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Gustav Dobos - One of the best experts on this subject based on the ideXlab platform.

  • somatoform disorders and Medically Unexplained Symptoms in primary care
    Deutsches Arzteblatt International, 2015
    Co-Authors: Heidemarie Haller, Holger Cramer, Romy Lauche, Gustav Dobos
    Abstract:

    Patients with non-specific, functional, or somatoform disorders seek contact with primary care physicians to an extent that is above average (1). They often have recurring physical Symptoms that cannot be explained at all, or only to an unsatisfactory degree, with a specific medical diagnosis. Even though psychiatric disorders highly correlate with Medically Unexplained Symptoms, the extent of the occurring Symptoms cannot be completely explained with psychopathological factors (e1– e3). For this reason, the DSM (Diagnostic and Statistical Manual for Mental Disorders) (e4, e5) and the ICD (International Classification of Diseases) (e6) classify such Symptoms that cannot be Medically explained in separate somatoform categories. To diagnose a somatization disorder, 6 to 13 (depending on the manual) impairing, Medically Unexplained Symptoms with a duration of at least two years are required. The undifferentiated somatoform disorder is less restrictive: it is defined as at least one impairing medical Symptom with a minimum duration of six months. The diagnosis of chronic pain disorder also requires one Medically Unexplained and impairing pain Symptom that has been present for six months or longer. The diagnosis of a conversion disorder is made in cases where at least one Unexplained and impairing neurological deficit is present. Somatoform autonomic dysfunction is characterized by a minimum of three Unexplained and impairing cardiovascular, gastrointestinal, respiratory, or urogenital Symptoms. The residual category of an unspecified somatoform disorder requires merely a Medically Unexplained Symptom, which doesn’t have to be accompanied by significant impairment. In the literature, the classifications abridged somatization disorder and multisomatoform disorder have also been described. Abridged somatization disorder is present if a minimum of four impairing, Medically Unexplained Symptoms are confirmed in women and six such Symptoms in men (2), whereas the definition of multisomatoform disorder applies if at least three impairing Unexplained Symptoms with a minimum duration of two years are diagnosed (3). Because of the overall low validity of the diagnostic criteria to date, the DSM-5 includes revised definitions and concepts for somatoform disorders and Medically Unexplained Symptoms. A corresponding update has been announced for ICD-11, expected in the spring of 2015. Medically Unexplained Symptoms and somatoform disorders are often underdiagnosed in primary care (e7) and therefore cannot be treated adequately. The associated costs therefore rise further—independent of somatic and psychiatric comorbidities (4). The most recent estimates assume that 20% of primary care patients have somatoform disorders (5). Ia-level evidence for the prevalence of subcategories of somatoform disorders and Medically Unexplained Symptoms does currently not exist. This article analyzes the prevalence rates in primary care on the basis of a systematic review of the literature with meta-analysis.

Heidemarie Haller - One of the best experts on this subject based on the ideXlab platform.

  • somatoform disorders and Medically Unexplained Symptoms in primary care
    Deutsches Arzteblatt International, 2015
    Co-Authors: Heidemarie Haller, Holger Cramer, Romy Lauche, Gustav Dobos
    Abstract:

    Patients with non-specific, functional, or somatoform disorders seek contact with primary care physicians to an extent that is above average (1). They often have recurring physical Symptoms that cannot be explained at all, or only to an unsatisfactory degree, with a specific medical diagnosis. Even though psychiatric disorders highly correlate with Medically Unexplained Symptoms, the extent of the occurring Symptoms cannot be completely explained with psychopathological factors (e1– e3). For this reason, the DSM (Diagnostic and Statistical Manual for Mental Disorders) (e4, e5) and the ICD (International Classification of Diseases) (e6) classify such Symptoms that cannot be Medically explained in separate somatoform categories. To diagnose a somatization disorder, 6 to 13 (depending on the manual) impairing, Medically Unexplained Symptoms with a duration of at least two years are required. The undifferentiated somatoform disorder is less restrictive: it is defined as at least one impairing medical Symptom with a minimum duration of six months. The diagnosis of chronic pain disorder also requires one Medically Unexplained and impairing pain Symptom that has been present for six months or longer. The diagnosis of a conversion disorder is made in cases where at least one Unexplained and impairing neurological deficit is present. Somatoform autonomic dysfunction is characterized by a minimum of three Unexplained and impairing cardiovascular, gastrointestinal, respiratory, or urogenital Symptoms. The residual category of an unspecified somatoform disorder requires merely a Medically Unexplained Symptom, which doesn’t have to be accompanied by significant impairment. In the literature, the classifications abridged somatization disorder and multisomatoform disorder have also been described. Abridged somatization disorder is present if a minimum of four impairing, Medically Unexplained Symptoms are confirmed in women and six such Symptoms in men (2), whereas the definition of multisomatoform disorder applies if at least three impairing Unexplained Symptoms with a minimum duration of two years are diagnosed (3). Because of the overall low validity of the diagnostic criteria to date, the DSM-5 includes revised definitions and concepts for somatoform disorders and Medically Unexplained Symptoms. A corresponding update has been announced for ICD-11, expected in the spring of 2015. Medically Unexplained Symptoms and somatoform disorders are often underdiagnosed in primary care (e7) and therefore cannot be treated adequately. The associated costs therefore rise further—independent of somatic and psychiatric comorbidities (4). The most recent estimates assume that 20% of primary care patients have somatoform disorders (5). Ia-level evidence for the prevalence of subcategories of somatoform disorders and Medically Unexplained Symptoms does currently not exist. This article analyzes the prevalence rates in primary care on the basis of a systematic review of the literature with meta-analysis.

