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Objective: To assess the effectiveness of a psycho-educational programme for the primary prevention of somatoform disorders in healthy primary care patients., Methods: Randomized, controlled trial. Participants (N=104) were randomly assigned to: (1) a psycho-educational intervention, or (2) no intervention at all. The primary outcome measure was somatoform disorder psychiatric diagnosis at 5-year follow-up. Secondary outcome measures were hypochondriasis, locus of control and attribution of symptoms and psychological distress., Results: At 3 and 6 months, and 5 years, the intervention group significantly decreased hypochondriasis and somatic attributions; and increased psychological and normalizing attributions and internal locus of control. Five years after baseline, the prevalence of somatoform disorders showed no differences between both groups. Nevertheless, overall psychiatric morbidity was less prevalent in the intervention group (odds ratio: 2.72; 95%CI:1.10-6.72). In addition, a decrease in depression and anxiety subscales and in overall General Health Questionnaire scoring (p<.05) was found in the intervention group., Conclusions: A primary prevention programme for somatization seems to be useful, not to decrease somatoform disorders, but to prevent anxiety and depressive disorders. The effects of overlapping psychobiological mechanisms are discussed., (Copyright 2009 Elsevier B.V. All rights reserved.)

Purpose of Review: Neuroimaging research in psychiatry has been increasing exponentially in recent years, yet many psychiatrists are relatively unfamiliar with this field. This article summarizes the findings of the most relevant research articles on the neuroimaging of somatoform, conversive, and dissociative disorders published from January 2007 through June 2008., Recent Findings: Neuroimaging findings summarized here include alterations of stress regulation and coping in somatoform pain disorders, the importance of catastrophizing in somatization disorder, and the relevance of a history of physical/sexual abuse in irritable bowel syndrome. Regarding fibromyalgia, three of the most significant advances have been the impossibility of differentiating primary and concomitant fibromyalgia in the presence of quiescent underlying disease, the role of hippocampal dysfunction, and the possibility that fibromyalgia may be characterized as an aging process. In dissociative disorders, the high levels of elaborative memory encoding and the reduced size of the parietal lobe are highlighted., Summary: The most promising clinical consequence of these studies, in addition to improving knowledge about the etiology of these illnesses, is the possibility of using neuroimaging findings to identify subgroups of patients, which could allow treatments to be tailored.

Objective: To determine how anxiety, depression, and somatic symptoms are related in a sample of university students in northern Mexico., Methods: An exploratory study was conducted through self-administered questionnaires applied to a convenience sample of 506 psychology students at two universities in Monterrey, in the state of Nuevo León, Mexico. To evaluate somatic symptoms, the Patient Health Questionnaire was used; for depression, the Beck Depression Inventory; and for anxiety, the Social Anxiety Scale for Adolescents. Spearman's correlation was used to determine to what extent the associations among the variables were significant. The Kruskal-Wallis test was used to compare anxiety and depression levels between groups of students organized by severity of somatic symptoms., Results: Of the participants, 129 (25.5%) presented somatic symptoms that were of medium intensity or severe; just 4 (0.8%) had severe depression; and only 2 (0.4%) students presented anxiety levels over 75% of the scale maximum. The severity of somatic symptoms increased in step with anxiety and depression levels. The somatic symptoms occurring most frequently and of greatest concern among the study sample were: headache, menstrual pain, and backache, as well as feeling tired and having difficulty sleeping., Conclusions: The direct association between the severity of somatic symptoms and depression and anxiety was confirmed. It is recommended that all treatment and/or prevention programs addressing one of these conditions, include the other two as well. Programs specifically aimed at university youth should be implemented.

