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The Value of Pseudoneurological Symptoms for Assessing Psychopathology in Primary Care

From UMDNJ–Robert Wood Johnson Medical School, Piscataway, New Jersey.

Address reprint requests to: Dr. Alejandro Interian, Department of Psychiatry, UMDNJ—Robert Wood Johnson Medical School, 675 Hoes Lane D306, Piscataway, NJ 08854-5635.

OBJECTIVE: This study sought to examine the relationship between pseudoneurological symptoms (PNS) and somatic and psychiatric symptom severity, physical functioning, and psychiatric comorbidity.

METHODS: Interview and questionnaire data were obtained from 120 patients with somatization who participated in a study assessing the efficacy of cognitive-behavioral therapy. Measures elicited information on psychiatric diagnoses, anxiety and depressive symptom levels, somatic symptoms, and physical functioning. Statistical analyses examined the relationship between PNS and the diagnosis of somatization disorder, physical and psychiatric symptom severity, and psychiatric comorbidity.

RESULTS: Roughly half of the sample had a history of four or more PNS. Results showed that having four or more PNS was not predictive of somatization disorder. However, having four or more PNS was found to be significantly correlated with the severity of anxiety, depression, somatic complaints, and physical dysfunction. These associations were identified while controlling for the symptom count of nonpseudoneurological symptoms, the presence of somatization disorder, and the presence of chronic painful physical conditions. In addition, having four or more PNS was significantly associated with a higher likelihood of receiving a diagnosis of major depression, dysthymia, panic disorder, and generalized anxiety disorder.

CONCLUSIONS: A history of four or more PNS is common among somatizing patients in primary care and associated with a more severe clinical presentation, even after controlling for other factors known to be associated with severity. Four or more PNS may identify a distinct subgroup of somatization and serve as a clinical indicator for identifying psychiatric disorders in primary care. Future studies should explore the assessment of PNS using briefer measures. Furthermore, PNS should be evaluated with samples more representative of US primary care populations, as well as samples that include adequate representation from other ethnic backgrounds (eg, African-American, Asian, etc.).

Key Words: pseudoneurological symptoms, • primary care, • somatization, • somatic symptom clusters, • psychiatric diagnosis.

Abbreviations: CGI = Clinical Global Impression;; CIDI = Composite International Diagnostic Interview;; HAM-A = Hamilton Anxiety Scale;; HAM-D = Hamilton Depression Scale;; MOS SF-10 = RAND MOS Short-Form Health Survey;; PHQ-13 = Patient Health Questionnaire somatic module;; PNS = pseudoneurological symptoms;; PRIME-MD = Primary Care Evaluation of Mental Disorders;; SD = somatization disorder.

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