Use of the Diagnostic Criteria for Psychosomatic Research (DCPR) in a Community Sample

Mangelli, Lara; Semprini, Federica; Sirri, Laura; Fava, Giovanni A.; Sonino, Nicoletta

doi:10.1176/appi.psy.47.2.143

Cited by 65 publications

(58 citation statements)

References 24 publications

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“…In a community-based sample, the prevalence of demoralization as measured by DCPR was far less frequent than the rates found among medically ill patients, suggesting that demoralization does not simply identify generic psychological distress 32 . Distress may get better with medication, psychotherapy, both or doing nothing.…”

Section: Passing or Transient Distress Or Non-specific Distressmentioning

confidence: 72%

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: Passing or Transient Distress Or Non-specific Distressmentioning

confidence: 72%

Distress, demoralization and psychopathology: Diagnostic boundaries

Figueiredo

2013

Eur. J. Psychiat.

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“…The feeling closely antedated the manifestations of a medical disorder or exacerbated its symptoms. DCPR demoralization appeared to be far less frequent in the general population 32 .…”

Section: Introductionmentioning

confidence: 82%

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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“…The presence of at least one DCPR diagnosis was common both among the FAs and controls, suggesting the high sensitivity of the DCPR instrument in detecting subthreshold psychological distress [31, 35, 36] but also indicating that meeting criteria for just one diagnosis does not discriminate FAs from others. Mangelli et al [36] recently assessed DCPR syndromes in a community sample and found that 59% of participants met criteria for at least one DCPR syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…irritable bowel syndrome or fibromyalgia) and to acknowledge the high percentage of psychiatric morbidity in patients with functional symptoms [21, 23, 24]. The DCPR has proved to be a promising diagnostic instrument in a variety of clinical populations, including patients with functional gastrointestinal disorders [25,26,27], with functional skin diseases [28], with ischemic heart disease [22, 29, 30], heart transplantation recipients [31], patients with endocrinological disorders [32], cancer [33, 34], various medical diseases [35], as well as in a community sample [36]. The DCPR-based clinical interview showed good inter-rater reliability in patients with medical-psychiatric comorbidity [37].…”

Section: Introductionmentioning

confidence: 99%

Frequent Attenders in Primary Care: Impact of Medical, Psychiatric and Psychosomatic Diagnoses

Ferrari

Galeazzi

Mackinnon

et al. 2008

Psychother Psychosom

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Background: Anxiety, mild depression and somatization are common in primary care (PC). Several studies have suggested that they may play a role in causing an excessive use of health care services, especially when combined with medical morbidity. The present case-control study explored how psychiatric and psychosomatic diagnoses and perceived quality of life are associated with the phenomenon of frequent attendance. Method: Fifty most frequent attenders (FAs) in a 1-year period at a PC clinic in Italy were compared with 50 randomly selected average frequency attenders at the same clinic. Sociodemographic and medical data were collected from PC files. The SCID-brief version for research and the Structured Interview for Diagnostic Criteria for Use in Psychosomatic Research (DCPR) were administered to both patient groups. Quality of life was also assessed. Results: FA status was associated with being female, older, less well educated, and living with their spouses and/or children. Medical-psychiatric comorbidity was more frequent in the FA group than in the control group. The median number of psychosomatic-DCPR syndromes per patient was 4 among FAs compared to only 1 in controls. Functional somatic symptoms secondary to a psychiatric disorder, type A behavior, irritable mood, and demoralization were significantly associated with being an FA. Perceived quality of life was significantly lower among FAs, although this was no longer significant after adjusting for sociodemographic variables. Conclusions: The present study confirms the association between medical-psychiatric comorbidity and frequent utilization of PC resources. It suggests a role for DCPR criteria in revealing subthreshold psychiatric comorbidity predicting a pattern of frequent attendance.

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Use of the Diagnostic Criteria for Psychosomatic Research (DCPR) in a Community Sample

Cited by 65 publications

References 24 publications

Distress, demoralization and psychopathology: Diagnostic boundaries

Distress, demoralization and psychopathology: Diagnostic boundaries

Subtyping demoralization in the medically ill by cluster analysis

Frequent Attenders in Primary Care: Impact of Medical, Psychiatric and Psychosomatic Diagnoses

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