Polypharmacy and somatic symptom disorder (SSD) are common conditions clinicians see every day in practice. Polypharmacy is easy to identify and causation seems to be straightforward. However, SSD may not be so obvious and may be an underlying cause of the polypharmacy that may be more difficult to identify. Identifying SSD as a potential psychiatric cause for polypharmacy and understanding that adding more medications will not adequately resolve the patient\'s symptoms is important to prevent polypharmacy from being exacerbated.

BACKGROUND: Functional somatic symptoms (FFS) and bodily distress disorders are highly prevalent across all medical settings. Services for these patients are dispersed across the health care system with minimal conceptual and operational integration, and patients do not currently access therapeutic offers in significant numbers due to a mismatch between their and professionals\' understanding of the nature of the symptoms. New service models are urgently needed to address patients\' needs and to align with advances in aetiological evidence and diagnostic classification systems to overcome the body-mind dichotomy.
METHODS: A panel of clinical experts from different clinical services involved in providing aspects of health care for patients with functional symptoms reviewed the current care provision. This review and the results from a focus group exploration of patients with lived experience of functional symptoms were explored by the multidisciplinary expert group, and the conclusions are summarised as recommendations for best practice.
RESULTS: The mapping exercise and multidisciplinary expert consultation revealed five themes for service improvement and pathway development: time/access, communication, barrier-free care, choice and governance. Service users identified four meta-themes for best practice recommendations: focus on healthcare professional communication and listening skills as well as professional attributes and knowledge base to help patients being both believed and understood in order to accept their condition; systemic and care pathway issues such as stronger emphasis on primary care as the first point of contact for patients, resources to reduce the length of the patient journey from initial assessment to diagnosis and treatment.
CONCLUSIONS: We propose a novel, integrated care pathway for patients with \'functional somatic disorder\', which delivers care according to and working with patients\' explanatory beliefs. The therapeutic model should operate based upon an understanding of the embodied nature of patient\'s complaints and provide flexible access points to the care pathway.

OBJECTIVE: The somatic symptom disorder (SSD) is characterized by one or more distressing or disabling somatic symptoms accompanied by an excessive amount of time, energy and emotion related to the symptoms. These manifestations of SSD have been linked to alterations in perception and appraisal of bodily signals. We hypothesized that SSD patients would exhibit changes in interoceptive accuracy (IA), particularly when emotional processing is involved.
METHODS: Twenty-three patients with SSD and 20 healthy controls were recruited. IA was assessed using the heartbeat perception task. The task was performed in the absence of stimuli as well as in the presence of emotional interference, i.e., photographs of faces with an emotional expression. IA were examined for correlation with measures related to their somatic symptoms, including resting-state heart rate variability (HRV).
RESULTS: There was no significant difference in the absolute values of IA between patients with SSD and healthy controls, regardless of the condition. However, the degree of difference in IA without emotional interference and with neutral facial interference was greater in patients with SSD than in healthy controls (p = 0.039). The IA of patients with SSD also showed a significant correlation with low-frequency HRV (p = 0.004) and high-frequency HRV (p = 0.007).
CONCLUSIONS: SSD patients showed more significant changes in IA when neutral facial interference was given. These results suggest that bodily awareness is more affected by emotionally ambiguous stimuli in SSD patients than in healthy controls.

Alterations in sensory processing, a key component of autism spectrum disorder (ASD), have recently attracted increasing attention as they result in peculiar responses to sensory stimuli, possibly representing a risk factor for the development of somatic symptom disorder (SSD). Contextually, other features also associated with ASD, such as alexithymia, camouflaging and altered verbal, and non-verbal communication, have been suggested to represent risk factors for the occurrence and worsening of somatic symptomatology. The aim of this work was to review the available literature about the association between SSD and the autism spectrum. The results highlighted not only a higher prevalence of autistic features in patients suffering from SSD and a higher prevalence of reported somatic symptomatology in subjects with ASD but also how ASD subjects with co-occurrent somatic symptoms exhibit more severe autism-linked symptomatology. From the paper reviewed also emerged many shared features between the two conditions, such as alexithymia, altered sensitivity to sensory stimuli, cognitive inflexibility, intolerance of uncertainty, and an increased risk of experiencing stressful life events, which may provide an explanation for the correlation reported. Even though studies on the topic are still scant, the evidence reported suggests the importance of further assessing the correlation between the two disorders.

