Search

BackgroundSomatisation is a common and frustrating clinical problem in primary care.MethodUsing structural diagnoses and functional measures, we examined the prevalence and associated features of somatisation disorder defined by three current nosologies and an abridged construct in subjects using primary care services.ResultsSomatisation disorder, diagnosed according to the standard criteria, was found to have a very low prevalence (range 0.06-0.5%), while more than one-fifth of the sample (22%) met the criteria for the abridged diagnosis. There was poor agreement between succeeding versions of the DSM system for identifying cases of somatisation disorder, each system ending up with rather disparate sets of individuals as well as variable levels of psychopathology and disability.ConclusionsAccording to these data, standard somatisation disorder diagnoses add little to the prediction of disability/psychopathology beyond the contributions of an abridged construct of somatisation.

ObjectiveWe examined the prevalence, correlates, and predictive value of an abbreviated somatization index, based on specific symptom thresholds, in primary care patients using services at a university-affiliated clinic.MethodWe interviewed 1456 patients with a survey instrument that included the Composite International Diagnostic Interview (CIDI) to elicit symptoms and diagnoses of several psychiatric disorders as well as demographic information and a measure of disability. Statistical analyses examined the relationship of abridged somatization with physical functioning and various demographic and diagnostic factors.ResultsAbout one fifth of this primary care sample met the abridged somatization criteria. "Somatizers," defined according to these criteria, had significantly higher levels of psychiatric comorbidity and disability than "nonsomatizers". Analyses taking into account the number and type of organ/body systems represented by the unexplained symptoms showed that this dimension adds specificity to the prediction of outcomes. Thus, regardless of the total number of medically unexplained symptoms, abridged somatization with unexplained symptoms attributable to four or more organ/body systems showed the strongest association with disability and psychopathology.ConclusionsAbridged Somatization is a frequent syndrome in primary care that is strongly associated with psychopathology and physical disability. Our research also yielded a new series of abridged somatization subtypes (eg, "discrete" vs. "comorbid" and "simple" vs. "polymorphous") that may effectively separate among various psychopathologies, and may become useful tools for future research with somatizing patients.

The object of this study was to assess the prevalence and correlates of the DSM-IV diagnosis of hypochondriasis in a primary care setting. A large sample (N = 1456) of primary care users was given a structured interview to make diagnoses of mood, anxiety, and somatoform disorders and estimate levels of disability. The prevalence of hypochondriasis (DSM-IV) was about 3%. Patients with this disorder had higher levels of medically unexplained symptoms (abridged somatization) and were more impaired in their physical functioning than patients without the disorder. Of the various psychopathologies examined, major depressive syndromes were the most frequent among patients with hypochondriasis. Interestingly, unlike somatization disorder, hypochondriasis was not related to any demographic factor. Hypochondriasis is a relatively rare condition in primary care that is largely separable from somatization disorder but seems closely intertwined with the more severe depressive syndromes.

Emotions are essential drivers of the learning process, influencing motivation, performance, and problem-solving abilities. In the field of Computer Science, students often struggle with negative emotions during programming activities, impacting their performance and project quality. To address this challenge, there is a growing need to introduce Computational Thinking skills at the pre-university level. This study focuses on understanding the emotions experienced by primary and secondary school students during Computational Thinking activities, involving both plugged and unplugged tools. A significant performance difference was observed between primary and secondary education levels, with the latter outperforming the former. The research identifies specific associations between concepts and emotions, highlighting age-related differences with younger students exhibiting more positive emotions. While gender-based disparities in Computer Science perception exist in secondary education, there are no corresponding distinctions in emotional responses. The study reveals a gender-based effect, with girls showing reduced emotional responses and lower Computational Thinking performance than boys. In summary, this research underscores the profound role of emotions in learning, providing essential insights for tailoring educational strategies considering gender-specific and programming concept-related factors. It also connects lower emotional reactions to inferior results, emphasizing the importance of heightened emotional engagement.

SCHOOLTHY: Automatic Menu Planner for Healthy and Balanced School Meals is a decision support tool that addresses the multi-objective menu planning problem in order to automatically produce meal plans for school canteens. Malnutrition is a widespread problem nowadays and is particularly serious when it affects children. In our environment, nutrition experts design healthy and balanced meal plans for children manually, which leaves significant room for improvement in terms of convenience and efficiency. SCHOOLTHY is presented herein as a proposal to improve and facilitate the work of these professionals. We focus on offering healthy and balanced meal plans that not only satisfy the recommended energy and nutrient intakes, but that also have a minimum cost and maximum variety of courses and food groups. Quantitative analyses that compare the meal plans yielded by SCHOOLTHY for meal plans designed by experts at hand and served in regional schools demonstrate the suitability of the proposal. Finally, we note that, thanks to its flexibility, SCHOOLTHY might be easily adapted to deal with other environments, such as hospitals, prisons and retirement homes, among others.

