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The Literature Collection contains over 10,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).
261 Results
241
The reporting of specific physical symptoms for mental distress in general practice
Type: Journal Article
Year: 2005
Publication Place: England
Abstract: OBJECTIVE: Do patients report specific physical symptoms in the presence of mental distress, taking into account the presence of somatic disease? METHODS: Cross-sectional data were collected from 1458 participants in eight general practices in The Netherlands. Electronic patient records provided information on somatic disease. Questionnaires included the Hospital Anxiety and Depression Scale (HADS) to measure mental distress and the Physical Symptom Checklist (PSC). RESULTS: Patients reporting mental distress reported all types of physical symptoms more often than did patients without mental distress. Multivariate analyses in women, corrected for the presence of somatic disease, did not substantially change the univariate pattern. Odds ratios were particularly high (>6) for feeling tired or having low energy, fatigue without exertion and forgetfulness. CONCLUSION: It is the level of mental distress rather than gender or somatic disease that accounts for the reporting of any physical symptom. Fatigue might be an exception, but here, the classification as "physical" rather then "mental" is somewhat ambiguous.
Topic(s):
Medically Unexplained Symptoms
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Reference Links: 
View the DOI record for The reporting of specific physical symptoms for mental distress in general practice
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View the PubMed citation for The reporting of specific physical symptoms for mental distress in general practice242
The role of post-migration living difficulties on somatization among first-generation immigrants visited in a primary care service
Type: Journal Article
Year: 2011
Publication Place: Italy
Abstract: The role of post-migration living difficulties (PMLD) on somatization was studied in 101 first generation immigrants visited in primary care. Premigratory traumas and post-traumatic stress disorder (PTSD) were also assessed. About one third of patients somatized. Sociodemographic variables were similar in somatizers and non-somatizers. Premigratory traumas, PTSD and the likelihood to report at least one serious or very serious PMLD were higher in somatizers. Four kinds of PMLD were more frequent in somatizers: worries about unavailability of health assistance, working problems, discrimination and poor social help. Traumas and PTSD influenced the effect of PMLD on somatization. Findings suggest that in specific samples of primary care immigrants severe premigratory traumas increase the sensitivity to PMLD and in turn distress due to PMLD amplifies the tendency to somatize.
Topic(s):
Healthcare Disparities
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, Medically Unexplained Symptoms
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244
The role of symptoms in the recognition of mental health disorders in primary care
Type: Journal Article
Year: 2003
Publication Place: United States
Abstract: This study investigates the role of patients' complaints and symptoms in the diagnostic process of mood and anxiety disorders in general practice. In 12 primary care practices, 1,211 patients were diagnosed with the aid of the National Institute of Mental Health Diagnostic Interview Schedule, then the diagnoses were compared with those established by the general practitioners. A low rate of concordance was found between these diagnoses. The absence of somatic illnesses and the presence of psychological complaints were the most important factors in the recognition of a mental illness by the general practitioners. The concordance between the general practitioners and the DIS diagnoses was higher if the patients had neither an acute nor a chronic somatic illness.
Topic(s):
Medically Unexplained Symptoms
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Reference Links: View the PubMed citation for The role of symptoms in the recognition of mental health disorders in primary care
245
The SOMATICS collaborative: Introduction to a National Institute on Drug Abuse cooperative study of pharmacotherapy for opioid treatment in criminal justice settings
Type: Journal Article
Year: 2016
Publication Place: United States
Abstract: BACKGROUND: Among the nearly 750,000 inmates in U.S. jails, 12% report using opioids regularly, 8% report use in the month prior to their offense, and 4% report use at the time of their offense. Although ample evidence exists that medications effectively treat Opiate Use Disorder (OUD) in the community, strong evidence is lacking in jail settings. The general lack of medications for OUD in jail settings may place persons suffering from OUD at high risk for relapse to drug use and overdose following release from jail. METHODS: The three study sites in this collaborative are pooling data for secondary analyses from three open-label randomized effectiveness trials comparing: (1) the initiation of extended-release naltrexone [XR-NTX] in Sites 1 and 2 and interim methadone in Site 3 with enhanced treatment-as usual (ETAU); (2) the additional benefit of patient navigation plus medications at Sites 2 and 3 vs. medication alone vs. ETAU. Participants are adults with OUD incarcerated in jail and transitioning to the community. RESULTS: We describe the rationale, specific aims, and designs of three separate studies harmonized to enhance their scientific yield to investigate how to best prevent jail inmates from relapsing to opioid use and associated problems as they transition back to the community. CONCLUSIONS: Conducting drug abuse research during incarceration is challenging and study designs with data harmonization across different sites can increase the potential value of research to develop effective treatments for individuals in jail with OUD.
