| |
The
distinction between measuring symptoms and somatization is somewhat
arbitrary. Again, symptoms are a manifestation of many defined
diseases, whereas somatization defines that subset of patients
who experience and report medically unexplained symptoms. There
is no "gold standard" measure for somatization.
The American
Psychiatric Association's Diagnostic and Statistical Manual, 3rd
Edition, Revised (DSM-III-R) provided a list of over 35 somatic
symptoms to serve as a checklist for somatoform disorders (i.e.
diagnoses consisting of medically unexplained symptoms attributable
to psychological factors). Symptoms could count, however, if they
had been bothersome any time during a patient's lifetime.
The Diagnostic
Interview (DIS) and its successor, the Comprehensive International
Diagnostic Interview (CIDI) have a long somatoform module that
incorporate the DSM symptom checklist. Inquiring about such a
long checklist of symptoms, probing to determine whether each
symptom endorsed may have been medically unexplained, and requiring
the patient to draw upon lifetime symptom recall has found to
be problematic in terms of both efficiency as well as reliability.
Because of
this, shorter symptom screeners have been proposed (Derogatis
et al.,1974; Othmer
and DeSouza,1985; Swartz
et al.,1986; Tacchini et
al.,1994). A comparison of several of these screeners along
with the PHQ-15 is shown in Table 17.1 below.
| Table17.1:
Comparison of PHQ-15 with other Somatization Screening
Measures *
|
|---|
| Characteristic
| PHQ-15
| WHO
SSD
| SCL-12
| Swartz
| Othmer
|
|---|
| Number
of symptoms
| 15
| 12
| 12
| 11
| 7
|
|---|
| Time
Frame of Symptoms
| 1
month
| 6
month
| 1
week
| Lifetime
| Lifetime
|
|---|
| Symptoms
included †
|
|
|
|
|
|
|---|
| Joint
or limb pain |
X
|
"X"
|
X
|
X
|
X
|
| Dizziness |
X
|
X
|
1/2
|
X
|
|
| Fatigue
|
X
|
X
|
X
|
|
|
| Headaches |
X
|
X
|
X
|
|
|
| Back
pain |
X
|
X
|
X
|
|
|
| Abdominal
pain |
X
|
X
|
|
X
|
|
| Chest
pain |
X
|
|
X
|
X
|
|
| Breathing
trouble |
X
|
|
X
|
|
X
|
| Fainting |
X
|
|
1/2
|
X
|
|
| Gas
or indigestion |
1/2
|
X
|
|
X
|
|
| Sleeping
trouble |
X
|
X
|
|
|
|
| Palpitations |
X
|
X
|
|
|
|
| Menstrual
problems |
X
|
|
|
|
|
| Diarrhea
(constipation) |
X
|
|
|
X
|
|
| Sexual
pain/problems |
X
|
|
|
|
X
|
| Vomiting |
|
|
|
X
|
X
|
| Numbness
or tingling |
|
X
|
X
|
|
|
| Weakness |
|
|
X
|
X
|
|
| Lump
in throat |
|
|
X
|
|
|
| Nausea |
1/2
|
|
|
X
|
|
| Heavy-
or light-headed |
|
X
|
|
|
|
| Dry
mouth |
|
X
|
|
|
|
| Heaviness
arms/legs |
|
|
X
|
|
|
| Hot
or cold spells |
|
|
X
|
|
|
| Feeling
sickly |
|
|
|
X
|
|
| Amnesia |
|
|
|
|
X
|
|
*
WHO-SSD indicates World Health Organization Schedule
for Somatoform Disorders screener; SCL-12 indicates
Hopkins Symptom Checklist somatization scale; Swartz
and Othmer represent 11-item and 7-item screeners,
respectively, for somatization disorder
†
X indicates that this symptom (or equivalent) is included
on the scale; 1/2 indicates that the two symptoms
so designated constitute a single item for the scale;
"X" indicates that a symptom close in type
to that in the table is represented on the scale
|
|
|