Objective: The goal of this study was to examine relationships among serious mental illness, general physical symptoms, and use of mental health services among persons presenting for admission at a community-based mental health center.Methods: Number and type of physical symptoms were assessed during the routine intake process. Individuals (N=1,022) were screened by phone with a modified version of the Physical Health Questionnaire-15. Diagnostic, demographic, and treatment information was tracked prospectively. Data were analyzed for 682 individuals who kept at least one appointment. Analyses examined associations among physical symptoms, diagnosis, and service use over time.Results: A total of 481 patients (71%) reported three or more physical symptoms. Patients with three or more physical symptoms were significantly older (p<.013), were more likely to be female (p<.001) and Spanish speaking (p<.05), and used significantly more services (p<.001) than did those with fewer physical symptoms. Both the number and the costs of services increased with the number of physical symptoms presented at intake. Patients with major depressive disorder were as likely as patients with schizophrenia or bipolar disorder to report having three or more physical symptoms.Conclusions: Within a mental health community-based population, most incoming clients with serious mental illness reported three or more physical symptoms. The number of reported physical symptoms was a significant predictor of mental health service use and cost over the episode of care, even after analyses controlled for confounders such as gender, age, and diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Little information is available about accuracy of diagnoses in clinical care for affective and other major mental disorders experienced by Latino patients. This study addressed two central research questions: Do Latinos have disproportionate rates of clinical diagnoses of major depression based on structured diagnostic interviews? Are diagnostic patterns consistent with patient profiles and medical record information?Methods: A total of 259 bilingual Latino, monolingual English-speaking Latino, and Euro-American patients aged 18 to 45 years with a history of severe depression or psychotic symptoms were compared across three clinical sites by using structured interviews.Results: Compared with Euro-Americans, bilingual Latinos had significantly higher rates of major depression and significantly lower levels of mania. No significant differences were found between monolingual English-speaking Latinos and Euro-Americans.Conclusions: Results suggest that the diagnostic process is affected by an apparent association with cultural-linguistic influences, notably speaking English as a second language. [ABSTRACT FROM AUTHOR]

Objective: Despite the demonstrated efficacy of psychosocial approaches to schizophrenia treatment that include a psychoeducational component, such as illness management, the implementation of these approaches into routine mental health treatment has been slow. The authors sought to examine the efficacy of a comprehensive, modularized, psychoeducational program called Team Solutions, which was designed to educate patients with major mental illnesses about their illness and how to manage it. Team Solutions was chosen for study because it is available over the Internet and other venues at no cost and is used by mental health agencies across the United States and Canada.Methods: Seventy-one persons with schizophrenia or schizoaffective disorder from three day treatment settings participated in this randomized, single-blind study. Participants were randomly assigned to attend one of two interventions: the Team Solutions intervention, which consisted of participating in a 24-week psychoeducational group focused on illness management, or treatment as usual.Results: For participants who attended the experimental group, significant improvement was observed in knowledge about schizophrenia. In addition, client satisfaction was high. However, no changes were observed in symptoms or functioning.Conclusions: Results indicated that participation in the Team Solutions psychoeducational group improved participants' knowledge. However, participation in the program did not demonstrate superiority over treatment as usual with respect to secondary and tertiary outcomes, such as symptom severity, treatment adherence, and global functioning. [ABSTRACT FROM AUTHOR]

The transformation of traditional education into a Sensitive, Manageable, Adaptable, Responsive and Timely (SMART) education involves the comprehensive modernisation of all educational processes. For such a transformation, smart pedagogies are needed as a methodological issue while smart learning environments represent the technological issue, both having as an ultimate goal to cultivate smart learners. Smart learners need to develop 21st century skills so that they can become into smart citizens of our changing world. Technology and computers are an essential aspect for this modernisation, not only in terms of technological support for smart environments but also in terms of offering new methodologies for smart pedagogy and the development of smart skills. In this context, computational thinking appears as a promising mechanism to encourage core skills since it offers tools that fit learners’ interests and gives them the possibility to better understand the foundations of our ICT-based society and environments. In this work, we raise to make an effort to encourage the development of computational thinking as an opportunity to transform traditional pedagogies to smarter methodologies. We provide a general background about computational thinking and analyse the current state-of-the-art of smart education, emphasizing that there is a lack of smart methodologies which can support the training of 21st century smart skills. Finally, we provide —to those educators interested in pursuing the philosophy of smart education— information about initiatives devoted to the dissemination or promotion of computational thinking; existing tools or materials which support educators for the development of computational thinking among the students; and previous experiences and results about the application of computational thinking in educational environments.

