Maria Weiss

Sleep Disturbances in Somatoform Pain Disorder

Patients with chronic somatoform pain often complain about sleep disorders. However, sleep disorder/disturbances are not an integrated part of the somatoform disorders in the DSM-IV and the ICD-10. Sleep is important for recreation. Deprivation of deep sleep stages is experimentally linked to muscle pain. Therefore, sleep disorder may play an important part in the persistence of somatoform pain disorder. The aim of the study was to evaluate the frequency of sleep disorder in patients with somatoform pain disorder and to correlate it with comorbid depression, pain parameters and psychosocial parameters. Method: In this study, 147 patients (mean age: 48.8 years; SD: 11.0) with the diagnosis of a somatoform pain disorder were studied with regard to affective comorbidity, pain duration (months), maximum pain within the last month, minimum pain within the last month and medium pain within the last month, psychosocial disability within the last month and the presence of a sleep disorder. Results: Eighty-four percent of the patients had a sleep disorder. The patients with a sleep disorder had significantly higher maximum and medium pain, a significantly higher level of psychosocial disability and a significantly lower overall subjective well-being. The medium pain and psychosocial disability in leisure and social activities are significant predictors for sleep disorder. Conclusions: The presence of a sleep disorder may be a hint for higher pain intensity and a higher level of psychosocial disability. Sleep disorder may be a factor in the persistence and aggravation of pain as well as psychosocial disability. Therefore, sleep disorder should be integrated in the therapeutic targets. It is suggested that sleep disorder should be a diagnostic criterion in somatoform pain disorder.

Zur Validität eines zweistufigen Screenings am Beispiel des Depressionsscreening

OBJECTIVE Several studies reported that general practitioners often do not recognize depressive disorders among their patients. Routine screening is a time-consuming procedure which might be improved by means of a two-step procedure. Using a very brief screening instrument in a first step reduces the number of patients needing a longer conventional screening in a second step. Only screening positives after this second step will be examined by the general practitioner (GP). METHODS Based upon validity scores from published studies, the expected validity of such a two-step procedure is being investigated. RESULTS This two-step screening procedure decreases the overall number of screening positives who have to be examined for the presence of depression by the GP. While the combined sensitivity slightly decreases, the combined specificity increases. CONCLUSIONS The proposed method allows for a practicable routine screening for depression by the GP. The procedure might further be improved through the development of instruments optimized for the first and the second step.

Contents Vol. 36, 2003

Medical and Scientifi c Publishers Basel • Freiburg • Paris • London New York • Bangalore • Bangkok Singapore • Tokyo • Sydney Drug Dosage The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant fl ow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specifi ed fee to the Copyright Clearance Center (see ‘General Information’).