Interrater Reliability, Prevalence, and Relation to ICD-10 Diagnoses of the Diagnostic Criteria for Psychosomatic Research in Consultation-Liaison Psychiatry Patients

Galeazzi, Gian Maria; Ferrari, Silvia; Mackinnon, Andrew; Rigatelli, Marco

doi:10.1176/appi.psy.45.5.386

Cited by 96 publications

(74 citation statements)

References 30 publications

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“…The findings suggest that demoralization is quite prevalent among the medically ill and that it is distinct and not hierarchically related to major depressive disorder 45 . The dis-tinction between demoralization and major depressive disorder was confirmed in other clinical populations 46 , including patients with skin diseases 47 and consultation-liaison psychiatry patients 48 . In a sample of heart transplanted patients, demoralization was significantly associated with a decrease in specific dimensions of psychological well-being and the co-occurrence of major depressive disorder did not alter those associations 49 .…”

Section: Major Depressive Disordermentioning

confidence: 74%

Distress, demoralization and psychopathology: Diagnostic boundaries

Figueiredo

2013

Eur. J. Psychiat.

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-Background and Objectives:The objectives of the manuscript are: (a) to review the understanding of demoralization and its assessment; (b) to describe its clinical progression; (c) to explain the differences between demoralization and other form of psychological distress; (d) to propose a set of criteria for future research on demoralization.Methods: A MEDLINE search using the keywords distress, subjective incompetence, depression, demoralization, helplessness, hopelessness and psychopathology was conducted. This was supplemented by a manual search of the literature.Results: Demoralization can be distinguished from passing or transient distress, nonspecific distress, sub-threshold depression or anxiety, and certain mental disorders. Demoralization can be a risk factor for the manifestation of psychopathology, the prodromal phase of a mental disorder, or a trigger for exacerbation or recurrence of psychiatric distress symptoms. The domains of distress and demoralization are described and research diagnostic criteria for demoralization are presented.Conclusions: The scales discussed in this article differ in their time frames and have not yet been applied to the same population at the same time. The role of demoralization as a risk factor for mental disorders is just beginning to be understood. The domains and the diagnostic criteria for demoralization presented in this article need to be confirmed by epidemiological and empirical studies. Future research should continue to clarify its role in the pathogenesis of both mental disorders and physical illnesses and identify appropriate interventions for its arrest or prevention. ObjectivesThis article has the following objectives: (a) to review the evolving understanding of demoralization and the methods proposed for its assessment; (b) to describe the clinical progression of demoralization; (c) to explain the differences between demoralization and passing or transient distress, non-specific distress and sub-threshold depression or anxiety, as well as the differences between demoralization and mental disorders such as major depressive disorder, dysthymic disorder, acute stress disorder, posttraumatic stress disorder, and adjustment disorder; and (d) to propose a set of criteria that may be considered for future research on demoralization. Understanding demoralizationAs defined by Frank, demoralization is the state of mind of a person deprived of spirit or courage, disheartened, bewildered, and thrown into disorder or confusion. He proposed that this state of mind occurs in many persons who seek psychotherapy, whatever their diagnostic label 1,2 . Demoralization always takes place within the context of a past, present, anticipated or imagined stressful situation. To further characterize the concept of demoralization, it has been proposed that the clinical hallmark of demoralization is "subjective incompetence" (SI) and that demoralization involves both SI and symptoms of distress, such as depression, anxiety, resentment, anger, or combinations thereof 3,4 . S...

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Section: Major Depressive Disordermentioning

confidence: 74%

Distress, demoralization and psychopathology: Diagnostic boundaries

Figueiredo

2013

Eur. J. Psychiat.