A multi-objective formulation of the Menu Planning Problem, which is termed the Multi-objective Menu Planning Problem, is presented herein. Menu planning is of great interest in the health field due to the importance of proper nutrition in today’s society, and particularly, in school canteens. In addition to considering the cost of the meal plan as the classic objective to be minimized, we also introduce a second objective aimed at minimizing the degree of repetition of courses and food groups that a particular meal plan consists of. The motivation behind this particular multi-objective formulation is to offer a meal plan that is not only affordable but also varied and balanced from a nutritional standpoint. The plan is designed for a given number of days and ensures that the specific nutritional requirements of school-age children are satisfied. The main goal of the current work is to demonstrate the multi-objective nature of the said formulation, through a comprehensive experimental assessment carried out over a set of multi-objective evolutionary algorithms applied to different instances. At the same time, we are also interested in validating the multi-objective formulation by performing quantitative and qualitative analyses of the solutions attained when solving it. Computational results show the multi-objective nature of the said formulation, as well as that it allows suitable meal plans to be obtained.

One of the main components of most modern Multi-Objective Evolutionary Algorithms (MOEAs) is to maintain a proper diversity within a population in order to avoid the premature convergence problem. Due to this implicit feature that most MOEAs share, their application for Single-Objective Optimization (SO) might be helpful, and provides a promising field of research. Some common approaches to this topic are based on adding extra—and generally artificial—objectives to the problem formulation. However, when applying MOEAs to implicit Multi-Objective Optimization Problems (MOPs), it is not common to analyze how effective said approaches are in relation to optimizing each objective separately. In this paper, we present a comparative study between MOEAs and Single-Objective Evolutionary Algorithms (SOEAs) when optimizing every objective in a MOP, considering here the bi-objective case. For the study, we focus on two well-known and widely studied optimization problems: the Knapsack Problem (KNP) and the Travelling Salesman Problem (TSP). The experimental study considers three MOEAs and two SOEAs. Each SOEA is applied independently for each optimization objective, such that the optimized values obtained for each objective can be compared to the multi-objective solutions achieved by the MOEAs. MOEAs, however, allow optimizing two objectives at once, since the resulting Pareto fronts can be used to analyze the endpoints, i.e., the point optimizing objective 1 and the point optimizing objective 2. The experimental results show that, although MOEAs have to deal with several objectives simultaneously, they can compete with SOEAs, especially when dealing with strongly correlated or large instances.

The polymyxin antibiotic colistin shows in vitro activity against Stenotrophomonas maltophilia. However, an increased incidence of colistin-resistant isolates has been recently observed. In addition, in vitro evaluation of colistin susceptibility for this organism has been problematic. The aims of this study were to investigate the colistin-resistance phenotypes displayed by S. maltophilia and their potential association with the challenging determination of colistin susceptibilities for this organism by even the recommended method. Colistin-resistance phenotypes were inferred by use of the recommended broth microdilution method in different clinical isolates of S. maltophilia. Most of the strains showed non-interpretable minimum inhibitory concentrations (MICs) for colistin due to an incomplete growth inhibition in wells of the microdilution plate. In addition, the subpopulation of bacteria resistant to colistin showed an increased ability to form biofilms on the plastic surface of MIC plates. The observed incomplete growth inhibition in the microdilution plates is compatible with a progressive adaptation to colistin or a heterogeneous susceptibility to this antibiotic. Therefore, to determine the existence of heteroresistance or adaptive resistance, four colistin-resistant clinical isolates were subjected to serial Etest assays, growth rate analyses, and the population analysis profile test. The experiments indicated that these S. maltophilia isolates display a colistin-resistant sub-population that survives and multiplies in the presence of the antibiotic. Interestingly, this phenomenon might not be explainable by the natural background mutation rate alone since the development of a resistant sub-population occurred upon the contact with the antibiotic and it was reversible. This complex colistin-resistance phenotype is exhibited differently by the different isolates and significantly affected colistin susceptibility testing. Furthermore, it can coexist with adaptive resistance to colistin as response to pre-incubation with sub-inhibitory concentrations of the antibiotic. Overall, the combined action of heterogeneous colistin-resistance mechanisms in S. maltophilia isolates, including colistin-induced biofilm formation, may hamper the correct interpretation of colistin susceptibility tests, thus having potentially serious implications on antimicrobial-therapy decision making.

