Relationships Between Somatic Symptoms and Panic-Agoraphobic Spectrum Among Frequent Attenders of the General Practice in Italy.
Adult
Aged
Agoraphobia
/ psychology
Female
General Practitioners
/ standards
Humans
Italy
Linear Models
Male
Medically Unexplained Symptoms
Middle Aged
Office Visits
/ statistics & numerical data
Panic Disorder
/ psychology
Patient Health Questionnaire
/ standards
Psychiatric Status Rating Scales
Self Report
Journal
The Journal of nervous and mental disease
ISSN: 1539-736X
Titre abrégé: J Nerv Ment Dis
Pays: United States
ID NLM: 0375402
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
pubmed:
25
3
2020
medline:
25
3
2021
entrez:
25
3
2020
Statut:
ppublish
Résumé
Frequent attenders (FAs) of general practitioners (GPs) often complain of nonspecific physical symptoms that are difficult to define according to typical medical syndromes criteria but could be acknowledged as atypical manifestations of mental disorders. We investigated the possible correlation between somatic symptoms and panic-agoraphobic spectrum symptoms in a sample of 75 FAs of GPs in Italy, with particular attention to the impact on functional impairment. Assessments included the Patient Health Questionnaire, Panic-Agoraphobic Spectrum-Self-Report (PAS-SR) lifetime version, Global Assessment of Functioning, and Clinical Global Impression. The PAS-SR total and domains scores were significantly higher among low-functioning FAs, especially anxious somatizations, hypochondriasis, anxious expectation, and reassurance orientation domains, suggesting this undetected symptom may determine the selective attention to the physical symptoms, illness-phobic/hypochondriac elaboration, and GP frequent attendance, often aimed at searching for reassurance, leading to severe impact on overall functioning and often inefficacious treatments.
Identifiants
pubmed: 32205774
doi: 10.1097/NMD.0000000000001163
pii: 00005053-202007000-00004
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
540-548Références
Balint M (Ed) (1957) The doctor, his patient and the illness (Vol. 234, p 609). London: Churchill Livingstone.
Ballas CA, Staab JP (2003) Medically unexplained physical symptoms: Toward an alternative paradigm for diagnosis and treatment. CNS Spectr. 8(12 suppl 3):20–26.
Bécares Martínez C, Arroyo Domingo MM, López Llames A, Marco Algarra J, Morales Suárez-Varela MM (2018) Vertigo and dizziness in hospital: Attendance, flow and characteristics of patients [in Spanish]. Acta Otorrinolaringol Esp. 69:219–225.
Benedetti A, Perugi G, Toni C, Simonetti B, Mata B, Cassano GB (1997) Hypochondriasis and illness phobia in panic-agoraphobic patients. Compr Psychiatry. 38:124–131.
Berrocal C, Moreno FR, Cano J (2007) Anxiety sensitivity and panic symptomatology: The mediator role of hypochondriacal concerns. Span J Psychol. 10:159–166.
Berrocal C, Ruiz Moreno MA, Gil Villa M, Hermoso P, Rucci P, Cassano GB (2006) Multidimensional assessment of the panic-agoraphobic spectrum: Reliability and validity of the Spanish version of the PAS-SR. J Anxiety Disord. 20:562–579.
Burton C, McGorm K, Weller D, Sharpe M (2011) Depression and anxiety in patients repeatedly referred to secondary care with medically unexplained symptoms: A case-control study. Psychol Med. 41:555–563.
Carmassi C, Dell'Oste V, Barberi FM, Pedrinelli V, Cordone A, Cappelli A, Cremone IM, Rossi R, Bertelloni CA, Dell'Osso L (2020) Do somatic symptoms relate to PTSD and gender after earthquake exposure? A cross-sectional study on young adult survivors in Italy. CNS Spectr. 1–7. doi: 10.1017/S1092852920000097.
doi: 10.1017/s1092852920000097
Carmassi C, Dell'Oste V, Ceresoli D, Moscardini S, Bianchi E, Landi R, Massimetti G, Nisita C, Dell'Osso L (2018) Frequent attenders in general medical practice in Italy: A preliminary report on clinical variables related to low functioning. Neuropsychiatr Dis Treat. 15:115–125.
Cassano GB, Banti S, Mauri M, Dell'Osso L, Miniati M, Maser JD, Shear MK, Frank E, Grochocinski VJ, Rucci P (1999) Internal consistency and discriminant validity of the structured clinical interview for panic agoraphobic Spectrum (SCI-PAS). Int J Methods Psychiatr Res. 8:138–145.
