Differential Diagnosis of Hypochondriacal Fears and Beliefs

Fava, Giovanni A.; Grandi, Silvana

doi:10.1159/000288417

Cited by 43 publications

(35 citation statements)

References 20 publications

(29 reference statements)

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“…Another 44 patients had high pre-treatment scores on two hypochondriasis scales, the Illness Attitude Scales (IAS) and the Whiteley Index (WI). The IAS was originally developed by Kellner [25, 26]; see also 27]and consists of 29 items which are to be rated on five-point Likert scales. Although Kellner had originally defined nine a-priori scales with three items per scale, a re-analysis reported by Speckens et al [21]and confirmed by us [28]suggests that two main dimensions labeled ‘health anxieties’ and ‘illness behavior’ can be differentiated.…”

Section: Methodsmentioning

confidence: 99%

Predictors of Course and Outcome in Hypochondriasis after Cognitive-Behavioral Treatment

Hiller

Leibbrand²,

Rief³

et al. 2002

Psychother Psychosom

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Background: Predictors of treatment outcome were evaluated in a clinical sample suffering from hypochondriasis. Methods: The sample consisted of 96 patients with hypochondriacal disorder according to DSM-IV or high syndrome scores on the Illness Attitude Scales (IAS) or Whiteley Index (WI). After intense inpatient cognitive-behavioral treatment (CBT), 60% of the patients were classified as responders because of substantial improvements or recovery from hypochondriacal symptomatology. Results: Non-responders were characterized by a higher degree of pre-treatment hypochondriasis, more somatization symptoms and general psychopathology (SCL-90R), more dysfunctional cognitions related to bodily functioning, higher levels of psychosocial impairments, and more utilization of the health care system as indicated by the number of hospital days and costs for inpatient treatments and medication. No predictive value was found for sociodemographic variables, comorbidity with other mental disorders and chronicity. Multiple linear regression showed that pre-treatment variables significantly predicted IAS scores at post-treatment (R² = 0.59), changes during treatment (0.10), IAS scores at follow-up two years later (0.41) and changes between baseline and follow-up (0.25). Conclusions: The results demonstrate the relevance of various psychopathological variables and health care utilization as important indicators for outcome and further course of clinical hypochondriasis.

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Section: Methodsmentioning

confidence: 99%

Predictors of Course and Outcome in Hypochondriasis after Cognitive-Behavioral Treatment

Hiller

Leibbrand²,

Rief³

et al. 2002

Psychother Psychosom

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“…The correlation between abnormal illness behavior and health habits may have implications in preventive efforts. Indeed, individuals with hypochondriacal fears and beliefs were found to take worse care of their health than control subjects in several studies [167]. They may be so distressed by their belief of having an undiagnosed or neglected disease that behaviors that may yield benefits in the distant future appear to be irrelevant to them.…”

Section: Application Of Psychological Therapies To Medical Diseasesmentioning

confidence: 99%

Psychosomatic Medicine: Emerging Trends and Perspectives

Fava

Sonino

2000

Psychother Psychosom

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130

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Developments have occurred in all aspects of psychosomatic medicine. Among factors affecting individual vulnerability to all types of disease, the following have been highlighted by recent research: recent and early life events, chronic stress and allostatic load, personality, psychological well-being, health attitudes and behavior. As to the interaction between psychological and biological factors in the course and outcome of disease, the presence of psychiatric (DSM-IV) as well as subclinical (Diagnostic Criteria for Psychosomatic Research) symptoms, illness behavior and the impact on quality of life all need to be assessed. The prevention, treatment and rehabilitation of physical illness include the consideration for psychosomatic prevention, the treatment of psychiatric morbidity and abnormal illness behavior and the use of psychotropic drugs in the medically ill. In the past 60 years, psychosomatic medicine has addressed some fundamental questions, contributing to the growth of other related disciplines, such as psychoneuroendocrinology, psychoimmunology, consultation-liaison psychiatry, behavioral medicine, health psychology and quality of life research. Psychosomatic medicine may also provide a comprehensive frame of reference for several current issues of clinical medicine (the phenomenon of somatization, the increasing occurrence of mysterious symptoms, the demand for well-being and quality of life), including its new dialogue with mind-body and alternative medicine.