Background: Somatoform disorders are characterized by the presence of multiple somatic symptoms without an organic cause that completely explains their symptoms. These patients generate a high cost in health services. We aim to evaluate the effectiveness and feasibility of a cognitive-behaviour therapy (CBT) programme, administered in group and individual formats in primary care for patients who are diagnosed with abridged somatization disorder., Design: Multicentre, randomized, controlled trial involving 3 groups, one of which is the control group consisting of standardized recommended treatment for somatization disorder in primary care (Smith's norms) and the 2 others, the intervention groups, consisting of cognitive-behavioural therapy (10 sessions) administered in individual format (intervention group 1) or in group format (intervention group 2)., Setting: 29 primary care health centres in the province of Zaragoza and 3 primary care health centres in the province of Mallorca, Spain., Sample: N = 204 patients, (68 in each of the three groups), aged 18-65 years, able to understand and read Spanish, who fulfil Escobar's criteria of Abridgged Somatization Disorder (SSI 4,6), stable with pharmacotherapy over the previous month, and who will remain stable for the next 3 months in the doctor's opinion, having signed informed consent., Control Group: Standardized recommended treatment for somatization disorder in primary care (Smith's norms). INTERVENTION group: 10 weekly sessions of CBT, following a protocol designed by Prof. Escobar's group at UMDNJ, USA. There are 2 different treatment conditions: individual and group format., Measurements: Survey on the use of health services, number and severity of somatic symptoms, anxiety, depression, quality of life and clinical global impression. The interviewers will not know which group the patient belongs to (blind). The assessments will be carried out at baseline, post-treatment, 6 months and 12 post-treatment., Main Variables: Utilization of health services, number and severity of somatic symptoms., Analysis: The analysis will be per intent to treat. We will use the general linear models of the SPSS v.15 statistical package, to analyse the effect of treatment on the result variable (utilization of health services, number and severity of somatic symptoms)., Discussion: It is necessary to develop more effective psychological treatments for somatoform disorders. This randomised clinical trial will determine whether cognitive behaviour therapy, both in group or in individual format, is effective for the treatment of these patients., Trial Registration: Current controlled trials ISRCTN69944771.

Introduction: A assess the efficacy of mirtazapine in the treatment of depression with somatic symptoms in a 3-months follow-up study., Design: multicenter, prospective, observational, open-label, and non controlled study., Sample: seven hundred and eleven patients recruited in outpatient psychiatric consultations by 98 psychiatrists nationwide., Instruments: 17-Item Hamilton Depression Rating Scale (HAMD-17) and Standardized Polyvalent Psychiatric Interview (SPPI), somatic symptoms section. Patients were assessed pretreatment and at 15, 30 and 90 days post-treatment., Results: Severity of depression assessed by HAMD-17 significantly decreased (p<0.0001) from 23.27 in the pretreatment assessment to 6.75 at 3 months post-treatment. Severity of somatic symptoms assessed by EPEP significantly decreased (p<0.0001) from 7.68 in the pre-treatment assessment to 2.28 at 3 months post-treatment. Mirtazapine modifies attribution of somatic symptoms in somatizers: in pretreatment assessment, 41.3 % of the sample attributed somatic symptoms to a psychological origin, while at 3 months post-treatment this percentage significantly increased (p<0.05) to 63.94%. Nearly half of the sample (48.52%) took benzodiazepines at the start of the study; but at 3 months post-treatment only 6.71% of the patients needed them. The incidence of adverse effects was 13.36% of the patients. From the total dropouts 4% were due to adverse events., Conclusions: Mirtazapine is an effective and safe antidepressant for the treatment of depression with somatic symptoms and is able to modify attribution of somatic symptoms in somatizing patients.

Introduction: Somatization disorder (SD) is considered the most valid, reliable and consistent disorder over time from the entire group of somatoform disorders and the most disabling and expensive for the health system. The aim of this paper is to assess the discriminative, attentional and cognitive process in SD patients by auditory-stimulus P300 evoked potential., Design: case-control study., Sample: cases group is made up of 25 patients, selected from the Miguel Servet University Hospital Somatoform Disorder Unit, that fulfill DSM-IV-TR criteria of SD using EPEP psychiatric interview. Twenty-five healthy and volunteer individuals without psychiatric or neurological disorders or history of disease were selected as control group. Both groups were matched by gender and age., Results: Mean P300 latency was significantly (p<0.01) higher in SD patients than in healthy people. The rest of variables studied (N100 latency, P200 latency, P300 amplitude in Pz) did not show any significant differences., Conclusions: SD patients show electrophysiological disturbances in the cognitive process of information.

Multisomatoform disorder (MSD), defined as 3 or more medically unexplained, currently distressing physical symptoms in addition to a long (> or =2 years) history of somatization, is a prevalent and disabling disorder in which few pharmacological trials have been referred to in the literature. Thirty-five MSD patients from the Somatoform Disorders Unit of the Miguel Servet University Hospital, Zaragoza, Spain, with pain of more than 3 months as the main symptom, were treated with topiramate in doses ranging from 300-400 mg/day. Patients were assessed at baseline and at one and six-months follow-up with the McGill Pain Questionnaire (MPQ), Pain Visual Analogue Scale (PVAS), Clinical Global Impresión (CGI), Global Assessment Functioning (GAF) and Hospital Anxiety Depression Scale (HADS). Eight patients (22.8%) dropped from the study, 3 due to side-effects and the other 5 because of lack of efficacy. All the outcome measures showed significant improvements at one-month except the ratings on the Hospital Anxiety Depression Scale. At six-months follow-up, clinician-rated assessments (CGI and GAF) still showed significant differences with baseline but less significant than at one-month follow-up. However, patient-rated assessments (MPQ and PVAS) did not present significant differences with baseline. Despite limitations of the study, topiramate seems to be effective in treating multisomatoform disorder patients with pain as the main symptom and a controlled randomized trial in these patients appears warranted. A possible "decay effect" in patient-rated assessments with any drug in somatoform disorder patients is discussed.

