Überprüfung der zeitlichen Stabilität medizinisch nicht erklärter Beschwerden und somatoformer Störungen vor dem Hintergrund unterschiedlicher Diagnosekonzepte

 

 Buy Article Permissions and Reprints

Zusammenfassung

Ziel dieser Untersuchung war, die Stabilität medizinisch nicht erklärter Symptome (MUS) und somatoformer Störungen vor dem Hintergrund unterschiedlicher Diagnosekonzepte (SSI4/6, DSM-IV, DSM-V) zu bestimmen und zu vergleichen. In einer 2-Phasen-Follow-up-Studie wurden 620 konsekutive Patienten mit dem PHQ-15 Fragebogen voruntersucht. In der zweiten Phase wurden 308 ausgewählte Personen ausführlich interviewt. 12 Monate später konnten 89,9% der Patienten erneut befragt werden. MUS und somatoforme Störungen wiesen schwache Stabilitätskoeffizienten auf. Für die Complex Somatic Symptom Disorder (DSM-V) fielen die Prävalenzraten geringer aus als erwartet. Innerhalb von einem Jahr gingen sie drastisch zurück. Bei der Revision somatoformer Störung im DSM-V sollte die Instabilität der Complex Somatic Symptom Disorder berücksichtigt werden. Zur Verbesserung der Stabilität sollte das Zeitkriterium um die Dauer psychischer Beschäftigung mit den Beschwerden erweitert werden.

Abstract

Objective: The aim of this study was to determine and to compare the stability of medically unexplained symptoms and somatoform disorders within the context of different diagnostic concepts (SSI4/6, DSM-IV, DSM-V).

Method: In a 2-stage follow-up study, 620 consecutive patients were first of all screened using the PHQ-15 questionnaire. In the second stage, 308 selected persons were then interviewed in detail. 12 months later, 89,9% of participants could be interviewed again.

Results: Medically unexplained symptoms and somatoform disorders showed weak stability coefficients. In regard to Complex Somatic Symptom Disorder (DSM-V), the prevalence rates were smaller than expected. Within a year, they declined drastically.

Conclusion: The instability of Complex Somatic Symptom Disorder should be taken into account when revising somatoform disorder for DSM-V. In order to improve stability, the time criterion should be extended by the duration of mental preoccupation with the ailments.

