Hypochondriasis

Psychiatric Services VOL 64 No 1. PSS. Articles | January 01, 2013 . Cochrane Systematic Reviews for the Mental Health Field: Is the Gold Standard Tarnished? Sharon Green-Hennessy, Ph.D. Psychiatric Services 2013; doi:

NotesCite this as: BMJ 2012;345:e6925

It is of considerable translational importance whether depression is a form or a consequence of sickness behavior. Sickness behavior is a behavioral complex induced by infections and immune trauma and mediated by pro-inflammatory cytokines. It is an adaptive response that enhances recovery by conserving energy to combat acute inflammation. There are considerable phenomenological similarities between sickness behavior and depression, for example, behavioral inhibition, anorexia and weight loss, and melanch

The authors assessed the defensive functioning of 290 patients with borderline personality disorder and compared it with that of 72 patients with other forms of axis II psychopathology over 16 years of prospective follow-up. They also assessed the relationship between time-varying defenses and recovery from borderline personality disorder.|The Defense Style Questionnaire, a self-report measure with demonstrated criterion validity and internal consistency, was initially administered at study entry. It was readministered at eight contiguous 2-year follow-up periods.|Borderline patients had significantly lower scores than axis II comparison subjects on one mature defense mechanism (suppression) and significantly higher scores on seven of the other 18 defenses studied: one neurotic-level defense (undoing), four immature defenses (acting out, emotional hypochondriasis, passive aggression, and projection), and two image-distorting/borderline defenses (projective identification and splitting)

The efficacy and acceptability of existing psychological interventions for health anxiety (hypochondriasis) are limited. In the current study, the authors aimed to assess the impact of mindfulness-based cognitive therapy (MBCT) on health anxiety by comparing the impact of MBCT in addition to usual services (unrestricted services) with unrestricted services (US) alone.|The 74 participants were randomized to either MBCT in addition to US (n = 36) or US alone (n = 38). Participants were assessed prior to intervention (MBCT or US), immediately following the intervention, and 1 year postintervention. In addition to independent assessments of diagnostic status, standardized self-report measures and assessor ratings of severity and distress associated with the diagnosis of hypochondriasis were used.|In the intention-to-treat (ITT) analysis (N = 74), MBCT participants had significantly lower health anxiety than US participants, both immediately following the intervention (Cohen's d = 0.48)

To chart clinical, laboratory, and psychometric profiles in patients who attribute their complaints to chronic Lyme disease.|We assessed the patients by clinical examination, laboratory tests, and questionnaires measuring fatigue, depression, anxiety, health-related quality of life, hypochondriasis, and illness perceptions.|We found no evidence of ongoing Borrelia burgdorferi (Bb) infection in any of the 29 included patients using current diagnostic guidelines and an extended array of tests. Eight (28%) had other well-defined illnesses. Twenty-one (72%) had symptoms of unknown cause, of those six met the suggested criteria for post-Lyme disease syndrome. Fourteen (48%) had presence of anti-Bb antibodies. The patients had more fatigue and poorer health-related quality of life as compared to normative data, but were not more depressed, anxious, or hypochondriacal. Their beliefs about the illness were characterized by negative expectations.|Our patients, who all attributed their symptoms

Clinician-administered measures to assess severity of illness anxiety and response to treatment are few. The authors evaluated a modified version of the hypochondriasis-Y-BOCS (H-YBOCS-M), a 19-item, semistructured, clinician-administered instrument designed to rate severity of illness-related thoughts, behaviors, and avoidance.|The scale was administered to 195 treatment-seeking adults with DSM-IV hypochondriasis. Test-retest reliability was assessed in a subsample of 20 patients. Interrater reliability was assessed by 27 interviews independently rated by four raters. Sensitivity to change was evaluated in a subsample of 149 patients. Convergent and discriminant validity was examined by comparing H-YBOCS-M scores to other measures administered. Item clustering was examined with confirmatory and exploratory factor analyses.|The H-YBOCS-M demonstrated good internal consistency, interrater and test-retest reliability, and sensitivity to symptom change with treatment. Construct validity

The objective was to assess the prevalence, demographics and risk factors of somatoform disorders (SDs) in departments of internal medicine at 23 randomly selected general hospitals in Shenyang, China.|A two-stage screening process was followed based on an expanded Chinese version of the 12-item General Health Questionnaire and the Structured Clinical Interview for DSM-IV-TR Axis I Disorders . A total of 5312 consecutive attendees of the outpatient at the departments of internal medicine were screened; 60 patients of 15 years or older were confirmed to have current SDs.|The 1-month prevalence of any type of SD was 1.56% [95% confidence interval (CI): 1.19%-2.02%], and those of undifferentiated SD, pain disorder, hypochondriasis and somatization disorder were 0.68% (0.47%-0.98%), 0.44% (0.15%-1.26%), 0.38% (0.22%-0.64%) and 0.06% (0.02%-0.20%), respectively. The prevalence of any SD and two types of SDs was higher in females than in males: relative risk (95% CI) for any SD=1.82

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