Assessment of Patients by DSM-III-R and DSM-IV in a Japanese Psychosomatic Clinic

Abstract

Background: The aim of this study was to investigate the clinical features of psychosomatic disorders in Japan. Methods: A total of 1,432 outpatients (515 males and 917 females; 9–95 years of age, mean age 36) attending a psychosomatic clinic for the first time were assessed by the DSM-III-R or DSM-IV semistructured interview. Results: Major ICD-10 diagnoses found were eating disorder, other anxiety disorders, autonomic nervous dysfunction, somatoform disorders, and irritable bowel syndrome. The most frequent diagnosis on the DSM-III-R and DSM-IV axis I was ‘somatoform disorders not otherwise specified’, followed by bulimia nervosa, ‘depressive disorder not otherwise specified’, anorexia nervosa, conversion disorder, major depression or depressive disorder, ‘panic disorder with agoraphobia‘, and ‘psychological factors affecting physical or medical condition’. On axis II, 11–17% of the patients met the criteria for personality disorder. On axis IV, 78–80% had mild or moderate psychosocial stress; major psychosocial and environmental problems classified by the DSM-IV were the problems with primary supports and occupation. Conclusions: The results seem to reinforce the belief that the diagnoses on the DSM-III-R and DSM-IV axis I are inadequate for describing psychosomatic phenomena. A new diagnostic system in combination with the multidimensional assessments by the DSM-III-R and DSM-IV is needed to form the common guidelines of diagnoses and therapies in psychosomatic medicine.

Anxiety Is a Good Indicator for Somatic Symptom Reduction through Behavioral Medicine Intervention in a Mind/Body Medicine Clinic

“…Major ICD-10 diseases seen in the present study are common in the Psychosomatic Outpatient Clinic [25]. Three dimensions (degree of discomfort, frequency and degree of interference with daily activities) of the 12 major symptoms were assessed, and standardized questionnaires (the SCL-90R and HPLP I and II) were used to assess the treatment effects.…”

Definition of Psychosomatic Medicine and the Applicability of DSM-IV-TR to Outpatients Visiting a Japanese Psychosomatic Clinic

“…Among all patients, 445 were referred from departments within the hospital, 177 were referred from outside the hospital, and the remaining 401 visited the clinic without referral. Based on our previous study [4], semi-structured interviews were conducted by physicians with all patients during their first visit to assess DSM-IV-TR axis I diagnoses. The results were coded and recorded in the database.…”

“…The other group included those with other DSM-IV-TR axis I codes, such as dementia (294) and schizophrenia (295). A detailed manual of diagnoses was created [4], and all three physicians in the clinic discussed the patients' diagnoses once per week to improve reliability. All tests of statistical significance were interpreted with a two-tailed criterion of p < 0.05.…”

Teaching and Training in the Psychiatric-Psychosomatic Consultation-Liaison Setting

“…The involvement of C-L psychiatry in the field of primary care, accounted for by the high prevalence of psychiatric disorders and their low recognition rate, creates new specific problems: on one side, the need for extending training programmes to primary care physicians and on the other side, the organisation of primary-care-based C-L psychiatry services, with all consequent theoretical and practical difficulties [54, 55, 56, 57, 58, 59, 60, 61, 62, 63]. Interest for C-L psychiatry in the primary care setting has only recently risen in Italy, and although a training programme specific for C-L psychiatrists operating in the community does not already exist in Modena, a few studies have been started that focus on the matter.…”