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Some patients with fibromyalgia also exhibit the neurological signs of cervical myelopathy. We sought to determine if treatment of cervical myelopathy in patients with fibromyalgia improves the symptoms of fibromyalgia and the patients' quality of life. A non-randomized, prospective, case control study comparing the outcome of surgical (n = 40) versus non-surgical (n = 31) treatment of cervical myelopathy in patients with fibromyalgia was conducted. Outcomes were compared using SF-36, screening test for somatization, HADS, MMPI-2 scale 1 (Hypochondriasis), and self reported severity of symptoms 1 year after treatment. There was no significant difference in initial clinical presentation or demographic characteristics between the patients treated by surgical decompression and those treated by non-surgical means. There was a striking and statistically significant improvement in all symptoms attributed to the fibromyalgia syndrome in the surgical patients but not in the non-surgical patients at 1 year following the treatment of cervical myelopathy (P <or= 0.018-0.001, Chi-square or Fisher's exact test). At the 1 year follow-up, there was a statistically significant improvement in both physical and mental quality of life as measured by the SF-36 score for the surgical group as compared to the non-surgical group (Repeated Measures ANOVA P < 0.01). There was a statistically significant improvement in the scores from Scale 1 of the MMPI-2 and the screening test for somatization disorder, and the anxiety and depression scores exclusively in the surgical patients (Wilcoxon signed rank, P < 0.001). The surgical treatment of cervical myelopathy due to spinal cord or caudal brainstem compression in patients carrying the diagnosis of fibromyalgia can result in a significant improvement in a wide array of symptoms usually attributed to fibromyalgia with attendant measurable improvements in the quality of life. We recommend detailed neurological and neuroradiological evaluation of patients with fibromyalgia in order to exclude compressive cervical myelopathy, a potentially treatable condition.
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PMID:Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications. 1742 87

This article revisits the links between psychopathology and functional gastrointestinal disorders such as irritable bowel syndrome (IBS), discusses the rational use of antidepressants as well as non-pharmacological approaches to the management of IBS, and suggests guidelines for the treatment of IBS based on an interdisciplinary perspective from the present state of knowledge. Relevant published literature on psychiatric disorders, especially somatization disorder, in the context of IBS, and literature providing direction for management is reviewed, and new directions are provided from findings in the literature. IBS is a heterogeneous syndrome with various potential mechanisms responsible for its clinical presentations. IBS is typically complicated with psychiatric issues, unexplained symptoms, and functional syndromes in other organ systems. Most IBS patients have multiple complaints without demonstrated cause, and that these symptoms can involve systems other than the intestine, e.g. bones and joints (fibromyalgia, temporomandibular joint syndrome), heart (non-cardiac chest pain), vascular (post-menopausal syndrome), and brain (anxiety, depression). Most IBS patients do not have psychiatric illness per se, but a range of psychoform (psychological complaints in the absence of psychiatric disorder) symptoms that accompany their somatoform (physical symptoms in the absence of medical disorder) complaints. It is not correct to label IBS patients as psychiatric patients (except those more difficult patients with true somatization disorder). One mode of treatment is unlikely to be universally effective or to resolve most symptoms. The techniques of psychotherapy or cognitive-behavioral therapy can allow IBS patients to cope more readily with their illness. Specific episodes of depressive or anxiety disorders can be managed as appropriate for those conditions. Medications designed to improve anxiety or depression are not uniformly useful for psychiatric complaints in IBS, because the psychoform symptoms that sound similar to those seen in psychiatric disorders may not have the same significance in patients with IBS.
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PMID:Relationship of functional gastrointestinal disorders and psychiatric disorders: implications for treatment. 1746 42

A comparative analysis was carried out of depressive and anxiety disorders in accordance to ICD-10 criteria in the group of patients with pain variant of somatization disorder (SD), vegetative dysfunction (VD) with monolocal pathological body sensations (PBS) and VD with be- and polylocal PBS (analogous of somatoform vegetative dysfunction without of an accent on disturbances of physiological functioning of any organs or system). Results of this analysis compared with frequency of depressive and anxiety symptomatic in the group of patients with depressive episode (DE). As a result of discriminative analysis 20 depressive and anxiety symptoms were established with possibility of determination of mutual distant/near of 4 clinical groups in feature's space. The SD and VD with monolocal PBS groups take place extreme position in the continuum of 4 clinical groups, DE and VD with be- and polylocal PBS - middle position. Pain variant of SD with primary light (rare middle) severe of depressive episode, as a rule, anxiety modality of low mood can be qualified as masked (somatization) depression. VD patients with be- and polylocal PBS were attributed to atypical monopolar depression; depressive episode without pathological body sensations (to the exclusion of possible vitalization of verbalization/no verbalization melancholy affect) occupied middle position in the continuum of monopolar depression as an affective psychosis.
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PMID:[Integrative estimation of depression, anxiety and somatoform disorders]. 1837 93