Literatur

• 1 Wise TN, Birket-Smith M. The somatoform disorders for DSM-V: the need for changes in process and content.  Psychosomatics. 2002;  43 437-440
  CrossrefPubMedGoogle Scholar
• 2 Rief W. Painting the picture of distressing somatic symptoms.  J Psychosom Res. 2010;  68 1-3
  CrossrefPubMedGoogle Scholar
• 3 Kroenke K. Physical symptom disorder: A simpler diagnostic category for somatization-spectrum conditions.  J Psychosom Res. 2006;  60 335-339
  CrossrefPubMedGoogle Scholar
• 4 Kroenke K, Spitzer RL, deGruy FV. et al . A symptom checklist to screen for somatoform disorders in primary care.  Psychosomatics. 1998;  39 263-272
  CrossrefPubMedGoogle Scholar
• 5 Escobar JI, Rubio-Stipec M, Canino G. et al . Somatic Symptom Index (SSI): a new and abridged somatization construct.  J Nerv Ment Dis. 1989;  177 140-146
  PubMedGoogle Scholar
• 6 Kroenke K, Spitzer RL, Gruy FV de. et al . Multisomatoform disorder. An alternative to undifferentiated somatoform disorder for the somatizing patient in primary care.  Arch Gen Psychiatry. 1997;  54 352-358
  CrossrefPubMedGoogle Scholar
• 7 Voigt K, Nagel A, Meyer B. et al . Towards positive diagnostic criteria: a systematic review of somatoform disorder diagnoses and suggestions for future classification.  J Psychosom Res. 2010;  68 403-414
  CrossrefPubMedGoogle Scholar
• 8 Rief W, Rojas G. Stability of somatoform symptoms – implications for classification.  Psychosom Med. 2007;  69 864-869
  CrossrefPubMedGoogle Scholar
• 9 Kent DA, Tomasson K, Coryell W. Course and outcome of conversion and somatization disorders.  Psychosomatics. 1995;  36 138-144
  CrossrefPubMedGoogle Scholar
• 10 Simon G, Gureje O. Stability of somatization disorder and somatization symptoms among primary care patients.  Arch Gen Psychiatry. 1999;  56 90-95
  CrossrefPubMedGoogle Scholar
• 11 Leiknes KA, Finset A, Moum T. et al . Overlap, comorbidity, and stability of somatoform disorders and the use of current versus lifetime criteria.  Psychosomatics. 2008;  49 152-162
  CrossrefPubMedGoogle Scholar
• 12 Mewes R, Rief W. Stabilität alternativer Klassifikationsansätze für somatoforme Störungen: Supplementum.  Z Klin Psychol Psychother. 2010;  1 26
  PubMedGoogle Scholar
• 13 Arnold IA, Waal MWM de, Eekhof JAH. et al . Somatoform disorder in primary care: course and the need for cognitive-behavioral therapy.  Psychosomatics. 2006;  47 498-503
  CrossrefPubMedGoogle Scholar
• 14 Rief W, Sharpe M. Somatoform disorders – new approaches to classification, conceptualization, and treatment.  J Psychosom Res. 2004;  56 387-390
  CrossrefPubMedGoogle Scholar
• 15 Leiknes KA, Finset A, Moum T. et al . Methological issues concerning lifetime medically unexplained and medically explained symptoms of the Composite International Diagnostic Interview: a prospective 11-year follow-up study.  J Psychosom Res. 2006;  61 169-179
  CrossrefPubMedGoogle Scholar
• 16 Kroenke K, Spitzer RL, Williams JBW. The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms.  Psychosom Med. 2002;  64 258-266
  CrossrefPubMedGoogle Scholar
• 17 Kroenke K, Arrington MW, Mangelsdorff AD. The prevalence of symptoms in medical outpatients and the adequacy of therapy.  Arch Intern Med. 1990;  150 1685-1689
  CrossrefPubMedGoogle Scholar
• 18 Rief W, Mewes R, Martin A. et al . Are psychological features useful in classifying patients with somatic symptoms?.  Psychosom Med. 2010;  72 648-655
  CrossrefPubMedGoogle Scholar
• 19 Andrews G, Peters L. The psychometric properties of the Composite International Diagnostic Interview.  Soc Psychiatry Psychiatr Epidemiol. 1998;  32 80-88
  PubMedGoogle Scholar
• 20 Hiller W, Zaudig M, Mombour W. Development of diagnostic checklists for use in routine clinical care.  Arch Gen Psychiatry. 1990;  47 782-784
  CrossrefPubMedGoogle Scholar
• 21 Fink P, Ewald H, Jensen J. et al . Screening for somatization and hypochondriasis in primary care and neurological in-patients: A seven-item scale for hypochondriasis and somatization.  J Psychosom Res. 1999;  40 261-273
  PubMedGoogle Scholar
• 22 Statistisches Bundesamt . Bildungsstand der Bevölkerung Ausgabe 2009 [Educational background in the population 2009].  Wiesbaden; 2009;  https://www-ec.destatis.de/csp/shop/sfg/bpm.html.cms.cBroker.cls?cmspath=struktur,vollanzeige.csp&ID=1024383
  PubMedGoogle Scholar
• 23 Kroenke K, Spitzer RL, Williams JBWLM. et al . Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment.  Arch Fam Med. 1994;  3 774-779
  CrossrefPubMedGoogle Scholar
• 24 Jackson JL, Passamonti M. The outcomes among patients presenting in primary care with a physical symptoms at 5 years.  J Gen Intern Med. 2005;  20 1032-1037
  CrossrefPubMedGoogle Scholar
• 25 Gara MA, Escobar JI. The stability of somatization syndromes over time.  Arch Gen Psychiatry. 2001;  58 94
  CrossrefPubMedGoogle Scholar
• 26 Barsky AJ, Borus JF. Somatization and medicalization in the era of managed care.  JAMA. 1995;  274 1931-1934
  CrossrefPubMedGoogle Scholar

Korrespondenzadresse

Natalie Steinbrecher

Johannes Gutenberg-Universität

Klinische Psychologie

Wallstraße 3

55122 Mainz

Email: steinbrn@uni-mainz.de