs, appears to have significant beneficial long-term effects on the symptoms of Hypochondriasis.
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a structured diagnostic interview for Hypochondriasis a proposed criterion standard
Journal of Nervous and Mental Disease, 1992Co-Authors: Arthur J Barsky, Paul D Cleary, Grace Wyshak, Robert L Spitzer, Janet B W Williams, Gerald L KlermanAbstract:We developed a structured diagnostic interview for DSM-III-R Hypochondriasis (SDIH) that is the first such clinician-administered instrument. The SDIH was administered to 88 general medical outpatients who scored above a predetermined cutoff on a hypochondriacal symptom questionnaire, and to 100 com
Paul M. Salkovskis - One of the best experts on this subject based on the ideXlab platform.
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A: Cognitive-behavioral treatment for severe and persistent health anxiety
2016Co-Authors: Paul M. Salkovskis, Hilary M.c. Warwick, Alicia C. DealeAbstract:Hypochondriasis is presently classified as a somatoform disorder. However, in terms of phenomenology and cognitive processes, it is probably best considered as a form of severe and persistent anxiety focused on health. This reconceptualization allows the application of Beck’s general cognitive theory of anxiety (1985) to the understanding and treatment of Hypochondriasis. In this paper, the classification and phenomenology of health anxiety is explained in terms of a specific cognitive-behavioral conceptualization. The way this conceptualization has been successfully applied to the treatment of health anxiety and hypochodriasis is described. The all-important task of engagement is accomplished as part of the cognitive assessment, which helps the patient develop and evaluate an alternative understanding of their problems. This understanding focuses on how misinterpretations of health-related information (mainly bodily variations and medical information) leads to a pattern of responses including anxiety, distorted patterns of attention, safety-seeking behaviors, and physiological arousal. These responses in turn account for the patient’s pattern of symptoms and functional impairment. Treatment progresses by helping the patient actively explore th
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a randomized clinical trial of cognitive behavioural therapy versus short term psychodynamic psychotherapy versus no intervention for patients with Hypochondriasis
Psychological Medicine, 2011Co-Authors: Per Soelberg Sorensen, Morten Birketsmith, Ulla Wattar, I Buemann, Paul M. SalkovskisAbstract:Background Hypochondriasis is common in the clinic and in the community. Cognitive behavioural therapy (CBT) has been found to be effective in previous trials. Psychodynamic psychotherapy is a treatment routinely offered to patients with Hypochondriasis in many countries, including Denmark. The aim of this study was to test CBT for Hypochondriasis in a centre that was not involved in its development and compare both CBT and short-term psychodynamic psychotherapy (STPP) to a waiting-list control and to each other. CBT was modified by including mindfulness and group therapy sessions, reducing the therapist time required. STPP consisted of individual sessions. Method Eighty patients randomized to CBT, STPP and the waiting list were assessed on measures of health anxiety and general psychopathology before and after a 6-month treatment period. Waiting-list patients were subsequently offered one of the two active treatments on the basis of re-randomization, and assessed on the same measures post-treatment. Patients were again assessed at 6- and 12-month follow-up points. Results Patients who received CBT did significantly better on all measures relative to the waiting-list control group, and on a specific measure of health anxiety compared with STPP. The STPP group did not significantly differ from the waiting-list group on any outcome measures. Similar differences were observed between CBT and STPP during follow-up, although some of the significant differences between groups were lost. Conclusions A modified and time-saving CBT programme is effective in the treatment of Hypochondriasis, although the two psychotherapeutic interventions differed in structure.
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Health anxiety levels in chronic pain clinic attenders
Journal of Psychosomatic Research, 2006Co-Authors: Sibylle Rode, Paul M. Salkovskis, Helen Dowd, Magdi HannaAbstract:Abstract Objective An application of the cognitive–behavioural model of health anxiety (Hypochondriasis) to chronic pain depends on the extent to which high levels of health anxiety occur in chronic pain, which has yet to be established. Methods The occurrence of health anxiety in consecutively recruited chronic pain patients ( n =161) and nonclinical controls with ( n =34) and without pain ( n =70) was investigated using a questionnaire measure of health anxiety. Results Conservative figures estimated a frequency of 36.7% for Hypochondriasis and 51.1% of severe and disabling health anxiety in the chronic pain sample. Conclusion The current finding that high levels of health anxiety are indeed very common in chronic pain indicates the potential value of an application of the cognitive–behavioural health anxiety model to at least the subgroup of highly health-anxious chronic pain patients.
