Dataset Information

The Theoretical Construction of a Classification of Clinical Somatic Symptoms in Psychosomatic Medicine Theory.

ABSTRACT:

Objective

This article adopts the perspective of psychosomatic medicine to present and test a theoretical model of the classification of clinical somatic symptoms. The theoretical model consists of four dimensions: emotional somatic symptoms, biological somatic symptoms, imaginative somatic symptoms, and cognitive somatic symptoms.

Method

A clinical somatic symptom classification scale was developed according to the theoretical model. A total of 542 participants completed the clinical somatic symptoms classification scale. The data were analyzed using exploratory and confirmatory factor analyses.

Results

The results confirmed the theoretical model. The analyses found that the proposed theoretical structure of the scale was good, as indicated by factor loadings and fit indices, and that the scale had good reliability and construct validity.

Conclusions

Based on the interpretation of the clinical symptoms of psychosomatic medicine, the treatment of chronic non-infectious diseases includes at least three dimensions: the first is the etiological treatment, the second is the pathophysiological and pathopsychological dimension, and the third is symptomatic treatment. The unified psychosomatic point of view and diverse clinical thinking modes are aimed at identifying different classes of somatic symptoms and important prerequisites for the treatment of these symptoms. We registered the study with the Chinese Clinical Trial Registry and it was approved by the West China Hospital, Sichuan University ethics committee.

Trial registration

The registration number is ChiCTR-OCS-14004632 (time: 2014-05-12).

SUBMITTER: Zeng F

PROVIDER: S-EPMC4985123 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Publications

The Theoretical Construction of a Classification of Clinical Somatic Symptoms in Psychosomatic Medicine Theory.

Zeng Fanmin F Sun Xueli X Yang Bangxiang B Shen Hong H Liu Ling L

PloS one 20160815 8

<h4>Objective</h4>This article adopts the perspective of psychosomatic medicine to present and test a theoretical model of the classification of clinical somatic symptoms. The theoretical model consists of four dimensions: emotional somatic symptoms, biological somatic symptoms, imaginative somatic symptoms, and cognitive somatic symptoms.<h4>Method</h4>A clinical somatic symptom classification scale was developed according to the theoretical model. A total of 542 participants completed the clin ...[more]

PMID: 27525701

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Project description:ObjectivesTo explore the perceived working mechanisms of psychosomatic therapy according to patients with persistent somatic symptoms (PSS) and their psychosomatic therapists.DesignQualitative study using semistructured face-to-face interviews and focus groups. All interviews were audiorecorded, transcribed verbatim and analysed, by two researchers independently, based on the thematic analysis.SettingAlongside a randomised controlled trial to establish the (cost-)effectiveness of psychosomatic therapy in patients with PSS in primary care, we conducted a process evaluation with a qualitative study. Patients were recruited in general practice in three regions in the Netherlands.ParticipantsInterviews were conducted with twenty patients with PSS who received psychosomatic therapy and 25 psychosomatic therapists. In addition, two focus groups were conducted with six and seven psychosomatic therapists, respectively.InterventionPsychosomatic therapy, delivered by specialised exercise and physical therapists, is a multimodal and tailored treatment based on the biopsychosocial model.Outcome measuresExperiences, opinions and views from patients' and therapists' perspective on psychosomatic therapy were identified.ResultsA total of 37 interviews with patients, 25 interviews and two focus groups with therapists were analysed. Three main themes emerged from the data of the patients: (1) continuous alternation of psychosocial conversations and body-oriented exercises; (2) awareness of body-mind connection and (3) good relationship with therapist. Four main themes emerged from the data of the therapists (1) building rapport; (2) continuously searching for common ground; (3) making patients aware of the interaction between body and mind; and (4) continuous alternation between exploration and treatment.ConclusionAccording to patients as well as therapists, the continuous alternation of psychosocial conversations and body-oriented exercises to provide awareness of the interaction between body and mind are the perceived working mechanism of psychosomatic therapy. Therapeutic alliance and finding common ground between patient and therapist are prerequisites for the success of psychosomatic therapy.Trial registration numberNL7157 (NTR7356).