Somatization disorder (SD) patients are difficult to treat and produce negative feelings in health professionals. Smith et al.'s guidelines have demonstrated cost-effectiveness in the treatment of these patients, but family doctors consider it difficult to put these into practice in the long term. The objective of this paper is to design and assess a pilot course, based on Smith's norms, to train general practitioners for the everyday management of SD patients in primary care. We have designed a 20-h practical course, using role-playing and video recording with standardized patients, and focusing on micro-skills recommended by the literature on the subject. Assessment of the efficacy of the course is made by evaluation of baseline and post course video recordings by researchers unaware of the order of the interviews. The comparison of baseline and post course assessments demonstrated a significant improvement in several key skills (giving a name to the illness, explaining the psychological and biological basis of the disease, and emphasizing stress reduction) but no change on others (explaining that SD is a well-known disorder, empowering the patient, not blaming the patient for his or her illness, and instilling hope). Finally, other skills such as assessing the patient's opinion of the illness, recognizing the reality of symptoms and informing that there is no life risk, were correctly done from the beginning and, therefore, showed no change. We found that training may facilitate the development of certain skills. However, some doctors' abilities might also require the use of techniques such as Balint groups to modify negative emotions, such as anger and fear, toward these patients.

Somatisation disorder patients show a high rate of alternative medicine consultations but most of them do not disclose this fact to the doctor owing to fear of reprisals. The reasons given for using these medicines do not equate to sociodemographic characteristics, psychiatric diagnosis or personality traits but instead to dissatisfaction with medical care and with diagnosis. These patients appreciate the longer and more frequent consultations as well as the better doctor-patient relationship of alternative medicines.

Somatizers are a kind of patients very prevalent, expensive for the health system and difficult to treat. In recent years, several treatment approaches, such as cognitive, psychodynamic or educative therapy, have demonstrated effectiveness for the management of these patients. This paper aims to analyze the research studies on group psychotherapy for the treatment of somatizers. Most of these studies are not solid from a methodological point of view. Based on these data, the authors summarize the indications, methodology, limitations and effectiveness of group psychotherapy in the treatment of somatizing patients.

The objective of this paper is to study the prevalence and clinical characteristics of functional, hypochondriacal, and presenting somatization (FSTS, HSTS, and PSTS, respectively) defined by standardized criteria, as well as the validity of their distinction in primary care in Spain. A two-stage epidemiological study of a representative sample (N = 1559) of primary care patients was carried out. In the first phase, the validated Spanish versions of General Health Questionnaire, Mini-Mental State Examination, and CAGE were used. In the second phase, the Standardized Polyvalent Psychiatric Interview, an interview for the multiaxial assessment of medical patients, was employed. The prevalence of any form of somatization in Spain was 21.3% (FSTS: 16.2%, PSTS: 9.4%, HSTS: 6.7%). Overlap of any of the three clinical forms was very frequent (42.7%). FSTS patients tended to be more chronic and showed higher scores in fatigue but lower scores in both depression and anxiety. Chronicity was frequent among somatizers, particularly in those who fulfilled more than one kind of somatization. Differences in diagnostic distribution among the three groups were also observed. In conclusion, this is the first study giving support to the validity of the distinction among three types of somatization in Spain, but overlap was more frequent than reported in North American studies.

The aim of this study was to determine whether attributional style is a stable pattern in somatizers, to analyse the sociodemographic and psychopathological characteristics that can modify it, and to study the relationship between attributional pattern and outcome. A total of 147 somatizers and 46 psychologizers from a representative sample (n = 1559) of primary care patients in Zaragoza, Spain were followed up for 1 year. Attribution of somatic symptoms was a stable construct in somatizers. Patients who modified attribution were younger (by 15 years on average), tended to be without a partner, and had a shorter illness duration (by 20 months on average) than those who maintained it. Attribution showed no correlation with outcome at the 1-year follow-up.

