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Bernd Löwe - One of the best experts on this subject based on the ideXlab platform.
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comparing the diagnostic concepts of icd 10 Somatoform Disorders and dsm 5 somatic symptom Disorders in patients from a psychosomatic outpatient clinic
Journal of Psychosomatic Research, 2018Co-Authors: Paul Husing, Bernd Löwe, Anne ToussaintAbstract:Abstract Objective The reconceptualization of somatic symptom and related Disorders in DSM-5 led to numerous consequences in terms of prevalence and affected patient populations. The present study aimed to investigate frequencies of ICD-10 Somatoform Disorders and DSM-5 somatic symptom Disorders, and how the respective diagnostic groups differ in terms of sociodemographic and psychopathological characteristics. It discusses the usefulness and reliability of the new diagnostic criteria. Method Patients from a German psychosomatic outpatient clinic ( n = 438) completed self-report questionnaires on depression (PHQ-9), anxiety (GAD-7), symptom burden (PHQ-15), psychological distress (SSD-12), and quality of life (SF-12). ICD-10 diagnoses were provided by treating clinicians, DSM-5 diagnoses were assessed via semi-structured telephone interviews. The prevalence of somatic symptom Disorders and their overlap with ICD-10 Somatoform Disorders was evaluated. Comparisons between patients with either diagnosis were drawn. Results More than half of the sample ( n = 239, 54.6%) fulfilled the criteria for a somatic symptom disorder. Compared to patients fulfilling ICD-10 criteria only, patients with a somatic symptom disorder presented higher levels of symptom related distress ( p = .045), health related anxiety ( p = .004), general anxiety ( p = .011), and lower mental health-related quality of life ( p = .015), while patients with ICD-10 Somatoform Disorders reported a lower physical health-related quality of life ( p = .031). Conclusion DSM-5 criteria included more patients than ICD-10 Somatoform Disorders in our sample. Patients diagnosed with a somatic symptom disorder appear to be more severely impaired in terms of general and health-related anxiety and psychological distress associated to their somatic symptoms, especially when diagnosed with a severe form of somatic symptom disorder.
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coding of medically unexplained symptoms and Somatoform Disorders by general practitioners an exploratory focus group study
BMC Family Practice, 2018Co-Authors: Nadine Janis Pohontsch, Bernd Löwe, Thomas Zimmermann, C Jonas, Marco Lehmann, Martin SchererAbstract:Medically unexplained symptoms (MUS) and Somatoform Disorders are common in general practices, but there is evidence that general practitioners (GPs) rarely use these codes. Assuming that correct classification and coding of symptoms and diseases are important for adequate management and treatment, insights into these processes could reveal problematic areas and possible solutions. Our study aims at exploring general practitioners’ views on coding and reasons for not coding MUS/Somatoform Disorders. We invited GPs to participate in six focus groups (N = 42). Patient vignettes and a semi-structured guideline were used by two moderators to facilitate the discussions. Recordings were transcribed verbatim. Two researchers analyzed the data using structuring content analysis with deductive and inductive category building. Three main categories turned out to be most relevant. For category a) “benefits of coding” GPs described that coding is seen as being done for reimbursement purposes and is not necessarily linked to the content of their reference files for a specific patient. Others reported to code specific diagnoses only if longer consultations to explore psychosomatic symptoms or psychotherapy are intended to be billed. Reasons for b) “restrained coding” were attempting to protect the patient from stigma through certain diagnoses and the preference for tentative diagnoses and functional coding. Some GPs admitted to c) “code inaccurately” attributing this to insufficient knowledge of ICD-10-criteria, time constraints or using “rules of thumb” for coding. There seem to be challenges in the process of coding of MUS and Somatoform Disorders, but GPs appear not to contest the patients’ suffering and accept uncertainty (about diagnoses) as an elementary part of their work. From GPs’ points of view ICD-10-coding does not appear to be a necessary requirement for treating patients and coding might be avoided to protect the patients from stigma and other negative consequences. Our findings supply a possible explanation for the commonly seen difference between routine and epidemiological data. The recent developments in the DSM-5 and the upcoming ICD-11 will supposedly change acceptance and handling of these diagnoses for GPs and patients. Either way, consequences for GPs’ diagnosing and coding behavior are not yet foreseeable.
