Assessing psychological factors affecting medical conditions: comparison between different proposals

• Published in: General hospital psychiatry Vol. 35; no. 2; pp. 141 - 146
• Main Authors: Guidi, Jenny, Rafanelli, Chiara, Roncuzzi, Renzo, Sirri, Laura, Fava, Giovanni A.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2013; Elsevier
• Subjects: Adult and adolescent clinical studies; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Diagnostic and Statistical Manual of Mental Disorders; Diagnostic Criteria for Psychosomatic Research; DSM-5; Female; Heart; Heart Failure - psychology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Italy - epidemiology; Male; Medical sciences; Middle Aged; Nosology. Terminology. Diagnostic criteria; Psychiatry; Psychological factors affecting medical condition; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Sensitivity and Specificity; Somatic symptom disorders; Somatization; Somatoform Disorders - classification; Somatoform Disorders - diagnosis; Somatoform Disorders - epidemiology; Somatoform disorders. Psychosomatics; Surveys and Questionnaires; Techniques and methods; Italy; Somatization; Somatic symptom disorders; Psychological factors affecting medical condition; DSM-5; Diagnostic Criteria for Psychosomatic Research; Human; Heart failure; Cardiovascular disease; Nosology; Symptomatology; Psychosomatics; Criterion; Psychological distress; Heart disease; Diagnostic and Statistical Manual V; Classification; Somatoform disorder; Diagnosis; Comparative study; Somatic disease
• ISSN: 0163-8343; 1873-7714; 1873-7714
• DOI: 10.1016/j.genhosppsych.2012.09.007

We compared the provisional Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for Somatic Symptom Disorders (SSD) and an alternative classification based on the Diagnostic Criteria for Psychosomatic Research (DCPR) as to prevalence and associations with dimensional measures of psychological distress and functioning in a population of medical patients. Seventy consecutive outpatients with congestive heart failure were administered an ad hoc structured clinical interview for the identification of DSM-5 SSD, the section concerning hypochondriasis of the Structured Clinical Interview for DSM-IV, the Structured Interview for DCPR and Paykel's Clinical Interview for Depression. Subjects also completed the Symptom Questionnaire and the Psychosocial Index. Global assessment of functioning was performed with the DSM-IV Axis V. A diagnosis within DSM-5 SSD was found in 13 patients (18.5%): 61.5% of them were diagnosed with the Psychological Factors Affecting Medical Condition category. Twenty-nine patients (41.4%) were classified according to the DCPR-based proposal: illness denial, demoralization and irritable mood were the most frequent specifiers. The DCPR-based classification showed a greater number of significant associations with dimensional measures of psychological distress, global functioning and stress. Compared to DSM-5 SSD, the DCPR-based proposal was more sensitive in detecting psychological factors relevant to illness course and provided a better characterization of such factors. The DCPR-based proposal was also superior in identifying patients with increased psychological distress and poor psychosocial functioning.