scholarly journals Dimensional analysis of depressive, anxious and somatic symptoms presented by primary care patients and their relationship with ICD-11 PHC proposed diagnoses

2018 ◽  
Vol 49 (5) ◽  
pp. 764-771 ◽  
Author(s):  
Carolina Ziebold ◽  
David P. Goldberg ◽  
Geoffrey M. Reed ◽  
Fareed Minhas ◽  
Bushra Razzaque ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Somatic Symptoms ◽  
Field Studies ◽  
Somatic Complaints ◽  
General Factor ◽  
Anxious Depression ◽  
Well Model ◽  
Primary Care Patients

AbstractBackgroundA study conducted as part of the development of the Eleventh International Classification of Mental Disorders for Primary Health Care (ICD-11 PHC) provided an opportunity to test the relationships among depressive, anxious and somatic symptoms in PHC.MethodPrimary care physicians participating in the ICD-11 PHC field studies in five countries selected patients who presented with somatic symptoms not explained by known physical pathology by applying a 29-item screening on somatic complaints that were under study for bodily stress disorder. Patients were interviewed using the Clinical Interview Schedule-Revised and assessed using two five-item scales that measure depressive and anxious symptoms. Structural models of anxious-depressive symptoms and somatic complaints were tested using a bi-factor approach.ResultsA total of 797 patients completed the study procedures. Two bi-factor models fit the data well: Model 1 had all symptoms loaded on a general factor, along with one of three specific depression, anxiety and somatic factors [x2 (627) = 741.016, p < 0.0011, RMSEA = 0.015, CFI = 0.911, TLI = 0.9]. Model 2 had a general factor and two specific anxious depression and somatic factors [x2 (627) = 663.065, p = 0.1543, RMSEA = 0.008, CFI = 0.954, TLI = 0.948].ConclusionsThese data along with those of previous studies suggest that depressive, anxious and somatic symptoms are largely different presentations of a common latent phenomenon. This study provides support for the ICD-11 PHC conceptualization of mood disturbance, especially anxious depression, as central among patients who present multiple somatic symptoms.

Masked Depression: Its Interrelations with Somatization, Hypochondriasis and Conversion

1988 ◽  
Vol 17 (4) ◽  
pp. 367-379 ◽  
Author(s):  
Robert Z. Fisch
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Somatic Symptoms ◽  
Somatic Complaints ◽  
Diagnosis And Treatment ◽  
Clinical Phenomenon ◽  
Clinical Problems

Masked depression appears to be a common clinical phenomenon. Most depressions present with some somatic complaints in addition to affective and cognitive ones. About one half of all depressions seen by primary care physicians initially present predominantly or exclusively with somatic symptoms. Many of these depressions are not recognized or are misdiagnosed and mistreated. The possible reasons for this are discussed here. The phenomenon of somatization in depressions and other conditions is reviewed and the interface with other related clinical problems like hypochondriasis and conversion is delineated. It is hypothesized that the proportion of depressions that are masked is positively correlated to the patients' tendency to somatize and negatively correlated to the doctors' ability to recognize depressions that hide behind somatic complaints. Suggestions for the diagnosis and treatment of masked depressions are given.

scholarly journals Diagnostic and treatment barriers to persistent somatic symptoms in primary care – representative survey with physicians

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Marco Lehmann ◽  
Nadine Janis Pohontsch ◽  
Thomas Zimmermann ◽  
Martin Scherer ◽  
Bernd Löwe
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Rating Scales ◽  
Treatment Guidelines ◽  
Somatic Symptoms ◽  
Diagnosis And Treatment ◽  
Treatment Barriers ◽  
Adequate Treatment ◽  
Physical Disease ◽  
Federal States