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Duration of untreated illness in patients with Somatoform Disorders
Journal of psychosomatic research, 2018Co-Authors: Annabel Herzog, Meike C. Shedden-mora, Pascal Jordan, Bernd LöweAbstract:Abstract Objective A long duration of untreated mental illness (DUI) has been found to be associated with negative long-term outcomes. Although somatic symptom and related Disorders are frequent in the general population and in primary care, data regarding the DUI of these Disorders is scarce. The aim of this study was to investigate the DUI in patients with Somatoform Disorders. Methods In a cross-sectional study, primary care patients at high risk of having a Somatoform disorder were identified using the Patient Health Questionnaire (PHQ). In a second step, life-time Somatoform disorder diagnosis was established using the Composite International Diagnostic Interview (CIDI). Additionally, DUI was retrospectively assessed via self-reporting and sociodemographic information was collected. Survival analysis was used to estimate the DUI and to identify patient-related predictors of DUI. Results A total of 139 patients with Somatoform Disorders were included in the analyses. The mean DUI in these patients was 25.2 years (median 23.1 years). Higher education significantly predicted shorter DUI, whereas gender and age of onset were unrelated to DUI. Conclusions The results reveal a substantial delay in adequate treatment of patients with Somatoform Disorders. The reported DUI emphasizes the importance of improvements in the management of patients with these Disorders.
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collaborative stepped care for Somatoform Disorders a pre post intervention study in primary care
Journal of Psychosomatic Research, 2016Co-Authors: Meike C Sheddenmora, Karl Wegscheider, Beatrice Gros, Katharina Lau, Antje Gumz, Bernd LöweAbstract:Abstract Objective The successful management of Somatoform Disorders in primary care is often limited due to low diagnostic accuracy, delayed referral to psychotherapy, and unstructured overuse of health care. This study aimed to investigate the feasibility of establishing a collaborative stepped health care network for Somatoform Disorders, and its impact on the diagnostic process and treatment recommendations in primary care. Method The Network for Somatoform and Functional Disorders ( Sofu-Net ) was established to connect 41 primary care physicians (PCP), 35 psychotherapists, and 8 mental health clinics. To evaluate Sofu-Net , primary care patients at high risk of having a Somatoform disorder were identified using the Patient Health Questionnaire, and were assessed in detail at the patient and PCP level. Discussion of psychosocial distress in the consultations, diagnostic detection rates and treatment recommendations were compared before and 12 months after establishing the network. Results Out of the pre- (n = 1645) and 12-months-post Sofu-Net patient samples (n = 1756), 267 (16.2%) and 269 (15.3%) high-risk patients were identified. From these, 156 and 123 patients were interviewed and information was assessed from their PCP. Twelve months after Sofu-Net establishment, high-risk patients more frequently discussed psychosocial distress with their PCP (63.3% vs. 79.2%, p p p Sofu-Net did not affect PCP's diagnostic detection rates or recommendation to initiate psychotherapy. Conclusion The study results indicate feasibility of an interdisciplinary network for Somatoform Disorders. Collaborative care networks for Somatoform Disorders have the potential to improve doctor–patient-communication and prescription behavior.
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the challenge of diagnosing non specific functional and Somatoform Disorders a systematic review of barriers to diagnosis in primary care
Journal of Psychosomatic Research, 2016Co-Authors: Alexandra M Murray, Anne Toussaint, Astrid Althaus, Bernd LöweAbstract:Abstract Objective Despite their prevalence and impact on patients and the health care system, non-specific, functional, and Somatoform Disorders are underdiagnosed. This problem is especially problematic in primary care if we are moving towards an integrated care model. The objective of the current study was to identify and aggregate potential barriers to the diagnosis in primary care settings. Methods Our systematic review methodology followed a pre-published protocol and was registered in PROSPERO (CRD42013002540). We combined qualitative and quantitative data from studies identified in online databases and by hand searching of reference lists. Data were synthesized in a data-driven way using a grounded-theory approach. The level of evidence and assessment of bias for the final included studies was independently conducted. Results Data from n = 177 full text publications were independently extracted and combined in a custom database. The final list of included studies was n = 42. From these, a total of n = 379 barriers were identified comprising 77 barrier-level codes, 16 thematic categories and five over-arching themes, i.e., patient-related, primary-care-practitioner related, doctor–patient interactional, situational, and conceptual and operational barriers. Conclusion Given the thematic range of the identified barriers, the diagnostic process of non-specific, functional, and Somatoform Disorders in primary care is highly complex. Individual or practice-level interventions, as well as public awareness initiatives are needed to help address the diagnostic challenges. A multi-factorial understanding of symptoms with a biopsychosocial parallel diagnostic approach should be encouraged. More direct empirical investigations are also needed.
