28 February 2012
Notes:
Michael Sharpe, Arthur Barsky and Francis Creed are members of the DSM-5 =
"Somatic Symptom Disorders" Work Group.=20
Francis Creed is a member of the "ICD-11 working group for Bodily =
Distress Disorders" aka "ICD-11 Revision Working Group on Somatoform =
Disorders" (led by O. Gureje).
The current ICD-11 Alpha drafting platform displays the following =
proposals for the Chapter 5 category known in ICD-10 as "Somatoform =
Disorders":
05A08 BODILY DISTRESS DISORDERS
05A08.00 Mild bodily distress disorder
05A08.01 Moderate bodily distress disorder
05A08.02 Severe bodily distress disorder
05A08.03 Somatization disorder
05A08.04 Undifferentiated somatoform disorder
05A08.05 Somatoform autonomic dysfunction
05A08.06 Persistent somatoform pain disorder=20
05A08.06.00 Persistent somatoform pain disorder=20
05A08.06.01 Chronic pain disorder with somatic and =
psychological factors [not in ICD-10]
05A08.07 Other somatoform disorders
05A08.08 Somatoform disorder, unspecified
Dr David Goldberg is Chairman, WHO Advisory Group for Classification in =
Primary Care: ICD11-PHC 1 - the condensed version of ICD-11.
According to this document: Journal of International Psychiatry, Volume =
8 Number 1 February 2011 =20
http://www.rcpsych.ac.uk/pdf/IPv8n1.pdf=20
at the time of publication, Dr Goldberg was proposing the following:
"A revised mental health classification for use in general medical =
settings: the ICD11-PHC 1"
"David Goldberg
[...]
"However, some of the ICD10-PHC disorders were equivalent to existing =
categories in the parent classification, and did not take into account =
developments in diagnostic thinking. An interesting example of this =
concerns 'medically unexplained symptoms', which appear to have fallen =
out of favour with our GP colleagues, who have taken the view that even =
some medically explained symptoms can be abnormally prolonged and =
accentuated. Psychiatrists have taken a similar view: the new concept of =
'complex somatic symptom disorder' being field tested for DSM-V also =
draws attention not to whether somatic symptoms can be explained, but to =
the cognitive components that may accompany them, whether they are part =
of a known physical disease or not."
[...]
"Box 2 The 28 disorders to be field tested for ICD11-PHC
[...]
"Body distress disorders
16 Bodily distress syndrome (new - was unexplained somatic complaints)
17 Health preoccupation (new)
18 Conversion disorder (was dissociative disorder)"
[...]
"A new category called bodily distress disorders will include conversion =
disorder (fairly common in some lower-income countries), health =
preoccupation (a new disorder similar to hypochondriasis) and the less =
severe 'bodily distress syndrome'. In the syndrome, the patient is both =
distressed and concerned and has three or more somatic symptoms in one =
bodily system. This is diagnosed only if the patient does not have one =
of the three dysphoric disorders."
[...]
"These proposals are radical indeed, and by no means all of the proposed =
disorders will survive the field tests. Each proposed category will be =
commented upon by experts who are not part of the group, as well as by =
the main advisory group responsible for ICD-11. Final amendments will be =
made by the primary care group before the revised classification is =
released for field tests. The field tests are likely to be quite =
extensive, and to involve studies in both high-income and low- and =
middle-income countries. A second set of revisions will be made after =
the field tests."
(Ed: Note: these proposals may have been subject to revision since =
publication early last year.)
------------------------------
PULSE Today
http://www.pulsetoday.co.uk/
Article
GP clinic 'helps patients deal with unexplained symptoms'=20
By Beatrice Baiden | 28 Feb 2012
A specialist clinic for patients with medically unexplained symptoms =
(MUS) in primary care can have a 'clinically meaningful' improvement on =
their quality of life, say UK researchers.
The pilot study looked at 32 patients from six north-east Edinburgh GP =
surgeries who had multiple specialist referrals and current disease =
symptoms that their GP believed could not be adequately explained by =
physical disease.
Patients were allocated randomly to two arms - usual care or a series of =
four clinic appointments with a GP with a special interest in MUS - and =
their quality of life was assessed at baseline and after the =
intervention.
Both study arms showed an improvement in quality of life, but =
improvements were more marked in the intervention group. The differences =
in Patient Health Questionnaire (PHQ-14) scores in the intervention =
group were 3.3, compared with 2.2 in the usual care group, and this =
difference was statistically significant when one outlier was removed.
Eight out of the 11 patients randomised to the clinic appointment =
reported it had helped them deal with their problems, and study leader =
Dr Christopher Burton, GP and senior research fellow at the University =
of Edinburgh, said MUS sufferers often incurred substantial health costs =
with repeated consultations, but the clinic results 'are in keeping with =
clinically meaningful benefit'.
------------------
http://www.jpsychores.com/issues?issue_key=3DS0022-3999(12)X0003-5=20
Journal of Psychosomatic Research
Volume 72, Issue 3 , Pages 242-247, March 2012
http://www.jpsychores.com/article/S0022-3999(11)00316-3/abstract =20
Healthcare costs incurred by patients repeatedly referred to secondary =
medical care with medically unexplained symptoms: A cost of illness =
study
=20
Christopher Burton Affiliations Centre for Population Health Sciences, =
University of Edinburgh, United Kingdom
Kelly McGorm Affiliations Centre for Population Health Sciences, =
University of Edinburgh, United Kingdom
Gerry Richardson Affiliations Centre for Health Economics, University =
of York, United Kingdom
David Weller Affiliations Centre for Population Health Sciences, =
University of Edinburgh, United Kingdom
=20
Michael Sharpe Affiliations Psychological Medicine Research, Department =
of Psychiatry, University of Oxford, United Kingdom
Corresponding author at: Psychological Medicine Research, University of =
Oxford Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, =
United Kingdom. Tel.: +44 1865 226397; fax: +44 1865 793101.
