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[A new, empirically established hypochondriasis diagnosis--secondary publication].

https://arctichealth.org/en/permalink/ahliterature173279
Source
Ugeskr Laeger. 2005 Aug 8;167(32):2896-9
Publication Type
Article
Date
Aug-8-2005
Author
Per K Fink
Eva Ørnbøl
Tomas Toft
Kaj Sparle Christensen
Lisbeth Frostholm
Frede Olesen
Author Affiliation
Arhus Universitetshospital, Arhus Sygehus, Forskningsklinikken for Funktionelle Lidelser og Psykosomatik, ogAarhus Universitet, Forskningsenheden for Almen Praksis. flip@as.aaa.dk
Source
Ugeskr Laeger. 2005 Aug 8;167(32):2896-9
Date
Aug-8-2005
Language
Danish
Publication Type
Article
Keywords
Adult
Aged
Denmark - epidemiology
Family Practice
Female
Humans
Hypochondriasis - classification - diagnosis - psychology
Interview, Psychological
Male
Mass Screening
Middle Aged
Psychiatric Status Rating Scales
Questionnaires
Somatoform Disorders - classification - diagnosis - epidemiology
Abstract
The narrow ICD-10 and DSM-IV definition of hypochondriasis makes it a rarely used diagnosis. Based on a latent class analysis of the symptoms exhibited by 701 patients (ages 18-65) in general practice, a new and more valid hypochondriasis diagnosis was defined in this study. The main symptom is "obsessive rumination about illnesses", and the patient must also have at least one of five other symptoms. The prevalence was 9.5 for both genders. There was a good agreement between the diagnoses made during the psychiatric interview and the physicians' assessments.
PubMed ID
16109196 View in PubMed
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A brief case-finding questionnaire for common mental disorders: the CMDQ.

https://arctichealth.org/en/permalink/ahliterature9248
Source
Fam Pract. 2005 Aug;22(4):448-57
Publication Type
Article
Date
Aug-2005
Author
Kaj Sparle Christensen
Per Fink
Tomas Toft
Lisbeth Frostholm
Eva Ornbøl
Frede Olesen
Author Affiliation
The Research Unit for General Practice, University of Aarhus, Denmark. kasc@alm.au.dk
Source
Fam Pract. 2005 Aug;22(4):448-57
Date
Aug-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Cross-Sectional Studies
Denmark
Family Practice
Female
Humans
Male
Mental Disorders - classification - diagnosis
Middle Aged
Questionnaires
Research Support, Non-U.S. Gov't
Abstract
OBJECTIVES: The aim of the study was to validate a new case-finding instrument for common mental disorders (CMDQ). METHODS: A cross-sectional, stratified, two-phase study was carried out in 28 general practices in Aarhus County, Denmark. 1785 consecutive patients, 18-65 years old, consulting 38 GPs with a new health problem participated. Patients were screened before consultation using a one-page screening questionnaire including subscales for somatisation (SCL-SOM and Whiteley-7), anxiety (SCL-ANX4), depression (SCL-DEP6) and alcohol abuse (CAGE). A stratified subsample of 701 patients was interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview. We tested the external validity of the scales using the SCAN interview as gold standard. All data were analysed using appropriate weighted procedures to control for the two-phase sampling design and non-response bias. RESULTS: Estimates of sensitivity and specificity for relevant ICD-10 diagnoses at theoretical optimal cut-off points on subscales: Depressive disorder: 78/86 (SCL-DEP6); Alcohol abuse or dependence: 78/97 (CAGE); Severe anxiety disorder: 77/85 (SCL-ANX4); Somatisation disorder: 83/56 (SCL-SOM); and 75/52 (Whiteley-7); any mental disorder: 72/72 (SCL-8). At the theoretical optimal cut-off points the CMDQ demonstrated higher diagnostic accuracy than GPs on any diagnosis evaluated. CONCLUSION: The study results suggest that the CMDQ has excellent external validity for use as a diagnostic aid in primary care settings.