Cassano GB, Michelini S, Shear MK, Coli E, Maser JD, Frank E (1997) The panic-agoraphobic spectrum: A descriptive approach to the assessment and treatment of subtle symptoms. Am J Psychiatry. 154(suppl 6):27–38.
Cassano GB, Rotondo A, Maser JD, Dell'Osso L, Mauri M (1998) The panicagoraphobic spectrum: Rationale, assessment, and clinical usefulness. CNS Spectr. 3:35–48.
Chavira DA, Stein MB, Golinelli D, Sherbourne CD, Craske MG, Sullivan G, Bystritsky A, Roy-Byrne PP (2009) Predictors of clinical improvement in a randomized effectiveness trial for primary care patients with panic disorder. J Nerv Ment Dis. 197:715–721.
Combs H, Markman J (2014) Anxiety disorders in primary care. Med Clin North Am. 98:1007–1023.
Dell'Osso B, Albert U, Atti AR, Carmassi C, Carrà G, Cosci F, Del Vecchio V, Di Nicola M, Ferrari S, Goracci A, Iasevoli F, Luciano M, Martinotti G, Nanni MG, Nivoli A, Pinna F, Poloni N, Pompili M, Sampogna G, Tarricone I, Tosato S, Volpe U, Fiorillo A (2015) Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice. Neuropsychiatr Dis Treat. 11:1885–1909.
Dell'Osso L, Bazzichi L, Consoli G, Carmassi C, Carlini M, Massimetti E, Giacomelli C, Bombardieri S, Ciapparelli A (2009) Manic spectrum symptoms are correlated to the severity of pain and the health-related quality of life in patients with fibromyalgia. Clin Exp Rheumatol. 27(5 Suppl 56):S57–S61.
Dell'Osso L, Carmassi C, Consoli G, Conversano C, Ramacciotti CE, Musetti L, Massimetti E, Pergentini I, Corsi M, Ciapparelli A, Bazzichi L (2011) Lifetime post-traumatic stress symptoms are related to the health-related quality of life and severity of pain/fatigue in patients with fibromyalgia. Clin Exp Rheumatol. 29(6 Suppl 69):S73–S78.
Dowrick CF, Bellon JA, Gomez MJ (2000) GP frequent attendance in Liverpool and Granada: The impact of depressive symptoms. Br J Gen Pract. 50:361–365.
Drenckhan I, Glöckner-Rist A, Rist F, Richter J, Gloster AT, Fehm L, Lang T, Alpers GW, Hamm AO, Fydrich T, Kircher T, Arolt V, Deckert J, Ströhle A, Wittchen HU, Gerlach AL (2015) Dimensional structure of bodily panic attack symptoms and their specific connections to panic cognitions, anxiety sensitivity and claustrophobic fears. Psychol Med. 45:1675–1685.
Endicott J, Spitzer RL, Fleiss JL, Cohen J (1976) The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry. 33:766–771.
Ferrari S, Galeazzi GM, Mackinnon A, Rigatelli M (2008) Frequent attenders in primary care: Impact of medical, psychiatric and psychosomatic diagnoses. Psychother Psychosom. 77:306–314.
Fifer SK, Mathias SD, Patrick DL, Mazonson PD, Lubeck DP, Buesching DP (1994) Untreated anxiety among adult primary care patients in a health maintenance organization. Arch Gen Psychiatry. 51:740–750.
Ford JD, Trestman RL, Steinberg K, Tennen H, Allen S (2004) Prospective association of anxiety, depressive, and addictive disorders with high utilization of primary, specialty and emergency medical care. Soc Sci Med. 58:2145–2148.
Frank E, Cassano GB, Shear K, Rotondo A, Dell'Osso L, Mauri M, Maser J, Grochocinski V (1998) The Spectrum model: A more coherent approach to the complexity of psychiatric symptomatology. CNS Spectr. 3:23–34.
Freixaneta MS, Calvo-Rojas V, Portell M (2019) Personality and psychopathology as predictors of patient-initiated overuse in general practice. J Psychosom Res. 120:53–59.
Gili M, Luciano JV, Serrano MJ, Jimenez R, Bauza N, Roca M (2011) Mental disorders among frequent attenders in primary care: A comparison with routine attenders. J Nerv Ment Dis. 199:744–749.