UNASSIGNED: Somatic symptom disorder (SSD) as introduced by the DSM-5 is characterized by chronic somatic symptoms not fully explained by underlying pathology and accompanied by psychological factors, the diagnostic B-criteria. These cognitive, affective, and behavioral disturbances are related to increased attention to somatic symptoms. However, there is a lack of empirical evidence regarding the association between the B-criteria and high symptom reporting in clinical settings.
UNASSIGNED: This 12-year retrospective, cross-sectional, observational study examined 6,491 patients from a German psychosomatic outpatient center. The somatoform subscale of HEALTH-49 was used to evaluate somatic symptom reporting. Excessive health concerns and other potential criteria associated with symptom reporting were determined using the ICD-10-Symptom Rating and other HEALTH-49 subscales.
UNASSIGNED: Regression analysis revealed that the established B-criteria for SSD were the strongest factors associated with somatic symptom reporting, with a standardized beta-coefficient of β = 0.31 (R2 = 0.428, df = 24, F = 187.886). Other psychobehavioral factors were clearly less associated with somatic symptom reporting, such as depressive symptoms with β = 0.15 and impaired activity and participation with β = 0.12. Sociodemographic factors, such as age (β = 0.16) and gender (β = 0.12), were also independently associated with somatic symptom reporting.
UNASSIGNED: This study provides evidence for the concept of SSD related to specific B-criteria associated with somatic symptom reporting, based on a large patient sample. These results point to an important role of psychological symptomatology in patients with somatic symptoms. The findings also suggest that additional factors contribute to the reporting of somatic symptoms. Our results may inform future diagnostic criteria for SSD.
This scientific study examines the association between psychobehavioral factors and somatic symptom reporting in a large sample of psychosomatic outpatients. We investigated the association of established and possible additional psychobehavioral criteria for somatic symptom disorder (SSD) as defined in the DSM-V. The study included 6,491 patients from a psychosomatic outpatient center over a 12-year period. The participants completed self-report questionnaires to assess somatic symptom reporting and psychobehavioral factors. The results showed that the B-criteria of SSD were associated with somatic symptom reporting, indicating the validity of these criteria in clinical practice. Other psychobehavioral factors, such as depressive symptoms and impaired activity and participation, as well as sociodemographic factors such as age and gender were also associated with somatic symptom reporting but to a much lesser extent. This study has limitations, including its retrospective and cross-sectional design, reliance on self-report measures, and the need for further research using longitudinal data and clinician-rated assessments to complement self-report data. However, our research highlights the importance of psychological symptomatology in individuals who report somatic symptoms. These findings may inform future diagnostic criteria and treatment approaches for individuals with SSD and improve treatment and patient outcomes.

UNASSIGNED: This study explored the association between self-compassion, alexithymia, and psychosomatic symptom distress in a clinical sample of somatic symptom disorder (SSD) patients participating in a mindfulness-based cognitive therapy (MBCT) program.
UNASSIGNED: One hundred sixteen SSD patients who had participated in an MBCT program and completed ≥4 intervention sessions were included in a retrospective study (76.7% women, mean age = 40.0, SD = 9.5). Psychometric measures of psychosomatic symptom distress [Brief Symptom Inventory-18 Global Severity Index (BSI-GSI)], self-compassion [Self-Compassion Scale (SCS)], and alexithymia [Toronto Alexithymia Scale (TAS)] were collected upon admission to the MBCT program and at 6-month follow-up following treatment inclusion.
UNASSIGNED: Serial mediation analysis (MBCT→ΔSCS→ΔTAS→ΔBSI-GSI) suggested that changes in both self-compassion and alexithymia had significant indirect effects on improvement in psychosomatic distress [ΔSCS β = -1.810, 95% bootstrap CI (-2.488, -1.160); ΔTAS β = -1.615, bootstrap 95% CI (-2.413, -0.896); ΔSCS→ΔTAS β = -0.621, bootstrap CI (-1.032, -0.315)]. Furthermore, a post-hoc analysis with a reverse sequence (MBCT→ΔTAS→ΔSCS→ΔBSI-GSI) revealed that reduction in alexithymia improved psychosomatic distress and that an increase in self-compassion was a subsequent outcome of alleviation of alexithymia [ΔTAS β = -2.235, bootstrap 95% CI (-3.305, -1.270); ΔSCS β = 0.013, 95% bootstrap CI (-0.600, 0.682); ΔTAS→ΔSCS β = -1.823, bootstrap CI (-2.770, -1.047)].
UNASSIGNED: Both alleviation of alexithymia and improvement in self-compassion play a mediating role in the reduction of psychosomatic distress in SSD patients following an MBCT program. Improvement in self-compassion might be a subsequent outcome of MBCT-related alleviation of alexithymia.

