Sandro Elisei

Psychosocial Functioning in Consultation-Liaison Psychiatry Patients: Influence of Psychosomatic Syndromes, Psychopathology and Somatization

Background:This study investigated whether the Diagnostic Criteria for Psychosomatic Research (DCPR) were able to predict psychosocial functioning in addition to psychiatric diagnoses and somatization in consultation-liaison psychiatry (CLP) patients. Method: A consecutive sample of 208 CLP patients were recruited and assessed for sociodemographic and medical data, psychopathology (SCID), psychosomatic syndromes (DCPR structured interview) and somatization (SCL-90-R SOM scale and multisomatoform disorder, MSD). The main endpoints were the mental and physical components of psychosocial functioning (SF-36). Results: A total of 185 (89%) patients had any psychiatric diagnosis, 51 (25%) had MSD positive criteria, 176 (85%) had any DCPR syndrome, and 105 (51%) had multiple DCPR syndromes. Although psychiatric and psychosomatic syndromes were variously associated with psychosocial functioning, hierarchical regression and effect size analyses showed that only DCPR syndromes, particularly demoralization and health anxiety, with somatization but not DSM-IV psychopathology independently predicted poor psychosocial functioning. Conclusions:The presence of psychosomatic syndromes, assessed with DCPR criteria, and high levels of somatization had larger effect size and were independent predictors of the mental and physical components of psychosocial dysfunction, over and above psychopathology. The DCPR classification can provide CLP professionals with a set of sensitive diagnostic criteria for a comprehensive clinical evaluation of psychosomatic syndromes that might play a significant mediating role in the course and the outcome of medical patients referred for psychiatric consultation.

Co-occurring psychiatric and substance use disorders among male detainees in Italy

This paper presents data on the prevalence of co-occurring substance use and psychiatric disorders among newly imprisoned males in Italy. Interviewers conducted semi-structured clinical interviews with n=302 male detainees seven days after their admission to the prison of Perugia from August 2005 through July 2006. Over half of male detainees (54.3%) had either a substance use disorder or another psychiatric disorder. One of every five detainees (20.9%) had comorbid substance use and psychiatric disorders. Compared to detainees with psychiatric disorder only, substance use disorder only, or no disorder, detainees with comorbid substance use and psychiatric disorders were significantly more likely to have severe impairment in the areas of employment, substance abuse, family and social functioning, and psychiatric symptoms. Findings underscore the need for careful diagnostic screening at intake, access to treatment during detention, and an effective transition to services at the time of release.

Psychological Factors Affecting Medical Conditions in Consultation-Liaison Psychiatry

Consultation-liaison (C-L) psychiatry has an important role in the identification and management of psychological problems in patients with medical disorders in general hospitals. The diagnostic tools C-L psychiatrists are usually provided with may reveal to be limited because of particular psychosomatic syndromes and subthreshold psychopathology that are undetected by psychiatric diagnostic criteria. The Diagnostic Criteria for Psychosomatic Research (DCPR) were developed with the aim of providing clinicians with operational criteria for psychosomatic syndromes to overcome the limitations shown by the most often diagnosed disorders in medical settings as adjustment, somatoform, mood, and anxiety disorders. In a group of 66 consecutive C-L psychiatry inpatients, a consistent prevalence of 71% DCPR syndromes was found, particularly secondary functional somatic symptoms, persistent somatization, health anxiety, and demoralization. Their overlap rates with DSM-IV diagnoses showed that the DCPR syndromes were able to identify psychological dimensions (as somatic symptom clustering, anxiety triggered by the current health status, and a feeling state of hopelessness) that do not meet or are not detected by DSM-IV. Furthermore, the DCPR syndromes identified patients with clinically significant functional impairment. These results replicate previous findings in C-L psychiatry using the DCPR categories and pave the way for further research to clarify their mediating role in the course and the outcome variance of medical and psychological problems of hospital inpatients referred for psychiatric consultation.

Assessing and staging bipolar disorder

We congratulate Duffy et al on their paper.[1][1] We have long argued that bipolar disorder is often underdiagnosed by community mental health teams, and that the reason for this is often failure to assess the longitudinal trajectory of patients with recurrent depression.[2][2],[3][3] We have

The Clinical Assessment of Prognostic Factors in Bipolar Disorder- an Audit

Introduction Prognostic staging is one of the most important current psychiatrical challenges. Objectives Bipolar prognostic factors must be identified to assist in staging. Aims To assess prognostic factors, to describe any correlation with the disease outcome and to recommend that psychiatrists assess bipolar patients, determining their stage of disease in order to identify possible high-risk groups of patients. Methods We collected data from the clinical notes of 70 bipolar outpatients seen at the initial psychiatric assessment clinic about socio-demographic and clinical factors. Results The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) outpatients; 60.9% reported anxiety, 71.7 % mixed state features and 72.7% rapid cycling. A comparison between 12 prognostic factors found that only the correlations between current illicit drug use/previous illicit drug use, current alcohol use/previous alcohol use, and current illicit drug use/anxiety were statistically significant; the correlation between previous illicit drug use/previous alcohol use, previous alcohol use/family history and mixed state features/anxiety were almost significant. 17 patients were assigned to a care coordinator; we found no statistically significant differences between the patients with or without a care coordinator on the basis of the presence of 12 possible prognostic factors. Conclusions In our sample, some patients were found not to have information available so we suggest that a questionnaire to remind clinicians of potentially useful information would be helpful to aid in prognostication. Specific features of the disease (family history, age at onset, features of depressive episodes and mixed state, rapid cycling) may be highlighted.

Contents Vol. 78, 2009

M. Bagby, Toronto, Ont. R. Balon, Detroit, Mich. P. Bech, Hillerød M. Biondi, Roma M. Bouvard, Chambery G. Chouinard, Montréal, Qué. P.M.G. Emmelkamp, Amsterdam S. Fassino, Torino M. Fava, Boston, Mass. H.J. Freyberger, Greifswald/Stralsund S. Grandi, Bologna D. Hellhammer, Trier J.I. Hudson, Belmont, Mass. I.M. Marks, London M.W. Otto, Boston, Mass. E.S. Paykel, Cambridge C. Rafanelli, Bologna C.D. Ryff , Madison, Wisc. U. Schnyder, Zürich J. Scott, Newcastle T. Sensky, London T. Th eorell, Stockholm E. Vieta, Barcelona T. Wise, Falls Church, Va. R. Zachariae, Aarhus Offi cial Journal of the International College of Psychosomatic Medicine (ICPM) Offi cial Journal of the International Federation for Psychotherapy (IFP)