Gill D, Dawes M, Sharpe M, Mayou R (1998) GP frequent consulters: Their prevalence, natural history, and contribution to rising workload. Br J Gen Pract. 48:1856–1857.
Guy W (1976) ECDEU assessment manual for psychopharmacology. Rockville, MD: U. S. Dept. of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch, Division of Extramural Research Programs.
Henningsen P, Jakobsen T, Schiltenwolf M, Weiss MG (2005) Somatization revisited: Diagnosis and perceived causes of mental disorders. J Nerv Ment Dis. 193:85–92.
Hiller W, Fichter MM (2004) High utilizers of medical care: A crucial subgroup among somatizing patients. J Psychosom Res. 56:437–443.
Houtveen JH, van Broeckhuysen-Kloth S, Lintmeijer LL, Bühring ME, Geenen R (2015) Intensive multidisciplinary treatment of severe somatoform disorder: A prospective evaluation. J Nerv Ment Dis. 203:141–148.
Hüsing P, Löwe B, Piontek K, Shedden-Mora M (2018) Somatoform disorder in primary care: The influence of co-morbidity with anxiety and depression on health care utilization. J Eval Clin Pract. 24:892–900.
Jadhakhan F, Lindner OC, Blakemore A, Guthrie E (2019) Prevalence of medically unexplained symptoms in adults who are high users of health care services: A systematic review and meta-analysis protocol. BMJ Open. 9:e027922.
Jyvasjarvi S, Joukamaa M, Väisänen E, Larivaara P, Kivelä SL, Keinänen-Kiukaanniemi S (1999) Alexithymia, hypochondriacal beliefs, and psychological distress among frequent attenders in primary health care. Compr Psychiatry. 40:292–298.
Jyvasjarvi S, Joukamaa M, Väisänen E, Larivaara P, Kivelä S, Keinänen-Kiukaanniemi S (2001) Somatizing frequent attenders in primary health care. J Psychosom Res. 50:185–192.
Jyvasjarvi S, Keinanen-Kiukaanniemi S, Vaisanen E, Larivaara P, Kivela SL (1998) Frequent attenders in a Finnish health Centre: Morbidity and reasons for encounter. Scand J Prim Health Care. 16:141–148.
Karlsson H, Lehtinen V, Joukamaa M (1995) Psychiatric morbidity among frequent attender patients in primary care. Gen Hosp Psychiatry. 17:19–25.
Katon W, Lin EH, Kroenke K (2007) The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry. 29:147–155.
Kirmayer LJ, Sartorius N (2007) Cultural models and somatic syndromes. Psychosom Med. 69:832–840.
Kivelä K, Elo S, Kääriäinen M (2018) Frequent attenders in primary health care: A concept analysis. Int J Nurs Stud. 86:115–124.
Kroenke K (2003) Patients presenting with somatic complaints: Epidemiology, psychiatric comorbidity and management. Int J Methods Psychiatr Res. 12:34–43.
Lowe B, Spitzer RL, Williams JB, Mussell M, Schellberg D, Kroenke K (2008) Depression, anxiety and somatization in primary care: Syndrome overlap and functional impairment. Gen Hosp Psychiatry. 30:191–199.
Martini C, Trincavelli ML, Tuscano D, Carmassi C, Ciapparelli A, Lucacchini A, Cassano GB, Dell'Osso L (2004) Serotonin-mediated phosphorylation of extracellular regulated kinases in platelets of patients with panic disorder versus controls. Neurochem Int. 44:627–639.
Matalon A, Nahmani T, Rabin S, Maoz B, Hart J (2002) A short-term intervention in a multidisciplinary referral clinic for primary care frequent attenders: Description of the model, patient characteristics and their use of medical resources. Fam Pract. 19:251–256.
Mayou R, Bass CM, Sharpe M (1995) Treatment of functional somatic symptoms (pp 66–86). Oxford: Oxford University Press.
Metzler DH, Mahoney D, Freedy JR (2016) Anxiety disorders in primary care. Prim Care. 43:245–261.
Musey PI Jr., Lee JA, Hall CA, Kline JA (2018) Anxiety about anxiety: A survey of emergency department provider beliefs and practices regarding anxiety-associated low risk chest pain. BMC Emerg Med. 18:10.
Neal RD, Heywood PL, Morley S (2000) I always seem to be there'—a qualitative study of frequent attenders. Br J Gen Pract. 50:716–723.