Abstract Background Many patients consult their primary care physician with persistent somatic symptoms such as pain or sickness. Quite often these consultations and further diagnostic measures yield no medical explanation for the symptoms – patients and physicians are left in uncertainty. In fact, diagnostic and treatment barriers in primary care hinder timely health-care provision for patients suffering from persistent somatic symptoms (PSS). The significance of individual barriers is still unknown. We compare and quantify these barriers from the perspective of primary care physicians and identify subpopulations of primary care physicians who experience particular barriers as most severe. Methods We mailed a questionnaire to primary care physicians (PCP) in Germany and asked them which barriers they consider most important. We invited a random sample of 12,004 primary care physicians in eight federal states in Germany. Physicians provided anonymous mailed or online responses. We also mailed a postcard to announce the survey and a mail reminder. Main measures were Likert rating scales of items relating to barriers in the diagnosis and treatment of PSS in primary care. Information on demography and medical practice were also collected. Results We analyzed 1719 data sets from 1829 respondents. PCPs showed strongest agreement with statements regarding (1.) their lack of knowledge about treatment guidelines, (2.) their perceptions that patients with PSS would expect symptom relief, (3.) their concern to overlook physical disease in these patients, and (4.) their usage of psychotropic drugs with these patients. More experienced PCPs were better able to cope with the possibility of overlooking physical disease than those less experienced. Conclusions The PCPs in our survey answered that the obligation to rule out severe physical disease and the demand to relieve patients from symptoms belong to the most severe barriers for adequate treatment and diagnosis. Moreover, many physicians admitted to not knowing the appropriate treatment guidelines for these patients. Based on our results, raising awareness of guidelines and improving knowledge about the management of persistent somatic symptoms appear to be promising approaches for overcoming the barriers to diagnosis and treatment of persistent somatic symptoms in primary care. Trial registration German Clinical Trials Register (Deutschen Register Klinischer Studien, DRKS) https://www.drks.de/drks_web/setLocale_EN.do The date the study was registered: October 2nd 2017 The date the first participant was enrolled: February 9th 2018 DRKS-ID: DRKS00012942

Somatization in Primary Care: A Comparative Survey of Immigrants from Various Ethnic Groups in Rome, Italy

2005 ◽  
Vol 35 (3) ◽  
pp. 241-248 ◽  
Author(s):  
Massimiliano Aragona ◽  
Lorenzo Tarsitani ◽  
Francesco Colosimo ◽  
Barbara Martinelli ◽  
Hassan Raad ◽  
...  
Keyword(s):  
Primary Care ◽  
Ethnic Groups ◽  
Somatic Symptoms ◽  
Somatic Complaints ◽  
Central Americans ◽  
Primary Care Unit ◽  
Primary Care Settings ◽  
South Central ◽  
Current Prevalence ◽  
Comparative Survey

Objectives: Those responsible for interviewing immigrants in primary care settings often underestimate the importance of somatic symptoms arising from psychological distress. This study investigates the current prevalence of somatization in immigrants, and evaluates the comparative rates of somatic complaints in four ethnic groups (Caucasians, Asians, South/Center Americans, and Africans). Methods: We studied the 301 consecutive outpatients (aged between 16 and 70 years) attending the “Caritas” primary care unit for immigrants in Rome (Italy) from January to December 2003, all of whom completed the 21-item version of the Bradford Somatic Inventory (BSI-21). Patients scoring 14 or more on the BSI-21 were considered at risk for somatization. Results: The current prevalence of somatization was 35.2%; 62.3% of the somatizers were women. A multiple regression analysis adjusting for the possible confounding effects of sex, age, education, and months of stay in Italy showed that South/Central Americans had significantly higher somatization scores than the other three groups. Conclusions: These findings suggest a high probability of somatization syndromes in immigrant patients. South/Central Americans tend to somatize more than other ethnic groups. A psychosomatic approach may be useful for immigrants in primary care settings.

