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Br J Gen Pract. Dec 2003; 53(497): 917–922.
PMCID: PMC1314743

Diagnosis of somatisation: effect of an educational intervention in a cluster randomised controlled trial.

Abstract

BACKGROUND: Somatisation is highly prevalent in primary care (present in 25% of visiting patients) but often goes unrecognised. Non-recognition may lead to ineffective treatment, risk of iatrogenic harm, and excessive use of healthcare services. AIM: To examine the effect of training on diagnosis of somatisation in routine clinical practice by general practitioners (GPs). DESIGN OF STUDY: Cluster randomised controlled trial, with practices as the randomisation unit. SETTING: Twenty-seven general practices (with a total of 43 GPs) in Vejle County, Denmark. METHOD: Intervention consisted of a multifaceted training programme (the TERM [The Extended Reattribution and Management] model). Patients were enrolled consecutively over a period of 13 working days. Psychiatric morbidity was assessed by means of a screening questionnaire. GPs categorised their diagnoses in another questionnaire. The primary outcome was GP diagnosis of somatisation and agreement with the screening questionnaire. RESULTS: GPs diagnosed somatisation less frequently than had previously been observed, but there was substantial variation between GPs. The difference between groups in the number of diagnoses of somatisation failed to reach the 5% significance (P = 0.094). However, the rate of diagnoses of medically unexplained physical symptoms was twice as high in the intervention group as in the control group (7.7% and 3.9%, respectively, P = 0.007). Examination of the agreement between GPs' diagnoses and the screening questionnaire revealed no significant difference between groups. CONCLUSION: Brief training increased GPs' awareness of medically unexplained physical symptoms. Diagnostic accuracy according to a screening questionnaire remained unaffected but was difficult to evaluate, as there is no agreement on a gold standard for somatisation in general practice.

Full Text

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Supplementary Material

Supplementary table 1. General practitioners' classification of the main problem presented by the patient in the consultation. The ratio of patients with a diagnosis of somatisation is presented for each GP:
Supplementary figure 1. General practitioners' classification of the main problem presented by the patient in the consultation as 'somatisation' compared with results from a patient screening questionnaire for somatisation:

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Lipowski ZJ. Somatization: the concept and its clinical application. Am J Psychiatry. 1988 Nov;145(11):1358–1368. [PubMed]
  • Fink P, Sørensen L, Engberg M, Holm M, Munk-Jørgensen P. Somatization in primary care. Prevalence, health care utilization, and general practitioner recognition. Psychosomatics. 1999 Jul-Aug;40(4):330–338. [PubMed]
  • Peveler R, Kilkenny L, Kinmonth AL. Medically unexplained physical symptoms in primary care: a comparison of self-report screening questionnaires and clinical opinion. J Psychosom Res. 1997 Mar;42(3):245–252. [PubMed]
  • Goldberg D, Bridges K. Screening for psychiatric illness in general practice: the general practitioner versus the screening questionnaire. J R Coll Gen Pract. 1987 Jan;37(294):15–18. [PMC free article] [PubMed]
  • Fink P. Surgery and medical treatment in persistent somatizing patients. J Psychosom Res. 1992 Jul;36(5):439–447. [PubMed]
  • Smith GR, Jr, Monson RA, Ray DC. Patients with multiple unexplained symptoms. Their characteristics, functional health, and health care utilization. Arch Intern Med. 1986 Jan;146(1):69–72. [PubMed]
  • Kroenke K, Taylor-Vaisey A, Dietrich AJ, Oxman TE. Interventions to improve provider diagnosis and treatment of mental disorders in primary care. A critical review of the literature. Psychosomatics. 2000 Jan-Feb;41(1):39–52. [PubMed]
  • Howe A. Detecting psychological distress: can general practitioners improve their own performance? Br J Gen Pract. 1996 Jul;46(408):407–410. [PMC free article] [PubMed]
  • Roter DL, Hall JA, Kern DE, Barker LR, Cole KA, Roca RP. Improving physicians' interviewing skills and reducing patients' emotional distress. A randomized clinical trial. Arch Intern Med. 1995 Sep 25;155(17):1877–1884. [PubMed]
  • Goldberg DP, Steele JJ, Smith C, Spivey L. Training family doctors to recognise psychiatric illness with increased accuracy. Lancet. 1980 Sep 6;2(8193):521–523. [PubMed]
  • Thompson C, Kinmonth AL, Stevens L, Peveler RC, Stevens A, Ostler KJ, Pickering RM, Baker NG, Henson A, Preece J, et al. Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial. Lancet. 2000 Jan 15;355(9199):185–191. [PubMed]
  • Kaaya S, Goldberg D, Gask L. Management of somatic presentations of psychiatric illness in general medical settings: evaluation of a new training course for general practitioners. Med Educ. 1992 Mar;26(2):138–144. [PubMed]
  • Blankenstein Annette H, van der Horst Henriëtte E, Schilte Albert F, de Vries Douwe, Zaat Joost O M, André Knottnerus J, van Eijk Jacques T M, de Haan Marten. Development and feasibility of a modified reattribution model for somatising patients, applied by their own general practitioners. Patient Educ Couns. 2002 Jul;47(3):229–235. [PubMed]
  • Fink Per, Rosendal Marianne, Toft Tomas. Assessment and treatment of functional disorders in general practice: the extended reattribution and management model--an advanced educational program for nonpsychiatric doctors. Psychosomatics. 2002 Mar-Apr;43(2):93–131. [PubMed]
  • Derogatis LR, Lipman RS, Covi L. SCL-90: an outpatient psychiatric rating scale--preliminary report. Psychopharmacol Bull. 1973 Jan;9(1):13–28. [PubMed]
  • Fink P, Ewald H, Jensen J, Sørensen L, Engberg M, Holm M, Munk-Jørgensen P. Screening for somatization and hypochondriasis in primary care and neurological in-patients: a seven-item scale for hypochondriasis and somatization. J Psychosom Res. 1999 Mar;46(3):261–273. [PubMed]
  • Kessler David, Bennewith Olive, Lewis Glyn, Sharp Deborah. Detection of depression and anxiety in primary care: follow up study. BMJ. 2002 Nov 2;325(7371):1016–1017. [PMC free article] [PubMed]
  • Schilte AF, Portegijs PJ, Blankenstein AH, Knottnerus JA. Somatisation in primary care: clinical judgement and standardised measurement compared. Soc Psychiatry Psychiatr Epidemiol. 2000 Jun;35(6):276–282. [PubMed]
  • Weich S, Lewis G, Donmall R, Mann A. Somatic presentation of psychiatric morbidity in general practice. Br J Gen Pract. 1995 Mar;45(392):143–147. [PMC free article] [PubMed]
  • Thornett Andrew Martyn, Pickering Ruth M, Willis Tracy, Thompson Chris. Membership of the Royal College of General Practitioners and recognition of depression in primary care. Br J Gen Pract. 2002 Jul;52(480):563–566. [PMC free article] [PubMed]

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