Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-29T17:02:54.878Z Has data issue: false hasContentIssue false
  • English
  • Français

Medically Unexplained Physical Symptoms: Toward an Alternative Paradigm for Diagnosis and Treatment

Published online by Cambridge University Press:  07 November 2014

Christos A. Ballas  and
Jeffrey P. Staab
Get access Rights & Permissions [Opens in a new window]

Abstract

The treatment of patients with unexplained medical symptoms is difficult because there is neither a clear etiology for the symptoms, nor a useful paradigm with which to understand and treat them. Patients with such symptoms are often referred to psychiatry with vague diagnoses of “somatization” or “hypochondriasis.” Rather than considering somatoform diagnoses based on the number or diversity of physical symptoms, evolving research suggests an emphasis on the type of physical symptom as an indicator of Axis I pathology. This article links specific symptomatic complaints, such as chronic pain, chest pain, and dizziness, to the respective Axis I disorders associated with them, such as depression, panic disorder, and anxiety disorders.

Type
Academic Supplement
Information
CNS Spectrums , Volume 8 , Issue S3: Anxiety and Depression in the Elderly: Implications for Diagnosis and Treatment , December 2003 , pp. 20 - 26
Copyright
Copyright © Cambridge University Press 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Kroenke, K. Patients presenting with somatic complaints: epidemiology, psychiatric comorbidity and management. Int J Methods Psychiatr Res. 2003;1:34–43.CrossRefGoogle Scholar
2.Kroenke, K, Spitzer, RL, deGruy, FV 3rd, et al.Multisomatoform disorder: An alternative to undifferentiated somatoform disorder for the somatizing patient in primary care. Arch Gen Psychiatry. 1997;4:352–358.CrossRefGoogle Scholar
3.Garcia-Campayo, J, Sanz-Carrillo, C. Topiramate as a treatment for pain in multisomatoform disorder patients: an open trial. Gen Hosp Psychiatry. 2002;6:417–421.CrossRefGoogle Scholar
4.Hahn, SR, Kroenke, K, Spitzer, RL, et al.The difficult patient: prevalence, psychopathology, and functional impairment. J Gen Intern Med. 1996;1:1–8.CrossRefGoogle Scholar
Erratum in: J Gen Intern Med 1996;3:191.Google Scholar
5.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
6.Chambers, J, Bass, C, Mayou, R. Noncardiac chest pain. Heart 1999;82:656–657.CrossRefGoogle Scholar
7.Dworkin, SF, Von Korff, M, LeResche, L. Multiple pains and psychiatric disturbance: an epidemiologic investigation. Arch Gen Psychiatry. 1990;47:239–244.CrossRefGoogle ScholarPubMed
8.Ericsson, M, WS, Poston, Linder, J, JE, Taylor, CK, Haddock, JR, ForeytDepression predicts disability in long-term chronic pain patients. Disabil Rehab. 2002;24:334–340.CrossRefGoogle ScholarPubMed
9.McBeth, J, Macfarlane, GJ, Silman, AJ. Does chronic pain predict future psychological distress? Pain. 2002;3:239–245.CrossRefGoogle Scholar
10.Geerlings, SW, Twisk, JW, Beekman, AT, Deeg, DJ, van Tilburg, W. Longitudinal relationship between pain and depression in older adults: sex, age and physical disability. Soc Psychiatry Psychiatric Epidemiol. 2002;1:23–30.CrossRefGoogle Scholar
11.Pincus, T, Burton, AK, Vogel, S, Field, AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine. 2002;5:E109–E120.CrossRefGoogle Scholar