Background: In healthcare, inadequate communication among providers and insufficient information transmission represent primary contributors to adverse events, particularly in medical specialties such as obstetrics and gynecology. The implementation of SBAR (Situation-Background-Assessment-Recommendation) has been proposed as a standardized communication tool to enhance patient safety. This study aims to evaluate the knowledge, attitudes, and practices related to SBAR communication through a pilot study conducted in a middle-income country., Methods: This prospective longitudinal study took place in the gynecology-obstetrics department of a Tunisian university hospital from May to June 2019. All medical and paramedical staff underwent comprehensive theoretical and practical training through a 4-hour SBAR simulation. To gauge participants' knowledge, anonymous multiple-choice questionnaires were administered before the training initiation, with a second assessment conducted at the end of the training to measure satisfaction levels. Two months later, the evaluation utilized questionnaires validated by the French National Authority for Health (HAS)., Results: Among the 62 care staff participants in this study, a majority (89%) demonstrated a low level of knowledge regarding the SBAR tool. The majority (75.8%) expressed enjoyment with the training and indicated their intention to implement changes in their practice by incorporating the SBAR tool in the future (80.7%). Notably, over half of the participants (79%) expressed satisfaction with the training objectives, and 74% reported acquiring new information. Evaluation of the practice revealed positive feedback, particularly in terms of clarity, the relevance of communication, and the time spent on the call., Conclusion: Our pilot study showed that the majority of professionals on the ward had little knowledge of the SBAR tool, a good attitude and a willingness to put it into practice. It is essential that healthcare managers and professionals from all disciplines work together to ensure that good communication practice is developed and maintained. Organisations, including universities and hospitals, need to invest in the education and training of students and health professionals to ensure good quality standardised communication., (© 2024. The Author(s).)

Uterine rupture is a life-threatening obstetric complication. The purpose of this study was to investigate the epidemiological features, maternal and foetal prognosis and different treatment options for uterine rupture in healthy and scarred uteri. We conducted a retrospective monocentric descriptive and analytical study of 60 cases of uterine rupture collected in the Department of Gynaecology-Obstetrics of the Center of Maternity and Neonatology, Monastir, from 2017 to 2021. Patients were classified according to the presence or absence of a uterine scar. Sixty patients were enrolled in the study. The majority of cases of rupture occurred in patients with scarred uterus (n=55). The most common clinical sign was abnormal foetal heart rate. No maternal deaths were recorded and perinatal mortality rate was 11%. Mean BMI, fetal macrosomia rate and mean parity were significantly higher in the healthy uterus group than in the scarred uterus group (p=0.033, 0.018, and 0.013, respectively). The maternal complications studied (post-partum haemorrhage, hysterectomy, blood transfusion, prolonged hospitalisation) were significantly more frequent in patients with unscarred uterine rupture (p=0.039; p=0.032; p=0.009; p=0.025 respectively). Uterine rupture is a life-threatening obstetrical event for the foetus and the mother. Fetal heart rate abnormality is the most common sign associated with uterine rupture. Management is based on conservative treatment in most cases. Patients with scarred uterus have a better prognosis., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts., (Copyright: Imen Ben Farhat et al.)

Background Burns continue to be a serious public health problem in India. It persists as an endemic disease in spite of implementing various preventive measures at the individual and community levels. Etiology and factors influencing burns are varied. There is a paucity of data regarding the clinico-demographic profile of burns disease, especially from emergency tertiary care settings in India. Objective To assess the proportion of burn patients having longer hospital stays (>1 week) and the influence of clinico-demographic factors associated with it among the burn patients presenting to the emergency department of a tertiary care institute in south India. Methodology An institution-based cross-sectional analytical study was conducted among burns patients attending the Emergency Medicine Department (EMD) of a tertiary care center between January 2017 and December 2017. Information on clinico-demographic profile and duration of hospital stay were captured using semi-structured data collection proforma. Results All the 327 burns injury patients who presented to our EMD during the study period were included. Among the 327 patients, 259 (79%) were admitted to the EMD. Among 259 admitted patients, 142 (55%) patients were discharged home. Among these 142 patients, 106 (74.6%; 95%CI 66.8-81.2) had longer hospital stays (more than one week). Female gender and facial/inhalational burns were found to have an independent effect on the length of hospital stay even after adjusted analysis. Conclusion Length of hospital stay is independently influenced by female gender and facial/inhalational burns. This study also identified the need for better home safety, child-proofing, proper pre-hospital care, and dedicated burns units in the community., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mahalingam et al.)