PubMed ID
15814580 View in PubMed
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The FIP study: a randomised, controlled trial of screening and recognition of psychiatric disorders.

https://arctichealth.org/en/permalink/ahliterature9595
Source
Br J Gen Pract. 2003 Oct;53(495):758-63
Publication Type
Article
Date
Oct-2003
Author
Kaj Sparle Christensen
Tomas Toft
Lisbeth Frostholm
Eva Ørnbol
Per Fink
Frede Olesen
Author Affiliation
Research Unit for Functional Disorders, Aarhus University Hospital, Research Unit for General Practice, Aarhus University. kspar@akh.aaa.dk
Source
Br J Gen Pract. 2003 Oct;53(495):758-63
Date
Oct-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Denmark
Family Practice
Female
Humans
Male
Mass Screening - methods
Mental Disorders - diagnosis
Middle Aged
Prognosis
Questionnaires - standards
Research Support, Non-U.S. Gov't
Abstract
BACKGROUND: Research on questionnaires as screening tools for psychiatric disorders has yielded conflicting results. AIM: To examine the effect of a routinely administered questionnaire on recognition of common psychiatric disorders in general practice. DESIGN OF STUDY: Randomised controlled trial. SETTING: Twenty-eight general practices in Aarhus County, Denmark. METHOD: Thirty-eight general practitioners (GPs) and 1785 consecutive patients, aged 18-65 years old, presenting with a new health problem, participated. Before consultation, patients were screened using a brief screening questionnaire (SQ) including somatisation, anxiety, depression, and alcohol abuse scales. Patients were randomised to one of two groups: 900 questionnaires were disclosed and scored by the GPs, 885 were blinded. A stratified subsample of 701 patients was interviewed after the consultation using a standardised psychiatric research interview (SCAN). RESULTS: Overall the GPs' recognition rates were 14% (95% confidence interval [CI] = -2 to 30) better for depression and 35% (95% CI = 2 to 68) better for alcohol problems when SQs were disclosed. Recognition rates for anxiety improved 8% (95% CI = -9 to 26) overall. In the case of somatoform disorders, disclosure showed no effect overall. Among those with high SQ scores, however, disclosure increased recognition rates on any mental disorder evaluated. CONCLUSION: This study demonstrated limited usefulness for routine screening for common psychiatric disorders. However, findings suggest that the SQ may be useful for case-finding among a subgroup of patients with high SQ scores.
PubMed ID
14601350 View in PubMed
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Mental disorders in primary care: prevalence and co-morbidity among disorders. results from the functional illness in primary care (FIP) study.

https://arctichealth.org/en/permalink/ahliterature9135
Source
Psychol Med. 2005 Aug;35(8):1175-84
Publication Type
Article
Date
Aug-2005
Author
Tomas Toft
Per Fink
Eva Oernboel
Kaj Christensen
Lisbeth Frostholm
Frede Olesen
Author Affiliation
Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark. tomas.toft@ouh.fyns-amt.dk
Source
Psychol Med. 2005 Aug;35(8):1175-84
Date
Aug-2005
Language
English
Publication Type
Article
Keywords
Adult
Alcoholism - diagnosis - epidemiology
Anxiety Disorders - diagnosis - epidemiology
Comorbidity
Female
Humans
Hypochondriasis - diagnosis - epidemiology
International Classification of Diseases
Male
Mental Disorders - diagnosis - epidemiology
Prevalence
Primary Health Care
Research Support, Non-U.S. Gov't
Somatoform Disorders - diagnosis - epidemiology
Abstract
