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BACKGROUND: Patients with persistent physical symptoms presenting in primary care are often affected by multiple symptoms and reduced functioning. The medical and societal costs of these patients are high, and there is a need for new interventions tailored to both the patients and health care system. OBJECTIVE: This study aimed to examine the usability of an unguided, self-help treatment program, "My Symptoms," developed to assist patients and general practitioners in symptom management. METHODS: In all, 11 users (4 patients with persistent physical symptoms and 7 laypeople) participated in web-based thinking-aloud interviews involving the performance of predefined tasks in the program. Thematic analysis was used to categorize the severity of usability issues. General usability heuristics were cross-referenced with the usability issues. RESULTS: The analysis identified important usability issues related to functionality, navigation, and content. The study shows how therapeutic knowledge in some cases was lost in the translation of face-to-face therapy to a digital format. The user testing helped uncover how the functionality of the digital elements and general navigation of the program played a huge part in locating and accessing the needed treatment. Examples of redesign to mediate the therapeutic value in the digital format involving health care professionals, web developers, and users are provided. The study also highlights the differences of involving patients and laypeople in the interviews. CONCLUSIONS: Taking the experience of common symptoms as a point of departure, patients and laypeople contributed to finding usability issues on program functionality, navigation, and content to improve the program and make the treatment more accessible to users.
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BACKGROUND: Somatic symptoms, which are common in major depressive disorder (MDD), are associated with a worse prognosis and increased health costs. AIMS: This randomized, double-blind, placebo-controlled study evaluated the efficacy of aripiprazole augmentation in MDD patients with somatic symptoms. METHODS: In all, 41 MDD patients with somatic symptoms completed the study. Participants who had been on a stable dose of antidepressants for at least 1 month were randomly assigned to receive an 8-week adjunctive treatment with either aripiprazole or placebo. The initiation dose of aripiprazole was 2 mg/day, which was later adjusted to 1-10 mg/day. The primary endpoint was the change in the Symptom Checklist-90-Revised-Somatization (SCL-90-R-SOM) score. We collected quantitative electroencephalogram data and performed spectral analyses to obtain the absolute power of frequency bands. RESULTS/OUTCOMES: The aripiprazole group (n = 20; 2.98 ± 1.75 mg/day) showed a significant improvement in SCL-90-R-SOM scores compared to the placebo group (n = 21; F = 8.56, p = 0.006), without significant differences in changes in depression and anxiety symptoms. Compared to the control, the aripiprazole group showed a greater decrease in total alpha power (F = 7.03, p = 0.01). Changes in frontal alpha power were positively correlated with changes in SCL-90-R-SOM scores in the aripiprazole group (r = 0.53, p = 0.014). CONCLUSIONS/INTERPRETATION: Aripiprazole adjunctive to antidepressants in patients with MDD and somatic symptoms improved somatic symptom severity without significant safety concerns, and this improvement correlated with a decrease in total and frontal alpha power.Trial Registration: https://cris.nih.go.kr; identifier: KCT0004607.
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Antipsicóticos , Trastorno Depresivo Mayor , Síntomas sin Explicación Médica , Quinolonas , Humanos , Aripiprazol/uso terapéutico , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastorno Depresivo Mayor/diagnóstico , Antipsicóticos/uso terapéutico , Piperazinas , Quinolonas/efectos adversos , Quimioterapia Combinada , Antidepresivos/uso terapéutico , Método Doble Ciego , Resultado del TratamientoRESUMEN
BACKGROUND: Impaired expression of genes which act on hormone signaling pathways is one of the factors affecting miscarriage. In this study, the expression levels of insulin receptor (INSR) and insulin receptor substrates-1 (IRS-1) genes in endometrial tissue of infertile women and fertile women with miscarriage in less than twenty weeks gestation for unknown reasons were evaluated. MATERIALS AND METHODS: In this case-control study, forty-two fertile women with children and 42 infertile women, who underwent in vitro fertilization (IVF), were selected. Both groups had abortions under twenty weeks gestation for unknown reasons. The endometrial tissue of all patients was prepared to evaluate the expression of INSR and IRS-1 genes by quantitative real-time polymerase chain reaction (PCR) method after RNA extraction. RESULTS: There was a statistically significant relationship between the expressions of INSR and IRS-1 genes in the endometrial tissue of the infertile women compared with the fertile women (P=0.002 and P=0.008, respectively). The expression level of genes was decreased in both groups by age and increasing body mass index (BMI). Comparison of genes expression levels in healthy and diabetic participants in each group showed a significant difference (P<0.0001), but no meaningful difference was indicated between diabetic infertile and fertile groups in terms of gene expression. INSR gene expression levels showed an increase in the fertile group in the second 10 weeks and a decrease in IRS-1 gene expression. But in the infertile group, both genes showed a slight increase in expression. CONCLUSION: It seems a decreased expression of insulin signaling pathway genes in the endometrial tissue of infertile women can be one of reasons for unspecified abortion. These genes may be strong molecular markers for infertility.
