Supplementary Material for: Management of Functional Somatic Syndromes and Bodily Distress

<p>Functional somatic syndromes (FSS), like irritable bowel syndrome or fibromyalgia and other symptoms reflecting bodily distress, are common in practically all areas of medicine worldwide. Diagnostic and therapeutic approaches to these symptoms and syndromes vary substantially across and within medical specialties from biomedicine to psychiatry. Patients may become frustrated with the lack of effective treatment, doctors may experience these disorders as difficult to treat, and this type of health problem forms an important component of the global burden of disease. This review intends to develop a unifying perspective on the understanding and management of FSS and bodily distress. Firstly, we present the clinical problem and review current concepts for classification. Secondly, we propose an integrated etiological model which encompasses a wide range of biopsychosocial vulnerability and triggering factors and considers consecutive aggravating and maintaining factors. Thirdly, we systematically scrutinize the current evidence base in terms of an umbrella review of systematic reviews from 2007 to 2017 and give recommendations for treatment for all levels of care, concentrating on developments over the last 10 years. We conclude that activating, patient-involving, and centrally acting therapies appear to be more effective than passive ones that primarily act on peripheral physiology, and we recommend stepped care approaches that translate a truly biopsychosocial approach into actual management of the patient.</p

Supplementary Material for: Effects of lifestyle and educational bridging programs before bariatric surgery on postoperative weight loss - a systematic review and meta-analysis

Objective: To fulfill the requirements for bariatric surgery, patients often need to participate in mandatory pre-operative lifestyle interventions (PLI). Currently, the efficacy of multi-month PLI-programs on body mass index (BMI) reduction from the start of the program (T0) through the immediate pre-operative time point (T1) to one-year post-surgery (T2), and how the amount of pre-operative BMI reduction affects post-operative outcome (T1 to T2) is unclear. The aim of this meta-analysis was to analyze the effects of PLI on body mass index (BMI) one-year post-surgery. Method: A systematic literature search was conducted according to PRISMA criteria. Randomized controlled trials that implemented PLI lasting 1-8 months before bariatric surgery were included. The BMI of the intervention group was compared with a control group before participation in the PLI (T0), after completion of the program before surgery (T1) and one-year post-surgery (T2). Finally, the impact of successful BMI reduction at T1 on BMI at T2 was analyzed. Results: N=345 patients derived from 4 studies undergoing PLI reduced their BMI at T1 by 1.5 units compared to the control group (95% CI: -2.73, -0.28). One-year post-surgery, both groups had lost comparable BMI points. The influence of reduced BMI at T1 on weight status at T2 is unclear due to the lack of available studies. Other endpoints and subgroup analyses were rarely examined. Conclusions: PLI reduce BMI before bariatric surgery more effectively than usual care. These differences are not detectable one-year post-surgery. Although a short-term energy reduction period before surgery is clearly important to minimize surgery risks, it is currently unclear whether, and if so under what circumstances, participation in a PLI is beneficial

Supplementary Material for: What Kind of Patients Receive Inpatient and Day-Hospital Treatment in Departments of Psychosomatic Medicine and Psychotherapy in Germany?

Introduction: Germany is one of the few countries with a medical specialty of psychosomatic medicine and psychotherapy and many treatment resources of this kind. Objective: This observational study describes the psychosomatic treatment programs as well as a large sample of day-hospital and inpatients in great detail using structured diagnostic interviews. Methods: Mental disorders were diagnosed according to ICD-10 and DSM-IV by means of Mini-DIPS and SCID-II. In addition to the case records, a modified version of the CSSRI was employed to collect demographic data and service use. The PHQ-D was used to assess depression, anxiety, and somatization. Results: 2,094 patients from 19 departments participated in the study after giving informed consent. The sample consisted of a high proportion of “complex patients” with high comorbidity of mental and somatic diseases, severe psychopathology, and considerable social and occupational dysfunction including more than 50 days of sick leave per year in half of the sample. The most frequent diagnoses were depression, somatoform and anxiety disorders, eating disorders, personality disorders, and somato-psychic conditions. Conclusions: Inpatient and day-hospital treatment in German university departments of psychosomatic medicine and psychotherapy is an intensive multimodal treatment for complex patients with high comorbidity and social as well as occupational dysfunction