Neue Leitlinien zu funktionellen und somatoformen Störungen

Hausteiner-Wiehle, Constanze; Schäfert, Rainer; Sattel, Heribert; Ronel, Joram; Herrmann, Markus; Haüser, Winfried; Martin, Alexandra; Henningsen, Peter

doi:10.1055/s-0032-1323743

Cited by 8 publications

(7 citation statements)

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“…Basierend auf einem biopsychosozialen Krankheitsmodell und im Sinne einer somatischen und psychosozialen Paralleldiagnostik 440 sollte bereits die Basisanamnese Fragen zu psychosozialen Aspekten wie z. B. Stressfaktoren in Beruf und Familie sowie zu Stimmung und Ängstlichkeit umfassen.…”

Section: Teil III – Diagnosesicherungunclassified

“…Von zentraler Bedeutung bei Verdacht auf RDS ist eine sorgfältige, einmalige somatische Diagnostik. Wiederholungen von Untersuchungen, die initial keinen wegweisenden Befund ergaben und für die keine erneute Indikation durch neu aufgetretene klinische Aspekte besteht, können zu einer Chronifizierung der Beschwerden beitragen und sollten daher auch bei Patientenwunsch unterbleiben 440 447 .…”

Section: Teil III – Diagnosesicherungunclassified

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Update S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM) – Juni 2021 – AWMF-Registriernummer: 021/016

et al. 2021

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Section: Teil III – Diagnosesicherungunclassified

Update S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM) – Juni 2021 – AWMF-Registriernummer: 021/016

et al. 2021

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“…However, not only is evidence concerning diagnostic criteria limited, but there are no randomized controlled trials with respect to (psycho-) therapy of conversion disorder, though a recent meta-analysis for somatoform disorders gives some hope [32]. Disorder-specific interventions and therapeutic attitudes seem of relevance [33]. …”

Section: Discussionmentioning

confidence: 99%

Differentiating cerebral ischemia from functional neurological symptom disorder: a psychosomatic perspective

et al. 2014

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BackgroundThe differential diagnosis of pseudo-neurological symptoms often represents a clinical challenge. The Diagnostic and Statistical Manual of Mental Disorders, DSM-5, made an attempt to improve diagnostic criteria of conversion disorder (functional neurological symptom disorder). Incongruences of the neurological examination, i.e. positive neurological signs, indicate a new approach - whereas psychological factors are not necessary anymore. As the DSM-5 will influence the International Classification of Diseases, ICD-11, this is of importance. In the case presented, a history of psychological distress and adverse childhood experiences coexisted with a true neurological disorder. We discuss the relevance of an interdisciplinary assessment and of operationalized diagnostic criteria.Case presentationA 32-year-old man presented twice with neurological symptoms without obvious pathological organic findings. A conversion disorder was considered early on at the second admission by the neurology team. Sticking to ICD-10, this diagnosis was not supported by a specialist for psychosomatic medicine, due to missing hints of concurrent psychological distress in temporal association with neurological symptoms. Further investigations then revealed a deep vein thrombosis (though D-dimers had been negative), which had probably resulted in a crossed embolus.ConclusionThe absence of a clear proof of biological dysfunction underlying neurological symptoms should not lead automatically to the diagnosis of a conversion disorder. In contrast, at least in more complex patients, the work-up should include repeated psychological and neurological assessments in close collaboration. According to ICD-10 positive signs of concurrent psychological distress are required, while DSM-5 emphasizes an incongruity between neurological symptoms and neurophysiological patterns of dysfunction. In the case presented, an extensive medical work-up was initially negative, and neither positive psychological nor positive neurological criteria could be identified. We conclude, that, even in times of more sophisticated operationalization of diagnostic criteria, the interdisciplinary assessment has to be based on an individual evaluation of all neurological and psychosocial findings. Prospective studies of inter-rater reliability and validity of psychological factors and positive neurological signs are needed, as evidence for both is limited. With respect to ICD-11, we suggest that positive neurological as well as psychological signs for functional neurological symptom disorder should be considered to increase diagnostic certainty.

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“…The triple term “non-specific, functional and somatoform (NFS) bodily complaints” is primarily used to describe a group of disorders or diseases for which no clear organic cause can be identified and which are due to a dysfunction or interaction between different organs or systems of the body ( 5 , 6 ). This term combines the terms “non-specific,” “functional” and “somatoform” and refers to disorders or diseases with physical symptoms or complaints for which no organic cause is found ( 7 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

“…Accordingly, NFS can be considered when the following three criteria are met: (a) the complaints cannot be attributed to a specific disease; (b) the function of the affected organ or organ system is impaired; (c) the complaints significantly affect daily life ( 5 ). Patients with NFS are common in general practice ( 5 , 6 ). By definition, NFS does not have a clear organic cause.…”

Section: Introductionmentioning

confidence: 99%

How symptoms of simple acute infections affect the SSS-8 and SSD-12 as screening instruments for somatic symptom disorder in the primary care setting

et al. 2023

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ObjectiveSomatic symptom disorder (SSD) is one of the most common reasons for consultations in primary care, in addition to simple acute infections. Questionnaire-based screening instruments to identify patients at high risk of SSD are thus of great clinical relevance. Although screening instruments are frequently used, it is currently unclear to what extent they are influenced by the concurrent presence of simple acute infections. Therefore, this study aimed to investigate how symptoms of simple acute infections affect the two established questionnaires as screening instruments for somatic symptom disorder in the primary care setting.MethodsIn our cross-sectional, multicenter design, a total of 1,000 patients in primary care practices were screened using the two most established SSD screening questionnaires, the 8-item Somatic Symptom Scale (SSS-8) and the 12-item Somatic Symptom Disorder—B Criteria Scale (SSD-12), followed by clinical assessment by the primary care physician.ResultsA total of 140 patients with a simple acute infection (acute infection group, AIG) and 219 patients with chronic somatic symptoms (somatic symptom group, SSG) were included. The patients in the SSG showed higher total SSS-8 and SSD-12 scores than the patients in the AIG; however, the SSS-8 was more susceptible to changes triggered by symptoms of a simple acute infection than the SSD-12.ConclusionThese results suggest that the SSD-12 is less susceptible to symptoms of a simple acute infection. Its total score and corresponding cutoff value provide a more specific and thus less susceptible screening tool for identifying SSD in primary care.

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Neue Leitlinien zu funktionellen und somatoformen Störungen

Cited by 8 publications

References 0 publications

Differentiating cerebral ischemia from functional neurological symptom disorder: a psychosomatic perspective

How symptoms of simple acute infections affect the SSS-8 and SSD-12 as screening instruments for somatic symptom disorder in the primary care setting

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