A European research agenda for somatic symptom disorders, bodily distress disorders, and functional disorders: Results of an estimate-talk-estimate delphi expert study

Background: Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD) are associated with high medical and societal costs and pose a substantial challenge to the population and health policy of Europe. To meet this challenge, a specific research agenda is needed as one of the cornerstones of sustainable mental health research and health policy for SSD, BDD, and FD in Europe. Aim: To identify the main challenges and research priorities concerning SSD, BDD, and FD from a European perspective. Methods: Delphi study conducted from July 2016 until October 2017 in 3 rounds with 3 workshop meetings and 3 online surveys, involving 75 experts and 21 European countries. EURONET-SOMA and the European Association of Psychosomatic Medicine (EAPM) hosted the meetings. Results: Eight research priorities were identified: (1) Assessment of diagnostic profiles relevant to course and treatment outcome. (2) Development and evaluation of new, effective interventions. (3) Validation studies on questionnaires or semi-structured interviews that assess chronic medical conditions in this context. (4) Research into patients preferences for diagnosis and treatment. (5) Development of new methodologic designs to identify and explore mediators and moderators of clinical course and treatment outcomes (6). Translational research exploring how psychological and somatic symptoms develop from somatic conditions and biological and behavioral pathogenic factors. (7) Development of new, effective interventions to personalize treatment. (8) Implementation studies of treatment interventions in different settings, such as primary care, occupational care, general hospital and specialty mental health settings. The general public and policymakers will benefit from the development of new, effective, personalized interventions for SSD, BDD, and FD, that will be enhanced by translational research, as well as from the outcomes of research into patient involvement, GP-patient communication, consultation-liaison models and implementation. Conclusion: Funding for this research agenda, targeting these challenges in coordinated research networks such as EURONET-SOMA and EAPM, and systematically allocating resources by policymakers to this critical area in mental and physical well-being is urgently needed to improve efficacy and impact for diagnosis and treatment of SSD, BDD, and FD across Europe

