Abnormal Illness Behavior, Alexithymia, Demoralization, and Other Clinically Relevant Psychosocial Syndromes in Kidney Transplant Recipients: A Comparative Study of the Diagnostic Criteria for Psychosomatic Research System versus ICD-10 Psychiatric Nosology

Battaglia, Yuri; Martino, Elena; Piazza, Giulia; Cojocaru, Elena; Massarenti, Sara; Peron, Luana; Storari, Alda; Grassi, Luigi

doi:10.1159/000490000

Cited by 12 publications

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“…8 In 1995, an international group of researchers developed a set of Diagnostic Criteria for Psychosomatic Research (DCPR) 10 to help clinicians in translating psychosocial variables at the interplay of biological, psychological, and social factors into operational tools. The DCPR had been applied in several medical settings: cardiology, [11][12][13] oncology, 14 dermatology, 15 endocrinology, 16 psychiatry, 17 consultation liaison psychiatry, 18 and primary care. 19 A semi-structured interview for DCPR was proposed.…”

Section: Introductionmentioning

confidence: 99%

Criterion-related validity in a sample of migraine outpatients: the diagnostic criteria for psychosomatic research

et al. 2019

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Objective.The Diagnostic Criteria for Psychosomatic Research (DCPR) are those of psychosomatic syndromes that did not find room in the classical taxonomy. More recently, the DCPR were updated, called DCPR-revised (DCPR-R). The present study was conducted to test the criterion-related validity of the DCPR-R.Methods.Two hundred consecutive subjects were enrolled at the Headache Center of Careggi University Hospital (Italy): 100 subjects had a diagnosis of chronic migraine (CM) and 100 had a diagnosis of episodic migraine (EM). Participants received a clinical assessment, which included the DCPR-revised Semi-Structured Interview (DCPR-R SSI), the Structured Clinical Interview for DSM-5 (SCID-5), and the psychosocial index (PSI).Results.Forty-seven subjects (23.5%) had at least one DSM-5 diagnosis: major depressive disorder (8.5%; n = 17) and agoraphobia (7.5%; n = 15) were the most frequent. One hundred and ten subjects (55%) reported a DCPR-R diagnosis: allostatic overload (29%; n = 58) and type A behavior (10.5%; n = 21) were the most frequent. When the incremental validity of the DCPR system over the DSM system was tested using PSI subscales as the criterion variable, the DCPR-R increased up to 0.11–0.24 the amount of explained variance. Subjects with at least one DCPR-R diagnosis showed lower PSI well-being scores (p = .001), higher PSI stress scores (p < .001), and higher PSI psychological distress scores (p = .008) than subjects without a DCPR-R diagnosis.Conclusion.The DCPR-R showed a good criterion-related validity in migraine outpatients. Thus, they might be implemented, together with the DSM-5, in the assessment of migraine subjects.

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Section: Introductionmentioning

confidence: 99%

Criterion-related validity in a sample of migraine outpatients: the diagnostic criteria for psychosomatic research

et al. 2019

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“…Regarding DCPR, 85 (63.4%) had at least 1 DCPR diagnosis (of whom 43 had 1 diagnosis and 42 more than one diagnosis). The specific characteristics and the details about the DCPR syndromes are reported elsewhere [19]. Of the total sample, 46 patients (34.3%) met the criteria for an ICD-10 diagnosis (ICD-10 cases), specifically reaction to severe stress and adjustment disorders (n = 21, 15.7%), anxiety disorders (n = 14, 10.4%), and mood disorders (n = 11, 8.2%: major depression n = 3, 2.2% and other mood disorders n = 8, 6%).…”

Section: Characteristics Of the Samplementioning

confidence: 99%

Section: Characteristics Of the Samplementioning

confidence: 99%

“…With respect to this, the Diagnostic Criteria for Psychosomatic Research (DCPR) were used as a complementary integration to the traditional nosographic psychiatric criteria for a better understanding of psychological distress in KTRs. In fact, the occurrence of DCPR diagnoses was found to be almost double than the ICD psychiatric diagnoses-especially abnormal illness behaviour, irritability, alexithymia, somatisation, and demoralization [19]. The high prevalence rate of psychiatric disorders and relevant psychosocial conditions supported the need to use a tool to assess physical and psychological symptoms of distress in KTRs.…”

Section: Introductionmentioning

confidence: 99%

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Screening Performance of Edmonton Symptom Assessment System in Kidney Transplant Recipients

