Medically Unexplained Somatic Symptoms in Different Cultures

Isaac, Mohan; Janča, Aleksandar; Burke, Kimberly Christie; Silva, J. A. Costa E; Acuda, S. W.; Altamura, Alfredo Carlo; Burke, Jay; Chandrashekar, C. R.; Miranda, Cláudio Torres de; Tacchini, G.

doi:10.1159/000288996

Cited by 41 publications

(13 citation statements)

References 6 publications

(6 reference statements)

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“…According to previous studies, women with CMD are also among the patients who regularly visit health care centers, 2 present complaints of several medically unexplained symptoms, [10][11][12] and are the mothers of undernourished children. 22 …”

Section: The Problemmentioning

confidence: 99%

“…This form of presenting mental suffering is cultural, and is particularly frequent among Latin Americans, including Brazilians. 2,[10][11][12] The association of CMD with medically unexplained somatic complaints in primary care strongly contributes to the low detection rate of the condition. As a result, undetected CMD patients go regularly to primary care centers, where complementary exams are excessively requested and they are frequently referred to specialists, or receive inadequate treatment by general practitioners.…”

Section: Introductionmentioning

confidence: 99%

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Common mental disorders in Petrópolis-RJ: a challenge to integrate mental health into primary care strategies

Fortes

Lopes

Villano

et al. 2011

Rev. Bras. Psiquiatr.

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OBJECTIVE: Common mental disorders are present in more than 50% of patients attending primary care clinics. The main objectives of this study were to detect whether there is any special group of patients within the Family Health Strategy that should be considered to be in greater risk for common mental disorders and to recommend alternative interventions to aid these patients. METHOD: In 2002, a cross-sectional study on common mental disorders seen at Family Health Strategy centers was conducted in Petrópolis, State of Rio de Janeiro. RESULTS: Common mental disorders were associated with women (OR = 2.90; 95% CI 1.82-4.32), younger than 45 years of age (OR = 1.43; 95% CI 1.02-2.01), with a monthly per capita family income of less than US$40.00 (OR = 1.68; 95% CI 1.20-2.39), and without a partner (OR = 1.71; 95% CI 1.22-2.39). Illiteracy was associated with common mental disorders among patients who were not extremely poor. Social support networks such as going often to church (OR = 0.62; 95% CI 0.43-0.89); participating in artistic and sporting activities (OR = 0.42; 95% CI 0.26-0.70) and having at least four trusted relatives or friends (OR = 0.53; 95% CI 0.31-0.91) was inversely associated with common mental disorders. DISCUSSION: Poor women with little social support represent a special group at risk for common mental disorders in the primary care setting. Some countries have developed special interventions to treat patients with common mental disorders in primary care. CONCLUSION: Mental health care programs could include evidence-based psychosocial interventions to assist women in overcoming the vicious circle of poverty and dealing with their mental disorders.

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Section: The Problemmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Common mental disorders in Petrópolis-RJ: a challenge to integrate mental health into primary care strategies

Fortes

Lopes

Villano

et al. 2011

Rev. Bras. Psiquiatr.

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“…In some cases the illness progresses and neurovegetative symptoms like fatigue, headache and difficulties concentrating are attributed to exposure to electric equipment in general. Medically unexplained somatic symptoms like the neurovegetative symptoms reported by this group of patients in Sweden are known to be prevalent in many cultures [3]. A recent survey of ‘electromagnetic hypersensitivity’ across Europe, supported by DG V of the European Union, showed considerable variations in occurrence and appearance of reported electromagnetic hypersensitivity between different countries [4].…”

Section: Introductionmentioning

confidence: 99%

Cognitive Behavioural Therapy for Patients with Electric Sensitivity – a Multidisciplinary Approach in a Controlled Study