Winfried Rief - One of the best experts on this subject based on the ideXlab platform.
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the distinction between medically unexplained and medically explained in the context of Somatoform Disorders
International Journal of Behavioral Medicine, 2013Co-Authors: Kristina Klaus, Winfried Rief, Elmar Brahler, Alexandra Martin, Heide Glaesmer, Ricarda MewesAbstract:Medically unexplained symptoms (MUS) currently constitute the main diagnostic criterion of Somatoform Disorders. It has been proposed that the required dichotomization of somatic complaints into MUS and medically explained symptoms (MES) should be abandoned in DSM-V. The present study investigated complaints in the general population in order to evaluate the relevance of a distinction between MUS and MES. Three hundred twenty-one participants from a population-based sample were interviewed by telephone to assess symptoms present during the previous 12 months. Complaints were examined in terms of health care use, diagnoses made by the physician and degree of impairment. At the 1-year follow-up, 244 subjects were re-interviewed in order to explore the stability of symptoms. The complaints frequently prompted participants to seek medical health care (several pain and pseudoneurological symptoms led to a doctors' visit in >80 % of cases), although etiological findings rarely suggested a medical pathology (occasionally <30 %). MUS and MES proved, to an equal degree, to impair individuals and prompt a change in lifestyle. Pain caused the worst impairment compared with other symptoms. The most prevalent MUS and MES were characterized by a transient course (approximately 60 % remitted, 55 % newly emerged to follow-up), although various unexplained pain complaints tended to be persistent (e.g., back pain 67 %). Remarkably, the appraised etiology as explained or unexplained changed from baseline to follow-up in many persisting symptoms (20 % MUS → MES, 50 % MES → MUS). In principal, MUS and MES resulted in comparable impairment and stability. Due to conceptual and methodological difficulties, classification criteria for Somatoform Disorders should not be restricted to somatic aspects of the symptomatology.
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relevance of cognitive and behavioral factors in medically unexplained syndromes and Somatoform Disorders
Psychiatric Clinics of North America, 2011Co-Authors: Alexandra Martin, Winfried RiefAbstract:Many physical complaints cannot be accounted for by any known specific pathophysiology or known disease; 25–80% of all symptoms presented in the primary care setting are considered to be of unclear origin. Even in the general population nspecific somatic symptoms are experienced very often. Though the majority of hese symptoms are transient phenomena that do not require further treatment, in ome people these bodily complaints persist over years, resulting in severe distress nd disability. Reviewing the existing longitudinal studies, evidence suggests that specially the presence of multiple symptoms (rather than single symptoms) of nclear origin is associated with chronic course and higher degrees of functional isability at follow-up. Moreover, it has been postulated that the presence of ognitive and behavioral features in patients with somatic symptoms is associated ith higher disability, symptom persistence, and increased health care needs. In this paper, we will summarize psychological features that are considered to be of relevance in the context of Somatoform Disorders, and that could be candidates for classification criteria for patients with complex syndromes.
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psychobiological perspectives on Somatoform Disorders
Psychoneuroendocrinology, 2005Co-Authors: Winfried Rief, Arthur J BarskyAbstract:Common physical symptoms such as abdominal pain, headache, back pain and dizziness play a major role for the health care system. Existing models for the development and maintenance of these symptoms emphasize a vicious circle with cognitive-perceptual, behavioral, and psychobiological components. In this manuscript, we present examples of psychobiological factors that might contribute to Somatoform Disorders. We emphasize that Somatoform symptoms are not strictly mental events, but are associated with a diversity of biological processes. The possible role of the endocrine and immune system, amino acids and neurotransmitters, but also physiological activation and cerebral activity is exemplified. These approaches are categorized using a model of perception and filtering of bodily signals. Studies are needed that combine the investigation of different biological systems with assessments of psychological variables in longitudinal trials, but also experimental investigations in humans examining the interaction of behavior changes, biological variations, and body perception are still rare.
