Download Somatic Symptoms in Mood and Anxiety Disorders

abstract number CG16P-0911
Somatic Symptoms in Mood and Anxiety Disorders
Cecilia Mainardi1, Biagio Cotugno1, Simone Belli1, Bruno Pacciardi1, Mauro Mauri1
¹Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, Italy
Il Poeta e il pittore. G De Chirico, 1975
Background: Somatization is a widespread human phenomenon. Its
phenomenology ranges from physiological response to stress to invalidating
psychopathology. Somatic symptoms are not always pathological except when they
achieves high levels of intensity, frequency and functional impairment.
Epidemiological literature about somatization disorder diagnosis is sparse and
inconclusive, but the majority of the data agree about the high prevalence of
comorbidity (especially with anxiety and depressive disorders) in patients with
somatization disorder, that interfere with diagnostic process. Clinicians may be
misleaded by depressive and anxious psychopathology, underestimating the role of
somatization disorders.
In order to give a contribution to a better understanding of the relationship among
anxiety, depressive and somatoform disorders we assessed psychopathological
comorbidity with structured clinical interviews in a sample of patients.
Methods
•  Naturalistic observational study on outpatients of a general practitioner and the outpatient of a psychiatric unit
at the university of Pisa (sample of 70 outpatients-preliminary data).
•  This study aimed to investigate prevalence, severity and comorbidity of somatization disorders and anxietydepressive disorders with specific scales (Patient Health Questionnaire,Hamilton Rating Scale for Anxiety,
Hamilton Rating Scale for Depression, Clinical Global Impression).
•  Patients over 65 years old were excluded from the survey, for increased likelihood of medical comorbidities.
•  Patients with history of alcohol or illicit drugs addiction/abuse were also excluded.
•  Patients with current or life-time history of psychotic symptoms were excluded.
•  A Pearson correlation between Hamilton scale scores and somatization items scores was performed.
Results and discussion: In most cases somatization disorders were detected among patients with both
anxiety and depressive disorders, no somatization disorders were diagnosed in those who had a depressive
disorder without anxious comorbidity. Among subjects who had an anxiety disorder without depressive
comorbidity an intermedium number of somatization diagnoses was found. Among subjects with no anxiety and
no depressive disorders three people resulted to have a somatization disorder.
The highest average scores on HAM-A and HAM-D were found in patients with anxious-depressive comorbidity
and somatization disorder.
In our sample somatization disorders were more prevalent in females than in males (30.95% vs 10.71%). This
finding was also supported by PHQ somatization items, being higher in females than in males.
Numberof Soma,za,on AveragePHQ Average
Conclusions:These preliminary findings are in line Average
pa,ents
disorder
scores
HAM-A
HAM-D
with literature data suggesting a close correlation
diagnosis
scores
scores
among somatization
and anxious-depressive
35
Group1
12
8.11
20.43
17.09
disorders.
Patients with depressive and anxiety symptoms do Group2
35
4
5.71
11.29
8.51
have a high chance of being affected by a comorbid
28
3
5.43
14.11
11.57
somatization disorder. At the same time patients Males
42
13
7.90
17.02
13.62
complaining about somatic symptoms have a high Females
chance of being diagnosed with depressive and
anxiety disorders. In both cases anxious more than pure depressive symptomathology seem to have a role in
patients with somatoform disorders.
Patients with multiple comorbidities had more severe psychiatric symptomatology; this may suggest an
interconnection among psychopathological dimensions or may just imply that patients with more comorbidities
also have a more severe burden of disease.
As for clinical practice this would suggest that patients complaining about somatic symptoms should be
assessed with the utmost care. In these patients the administration of rating scales aimed at investigating
psychiatric comorbidity seems to be mandatory and specialistic consultation should be offered.
The authors have no conflicts of interest to disclose.
References
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[3] Hanel G, Henningsen P, Herzog W, Sauer N, Schaefert R, Szecsenyi J & Löwe B. (2009) Depression, anxiety, and somatoform disorders: vague or distinct categories in primary care? Results from a large cross-sectional study.
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[5] Mauri, M., Cargioli, C., Pacciardi, ., Belli, S., & Luchini, F. (2013). Disturbo di somatizzazione e Disturbo da Conversione: differenze psicopatologiche, cliniche e terapeutiche. L'altro, 16(3), 13-19.