Project description:ObjectiveThe aim of this study is to investigate the psychometric characteristics of outpatients diagnosed with somatic symptom disorder (SSD) in biomedical, Traditional Chinese Medicine (TCM) and psychosomatic settings.Materials and methodsA total of 697 participants who completed SCID-5 and questionnaires were presented in our former study, as 3 of them had missed questionnaire data, a total of 694 participants are presented in this study. A secondary analysis of the psychometric characteristics of Somatic Symptom Disorder-B Criteria Scale (SSD-12), Somatic Symptom Severity Scale of the Patient-Health Questionnaire (PHQ-15), Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) is done to compare differences among outpatients from the three settings of medical specialties.ResultsBased on the DSM-5 criteria, 90 out of 224 (40.2%) participants enrolled in biomedical departments (represented by neurology and gastroenterology departments), 44/231 (19.0%) in TCM departments, and 101/239 (42.3%) in the psychosomatic medicine departments were diagnosed with SSD. The scores of PHQ-15 in the biomedical, TCM and psychosomatic settings were 11.08 (± 4.54), 11.02 (± 5.27) and 13.26 (± 6.20); PHQ-9 were 10.43 (± 6.42), 11.20 (± 5.46) and 13.42 (± 7.32); GAD-7 were 8.52 (± 6.22), 9.57 (± 5.06) and 10.83 (± 6.24); SSD-12 were 22.26 (± 11.53), 22.98 (± 10.96) and 25.03 (± 11.54) respectively. The scores of PHQ-15, PHQ-9 and GAD-7 in SSD patients were significantly higher in psychosomatic departments than that in biomedical settings (p < 0.05). The cutoff point for SSD-12 was ≥16 in total patients; 16, 16, 17 in biomedical, TCM and psychosomatic settings, respectively. The cutoff point for PHQ-15 was found to be ≥8 in total patients; 8, 9, 11 in biomedical, TCM and psychosomatic settings, respectively.ConclusionSSD patients from psychosomatic departments had higher level of somatic symptom severity, depression and anxiety than from TCM and biomedical settings. In our specific sample, a cutoff point of ≥16 for SSD-12 could be recommended in all three settings. But the cutoff point of PHQ-15 differs much between different settings, which was ≥8, 9, and 11 in biomedical, TCM, and psychosomatic settings, respectively.

Project description:ObjectivePersistent somatic symptoms (PSSs) are defined as symptoms not fully explained by well-established pathophysiological mechanisms and are prevalent in up to 10% of patients in primary care. The present study aimed to explore methods to identify patients with a recognisable risk of having PSS in routine primary care data.DesignA cross-sectional study to explore four identification methods that each cover part of the broad spectrum of PSS was performed. Cases were selected based on (1) PSS-related syndrome codes, (2) PSS-related symptom codes, (3) PSS-related terminology and (4) Four-Dimensional Symptom Questionnaire scores and all methods combined.SettingCoded electronic health record data were extracted from 76 general practices in the Netherlands.ParticipantsPatients who were registered for at least 1 year during 2014-2018, were included (n=169 138).Outcome measuresIdentification methods were explored based on (1) PSS sample sizes and demographics, (2) presence of chronic conditions and (3) healthcare utilisation (HCU) variables. Overlap between methods and practice specific differences were examined.ResultsThe percentage of cases identified varied between 0.3% and 7.0% across the methods. Over 58.1% of cases had chronic physical condition(s) and over 33.8% had chronic mental condition(s). HCU was generally higher for cases selected by any method compared with the total cohort. HCU was higher for method B compared with the other methods. In 26.7% of cases, cases were selected by multiple methods. Overlap between methods was low.ConclusionsDifferent methods yielded different patient samples which were general practice specific. Therefore, for the most comprehensive data-based selection of PSS cases, a combination of methods A, C and D would be recommended. Advanced (data-driven) methods are needed to create a more sensitive algorithm for identifying the full spectrum of PSS. For clinical purposes, method B could possibly support screening of patients who are currently missed in daily practice.

