Depression, anxiety, and somatoform disorders: Vague or distinct categories in primary care? Results from a large cross-sectional study

Hanel, Gertraud; Henningsen, Peter; Herzog, Wolfgang; Sauer, Nina; Schaefert, Rainer; Szécsényi, Joachim; Löwe, Bernd

doi:10.1016/j.jpsychores.2009.04.013

Cited by 214 publications

(147 citation statements)

References 56 publications

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“…At least one third of patients with SFDs (up to about 70%, depending on the study under consideration) are said to be suffering from concurrent depression and/or anxiety (Cebulla, 2002, De Waal et al, 2004Fink et al, 2004;Hanel et al, 2009;Henningsen et al, 2003;Kroenke, 2003;Löwe et al, 2008b). The degree of association has been found to be particularly high for somatisation disorder, with there being a dose-effect relationship between the number of somatic symptoms (i.e.…”

Section: )mentioning

confidence: 99%

Somatoform disorders and causal attributions in patients with suspected allergies: Do somatic causal attributions matter?

Groben¹,

Hausteiner²

2011

Journal of Psychosomatic Research

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Section: )mentioning

confidence: 99%

Somatoform disorders and causal attributions in patients with suspected allergies: Do somatic causal attributions matter?

Groben¹,

Hausteiner²

2011

Journal of Psychosomatic Research

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“…Whether we call it fibromyalgia or characterize it as a physical symptom or bodily distress disorder, what we have actually done is take a cloud of different symptoms and symptom severity, including pain symptoms, and organize it into convenient and useful syndromes-but not into discrete diseases or distinctly separate syndromes (11). Studies using functional magnetic resonance imaging and similar tools that purport to give insights about fibromyalgia may be tapping into the wider domain of functional and psychological disorders (12).…”

mentioning

confidence: 99%

What Is Fibromyalgia, How Is It Diagnosed, and What Does It Really Mean?

Wolfe

Walitt

Haüser

2014

Arthritis Care & Research

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Prior to the 1970s and 1980s, fibromyalgia represented an amorphous set of symptoms and definitions-local, regional, or widespread pain with or without other symptoms, including, for some, the idea of "psychogenic rheumatism" (1). The American College of Rheumatology (ACR) 1990 criteria de facto established and redefined fibromyalgia to require the presence of widespread pain and multiple (Ն11) tender points (2). The 2 criteria items were measures of pain, and their diagnostic cutoff levels were determined by comparing patients with fibromyalgia to those without it. But who were the original patients with fibromyalgia and what were they like, this group that constituted the gold standard?We know now that they were chosen in part by individual physician tolerance of the presence and severity of somatic symptoms, and by the degree of patient distress. The subsequent idea that the 1990 criteria were just about pain was not correct: the criteria implied substantial, if unmeasured, symptomatic distress. In clinical practice after the 1990 criteria were adopted, it was symptoms that made the clinician think of fibromyalgia-and the tender point examination that sometimes followed.Tender points, the "semi-objective" physical finding, were elusive. Most physicians did not know how to carry out the tender point examination and generally skipped it. When performed, it was most often done incorrectly. The cervical tender points were almost impossible to assess correctly; body habitus and behavioral characters interfered with criteria-provided instructions, and no one really used (or understood) the recommended 4 kg of force. When physicians began the tender point examination, the patient's interview had already provided clues as to what the examination results might be. It is fair to say that the examination may have been influenced by physician beliefs as well as by the contributions of patients. The fibromyalgia examination provided an approximate estimate of tender points-easy at the extremes of tenderness, but much more uncertain in the important middle. Fibromyalgia diagnosis often depended on physician referral, behavioral and emotional characteristics of patients, and the skill, interest, and beliefs of the physicians. Different physicians could and often did come up with different results. In the absence of careful training, the easy assumption that the examination was reliable was usually an untested and dubious assumption.The 2010 ACR criteria approached the fibromyalgia identification problem differently (3). Using the 1990 ACR criteria as the gold standard, fibromyalgia criteria were constructed that excluded tender points, but included a count of pain locations and the physician's rating of the most discriminative symptoms. In these criteria, musculoskeletal pain accounted for about 50% of the criteria score, while the other 50% came from fatigue, sleep, cognitive problems, and an estimate of the overall degree of somatic symptom severity. The relative contributions were not fixed, and it was possible for patie...

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“…They may have unrecognized pathological disorders, especially personality disorders, or have an exaggerated feeling that they deserve more care or attention. [13][14][15][16] They are often excessive consumers of medical services. Indeed, their clinical records evidence an increased number of consultations and visits to various medical facilities and free emergency services with poor adherence to both treatment and medical recommendations.…”

Section: The Patient Factormentioning

confidence: 99%

Difficult ("heartsink") patients and clinical communication difficulties

Pérez‐López¹

2010

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Managing the difficult patient requires a set of skills or strategies oriented at improving the physician-patient relationship and avoiding conflictive situations. There are different types of difficult patients who should be precisely identified for their management. These patients seek appropriate medical care which is not always provided. However, some may have unrecognized pathological illnesses, especially personality or psychiatry disorders. Clinical communications may be altered by professional and situational factors. In some circumstances, clinical symptoms are medically unexplainable or poorly defined as part of a disease or syndrome. Organic disease should be ruled out before patients are classified as having a somatoform disorder. Diagnosis may be delayed when symptoms are not properly evaluated therefore causing serious health consequences. Clinical competence, empathy, and high quality communication is required to succeed in difficult clinical encounters.

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Depression, anxiety, and somatoform disorders: Vague or distinct categories in primary care? Results from a large cross-sectional study

Cited by 214 publications

References 56 publications

Somatoform disorders and causal attributions in patients with suspected allergies: Do somatic causal attributions matter?

Somatoform disorders and causal attributions in patients with suspected allergies: Do somatic causal attributions matter?

What Is Fibromyalgia, How Is It Diagnosed, and What Does It Really Mean?

Difficult ("heartsink") patients and clinical communication difficulties

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Depression, anxiety, and somatoform disorders: Vague or distinct categories in primary care? Results from a large cross-sectional study

Cited by 214 publications

References 56 publications

Somatoform disorders and causal attributions in patients with suspected allergies: Do somatic causal attributions matter?

Somatoform disorders and causal attributions in patients with suspected allergies: Do somatic causal attributions matter?

What Is Fibromyalgia, How Is It Diagnosed, and What Does It Really Mean?

Difficult (&quot;heartsink&quot;) patients and clinical communication difficulties

Contact Info

Product

Resources

About

Difficult ("heartsink") patients and clinical communication difficulties