Clinimetrics

'Clinimetrics' is the term introduced by Alvan R. Feinstein in the early 1980s to indicate a domain concerned with indexes, rating scales and other expressions that are used to describe or measure symptoms, physical signs and other clinical phenomena. Clinimetrics has a set of rules that govern the structure of indexes, the choice of component variables, the evaluation of consistency, validity and responsiveness. This review illustrates how clinimetrics may help expanding the narrow range of information that is currently used in clinical science. It will focus on characteristics and types of clinimetric indexes and their current use. The clinimetric perspective provides an intellectual home for clinical judgment, whose implementation is likely to improve outcomes both in clinical research and practice

Psychiatric disorders associated with Cushing's syndrome. Epidemiology, pathophysiology and treatment

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Rehabilitation in endocrine patients: A novel psychosomatic approach.

Long-standing endocrine disorders may imply a degree of irreversibility of the pathological process and induce highly individualized affective responses. The psychosocial impairment that is associated with incomplete remission from endocrine illness suggests the need for an innovative approach to treatment, introducing in clinical endocrinology the concept of rehabilitation, which in other fields of medicine is already established. This new proposal stems from a number of unresolved issues related to the high prevalence of psychosocial impairment in patients adequately treated for various endocrine conditions. Indeed, rehabilitation in endocrinology may be indicated in the following cases: (a) delayed recovery after appropriate treatment; (b) discrepancy between endocrine status and current functioning; (c) presence of a decline in physical and social functioning; (d) persistence of important comorbidity, with special reference to psychiatric disturbances; (e) assessment of abnormal illness behavior; (f) problems with lifestyle and risk behavior, and (g) potential role of stress in endocrine disturbances. The endocrine rehabilitation team should ideally include a trained clinical endocrinologist, a physical therapist and a psychologist, with opportunities for other specialist consultations. The goal of such service would be to ensure education, support and specific interventions, helping the patient and his/her family to achieve optimal coping with the difficulties of the recovery process. Due to its comprehensive psychosomatic characterization, this new approach would likely increase the chances of obtaining full recovery in a significant proportion of patients and has the potential of being cost-effective

A Psychoneuroendocrinology Service

BACKGROUND: Research evidence has highlighted the relevance of endocrine/metabolic abnormalities in psychiatry and of psychosocial implications in endocrinology. However, the value of interdisciplinary expertise has not been implemented in clinical practice. We have therefore designed a new outpatient clinic, called the Psychoneuroendocrinology Service, to apply the principles of current psychosomatic medicine and report here on the first 100 referrals. METHODS AND RESULTS: Of the first 100 patients (74 females/26 males; mean age 44 +/- 13.8 years), the sources of referral were the Mental Health Center (n = 41), specialists (n = 37) and primary care physicians (n = 22). The main reasons for referral were endocrine assessment (n = 40), unexplained medical symptoms (n = 18) and poor response to treatment (n = 17). The most frequent medical diagnoses were obesity/overweight (n = 22), hypertension (n = 20) and hypothyroidism (n = 11). The most frequent psychiatric diagnoses were major depression (n = 15), schizophrenia/schizoaffective disorder (n = 13) and bipolar disorder (n = 12). Subclinical symptoms (Diagnostic Criteria for Psychosomatic Research) found were persistent somatization (n = 18), demoralization (n = 14) and irritable mood (n = 7). Therapeutic strategies included lifestyle modifications (n = 45), explanatory therapy (n = 30), low-dose clonazepam (n = 23) and modifications of existing treatment with psychotropic drugs (n = 16). CONCLUSIONS: In this highly selected population, several difficult patients could be appropriately managed by virtue of a holistic view. Such an approach must involve experienced clinicians with a broad-spectrum training in psychoneuroendocrinology and psychosomatic medicine. If confirmed in its efficacy and cost-effectiveness, this model might be further expanded