Topic(s):
Opioids & Substance Use
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, Healthcare Disparities
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, Medically Unexplained Symptoms
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246
The somatization in primary care study: a tale of three diagnoses
Type: Journal Article
Year: 2003
Publication Place: United States
Abstract: Somatization is a common phenomenon that has been defined in many ways. The two most widely used diagnoses, Somatization Disorder (SD) and Abridged Somatization Disorder (ASD), are based on lifetime unexplained symptoms. However, reports indicate instability in lifetime symptom recall among somatizing patients. Multisomatoform disorder (MSD) is a new diagnosis based on current unexplained symptoms. To understand how knowledge about SD and ASD translates to MSD, we examined the diagnostic concordance, impairment and health care utilization of these groups in a sample from the Somatization in Primary Care Study. The diagnostic concordance was high between MSD and SD, but lower between MSD and ASD. All three groups reported considerable physical impairment (measured using the PCS subscale of the SF-36). The mental health (MCS) scores for the three groups were only slightly lower than those of the general population. Over the course of one year, physical functioning fell significantly for all three groups. Mental functioning did not change significantly for any of the three groups over this period. Utilization patterns were very similar for the three groups. The high prevalence, serious impairment, and worsening physical functioning over the course of one year suggest the importance of developing interventions in primary care to alleviate the impaired physical functioning and reduce utilization in somatizing patients. MSD should be a useful diagnosis for targeting these interventions because it identifies a sizable cohort of somatizing patients reporting impairment of comparable severity to full SD, using a more efficient diagnostic algorithm based on current symptoms.
Topic(s):
Medically Unexplained Symptoms
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Reference Links: View the PubMed citation for The somatization in primary care study: a tale of three diagnoses
248
The treatment of patients with medically unexplained physical symptoms in China: a study comparing expectations and treatment satisfaction in psychosomatic medicine, biomedicine, and traditional Chinese medicine
Type: Journal Article
Year: 2011
Publication Place: United States
Abstract: OBJECTIVE: Little is known about treatment for patients with medically unexplained symptoms (MUS) in China. This study investigates the treatment expectations and treatment satisfaction of patients with MUS in psychosomatic medicine, biomedicine, and Traditional Chinese Medicine (TCM). METHOD: In a cross-sectional survey, n = 96 (10.3%) out of 931 participating patients were screened positive for multiple somatoform symptoms. These patients answered questionnaires concerning symptom duration, number of doctor visits, functional impairment, emotional distress, treatment expectations, treatment satisfaction, and empathy in the consultation. The physicians filled in a questionnaire about applied or recommended treatment. RESULTS: Most of the patients from psychosomatic medicine wanted psychotherapy. In TCM, 55% of the patients had already received TCM treatment and most of them wanted to continue TCM treatment. Patients in biomedicine did not express clear expectations; most of them had had no previous treatment. A combination of treatment methods was most prevalent in biomedicine in comparison to psychosomatic medicine and TCM. The outcome from the patients' point of view was significantly better in TCM than in psychosomatic medicine and biomedicine. Psychosomatic medicine's strength was the empathetic physician-patient interaction. CONCLUSIONS: From a biopsychosocial perspective, these results suggest that various treatment approaches with various emphases can be effective depending on the patient's complaints, his illness beliefs, and what the physician offers. The results will be verified in a larger multicenter longitudinal study.
Topic(s):
Medically Unexplained Symptoms
See topic collection
249
The value of pseudoneurological symptoms for assessing psychopathology in primary care
Type: Journal Article
Year: 2004
Publication Place: United States
Abstract: OBJECTIVE: This study sought to examine the relationship between pseudoneurological symptoms (PNS) and somatic and psychiatric symptom severity, physical functioning, and psychiatric comorbidity. METHODS: Interview and questionnaire data were obtained from 120 patients with somatization who participated in a study assessing the efficacy of cognitive-behavioral therapy. Measures elicited information on psychiatric diagnoses, anxiety and depressive symptom levels, somatic symptoms, and physical functioning. Statistical analyses examined the relationship between PNS and the diagnosis of somatization disorder, physical and psychiatric symptom severity, and psychiatric comorbidity. RESULTS: Roughly half of the sample had a history of four or more PNS. Results showed that having four or more PNS was not predictive of somatization disorder. However, having four or more PNS was found to be significantly correlated with the severity of anxiety, depression, somatic complaints, and physical dysfunction. These associations were identified while controlling for the symptom count of nonpseudoneurological symptoms, the presence of somatization disorder, and the presence of chronic painful physical conditions. In addition, having four or more PNS was significantly associated with a higher likelihood of receiving a diagnosis of major depression, dysthymia, panic disorder, and generalized anxiety disorder. CONCLUSIONS: A history of four or more PNS is common among somatizing patients in primary care and associated with a more severe clinical presentation, even after controlling for other factors known to be associated with severity. Four or more PNS may identify a distinct subgroup of somatization and serve as a clinical indicator for identifying psychiatric disorders in primary care. Future studies should explore the assessment of PNS using briefer measures. Furthermore, PNS should be evaluated with samples more representative of US primary care populations, as well as samples that include adequate representation from other ethnic backgrounds (eg, African-American, Asian, etc.).