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Medically unexplained symptoms (MUS) are persistent bodily symptoms without known pathology. An unofficial term has recently emerged in Taiwan to accommodate MUS: autonomic imbalance (AI). AI literally refers to disturbances of the autonomic nervous system (ANS) that innervates vital organs. However, AI is variously conceptualised by different parties. This study intends to investigate what is in the name of AI. It draws on available databases and in-depth interviews with AI sufferers and Western and Chinese medicine physicians. Some physicians research ANS functions through heart rate variability measurements. Research findings show that physicians regard AI as a convenient term for clinical communication and a euphemistic substitute for MUS or even psychiatric diagnoses. It is not a 'real thing'. However, AI sufferers treat AI as a bona fide disease, only that it has not been officially classified. AI is therefore an unfaithful translation, or an uncontrolled equivocation, of MUS. The paper concludes by discussing the implications of treating AI as an equivocation. These implications include the limitations of the current diagnostic criteria, the necessity to rethink the dichotomy of mind and body, and the underlying realities exposed or masked by 'diagnosis'.
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Síntomas sin Explicación Médica , Comunicación , Humanos , Trastornos Somatomorfos , TaiwánRESUMEN
PURPOSE: This study was done to identify the moderating effect of spiritual well-being between somatic symptoms and quality of life in adults. METHODS: This study was conducted using a questionnaire which included item for somatic symptoms, spiritual well-being, and quality of life. Data were collected from 226 adults living in Korea from April to May, 2018. Using the IBM SPSS 21.0 statistics program, the collected data were analyzed through descriptive statistics and hierarchical multiple regression analysis. RESULTS: The mean cores (men/women) of somatic symptoms, spiritual well-being, and quality of life were 1.48±0.32 (1.44±0.34 / 1.50±0.31), 2.80±0.55 (2.68±0.53 / 2.86±0.55), and 2.49±0.49 (2.50±0.56/2.49±0.45), respectively. Somatic symptoms and spiritual well-being explained approximately 46% of quality of life. Moderating effect of spiritual well-being was statistically non-significant in adults, but significant in men. CONCLUSION: It is necessary to consider spiritual well-being variables as a strategy for improving the quality of life of men. Also, it is suggested a qualitative study to understand in depth the subjective spiritual well-being.
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Adulto , Humanos , Masculino , Corea (Geográfico) , Calidad de Vida , EspiritualidadRESUMEN
Medically unexplained symptoms (MUS) are extremely common in general practice as in all medical specialties, but their designation is not unambiguous and the approaches to take care of the patients differ from conventional therapeutic approaches. The difficulty is not to confirm the diagnosis, which is rapidly obvious with some experience, but to establish a genuinely human therapeutic relationship, without any technical help, which pushes the doctor to the edge of his empathy and communication skills. The discomfort or even distress regularly encountered by physicians in front of a patient with MUS shows that the foundations of the doctor-patient relationship under uncertainty are poorly mastered. Patients with MUS are regularly abused by the doctors, who unwittingly participate in the maintenance of their symptoms and even freeze them, leading to disastrous psychosocial and economic consequences. Yet the doctor-patient relationship is the key to their recovery or, at least, their improvement. The means of a successful patient-centered relationship are not always intuitive but can be learned. It is therefore essential to include SMI in medical school curricula and post-graduate medical education. Finally, if the management of early MUS mainly concerns the family medicine, that of severe MUS, including some fibromyalgia and chronic fatigue syndromes, falls within the scope of the internist doctor, who should be able to deliver a comprehensive care in partnership with the general practitioner and possibly a psychiatrist.