BACKGROUND: Prevalence and co-occurrence of mental disorders is high among patients consulting their family general practitioner (GP) for a new health problem, but data on diagnostics and socio-demographics are sketchy. METHOD: A cross-sectional two-phase epidemiological study. A total of 1785 consecutive patients with new complaints, aged 18-65 years, consulting 28 family practices during March-April 2000 in Aarhus County, Denmark were screened, in the waiting room, for mental and somatic symptoms with SCL-8 and SCL-Somatization questionnaires, for illness worry with Whitely-7 and for alcohol dependency with CAGE. In a stratified random sample of 701 patients, physician interviewers established ICD-10 diagnoses using the SCAN interview. Prevalence was calculated using weighted logistic regression, thus correcting for sample skewness. RESULTS: Half of the patients fulfilled criteria for an ICD-10 mental disorders and a third of these for more than one group of disorders. Women had higher prevalence of somatization disorder and overall mental disorders than men. Men had higher prevalence of alcohol abuse and hypochondriasis than women. Psychiatric morbidity tended to increase with age. Prevalence of somatoform disorders was 35.9% (95% CI 30.4-41.9), anxiety disorders 164% (95% CI 12.7-20.9), mood disorders 13.5% (95% CI 11.1-16.3), organic mental disorders 3.1% (95% CI 1.6-5.7) and alcohol abuse 2.2% (95% CI 1.5-3.1). Co-morbidities between these groups were highest for anxiety disorders, where 89% also had another mental diagnosis, and lowest for somatoform disorders with 39%. CONCLUSIONS: ICD-10 mental disorders are very prevalent in primary care and there is a high co-occurrence between most disorders. Somatoform disorders, however, more often than not exist without other mental disorders.
PubMed ID
16116943 View in PubMed
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[Models for continuing education in general practice focusing on functional disorders].

https://arctichealth.org/en/permalink/ahliterature187473
Source
Ugeskr Laeger. 2002 Nov 11;164(46):5396-9
Publication Type
Article
Date
Nov-11-2002
Author
Marianne Rosendal
Tomas Toft
Per K Fink
Flemming Bro
Frede Olesen
Author Affiliation
Aarhus Universitet, Institut for Almen Medicin, Arhus Universitetshospital. m.rosendal@dadlnet.dk
Source
Ugeskr Laeger. 2002 Nov 11;164(46):5396-9
Date
Nov-11-2002
Language
Danish
Publication Type
Article
Keywords
Denmark
Education, Medical, Continuing - methods
Family Practice - education
Humans
Models, Educational
Psychophysiologic Disorders - diagnosis - therapy
Somatoform Disorders - diagnosis - therapy
PubMed ID
12469388 View in PubMed
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A new, empirically established hypochondriasis diagnosis.

https://arctichealth.org/en/permalink/ahliterature9404
Source
Am J Psychiatry. 2004 Sep;161(9):1680-91
Publication Type
Article
Date
Sep-2004
Author
Per Fink
Eva Ørnbøl
Tomas Toft
Kaj Christensen Sparle
Lisbeth Frostholm
Frede Olesen
Author Affiliation
Research Unit for Functional Disorders, Aarhus University Hospital, DK-8000 Aarhus C, Denmark. flip@akh.aaa.dk
Source
Am J Psychiatry. 2004 Sep;161(9):1680-91
Date
Sep-2004
Language
English
Publication Type
Article
Keywords
Adult
Alcoholism - diagnosis - epidemiology
Anxiety Disorders - diagnosis - epidemiology
Comorbidity
Denmark - epidemiology
Depressive Disorder - diagnosis - epidemiology
Diagnostic and Statistical Manual of Mental Disorders
Female
Humans
Hypochondriasis - classification - diagnosis - psychology
Male
Mass Screening - methods
Personality Inventory
Primary Health Care - methods
Psychiatric Status Rating Scales - statistics & numerical data
Psychometrics
Reproducibility of Results
Research Support, Non-U.S. Gov't
Severity of Illness Index
Somatoform Disorders - classification - diagnosis - epidemiology
Terminology
Abstract
OBJECTIVE: The narrow ICD-10 and DSM-IV definition of hypochondriasis makes it rarely used yet does not prevent extensive diagnosis overlap. This study identified a distinct hypochondriasis symptom cluster and defined diagnostic criteria. METHOD: Consecutive patients (N=1,785) consulting primary care physicians for new illness were screened for somatization, anxiety, depression, and alcohol abuse. A stratified subgroup of 701 patients were interviewed with the Schedules for Clinical Assessment in Neuropsychiatry and questions addressing common hypochondriasis symptoms. Symptom patterns were analyzed by latent class analysis. RESULTS: Patients fell into three classes based on six symptoms: preoccupation with the idea of harboring an illness or with bodily function, rumination about illness, suggestibility, unrealistic fear of infection, fascination