abstract is to blame, but there is no way to tell how patients with FM
were diagnosed or how somatization was defined and how it was decided
whether patients had both. Nor do we know how it was determined that
the controls were "healthy." A key issue is there is no diagnostic
test for either fibromyalgia or somatization which means that
misdiagnosis is a possibility. For example the DSM IV criteria for
somatization disorder is as follows:
Diagnostic criteria for 300.81 Somatization Disorder
A. A history of many physical complaints beginning before age 30 years
that occur over a period of several years and result in treatment
being sought or significant impairment in social, occupational, or
other important areas of functioning. (People who are severely ill may
have such a history.)
B. Each of the following criteria must have been met, with individual
symptoms occurring at any time during the course of the disturbance:
(1) four pain symptoms: a history of pain related to at least four
different sites or functions (e.g., head, abdomen, back, joints,
extremities, chest, rectum, during menstruation, during sexual
intercourse, or during urination)
(2) two gastrointestinal symptoms: a history of at least two
gastrointestinal symptoms other than pain (e.g., nausea, bloating,
vomiting other than during pregnancy, diarrhea, or intolerance of
several different foods)
(3) one sexual symptom: a history of at least one sexual or
reproductive symptom other than pain (e.g., sexual indifference,
erectile or ejaculatory dysfunction, irregular menses, excessive
menstrual bleeding, vomiting throughout pregnancy)
(4) one pseudoneurological symptom: a history of at least one symptom
or deficit suggesting a neurological condition not limited to pain
(conversion symptoms such as impaired coordination or balance,
paralysis or localized weakness, difficulty swallowing or lump in
throat, aphonia, urinary retention, hallucinations, loss of touch or
pain sensation, double vision, blindness, deafness, seizures;
dissociative symptoms such as amnesia; or loss of consciousness other
than fainting)
C. Either (1) or (2):
(1) after appropriate investigation, each of the symptoms in Criterion
B cannot be fully explained by a known general medical condition or
the direct effects of a substance (e.g., a drug of abuse, a
medication)
(2) when there is a related general medical condition, the physical
complaints or resulting social or occupational impairment are in
excess of what would be expected from the history, physical
examination, or laboratory findings
D. The symptoms are not intentionally feigned or produced.
For example a woman may have irregular menses or a urinary tract
infection unrelated to fibromyalgia, but might then meet the criteria
for somatization simply because a medical history reveals both. Or for
example, the examiner determines that in their experience or opinion
that the symptoms or impairment are excessive, but has no objective
means of proving this other than their opinion on a symptom or
situation they are not actually experiencing. In this study a
questionnaire was substituted for cognitive impairment instead of
objective testing in specific areas related to fibromyalgia. This
could also confound the results
Thus the proton magnetic resonance spectroscopy findings of a study
like this may be accurate, but the interpretation may or may not apply
to any or all of the three groups.
Acta Psychiatr Scand. 2011 Dec 30. doi:
10.1111/j.1600-0447.2011.01820.x. [Epub ahead of print]
Brain dysfunction in fibromyalgia and somatization disorder using
proton magnetic resonance spectroscopy: a controlled study.
Fayed N, Andres E, Rojas G, Moreno S, Serrano-Blanco A, Roca M,
Garcia-Campayo J.
Department of Radiology, Quir=C3=B3n Hospital, Zaragoza, Spain CIBER
Epidemiology and Public Health, Clinic Epidemiology Unit, 12 de
Octubre Hospital, Madrid, Spain Department of Psychiatry, Aragonese
Institute of Health Sciences, Miguel Servet Hospital and University of
Zaragoza, Zaragoza, Spain Sant Joan de D=C3=A9u Health Parc & Sant Joan de
D=C3=A9u Foundation, Sant Boi de Llobregat, Barcelona, Spain Health
Sciences Research Universitary Institut, Juan March Hospital, Illes
Balears University, Palma de Mallorca, Baleares, Spain.
Abstract
Objective:=E2=80=82 To evaluate the brain metabolite patterns in patients w=
ith
fibromyalgia (FM) and somatization disorder (STD) compared with
healthy controls through spectroscopy techniques and correlate these
patterns with psychological variables.
Method:=E2=80=82 Design. Controlled, cross-sectional study.
Sample. Patients were recruited from primary care in Zaragoza, Spain.
The control group was recruited from hospital staff.
Patients were administered questionnaires on pain catastrophizing,
anxiety, depression, pain, quality of life, and cognitive impairment.
All patients underwent Magnetic Resonance Imaging and magnetic
resonance spectroscopy (MRS).
Results:=E2=80=82 A significant increase was found in the glutamate=E2=80=
=83+
glutamine (Glx) levels in the posterior cingulate cortex (PCC): 10.73
(SD: 0.49) for FM and 9.67 (SD: 1.10) for STD 9.54 (SD: 1.46) compared
with controls (P=3D0.043).
In the FM=E2=80=83+=E2=80=83STD group, a correlation between Glx and pain
catastrophizing in PCC (r=E2=80=83=3D=E2=80=830.397; P=E2=80=83=3D=E2=80=83=
0.033) and between quality of
life and the myo-inositol/creatine ratio in the left hippocampus
(r=3D-0.500; P=3D0.025) was found.
To conclude Glutamate seems to be relevant in the molecular processes
involved in FM and STD. It also opens the door for Proton MRS ((1)
H-MRS) in STD and suggests that reducing glutamatergic activity
through pharmacological treatment could improve the outcome of
patients with FM and STD. Conclusion:=E2=80=82 Glutamate seems to be releva=
nt
in the molecular processes involved in FM and STD. It also opens the
door for Proton MRS ((1) H-MRS) in STD and suggests that reducing
glutamatergic activity through pharmacological treatment could improve
the outcome of patients with FM and STD.
=C2=A9 2011 John Wiley & Sons A/S.
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