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Objective: The aim of this paper is to investigate how doctors working in primary health care in Latin American address patients with common mental disorders and to investigate how stigma can affect their clinical decisions. Methods: Using a cross-sectional design, we applied an online self-administered questionnaire to a sample of 550 Primary Care Physicians (PCPs) from Bolivia, Brazil, Cuba and Chile. The questionnaire collected information about sociodemographic variables, training and experience with mental health care. Clinicians’ stigmatizing attitudes towards mental health were measured using the Mental Illness Clinicians' Attitudes Scale (MICA v4). The clinical decisions of PCPs were assessed through three clinical vignettes representing typical cases of depression, anxiety and somatization. Results: A total of 387 professionals completed the questionnaires (70.3% response rate). The 63.7% of the PCPs felt qualified to diagnose and treat people with common mental disorders. More than 90% of the PCPs from Bolivia, Cuba and Chile agreed to treat the patients presented in the three vignettes. We did not find significant differences between the four countries in the scores of the MICA v4 stigma levels, with a mean = 36.3 and SD = 8.3 for all four countries. Gender (p = .672), age (p = .171), training (p = .673) and years of experience (p = .28) were unrelated to stigma. In the two multivariate regression models, PCPs with high levels of stigma were more likely to refer them to a psychiatrist the patients with depression (OR = 1.03, 95% CI, 0.99 to 1.07 p<0.05) and somatoform symptoms somatoform (OR = 1.03, 95% CI, 1.00 to 1.07, p<0.05) to a psychiatrist. Discussion: The majority of PCPs in the four countries were inclined to treat patients with depression, anxiety and somatoform symptoms. PCPs with more levels of stigma were more likely to refer the patients with depression and somatoform symptoms to a psychiatrist. Stigmatizing attitudes towards mental disorders by PCPs might be important barriers for people with mental health problems to receive the treatment they need in primary care. [ABSTRACT FROM AUTHOR]

Background: Inattention to symptoms of mental disorders and substance abuse in patients with HIV/AIDS and other at-risk groups, may lead to irreversible damages. The purpose of this study was to compare the psychopathological dimensions in substance abusers with and without HIV/AIDS and healthy matched groups. Methods: In a cross-sectional and analytical study, selected samples (by available, consecutive, and objective methods) were 43 HIV-positive substance abusers, 49 HIV negative substance abusers under methadone maintenance therapy (MMT) in the counseling clinic of Behavioral Diseases and Addiction Abandonment, and 45 ordinary individuals. All of them were evaluated by matched confounding variables via Symptom Checklist-90-Revised (SCL-90-R). Findings: Results indicated a significant difference between these groups in the Global Severity Index (GSI), Positive Symptom Distress Index (PSDI), and Positive Symptom Total (PST) (P < 0.001). Two by two the comparison of the three groups from psychopathological dimensions revealed that substance abusers with HIV/AIDS persistently suffer more mental problems in all dimensions compared with healthy individuals (P < 0.05). In addition, in comparison with HIV negative substance abusers, they also suffer more mental problems in other dimensions, including somatization, interpersonal sensitivity, depression, anxiety, phobia, and psychoticism (P < 0.05). Yet, the difference in paranoid ideation, hostility, and obsessive-compulsive cases was insignificant. Two by two, the comparison between healthy individuals and substance abusers without HIV/AIDS showed higher levels of depression and psychoticism in substance abusers (P < 0.05), but no difference in other dimensions. Conclusion: Comorbidity of substance abuse and HIV diagnosis intensify mental disorder symptoms. Moreover, lack of prevention and implementation of appropriate psychological and psychiatric interventions after substance abuse and HIV lead to extended establishment of mental disorder symptoms. [ABSTRACT FROM AUTHOR]

Somatization disorder (SD) was included as a new syndrome in the DSM-III (APA, 1980), but its removal from the DSM-V as a diagnostic category is more than probable. This work examines the main studies that SD has generated in the last 30 years as regards epidemiology, comorbidity, and associated psychological variables: illness concern, somatosensory amplification, somatic attribution, alexithymia, and neuroticism. The several nosological proposals in the past decade are also revised, as well as the debate that developed until the current DSM-V classification proposals. The radical changes proposed by the DSM-V work group are considered necessary and positive, although two risks of the proposal are also exposed: clustering under the same diagnostic category the current SD and hypochondriasis, and including non-explained and factitious symptoms in the same category. [ABSTRACT FROM AUTHOR]