with medical information, and fear of prescribed medication. All symptoms, particularly rumination, were frequent in one of the classes. Classification allowed definition of new diagnostic criteria for hypochondriasis and division of the cases into "mild" and "severe." The weighted prevalence of severe cases was 9.5% versus 5.8% for DSM-IV hypochondriasis. Compared with DSM-IV hypochondriasis, this approach produced less overlap with other somatoform disorders, similar overlap with nonsomatoform psychiatric disorders, and similar assessments by primary care physicians. Severe cases of the new hypochondriasis lasted 2 or more years in 54.3% of the subjects and 1 month or less in 27.2%. CONCLUSIONS: These results suggest that rumination about illness plus at least one of five other symptoms form a distinct diagnostic entity performing better than the current DSM-IV hypochondriasis diagnosis. However, these criteria are preliminary, awaiting cross-validation in other subject groups.
PubMed ID
15337660 View in PubMed
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The patients' illness perceptions and the use of primary health care.

https://arctichealth.org/en/permalink/ahliterature70485
Source
Psychosom Med. 2005 Nov-Dec;67(6):997-1005
Publication Type
Article
Author
Lisbeth Frostholm
Per Fink
Kaj S Christensen
Tomas Toft
Eva Oernboel
Frede Olesen
John Weinman
Author Affiliation
Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark. frost@as.aaa.dk
Source
Psychosom Med. 2005 Nov-Dec;67(6):997-1005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Attitude to Health
Chronic Disease - epidemiology
Comparative Study
Denmark - epidemiology
Female
Follow-Up Studies
Health status
Humans
Life Style
Linear Models
Male
Middle Aged
Patient Acceptance of Health Care
Patients - psychology - statistics & numerical data
Personality Inventory
Primary Health Care - utilization
Questionnaires
Research Support, Non-U.S. Gov't
Sick Role
Somatoform Disorders - diagnosis - epidemiology - psychology
Stress, Psychological - epidemiology - psychology
Abstract
OBJECTIVE: To investigate if primary care patients' perceptions of a current health problem were associated with use of health care. METHOD: One thousand seven hundred eighty-five patients presenting a new health problem to 1 of 38 physicians from 28 general practices in Aarhus County, Denmark. Patients completed a questionnaire on their illness perceptions and emotional distress before the consultation. The physicians completed a questionnaire for each patient on diagnostics and prognostics. Register data on primary health care utilization 3 years before and 2 years after baseline were obtained. Odds ratios were estimated to examine associations between previous health care use and illness perceptions. Linear regression analysis was performed to examine if illness perceptions predicted later health care use. RESULTS: Previous use: Higher use was associated with psychosocial, stress, and lifestyle attributions. Accident/chance attributions were associated with higher use for patients with a chronic disorder but with lower use for patients without a chronic disorder. A strong illness identity (number of self-reported symptoms), illness worry, a long timeline perspective, a belief that the symptoms would have serious consequences, and all emotional distress variables were associated with higher use. Use during follow-up: Infection/lowered immunity attributions were associated with higher use for patients with a chronic disorder, whereas psychosocial and lifestyle attributions were associated with higher use for all patients. Illness worry and all emotional distress variables predicted higher health care use. A strong illness identity, a long timeline perspective, a belief in serious consequences, and stress and accident/chance attributions were among the strongest predictors of health care use in a multivariate model including all variables. CONCLUSIONS: Patients' perceptions of a current health problem are associated with health care use and may offer an obvious starting point for a biopsychosocial approach in primary care.
