Unexplained Somatic Symptoms during Major Depression: Prevalence and Clinical Impact in a National Sample of Italian Psychiatric Outpatients

Perugi, Giulio; Canonico, Pier Luigi; Carbonato, Paolo; Mencacci, Claudio; Muscettola, Giovanni; Pani, Luca; Torta, Riccardo; Vampini, Claudio; Fornaro, Michele; Parazzini, Fabio; Dumitriu, Arina

doi:10.1159/000319848

Cited by 23 publications

(18 citation statements)

References 99 publications

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“…The present study is based on a post-hoc partial analysis of the database collected for a previous study, including 571 consecutive patients with a diagnosis of MDE, according to DSM-IV-TR, that were enrolled in a large cross-sectional, multicentre, observational study (COME TO ME) 9. The study involved 30 psychiatric outpatient facilities, distributed throughout Italy, investigating the prevalence of medically unexplained somatic symptoms in the course of MDE, which resulted in severe depressive symptomatology, high rates of misdiagnosis, and improper treatment and health resource utilization.…”

Section: Methodsmentioning

confidence: 99%

Prevalence and diagnostic distribution of medically unexplained painful somatic symptoms across 571 major depressed outpatients

Fornaro¹,

Perugi²,

Maremmani³

et al. 2011

NDT

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Objective:To assess the prevalence and distribution of medically unexplained painful somatic symptoms (PSSs) versus nonpainful somatic symptoms (NPSSs) in patients diagnosed with major depressive episode (MDE).Method:A total of 571 outpatients diagnosed with MDE according to DSM-IV-TR criteria were consecutively enrolled into a cross-sectional, multicentric, observational study over a period of 7 months. Subjects were evaluated by means of the ad hoc validated 30-item Somatic Symptoms Checklist (SSCL-30) and Zung’s questionnaires for depression and anxiety. The 32-item Hypomania Checklist (HCL-32) was also administered in order to explore any eventual association of PSSs or NPSSs with sub-threshold (DSM-IV-TR [Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision] not recognized) bipolar disorder (BD).Results:In our sample, just 183 patients (32%) did not report painful somatic symptoms (NPSSs). Of these, 90 patients (15.76%) had no somatic symptoms at all. The remaining 388 (68%) had at least one PSS being subdivided as follows: 248 (43%) had one or two PSSs, while 140 (25%) experienced two or more. Patients with at least one PSS also reported a greater number of nonpainful somatic symptoms than NPSS. Bipolar patients (associated with higher HCL-32 scores) were less represented across PSS cases than NPSS subjects. Conversely, females were more prone to having a higher number of total somatic symptoms (and bipolar features).Conclusion:PSSs are common in patients with MDE, especially among those patients reporting fewer somatic symptoms in general as opposed to those patients who exhibit more somatic symptoms (both PSSs and NPSSs) with lower relative number of PSSs. A major therapeutic implication is that antidepressant monotherapy could be used with more confidence in unexplained PSS patients than in NPSS patients because of the latter group’s lower frequency of (sub)-threshold bipolar features.

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Section: Methodsmentioning

confidence: 99%

Prevalence and diagnostic distribution of medically unexplained painful somatic symptoms across 571 major depressed outpatients

Fornaro¹,

Perugi²,

Maremmani³

et al. 2011

NDT

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“…The mean HCL-32 value in the study by Vancampfort et al [42], conducted in a group of 67 patients with bipolar disorder, was 15.80 ± 6.50. Perugi et al [43] found 15 or more hypomanic characteristics based on the HCL-32 in almost half of the studied group (n = 253, 45.2%).…”

Section: Discussionmentioning

confidence: 87%

Occurrence of mood disorders among educationally active older adults in Bialystok, Poland: a cross-sectional study