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psychobiological aspects of Somatoform Disorders contributions of monoaminergic transmitter systems
Neuropsychobiology, 2004Co-Authors: Winfried Rief, Florian Pilger, Daniel Ihle, Robert Verkerk, Simon Scharpe, Michael MaesAbstract:Objective: To evaluate the possible biological aspects of ‘unexplained physical symptoms’, this study examined serotonergic and noradrenergic monoamino acids in Somatoform Disorders
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a new approach to the assessment of the treatment effects of Somatoform Disorders
Psychosomatics, 2003Co-Authors: Winfried Rief, Wolfgang HillerAbstract:A new 53-item instrument for the evaluation of treatment effects in Somatoform Disorders, the Screening for Somatoform Symptoms—7 (SOMS-7), is presented. It covers all somatic symptoms mentioned as occurring in somatization disorder, according to DSM-IV and ICD-10. A group of 325 patients was assessed at the beginning and end of treatment to compute scores of reliability and validity. The new scale showed high internal consistency (alpha = 0.92) and revealed two composite indices: somatization symptom count and somatization severity index. These indices discriminated patients fulfilling complete criteria for Somatoform Disorders, patients with somatization syndrome, and patients with other mental and psychosomatic Disorders. The instrument confirmed symptom reductions between admission and discharge, while in another group composed of wait-listed patients, no significant decrease in symptoms was observed. In sum, the SOMS-7 seems to be a comprehensive, reliable, and valid instrument for the evaluation of treatment effects in patients with Somatoform Disorders.
K Kroenke - One of the best experts on this subject based on the ideXlab platform.
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efficacy of treatment for Somatoform Disorders a review of randomized controlled trials
FOCUS, 2009Co-Authors: K KroenkeAbstract:Objective:To review the evidence from randomized clinical trials (RCTs) that have focused on the treatment of patients with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) Somatoform Disorders. Although Somatoform Disorders are among the most common mental Disorders presenting in the general medical setting, the strength of evidence for specific treatments has not been well synthesized. Methods: MEDLINE search of articles published in English from 1966 to 2006, using the following search terms: randomized clinical trial, Somatoform Disorders, somatization disorder, undifferentiated Somatoform disorder, hypochrondriasis, conversion disorder, pain disorder, and body dysmorphic disorder. Results: A total of 34 RCTs involving 3922 patients were included. Two thirds of the studies involved somatization disorder (n = 4 studies) and lower threshold variants, such as abridged somatization disorder (n = 9) and medically unexplained symptoms (n = 10). Cognitive behavioral therapy (CBT) w...
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Somatoform Disorders and recent diagnostic controversies
Psychiatric Clinics of North America, 2007Co-Authors: K KroenkeAbstract:Several classification issues regarding Somatoform Disorders are being debated as the process for revising the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) unfolds over the next 5 years. Eight key questions center around the appropriate stakeholders for DSM-V, changes in terminology, movement of certain Disorders within or outside of Axis I, the validity of symptom explanation as a core criterion, the status of functional somatic syndromes, the reliance on symptom counts, the reliability of lifetime symptom recall, and the value of symptom grouping. Somatic symptom measures are reviewed, and a brief self-rated scale is described in detail.
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revising the classification of Somatoform Disorders key questions and preliminary recommendations
Psychosomatics, 2007Co-Authors: K Kroenke, Michael Sharpe, Richard SykesAbstract:As the DSM–V process unfolds, Somatoform Disorders are a diagnostic category for which major revisions seem warranted. The Conceptual Issues in Somatoform and Similar Disorders (CISSD) project recently convened three workshops, involving 24 experts. The CISSD identified key questions related to stakeholders; terminology; appropriate axis (I versus III); medically unexplained criteria; status of functional somatic syndromes; and symptom counts, grouping, lifetime recall, and checklists. Preliminary recommendations include substantial revision of the category of Somatization Disorder, elimination of Undifferentiated Somatoform Disorder and Pain Disorder, terminology changes, and potential shifting of certain Disorders to different DSM categories or axes.
