The Clinical Process in Psychiatry

Fava, Giovanni A.; Rafanelli, Chiara; Tomba, Elena

doi:10.4088/jcp.10r06444

Cited by 134 publications

(237 citation statements)

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“…However, the findings of this study highlight the importance of detecting demoralization alone or in comorbidity with major depression, somatization, adjustment and anxiety disorders. Exclusive reliance on psychiatric diagnostic criteria has impoverished the clinical process and does not reflect the complex thinking that underlies decisions in psychiatric practice 61 . Identifying and subtyping demoralization in the setting of medical disease may yield improved targets for research and treatment trials, as is currently advocated in major depression [62][63][64] .…”

Section: Discussionmentioning

confidence: 99%

Subtyping demoralization in the medically ill by cluster analysis

et al. 2013

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ITALY ABSTRACT -Background and Objectives:There is increasing interest in the issue of demoralization, particularly in the setting of medical disease. The aim of this investigation was to use both DSM-IV comorbidity and the Diagnostic Criteria for Psychosomatic Research (DCPR) in order to characterize demoralization in the medically ill.Methods: 1700 patients were recruited from 8 medical centers in the Italian Health System and 1560 agreed to participate. They all underwent a cross-sectional assessment with DSM-IV and DCPR structured interviews. 373 patients (23.9%) received a diagnosis of demoralization. Data were submitted to cluster analysis.Results: Four clusters were identified: demoralization and comorbid depression; demoralization and comorbid somatoform/adjustment disorders; demoralization and comorbid anxiety; demoralization without any comorbid DSM disorder. The first cluster included 27.6% of the total sample and was characterized by the presence of DSM-IV mood disorders (mainly major depressive disorder). The second cluster had 18.2% of the cases and contained both DSM-IV somatoform (particularly, undifferentiated somatoform disorder and hypochondriasis) and adjustment disorders. In the third cluster (24.7%), DSM-IV anxiety disorders in comorbidity with demoralization were predominant (particularly, generalized anxiety disorder, agoraphobia, panic disorder and obsessive-compulsive disorder). The fourth cluster had 29.5% of the patients and was characterized by the absence of any DSM-IV comorbid disorder.Conclusions: The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of demoralization as encompassed by the DCPR. Subtyping demoralization may yield improved targets for psychosomatic research and treatment trials.

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Section: Discussionmentioning

confidence: 99%

Subtyping demoralization in the medically ill by cluster analysis

et al. 2013

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“…The time has come, however, to question the massive use of antidepressant drugs in cardiology settings and the current research priorities that do not acknowledge type A behavior, lifestyle and the longitudinal course of mood disorders [90]. Depression in CAD may simply be the final common pathway of a number of psychosomatic developments and may be a partial and misleading target for treatment.…”

Section: Future Prospectsmentioning

confidence: 99%

“…Both psychosocial assessment and intervention in cardiac patients should incorporate a wider range of clinical phenomena which may interact with depressive symptomatology and its treatment. Such phenomena include type A behavior, lifestyle, illness behavior and psychological well-being [90,91]. …”

Section: Future Prospectsmentioning

confidence: 99%

Is Depression the Wrong Treatment Target for Improving Outcome in Coronary Artery Disease?

Rafanelli¹,

Sirri

Grandi³

et al. 2013

Psychother Psychosom

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“…Examples are embitterment reactions, work phobia, resilience deficit syndromes, mild cognitive dysfunctions, demoralization or irritable mood [9,30,31,32,33,34,35,36,37,38]. Assessment also includes a functional analysis of interactions between mental disorder, personality and environment [39].…”

Section: Inpatient Psychosomatic Treatment Processmentioning

confidence: 99%

Psychosomatic Inpatient Rehabilitation: The German Model

Lindén¹

2014

Psychother Psychosom

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The term ‘psychosomatic' has many connotations, be it in the sense of a general biopsychosocial concept in medicine as outlined in the ICF (International Classification of Functioning, Disability and Health) of the World Health Organization, a holistic and person-centered view of the patient beyond the illness, the treatment of somatoform or somatic disorders, or special psychotherapeutic approaches. In Germany, there are also about 25,000 inpatient beds in ‘psychosomatic rehabilitation hospitals', which treat approximately 5/1,000 inhabitants in the working age population per year. These institutions give an example of how to translate the theoretical concepts of psychosomatic medicine and of the ICF into clinical practice. ‘Psychosomatic rehabilitation' aims at the prevention, treatment and compensation of chronic illness by a biopsychosocial approach. This includes a multilevel psychosomatic assessment and a multidimensional treatment focus including the reduction of symptoms, the training of capacities, the coping with chronic illness and impairment, the restoration of well-being and normal life, and the occupational reintegration including the search for a workplace, which allows work in spite of impairment. Scientific studies have shown that the psychological status, the motivation to work, the number of days on sickness leave and occupational reintegration can be improved, and that the system pays for the patients themselves, but also pension and health insurance companies.

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The Clinical Process in Psychiatry

Abstract: Current assessment strategies in psychiatric research do not reflect the sophisticated thinking that underlies clinical decisions in practice. The clinimetric perspective provides an intellectual home for the reproduction and standardization of these clinical intuitions.

Cited by 134 publications

References 0 publications

Subtyping demoralization in the medically ill by cluster analysis

Subtyping demoralization in the medically ill by cluster analysis

Is Depression the Wrong Treatment Target for Improving Outcome in Coronary Artery Disease?

Psychosomatic Inpatient Rehabilitation: The German Model

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