Browsing by keyword "Work Group on Substance Abuse Disorders"
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A randomized clinical trial of a care recommendation letter intervention for somatization in primary carePURPOSE: This paper describes the impact of a care recommendation (CR) letter intervention on patients with multisomatoform disorder (MSD) and analysis of patient factors that affect the response to the intervention. METHODS: One hundred eighty-eight patients from 3 family practices, identified through screening of 2,902 consecutive patients, were classified using somatization diagnoses based on the number of unexplained physical symptoms from a standardized mental health interview. In a controlled, single-crossover trial, patients were randomized to have their primary care physician receive the CR letter either immediately following enrollment or 12 months after enrollment. The CR letter notified the physician of the patient's somatization status and provided recommendations for the patient's care. Patients were followed for 24 months with assessments of functional status at baseline, 12, and 24 months. RESULTS: Longitudinal analysis revealed a 12-month intervention effect for patients with multisomatoform disorder (MSD) of 5.5 points (P < .001) on the physical functioning (PCS) scale of the SF-36. Analysis of scores on the MCS scale of the SF-36 found no significant effect on mental functioning. The intervention was more effective for patients with 1 or more comorbid chronic physical diseases (P = .01). CONCLUSIONS: The CR letter has a favorable impact on physical impairment of primary care patients with MSD, especially for patients with comorbid chronic physical disease. Multisomatoform disorder appears to be a useful diagnostic classification for managing and studying somatization in primary care patients.
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Complex posttraumatic stress disorder: evidence from the primary care settingSexual abuse is a common problem among female primary care medical patients. There is a wide spectrum of long-term sequelae, ranging from mild to the complex symptom profiles consistent with the theories of a posttraumatic sense of identity. Generally, the latter occurs in the context of severe, chronic abuse, beginning in childhood and often compounded by the presence of violence, criminal behavior, and substance abuse in the family of origin. In this study we search for empirical evidence for the existence of a complex posttraumatic stress syndrome in 99 women patients at 3 family practice outpatient clinics who report a history of sexual abuse. A structured interview was administered by trained female interviewers to gather data on family history and psychiatric symptoms and diagnoses. Empirical evidence from cluster analysis of the data supports the theory of a complex posttraumatic syndrome. The severity gradient based on symptoms roughly parallels the severity gradient based on childhood abuse and sociopathic behavior and violence in the family of origin, with the most severely abused subjects characterized by symptom patterns that fit the description of a complex posttraumatic stress syndrome.
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Does major depressive disorder with somatic delusions constitute a distinct subtype of major depressive disorder with psychotic featuresBACKGROUND: Among patients with major depression with psychotic features, little is known about the extent to which those with and without somatic delusions differ. METHODS: The first 183 participants in the STOP-PD study were divided into two groups based on the presence or absence of somatic delusions and were compared on multiple demographic and clinical characteristics. RESULTS: In the multivariate analysis, those with somatic delusions reported more somatic symptoms, rated their health as worse, and were less likely to have persecutory delusions. CONCLUSIONS: Based on the methods we used, we could not detect meaningful differences between subjects with and without somatic delusions. This suggests that the presence of irrational somatic ideation does not define a distinct clinical subgroup among patients with psychotic depression. This finding needs to be replicated.
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Dual diagnosis in primary care. Detecting and treating both the addiction and mental illnessThe initial phase of treatment includes engaging the patient in a discussion about the doctor's concerns and providing patients with information about the problems as well as the possibility of change. Treatment of dual disorders often requires a heightened awareness of the consequences of the problem and the development of a realistic plan for change. The treatment plan must attempt to evaluate and treat the addiction and the psychiatric and medical illnesses.
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The somatization in primary care study: a tale of three diagnosesSomatization 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.