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Efficacy of treatment for Somatoform Disorders: a review of randomized controlled trials
Psychosomatic Medicine, 2007Co-Authors: K KroenkeAbstract:OBJECTIVE: To review the evidence from randomized clinical trials (RCTs) that have focused on the treatment of patients with Diagnostic and Statistical Manual of Mental Disorders, 4(th) Edition (DSM-IV) Somatoform Disorders. Although Somatoform Disorders are among the most common mental Disorders presenting in the general medical setting, the strength of evidence for specific treatments has not been well synthesized. METHODS: MEDLINE search of articles published in English from 1966 to 2006, using the following search terms: randomized clinical trial, Somatoform Disorders, somatization disorder, undifferentiated Somatoform disorder, hypochrondriasis, conversion disorder, pain disorder, and body dysmorphic disorder. RESULTS: A total of 34 RCTs involving 3922 patients were included. Two thirds of the studies involved somatization disorder (n = 4 studies) and lower threshold variants, such as abridged somatization disorder (n = 9) and medically unexplained symptoms (n = 10). Cognitive behavioral therapy (CBT) was effective in most studies (11 of 13), as were antidepressants in a small number (4 of 5) of studies. RCTs examining a variety of other treatments showed benefit in half (8 of 16) of the studies, the most consistent evidence existing for a consultation letter to the primary care physician. Effective treatments have been established for all Somatoform Disorders except conversion disorder (1 of 3 studies showing benefit) and pain disorder (no studies reported). CONCLUSION: CBT is the best established treatment for a variety of Somatoform Disorders, with some benefit also demonstrated for a consultation letter to the primary care physician. Preliminary but not yet conclusive evidence exists for antidepressants.
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Somatoform Disorders: Time for a New Approach in DSM-V
The American journal of psychiatry, 2005Co-Authors: Richard Mayou, K Kroenke, Laurence J. Kirmayer, Greg E. Simon, Michael SharpeAbstract:OBJECTIVE: DSM-III introduced Somatoform Disorders as a speculative diagnostic category for somatic symptoms “not explained by a general medical condition.” Although retained and enlarged in DSM-IV, Somatoform Disorders have been the subject of continuing criticism by both professionals and patients. The extended period of preparation for DSM-V offers an important opportunity to reconsider the category of Somatoform Disorders. METHOD: Exploration of the diverse aims of a diagnostic classification indicates that the authors must not only address the conceptual and practical problems associated with this category but also reconcile it with the parallel medical descriptive classification of functional symptoms and syndromes. RESULTS: The existing Somatoform Disorders categories require modification. The authors favor the radical option of the abolition of the categories. Diagnoses currently within Somatoform Disorders could be redistributed into other groupings, and the Disorders currently defined solely by ...
Hans-jürgen Möller - One of the best experts on this subject based on the ideXlab platform.
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st john s wort extract li 160 in Somatoform Disorders results of a placebo controlled trial
Psychopharmacology, 2002Co-Authors: Hans-peter Volz, H Murck, Siegfried Kasper, Hans-jürgen MöllerAbstract:Abstract Rationale and objective. Preliminary data have shown that St John's wort might possess some specific efficacy in patients with Somatoform complaints. Therefore, the efficacy of the Hypericum extract LI 160 in patients with Somatoform Disorders should be studied in a double-blind placebo-controlled fashion. Methods. This was a multicentre, randomised, placebo controlled, 6-week trial comparing the efficacy of LI 160 (600 mg/day) and placebo in 151 out-patients suffering from somatization disorder (ICD-10: F45.0), undifferentiated Somatoform disorder (F45.1), or Somatoform autonomic dysfunctions (F45.3). The primary outcome measure was the decrease of the Hamilton Anxiety Scale, subfactor somatic anxiety (HAMA-SOM), during the trial period. Results. LI 160 was superior effective concerning the primary outcome criterion HAMA-SOM [decrease from 15.39 (SD 2.68) to 6.64 (4.32) in the Hypericum group and from 15.55 (2.94) to 11.97 (5.58) in the placebo group (statistically significant difference, P=0.001)]. This was corroborated by the result of a statistically significant superior efficacy in the outcome criteria additionally used such as Clinical Global Impression, HAMA-total score, HAMA, subscore psychic anxiety, Hamilton Depression Scale, Self-Report Symptom Inventory 90 items – revised (SCL-90-R), and SCL-90-R, subscore somatic anxiety. The efficacy of LI 160 was preserved after splitting the population in those with mild and those with severe depressive symptoms. Tolerability of LI 160 was excellent. Conclusion. The data from this trial show excellent efficacy and tolerability for LI 160 in Somatoform Disorders. The efficacy is independent of an existing depressive mood. This is the first study showing the efficacy of a drug in patients with somatisation disorder independent of depressive symptomatology.
