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Somatoform Symptoms and Treatment Nonadherence in Depressed Family Medicine Outpatients
Robert Keeley, MD;
Marcia Smith, PhD;
John Miller, MD
Arch Fam Med. 2000;9:46-54.
Objectives To examine whether somatoform symptoms, specifically symptoms of conversion, somatization, and hypochondriasis, are associated with side-effect reporting and treatment nonadherence in depressed family medicine outpatients, and to measure whether symptoms improve with pharmacotherapy.
Design Inception cohort study with 14-week follow-up.
Setting Inner-city family medicine residency clinic.
Patients Thirty-nine consecutive adults with major depressive disorder were asked to participate, and 30 consented.
Intervention Antidepressants for 14 weeks.
Main Outcome Measures The Personality Assessment Inventory (PAI) was administered before treatment. The PAI is a self-reported inventory compatible with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, designed to measure a broad range of personality characteristics. After 14 weeks, the side-effect incidence and treatment nonadherence rates were determined, and 12 patients were readministered the PAI.
Results Depressed family medicine patients demonstrated trends toward elevated Somatic Complaints scale and conversion subscale scores and a lower Suicidal Ideation scale score relative to those of a standardized depressed psychiatric patient profile. Conversion and hypochondriacal symptoms were associated with side-effect reporting and treatment nonadherence. Somatization and hypochondriacal symptoms improved clinically and statistically during treatment for depression.
Conclusions Somatoform distress is a complex, common, and understudied phenomenon in primary care that can adversely affect the treatment of depression. Somatoform symptoms of conversion and hypochondriasis, but not somatization, were found to be risk factors for treatment nonadherence. Somatization and hypochondriacal symptoms may represent personality states that improve with pharmacotherapy, and conversion symptoms may be a personality trait resistant to medical treatment for depression.
From the St Anthony Family Medicine Residency, St Anthony Central Hospital, Denver, Colo. Dr Keeley is now with the Salud Family Health Center, Longmont, Colo, and is a Clinical Instructor at the Department of Family Medicine, University of Colorado School of Medicine, Denver. Dr Smith is now with the Department of Family Medicine, Brown University, Providence, RI.
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