Assessing Somatization in Functional Gastrointestinal Disorders: Integration of Different Criteria

Porcelli, Piero; Carne, Massimo De; Fava, Giovanni A.

doi:10.1159/000012394

Cited by 77 publications

(62 citation statements)

References 38 publications

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“…The problem of diagnosis of demoralization is complicated, partly because of the need for a clear distinction between distress and SI, partly because demoralization appears to be a process and not a static and immutable entity, and partly because demoralization may coexist with mental disorders as well as physical illnesses. For example, demoralization has been documented in primary care patients 45,46 , and in patients with coronary artery disease 50 , motor neuron disease 51 , functional gastrointestinal disorders 52,53 , breast cancer 54,55 , and gastrointestinal and colorectal cancer 19,45,46 . Hopelessness was significantly associated with an increased risk of cardiovascular disorders and cancer [56][57][58][59][60] , predicted the length of survival in patients with coronary artery disease 61 and the progression of carotid atherosclerosis 62 .…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

Distress, demoralization and psychopathology: Diagnostic boundaries

Figueiredo

2013

Eur. J. Psychiat.

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“…heart transplant recipients) needs to be considered in forthcoming studies, and future research should also include longitudinal study designs. Seventh, the Diagnostic Criteria for Psychosomatic Research, as proposed by Fava et al [75], should be used in future studies in order to improve the identification of psychological factors which could result in a worsening of HRQOL in OLT recipients [54,[76][77][78].…”

Section: Discussionmentioning

confidence: 99%

Psychiatric and Psychosocial Outcome of Orthotopic Liver Transplantation

Rothenhäusler¹,

Ehrentraut²,

Kapfhammer³

et al. 2002

Psychother Psychosom

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Background:The study aimed to explore the prevalence of psychiatric disorders among orthotopic liver transplantation (OLT) recipients, and to investigate how psychiatric morbidity was linked to health-related quality of life (HRQOL). Methods: We recruited 75 patients who had undergone OLT a median of 3.8 years previously (range = 5-129 months). Psychiatric morbidity was assessed using the Structural Clinical Interview for the DSM-III-R. Psychometric observer-rating and self-rating scales were administered to evaluate cognitive functioning (SKT), depressive symptomatology (HAMD 17 ), posttraumatic stress symptoms (PTSS-10), social support (SSS), and HRQOL (SF-36 Health Status Questionnaire). Treatment characteristics were obtained from medical records. Results: 22.7% (n = 17) of our sample had a current or probable psychiatric diagnosis according to DSM-III-R: 2.7% full posttraumatic stress disorder (PTSD) (n = 2), 2.7% major depressive disorder (MDD) comorbid to full PTSD (n = 2), 1.3% MDD comorbid to partial PTSD (n = 1), and 16% partial PTSD (n = 12). Patients with PTSD symptoms demonstrated lower cognitive performance, higher severity of depressive symptoms and more unfavorable perception of social support. OLT-related PTSD symptomatology was associated with maximal decrements in HRQOL. The duration of intensive care treatment, the number of medical complications, and the occurrence of acute rejection were positively correlated with the risk of PTSD symptoms subsequent to OLT. Conclusion: OLT-related PTSD symptomatology impairing HRQOL is a complication for a subgroup of OLT recipients. Health-care providers should be aware of the possible presence of PTSD in OLT survivors.

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“…The application of the DCPR operational criteria has permitted to document the occurrence of demoralization across different medical settings, substantiating previous findings that used dimensional tools 20, 21 . In studies utilizing the DCPR, demoralization was found in 14-44% of patients with cardiac 22 , oncological 23 , dermatological 24 , gastrointestinal 25 and endocrine conditions [26][27][28] , in those recruited in primary care 29 and in consultation-liaison psychiatry settings 30,31 . Table 1 DCPR criteria for demoralization A through C are required A.…”

Section: Introductionmentioning

confidence: 99%

Subtyping demoralization in the medically ill by cluster analysis

et al. 2013

Self Cite

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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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Assessing Somatization in Functional Gastrointestinal Disorders: Integration of Different Criteria

Cited by 77 publications

References 38 publications

Distress, demoralization and psychopathology: Diagnostic boundaries

Distress, demoralization and psychopathology: Diagnostic boundaries

Psychiatric and Psychosocial Outcome of Orthotopic Liver Transplantation

Subtyping demoralization in the medically ill by cluster analysis

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