Risk Classification of Adult Primary Care Patients by Self-Reported Quality of Life

Medical Care ◽  
2005 ◽  
Vol 43 (2) ◽  
pp. 189-193 ◽  
Author(s):  
George R. Parkerson ◽  
William E. Hammond ◽  
J Lloyd Michener ◽  
Kimberly S.H. Yarnall ◽  
Jeffrey L. Johnson
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Risk Classification ◽  
Primary Care Patients

scholarly journals Early detection of asthma and chronic obstructive pulmonary disease in primary care patients

2013 ◽  
Vol 66 (1-2) ◽  
pp. 46-52 ◽  
Author(s):  
Marija Vukoja ◽  
Predrag Rebic ◽  
Zorica Lazic ◽  
Marija Mitic-Milikic ◽  
Branislava Milenkovic ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
Pulmonary Disease ◽  
General Practitioners ◽  
Primary Care Physicians ◽  
Smoking History ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Number Of Patients ◽  
Primary Care Patients

Introduction. Asthma and chronic obstructive pulmonary disease are often unrecognized and undertreated. The aim of this study was to describe the frequency of chronic obstructive pulmonary disease and asthma in primary care patients in Serbia, and to examine the agreement between general practitioners and pulmonologists on the diagnosis of chronic obstructive pulmonary disease and asthma. Material and Methods. In this multicenter observational study, the general practitioners identified eligible patients from October 2009 to June 2010. The study included all adult patients with respiratory symptoms and/or smoking history based on structured interview. The patients were referred to a pulmonologist and underwent a diagnostic work-up, including spirometry. Results. There were 2074 patients, 38.4% men, their mean age being 54?15.5 years. The patients were mostly current (40.3%) or ex-smokers (27.4%). The common symptoms included shortness of breath (84.9%), cough (79.1%) and wheezing (64.3%). The diagnosis of chronic obstructive pulmonary disease was confirmed by pulmonologists in 454 (21.9%) and asthma in 455 (21.9%) patients. The chronic obstructive pulmonary disease was newly diagnosed in 226 (10.9%) and asthma in 269 (13%) of the cases. There was a moderate agreement between the pulmonologists and general practitioners on the diagnosis of chronic obstructive pulmonary disease (kappa 0.41, 95%CI 0.36-0.46) and asthma (kappa 0.42, 95% CI 0.37-0.465). Conclusion. A significant number of patients seen in the general practitioner?s office were diagnosed with chronic obstructive pulmonary disease or asthma and half of them represent new cases. A substantial proportion of patients referred to a pulmonologist by primary care physicians have been misdiagnosed.

Variations in health services utilization by primary care patients

2002 ◽  
Vol 15 (2) ◽  
pp. 116-125 ◽  
Author(s):  
Victoria Bolaños-Carmona ◽  
Ricardo Ocaña-Riola ◽  
Alexandra Prados-Torres ◽  
Pilar Gutiérrez-Cuadra
Keyword(s):  
Primary Care ◽  
Health Service ◽  
Primary Care Physicians ◽  
Service Use ◽  
Patient Characteristics ◽  
Important Variable ◽  
Services Utilization ◽  
Care Groups ◽  
Physician Characteristics ◽  
Primary Care Patients

This study analyses how both ambulatory care groups (ACGs) and physician characteristics explain the variability in health-service use among primary care patients in Spain. During the period 1996-1997, data derived from 52 152 patients and their 38 respective primary care physicians were collected. The response variables were as follows: number of visits; diagnostic tests requested; and referrals to a specialist. ACGs are an important variable that should be taken into account in order to explain health-service utilization. As for professionals, age and the post they hold are essential factors. Most of the unexplained variability is caused by patient characteristics.

