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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In diagnosis of functional somatic disorders, it is important to remember that the patient has no control over symptoms in somatization disorder, conversion disorder, psychogenic pain, and hypochondriasis. In addition, the environmental goals are recognizable only with careful history taking. Although voluntary symptom production is involved in both factitious disorder and malingering, environmental goals in the latter disorder are much more obvious. Depression can be an accompanying feature of all of these disorders; however, it is most closely linked with psychogenic pain. Atypical or masked depression should be included in differential diagnosis in elderly patients with somatic complaints. Referral to a consultation-liaison psychiatrist can help in evaluation and diagnosis of a somatic disorder. Joint consultation is the most effective way to plan treatment for this difficult group of patients.
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PMID:Functional somatic disorders. Key diagnostic features. 394 96

Patients with chronic psychogenic pain appear to suffer from a specific depressive type of disease, with somatized pain as the prime expression of a concealed mental agony (pain-prone disorder). This view is supported by clinical, premorbid, and psychodynamic findings, as well as by the presence of biological markers including a family history of affective disorders and response to antidepressants. Additional biological markers of depression include shortened rapid eye movement (REM) latency in sleep and nonsuppression in the dexamethasone suppression test (DST). The study of both markers in 20 consecutive pain-prone patients with insomnia showed clearly abnormal REM latency and/or DST nonsuppression in one half of the otherwise homogeneous group. There was high correlation between DST cortisol level and REM latency. both biological markers tend to predict response to antidepressants. The findings confirm that the pain-prone disorder can be viewed as a variant of depressive disease.
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PMID:Biological markers for depression in chronic pain. 708 2

In 98 out-patients who visited our pain clinic, we evaluated their psychological status before the first examination and one month after the treatment, using self-rating depression scale (SDS) and state-trate anxiety inventory (STAI). SDS, state anxiety, and trate anxiety scores were significantly higher in the patients with pain (trigeminal neuralgia, neck-shoulder-arm pain syndrome, lumbago and psychological pain, n = 55) compared with the patients without pain (sudden deafness and facial nerve palsy, n = 43) (P < 0.01, 0.05, 0.01). Of the patients with pain, patients with psychogenic pain showed the highest score in every test. The scores of SDS and state anxiety became significantly lower one month after the treatments compared with ones before the first examination (P < 0.01). It was considered that the decline in every score was due to the treatments in our pain clinic. In patients whose score of trate anxiety before the first examination was more than 50 points, the SDS and state anxiety showed high scores even one month after the treatments. This finding suggests that these patients need psychosomatic managements.
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PMID:[Psychological evaluation of out-patients in our pain clinic using self-rating depression scale and state-trate anxiety inventory questionnaire]. 774 89

The psychiatrist might be called upon for states of pain on two occasions. The first is when the pain is mainly functioned, with or without a previous history of organic pain. It is most frequently met, with various diagnostic difficulties, in hypochondriac neurosis, complaining delirium, schizophrenia, multiple somatizations, isolated psychogenic pain and masked depression. The second is when the pain is organic, always progressive, with associated psychiatric disturbances which interact with it. We shall consider these various problems from both a clinical and a therapeutic point of view aiming at their practical rather than their theoretical aspects.
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PMID:[The psychiatrist and pain]. 793 86

The efficacy of inpatient psychosomatic psychotherapy was proved by a naturalistic prospective study with 50 psychogenic pain patients over an average time period of 12 weeks. At the end of inpatient psychotherapy about 60% of all patients achieved pain mitigation. According to the aim of our therapeutic concept to specially improve the perception and verbalization of their own conflicts or affects about 86% of all patients judged to have an enhanced competence in problem solving. The hypothesis that depression may often occur as a consequence of several years lasting chronic pain, could not be confirmed in our study. In contrast no remarkable correlation was found between symptom duration and depressive or anxious mood respectively. Concerning prognosis it seems to be significant that an increased tendency for rationalization or intellectualization diminished clinical outcome success as well as it occurred with enhanced acute pain sensation.
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PMID:[Inpatient psychotherapy with chronic psychogenic pain patients]. 797 47

Ninety men between the ages of 20 to 65 were studied to investigate the relationships between stress, depression and psychogenic pain. Three groups (the coronary heart disease (CHD) group; the left-sided psychogenic chest pain (LPCP) group; and the control group) comprising 30 patients per group, each completed the Social Readjustment Rating Scale (SRRS), as a measure of stress; the Schedule of Recent Experience, to document the recency of actual life events experienced as listed in the SRRS; and the Beck Depression Inventory, as a measure of the severity of depression. Separate analyses of the variables stress and depression failed to yield significant stress differences in the 3 groups, but the LPCP group was significantly more depressed than the CHD and control groups. Factor analysis, however, indicated that the stress profiles were significantly different in each of the 3 groups. This study indicates that the condition of LPCP shares a similar depressive profile to other psychogenic pain conditions and further lends support to the hypothesis linking psychogenic pain to depressive disorders.
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PMID:Stress, depression and left-sided psychogenic chest pain. 837 90

