Somatic complaints

Tseng, W-S. (1975). The nature of somatic complaints among psychiatric patients the Chinese case. Compr. Psychiatry, 16(3), 237—45. 

SSMAXCOV analyses—performed without standardization of the input—of the selected conduct disorder, CATS, and PCL-YV items produced clearly peaked curves, although the highest covariances of these plots were between. 03 and. 04, which is below the threshold. Taxon base rate estimates and their variability were not reported. The somatic complaints graph had a peak (highest covariance of. 04), but this peak was obscured by a right-end cusp. The authors took this as evidence of the dimensional structure of somatization. On the other hand, if the cusp was removed, one would probably conclude that the picture is taxonic. Furthermore, it is possible that the cusp... 

Beach and Amir have demonstrated that with a given sample using the same procedures, some markers of depression may define a taxon, while others do not. In other words, both continuous and taxonic forms of depression exist. However, questions remain about the nature of the identified taxon. Is it really a depression taxon or has the exclusive focus on vegetative symptoms changed the nature of the construct Interestingly, certain somatic symptoms, such as sleep and appetite disturbance, are common in many disorders and can be considered the physical component of nonspecific distress (Clark Watson, 1991). Thus, perhaps the identified taxon is not a depression taxon at all and actually reflects general somatic complaints. Only construct validation can address these concerns. 

The first step is the recognition that a depressed mood is not synonymous with a depressive episode. Conversely, an episode of depression may not present with a mood complaint, but rather with associated symptoms such as insomnia or other somatic complaints. This is particularly true for the elderly and for those seen in primary care settings. Even when a mood complaint is prominent, it may not be described as depressed, but instead as irritable or anxious. Thus, patients with MDD may have a variety of complaints other than depressed mood, including the following ... 

Various somatic complaints, such as headache or gastrointestinal distress... 

Reports vary as to the predominant picture, which ranges from one quite similar to melancholia to one more consistent with an atypical depressive disorder or a bipolar II disorder (Table 6-5). Complaints usually involve a diminution in energy, followed by an increased need for sleep, increased appetite and weight, and a lack of involvement or interest in one s activities. Only toward the end of the episode onset does the patient become aware of the depressed mood and such classic symptoms as poor concentration, feelings of self-worthlessness, and multiple somatic complaints. Insomnia often develops over the next 1 to 2 months. Whereas this atypical picture is more characteristic of the early phases of the illness, reminiscent of certain bipolar subtypes, the affective episode appears to evolve toward a more classic depressive syndrome as it progresses over multiple seasons. 

The problem of resistance is most troublesome on the Sensory level. It frequently takes the form of a somatic complaint, perhaps nausea or pain. Less often, but much more dramatically, it may take the form of extremely intense pleasure sensations that the patient will not want to relinquish. Some psychedelic therapists deal with resistance by interpretation or just by identifying it for what it is. The resistance can be handled more effectively and profitably, however, if drug-state phenomena are utilized. For example, a patient complaining of a pain in his shoulder can be asked to transfer the pain to a foot, then an elbow, and finally to his hand. Often this will be done, and then the patient is handed some not-too-sympathetic object and is told to "put the pain in the object." Then the therapist places the object out of sight and... 

Fukunishi I, Matsumoto T, Negishi M, Hayashi M, Hosaka T, Moriya H. Somatic complaints associated with depressive symptoms in HIV-positive patients. Psychother Psychosom 1997 66 248-251. 

Sleep disorders such as sleep apnea, narcolepsy, delayed sleep-phase syndrome (DSPS), and insomnia can cause problem sleepiness and difficulty functioning during the day for adolescents (103). Over the course of several studies, Roberts and colleagues have shown that insomnia and related sleep problems have adverse consequences for the future functioning of adolescents (107,108). In particular, insomnia symptoms such as nonrestorative sleep, difficulty initiating sleep, and daytime sleepiness predicted self-esteem difficulties, interpersonal relationship problems, and symptoms of depression, along with somatic complaints (108). 

Kelly R, Russo J, Katon W. Somatic complaints among pregnant women cared for in obstetrics normal pregnancy or depressive and anxiety symptom amplification revisited Gen Hosp Psychiatry 2001 23 107-113. 