PubMed ID
16314606 View in PubMed
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A randomised controlled trial of brief training in assessment and treatment of somatisation: effects on GPs' attitudes.

https://arctichealth.org/en/permalink/ahliterature70702
Source
Fam Pract. 2005 Aug;22(4):419-27
Publication Type
Article
Date
Aug-2005
Author
Marianne Rosendal
Flemming Bro
Ineta Sokolowski
Per Fink
Tomas Toft
Frede Olesen
Author Affiliation
Research Unit, Institute for General Practice, Aarhus University Hospital, DK-8000 Aarhus C, Denmark. m.rosendal@dadlnet.dk
Source
Fam Pract. 2005 Aug;22(4):419-27
Date
Aug-2005
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Denmark
Female
Humans
Inservice training
Male
Middle Aged
Physicians, Family - psychology
Questionnaires
Research Support, Non-U.S. Gov't
Somatoform Disorders - diagnosis - therapy
Abstract
BACKGROUND: Somatising patients frequently present in primary care but GPs often express frustration in dealing with them. A negative attitude may result in missed diagnoses and ineffective treatment. OBJECTIVE: This study aimed to evaluate the effect of a novel, multifaceted training programme on GPs' attitudes towards somatisation. METHODS: The study was performed as a cluster randomised controlled trial with practices as randomisation unit and with a follow-up period of 12 months. Forty-three GPs from 27 practices in Vejle County, Denmark participated. The intervention consisted of a cognitive-oriented educational programme on assessment, treatment and management of somatisation (The Extended Reattribution and Management Model). Outcome measures were GPs' attitudes toward somatoform disorder and somatisation in general measured by the means of questionnaires at baseline and follow-up. The primary outcome was a change in response. RESULTS: Baseline values confirmed previous findings that GPs find it difficult to deal with somatising patients. Compared with the control doctors, intervention doctors' attitudes towards patients with somatoform disorders had changed significantly 12 months after training on the parameters enjoyment (P = 0.008) and anxiety (P = 0.002). Doctors also felt more comfortable in dealing with somatising patients in general (P = 0.002). Attitudes about other parameters related to the doctors feelings, aetiology and course of somatisation changed in the expected direction, but these changes were not statistically significant. CONCLUSION: A brief multifaceted training programme focussing on somatisation was accompanied by a significant change in GPs' attitude towards patients with somatoform disorders.
PubMed ID
15897211 View in PubMed
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A randomized controlled trial of brief training in the assessment and treatment of somatization in primary care: effects on patient outcome.

https://arctichealth.org/en/permalink/ahliterature162833
Source
Gen Hosp Psychiatry. 2007 Jul-Aug;29(4):364-73
Publication Type
Article
Author
Marianne Rosendal
Frede Olesen
Per Fink
Tomas Toft
Ineta Sokolowski
Flemming Bro
Author Affiliation
The Research Unit for General Practice, University of Aarhus, DK-8000 Aarhus, Denmark. m.rosendal@dadlnet.dk
Source
Gen Hosp Psychiatry. 2007 Jul-Aug;29(4):364-73
Language
English
Publication Type
Article
Keywords
Adult
Denmark
Family Practice
Female
Humans
Male
Mental health
Middle Aged
Outcome Assessment (Health Care)
Primary Health Care
Questionnaires
Somatoform Disorders - diagnosis - therapy
Teaching
Abstract
Our aim was to evaluate the effect of an educational program designed to improve care for somatizing patients in primary care.