Neal RD, Heywood PL, Morley S, Clayden AD, Dowell AC (1998) Frequency of patients' consulting in general practice and workload generated by frequent attenders: Comparisons between practices. Br J Gen Pract. 48:895–898.
Norton J, David M, de Roquefeuil G, Boulenger JP (2012) Frequent attendance in family practice and common mental disorders in an open access health care system. J Psychosom Res. 72:413–418.
Reho TTM, Atkins SA, Talola N, Viljamaa M, Sumanen MPT, Uitti J (2019a) Frequent attenders in occupational health primary care: A cross-sectional study. Scand J Public Health 47:28–36.
Reho TTM, Atkins SA, Talola N, Sumanen MPT, Viljamaa M, Uitti J (2019b) Occasional and persistent frequent attenders and sickness absences in occupational health primary care: A longitudinal study in Finland. BMJ Open 9:e024980.
Ridsdale L, Evans A, Jerrett W, Mandalia S, Osler K, Vora H (1994) Patients who consult with tiredness: Frequency of consultation, perceived causes of tiredness and its association with psychological distress. Br J Gen Pract. 44:413–416.
Salkovskis PM, Clark DM, Hackmann A, Wells A, Gelder MG (1999) An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia. Behav Res Ther. 37:559–574.
Scaife B, Gill P, Heywood P, Neal R (2000) Socio-economic characteristics of adult frequent attenders in general practice: Secondary analysis of data. Fam Pract. 17:298–304.
Schütte K, Vocks S, Waldorf M (2016) Fears, coping styles, and health behaviors: A comparison of patients with hypochondriasis, panic disorder, and depression. J Nerv Ment Dis. 204:778–786.
Shear MK, Cassano GB, Frank E, Rucci P, Rotondo A, Fagiolini A (2002) The panic-agoraphobic spectrum: Development, description and clinical significance. Psychiatr Clin North Am. 25:739–756.
Shear MK, Frank E, Rucci P, Fagiolini DA, Grochocinski VJ, Houck P, Cassano GB, Kupfer DJ, Endicott J, Maser JD, Mauri M, Banti S (2001) Panic-agoraphobic spectrum: Reliability and validity of assessment instruments. J Psychiatr Res. 35:59–66.
Simon GE, VonKorff M, Piccinelli M, Fullerton C, Ormel J (1999) An international study of the relation between somatic symptoms and depression. N Engl J Med. 341:1329–1335.
Smits FT, Brouwer HJ, ter Riet G, van Weert HC (2009) Epidemiology of frequent attenders: A 3-year historic cohort study comparing attendance, morbidity and prescriptions of one-year and persistent frequent attenders. BMC Public Health. 24:36.
Smits FT, Brouwer HJ, Zwinderman AH, Mohrs J, Schene AH, van Weert HC, ter Riet G (2014) Why do they keep coming back? Psychosocial etiology of persistence of frequent attendance in primary care: A prospective cohort. J Psychosom Res. 77:492–503.
Spitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire. JAMA. 282:1737–1744.
Spitzer RL, Williams JB, Kroenke K (1994) Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA. 272:1749–1756.
Starfield B, Shi L, Macinko J (2005) Contribution of primary care to health systems and health. Milbank Q. 83:457–502.
Stewart DE (2003) Physical symptoms of depression: Unmet needs in special populations. J Clin Psychiatry. 64(suppl 7):12–16.
Sundquist J, Ohlsson H, Sundquist K, Kendler KS (2017) Common adult psychiatric disorders in Swedish primary care where most mental health patients are treated. BMC Psychiatry. 17:235.
Tschan R, Best C, Wiltink J, Beutel ME, Dieterich M, Eckhardt-Henn A (2013) Persistence of symptoms in primary somatoform vertigo and dizziness: A disorder “lost” in health care? J Nerv Ment Dis. 201:328–333.
Vedsted P, Christensen MB (2005) Frequent attenders in general practice care: A literature review with special reference to methodological considerations. Public Health. 119:118–137.
Williams ER, Guthrie E, Mackway-Jones K, James M, Tomenson B, Eastham J, McNally D (2001) Psychiatric status, somatisation, and health care utilization of frequent attenders at the emergency department: A comparison with routine attenders. J Psychosom Res. 50:161–167.
Young V, Mehl-Madrona L, Mainguy B (2018) A patient-centered approach to a rural general practice in distress and the search for a solution. Perm J. 22:17–099.