There is no doubt that chronic pain is recognized as a biopsychosocial phenomenon in which biological, psychological, and social factors dynamically interact with each other. Thus, the role of psychological factors and understanding chronic, persistent disabling pain has been well recognized, but poorly understood. Approximately 1/2 to 2/3 of all patients diagnosed with chronic pain manifest to various levels of psychological distress. Chronic pain and psychological disorders are the two most common elements in the United States. Statistics show that, approximately 22% of Americans suffer from a diagnosable mental disorder in a given year. In addition, 28% of the American population suffers with chronic pain. Depression in chronic pain is the most common condition, followed by generalized anxiety disorder, somatization disorder, and drug dependence. However, psychogenic pain appears to be the least prevalent of all psychopathological issues. Chronic pain disability is a complex psychosocial economic phenomenon. There is no data in the literature with regards to treatment of personality disorders, anxiety disorders, and somatization disorders in managing chronic pain. In contrast, treatment of depression and the influence of treatment on outcomes have been studied to some extent. In conclusion, patients with chronic pain frequently have psychopathology - most often common depressive disorders, anxiety disorders, somatization disorders, drug dependence and occasionally personality disorders. This review discusses various issues involved with psychopathology in chronic pain including epidemiology; relationship of psychopathology to pain; influence of depression, generalized anxiety disorder, somatization, and personality disorders on chronic pain, along with diagnosis and management in interventional pain management.
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PMID:Understanding psychological aspects of chronic pain in interventional pain management. 1689 59

Address arthritis-associated pain as a disease entity, not as a sensory entity. Attempt to classify chronic pain as nociceptive pain, neuropathic pain, fibromyalgia-type pain, or psychogenic pain (very uncommon); specific treatment approaches are required for these different types of pain. Overcome your negative bias against fibromyalgia and review recent discoveries that have led to classification of fibromyalgia as a biologically-based neurosensory disorder. Use the simple and convenient ways that are available to measure pain and its concomitants (fatigue, poor sleep, depression, anxiety, and impaired physical functioning) both at initial evaluation and in follow-up visits as a guide to therapy. Do not fear use of opioids; just be careful with this class of drug.
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PMID:Pain and arthritis. 1823 66

Burning mouth syndrome (BMS) is an oral dysaesthesia that causes chronic orofacial pain in the absence of a detectable organic cause. The aetiology of BMS is complex and multifactorial, and has been associated in the literature with menopause, trigger events and even genetic polymorphisms. Other studies have found evidence for mechanisms such as central and peripheral nervous system changes, with clinical and laboratory investigations supporting a neuropathologic cause. These physiological explanations notwithstanding, there is still much evidence that BMS aetiology has at least some psychological elements. Somatoform pain disorder has been suggested as a mechanism and factors such as personality, stress, anxiety, depression and other psychological, psychosocial and even psychiatric disorders play a demonstrable role in BMS aetiology and symptomatology. In order to treat BMS patients, both physiological and psychological factors must be managed, but patient acceptance of possible components of psychological disease basis is a major hurdle. Clinical signs of patient stress, anxiety or depression are a useful reinforcement of clinical discussions. The current paper proposes a number of clinical signs that may be useful for both clinical assessment and subsequent patient discussions by providing visible supportive evidence of the diagnosis.
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PMID:Burning mouth syndrome and psychological disorders. 1947 48

Chronic pain is a common issue worldwide and remains a big challenge to physicians, particularly when the underlying causes do not meet any specific disease for settlement. Such medically unexplained somatic symptoms of pain that lack an integrated diagnosis in medicine have a high psychiatric comorbidity such as depression, and will require a multidisciplinary treatment strategy for a better outcome. Thus, most patients deserted management in spite of being inadequately treated and even presented with high resistance to analgesic drugs. Noninvasive brain stimulation, including repetitive transcranial magnetic stimulation (rTMS), has been used to treat refractory neuropathic pain and the analgesic efficacy is promising. So far, some case series and randomized rTMS studies have reported on patients with certain medically unexplained symptoms (MUSs) of pain (e.g., psychogenic pain or somatic symptoms in major depression and fibromyalgia). However, there is still no review article that is specific to the efficacy of rTMS on chronic unexplained symptoms of pain. Therefore, in the present review, we ventured to clarify the terminology and summarized the analgesic effects of rTMS on chronic MUSs of pain.
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PMID:Efficacy and practical issues of repetitive transcranial magnetic stimulation on chronic medically unexplained symptoms of pain. 2396 59


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