Topic(s):
Medically Unexplained Symptoms
See topic collection
Reference Links: View the PubMed citation for The value of pseudoneurological symptoms for assessing psychopathology in primary care
250
Training general practitioners in the treatment of functional somatic symptoms: Effects on patient health in a cluster-randomised controlled trial (the Functional Illness in Primary Care study)
Type: Journal Article
Year: 2010
Publication Place: Switzerland
Abstract: BACKGROUND: Patients with medically unexplained or functional somatic symptoms (FSS) are prevalent in primary care. In this pragmatic cluster-randomised controlled trial we aimed to test the effect of a training programme (The Extended Reattribution and Management model) for general practitioners (GPs) in the treatment of FSS. METHODS: 38 participating GPs were randomised to the control group or the training group. The GPs included consecutive 18- to 65-year-old patients presenting during a 3-week period for new health complaints. We assessed a stratified subsample with the psychiatric interview Schedules of Clinical Assessment in Neuropsychiatry. Of 701 patients interviewed, 350 fulfilled the diagnostic criteria for any ICD-10 somatoform disorder (SD) and 111 presented FSS without fulfilling these criteria (sub-threshold SD). Patients completed questionnaires at baseline and after 3, 12 and 24 months. The questionnaires included assessment of health status (36-item Medical Outcomes Study Short Form; SF-36), health anxiety (Whiteley-7) and physical symptoms (Symptom Check List-90, somatization subscale). RESULTS: Patients with SD consulting trained GPs improved more on our primary outcome of physical functioning than patients consulting control GPs at the 3-month follow-up (p = 0.004), but the improvement was not statistically significant at later follow-up. We found no significant differences in improvement between patients with SD and those with sub-threshold SD. Results for other SF-36 subscales, physical symptoms and health anxiety only showed statistically significant differences between the intervention and control groups for patients with SD; patients consulting trained GPs had less improvement in vitality, health anxiety and physical symptoms at 24 months compared with the control group. CONCLUSIONS: GP training may accelerate improvement in physical functioning for patients with SD. However, the effect is small and may not be clinically significant.
Topic(s):
Education & Workforce
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, Medically Unexplained Symptoms
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252
Treating patients with functional somatic symptoms. A treatment guide for use in general practice
Type: Journal Article
Year: 2003
Publication Place: Norway
Abstract: Patients who experience body symptoms in response to psychosocial stress are a challenge for the general practitioner (GP). This paper is a contribution to the improved treatment of these patients. It presents a specific psychosocial treatment model provided by the GP including the following steps: (a) taking a thorough symptom history, conducting a psychosocial anamnesis and exploring the patient's own perception of the illness, (b) developing alternative perceptions of the illness by understanding the psycho-physiological relationship; and (c) reducing the impact of psychosocial stress. The application of these specific techniques requires a trustful, helping alliance between the doctor and the patient and cooperation with mental health services.
Topic(s):
Medically Unexplained Symptoms
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Reference Links: View the PubMed citation for Treating patients with functional somatic symptoms. A treatment guide for use in general practice
253
Treating patients with medically unexplained symptoms in primary care
Type: Journal Article
Year: 2003
Publication Place: United States
Abstract: BACKGROUND: There are no proven, comprehensive treatments in primary care for patients with medically unexplained symptoms (MUS) even though these patients have high levels of psychosocial distress, medical disability, costs, and utilization. Despite extensive care, these common patients often become worse. OBJECTIVE: We sought to identify an effective, research-based treatment that can be conducted by primary care personnel. DESIGN: We used our own experiences and files, consulted with experts, and conducted an extensive review of the literature to identify two things: 1). effective treatments from randomized controlled trials for MUS patients in primary care and in specialty settings; and 2). any type of treatment study in a related area that might inform primary care treatment, for example, depression, provider-patient relationship. MAIN RESULTS: We developed a multidimensional treatment plan by integrating several areas of the literature: collaborative/stepped care, cognitive-behavioral treatment, and the provider-patient relationship. The treatment is designed for primary care personnel (physicians, physician assistants, nurse practitioners) and deployed intensively at the outset; visit intervals are progressively increased as stability and improvement occur. CONCLUSION: Providing a comprehensive treatment plan for chronic, high-utilizing MUS patients removes one barrier to treating this common problem effectively in primary care by primary care personnel.