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Médicos Generales , Medicina Interna , Síntomas sin Explicación Médica , Relaciones Médico-Paciente , Incertidumbre , Terapias Complementarias/estadística & datos numéricos , Médicos Generales/psicología , Médicos Generales/normas , Humanos , Medicina Interna/métodos , Medicina Interna/normas , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/etiología , Trastornos Somatomorfos/terapiaRESUMEN
Within primary care settings, patients with medically unexplained symptoms (MUS) are common, often present with comorbid psychopathology, and have high rates of healthcare utilization. Despite increased healthcare utilization, these patients often have poor outcomes that frustrate patients and providers alike. A behavioral consultation intervention for primary care patients with MUS (n = 10) was developed and assessed. All participants completed all intervention and assessment sessions and rated the intervention favorably. Participants self-report scores revealed statistically significant improvements from baseline to 3-month follow-up on physical functioning, mental functioning, and physical symptoms. Notwithstanding the limitations of open trial designs, these findings demonstrate high feasibility for a behavioral health consultation treatment model for patients with MUS and highlight the need for further research.
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Terapia Conductista/métodos , Síntomas sin Explicación Médica , Atención Primaria de Salud/métodos , Adulto , Análisis de Varianza , Ansiedad/terapia , Femenino , Indicadores de Salud , Humanos , Masculino , Persona de Mediana Edad , New England , Satisfacción del Paciente , Derivación y Consulta , Autoinforme , Resultado del TratamientoRESUMEN
OBJECTIVE: Medically unexplained symptoms are physical symptoms, which cannot be explained by organic causes. This study aimed to investigate mental health in patients with medically unexplained physical symptoms. METHOD: One hundred outpatients who were admitted to the Electro Diagnosis Clinic of Imam Khomeini hospital, Ahvaz/Iran, participated in this study. Data were collected using physical examination, paraclinical examinations, and SCL-90-R, and analyzed through multivariate analysis of variance (MANOVA), Chi-square test and Fisher's exact test. RESULTS: The findings revealed significant differences between clients with medically explained and unexplained symptoms in obsessive compulsive and somatization (p<0.05). Differences in depression, anxiety, phobia, psychosis, aggression and paranoia were not significant (p>0.05). CONCLUSION: The present study suggested an association between some psychological problems and somatic symptoms. Therefore, screening for psychological impairments can improve clinical outcomes. .
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OBJECTIVE: To assess the somatic and psychic components of venous-type leg symptoms. METHODS: The psychic versus somatic venous disease questionnaire (PsySoVDQ) was applied to 1,800 participants of the Bonn Vein Study (BVS) II. RESULTS: Factor analysis of the PsySoVDQ made it possible to distinguish a psychic component (PC; 5 items, Cronbach's alpha = 0.73) separate from a somatic component (SC; 4 items, Cronbach's alpha = 0.67). The PC reflected anxiety and inhibition, was prevalent in 39.8% and explained 7.3% of the BVS findings. Higher PC scores were typically found in younger, slim women of higher social status, with feelings of leg heaviness and tension, and reduced psychic quality of life. The SC prevailed in 37.4% and explained 16.5% of BVS findings. Typical SC scorers were older, overweight women with lower social status, more symptoms (including swelling), signs of chronic venous insufficiency, ultrasound-documented venous abnormalities, and reduced multidimensional quality of life. The SC's predictive accuracy for CEAP 2 and 3 (classification according to clinical findings, etiology, anatomy, pathophysiology) was equal to that of the BVS assessment. CONCLUSION: The PsySoVDQ identified somatic and psychic components of the widespread and frequently reported leg symptoms in the general population. Nevertheless, in the majority of subjects symptoms remained unexplained. A neuropsychological and neurobiological hypothesis is advanced.