Cybulski

Krajewska-Kułak

et al. 2020

Ann Gen Psychiatry

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Background: Mood disorders in older people are an increasingly serious health and social problem, and their prevalence increases with age. The most common mood disorders are bipolar disorder, which is the occurrence of mania and hypomania, and depressive disorders. The aim of this study was to determine the prevalence of mood disorders in a group of educationally active elderly people living in Bialystok, Poland. Methods: The study included a total of 162 people-residents of Bialystok-aged 60 or older; 135 women (83.33%) and 27 men (16.67%). The study used five standardized psychometric scales: The Mood Disorder Questionnaire (MDQ), Hypomania Check List (HCL-32), Geriatric Depression Scale (GDS) and The Zung Self-Rating Depression Scale (Zung SDS). Results: Nearly 90.00% of the respondents obtained GDS scores indicating the presence of mild depressive symptoms; however, on the Zung SDS, which also evaluates depression symptom levels, the result obtained in almost the same number of respondents showed an absence of these symptoms. A similar percentage of respondents also obtained values on the MDQ that allow to determine a lack of bipolar disorder characteristics in the studied population. Over half of the respondents (58.02%) did not show symptoms of hypomania using the HCL-32. There was a significant correlation between the results of the GDS and Zung SDS, the HCL-32 and MDQ, as well as the HCL-32 and Zung SDS in the total studied group. Conclusions: Mood disorders, particularly depression, constitute a significant social and health problem in the group of educationally active older adults living in Bialystok. In light of the obtained research results, it is recommended to conduct and improve already realized health education programs for the elderly on the subject of mood disorder prevention and their impact on quality of life. There is a need for further research on mood disorders in the elderly to determine their prevalence on a national scale.

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“…The present study is based on a post-hoc partial analysis of the database collected for a previous study including 571 consecutive patients with a diagnosis of an major depressive episode (MDE), according to DSM-IV, who were enrolled in a large cross-sectional, multicenter, observational study (Come To Me) [31]. The study involved 30 psychiatric outpatient facilities, distributed throughout Italy, assessing the impact of medically unexplained somatic symptoms in course of an MDE and its relationship to the severity of depressive symptomatology, the risk for misdiagnosis and associated improper treatment and health resource overutilization.…”

Section: Methodsmentioning

confidence: 99%

“…The aim of the present study is to explore the factorial structure of HCL-32 in a large national sample of patients enrolled in a study exploring the presence of somatic symptoms during major depression [31] and to analyze the discriminative power of different factors in distinguishing non-bipolar from bipolar patients. Another goal of the study is to define some of the characteristics identified by the HCL-32, but not recognized by the patients (depending on the patient’s ability to recall hypomanic episodes and on the patient’s awareness that they represent part of the affective illness) or alternatively by the clinicians (depending on the clinician’s attitude in interviewing patients and in the interpretation of the hypomanic manifestations).…”

Section: Introductionmentioning

confidence: 99%

Discriminative Hypomania Checklist-32 Factors in Unipolar and Bipolar Major Depressive Patients

et al. 2012

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Background: Although manic or hypomanic episodes define bipolar disorder (BD), most patients show a predominance of depressive symptomatology, often associated with delayed or disregarded BD diagnosis. The Hypomania Checklist-32 (HCL-32) has therefore been developed and tested internationally to facilitate BD recognition. Sampling andMethods: Five hundred seventy-one (563 eligible) patients diagnosed with a major depressive episode according to DSM-IV criteria were consecutively enrolled in a cross-sectional, multicenter, observational study (Come To Me). Lifetime manic or hypomanic features were assessed by the HCL-32, and severity of depressive and anxious symptomatology was assessed using the Zung’s self-report questionnaires for depression and anxiety. Results: Among the patients diagnosed with BD (n = 119), either type I or type II, the occurrence of (hypo)manic symptoms was significantly higher compared to major depressive disorder (MDD) symptoms according to HCL-32 total and subscale scores obtained using a score of 14, which ensured an optimal discrimination between BD and MDD with a sensitivity of 0.85 and a specificity of 0.78. Conclusions: Although some false positives might occur, the HCL-32 was confirmed to be a useful instrument in the detection of past hypomania in MDD patients, finally contributing to proper therapeutic choices.

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Unexplained Somatic Symptoms during Major Depression: Prevalence and Clinical Impact in a National Sample of Italian Psychiatric Outpatients

Cited by 23 publications

References 99 publications

Prevalence and diagnostic distribution of medically unexplained painful somatic symptoms across 571 major depressed outpatients

Prevalence and diagnostic distribution of medically unexplained painful somatic symptoms across 571 major depressed outpatients

Occurrence of mood disorders among educationally active older adults in Bialystok, Poland: a cross-sectional study

Discriminative Hypomania Checklist-32 Factors in Unipolar and Bipolar Major Depressive Patients

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