There is a lower incidence of suicide in the Philippines compared to other developed/developing countries, but the trend has been increasing. This study aims to identify the correlates of suicide attempts in Filipino youth using the World Health Organization's 2015 Global School-Based Health Survey. All schools in the Philippines with grades 7-10 were included. A stratified sampling design was used, and participants were randomly sampled. Of the 8,761 students who participated in the survey, 16.2% have attempted suicide at least once in the past 12 months. The factors that increased the risk of suicide attempts include female gender, being physically attacked, getting bullied, feeling lonely, poor sleep, having few close friends, smoking, alcohol use, less physical activity, use of amphetamine/methamphetamine, and less parental supervision. The use of methamphetamine/amphetamine is the single best risk factor of suicide attempts among Filipino youth with OR= 4.6; 95% CI [3.8, 5.6]., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Lagman et al.)

It is now well documented that schizophrenia is associated with impairments in visual processing at all levels of vision, and that these disturbances are related to deficits in multiple higher-level cognitive and social cognitive functions. Visual remediation methods have been slow to appear in the literature as a potential treatment strategy to target these impairments, however, in contrast to interventions that aim to improve auditory and higher cognitive functions in schizophrenia. In this report, we describe a National Institute of Mental Health (NIMH)-funded R61/R33 grant that uses a phased approach to optimize and evaluate a novel visual remediation intervention for people with schizophrenia. The goals of this project are: (1) in the R61 phase, to establish the optimal components and dose (number of sessions) of a visual remediation intervention from among two specific visual training strategies (and their combination) for improving low and mid-level visual functions in schizophrenia; and (2) in the R33 phase, to determine the extent to which the optimal intervention improves not only visual processing but also higher-level cognitive and role functions. Here we present the scientific background for and innovation of the study, along with our methods, hypotheses, and preliminary data. The results of this study will help determine the utility of this novel intervention approach for targeting visual perceptual, cognitive, and functional impairments in schizophrenia., Competing Interests: CONFLICTS OF INTEREST The authors declare that they have no conflicts of interest.

Intraoperative search for the sentinal node using patent blue is considered a non risk procedure. We emphasize the highly exceptional nature of this adverse effect previously observed in other disciplines using this coloring agent. We present a case of allergic reaction to patent blue in a patient who underwent left mastectomy with sentinel lymph node. About 25 min after the dye injection, the patient developed increased heart frequency and allergic skin reaction. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. The patient recovered uneventfully and was discharged from the PACU 3h after the end of surgery without skin changes and was discharged from hospital on the morning after surgery. Allergic reactions with the use of patent blue are far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye. Skin tests done later confirmed allergy to patent blue dye; the tests induced a small syndrome reaction. Surgical personnel who use patent blue dye should be made aware of the risk of allergic reactions, sometimes severe, to this dye., Competing Interests: The authors declare no competing interest.

Objective: Negative health consequences of smoking have prompted many correctional facilities to become tobacco free, including the New Jersey Department of Corrections, and this study examined the results of implementing tobacco-free policies., Methods: Mortality rates in the total population of inmates and in a subgroup with identified special mental health needs or mental illnesses (referred to in this article as persons with special needs) were measured from January 2005 through June 2014, a period during which tobacco use was significantly reduced and then eliminated., Results: The total mortality rate of all causes of death combined was three times higher for persons with special needs in 2005 compared with those without special needs. The total annual mortality rate decreased by 13%, from 232 to 203 per 100,000 population between 2005 and 2013. The mortality rate for persons identified as having special needs decreased by 48%, from an average of 676 per 100,000 population over the eight-year period before the ban to 353 per 100,000 in the 18 months after the ban. Reduced mortality among persons with special needs between 2005 and 2014 in half-year increments was correlated with the reduction and elimination of tobacco products (median bootstrapped Pearson r=.60, 95% confidence interval [CI] =.21 to .86). In strong contrast, however, the bootstrapped correlation between the mortality rate of persons not identified as having special needs and tobacco sales over the same period was not significant (median Pearson r=-.13, CI=-.50 to .28). No other major medical intervention occurred during these years., Conclusions: This striking correlation of quick and substantial reduction of mortality among individuals with a mental illness in association with the reduction and subsequent ban of smoking suggests that smoking may play a major role in the reduced life span of persons with mental illness.