Steven Nordin - One of the best experts on this subject based on the ideXlab platform.

  • chemosensory perception Symptoms and autonomic responses during chemical exposure in multiple chemical sensitivity
    International Archives of Occupational and Environmental Health, 2016
    Co-Authors: Linus Andersson, Thomas Meinertz Dantoft, Sine Skovbjerg, Annasara Claeson, Nina Lind, Steven Nordin
    Abstract:

    Purpose Multiple chemical sensitivity (MCS) is a prevalent Medically Unexplained Symptom characterized by Symptom reactions to everyday chemical exposure below hygienic thresholds. The aim of this study was to investigate the expressions of hyper-reactivity in MCS during whole-body exposure to low concentrations of the odorant n-butanol.

  • chemosensory perception Symptoms and autonomic responses during chemical exposure in multiple chemical sensitivity
    International Archives of Occupational and Environmental Health, 2016
    Co-Authors: Linus Andersson, Thomas Meinertz Dantoft, Sine Skovbjerg, Annasara Claeson, Nina Lind, Steven Nordin
    Abstract:

    Multiple chemical sensitivity (MCS) is a prevalent Medically Unexplained Symptom characterized by Symptom reactions to everyday chemical exposure below hygienic thresholds. The aim of this study was to investigate the expressions of hyper-reactivity in MCS during whole-body exposure to low concentrations of the odorant n-butanol. We exposed 18 participants with MCS and 18 non-ill controls to a low concentration of the odorant n-butanol using an exposure chamber. The first 10 min constituted blank exposure, after which the n-butanol concentration increased and reached a plateau at 11.5 mg/m3. MCS participants, compared with controls, reported greater perceived odor intensities, more unpleasantness to the exposure and increasing Symptoms over time. MCS participants also expressed higher pulse rate and lower pulse rate variability than controls did. No group differences were found for breathing rate or tonic electrodermal activity responses. We conclude that MCS sufferers differ from healthy controls in terms of autonomic responses, Symptoms and chemosensory perception during chemical exposure.

Thomas Meinertz Dantoft - One of the best experts on this subject based on the ideXlab platform.

  • chemosensory perception Symptoms and autonomic responses during chemical exposure in multiple chemical sensitivity
    International Archives of Occupational and Environmental Health, 2016
    Co-Authors: Linus Andersson, Thomas Meinertz Dantoft, Sine Skovbjerg, Annasara Claeson, Nina Lind, Steven Nordin
    Abstract:

    Purpose Multiple chemical sensitivity (MCS) is a prevalent Medically Unexplained Symptom characterized by Symptom reactions to everyday chemical exposure below hygienic thresholds. The aim of this study was to investigate the expressions of hyper-reactivity in MCS during whole-body exposure to low concentrations of the odorant n-butanol.

  • chemosensory perception Symptoms and autonomic responses during chemical exposure in multiple chemical sensitivity
    International Archives of Occupational and Environmental Health, 2016
    Co-Authors: Linus Andersson, Thomas Meinertz Dantoft, Sine Skovbjerg, Annasara Claeson, Nina Lind, Steven Nordin
    Abstract:

    Multiple chemical sensitivity (MCS) is a prevalent Medically Unexplained Symptom characterized by Symptom reactions to everyday chemical exposure below hygienic thresholds. The aim of this study was to investigate the expressions of hyper-reactivity in MCS during whole-body exposure to low concentrations of the odorant n-butanol. We exposed 18 participants with MCS and 18 non-ill controls to a low concentration of the odorant n-butanol using an exposure chamber. The first 10 min constituted blank exposure, after which the n-butanol concentration increased and reached a plateau at 11.5 mg/m3. MCS participants, compared with controls, reported greater perceived odor intensities, more unpleasantness to the exposure and increasing Symptoms over time. MCS participants also expressed higher pulse rate and lower pulse rate variability than controls did. No group differences were found for breathing rate or tonic electrodermal activity responses. We conclude that MCS sufferers differ from healthy controls in terms of autonomic responses, Symptoms and chemosensory perception during chemical exposure.

Martin Johnson - One of the best experts on this subject based on the ideXlab platform.

  • persistent pain not a Medically Unexplained Symptom
    British Journal of General Practice, 2011
    Co-Authors: Amanda C De C Williams, Martin Johnson
    Abstract:

    At the same time as the study of pain is flourishing as a basic and applied science, and attention is paid nationally to reducing the gap between provision and need (chronic/persistent pain is a Royal College of General Practitioners priority for 2011-2013),1,2 there are moves to categorise it as a Medically Unexplained Symptom (MUS). This is puzzling on a scientific level, and seriously retrogressive at a healthcare level. It is nearly 50 years since Melzack and Wall published their gate control theory,3 presenting an integrated model of physiological and psychological processing, and challenging existing dualistic interpretations of many pain phenomena: > ‘The contemporary custom of assigning the cause of pain either to peripheral pathology or to mental pathology is too simple because it ignores the subtle dynamic properties of peripheral tissue and of the nervous system … which could explain many … diseases … which have previously been attributed to mental disorders.’3 On the …