From Clinical Observations to Clinimetrics: A Tribute to Alvan R. Feinstein, MD

Background: Psychiatric disorders are frequent in dermatology patients, and many studies pointed out complex, mutual relationships between psyche and skin. Our aim was to provide a systematic psychosocial evaluation of a large and heterogeneous population of patients with skin diseases, including assessments of quality of life, psychiatric status according to the DSM-IV and psychological conditions with psychosomatic relevance according to established criteria (Diagnostic Criteria for Psychosomatic Research, DCPR). Methods: We studied 545 dermatological inpatients aged 18–65 years, free from dementia and cognitive impairment. They completed the Skindex-29 and the 12-item General Health Questionnaire (GHQ-12) and were administered the SCID-I and the Structured Interview for Psychological Conditions of Psychosomatic Relevance by a trained mental health professional blinded to questionnaire scores. Results: Overall, 38% of patients received a DSM-IV diagnosis. The most common diagnoses were mood (20%) and anxiety disorders (16%); 48% of patients also received a DCPR diagnosis. The most common were demoralisation, irritable mood, type A behaviour and various forms of abnormal illness behaviour. Adjusting for gender, age, and education, the presence of DSM-IV or DCPR diagnoses was significantly associated with high scores on the GHQ-12 and on the Functioning and Emotions scales of the Skindex-29. Also, DCPR diagnoses were significantly associated with high scores on the Symptoms scale of the Skindex-29. Conclusions: These findings highlight the high frequency of psychosocial problems in patients with skin disease and suggest that the joint use of DSM-IV and DCPR criteria may help identify those patients in whom psychiatric issues are worthy of increased clinical attention.

Section: Discussionsupporting

confidence: 81%

Psychosomatic Assessment of Skin Diseases in Clinical Practice

Picardi

Pasquini

Abeni

et al. 2005

“…Further, it was not possible to determine, due to the cross-sectional design, whether psychological distress preceded or followed the onset of aldosteronism. Nonetheless, the findings appear to be important in view of the methodology that was used (semistructured research interviews), encompassing both clinical and subclinical psychiatric symptomatology [27,28,29]. …”

Section: Discussionmentioning

confidence: 99%

Psychological Aspects of Primary Aldosteronism

Sonino

Fallo

Fava

2006

Self Cite

Background: Except for 3 case reports of Conn’s syndrome presenting as depression, psychosocial factors have not been explored in primary aldosteronism. We investigated psychological correlates in primary aldosteronism using methods that were found to be sensitive and reliable in psychosomatic research. Method: Ten consecutive newly diagnosed patients with primary aldosteronism were studied: 5 males/5 females; mean age (±SD) 45.5 ± 6.6 years, age range 34–54 years; 4 with an aldosterone-producing adenoma and 6 with idiopathic aldosteronism; systolic/diastolic blood pressure 189 ± 20/111 ± 7.7 mm Hg; upright plasma aldosterone 40.0 ± 18.3 ng/dl; upright plasma renin activity (PRA) 0.2 ± 0.1 ng/ml/h; aldosterone/PRA ratio 229.2 ± 191.0; serum K⁺ 3.5 ± 0.5 mmol/l. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for eliciting psychiatric diagnoses, and a shortened version of the structured interview for subclinical psychological syndromes, the Diagnostic Criteria for Psychosomatic Research (DCPR), were administered. Results: Seven patients (2 with aldosterone-producing adenoma and 5 with idiopathic hyperaldosteronism) received both DSM-IV and DCPR diagnoses, while 3 had neither. As to DSM-IV, generalized anxiety disorder was detected in 6 cases (in 1 it was associated with panic disorder and in 1 with major depression) and obsessive-compulsive disorder in 1. The most frequent DCPR cluster was demoralization (5 cases), while persistent somatization occurred in 2 cases (associated with demoralization in 1) and irritable mood in 1. Conclusions: The occurrence of anxiety disorders in patients with primary aldosteronism was much higher than that found in the general population and in primary care. Since an association between hyperaldosteronism and anxiety has also been suggested in previous animal studies, it seems worthwhile to gain further knowledge on clinical aspects by larger population studies.

“…It has been suggested [44,45,46] that a clinimetric, instead of psychometric, model should guide the assessment tools in psychiatry. Clinimetrics is the domain concerned with indexes, rating scales and other expressions that are used to describe or measure symptoms, physical signs and other clinical phenomena in medicine [47].…”

Section: The Misleading Effects Of Psychometric Theory On Clinical Asmentioning

confidence: 99%

“…Such phenomena include the types, severity and sequence of symptoms, rate of progression of the illness, severity and type of comorbidity, problems of functional capacity and reasons for medical decisions. Endorsement of a clinimetric, instead of psychometric, model [43,44,45,46] may entail important implications for increasing sensitivity of assessment tools [44], staging of psychiatric disorders for assessing the progression of disease, its overall severity and response to previous treatment [48], hierarchical organization of comorbidity [44, 49, 50], determination of recovery [51, 52] and implementation of sequential treatment strategies [53]. …”

Section: The Misleading Effects Of Psychometric Theory On Clinical Asmentioning

confidence: 99%

The Intellectual Crisis of Psychiatric Research

Fava¹

2006

The aim of this paper was to examine the intellectual crisis and the potential sources of reveille in clinical research in psychiatry. Current prevailing conceptual models in psychiatry are critically examined, with particular reference to neurobiology, clinical psychopharmacology, assessment, and the therapeutic process. Biological reductionism, neglect of individual responses to treatment, massive propaganda from the pharmaceutical industry, misleading effects of psychometric theory on clinical assessment, and lack of consideration of multiple therapeutic ingredients and of the role of psychological well-being are identified as major sources of an intellectual crisis in psychiatric research. The conceptual crisis of psychiatry is shared by other areas of clinical medicine and stems from a narrow concept of science that neglects clinical observation, the basic method of medicine. A unified concept of health and disease may yield new clinical insights in psychiatric disorders, and may result in therapeutic efforts of more enduring quality than current strategies.