The expectation that Chinese people present distress somatically is a central prediction of cultural psychopathology and has been the subject of considerable theoretical speculation. At the same time, empirical studies have been infrequent and have yielded mixed results. The authors examined symptom presentation in Chinese (n = 175) and Euro-Canadian (n = 107) outpatients, using spontaneous problem report, structured clinical interview, and symptom questionnaire methods. All 3 methods yielded cross-culturally equivalent somatic and psychological symptom subscales. Chinese outpatients reported more somatic symptoms on spontaneous problem report and structured clinical Interview compared with Euro-Canadians, who in turn reported more psychological symptoms on all 3 methods. The relation between culture and somatic symptom presentation was mediated by a tendency toward externally oriented thinking. Difficulties with identifying emotions or describing them to others did not differ significantly across cultures, supporting a nonpathological interpretation of observed differences. Psychological symptom effects were larger and more consistent than somatic symptom effects; because other studies have confirmed the ubiquity of somatic presentations worldwide, these results suggest that Western psychologization may be more culturally specific than is Chinese somatization. [ABSTRACT FROM AUTHOR]

Much research has recently been conducted on somatoform disorders demonstrating their clinical importance, associated health-service burden and economic cost. These conditions are often comorbid with other mental and physical disorders and particularly prevalent in primary care and general medical settings. Although culture-specific manifestations and variations of somatization occur—it is now accepted that medically unexplained somatic symptoms are a universal phenomenon. The management of somatoform disorders is generally a complex and lengthy process; however, a number of recent studies have demonstrated the effectiveness of short-term treatments such as cognitive behaviour therapy and educational interventions. Despite advances in their understanding and treatment, debate still surrounds the conceptualization and categorization of somatoform disorders, with a number of experts proposing a complete revaluation and reassignment of this diagnostic classification category. The following paper represents a review of recently published literature on frequency, characteristics, conceptualization, impact and management of somatoform disorders. [ABSTRACT FROM AUTHOR]

Focuses on several issues in somatoform disorders. Definition of somatoform disorders; Categories of the disorders; Prevalence of somatoform disorders.

Background: Somatisation is a common and frustrating clinical problem in primary care.Method: Using 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.Results: Somatisation 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.Conclusions: According to these data, standard somatisation disorder diagnoses add little to the prediction of disability/psychopathology beyond the contributions of an abridged construct of somatisation. [ABSTRACT FROM AUTHOR]

The study began with the systematic clinical evaluation of a cross-section of 500 of the clinic's patients. This was followed by a 'blind' follow-up of the index subjects and a 'blind' study of first-degree relatives. The present report deals with the diagnosis of Briquet's syndrome (hysteria, somatisation disorder) at index, at follow-up, and among first-degree relatives. The data indicate that the criteria used for the diagnosis of Briquet's syndrome select patients who show a high degree of diagnostic consistency over many years, although not all patients who meet these criteria at follow-up receive the diagnosis of Briquet's syndrome initially. Most importantly, the diagnostic criteria select cases associated with a strong familial increase in the risk of Briquet's syndrome and in the risk of antisocial personality. Both are increased among first-degree female relatives, while only antisocial personality is increased among first-degree male relatives. [ABSTRACT FROM AUTHOR]

The article presents several studies on the role of psychiatric disorder in parental breakdown. These studies have significance in establishing a role for psychiatric disorder. The authors of these studies selected 50 patients who had Briquet's syndrome and other criteria for somatization disorder. With this, the researchers found that poor parenting had been associated with a specific psychiatric disorder as measured by child abuse or the removal of the child from the home. Furthermore, these studies consider severe parenting problems and some have noted women with depression alone to have parental difficulties.