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Opipramol for the treatment of Somatoform Disorders results from a placebo-controlled trial
European Neuropsychopharmacology, 2000Co-Authors: Hans-peter Volz, Ingrid Reimann, Hans-jürgen Möller, Klaus-dieter StollAbstract:Abstract Although Somatoform Disorders are highly prevalent, so far there is no established pharmacological treatment. Opipramol is a psychopharmacon widely prescribed in Germany. Early trials with opipramol showed the drug’s effectiveness in anxiety states coupled with somatic complaints. Therefore, the efficacy of opipramol in Somatoform Disorders was evaluated using adequate clinical trial methods. A multicentre, randomized, 6-week, placebo-controlled clinical trial was performed in a total of 200 patients suffering from Somatoform Disorders according to ICD-10. In the main outcome criterion, the somatic subscore of the Hamilton Anxiety Scale, and in nearly all other outcome criteria opipramol (200 mg/day) was statistically more effective than placebo. A similar number of adverse events was noted in both groups. The results of this first-placebo-controlled study in Somatoform Disorders suggest efficacy of opipramol in this indication but need replication.
Wolfgang Hiller - One of the best experts on this subject based on the ideXlab platform.
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pharmacological interventions for Somatoform Disorders in adults
Cochrane Database of Systematic Reviews, 2014Co-Authors: Maria Kleinstauber, Michael Witthoft, Wolfgang Hiller, Andres Steffanowski, Harm W J Van Marwijk, Michael J LambertAbstract:BACKGROUND: Somatoform Disorders are characterised by chronic, medically unexplained physical symptoms (MUPS). Although different medications are part of treatment routines for people with Somatoform Disorders in clinics and private practices, there exists no systematic review or meta-analysis on the efficacy and tolerability of these medications. We aimed to synthesise to improve optimal treatment decisions.OBJECTIVES: To assess the effects of pharmacological interventions for Somatoform Disorders (specifically somatisation disorder, undifferentiated Somatoform disorder, Somatoform autonomic dysfunction, and pain disorder) in adults.SEARCH METHODS: We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) (to 17 January 2014). This register includes relevant randomised controlled trials (RCTs) from The Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). To identify ongoing trials, we searched ClinicalTrials.gov, Current Controlled Trials metaRegister, the World Health Organization International Clinical Trials Registry Platform, and the Chinese Clinical Trials Registry. For grey literature, we searched ProQuest Dissertation {\&} Theses Database, OpenGrey, and BIOSIS Previews. We handsearched conference proceedings and reference lists of potentially relevant papers and systematic reviews and contacted experts in the field.SELECTION CRITERIA: We selected RCTs or cluster RCTs of pharmacological interventions versus placebo, treatment as usual, another medication, or a combination of different medications for Somatoform Disorders in adults. We included people fulfilling standardised diagnostic criteria for somatisation disorder, undifferentiated Somatoform disorder, Somatoform autonomic dysfunction, or Somatoform pain disorder.DATA COLLECTION AND ANALYSIS: One review author and one research assistant independently extracted data and assessed risk of bias. Primary outcomes included the severity of MUPS on a continuous measure, and acceptability of treatment.MAIN RESULTS: We included 26 RCTs (33 reports), with 2159 participants, in the review. They examined the efficacy of different types of antidepressants, the combination of an antidepressant and an antipsychotic, antipsychotics alone, or natural products (NPs). The duration of the studies ranged between two and 12 weeks.One meta-analysis of placebo-controlled studies showed no clear evidence of a significant difference between tricyclic antidepressants (TCAs) and placebo for the outcome severity of MUPS (SMD -0.13; 95{\%} CI -0.39 to 0.13; 2 studies, 239 participants; I(2) = 2{\%}; low-quality evidence). For