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“…Furthermore, preliminary data examining the DT and the HADS compared with the International Classification of Diseases, Tenth Revision (ICD-10) in Italian cancer patients seem to confirm validity of both psychological tools [36]. It also has to be considered that even gold standard psychiatric nosographic systems [e.g., Diagnostic and Statistical Manual for Mental Disorders-Fourth Revision (DSM-IV) and ICD-10] lack criteria for the identification of some important dimensions of psychosocial morbidity (e.g., health anxiety, demoralization, irritable mood) in medically ill patients, including cancer patients [37,38]. Bearing these limitations in mind, the findings of the study showed that both the DT and the MT were useful in rapidly assessing psychosocial distress in cancer patients in a different cultural area in comparison with English-speaking countries.…”

Section: Discussionmentioning

confidence: 94%

Use of distress and depression thermometers to measure psychosocial morbidity among southern European cancer patients

Gil

Grassi

Travado

et al. 2005

Support Care Cancer

140

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“…This is not a new finding. In fact, previous studies suggested that demoralization can be found in major depression: Klein 37 claimed that demoralization may develop in ''endogenomorphic depression'', and Galeazzi et al 30 and Mangelli et al 10 observed demoralization in more than 50% of medically ill patients with major depression. In a study conducted by Marchesi and Maggini 38 , the presence of major depression was related to an increase of demoralization scores.…”

Section: Discussionmentioning

confidence: 99%

“…The interview for DCPR consists of 58 items scored in a yes/no response format evaluating the presence of 1 or more of 12 psychosomatic syndromes. The interview has shown excellent inter-rater reliability, construct validity, and predictive validity for psychosocial functioning and treatment outcome 30 .…”

Section: Assessmentmentioning

confidence: 99%

“…The application of the DCPR operational criteria has permitted to document the occurrence of demoralization across different medical settings, substantiating previous findings that used dimensional tools 20, 21 . In studies utilizing the DCPR, demoralization was found in 14-44% of patients with cardiac 22 , oncological 23 , dermatological 24 , gastrointestinal 25 and endocrine conditions [26][27][28] , in those recruited in primary care 29 and in consultation-liaison psychiatry settings 30,31 . Table 1 DCPR criteria for demoralization A through C are required A.…”

Section: Introductionmentioning

confidence: 99%

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Subtyping demoralization in the medically ill by cluster analysis

et al. 2013

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ITALY ABSTRACT -Background and Objectives:There is increasing interest in the issue of demoralization, particularly in the setting of medical disease. The aim of this investigation was to use both DSM-IV comorbidity and the Diagnostic Criteria for Psychosomatic Research (DCPR) in order to characterize demoralization in the medically ill.Methods: 1700 patients were recruited from 8 medical centers in the Italian Health System and 1560 agreed to participate. They all underwent a cross-sectional assessment with DSM-IV and DCPR structured interviews. 373 patients (23.9%) received a diagnosis of demoralization. Data were submitted to cluster analysis.Results: Four clusters were identified: demoralization and comorbid depression; demoralization and comorbid somatoform/adjustment disorders; demoralization and comorbid anxiety; demoralization without any comorbid DSM disorder. The first cluster included 27.6% of the total sample and was characterized by the presence of DSM-IV mood disorders (mainly major depressive disorder). The second cluster had 18.2% of the cases and contained both DSM-IV somatoform (particularly, undifferentiated somatoform disorder and hypochondriasis) and adjustment disorders. In the third cluster (24.7%), DSM-IV anxiety disorders in comorbidity with demoralization were predominant (particularly, generalized anxiety disorder, agoraphobia, panic disorder and obsessive-compulsive disorder). The fourth cluster had 29.5% of the patients and was characterized by the absence of any DSM-IV comorbid disorder.Conclusions: The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of demoralization as encompassed by the DCPR. Subtyping demoralization may yield improved targets for psychosomatic research and treatment trials.

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Interrater Reliability, Prevalence, and Relation to ICD-10 Diagnoses of the Diagnostic Criteria for Psychosomatic Research in Consultation-Liaison Psychiatry Patients

Cited by 96 publications

References 30 publications

Distress, demoralization and psychopathology: Diagnostic boundaries

Distress, demoralization and psychopathology: Diagnostic boundaries

Use of distress and depression thermometers to measure psychosocial morbidity among southern European cancer patients

Subtyping demoralization in the medically ill by cluster analysis

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