Depression rating scales contain items that are not specific to depression, including sleeping difficulties, anxiety, agitation and somatic complaints. These symptoms are likely to respond to the non-specific sedative effects that occur with most tricyclics and many other antidepressants. Hence changes in rating scale scores may merely reflect drug-induced effects. 

Tightening in throat, chest, or stomach Worsening of chronic conditions Somatic complaints... 

Adolescents tend to respond to a disaster much the same as do adults. However, this may also be accompanied by the awareness of a life unlived, a sense of a foreshortened future, and the fragility of life (Shaw, 2000). Adolescents may also exhibit a decline in academic performance, rebellion at home or school, and delinquency, as well as somatic complaints and social withdrawal. Adolescents may feel a strong need to make a contribution to the recovery effort and find meaningful ways to make a difference. ... 

Various somatic complaints have been reported in patients in whom neuroleptic drugs are abruptly withdrawn (SEDA-20, 44). The incidence of these complaints varies widely in different reports, from 0 to 75%. Common complaints include headache, vomiting, nausea, diarrhea, insomnia, abdominal pain, rhinorrhea, and muscle aches. On rare occasions, the symptoms resemble those of benzodiazepine withdrawal (appetite change, dizziness, tremulousness, numbness, nightmares, a bad taste in the mouth, fever, sweating, vertigo, tachycardia, and anxiety), but it is possible that in some of the reported cases there was actually benzodiazepine withdrawal. Some of these symptoms may also have been linked to... 

Case Conclusion After beginning another rule-out Ml protocol, CV was given an IM injection of lorazepam to acutely control her anxiety and related somatic complaints. She was seen by her primary care provider the next day and ultimately diagnosed with panic disorder and agoraphobia. She was started on daily paroxetine therapy and instructed that she could use clonazepam as needed for extreme anxiety. In addition, she was counseled to diminish the use of alcohol to self-medicate. A referral for psychological counseling was given as well. 

Constipation is a commonly encountered medical condition in the United States for which many patients initiate self-treatment. One reason constipation continues to be a frequent problem in this country is lack of adequate dietary fiber. Another unfortunate problem is that many people have misconceptions about normal bowel function, and think that daily bowel movements are required for health and well being. Others believe that the lack of a daily bowel movement contributes to the accumulation of toxic substances or is associated with various somatic complaints. These misconceptions often lead to the inappropriate use of laxatives by the general public. 

For perimenopausal depression, antidepressants usually are dosed daily at standard dosages for major depression, although some women may respond to lower doses. Estradiol deficiency may decrease the activity of 5-HT and decrease the efficacy of antidepressants. Two open-label studies have reported that citalopram in doses of 20-60 mg/day was effective in treating depression in peri- and postmenopausal women and had augmenting effects in depressed subjects who were still symptomatic after treatment with transdermal estradiol (i.e., improved symptoms of anxiety and somatic complaints). " ... 

Other Dissociation, nightmares, insomnia, excessive dreaming, fatigue, poor appetite, somatic complaints, change in libido... 

Other Insomnia, poor appetite, loss of libido, nightmares, fatigue, somatic complaints... 

Other Fatigue, somnolence, insomnia, decreased libido, impotence, somatic complaints, various developmental delays in infants... 

Htlbner, Lande and Podzuweit 1993 40 neurotic depression or brief depressive reaction with somatic complaints (masked depression) [ICD-9 300.4, 309.0] Jarsin (LI 160) 3 x 300 mg 4 weeks A randomized patients, except 1 who did not fulfill inclusion criteria (Hyp 20, Pic 19) R HAMD decrease in mean total score from 12.55 to approx. 5 (placebo 12.37 to approx. 10). p<0.05 (U-test) response rate (decrease in total score 250% or total score <10) 70% (placebo 47%) CGI change 45% of patients "very much improved" (placebo 21%) and 35% "unchanged" or "worsened" (placebo 74%) B-L decrease in mean total score from 17.75 to 6.8 (placebo 16.74 to 16.9) Somatic complaints resolved in more patients of the Hypericum group than of the placebo group... 

Sometimes the addict may adjust at a financially supportable level of drug intake and carry a moderate habit for j ears. He is usually a more intelligent addict who has some insight into his fundamental difficulties. The added conflict of addiction may be too much for endurance. The addict makes a neAV adjustment by rationalizing the entire difficulty on the basis of somatic complaints. The borderline group shades into the psychoneurotic (group 3). 

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