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UNASSIGNED: Experiences of displacement have been associated with the prevalence of mental health disorders owing to certain factors.
UNASSIGNED: This study aimed to identify the correlates of Somatic Symptom Disorder (SSD) among internally displaced adults in Ogoja displacement settlements, Nigeria.
UNASSIGNED: This was a cross-sectional study of 335 respondents. SSD was assessed using the SOM-SCL section of the Common Mental Disorder Questionnaire while a semi-structured questionnaire was used to collect data on sociodemographic and displacement-related factors. Data were analysed using descriptive statistics, Chi-square, and multivariable logistic regression.
UNASSIGNED: The prevalence of somatoform disorder was 59.1%. Factors found to be significant in each bivariate Chi-square analysis were modelled for the mental disorder. The multivariate analysis revealed that being married (AOR=2.80; p=0.020) prolonged displacement (AOR=3.29; p=0.003), discrimination (AOR=2.25; p=0.010), disease outbreak (AOR=1.92; p=0.030), loss of loved ones (AOR=1.34; p=0.028), overcrowded households (AOR=2.30; p=0.008), and fear of reprisals (AOR=2.05; p=0.026) were significantly associated with somatoform disorder.
UNASSIGNED: The findings suggest that the high prevalence of the studied outcome is related to several stressors and events among Internally displaced persons. Evidence-based mental health support efforts by different bodies in creating and routinely arranging mental health clinical interventions for this population is recommended.

UNASSIGNED: Based on two diagnostic accuracy studies in high-prevalence settings, two distinctly different combinations of cut-off values have been recommended to identify persons at risk for somatic symptom disorder (SSD) with the combination of the Patient-Health Questionnaire-15 (PHQ-15) and the Somatic Symptom Disorder-B Criteria Scale (SSD-12). We investigated whether the reported sensitivity and specificity of both recommended cut-off combinations are transferable to primary care.
UNASSIGNED: In a cross-sectional study, 420 unselected adult primary care patients completed PHQ-15 and SSD-12. Patients scoring ≥9 and ≥ 23 (recommended cut-off combination #1) or ≥ 8 and ≥ 13 (recommended cut-off combination #2) were considered test-positive for SSD, respectively. To assess the validity of the reported sensitivity and specificity in different low- to high-prevalence settings, we compared correspondingly expected proportions of test positives to the proportion observed in our sample.
UNASSIGNED: Based on combination #1, 38 participants (9%) were found to be test positive, far fewer than expected, based on the reported values for sensitivity and specificity (expected minimum frequency 30% with a true prevalence ≥1%). This can only be explained by a lower sensitivity and higher specificity in primary care. For combination #2, 98 participants (23%) were test positive, a finding consistent with a true prevalence of SSD of 15% or lower.
UNASSIGNED: Our analyzes strongly suggest that the sensitivity and specificity estimates reported for combination #1 are not applicable to unselected primary care patients and that the cut-off for the SSD (≥23) is too strict. Cut-off combination #2 seems more applicable but still needs to be tested in studies that compare screening findings by questionnaires with validated diagnostic interviews as reference standards in primary care populations.

Somatic symptom disorder (SSD) involves physical symptoms like palpitations, pain, weakness, dizziness, and pseudo-neurological symptoms. These symptoms are accompanied by excessive thoughts, emotions, and behaviors related to the symptom, causing significant distress and impairment lasting at least six months. They may not be explained by any underlying medical conditions. SSD can be resistant to standard treatment modalities like Cognitive Behavioral Therapy (CBT), Selective Serotonin Reuptake Inhibitors (SSRIs), and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs). Antipsychotics, in particular second generations, have also been used to treat SSD but not as frequently. This case report shows the improvement in symptomatology of SSD after low-dose quetiapine was used for its management. This case is a 41-year-old Hispanic male with a diagnosis of SSD who presented to the outpatient clinic for severe somatic symptoms. The use of low-dose second-generation antipsychotic (SGA), in particular quetiapine, to successfully improve symptoms and patient functionality after just four weeks on quetiapine as the patient and wife both reported significant normalization of intrusive thoughts and health-related behaviors. To the best of our knowledge, this is the first case demonstrating symptom improvement in SSD following the addition of low-dose quetiapine to SNRI treatment.