Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease which impairs the quality of life. The objective of study was to evaluate the effectiveness of Brief Group Psychoanalytic Psychotherapy to improve quality of life, depression, anxiety and coping strategies in SLE patients. Methods: In a randomized clinical trial, 80 female SLE patients were allocated into two groups: therapy group (n = 37) and control group (n = 43). Therapy group (TG) attended weekly psychotherapy sessions for 20 weeks; control group (CG) remained on a waiting list. Both groups received standard medical care. Questionnaires and scales were applied by blinded evaluators at baseline (T1) and after 20 weeks (T2): Socioeconomic Status, SLE International Collaborating Clinic/American College of Rheumatology-Damage Index, SLE International Disease Activity, SLE Specific Symptom Checklist, SLE Quality of life, Hospital Anxiety Depression Scale, Coping Strategies Inventory. Intent to treat intra-and inter-group analysis was performed for all variables in T1 and T2 using Qui-square, t-Student, Mann-Whitney and Wilcoxon tests. Analysis of Variance was used to compare categorical variables over time. P < 0.05 was considered significant.Results: The mean age of patients was 42 years; 54% were white, with mean disease duration of years 12. At baseline, both groups were homogeneous in all variables, including medications. After 20 weeks of psychotherapy TG was significantly different from CG, with lower frequency of symptoms (p = 0.001), lower level of anxiety (p = 0.019) and depression (p = 0.022), better index in five of six domains of quality of life scale (p ≤ 0.005), including total SLEQOL (p < 0.001) and with higher positive planful problem solving strategy (p = 0.017). No change in disease activity score was observed in both groups. Conclusions: Psychoanalytic psychotherapy was effective to improve many domains of quality of life and one positive coping skill and to reduce SLE symptoms, anxiety and depression levels. Brief group psychotherapy can be a useful tool to complement medical care in SLE patients. Trial registration: Number NCT01840709.

Resumotanto entre diferentes SSFs como entre elas e os TSs, apontando também para um clínico, poderia receber o diagnóstico de SSF. Apresenta-se um demonstra a necessidade de abordagens integradas. São mencionadas algumas experiências nesse campo do Programa de Atendimento e Estudos de Somatização da Universidade Federal de São Paulo (UNIFESP). Palavras-chave: co-morbidade. AbstractClinical features characterized by symptoms unexplained by general medical conditions are very common in the clinical practice, accounting care facilities. They are currently classified as somatoform disorders (SD) in psychiatry, and as functional somatic syndromes (FSS) in and its exclusion has even been proposed in future international classifications. FSS are characterized by symptoms, suffering and incapability rather than by specific diseases, and include but are not limited to fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, and several pain syndromes. Overlapping of clinical present, both among different FSS and between FSS and SD, also pointing to the comorbidity issue. The same patient may be diagnosed with SD when seen by a psychiatrist, but when referred to a general practitioner he/she could be diagnosed with FSS. An overlapping field is presented, suggesting that modifications should occur in terms of conceptualization, diagnostic classification and therapeutic approach. The study of medically unexplained symptoms demonstrates the need for integrated approaches. Some related experiences of the Program of Care and Studies on Somatization (Universidade Federal de São Paulo [UNIFESP]) are presented.

1 Esse termo atualmente tem diversas conotações, dependendo em que contexto é usado. Pode ser definido descritivamente como "a tendência para experienciar e comunicar distúrbios e sintomas somáticos não explicados pelos achados patológicos, atribui-los a doenças físicas e procurar ajuda médica para eles" (Lipowski).2 Pode ocorrer em diferentes formas: desde só como um modo de se expressar (uma variação individual normal), ou indicando uma doença orgânica ainda não diagnosticada, ou como parte de outras patologias psiquiátricas ou propriamente como um transtorno somatoforme.* Os quadros de somatização são muito freqüentes nos serviços de saúde, sendo responsáveis por grande número de consultas médicas e gerando importantes gastos. Apesar das dimensões dessa questão, temos notícias de poucos locais em nosso meio desenvolvidos para cuidar especificamente dessa população. No artigo são apresentados dois relatos concisos de casos de pacientes somatizadores mostrando característi-cas freqüentes e questões que surgem no seu tratamento. Descreve-se o funcionamento de um programa de atendimento a somatizadores vinculado a uma universidade pública (Universidade Federal de São Paulo/Escola Paulista de Medicina). Este dispõe de triagem, atendimentos clínicos, grupos psicossociais e psicoterápicos. É discutida a complexidade da abordagem a esse grupo de pacientes e possíveis modelos de intervenção.Somatização. Transtornos somatoformes. Tratamento. Serviços de saúde mental.Cases of somatization disorders are seen very frequently in health care services and account for a large number of medical consultations and significant expenses. Despite the importance of this health problem, we don't know many specialized services to take care of this population. Two summarized cases of somatizer patients are presented, emphasizing the most frequent aspects of their condition and the problems found in their treatment. Also, a service for somatizer patients associated with a public university (Universidade Federal de São Paulo/ Escola Paulista de Medicina) is described: its screening procedures, medical consultations, and psychosocial and psychoterapeutical groups. The difficulty in approaching this group of patients and possible models of intervention are also presented.Somatization. Somatoform disorders. Treatment. Mental health services. Resumo Descritores Abstract KeywordsA introdução da categoria diagnóstica "Transtornos Somatoformes" (TS) nas classificações internacionais de doenças é relativamente recente, tendo ocorrido em 1980 através do Manual Diagnóstico e Estatístico de Transtornos Mentais, 3 a edição (DSM-III) 3 e em 1992 na Classificação Internacional de Doenças, 10 a edição (CID-10). 4 Esses transtornos caracterizam-se pela presença prolongada (de meses a anos) de queixas freqüentes de sintomatologia física que sugerem a presença de um substrato orgânico mas que não se explicam adequadamente por: patologias orgânicas conhecidas, efeitos diretos decorrentes da utilização de álcool ou drogas, ou outros transtornos mentais; ca...