Received 9 June 2011; received in revised form 13 December 2011; =
accepted 20 December 2011. published online 18 January 2012.
Abstract=20
Background
Some patients are repeatedly referred from primary to secondary care =
with medically unexplained symptoms (MUS). We aimed to estimate the =
healthcare costs incurred by such referrals and to compare them with =
those incurred by other referred patients from the same defined primary =
care sample.
Methods
Using a referral database and case note review, all adult patients aged =
less than 65years, who had been referred to specialist medical services =
from one of five UK National Health Service primary care practices in a =
five-year period, were identified. They were placed in one of three =
groups: (i) repeatedly referred with MUS (N=3D276); (ii) infrequently =
referred (IRS, N=3D221), (iii) repeatedly referred with medically =
explained symptoms (N=3D230). Secondary care activities for each group =
(inpatient days, outpatient appointments, emergency department =
attendances and investigations) were identified from primary care =
records. The associated costs were allocated using summary data and the =
costs for each group compared.
Results
Patients who had been repeatedly referred with MUS had higher mean =
inpatient, outpatient and emergency department costs than those =
infrequently referred (=A33,539, 95% CI 1458 to 5621, =A3778 CI 705 to =
852 and =A399, CI 74 to 123 respectively. The mean overall costs were =
similar to those of patients who had been repeatedly referred with =
medically explained symptoms.
Conclusions
The repeated referral of patients with MUS to secondary medical care =
incurs substantial healthcare costs. An alternative form of management =
that reduces such referrals offers potential cost savings.
Keywords: Cost of illness, MUS, Primary care, Referrals, Somatoform =
disorders
----------------
http://www.jpsychores.com/article/S0022-3999(12)00025-6/abstract=20
Journal of Psychosomatic Research
Article in Press
The epidemiology of multiple somatic symptoms
Francis H. Creed Affiliations School of Community Based Medicine, The =
University of Manchester, Manchester, UK
Corresponding author at: School of Community Based Medicine, 3rd floor, =
Jean McFarlane Building, University Place, Oxford Road, Manchester, M13 =
9PL. Tel.: +44 161 276 5331; fax: +44 161 306 7945.
=20
Ian Davies Affiliations Arthritis Research UK Epidemiology Unit, The =
University of Manchester, Manchester, UK
Judy Jackson Affiliations School of Community Based Medicine, The =
University of Manchester, Manchester, UK
=20
Alison Littlewood Affiliations Arthritis Research UK Epidemiology Unit, =
The University of Manchester, Manchester, UK
=20
Carolyn Chew-Graham Affiliations School of Community Based Medicine, =
The University of Manchester, Manchester, UK
Barbara Tomenson Affiliations School of Community Based Medicine, The =
University of Manchester, Manchester, UK
Gary Macfarlane Affiliations Aberdeen Pain Research Collaboration =
(Epidemiology Group), University of Aberdeen, UK
Arthur Barsky Affiliations Department of Psychiatry, Brigham and =
Women's Hospital and Harvard Medical School, Boston, MA, USA
Wayne Katon Affiliations Department of Psychiatry & Behavioural =
Sciences, University of Washington School of Medicine, Seattle, WA, USA
John McBeth Affiliations Arthritis Research UK Epidemiology Unit, The =
University of Manchester, Manchester, UK
Received 18 October 2011; received in revised form 12 January 2012; =
accepted 12 January 2012. published online 06 February 2012.=20
Corrected Proof
Abstract=20
Background
The risk factors for a high total somatic symptom count are unclear; and =
it is not known whether total somatic symptoms count is a predictor of =
impaired health status.
Method
A prospective population-based cohort study in North West England. =
Randomly sampled residents (1443 participants; 58% response) completed =
questionnaires to determine number of somatic symptoms (SSI), health =
status and a wide range of risk factors; 741 completed questionnaires =
1year later. We used logistic regression to identify risk factors for =
high SSI at follow-up and for persistently high SSI. We used ANCOVAR and =
multiple regression to assess whether baseline SSI predicted health =
status at follow-up.
Results
Twenty-one percent of participants scored over 25 on the Somatic Symptom =
Inventory (SSI) at baseline and 14% at both baseline and follow-up. Risk =
factors for a persistent high SSI were: fewer than 12 years of =
education, separated, widowed or divorced status, reported psychological =
abuse during childhood, co-existing medical illnesses, anxiety and =
depression. In multivariate analysis baseline SSI predicted health =
status (SF12 physical component score and health-related quality of life =
(EuroQol)) 12 months later. Persistent high SSI was a clinically =
meaningful predictor of these outcomes.
Conclusions
Our data support a biopsychosocial approach to somatic symptoms rather =
than the dualistic approach of identifying "medically unexplained" =
symptoms. The risk factors for total somatic symptom count were those =
associated with psychiatric disorders including physical illness. A =
persistent high somatic symptom count provides a readily measured =
dimension of importance in epidemiology as a predictor of health status.
Keywords: Somatoform disorders, Somatisation, Epidemiology, =
Health-related quality of life
----------------------
Suzy Chapman
_____________________
http://dxrevisionwatch.wordpress.com=20
http://meagenda.wordpress.com
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