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“…Curiosamente, pacientes hipocondría-cos só não se diferenciariam dos não-hipocondríacos em rela-Pânico e hipocondria Torres AR et al ção a hábitos de saúde, ou seja, não se cuidariam melhor. Para Kellner et al, 10 isto se deve ao fato de que a idéia perturbadora de já estar com uma doença grave não diagnosticada poderia levá-los a negligenciar comportamentos que visassem benefí-cios futuros para a saúde.…”

Section: Problemas Conceituais E Critérios Diagnósticosunclassified

“…ex., alimentares, em relação ao fumo), apesar de mais preocupados com doenças, como descrito na hipocondria primária. 10 Além disso, 48% deles tinham algum problema físico, como asma, hipoglicemia ou hér-nia de hiato (significativamente mais que os outros grupos).…”

Section: Ocorrência De Sintomas Hipocondríacos No Transtorno De Pânicounclassified

“…Porém, a melhor diferenciação das várias formas de crenças e medos hipocondríacos pode levar a abordagens terapêuticas mais específicas e bem-sucedidas. 10 A sobreposição entre TP/agorafobia e hipocondria parece ser consideravelmente extensa e específica, uma co-ocorrência maior do que a esperada ao acaso; entretanto, mais pacientes apresentam as duas condições separadamente do que em associação. 2,27 Hipocondria e TP poderiam também coexistir sem que uma condição seja considerada principal ou cronologicamente primária.…”

Section: Conclusõesunclassified

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Sobre o transtorno de pânico e a hipocondria: uma revisão

Torres¹,

Crepaldi²

2002

Rev. Bras. Psiquiatr.

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Introdução/Objetivos: A hipocondria é associada a diversos transtornos de ansiedade, sobretudo ao transtorno de pânico (TP). Estima-se que 50% a 70% dos pacientes com TP tenham sintomas hipocondríacos, e que 13% a 17 % dos hipocondríacos tenham TP associado. O presente estudo teve como objetivo revisar a literatura sobre as relações clínicas, fenomenológicas, cognitivas e psicodinâmicas entre o TP e a hipocondria, além de discutir aspectos conceituais e critérios diagnósticos. Métodos: A busca de artigos foi feita pelo sistema Medline entre 1990 e 2001, utilizando-se, como palavraschave, transtorno de pânico, agorafobia, hipocondria e preocupações hipocondríacas. Resultados: Considera-se que há comorbidade com hipocondria no TP quando as preocupações com saúde não se restringem a sintomas das crises de pânico. Apesar de geralmente consideradas secundárias, vários pacientes com TP apresentam, antes da primeira crise, manifestações hipocondríacas que podem ser consideradas prodrômicas. A ansiedade pode gerar, num círculo vicioso, preocupações excessivas com saúde, auto-observação seletiva e antecipação do pior. Apesar do viés catastrófico comum, no TP sintomas autonômicos aumentam rapidamente até culminar num ataque, a catástrofe temida é iminente, com comportamentos de esquiva e busca imediata de socorro. Na hipocondria, temem-se doenças mais insidiosas, predominam comportamentos de hipervigilância e busca de reafirmação, as crenças são mais disfuncionais, é pior a relação médico-paciente e maior o foco de sensações erroneamente interpretadas catastroficamente. O medo patológico da morte e a alexitimia estariam presentes nos dois quadros. Conclusão: A sobreposição clínica entre TP/agorafobia e hipocondria é relevante, mas não completa. A relação entre os dois quadros é complexa e possivelmente bidirecional, um aumentando a vulnerabilidade ao outro. Há diferenças fenomenológicas identificáveis e relevantes, com implicações diagnósticas e terapêuticas.Transtorno de pânico. Agorafobia. Hipocondria. Neurose hipocondríaca. Diagnóstico diferencial. Comorbidade. Introduction/Objectives:Hypochondriasis has been associated with several anxiety disorders, especially with panic disorder (PD). It is estimated that 50% to 70% of PD patients have hypochondriacal symptoms and 13% to 17% of patients with hypochondriasis have associated PD. The objective of this study was to review the literature on clinical, phenomenological, cognitive and psychodynamic relationships between PD and hypochondriasis, and to discuss conceptual aspects and diagnostic criteria. Methods: A Medline search was conducted between 1990 and 2001 using the following keywords: panic disorder, agoraphobia, hypochondriasis, and hypochondriacal concerns. Results: It is considered hypochondriasis comorbidity in PD only when health worries are not restricted to panic attack symptoms. Although usually regarded as a secondary phenomenon, hypochondriacal preoccupations precede the first panic attack in many PD patients and may be considered prodromal symptoms...

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Differential Diagnosis of Hypochondriacal Fears and Beliefs

Cited by 43 publications

References 20 publications

Predictors of Course and Outcome in Hypochondriasis after Cognitive-Behavioral Treatment

Predictors of Course and Outcome in Hypochondriasis after Cognitive-Behavioral Treatment

Psychosomatic Medicine: Emerging Trends and Perspectives

Sobre o transtorno de pânico e a hipocondria: uma revisão

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