Somatic symptoms among older depressed primary care patients

2003 ◽  
Vol 18 (6) ◽  
pp. 547-548 ◽  
Author(s):  
Bart Sheehan ◽  
Christopher Bass ◽  
Richard Briggs ◽  
Robin Jacoby
Keyword(s):  
Primary Care ◽  
Somatic Symptoms ◽  
Primary Care Patients

scholarly journals A hierarchical classes analysis (HICLAS) of primary care patients with medically unexplained somatic symptoms

1998 ◽  
Vol 81 (1) ◽  
pp. 77-86 ◽  
Author(s):  
Michael A Gara ◽  
Roxanne Cohen Silver ◽  
Javier I Escobar ◽  
Alison Holman ◽  
Howard Waitzkin
Keyword(s):  
Primary Care ◽  
Somatic Symptoms ◽  
Hierarchical Classes ◽  
Medically Unexplained ◽  
Primary Care Patients ◽  
Medically Unexplained Somatic Symptoms

The chronically mentally ill in primary care

1985 ◽  
Vol 15 (2) ◽  
pp. 265-273 ◽  
Author(s):  
Darrel A. Regier ◽  
Jack D. Burke ◽  
Ronald W. Manderscheid ◽  
Barbara J. Burns
Keyword(s):  
Primary Care ◽  
Mental Disorder ◽  
Mentally Ill ◽  
Primary Care Physicians ◽  
Service Needs ◽  
Medical Problems ◽  
Chronically Mentally Ill ◽  
Severe Impairment ◽  
Primary Care Patients

SynopsisThe role of primary care physicians in addressing the needs of chronically mentally ill patients is examined from three perspectives: (1) assessing community prevalence; (2) treating chronic medical problems in the context of other human service needs; and (3) treating specific types of chronic mental disorders. About 30% of primary care patients were found to have at least one Research Diagnostic Criteria mental disorder, five-sixths of which had a duration greater than 1 year. However, about 9% of patients had some impairment and 2% had severe impairment associated with a mental disorder. Although affective disorders have the highest overall rates, personality, psychotic, and anxiety disorders contribute the greatest proportion of severe disability.

scholarly journals A systematic review of behavioural weight-loss interventions involving primary-care physicians in overweight and obese primary-care patients (1999–2011)

2012 ◽  
Vol 16 (11) ◽  
pp. 2083-2099 ◽  
Author(s):  
Sze Lin Yoong ◽  
Mariko Carey ◽  
Rob Sanson-Fisher ◽  
Alice Grady
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Weight Loss ◽  
High Intensity ◽  
Primary Care Physicians ◽  
Population Characteristics ◽  
Significant Weight Loss ◽  
Primary Care Patients ◽  
Clinically Significant ◽  
Weight Loss Interventions

AbstractObjectiveThe present review aimed to examine the effectiveness of behavioural weight-loss interventions involving primary-care physicians in producing weight loss in overweight and obese primary-care patients.DesignA systematic review was conducted by searching online databases (MEDLINE, EMBASE, Cochrane, PsycINFO and SCOPUS) from January 1999 to December 2011. All abstracts were screened and coded for eligibility. The Cochrane Effective Practice and Organisation of Care Group quality criteria were used to assess the methodological adequacy of included studies. Information related to study design, population characteristics and intervention details was extracted.SettingPrimary care.SubjectsOverweight or obese (defined as having a BMI ≥ 25·0 kg/m2) primary-care patients.ResultsSixteen different studies were included. Of these, six assessed primary-care physicians’ delivery of weight-loss counselling; nine assessed weight-loss counselling delivered by non-physician personnel with monitoring by primary-care physicians; and one assessed a multi-component intervention. Overall, high-intensity weight-loss counselling by primary-care physicians resulted in moderate but not clinically significant weight loss. High-intensity weight-loss counselling delivered by non-physicians, meal replacements delivered in conjunction with dietitian counselling and referral to commercial weight-loss centre programmes accompanied by regular monitoring by a primary-care physician were effective in producing clinically significant weight loss. Dietitian-delivered care appeared effective in producing weight loss regardless of level of intervention intensity.ConclusionsOverall, there were few studies on this topic and the methodological rigour of some included studies was poor. Additional studies assessing the effectiveness and acceptability of potential interventions are needed to confirm these findings.

Sign in / Sign up

Export Citation Format

Share Document