12.Feder, A, Olfson, M, Gameroff, M, et al.Medically unexplained symptoms in an urban general medicine practice. Psychosomatics. 2001;3:261–268.CrossRefGoogle Scholar
13.Walker, EA, Katon, WJ, Jemelka, RP, Roy-Bryne, PP. Comorbidity of gastrointestinal complaints, depression, and anxiety in the Epidemiologic Catchment Area (ECA) study. Am J Med. 1992;92(suppl):26S–30S.CrossRefGoogle ScholarPubMed
14.Fleet, R, Lavoie, K, Beitman, BD. Is panic disorder associated with coronary artery disease? A critical review of the literature. J Psychosom Res. 2000;48:347–356.CrossRefGoogle ScholarPubMed
15.Maunder, RG. Panic disorder associated with gastrointestinal disease: review and hypotheses. J Psychosom Res. 1998;1:91–105.CrossRefGoogle Scholar
16.Carter, CS, Servan-Schreiber, D, Perlstein, WM. Anxiety disorders and the syndrome of chest pain with normal coronary arteries: prevalence and pathophysiology. J Clin Psychiatry. 1997;58(Suppl 3):70–73.Google ScholarPubMed
17.Fleet, RP, Dupuis, G, Marchand, A, Burelle, D, Beitman, BD. Panic disorder, chest pain, and coronary artery disease: literature review. Can J Cardiol. 1994;8:827–834.Google Scholar
18.Fleet, RP, Dupuis, G, Marchand, A, Burelle, D, Arsenault, A, Beitman, BD. Panic disorder in emergency department chest pain patients: prevalence, comorbidity, suicidal ideation, and physician recognition. Am J Med. 1996;4:371–380.CrossRefGoogle Scholar
19.Sullivan, AK, Holdright, DR, Wright, CA, Sparrow, JL, Cunningham, D, Fox, KM. Chest pain in women: clinical, investigative, and prognostic features. BMJ. 1994;308:883–886.CrossRefGoogle ScholarPubMed
20.Varia, I, Logue, E, O'connor, C, et al.Randomized trial of sertraline in patients with unexplained chest pain of noncardiac origin. Am Heart J. 2000;3:367–372.CrossRefGoogle Scholar
21.Cox, ID, Hann, CM, Kaski, JC. Low dose imipramine improves chest pain but not quality of life in patients with angina and normal coronary angiograms. Eur Heart J. 1998;2:250–254.CrossRefGoogle Scholar
22.Cannon, RO 3rd, Quyyumi, AA, Mincemoyer, R, et al.Imipramine in patients with chest pain despite normal coronary angiograms. N Engl J Med. 1994;20:1411–1417.CrossRefGoogle Scholar
23.Hoffman, RM, Einstadter, D, Kroenke, K. Evaluating dizziness. Am J Med. 1999;5:468–478.CrossRefGoogle Scholar
24.Kroenke, K, Hoffman, RM, Einstadter, D. How common are various causes of dizziness? A critical review. South Med J. 2000;2:160–167.Google Scholar
25.Eckhardt-Henn, A, Breuer, P, Thomalske, C, Hoffmann, SO, Hopf, HC. Anxiety disorders and other psychiatric subgroups in patients complaining of dizziness. J Anxiety Disord. 2003;4:369–388.CrossRefGoogle Scholar
26.Staab, JP. Diagnosis and treatment of psychologic symptoms and psychiatric disorders in patients with dizziness and imbalance. Otolaryngol Clin North Am. 2000;3:617–635.CrossRefGoogle Scholar
27.Kapfhammer, HP, Mayer, C, Hock, U, Huppert, D, Dieterich, M, Brandt, T. Course of illness in phobic postural vertigo. Acta Neurol Scand. 1997;1:23–28.CrossRefGoogle Scholar
28.Simpson, RB, Nedzelski, JM, Barber, HO, Thomas, MR. Psychiatric diagnoses in patients with psychogenic dizziness or severe tinnitus. J Otolaryngol. 1988;6:325–330.Google Scholar
29.Park, L, Hinton, D. Dizziness and panic in China: associated sensations of zang fu organ disequilibrium. Cult Med Psychiatry. 2002;2:225–257.CrossRefGoogle Scholar
