Somatized depression and somatoform disorders in general medical practice: a comparative clinical and psychopathological analysis

Background. Primary care patients present with physical complaints without an appropriate organic or somatic explanation in 20–30 % of cases. Functional somatic symptoms pose significant challenges in diagnosis, treatment, and therapy, associated with significant unnecessary costs and a reduced quality of life for socially active general practitioners.

The aim of the study was to comprehensively examine the clinical characteristics of somatized mental disorders in general medical patients, aimed at developing a typology and optimizing treatment.

Materials and methods. A two-center, cross-sectional, observational study was conducted among 80 patients (27 men, 53 women, mean age 37.3±12.4 years) who presented to Sechenov University clinics with functional somatic symptoms. Diagnoses were verified according to ICD-10 criteria. A psychopathological examination, the Hospital Anxiety and Depression Scale (HADS), the Somatic Symptom Questionnaire (PHQ-15), the Quality-of Life-Questionnaire (SF-36), and the Structured Clinical Interview for the Diagnosis of Personality Disorders (SCID-II) were used. Statistical analysis was performed using IBM SPSS Statistics 26.

Results. Based on the clinical and psychopathological analysis, two groups were distinguished: patients with depressive disorders with somatic symptoms such as depressive hyperesthesia in the somatopsychic sphere (n=40) and patients with somatoform disorders, where somatic symptoms appeared in the structure of body-oriented anxiety-hypochondriacal syndrome (n=40). In the group with depressive disorders, depressive affect prevailed (17.0±4.2 points on the HADS scale) with a high level of concomitant anxiety (13.5±2.8 points), diffuse polymorphic somatic symptoms were recorded (15.2±3.1 points on the PHQ-15 scale) with daily fluctuations and morning deterioration, as well as a global decrease in the quality of life according to the affective-dependent scales of the SF-36 (general health, vitality, emotional state). In the group with somatoform disorders, anxiety symptoms dominated (16.0±3.4 points) with moderate depression (10.2±2.5 points), focused intense somatic symptoms were noted (12,4±2,7 points on the PHQ-15 scale).

Conclusion. The developed typology confirms the pathogenetic heterogeneity of the somatization phenomenon and creates the basis for a differential approach to the diagnosis and treatment of this category of patients in general medical practice.

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