Topic(s):
Medically Unexplained Symptoms
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Reference Links: View the PubMed citation for Treating patients with medically unexplained symptoms in primary care
256
Using nurse practitioners to implement an intervention in primary care for high-utilizing patients with medically unexplained symptoms
Type: Journal Article
Year: 2003
Publication Place: United States
Abstract: Patients with medically unexplained symptoms (MUS) often are a source of frustration for clinicians, and despite high quality biomedical attention and frequent diagnostic tests, they have poor health outcomes. Following upon progress in depression treatment approaches, we developed a multidimensional treatment protocol for deployment by primary care personnel. This multi-faceted intervention for MUS patients emphasized cognitive-behavioral principles, the provider-patient relationship, pharmacological management, and treating comorbid medical diseases. We deployed it in an HMO using nurse practitioners (NP) to deliver the intervention to 101 patients, while 102 controls continued to receive medical care from their usual primary care physician. Successful deployment of the intervention required training the NPs, continuing support for the NPs in their management of this difficult population, and establishing strong communication links with the HMO. This paper addresses the practical considerations of using primary care personnel to implement a complex intervention in primary care, and it includes a discussion of special challenges encountered as well as solutions developed to overcome them.
Topic(s):
Education & Workforce
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, Financing & Sustainability
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, Medically Unexplained Symptoms
See topic collection
257
What can we learn from a cross-national study of somatic distress?
Type: Journal Article
Year: 2004
Publication Place: England
Topic(s):
Medically Unexplained Symptoms
See topic collection
Reference Links:
View the DOI record for What can we learn from a cross-national study of somatic distress?
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View the PubMed citation for What can we learn from a cross-national study of somatic distress?258
What do general practice patients want when they present medically unexplained symptoms, and why do their doctors feel pressurized?
Type: Journal Article
Year: 2005
Publication Place: England
Abstract: OBJECTIVE: We tested predictions that patients with medically unexplained symptoms (MUS) want more emotional support and explanation from their general practitioners (GPs) than do other patients, and that doctors find them more controlling because of this. DESIGN: Thirty-five doctors participated in a cross-sectional comparison of case-matched groups. Three hundred fifty-seven patients attending consecutively with MUS were matched for doctor and time of attendance with 357 attending with explained symptoms. Patients self-reported the extent to which they wanted somatic intervention, emotional support, explanation and reassurance. Doctors rated their perception of patients' influence on the consultation. Predictions were tested by multilevel analyses. RESULTS: Patients with MUS sought more emotional support than did others, but no more explanation and reassurance or somatic intervention. A minority of doctors experienced them as exerting more influence than others. The experience of patient influence was related to the patients' desire for support. CONCLUSIONS: Future research should examine why GPs provide disproportionate levels of somatic intervention to patients who seek, instead, greater levels of emotional support.
Topic(s):
Medically Unexplained Symptoms
See topic collection
259
What is the evidence for the efficacy of treatments for somatoform disorders? A critical review of previous intervention studies
Type: Journal Article
Year: 2007
Publication Place: United States
Abstract: OBJECTIVE: To review published literature for the highest level of evidence on the efficacy of treatment for patients with medically unexplained symptoms. METHODS: A comprehensive literature search was carried out in Cochrane library, Medline (1971-2007), PsychINFO (1974-2006), and EMBASE (1980-2007) to identify pharmacological, nonpharmacological, psychological, and other interventions, using the search terms "medically unexplained symptoms," "somatisation," "somatization," "somatoform disorders," "psychological therapies," "cognitive behavior therapy," "pharmacological therapies," "management," "therapy," "drug therapy," and "anti-depressants" with Boolean operators AND and OR on the entire text. Searches were confined to literature in English. RESULTS: Studies were carried out in primary, secondary, and tertiary care settings. The therapists ranged from medical specialists, psychiatrists, and psychologists to primary care physicians. Three types of interventions (antidepressant medication, cognitive behavioral therapy (CBT), and other nonspecific interventions) were supported by evidence on the efficacy of treatment for patients with medically unexplained symptoms. There is more level I evidence for CBT compared with the amount for other approaches. There was only one study reported from the developing world. CONCLUSIONS: CBT is efficacious for either symptom syndromes or for the broader category of medically unexplained symptoms, reducing physical symptoms, psychological distress, and disability. A relatively small number of studies were carried out in primary care, but the trend has been changing over the last decade. No studies have compared pharmacological and psychological treatments. Most trials assessed only short-term outcomes. Use of divergent selection procedures, interventions, outcome measures, and instruments, and other methodological differences observed in these studies hamper the ability to compare treatment effects across studies.
Topic(s):
Medically Unexplained Symptoms
See topic collection
260
Why do primary care physicians propose medical care to patients with medically unexplained symptoms? A new method of sequence analysis to test theories of patient pressure
Type: Journal Article
Year: 2006
Topic(s):
Medically Unexplained Symptoms
See topic collection