new-generation antidepressants (NGAs), there was very low-quality evidence showing they were effective in reducing the severity of MUPS (SMD -0.91; 95{\%} CI -1.36 to -0.46; 3 studies, 243 participants; I(2) = 63{\%}). For NPs there was low-quality evidence that they were effective in reducing the severity of MUPS (SMD -0.74; 95{\%} CI -0.97 to -0.51; 2 studies, 322 participants; I(2) = 0{\%}).One meta-analysis showed no clear evidence of a difference between TCAs and NGAs for severity of MUPS (SMD -0.16; 95{\%} CI -0.55 to 0.23; 3 studies, 177 participants; I(2) = 42{\%}; low-quality evidence). There was also no difference between NGAs and other NGAs for severity of MUPS (SMD -0.16; 95{\%} CI -0.45 to 0.14; 4 studies, 182 participants; I(2) = 0{\%}).Finally, one meta-analysis comparing selective serotonin reuptake inhibitors (SSRIs) with a combination of SSRIs and antipsychotics showed low-quality evidence in favour of combined treatment for severity of MUPS (SMD 0.77; 95{\%} CI 0.32 to 1.22; 2 studies, 107 participants; I(2) = 23{\%}).Differences regarding the acceptability of the treatment (rate of all-cause drop-outs) were neither found between NGAs and placebo (RR 1.01, 95{\%} CI 0.64 to 1.61; 2 studies, 163 participants; I(2) = 0{\%}; low-quality evidence) or NPs and placebo (RR 0.85, 95{\%} CI 0.40 to 1.78; 3 studies, 506 participants; I(2) = 0{\%}; low-quality evidence); nor between TCAs and other medication (RR 1.48, 95{\%} CI 0.59 to 3.72; 8 studies, 556 participants; I(2) =14{\%}; low-quality evidence); nor between antidepressants and the combination of an antidepressant and an antipsychotic (RR 0.80, 95{\%} CI 0.25 to 2.52; 2 studies, 118 participants; I(2) = 0{\%}; low-quality evidence). Percental attrition rates due to adverse effects were high in all antidepressant treatments (0{\%} to 32{\%}), but low for NPs (0{\%} to 1.7{\%}).The risk of bias was high in many domains across studies. Seventeen trials (65.4{\%}) gave no information about random sequence generation and only two (7.7{\%}) provided information about allocation concealment. Eighteen studies (69.2{\%}) revealed a high or unclear risk in blinding participants and study personnel; 23 studies had high risk of bias relating to blinding assessors. For the comparison NGA versus placebo, there was relatively high imprecision and heterogeneity due to one outlier study. Although we identified 26 studies, each comparison only contained a few studies and small numbers of participants so the results were imprecise.AUTHORS' CONCLUSIONS: The current review found very low-quality evidence for NGAs and low-quality evidence for NPs being effective in treating Somatoform symptoms in adults when compared with placebo. There was some evidence that different classes of antidepressants did not differ in efficacy; however, this was limited and of low to very low quality. These results had serious shortcomings such as the high risk of bias, strong heterogeneity in the data, and small sample sizes. Furthermore, the significant effects of antidepressant treatment have to be balanced against the relatively high rates of adverse effects. Adverse effects produced by medication can have amplifying effects on symptom perceptions, particularly in people focusing on somatic symptoms without medical causes. We can only draw conclusions about short-term efficacy of the pharmacological interventions because no trial included follow-up assessments. For each of the comparisons where there were available data on acceptability rates (NGAs versus placebo, NPs versus placebo, TCAs versus other medication, and antidepressants versus a combination of an antidepressant and an antipsychotic), no clear differences between the intervention and comparator were found.Future high-quality research should be carried out to determine the effectiveness of medications other than antidepressants, to compare antidepressants more thoroughly, and to follow-up participants over longer periods (the longest follow up was just 12 weeks). Another idea for future research would be to include other outcomes such as functional impairment or dysfunctional behaviours and cognitions as well as the classical outcomes such as symptom severity, depression, or anxiety.