Body image changes in transplant patients

The aim of this study was to investigate body image changes in transplant patients. The general part of the study introduces a comprehensive literature review of the concept of body image, its evolution and evaluation from several different disciplines, with a particular emphasis on the internal body image. Our discussion draws on Lipowski’s (1977) definition of body image as perceptions of, attitudes towards, and beliefs about one's body and its functions. The next chapter presents the multiple realities of transplantation and the dilemmas associated with this form of treatment, as well as an overview of organ transplant psychiatry literature, and a critical review of the psychosocial dimensions of the quality of life research in organ recipients. In the third chapter, our study turns into an extensive review and an evaluation of published findings in the effects of transplantation on the body image. The specific part presents the aims of the study and the main hypothesis. Two hundred and twenty patients (heart-, lung-, liver-, renal- candidates and recipients) from the Organ Transplant Units and a Dialysis Unit in Northern Greece were enrolled. These patients were assessed within the framework of liaison-psychiatry to the Organ Transplant Units. The patients completed the Draw a Person test, and Inside-of-the-Body test. The tests were performed at the end of a 30 to 90 minutes-long interview, which included a semi-structured psychiatric clinical assessment, specialized psychosocial evaluation regarding the transplantation (Psychosocial Assessment of Candidates for Transplantation, Olbrisch 1989) and a discussion of ‘transplant and donor’. Only the drawings that were acquired in the first interview of each patient entered the data set. Several groups (employees, medical students, obese individuals with body- image concerns, cardiac surgery patients, and family members of transplant patients) served as controls. Both quantitative and qualitative analyses of the drawings were performed. Results from Draw a Person testing showed that drawings by the transplant patients were significantly different from those of normal controls, although not from the drawings of the obese group. Of note, examiner and situational variables had a significant impact on the results. There were not significant differences between drawings from candidates and recipients, renal- liver- and heart- patients, hospitalized or not patients. Qualitative analyses showed that patients’ drawings were poorly formed and rather disorganized. In the Inside-of-the-Body testing, patient groups drew the diseased organ more often than the control groups. The renal recipients drew two kidneys more often than the control groups; interestingly enough, the graft was rarely depicted on the drawings. Certain drawings among renal patients depicted kidneys in a unique and peculiar way, i.e. reverse circumference of the kidneys, kidneys drawn in the out-of-the-body space... In renal patients a significant association was found between the depiction of the kidneys in the Inside-of-the-Body test and better performance in Draw a Person test. The above findings suggest that ‘the new organ is not psychologically inert’ (Castelnuovo-Tedesco, 1981). In addition, they are not consistent with the more traditional interpretation of a gradual incorporation of the transplanted organ; rather, they seem to suggest that the graft is placed in an intermediate space, and the patients treat it as a transitional object. The defense mechanism of denial is activated for the psychological ‘acceptance’ of the new organ. Based on our findings, we believe that renal transplantation research could be a fruitful field for the study of body image in transplantation. In addition, the finding of denial as a basic defense suggests that clinical research should re-evaluate patients' narratives, including data gathered from self-administered questionnaires and be less willing to accept them at face value. From a clinical management point of view, our work would support recommendations for Human Figure Drawings to be included in formal clinical examination settings. They are easy to use and could reveal important information about the patients. As the graft tends to be psychologically active, practical measures that facilitate the psychological graft compatibility (/acceptance) -such as non-disclosure of any donor- or graft-related information- should be seriously considered. This work documents the variable, and often times latent meanings of transplantation for each patient. In addition, it should alert clinicians to overlooked or hidden body image disturbances and their implications. In our view, although there is no doubt that transplant patients need a ‘time for silence’ (Mai, 1985) and physicians should respect it, it is equally true that, when patients express the desire to talk about ‘the strange things that are crossing their minds’, they should be encouraged to do so by physicians who are able to tune into this kind of discussion.