Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment

Kroenke, Kurt; Spitzer, Robert L.; Williams, Janet B. W.; Linzer, Mark; Hahn, Steven R.; deGruy, Frank V.; Brody, Daniel A.

doi:10.1001/archfami.3.9.774

Cited by 662 publications

(453 citation statements)

References 15 publications

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“…Chronic symptoms, idiopathic or not, contribute substantially to patient levels of disability (Escobar et al 1987;Kroenke et al 1994). Chronic symptoms and associated disability often lead to and are produced by distress, worry, anxiety and depression (Von Korff & Simon 1996;Armenian et al 1998;Gureje et al 1998Gureje et al , 2001.…”

Section: Chronic Idiopathic Symptoms Among War Veteransmentioning

confidence: 99%

Managing future Gulf War Syndromes: international lessons and new models of care

Engel

Hyams

Scott

2006

Phil. Trans. R. Soc. B

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After the 1991 Gulf War, veterans of the conflict from the United States, United Kingdom, Canada, Australia and other nations described chronic idiopathic symptoms that became popularly known as 'Gulf War Syndrome'. Nearly 15 years later, some 250 million dollars in United States medical research has failed to confirm a novel war-related syndrome and controversy over the existence and causes of idiopathic physical symptoms has persisted. Wartime exposures implicated as possible causes of subsequent symptoms include oil well fire smoke, infectious diseases, vaccines, chemical and biological warfare agents, depleted uranium munitions and post-traumatic stress disorder. Recent historical analyses have identified controversial idiopathic symptom syndromes associated with nearly every modern war, suggesting that war typically sets into motion interrelated physical, emotional and fiscal consequences for veterans and for society. We anticipate future controversial war syndromes and maintain that a population-based approach to care can mitigate their impact. This paper delineates essential features of the model, describes its public health and scientific underpinnings and details how several countries are trying to implement it. With troops returning from combat in Afghanistan, Iraq and elsewhere, the model is already getting put to the test.

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Section: Chronic Idiopathic Symptoms Among War Veteransmentioning

confidence: 99%

Managing future Gulf War Syndromes: international lessons and new models of care

Engel

Hyams

Scott

2006

Phil. Trans. R. Soc. B

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“…9 However, some specific symptoms can be considered potential markers for anxiety. For example, in one study, 10 anxiety was found frequently in patients who had chest pain, fatigue, headache, insomnia, and abdominal pain. In another survey, panic disorder was commonly found in patients who were experiencing chest pain but had no evidence of coronary artery disease.…”

Section: Somatic Symptomatologymentioning

confidence: 99%

“…11 The number of different physical symptoms reported by patients may also provide a clue to underlying anxiety. Kroenke and colleagues 10 found that whereas anxiety was diagnosed in only 1% of patients who had 1 or no physical complaint and in 7% of those reporting 2 or 3 somatic signs, 48% of patients with 9 or more physical symptoms were found to have anxiety. Anxious patients presenting with physical symptomatology, known as "somatizers," can be identified by the excessive number of office visits and telephone calls they make to their physicians.…”

Section: Somatic Symptomatologymentioning

confidence: 99%

A Review of the Diagnosis, Pharmacologic Treatment, and Economic Aspects of Anxiety Disorders

Arikian¹,

Gorman²

2001

Prim. Care Companion CNS Disord.

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“…The distress, disability, and role impairment associated with chronic somatization and hypochondriasis is comparable to that of several chronic medical conditions. [1][2][3] Somatizing and hypochondriacal patients are disproportionately high utilizers of medical care, yet both they and their physicians find their care costly, unhelpful, frustrating, and unsatisfactory. [4][5][6][7][8][9] Several interventions have been introduced to improve the care of somatizing and hypochondriacal patients.…”

Section: Introductionmentioning

confidence: 99%

“…30 First, these tend to be chronic and treatment resistant problems that are maintained by psychological and psychosocial homeostasis. 3,[31][32][33] Second, altering the physicians' management of these patients is difficult. Third, many eligible patients refuse referral to psychiatric or mental health services, finding them stigmatizing and believing their problems are exclusively medical.…”

Section: Introductionmentioning

confidence: 99%

A Randomized Trial of Treatments for High-Utilizing Somatizing Patients

et al. 2013

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BACKGROUND: Somatization and hypochondriacal health anxiety are common sources of distress, impairment, and costly medical utilization in primary care practice. A range of interventions is needed to improve the care of these patients. OBJECTIVE: To determine the effectiveness of two cognitive behavioral interventions for high-utilizing, somatizing patients, using the resources found in a routine care setting. DESIGN: Patients were randomly assigned to a two-step cognitive behavioral treatment program accompanied by a training seminar for their primary care physicians, or to relaxation training. Providers routinely working in these patients' primary care practices delivered the cognitive behavior therapy and relaxation training. A follow-up assessment was completed immediately prior to treatment and 6 and 12 months later. SUBJECTS: Eighty-nine medical outpatients with elevated levels of somatization, hypochondriacal health anxiety, and medical care utilization. MEASUREMENTS: Somatization and hypochondriasis, overall psychiatric distress, and role impairment were assessed with well-validated, self-report questionnaires. Outpatient visits and medical care costs before and after the intervention were obtained from the encounter claims database. RESULTS: At 6 month and 12 month follow-up, both intervention groups showed significant improvements in somatization (p< 0.01), hypochondriacal symptoms (p<0.01), overall psychiatric distress (p< 0.01), and role impairment (p<0.01). Outcomes did not differ significantly between the two groups. When both groups were combined, ambulatory visits declined from 10.3 to 8.8 (p=0.036), and mean ambulatory costs decreased from $3,574 to $2,991 (p=0.028) in the year preceding versus the year following the interventions. Psychiatric visits and costs were unchanged. CONCLUSIONS: Two similar cognitive behavioral interventions, delivered with the resources available in routine primary care, improved somatization, hypochondriacal symptoms, overall psychiatric distress, and role function. They also reduced the ambulatory visits and costs of these high utilizing outpatients.K E Y W O R D S : co g n it i v e b e ha v i or t h e ra p y ; so m a t i z a t i o n; hypochondriasis; medical utilization; medical care costs.

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Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment

Cited by 662 publications

References 15 publications

Managing future Gulf War Syndromes: international lessons and new models of care

Managing future Gulf War Syndromes: international lessons and new models of care

A Review of the Diagnosis, Pharmacologic Treatment, and Economic Aspects of Anxiety Disorders

A Randomized Trial of Treatments for High-Utilizing Somatizing Patients

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