Battaglia

Zerbinati

Piazza

et al. 2020

JCM

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An average prevalence of 35% for psychiatric comorbidity has been reported in kidney transplant recipients (KTRs) and an even higher prevalence of other psychosocial syndromes, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR), has also been found in this population. Consequently, an easy, simple, rapid psychiatric tool is needed to measure physical and psychological symptoms of distress in KTRs. Recently, the Edmonton Symptom Assessment System (ESAS), a pragmatic patient-centred symptom assessment tool, was validated in a single cohort of KTRs. The aims of this study were: to test the screening performances of ESAS for the International Classification of Diseases-10th Revision (ICD-10) psychiatric diagnoses in KTRs; to investigate the optimal cut-off points for ESAS physical, psychological and global subscales in detecting ICD-10 psychiatric diagnoses; and to compare ESAS scores among KTR with ICD-10 diagnosis and DCPR diagnosis. 134 KTRs were evaluated and administered the MINI International Neuropsychiatric Interview 6.0 and the DCPR Interview. The ESAS and Canadian Problem Checklist (CPC) were given as self-report instruments to be filled in and were used to examine the severity of physical and psychological symptoms and daily-life problems. The physical distress sub-score (ESAS-PHYS), psychological distress sub-score (ESAS-PSY) and global distress score (ESAS-TOT) were obtained by summing up scores of six physical symptoms, four psychological symptoms and all single ESAS symptoms, respectively. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. Receiving Operating Characteristic (ROC) analysis was used to examine the ability of the ESAS emotional distress (DT) item, ESAS-TOT, ESAS-PSY and ESAS-PHYS, to detect psychiatric cases defined by using MINI6.0. The area under the ROC curve for ESAS-TOT, ESAS-PHYS, ESAS-PSY and DT item were 0.85, 0.73, 0.89, and 0.77, respectively. The DT item, ESAS-TOT and ESAS-PSY optimal cut-off points were ≥4 (sensitivity 0.74, specificity 0.73), ≥20 (sensitivity 0.85, specificity 0.74) and ≥12 (sensitivity 0.85, specificity 0.80), respectively. No valid ESAS-PHYS cut-off was found (sensitivity <0.7, specificity <0.7). Thirty-nine (84.8%) KTRs with ICD-10 diagnosis did exceed both ESAS-TOT and ESAS-PSY cut-offs. Higher scores on the ESAS symptoms (except shortness of breath and lack of appetite) and on the CPC problems were found for ICD-10 cases and DCRP cases than for ICD-10 no-cases and DCPR no-cases. This study shows that ESAS had an optimal screening performance (84.8%) to identify ICD-10 psychiatric diagnosis, evaluated with MINI; furthermore, ESAS-TOT and ESAS-PSY cut-off points could provide a guide for clinical symptom management in KTRs.

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“…Other significant clinical conditions (e.g., demoralization, health anxiety, and abnormal illness behavior), affecting a further 25-30% of KTRs, were detected by using the Diagnostic Criteria for Psychosomatic Research (DCPR) interview [6,7].…”

Section: Introductionmentioning

confidence: 99%

The Use of Demoralization Scale in Italian Kidney Transplant Recipients

Battaglia

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Piazza

et al. 2020

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Demoralization is a commonly observed syndrome in medically ill patients. The risk of demoralization may increase in patients after a kidney transplant (KTRs) because of the stressful nature of renal transplantation, psychosocial challenges, and adjustment needs. No study is available on demoralization amongst KTRs. The purpose of our study was to evaluate the validity of the Italian version of the Demoralization Scale (DS-IT) and the prevalence of demoralization in KTRs. Also, we aimed at exploring the association of the DS-IT with International Classification of Diseases (ICD) psychiatric diagnoses, post-traumatic growth (PTG), psychological and physical symptoms, and daily-life problems. A total of 134 KTRs were administered the MINI International Neuropsychiatric Interview 6.0. and the Diagnostic Criteria for Psychosomatic Research–Demoralization (DCPR/D) Interview. The DS-IT, the Edmonton Symptom Assessment System (ESAS), the Canadian Problem Checklist (CPC), were used to measure demoralization, physical and psychological symptoms, and daily-life problems; also, positive psychological experience of kidney transplantation was assessed with the PTG Inventory. Routine biochemistry and sociodemographic data were collected. Exploratory factor analysis demonstrated a four-dimensional factor structure of the DS-IT, explaining 55% of the variance (loss of meaning and purpose, disheartenment, dysphoria, and sense of failure). DS-IT Cronbach alpha coefficients indicated good or acceptable level of internal consistency. The area under the Receiving Operating Characteristics (ROC) curve for DS-IT (against the DCPR/D interview as a gold standard) was 0.92. The DS-IT optimal cut-off points were ≥20 (sensitivity 0.87, specificity 0.82). By examining the level of demoralization, 14.2%, 46.3%, 24.6%, and 14.6% of our sample were classified as having no, low, moderate, and high demoralization, respectively, with differences according to the ICD psychiatric diagnoses (p < 0.001). DS-IT Total and subscales scores were positively correlated with scores of ESAS symptoms and CPC score. A correlation between DS-IT loss of meaning and purpose subscale and PTGI appreciation of life subscale (p < 0.05) was found. This study shows, for the first time, a satisfactory level of reliability of the DS-IT and a high prevalence of severe demoralization in KTRs.

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Abnormal Illness Behavior, Alexithymia, Demoralization, and Other Clinically Relevant Psychosocial Syndromes in Kidney Transplant Recipients: A Comparative Study of the Diagnostic Criteria for Psychosomatic Research System versus ICD-10 Psychiatric Nosology

Cited by 12 publications

References 9 publications

Criterion-related validity in a sample of migraine outpatients: the diagnostic criteria for psychosomatic research

Criterion-related validity in a sample of migraine outpatients: the diagnostic criteria for psychosomatic research

Screening Performance of Edmonton Symptom Assessment System in Kidney Transplant Recipients

The Use of Demoralization Scale in Italian Kidney Transplant Recipients

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