Σκοπός της εργασίας ήταν να διερευνήσει τις μεταβολές της σωματικής εικόνας σε μεταμοσχευμένους ασθενείς. Στο γενικό ΜΕΡΟΣ, αρχικά, επιχειρήθηκε ανασκόπηση της έννοιας σωματική εικόνα και παρουσίαση των πορισμάτων διάφορων επιστημονικών κλάδων που ασχολούνται με το ευρύ πεδίο της σωματικής εμπειρίας. Η ιδιαίτερη εστίαση αφορούσε θέματα σχετιζόμενα με το εσωτερικό του σώματος, την εσωτερική σωματική εικόνα· η τελευταία προσεγγίστηκε μέσα από την οπτική του Lipowski, δηλαδή ως η θεωρητική έννοια-κλειδί που εκφράζει τις αισθήσεις από, τις στάσεις προς, και τις πεποιθήσεις γύρω από το εσωτερικό του σώματος και τις λειτουργίες του. Το επόμενο κεφάλαιο ασχολήθηκε με τις μεταμοσχεύσεις και πιο συγκεκριμένα, εισαγωγικές παρατηρήσεις αναφορικά με τις πολλαπλές αναγνώσεις των δεδομένων και διλημμάτων που εγείρονται από τη συγκεκριμένη θεραπεία, σύντομη παρουσίαση θεμάτων από το χώρο της ψυχιατρικής των μεταμοσχεύσεων και κριτική ανασκόπηση της βιβλιογραφίας που διερευνά τις ψυχοκοινωνικές διαστάσεις της ποιότητας ζωής των ασθενών σε θεραπείες υποκατάστασης. Ακολούθως, επιχειρήθηκε ευρεία ανασκόπηση των δημοσιευμένων κλινικών παρατηρήσεων και μελετών που σχετίζονται με τις επιδράσεις της μεταμόσχευσης στη σωματική εικόνα. Στο ειδικό μέρος αρχικά παρουσιάστηκαν οι στόχοι της εργασίας και οι ερευνητικές υποθέσεις. Στην εργασία συμμετείχαν 220 ασθενείς (υποψήφιοι και λήπτες) από τις Κλινικές Μεταμοσχεύσεων συμπαγών οργάνων στη Β. Ελλάδα και από μια Μονάδα Τεχνητού Νεφρού. Οι ασθενείς εξετάστηκαν στο πλαίσιο διασυνδετικής-ψυχιατρικής προς τις Κλινικές Μεταμοσχεύσεων. Μεθοδολογικά, αξιοποιήθηκε η σχεδίαση της ανθρώπινης φιγούρας (Draw a Person test, Inside-of-the-Body test). Οι δοκιμασίες ελήφθησαν μετά από συνέντευξη, διάρκειας 30 -90', που αφορούσε ψυχιατρική εκτίμηση, εξειδικευμένη ψυχοκοινωνική αξιολόγηση ασθενών προς μεταμόσχευση (PACT) και συζήτηση αναφορικά με μόσχευμα και δότη. Για την εργασία αξιοποιήθηκαν σχέδια από πολλαπλές ομάδες ελέγχου (εργαζόμενοι, φοιτητές Ιατρικής, παχύσαρκοι με διαταραχή της σωματικής εικόνας, καρδιοχειρουργικοί ασθενείς, αλλά και συγγενείς των ασθενών της πειραματικής ομάδας, όπως και μεταμοσχευμένοι -προμήθεια των δοκιμασιών μέσω διαφορετικής μεθοδολογίας). Τα σχέδια εκτιμήθηκαν με αντικειμενικό τρόπο και ακολούθησε στατιστική ανάλυση. Επιπλέον, επιχειρήθηκε ποιοτική ανάλυση των σχεδίων. Στο Draw a Person test, τα σχέδια των ασθενών εμφανίστηκαν έντονα διαταραγμένα- στατιστικά οι μελετώμενες μεταβλητές δε διέφεραν από ομάδα παχύσαρκων με διαταραχή της σωματικής εικόνας. Καθώς αποδείχτηκε πως η ερευνητική διαδικασία επηρέασε τα αποτελέσματα, οι στατιστικές διαφορές που προέκυψαν με τις ομάδες που αντιπροσώπευαν τον υγιή πληθυσμό δεν ήταν αξιόπιστες. Μεταξύ των υποομάδων των μεταμοσχευμένων (υποψήφιοι- λήπτες, νεφροπαθείς-ηπατοπαθείς-καρδιοπαθείς, νοσηλευόμενοι και μη ασθενείς...) δε διαπιστώθηκαν σημαντικές διαφορές. Στο Inside-of-the-Body test, οι ασθενείς σχεδίασαν το όργανο που πάσχει αναλογικώς συχνότερα. Οι νεφροπαθείς που σχεδίασαν νεφρούς εμφάνισαν αναλογικώς περισσότερα σχέδια με δύο νεφρούς, ενώ σε ορισμένα σχέδια παρουσιάστηκε ένας ιδιόμορφος τρόπος απεικόνισης των νεφρών. Παραδόξως, το μόσχευμα σπανίως απεικονίστηκε. Τέλος είναι αξιοσημείωτη η στατιστική σύνδεση απεικόνισης νεφρού στο Inside-of-the-Body test με καλύτερο ποιοτικώς σχέδιο στο Draw a Person test, η οποία διαπιστώθηκε σε (άνδρες) νεφροπαθείς. Τα ευρήματα παρέχουν σημαντικές ενδείξεις πως το μόσχευμα δεν είναι ψυχικώς αδρανές. Η εργασία δεν υποστηρίζει τον παραδοσιακό τρόπο ερμηνείας περί (σταδιακής) εσωτερίκευσης του μοσχεύματος· το μόσχευμα μάλλον τοποθετείται σε έναν ενδιάμεσο χώρο και οι ασθενείς το χειρίζονται ως μεταβατικό αντικείμενο. Η ‘ψυχική αποδοχή’ του μοσχεύματος, η ενδοψυχική ολοκλήρωσή του φαίνεται ότι αξιοποιεί το μηχανισμό της ‘άρνησης’. Στο ερευνητικό επίπεδο, η μελέτη προτείνει τη μεταμόσχευση νεφρού ως το προνομιακό πεδίο για τη διερεύνηση της σωματικής εικόνας στη μεταμόσχευση. Επιπλέον, η διαπίστωση ότι η άρνηση αποτελεί βασικό αμυντικό μηχανισμό οδηγεί σε ανάγκη επανεκτίμησης των λεγομένων των ασθενών (συμπεριλαμβανομένων αυτοσυμπληρούμενων ερωτηματολογίων) και, κυρίως, προσεκτικής ερμηνείας των αποτελεσμάτων που βασίζονται σε αυτά. Σε κλινικό επίπεδο, το 'κλινικό εργαλείο’ σχεδίαση της ανθρώπινης φιγούρας, αφού αντιπροσωπεύει έναν εύκολο και γρήγορο τρόπο ανίχνευσης σημαντικών πληροφοριών, αξίζει να αξιοποιείται συστηματικά, ως διαδικασία ρουτίνας.Με βάση τα υπάρχοντα δεδομένα, η πολιτική μη-αποκάλυψης πληροφοριών για δότη-μόσχευμα αποτελεί ιατρική αναγκαιότητα, καθώς πιθανόν διευκολύνει την ‘ψυχική συμβατότητα’ και ‘ψυχική αποδοχή’ του μοσχεύματος. Η εργασία επαναφέρει στο προσκήνιο το αυστηρώς προσωπικό νόημα (meaning) της εμπειρίας της μεταμόσχευσης, αρκετές φορές ‘κρυμμένο’ και σε επιφανειακή αντίθεση με τα λόγια που ο ασθενής εκστομίζει... Οι ασθενείς έχουν ανάγκη μιας περιόδου σιωπής (a time for silence, Mai 1985) και οι ιατροί δε θα πρέπει να αποθαρρύνουν αυτή τη διαδικασία. Όμως, αν αποφασίσουν να μιλήσουν για όσα περίεργα ‘περνάνε από το μυαλό τους’, θα ήταν πολύ χρήσιμο ο ιατρός να μπορέσει να τους ακούσει..