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psychological approaches to origins and treatments of Somatoform Disorders
Annual Review of Clinical Psychology, 2010Co-Authors: Michael Witthoft, Wolfgang HillerAbstract:Medically unexplained symptoms are the defining feature of Somatoform Disorders (SFD) as currently included in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the International Classification of Diseases, Tenth Edition. Cognitive, behavioral, biological, and social variables are important to our understanding of SFD. Research in the past decade has highlighted the central role of (a) prolonged attention allocation to bodily sensations, (b) the dysfunctional role of catastrophizing symptoms as signs of severe illness, (c) neuroendocrine alterations, and (d) the influence of illness behavior (e.g., the avoidance of physical activity) on the maintenance and chronicity of SFD. Additionally, conditioning approaches have demonstrated that perceiving somatic discomfort can easily be learned. In addition to current models of etiology and pathogenesis, the existing evidence on the efficacy and effectiveness of psychotherapy for SFD is reviewed. Finally, future directions and some current...
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a new approach to the assessment of the treatment effects of Somatoform Disorders
Psychosomatics, 2003Co-Authors: Winfried Rief, Wolfgang HillerAbstract:A new 53-item instrument for the evaluation of treatment effects in Somatoform Disorders, the Screening for Somatoform Symptoms—7 (SOMS-7), is presented. It covers all somatic symptoms mentioned as occurring in somatization disorder, according to DSM-IV and ICD-10. A group of 325 patients was assessed at the beginning and end of treatment to compute scores of reliability and validity. The new scale showed high internal consistency (alpha = 0.92) and revealed two composite indices: somatization symptom count and somatization severity index. These indices discriminated patients fulfilling complete criteria for Somatoform Disorders, patients with somatization syndrome, and patients with other mental and psychosomatic Disorders. The instrument confirmed symptom reductions between admission and discharge, while in another group composed of wait-listed patients, no significant decrease in symptoms was observed. In sum, the SOMS-7 seems to be a comprehensive, reliable, and valid instrument for the evaluation of treatment effects in patients with Somatoform Disorders.
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a controlled treatment study of Somatoform Disorders including analysis of healthcare utilization and cost effectiveness
Journal of Psychosomatic Research, 2003Co-Authors: Wolfgang Hiller, Manfred M Fichter, Winfried RiefAbstract:Abstract Objective: The purpose of this prospective study was to evaluate the effects of cognitive-behavioral treatment (CBT) on mental health status and healthcare utilization in patients with Somatoform Disorders (SFD) of a specialized tertiary care center. Methods: According to DSM-IV interviews, 54 patients had somatization disorder (SD), 51 abridged somatization syndrome (SSI-8) and 67 other defined SFD. A clinical non-SFD comparison group consisted of 123 patients. Treatment effects were controlled against the waiting list. Cost calculations for the 2-year periods before and after treatment were based on medical and billing records from health insurance companies. Results: The SFD patients improved significantly with respect to physical symptom distress, health anxieties, dysfunctional beliefs towards body and health, depression and psychosocial functioning. Their outpatient plus inpatient charges during the 2 years prior to treatment were about 2.2-fold higher than for average patients of the health system. At the 2-year follow-up, we found treatment-related cost offset of 382 € (−24.5%) for outpatient and 1098 € (−36.7%) for inpatient care. Indirect socioeconomic costs due to days lost from work decreased by 6702 € (−35.3%). Per patient savings of 32,174 € (−63.9%) were found in a subgroup of somatizing high-utilizers. Conclusion: The results encourage including treatment strategies to reduce Somatoform illness behavior into clinical practice.
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toward empirically based criteria for the classification of Somatoform Disorders
Journal of Psychosomatic Research, 1999Co-Authors: Winfried Rief, Wolfgang HillerAbstract:Abstract There is a major need for an empirical evaluation of classification criteria for Somatoform Disorders. The present study analyzes psychometric properties of the existing criteria for somatization disorder. The full sample consisted of 324 patients seeking help because of “psychosomatic problems.” Data from a subsample of carefully diagnosed patients with somatization syndrome (n=76) and a clinical comparison group (n=32) permitted the analysis of the discriminative power of items. Twenty-one somatic symptoms adopted from DSM-IV and ICD-10 criteria did not exhibit the necessary psychometric characteristics (item probability, item-total correlation, etc.). Thirty-two somatic symptoms showed a satisfactory psychometric performance. A cut-off of seven or more symptoms yielded the best discrimination between low and high disability. New criteria for somatization syndrome (“polysymptomatic Somatoform disorder”) are proposed taking into account for the strong association of somatization and abnormal illness behavior.
