Journal of psychosomatic research
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The growing evidence for a key role of psychophysiological processes in the etiopathogenesis of functional gastrointestinal disorders (FGID) originates from various sources, including epidemiological, psychometric, physiological, and behavioural studies. Functional neuroimaging has improved our knowledge about central processing of visceral pain, a defining feature of FGID. However, results have been disappointingly inconsistent, often due to psychosocial factors not being controlled for. ⋯ We therefore propose a framework for the development of an integrative cross-disciplinary research strategy based on advancing our understanding of visceral nociceptive physiology in health as well as vulnerability and susceptibility factors for FGID. This approach will allow the identification of factors responsible for the inter-individual differences in visceral pain perception and susceptibility to chronic visceral pain, leading to the description of multidimensional (visceral) pain "endophenotypes." These may represent the critical steps needed towards a pathophysiological, rather than symptom-based, classification of FGID, which may be more suitable for genetic association studies. This approach may ultimately culminate in individual tailoring of treatment, in addition to disease prevention, thereby improving outcomes for the patient and researcher alike.
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The classification of somatoform disorders is currently being revised in order to improve its validity for the DSM-V and ICD-11. In this article, we compare the validity and clinical utility of current and several new diagnostic proposals of those somatoform disorders that focus on medically unexplained somatic symptoms. ⋯ Results from the reviewed studies suggest that, of all current and new diagnostic suggestions, complex somatic symptom disorder and the CISSD definition appear to have advantages regarding validity and clinical utility. The integration of psychological and behavioral criteria could enhance construct and descriptive validity, and confers prospectively relevant treatment implications. The incorporation of a dimensional approach that reflects both somatic and psychological symptom severity also has the potential to improve predictive validity and clinical utility.
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Functional somatic syndromes commonly occur together, share a genetic component and are associated with numerous somatic symptoms. This study aimed to determine if genetic variation in two neuroendocrine systems, the serotoninergic system and the hypothalamic-pituitary-adrenal (HPA) axis, was associated with the number of reported somatic symptoms. ⋯ This study finds association of SNPs in HTR2A, SERPINA6, and TPH2 with somatic symptoms implicating them as potentially important in the shared genetic component to functional somatic syndromes, although replication is required.
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In order to clarify the classification of physical complaints not attributable to verifiable, conventionally defined diseases, a new diagnosis of bodily distress syndrome was introduced. The aim of this study was to test if patients diagnosed with one of six different functional somatic syndromes or a DSM-IV somatoform disorder characterized by physical symptoms were captured by the new diagnosis. ⋯ Bodily distress syndrome seem to cover most of the relevant "somatoform" or "functional" syndromes presenting with physical symptoms, not explained by well-recognized medical illness, thereby offering a common ground for the understanding of functional somatic symptoms. This may help unifying research efforts across medical disciplines and facilitate delivery of evidence-based care.
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The purpose of this study was to collate all works relating to delirium and probable delirium in children and adolescents published since 1980. ⋯ Delirium is an important but neglected disorder of childhood associated with significant morbidity and high mortality. Current clinical practice for management is based on slim empirical evidence.