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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Response to the letter by Escobar on our publication ‘Detecting somatoform disorders in primary care’
Developing a Dimensional Measure for Somatic Symptom Disorders
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Hiske van Ravesteijn, Nijmegen, the Netherlands MD and PhD student in Psychiatry and Primary Care at UMCN St Radboud Nijmegen, Peter Lucassen
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We appreciate very much the compliments of professor Escobar about our article ‘Detecting somatoform disorders in Primary care with the PHQ- 15. Our responses to his remarks: 1. We agree with professor Escobar that somatic symptoms often indicate depression and anxiety syndromes in primary care. We are also aware of the large overlap between somatoform disorders, depressive disorders and anxiety disorders. Indeed, in primary care a combination of these disorders is more prevalent than a disorder in its pure form. However, for the purpose of this article we chose to focus and to pay attention to this subject only. For anxiety syndromes we intend to analyze the data further according to the suggestions of professor Escobar and hope to inform the readers about our results in the near future. The exclusion of depressed patients at baseline was a disadvantage for this research question. However, as this study was part of a larger project, we had to accept this. 2. We agree with professor Escobar that we were not entirely clear about the exclusions for this study. We did not exclude patients with multiple comorbidities unless they were so severely ill that asking for participation in a scientific study would be ethically unacceptable. So, we included for example all diabetic patients with chronic pulmonary disease and/or heart failure and/or GERD and so on. The same goes for cancer patients: patients with cancer who were in a stable phase of their disease were included; we only excluded patients currently on chemotherapy and patients in the terminal stage of their disease. 3. Again we agree with professor Escobar: we consider the number of somatic, symptoms regardless of explanations, as a promising tool for primary care practitioners. However, we chose to further develop an already established instrument for the care of mental health problems in primary care. Moreover, the PHQ-15 is part of a questionnaire that is appropriate to deal with other frequently occurring mental health problems in primary care. Yours sincerely, Hiske van Ravesteijn and Peter Lucassen Competing interests: None declared |
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Javier I Escobar, New Brunswick, NJ, USA Professor of Psychiatry and Family Medicine
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The paper by van Revejstein et al in the May/June issue of the journal, provides important information on the use of the PHQ-15 in primary care populations. The study was well designed, the methodology seems impressive and the results look very encouraging. According to these data, the use of a relatively simple instrument facilitates the screening of patients with severe somatic symptom disorders in primary care.
There are a couple of issues that may limit the usefulness of this study to many primary care practitioners.
1-Somatic symptoms (somatic presentations) often presage depression/anxiety syndromes in primary care and these syndromes are extremely common. One would have hoped that the authors had examined the PHQ-15 as a possible tool to screen for these common syndromes. Unfortunately, because they focused their analyses exclusively on "somatoform" syndromes, they excluded patients with "depression" and did not tell us much about those with anxiety disorders.
2-In primary care, patients with multisystem diseases (advanced diabetes, SLE) or multiple coexistent diseases (CHD, CAD, Diabetes, GERD and several others) often present with added unexplained somatic symptoms. These syndromes seem to be also very common. However, the paper tells us very little about these patients, except that patients with "severe somatic disease" were excluded.
3-Finally, since it is very difficult to sort out explained from unexplained physical symptoms, one wonders if a simple count of somatic symptoms --regardless of explanations-- may prove to be a more practical tool for primary care practitioners.
Competing interests: None declared |
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