In primary and secondary medicine "non-specific, functional, and somatoform bodily complaints" are common and often take a chronic course, with the patients' quality of life usually markedly impaired, and give rise to high direct and indirect costs. They are challenging as they can deteriorate in case of inappropriate behavior on the physician's part. Coordinated by both German professional associations of Psychosomatic Medicine a new evidence based guideline was developed, aiming to transfer relevant diagnostic and therapeutic knowledge to all physicians who are in charge of these patients. After establishing a stable therapeutic alliance a symptom- and coping-oriented attitude could be demonstrated to be helpful. A biopsychosocial diagnostic evaluation combines a thorough assessment of bodily complaints and early introduces a sensitive discussion of signs of psychosocial stress, which can be extended carefully in case problems of this type are present. In less severe courses, physical/social activation is recommended and the patient's explanatory disease model should be extended towards a psychological dimension. More severe and complicated courses require a more structured approach consisting of regular appointments (as opposed to ad-hoc appointments whenever the patient feels worse) and an active cooperation of the patient. A coordinated, multimodal management includes additional measures as graded activation, psychotherapy, relaxation training or--if indicated--temporary medication.

The correlations between (a) the patients' memory complaints, (b) the informants' rating of the patients' cognitive impairment, and (c) cognitive performance according to the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) were examined in 163 patients with probable or possible Alzheimer's disease. The patients' complaints were weakly correlated with informants' view (p < 0.05), closely correlated with depressive mood (p < 0.0001), but not with cognitive performance or the stage of dementia. The results of Clinical Dementia Rating, Mini-Mental State Examination and the Cambridge Cognitive Examination were significantly correlated with the informants' rating of cognitive impairment (p < 0.0001). These results are in line with previous studies and confirm (1) the suitability of CAMDEX for the structured examination of dementia patients and their caregivers, (2) the association between affective disturbances and the perception of cognitive deficits, and (3) the importance informants' rating for the valid evaluation of demented patients.

No abstract

No abstract

No abstract