Somatization disorder is a somatoform disorder that overlaps with a number of functional somatic syndromes and has high comorbidity with major depression and anxiety disorders. Proposals have been made for revising the category of somatoform disorders, for simplifying the criteria for somatization disorder, and for emphasizing the unitary nature of the functional somatic syndromes in future classifications. A review of the cognitive-affective neuroscience of somatization disorder and related conditions suggests that overlapping psychobiological mechanisms mediate depression, anxiety, and somatization symptoms. Particular genes and environments may contribute to determining whether symptoms are predominantly depressive, anxious, or somatic, and there are perhaps also overlaps and distinctions in the distal evolutionary mechanisms that produce these symptoms.
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PMID:Cognitive-affective neuroscience of somatization disorder and functional somatic syndromes: reconceptualizing the triad of depression-anxiety-somatic symptoms. 1849 75

Anxiety or masked depression are often associated with somatisation in elderly. Hypochondriasis is an excessive preoccupation or worry about having a serious illness. The DSM-IV defines it as a somatoform disorder. It affects about 3% of the population but has a heavy health care cost. Depression, obsessive-compulsive disorder generalized anxiety and somatization disorder are common in elderly and are the most common accompanying conditions in people with hypochondriasis. Old persons' unexplained medical symptoms in generalized anxiety and their relationship to the somatoform disorders are presented. Supportive care and psychotherapy are as necessary as antidepressant to help patients.
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PMID:[Hypochondriasis and somatisation in elderly]. 1914 66

Herbal drugs are often used in patients with somatoform disorders yet, the available evidence is limited. The aim of the present short-term study was to evaluate in a pharmaco-clinical trial the additional benefit of butterbur in a fixed herbal drug combination (Ze 185 = 4-combination versus 3-combination without butterbur and placebo) in patients with somatoform disorders.For a 2-week treatment in patients with somatization disorder (F45.0) and undifferentiated somatoform disorder (F45.1), 182 patients were randomized for a 3-arm trial (butterbur root, valerian root, passionflower herb, lemon balm leaf versus valerian root, passionflower herb, lemon balm leaf versus placebo). Anxiety (visual analogue scale - VAS) and depression (Beck's Depression Inventory - BDI) served as primary parameters, Clinical Global Impression (CGI) was a secondary parameter.The 4-combination was significantly superior to the 3-combination and placebo (4-combination > 3-combination > placebo) in all the primary and secondary parameters (PP-population). Analysis of the ITT population confirmed these results. As to safety, no serious adverse events occurred. In total 9 non-serious adverse events were documented but the distribution did not differ significantly between the treatment groups.This herbal preparation (Ze185) showed to be an efficacious and safe short-term treatment in patients with somatoform disorders.
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PMID:Fixed herbal drug combination with and without butterbur (Ze 185) for the treatment of patients with somatoform disorders: randomized, placebo-controlled pharmaco-clinical trial. 1927 98

The objective of this study was to examine the changes in psychiatric symptoms and interpersonal problems in 34 adults with a history of childhood sexual abuse and posttraumatic stress disorder who attended a 3-month inpatient treatment program. Levels of posttraumatic, depressive, and general psychiatric symptoms and interpersonal problems were assessed at pre-care evaluation, admission, discharge, and 1-year follow-up using the Impact of Event Scale, the Beck Depression Inventory, the Symptom Check List 90 Revised, and the Inventory of Interpersonal Problems. Work status was assessed at admission and at follow-up. Significant improvements were seen during treatment on the global scores of all instruments except the Beck Depression Inventory. At follow-up, patients had kept their gains on symptom measures and experienced further progress regarding interpersonal problems. At discharge, 3 of the previously 32 unemployed patients were able to return to work. Patients with comorbid somatization disorder tended to have higher levels of distress and less favorable treatment response. Future studies should include pre- and posttreatment assessment of dissociation to evaluate its association with outcome.
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PMID:Inpatient treatment for adult survivors of childhood sexual abuse: a preliminary outcome study. 1958 39