Evaluation was performed during routine clinical care in a cluster randomized controlled trial. Patients were included consecutively, and those with a high score on rating scales for somatization were selected for follow-up (n=911). Follow-up was conducted 3 months (response rate=0.74) and 12 months (response rate=0.69) after inclusion using questionnaires measuring quality of life (Medical Outcomes Study 36-Item Short Form), disability days (WHO's Disability Assessment Schedule), somatization (Whiteley-7 and Symptom Checklist Somatic Symptom Scale) and patient satisfaction (European Project on Patient Evaluation of General Practice Care). We analyzed differences from baseline to follow-up and compared these for intervention and control groups.
Self-reported health improved in both intervention and control groups during follow-up for patients with a high score for somatization, but changes were small. We could not demonstrate any difference between the control group and the intervention group with regard to our primary outcome 'physical functioning.' Patients in the intervention group tended to be more satisfied at 12-month follow-up than those in the control group, but this difference fell short of statistical significance.
Training of primary care physicians showed no statistically significant effect on clinical outcome and showed nonsignificant improvement in patient satisfaction with care for patients with a high score for somatization.
PubMed ID
17591514 View in PubMed
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Screening for common mental disorders: who will benefit? Results from a randomised clinical trial.

https://arctichealth.org/en/permalink/ahliterature9222
Source
Fam Pract. 2005 Aug;22(4):428-34
Publication Type
Article
Date
Aug-2005
Author
Kaj Sparle Christensen
Tomas Toft
Lisbeth Frostholm
Eva Ornbøl
Per Fink
Frede Olesen
Author Affiliation
The Research Unit for General Practice, University of Aarhus, DK-8200 Aarhus, Denmark. kasc@alm.au.dk
Source
Fam Pract. 2005 Aug;22(4):428-34
Date
Aug-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Denmark
Family Practice
Female
Humans
Male
Mental Disorders - diagnosis
Middle Aged
Research Support, Non-U.S. Gov't
Abstract
BACKGROUND: Outcomes of studies on mental health screening in primary care are conflicting. A feasible and effective case-finding approach could benefit both GPs and their patients. OBJECTIVES: (1) to examine the effect of using a composite screening questionnaire (SQ) on GPs' recognition and provision of care, and (2) to outline useful strategies for case-finding. METHODS: 38 GPs in Aarhus County, Denmark, volunteered to participate in this trial. 1785 consecutive patients aged 18-65 years consulting with new health problems were included. Patients were screened before consultation using an SQ including scales for somatisation, anxiety, depression and alcohol abuse. Patients were randomised into one of two groups: 900 questionnaires were disclosed to and scored by GPs, 885 were blinded. Number of diagnoses, subjects of conversation, and actions taken were analysed. Additional analyses aimed to identify GP and patient factors that could predict improved outcomes. RESULTS: Overall, disclosure of SQ results increased GPs' recognition of mental disorders by 3.8% [95% confidence interval (CI) -0.5% to 8.0%], and 6.6% (95% CI 1.2% to 12.0%) for patients screened positive. There was a marked variation in GPs' detection rates, and for GPs with moderate or low recognition rates increases were significant (P = 0.001). Conversation on psychological topics increased by 3.2% (95% CI -0.7% to 7.1%), and by 7.0% (95% CI 1.8% to 12.3%) for patients screened positive. Rates of planned follow-up consultations increased by 3.9% (95% CI 0.6% to 7.3%) and by 4.9% (95% CI 0.7% to 9.1%) for patients screened positive. GPs' self-reported benefit from screening was related to better outcomes. A range of patient and GP factors suggesting added value from using SQs were identified. CONCLUSION: GPs' recognition and provision of mental health care can be influenced by the use of composite SQs. Perceived benefit from screening may serve as a useful predictor of better patient management. Pragmatic case-finding approaches need further evaluation.
PubMed ID
15897212 View in PubMed
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12 records – page 1 of 2.