Objective: Although many studies have reported higher rates of trauma exposure and posttraumatic stress disorder (PTSD) among persons with severe mental illness, the screening, diagnosis, and treatment of PTSD in public mental health centers remain at a suboptimal level and PTSD is often overlooked and untreated. This study used routine PTSD screening and service use data in electronic medical records to determine the association of PTSD, psychiatric symptoms, and service use in a sample of individuals with serious mental illness in a community-based treatment setting., Methods: The sample included 1,834 active clients between January 2007 and November 2010 who were screened for PTSD and who completed the 24-item Behavior and Symptom Identification Scale (BASIS-24). Service data included services provided a year before and a year after the screening date., Results: PTSD was associated with more severe psychiatric symptoms and increased no-show rates but not with increased service use or use of high-intensity services. PTSD likelihood interacted with race in accounting for elevated scores among African Americans on the psychosis domain of the BASIS-24., Conclusions: PTSD screening is feasible and recommended in service environments and may contribute significantly to better understanding of racial-ethnic and other differences in service use and diagnostic practices.

Objective: This study investigated concordance between self-perceived and measured weight status for persons with serious mental illness., Methods: A total of 586 mental health clients assessed their weight as underweight, normal, overweight, or obese. The agreement between these self-assessments and the same categories based on measured body mass index was related to gender, ethnicity, education, age, and psychiatric diagnosis., Results: Three hundred consumers (51%) underestimated their weight (they thought they weighed less than they did); only 35 (6%) overestimated it. In logistic regression analyses, gender, education, and psychiatric diagnosis showed significant effects on accuracy of self-perception, but ethnicity and age did not., Conclusions: People with serious mental illness are more likely than others to have weight problems, which contribute to higher rates of morbidity and mortality. However, they also tend to underestimate their weight. This gap between reality and self-perception must be addressed.

Objective: To evaluate the prevalence and role of psychiatric comorbidity and other psychological factors in patients with chronic Lyme disease (CLD)., Methods: We assessed 159 patients drawn from a cohort of 240 patients evaluated at an academic Lyme disease referral center. Patients were screened for common axis I psychiatric disorders (e.g., depressive and anxiety disorders); structured clinical interviews confirmed diagnoses. Axis II personality disorders, functional status, and traits like negative and positive affect and pain catastrophizing were also evaluated. A physician blind to psychiatric assessment results performed a medical evaluation. Two groups of CLD patients (those with post-Lyme disease syndrome and those with medically unexplained symptoms attributed to Lyme disease but without Borrelia burgdorferi infection) were compared with 2 groups of patients without CLD (patients recovered from Lyme disease and those with an identifiable medical condition explaining symptoms attributed to Lyme disease)., Results: After adjusting for age and sex, axis I psychiatric disorders were more common in CLD patients than in comparison patients (P = 0.02, odds ratio 2.64, 95% confidence interval 1.30-5.35), but personality disorders were not. Patients with CLD had higher negative affect, lower positive affect, and a greater tendency to catastrophize pain (P < 0.001) than comparison patients. All psychological factors except personality disorders were related to level of functioning. A predictive model based on these psychological variables was confirmed. Fibromyalgia was diagnosed in 46.8% of CLD patients., Conclusion: Psychiatric comorbidity and other psychological factors distinguished CLD patients from other patients commonly seen in Lyme disease referral centers, and were related to poor functional outcomes.

Clusters of medically unexplained physical symptoms have been referred to in the literature by many different labels, including somatization, symptom-based conditions, and functional somatic syndromes, among many others. The traditional medical perspective has been to classify and study these symptoms and functional syndromes separately. In psychiatry, current taxonomies (Diagnostic and Statistical Manual of Mental Disorder, 4th edition, and The International Statistical Classification of Diseases and Related Health Problems, 10th revision) classify these syndromes together under the rubric of somatoform disorders. In this article we approach medically unexplained physical symptoms from a psychiatric perspective and discuss the common features that unite multiple unexplained symptoms or functional somatic syndromes as a class. Included in this article is a discussion of nosological issues, clinical assessment, how these syndromes are viewed within the various medical specialties, and clinical management and treatment.