PMID- 12670609
OWN - NLM
STAT- MEDLINE
DCOM- 20030909
LR  - 20190901
IS  - 0022-3999 (Print)
IS  - 0022-3999 (Linking)
VI  - 54
IP  - 4
DP  - 2003 Apr
TI  - An empirically derived taxonomy of common distress syndromes in the medically 
      ill.
PG  - 323-30
AB  - OBJECTIVE: Contemporary psychiatric classifications have not proved to be useful 
      in the understanding and care of people with physical illness. Distress syndromes 
      are common, but classifications fail to differentiate syndromes relevantly. We 
      sought to take a fresh look at the common distress syndromes in the medically 
      ill. METHODS: 312 medical inpatients were interviewed using a structured 
      psychiatric interview [the Monash Interview for Liaison Psychiatry (MILP)] to 
      elicit the presence of mood, anxiety and somatoform symptoms. A previously 
      reported examination of these data using latent trait analysis revealed the 
      dimensions of demoralization, anhedonia, autonomic anxiety, somatoform symptoms 
      and grief. Patients were scored on these dimensions and, on the basis of these, 
      subjected to cluster analysis. Derived classes were compared on a range of 
      demographic and clinical data including psychiatric diagnosis. RESULTS: Six 
      classes were found, distinguished by general levels of distress (measured by 
      demoralization, autonomic anxiety and somatoform symptoms), anhedonia and grief. 
      The most distressed groups were Demoralization and Demoralized Grief. Anhedonic 
      Depression showed moderate levels of distress but the highest level of social 
      dysfunction. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) 
      categories of mood disorders did not follow any particular pattern other than 
      reflecting severity of distress. The classes of high distress (Demoralization and 
      Demoralized Grief) were significantly associated with younger age, past history 
      of psychiatric treatment, low Global Assessment of Functioning (GAF) scores over 
      the previous 12 months and DSM-IV somatoform disorders. Patients with Demoralized 
      Grief tended to acknowledge their illness as a significant and relevant stressor. 
      Patients with Demoralization identified other stressors as significant. 
      CONCLUSION: Concepts of demoralization, anhedonia and grief differentiate between 
      important clinical syndromes and have informed the development of a taxonomy of 
      common distress syndromes in the medically ill. Research is required to further 
      explore the validity and utility of these concepts.
FAU - Clarke, David M
AU  - Clarke DM
AD  - Consultation-Liaison Psychiatry Research Unit, Department of Psychological 
      Medicine, Monash University, Melbourne, Victoria, Australia. 
      david.clarke@med.monash.edu.au
FAU - Smith, Graeme C
AU  - Smith GC
FAU - Dowe, David L
AU  - Dowe DL
FAU - McKenzie, Dean P
AU  - McKenzie DP
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - J Psychosom Res
JT  - Journal of psychosomatic research
JID - 0376333
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cluster Analysis
MH  - Depressive Disorder/*classification/diagnosis
MH  - Diagnostic and Statistical Manual of Mental Disorders
MH  - Empirical Research
MH  - Female
MH  - *Health Status
MH  - Humans
MH  - International Classification of Diseases
MH  - Male
MH  - Middle Aged
MH  - Surveys and Questionnaires
MH  - Syndrome
EDAT- 2003/04/03 05:00
MHDA- 2003/09/10 05:00
CRDT- 2003/04/03 05:00
PHST- 2003/04/03 05:00 [pubmed]
PHST- 2003/09/10 05:00 [medline]
PHST- 2003/04/03 05:00 [entrez]
AID - S0022399902004105 [pii]
AID - 10.1016/s0022-3999(02)00410-5 [doi]
PST - ppublish
SO  - J Psychosom Res. 2003 Apr;54(4):323-30. doi: 10.1016/s0022-3999(02)00410-5.