Psychosocial Functioning in Consultation-Liaison Psychiatry Patients: Influence of Psychosomatic Syndromes, Psychopathology and Somatization

172

100

Background: This systematic review aims to investigate the association between comorbid mental disorders and quality of life (QoL) in patients with chronic medical diseases. Methods: Studies investigating adults with diabetes mellitus, coronary artery disease, asthma, chronic back pain and colorectal cancer were included. Two reviewers independently extracted data and assessed methodological criteria. Effect sizes for QoL scores were analyzed in random-effects meta-analyses. Subgroup and sensitivity analyses were conducted. Results: The database search identified 7,291 references and 65 primary studies were included. Medically ill persons with comorbid mental disorders showed a significantly decreased overall (d = –1.10; 95% CI = –1.34 to –0.86), physical (d = –0.64; 95% CI = –0.74 to –0.53) and psychosocial (d = –1.18; 95% CI = –1.42 to –0.95) QoL compared to persons without mental disorders. Subgroup analyses did not reveal significant differences between the examined medical diseases or mental disorders. Conclusion: The review provides evidence of a substantially reduced psychosocial and physical QoL in medically ill patients with comorbid mental disorders. This patient-reported outcome highlights the importance of recognizing and treating comorbid mental disorders in the medically ill.

Section: Discussionmentioning

confidence: 99%

Quality of Life in Medically Ill Persons with Comorbid Mental Disorders: A Systematic Review and Meta-Analysis

Baumeister

Hutter

Bengel

et al. 2011

172

100

“…The Structured Interview for the DCPR was used to identify alexithymia in several medical settings [49,50,51,52], in consultation-liaison psychiatry patients [53,54], as well as in a community-based sample [55]. Previous studies [56,57,58] found a good discriminant validity of the DCPR section for alexithymia, which had a sensitivity ranging from 67.4% when compared to the TAS-26 [56] to 92.9% utilizing the TAS-20 as a reference [58] and a specificity ranging from 74.7% with the TAS-26 [56] to 91.2% with the TAS-20 [58].…”

Section: Methodsmentioning

confidence: 99%

Kellner’s Emotional Inhibition Scale: A Clinimetric Approach to Alexithymia Research

Grandi

Sirri

Wise

et al. 2011

Background: Emotional inhibition has been an enduring concept in the psychosomatic literature explaining the onset and course of medical disorders. Currently the personality style of alexithymia is a focus of this dimension in psychosomatic theory, while actual conscious emotional inhibition, which may overlap with alexithymia, has received less attention. In the early 80s Robert Kellner developed the Emotional Inhibition Scale (EIS), a self-rating scale for emotional inhibition based on clinimetric principles. In this study we explored whether the EIS differentiated a sample of cardiac recipients from normal controls, as well as the associations between the EIS and 2 measures of alexithymia, i.e. the Toronto Alexithymia Scale-20 (TAS-20) and the Diagnostic Criteria for Psychosomatic Research (DCPR). We also examined whether the EIS and the TAS-20 were differently related to depressive symptoms measured by the Symptom Questionnaire (SQ). Methods: Ninety-five heart-transplanted patients and a sample of normal controls, matched for sociodemographic variables, were administered the EIS (total score and 4 subscales concerning ‘verbal inhibition’, ‘timidity’, ‘disguise of feelings’, and ‘self-control’), the TAS-20, the SQ, and the Structured Interview according to the DCPR for alexithymia. Results: Cardiac recipients did not display significant differences compared to normal controls in observer (DCPR) and self-rated (TAS-20) measures of alexithymia. There were, however, significant differences in EIS with regard to ‘disguise of feelings’. In both groups the EIS ‘verbal inhibition’ and ‘timidity’ subscales were positively associated with the TAS-20, while the EIS ‘disguise of feelings’ and ‘self-control’ subscales were independent of alexithymia. Depressive symptoms were more related to TAS-20 than EIS total scores. Conclusions: Our results suggest that emotional inhibition and alexithymia are distinct phenomena even though they may share certain features. The EIS appears to be relatively independent of depressed mood and will be useful in assessing the individual’s conscious management of affect in future psychosomatic research.

“…The second point in the criteria (table 1B) is concerned with the clinical manifestations, which may range from psychiatric to psychosomatic/subclinical symptoms, according to DSM-IV [2] and the Diagnostic Criteria for Psychosomatic Research (DCPR) [34,35,36,37,38], respectively, and from impairment in social and occupational functioning to decrease in well-being [23,39]. …”

Section: Clinimetric Definition Of Allostatic Loadmentioning

confidence: 99%

Clinical Assessment of Allostatic Load and Clinimetric Criteria

Fava

Guidi²,

Semprini³

et al. 2010

113

102

The concept of allostasis emphasizes that healthy functioning requires continual adjustments to the internal physiological milieu. Allostatic load reflects the cumulative effects of stressful experiences in daily life. When the cost of chronic exposure to fluctuating or heightened neural or neuroendocrine responses exceeds the coping resources of an individual, allostatic overload ensues. So far these issues have been addressed only on pathophysiological terms that do not find application in clinical settings. However, several features that have been described in psychosomatic research may allow the assessment of allostatic load on clinical grounds. Clinimetric criteria for the determination of allostatic overload are suggested. They are based on: (a) the presence of a stressor exceeding individual coping skills, and (b) clinical manifestations of distress. They may provide specification to the fourth axis of DSM, may supplement the Diagnostic Criteria for Psychosomatic Research, and may help discriminate neuroendocrine patterns with important clinical and research implications. A state of allostatic overload is frequently associated with alterations in biological markers and calls for a close medical evaluation of the patient’s condition. The ultimate goal is to be able to prevent or decrease the negative impact of excessive stress on health.