30.Staab, JP, Ruckenstein, MJ. Which comes first? Psychogenic dizziness versus otogenic anxiety. Laryngoscope. 2003;113:1714–1718.CrossRefGoogle ScholarPubMed
31.Smout, AJ, DeVore, MS, Dalton, CB, Castell, DO. Cerebral potentials evoked by oesophageal distension in patients with non-cardiac chest pain. Gut. 1992;3:298–302.CrossRefGoogle Scholar
32.Staab, JP, Ruckenstein, MJ, Solomon, D, Shepard, NT. Serotonin reuptake inhibitors for dizziness with psychiatric symptoms. Headache. 2003;4:428.CrossRefGoogle Scholar
33.Staab, JP, Ruckenstein, MJ, Amsterdam, JD. A prospective trial of sertraline for chronic dizziness with anxiety. Poster presented at: 156th Annual Meeting of the American Psychiatric Association; May 20, 2003; San Francisco, CA.Google Scholar
34.Lorenz, R, Jorysz, G, Clasen, M. The globus syndrome: value of flexible endoscopy of the upper gastrointestinal tract. J Laryngol Otol. 1993;6:535–537.CrossRefGoogle Scholar
35.Moser, G, Vacariu-Granser, GV, Schneider, C, et al.High incidence of esophageal motor disorders in consecutive patients with globus sensation. Gastroenterology. 1991;6:1512–1521.CrossRefGoogle Scholar
36.Timon, C, O'Dwyer, T, Cagney, D, Walsh, M. Globus pharyngeus: long-term follow-up and prognostic factors. Ann Otol Rhinol Laryngol. 1991;100(5 Pt 1):351–354.CrossRefGoogle ScholarPubMed
37.Liebowitz, MR. Globus hystericus and panic attacks. Am J Psychiatry. 1987;3:390–391.CrossRefGoogle Scholar
38.Hinton, D, Um, K, Ba, P. A unique panic-disorder presentation among Khmer refugees: the sore-neck syndrome. Cult Med Psychiatry. 2001;3:297–316.CrossRefGoogle Scholar
39.Koloski, NA, Talley, NJ, Boyce, PM. Does psychological distress modulate functional gastrointestinal symptoms and health care seeking? A prospective, community Cohort study. Am J Gastroenterol. 2003;4:789–797.CrossRefGoogle Scholar
40.Toner, BB, Garfinkel, PE, Jeejeebhoy, KN. Psychological factors in irritable bowel syndrome. Can J Psychiatry. 1990;35:158–161.CrossRefGoogle ScholarPubMed
41.Whitehead, WE, Bosmajian, L, Zonderman, AB, Costa, PT Jr, Schuster, MM. Symptoms of psychologic distress associated with irritable bowel syndrome. Comparison of community and medical clinic samples. Gastroenterology. 1988;95:709–714.CrossRefGoogle ScholarPubMed
42.Smith, RC, Greenbaum, DS, Vancouver, JB, et al.Psychosocial factors are associated with health care seeking rather than diagnosis in irritable bowel syndrome. Gastroenterology. 1990;98:293–301.CrossRefGoogle ScholarPubMed
43.Koloski, NA, Talley, NJ, Huskic, SS, Boyce, PM. Predictors of conventional and alternative health care seeking for irritable bowel syndrome and functional dyspepsia. Aliment Pharmacol Ther. 2003;6:841–851.CrossRefGoogle Scholar
44.Lydiard, RB, Falsetti, SA. Anxiety and the irritable bowel syndrome: psychiatric, medical, or both? J Clin Psychiatry. 1997;58(suppl 3):51–58.Google ScholarPubMed
45.Lydiard, RB, Greenwald, S, Weissman, MM, Johnson, J, Drossman, DA, Ballenger, JC. Panic disorder and gastrointestinal symptoms: findings from the NIMH Epidemiologic Catchment Area project. Am J Psychiatry. 1994;1:64–70.Google Scholar
46.Masand, PS, Gupta, S, Schwartz, TL, et al.Does a preexisting anxiety disorder predict response to paroxetine in irritable bowel syndrome? Psychosomatics. 2002;6:451–455.CrossRefGoogle Scholar