Project description:BackgroundThe origin of Narrative Medicine dates back to more than 20 years ago at an international level. Narrative Medicine is not an alternative to evidence-based medicine, however these two approaches are integrated. Narrative Medicine is a methodology based on specific communication skills where storytelling is a fundamental tool to acquire, understand and integrate several points of view related to persons involving in the disease and in the healthcare process. Narrative Medicine, henceforth NM, represents a union between disease and illness between the doctor's clinical knowledge and the patient's experience. According to Byron Good, "we cannot have direct access to the experience of others' illness, not even through in-depth investigations: one of the ways in which we can learn more from the experience of others is to listen to the stories of what has happened to other people." Several studies have been published on NM; however, to the best of our knowledge, no scoping review of the literature has been performed.ObjectiveThis paper aims to map and synthetize studies on NM according to theory, clinical practice and education/training.MethodThe scoping review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist. A search was conducted in PubMed, APA PsycNet and Jstor. Two authors independently assessed the eligibility and methodological quality of the studies and extracted the data. This review refers to the period from 1998 to 2022.ResultsA total of 843 abstracts were identified of which 274 papers were selected based on the title/abstract. A total of 152 papers in full text were evaluated and 76 were included in the review. Papers were classified according to three issues: ✘ Nineteen studies focused on the definition and concept of NM (Theoretical). ✘ Thirty-eight papers focused on the collection of stories, projects and case reports (Clinical practice). ✘ Nineteen papers focused on the implementation of the Narrative Medicine approach in the education and training of medical doctors (Education and training).ConclusionsThis scoping review presents an overview of the state of the art of the Narrative Medicine. It collect studies performed mainly in Italy and in the United States as these are the countries developing the Narrative Medicine approach in three identified areas, theoretical, clinical practice and education and training. This scoping review will help to promote the power of Narrative Medicine in all three areas supporting the development of methods to evaluate and to measure the Narrative Medicine approach using key performance indicators.

Project description:BackgroundAdolescent mental health problems are on the rise globally, including in Sweden. One indicator of this trend is increased psychosomatic symptoms (PSS) over time. Lifestyle factors such as physical activity (PA), diet, smoking, and alcohol consumption may influence the time trends in PSS; however, the evidence base is scarce. The aim of this study was to investigate associations between time trends in PSS and lifestyle factors.MethodsThe study was based on data collected from a nationally representative sample of 9,196 fifteen-year-old boys and girls in Sweden using the Health Behavior in School-aged Children (HBSC) symptom checklist. The sample comprised nearly equal proportions of girls (50.5%) and boys. The lifestyle factors examined in this study included PA, regular breakfast intake, consumption of fruits, vegetables, sweets, or soft drinks, smoking, and alcohol drunkenness. We used data from 2002 to 2018 and stratified by family affluence scale (FAS) to demonstrate how the associations varied among the FAS groups. We fitted separate regression models for the high- and low-FAS groups, where interaction terms between the year of survey and each lifestyle factor were used to estimate the level and direction of associations between the factors and trends in PSS.ResultsThere was a generally increasing trend in PSS mean scores from 2.26 in 2002 to 2.49 in 2018 (p <.001). The changes in each survey year compared to the average mean scores during the preceding years were significant in all years except 2010. Regular breakfast intake, daily fruit and vegetable consumption, and higher PA were associated with lower PSS mean scores, while smoking and drunkenness had opposite associations with PSS. The only significant interaction between survey year and the lifestyle factors was observed regarding drunkenness in the high FAS group, suggesting that the association between trends in PSS and the experience of getting drunk at least twice got stronger over time (B = 0.057; CI:0.016, 0.097; p <.01).ConclusionsThe results indicate increasing trends in PSS among young people in Sweden from 2002 to 2018, with a significant increase observed among adolescents in the high FAS group who reported getting drunk on at least two occasions.

Dataset Information

The Theoretical Construction of a Classification of Clinical Somatic Symptoms in Psychosomatic Medicine Theory.

Objective

Method

Results

Conclusions

Trial registration

Publications

The Theoretical Construction of a Classification of Clinical Somatic Symptoms in Psychosomatic Medicine Theory.

Similar Datasets

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