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the health anxiety inventory development and validation of scales for the measurement of health anxiety and Hypochondriasis
Psychological Medicine, 2002Co-Authors: Paul M. Salkovskis, Hilary M.c. Warwick, Katharine A Rimes, David M. ClarkAbstract:Background. A self-rated measure of health anxiety should be sensitive across the full range of intensity (from mild concern to frank Hypochondriasis) and should differentiate people suffering from health anxiety from those who have actual physical illness but who are not excessively concerned about their health. It should also encompass the full range of clinical symptoms characteristic of clinical Hypochondriasis. The development and validation of such a scale is described. Method. Three studies were conducted. First, the questionnaire was validated by comparing the responses of patients suffering from Hypochondriasis with those suffering from Hypochondriasis and panic disorder, panic disorder, social phobia and non-patient controls. Secondly, a state version of the questionnaire was administered to patients undergoing cognitive-behavioural treatment or wait-list in order to examine the measure's sensitivity to change. In the third study, a shortened version was developed and validated in similar types of sample, and in a range of samples of people seeking medical help for physical illness. Results. The scale was found to be reliable and to have a high internal consistency. Hypochondriacal patients scored significantly higher than anxiety disorder patients, including both social phobic patients and panic disorder patients as well as normal controls. In the second study, a ‘state’ version of the scale was found to be sensitive to treatment effects, and to correlate very highly with a clinician rating based on an interview of present clinical state. A development and refinement of the scale (intended to reflect more fully the range of symptoms of and reactions to Hypochondriasis) was found to be reliable and valid. A very short (14 item) version of the scale was found to have comparable properties to the full length scale. Conclusions. The HAI is a reliable and valid measure of health anxiety. It is likely to be useful as a brief screening instrument, as there is a short form which correlates highly with the longer version.
Erik Andersson - One of the best experts on this subject based on the ideXlab platform.
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Optimal cut-off points on the health anxiety inventory, illness attitude scales and whiteley index to identify severe health anxiety.
PLOS ONE, 2015Co-Authors: Erik Hedman, Mats Lekander, Brjánn Ljótsson, Nils Lindefors, Gerhard Andersson, Christian Ruck, Erik AnderssonAbstract:Background Health anxiety can be viewed as a dimensional phenomenon where severe health anxiety in form of DSM-IV Hypochondriasis represents a cut-off where the health anxiety becomes clinically significant. Three of the most reliable and used self-report measures of health anxiety are the Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS) and the Whiteley Index (WI). Identifying the optimal cut-offs for classification of presence of a diagnosis of severe health anxiety on these measures has several advantages in clinical and research settings. The aim of this study was therefore to investigate the HAI, IAS and WI as proximal diagnostic instruments for severe health anxiety defined as DSM-IV Hypochondriasis. Methods We investigated sensitivity, specificity and predictive value on the HAI, IAS and WI using a total of 347 adult participants of whom 158 had a diagnosis of severe health anxiety, 97 had obsessive-compulsive disorder and 92 were healthy non-clinical controls. Diagnostic assessments were conducted using the Anxiety Disorder Interview Schedule. Results Optimal cut-offs for identifying a diagnosis of severe health anxiety was 67 on the HAI, 47 on the IAS, and 5 on the WI. Sensitivity and specificity were high, ranging from 92.6 to 99.4%. Positive and negative predictive values ranged from 91.6 to 99.4% using unadjusted prevalence rates. Conclusions The HAI, IAS and WI have very good properties as diagnostic indicators of severe health anxiety and can be used as cost-efficient proximal estimates of the diagnosis.
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internet based cognitive behavioural therapy for severe health anxiety randomised controlled trial
British Journal of Psychiatry, 2011Co-Authors: Erik Hedman, Brjánn Ljótsson, Gerhard Andersson, Gordon J G Asmundson, Erik Andersson, Christian Ruck, Nils LindeforsAbstract:Background Hypochondriasis, characterised by severe health anxiety, is a common condition associated with functional disability. Cognitive–behavioural therapy (CBT) is an effective but not widely disseminated treatment for Hypochondriasis. Internetbased CBT, including guidance in the form of minimal therapist contact via email, could be a more accessible treatment, but no study has investigated internet-based CBT for Hypochondriasis. Aims To investigate the efficacy of internet-based CBT for Hypochondriasis. Method A randomised controlled superiority trial with masked assessment comparing internet-based CBT (n = 40) over 12 weeks with an attention control condition (n = 41) for people with Hypochondriasis. The primary outcome measure was the Health Anxiety Inventory. This trial is registrated with ClinicalTrials.gov (NCT00828152). Results Participants receiving internet-based CBT made large and superior improvements compared with the control group on measures of health anxiety (between-group Cohen’s d range