Hysteria (Briquet's Syndrome) and sociopathy cluster in the same families instead of segregating as independent traits. Assortative mating between hysterics and sociopaths increases the observed similarity between relatives, but the familial association between sociopathy and hysteria remains after taking assortative mating into account. The Multifactorial Model of Disease Transmission with three thresholds related to severity and sex accounts for population and family data about sociopathic men, sociopathic women, and women with hysteria. The data were obtained for 227 first-degree relatives and for 800 subjects in the general population. Depending on the sex of the individual and its severity, the same aetiological process may lead to different, sometimes overlapping, clinical pictures. Specifically, analysis indicates that hysteria in women is a more prevalent and less deviant manifestation of the same process that causes sociopathy in women. [ABSTRACT FROM AUTHOR]

The DSM-III-(R) definition of somatization disorder is too restrictive for use in general practice. A more comprehensive definition, the "somatic symptom index" (SSI) has shown good validity in open populations. However, a definition has to differentiate validly within a population of frequent attenders to be a useful diagnostic instrument in general practice. We studied a threshold of five complaints (nearly identical to the SSI) in 80 Dutch general practice patients. Patients were selected on age (20-44 years), history of back, neck or abdominal complaints, and on frequency of consultation- at least 12 consultations in the previous 3 years, corrected for consultations with compelling somatic reason for encounter. Prevalence of somatization in this group was 45%. Women had a 2 times higher risk of somatization. A relation with age was not found. Somatization was related to depressive complaints (relative risk 2.5) and probably also to anxiety. Somatizing patients consulted their general practitioner more often and had more health problems (especially psychic problems) than non-somatizers. These results support the validity of this definition. The distinction between our definition of somatization and somatization defined as a symptom of psychiatric (e.g. depressive or anxiety) disorder is emphasized. [ABSTRACT FROM AUTHOR]

In a sample of 188 consecutive female psychiatric patients, Briquet's syndrome was found to be associated more closely with the aggregation of both major depression and either panic disorder or agoraphobia than with major depression or panic disorder-agoraphobia alone. These results are consistent with the hypothesis of a shared diathesis underlying some cases of major depression, panic disorder, agoraphobia, and Briquet's syndrome. The author proposes that Briquet's syndrome may represent the most extreme expression of a tendency for a number of physical and psychological syndromes to aggregate. [ABSTRACT FROM AUTHOR]

The article presents a study that describes the clinical features of patients with depressive disorders who were referred to a special hypochondriasis clinic after prolonged general medical evaluation. The study compared 21 patients with similar diagnosis but no somatic symptoms and patients with depressive illnesses developing somatic symptoms. The study found that patients with somatic symptoms have greater similarity between their pattern of symptoms and those of their mothers, poorer marriage relationships and sexual adjustment and a greater chronicity of the current illness compared to patients without somatic symptoms.

We describe the patterns of illness attributed to sorcery among 209 patients who attended a special clinic in south India. Somatisation and conversion disorders accounted for the majority of patients, although several other psychiatric and medical disorders were also seen. Aspects of treatment of such patients in the sociocultural context are discussed. [ABSTRACT FROM AUTHOR]

50 patients with difficult depressive episode without psychotic symptoms were examined: 25 in the structure of bipolar depression of the II type (BD), 25 recurrent depression (RD). Methods: Clinico-psychopathological with the data verification to SCL-90-R, statistic - Mann-Whitney U-test, Spearmen Rank Order Correlations, Wilcoxon Matched Pairs test. Among patients BD, as opposed to the patients RD, the stronger direct correlation interconnection of “depression” and “somatization”, “obsessivness” is defined (r 0,62-0,81). Compared indications of depression level and basical “index of symptoms’ evidence” (p>0,05) in droups, the patients BD as opposed to the patients RD at p< 0,05 the indications of “anxiety” (2,08&1,67), “somatization” (1,97&1,68), “obsessivness” (1,76&1,4) are higher. These data may show the “residual manic equivalent” in the form of somatization, obsessivness symptoms in the structure of the BD depression, its atypical type and differential - diagnostic symptoms with depression in RD structure is identified. The effectiveness of hospital complex therapy of BD patients is estimated. During 56 days the patients got Seroquel therapy in a dose 150-600 mg/day, group behavioral therapy, sociotherapy. Up to the 10th day of the treatment the indications of “anxiety” (p< 0,05), “depression” (p< 0,05), up to 14th day “somatization” (p< 0,05), up to 21st day “obsessivness” (p< 0,05) were reduced. After hospital complex therapy patients got supporting Seroquel therapy in a dose 50-200 mg/day. In catamnesis in 6 months 11 patients were examined, their state was defined as “stably positive”. These data indicate that the complex therapy of bipolar depression of the II type patients, including Seroquel is effective. [Copyright &y& Elsevier]