Background: The objectives of the study are to document the frequency of use of the general medical services by psychiatric patients, to measure how many consultations are due to somatization and suicide attempts and to know the existence of possible differences between psychiatric inpatients and outpatients in relation to the reason of medical consultation., Design: retrospective study. Site: Manchester Royal Infirmary, a university third level hospital in Manchester (United Kingdom)., Patients: patients from the psychiatric department seen during the period from July 1st to December 31st in 1992 (n = 1,012 patients)., Results: The percentage of patients that consults a medical/surgical department in one year is 27.5%, 25.2% of outpatients and 36.3% of inpatients. Non-medical reasons are 42.3% of these consultations: 30.4% somatization phenomena and 10.8% suicide attempts. The frequency of somatization in psychiatric patients (30.4%) is similar to that described in non-psychiatric patients. The psychiatric inpatients that are referred to a medical department as inpatients show a significant lower rate of somatization (2.2%) and a higher rate of suicide (35.5%)., Conclusions: On fourth of psychiatric patients consult a medical department in one year and more than 40% of these consultations are not due to somatic diseases. The frequency of somatization in psychiatric patients is similar to the observed in other patients. Psychiatric inpatients that are also medical inpatients in one year constitute a specific high risk group.

The objective of this study was to validate the Spanish version of the Othmer and DeSouza Screening Test for Somatization Disorder. We have designed a validity study using the Standardized Polyvalent Psychiatric Interview, an instrument specifically designed to diagnose psychiatric morbidity in medical settings as the 'golden rule'. The control group displayed 'functional' and 'presenting' somatization. The Othmer and DeSouza Screening Test, with a threshold of three symptoms, shows 88% sensitivity, 78% specificity and a misclassification rate of 17%. It is concluded that Othmer and DeSouza's screening test, with a threshold of three symptoms, is a useful tool for the diagnosis of somatization disorder in medical and primary care settings in Spain. Discrepancies with US findings are discussed on a cross-cultural basis.

A new semistructured instrument, the Standardized Polyvalent Psychiatric Interview or SPPI has been developed primarily for assessing medical patients. It has been built on the Clinical Interview Schedule and is intended to evaluate individuals in a multiaxial schema: psychopathology, including duration and severity of disorder; somatic disturbance; social problems and social supports: and pre-morbid personality, with special emphasis on 'neuroticism'. The SPPI generates enough information to allow the use of different research diagnostic criteria, including DSM-III-R, ICD-10 and Goldberg's criteria of 'attribution' of somatic symptoms and 'relationships between psychiatric and physical disorder'. It also includes a section related to recommended treatment. The new interview fulfils standards of feasibility, face and content validity. An incomplete block design, inter-rater reliability study was carried out with a consecutive sample of 48 out-patients referred to the Psychosomatic-Liaison Service of the University Hospital of Zaragoza. A broad range of agreement coefficients were calculated, the results being quite acceptable (most kappas are in the range from 0.7 to 0.9) and tending to support the procedural validity of the interview.

Introduction. A assessment of the efficacy of mirtazapine in the treatment of depression with somatic symptoms in a 3-months follow-up study. Material and methods. Design: multicenter, prospective, observational, open-label, and non controlled study. Sample: seven hundred and eleven patients recruited in outpatient psychiatric consultations by 98 psychiatrists nationwide. Instruments: 17-Item Hamilton Depression Rating Scale (HAMD-17) and Standardized Polyvalent Psychiatric Interview (SPPI), somatic symptoms section. Patients were assessed pretreatment and at 15, 30 and 90 days post-treatment. Results. Severity of depression assessed by HAMD-17 significantly decreased (p < 0.0001) from 23.27 in the pretreatment assessment to 6.75 at 3 months post-treatment. Severity of somatic symptoms assessed by EPEP significantly decreased (p < 0.0001) from 7.68 in the pre-treatment assessment to 2.28 at 3 months post-treatment. Mirtazapine modifies attribution of somatic symptoms in somatizers: in pretreatment assessment, 41.3 % of the sample attributed somatic symptoms to a psychological origin, while at 3 months post-treatment this percentage significantly increased (p < 0.05) to 63.94%. Nearly half of the sample (48.52%) took benzodiazepines at the start of the study; but at 3 months post-treatment only 6.71% of the patients needed them. The incidence of adverse effects was 13.36% of the patients. From the total dropouts 4% were due to adverse events. Conclusions. Mirtazapine is an effective and safe antidepressant for the treatment of depression with somatic symptoms and is able to modify attribution of somatic symptoms in somatizing patients. [ABSTRACT FROM AUTHOR]