Hillert

Hedman

Dölling

et al. 1998

Psychother Psychosom

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Background: Electric sensitivity is a syndrome that still lacks diagnostic criteria and proven aetiology. The suffering of afflicted persons motivates development and evaluation of effective handling and treatments. The aim of the study was to evaluate the effect of cognitive behavioural therapy in patients with electric sensitivity. Methods: Cognitive behavioural treatment, as part of a multidisciplinary treatment package for patients with electric sensitivity, was evaluated in a controlled trial. Ten patients who received treatment were compared to 12 controls. Outcome measures included different dimensions such as symptoms, beliefs, behaviour, and biochemical measurements of stress-related variables. All outcome measures were collected prior to the study, post-treatment, and after an additional 6-month follow-up. Results: The therapy group rated their electric sensitivity as significantly lower than did the control group at the 6-month follow-up, and reduction of self-rated discomforts from triggering factors was significant in the therapy group. There were no systematic changes in the biochemical variables. The symptom indices were significantly reduced over time, and ability to work continued to be good in both groups. Conclusion: The prognosis for this syndrome is good with early intervention and cognitive therapy may further reduce the perceived hypersensitivity. This may have important implications on handling of patients with electric sensitivity.

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“…Accordingly, the nature of the symptoms is complex, and not limited to patients' immediate reality, but also reflects the interaction with the environment [8] and cultural milieu. Persistent and, at times, disrupting somatic symptoms are frequently encountered in medical practice, in the absence of any objective sign of disease [9] : it is estimated that up to 40 % of those who seek medical advice have medically unexplained somatic symptoms. These symptoms may indicate the presence of an underlying mental disorder (i.e.…”

Section: Introductionmentioning

confidence: 99%

Chronic fatigue syndrome: a hypothesis focusing on the autonomic nervous system

Pagani

Lucini

1999

Clinical Science

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Chronic fatigue syndrome is a debilitating illness of unknown aetiology, with estimated levels of prevalence of up to about 8. 7/100 000 in the U.S.A. Like pain fatigue it is a personal, emotionally rich experience, which may originate from peripheral or central sites (or both). The nature of the symptoms is complex and reflects the interaction of the patient with the environment and cultural milieu. Accordingly the common use of the same terminology for different types of fatigue may be misleading. Autonomic activation is a key component of both real and simulated physical exercise. Alterations in autonomic nervous system activity are a key component of several physiopathological conditions. In chronic fatigue syndrome disturbances in autonomic activity, and in other homoeostatic mechanisms, such as the hormonal and immune systems, have been reported recently. In this review we followed the hypothesis that in chronic fatigue syndrome the paradoxical condition of disturbing somatic symptoms in the absence of organic evidence of disease might be addressed by focusing on attending functional correlates. In particular we addressed possible alterations in cardiovascular autonomic control, as can be assessed by spectral analysis of R-R interval and systolic arterial pressure variability. With this approach, in subjects complaining of unexplained fatigue, we obtained data suggesting a condition of prevailing sympathetic modulation of the sino-atrial node at rest, and reduced responsiveness to excitatory stimuli. Far from considering the issue resolved, we propose that in the context of the multiple physiological and psychological interactions involved in the perception and self-reporting of symptoms, attendant changes in physiological equivalents might furnish a convenient assessment independent from subjective components. Indices of sympathetic modulation could, accordingly, provide quantifiable signs of the interaction between subject's efforts and environmental demands, independently of self descriptions, which could provide convenient measurable outcomes, both for diagnosis and treatment titration in chronic fatigue syndrome.

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Medically Unexplained Somatic Symptoms in Different Cultures

Cited by 41 publications

References 6 publications

Common mental disorders in Petrópolis-RJ: a challenge to integrate mental health into primary care strategies

Common mental disorders in Petrópolis-RJ: a challenge to integrate mental health into primary care strategies

Cognitive Behavioural Therapy for Patients with Electric Sensitivity – a Multidisciplinary Approach in a Controlled Study

Chronic fatigue syndrome: a hypothesis focusing on the autonomic nervous system

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