Validation of the Greek version of the distress thermometer compared to the clinical interview for depression

Funding text This study was partly supported by research grants funded by the Cyprus University of Technology (statistical analysis) and Papageorgiou General Hospital (copyright expenses to NCCN). No funding sources were used in the design of the study, interpretation of data and in writing of the manuscript. AcknowledgementsBackground: The Distress Thermometer (DT) is worldwide the most commonly used instrument for quick screening of emotional burden in patients with cancer. In order to validate the Greek version of the DT in the Greek population we aimed to explore the capacity of the DT to identify patients with comorbid depressive diagnosis. Methods: We analyzed the routinely collected clinical data from 152 patients with cancer who had been evaluated by the consultation-liaison psychiatric service and had received a diagnosis of either depressive disorder or no psychiatric diagnosis. The score of the DT accompanied by the list of problems in the Problem List, the depression status, and the clinical and demographic characteristics entered the data sheet. Results: The ROC analysis revealed that the DT achieved a significant discrimination with an area under the curve of 0.79. At a cut-off point of 4, the DT identified 85% of the patients with an ICD-10 depressive diagnosis (sensitivity) and 60% of the patients without a psychiatric diagnosis (specificity). The positive predictive value was 44%, the negative predictive value 92% and the diagnostic odd ratio 8.88. Fatigue and emotional difficulties were the most commonly reported problems by the patients. Conclusion: The Greek version of the DT has a sufficient overall accuracy in classifying patients regarding the existence of depressive disorders, in the oncology setting. Therefore, it can be considered as a valid initial screening tool for depression in patients with cancer; patients scoring ≥4 should be assessed by a more thorough mental evaluation

COVID-19-related consultation-liaison (CL) mental health services in general hospitals : a perspective from Europe and beyond

Objective: The COVID-19 pandemic posed new challenges for integrated health care worldwide. Our study aimed to describe newly implemented structures and procedures of psychosocial consultation and liaison (CL) services in Europe and beyond, and to highlight emerging needs for co-operation. Methods: Cross-sectional online survey from June to October 2021, using a self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies, working groups, and heads of CL services. Results: Of the participating 259 CL services from Europe, Iran, and parts of Canada, 222 reported COVID-19 related psychosocial care (COVID-psyCare) in their hospital. Among these, 86.5% indicated that specific COVID-psyCare co-operation structures had been established. 50.8% provided specific COVID-psyCare for patients, 38.2% for relatives, and 77.0% for staff. Over half of the time resources were invested for patients. About a quarter of the time was used for staff, and these interventions, typically associated with the liaison function of CL services, were reported as most useful. Concerning emerging needs, 58.1% of the CL services providing COVID-psyCare expressed wishes for mutual information exchange and support, and 64.0% suggested specific changes or improvements that they considered essential for the future. Conclusion: Over 80% of participating CL services established specific structures to provide COVID-psyCare for patients, their relatives, or staff. Mostly, resources were committed to patient care and specific interventions were largely implemented for staff support. Future development of COVID-psyCare warrants intensified intra- and inter-institutional exchange and co-operation.info:eu-repo/semantics/publishedVersio

COVID-19-related consultation-liaison (CL) mental health services in general hospitals:a perspective from Europe and beyond

Abstract Objective: The COVID-19 pandemic posed new challenges for integrated health care worldwide. Our study aimed to describe newly implemented structures and procedures of psychosocial consultation and liaison (CL) services in Europe and beyond, and to highlight emerging needs for co-operation. Methods: Cross-sectional online survey from June to October 2021, using a self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies, working groups, and heads of CL services. Results: Of the participating 259 CL services from Europe, Iran, and parts of Canada, 222 reported COVID-19 related psychosocial care (COVID-psyCare) in their hospital. Among these, 86.5% indicated that specific COVID-psyCare co-operation structures had been established. 50.8% provided specific COVID-psyCare for patients, 38.2% for relatives, and 77.0% for staff. Over half of the time resources were invested for patients. About a quarter of the time was used for staff, and these interventions, typically associated with the liaison function of CL services, were reported as most useful. Concerning emerging needs, 58.1% of the CL services providing COVID-psyCare expressed wishes for mutual information exchange and support, and 64.0% suggested specific changes or improvements that they considered essential for the future. Conclusion: Over 80% of participating CL services established specific structures to provide COVID-psyCare for patients, their relatives, or staff. Mostly, resources were committed to patient care and specific interventions were largely implemented for staff support. Future development of COVID-psyCare warrants intensified intra- and inter-institutional exchange and co-operation