Functional weakness describes weakness which is both internally inconsistent and incongruent with any recognizable neurological disease. It may be diagnosed as a manifestation of conversion disorder or dissociative motor disorder. Other names include psychogenic or 'non-organic' paralysis. We aimed to describe the incidence, demographic and clinical characteristics of cases with functional weakness of less than 2 years duration, and to compare these with controls with weakness attributable to neurological disease. Both cases and controls were recruited from consultant neurologists in South East Scotland. Participating patients underwent detailed assessments which included: physical examination, structured psychiatric interview (Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders), measures of symptoms, disability and distress [Short Form (36) Health Survey, Hospital and Anxiety Depression Scale], and assessment of their illness beliefs using an augmented version of the Illness Perception Questionnaire. In total, 107 cases (79% female, mean age 39 years, median duration of illness 9 months) were recruited. This number suggests a minimum annual incidence of 3.9/100 000. Forty-six controls (83% female, median age 39 years, duration 11 months) were also recruited. Compared to controls, cases had similar levels of disability but more physical symptoms, especially pain. They had a higher frequency of psychiatric disorders, especially current major depression (32 versus 7%, P < 0.0001), generalized anxiety disorder (21 versus 2%, P < 0.005), panic disorder (36 versus 13%, P < 0.001) and somatization disorder (27 versus 0%, P < 0001). There was no difference in median self-rated anxiety and depression scores. Paradoxically, they were less likely than controls to agree that stress was a possible cause of their illness (24 versus 56%, P < 0.001). Cases were twice as likely as controls to report that they were not working because of their symptoms (65 versus 33%, P < 0.0005). Functional weakness is a commonly encountered clinical problem. Patients with this symptom are as disabled as patients with weakness of similar duration due to neurological disease. There is a paradox between the frequency of depression and anxiety diagnoses and the patient's willingness to accept these as potentially relevant to their symptoms. We discuss the theoretical and practical implications of these findings for the concept of conversion disorder.
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PMID:The symptom of functional weakness: a controlled study of 107 patients. 2039 62

In this study the prevalence and comorbidity of mental disorders were examined for the first time with the Structured Clinical Interview for DSM-IV (SCID-I) in a consecutive sample of Turkish speaking patients (n=51). The symptom severity of the depressiveness was measured with the Beck Depression Inventory (BDI), of the somatoform complaints with the Screening for Somatoform Symptoms (SOMS) and of the posttraumatic stress disorder (PTSD) with the Essen Trauma Inventory (ETI). The most common current diagnoses were the somatization disorder (41.2%; n=21), a single episode of major depression (37.3%; n=19) and the PTSD (31.4%; n=16). In 80.4% (n=41) of the patients at least one comorbid mental disorder was documented. In comparison with German reference values the Turkish patients showed a significant higher severity of the depressive and posttraumatic, however not of the somatoform symptomatology.
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PMID:[Prevalence, comorbidity and severity of psychosomatic disorders in outpatients with Turkish migration background]. 2208 66

Somatoform disorders among children and adolescents may cause impairment in educational and social functioning and generate a great deal of psychosocial distress. The diagnosis of such disorders is complex due to the fact that they may appear as medical conditions. Hence, most of somatoform patients do not seek psychiatric assistance. The common feature of somatoform disorders as described in DSM-IV-TR is the presence of physical symptoms suggesting an underlying medical condition that is either not found or does not account for the level of functional impairment. The diagnostic criteria for the somatoform disorders were established for adults and are applied to children for lack of child-specific research base and a developmentally appropriate alternative system. The most common somatoform disorders in children and adolescents are recurrent abdominal pain and tension headache. Other disorders in the category include: somatization disorder, undifferentiated somatoform disorder, conversion disorder, hypochondriasis and body dysmorphic disorder Treatment is applied through a combination of pharmacotherapy and psychotherapy. SSRI'S are effective in somatoform disorders that have co-morbidity with anxiety and depression as well as in body dysmorphic disorder and hypochondriasis. Conversion disorder is usually treated with benzodiazepines and pain disorder with light analgesics, tricyclics and tegretol. In terms of psychotherapy, treatments most effective for somatoform disorders have been found to be cognitive-behavioral therapy, hypnosis and biofeedback.
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PMID:[Somatoform disorders in children and adolescents]. 2216 50


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