Diagnostic Criteria for Psychosomatic Research – revised version by Giovanni A. Fava and his research team

Diagnostic Criteria for Psychosomatic Research (DCPR), developed by a team of Italian and American researchers at the end of the 20th century, was elaborated and then revised based on observations and studies conducted by clinicians. In this paper, we present their current version known as DCPR-R. This classification system departs from the functional/organic dichotomy of disorders. The new criteria allow for the assessment of the role of multiple emotional/behavioural dimensions and responses in the functioning of an affected person. The revised version has four diagnostic modules, i.e., stress, illness behaviour, psychological manifestation, and personality. The authors introduced an additional factor to describe life experiences that contribute to stress (allostatic overload). Illness behaviours include health anxiety, disease phobia, hypochondriasis, thanatophobia, illness denial, persistent somatisation, conversion, and anniversary reaction. Irritable mood, somatic symptoms secondary to a psychiatric disorder and demoralisation are psychological manifestations. Type A behaviour pattern and alexithymia are considered personalityrelated factors. The authors of DCPR-R proposed a certain number of criteria to be met in order to diagnose each of these syndromes. The system makes it possible to clearly determine the presence of a given syndrome, but it does not allow to assess its severity. Psychosomatic syndromes play an important role in the development and/or course of somatic diseases. Inclusion of these syndromes in clinical diagnosis has made it possible to expand the spectrum of information about patient’s functioning, and, once they are diagnosed, offer appropriate psychological assistance, which will translate into an improvement in the quality of life.

Attitude to disease in patients following cardiac emergencies

Objective. To assess attitudes toward disease in patients following cardiac emergencies at early stages of rehabilitation. Design and methods. The study sample consisted of 70 patients (23 females, 47 males) aged 35-67 years (54,5 ± 6,4 years old) hospitalized with myocardial infarction (MI; 55,7 %), unstable angina (18,6 %) or for planned cardiac surgery (25,7 %). The following methods were used: interview, medical records analysis, «Method for psychological diagnostics of attitude towards disease» (Wasserman L.I. et al., 2005). Results. Most patients (48,6 %) have «ergopathic» attitude toward disease characterized by aspiration to overcome disease in order to maintain the level of social activity they had had before the hospitalization. Denial of illness itself was found in 22,9 % cases, denial of possible illness consequences — in 51,4 %. Females, patients with recurrent cardiac attack and those, who had emergent (versus planned) hospitalization were more frustrated by the disease. Males and patients, who survived MI for the first time, were more prone to deny the fact of the disease as well as its possible consequences. Denial of the fact of illness was typical only of patients with the most life-threatening states — MI (compared to unstable angina). This may be regarded as an evidence of defensive/protective character of illness denial. Conclusion. Resistance, active overcoming and denial are predominant psychological tendencies in reaction to illness in patients following cardiac emergencies at early stages of rehabilitation. In case of ineffectiveness of these psychological strategies there is an increased risk of psychosocial disturbances. These characteristics of attitude toward illness in cardiac patients should be taken into account in the treatment and rehabilitation process.

When the Patient Says No

The need to ascertain appropriate decision-making capacity is greatest when dealing with refusals of lifesaving or life-prolonging treatment. This may be complicated by delirium, concurrent depression, metabolic disturbances or significant symptom burden, family conflicts, and social issues. This is a case of a 48-year-old patient with a long-standing history of a symptomatic pan-invasive pituitary adenoma who refused life-prolonging treatment. Ultimately, a patient must be able to understand the information given to him, evaluate the consequences of the options presented, deliberate on these options based on his values, communicate this choice, and maintain consistency overtime. These refusals of treatment may fluctuate with time and intensity of the illness. Denial of this right of autonomy and self-determination may worsen the individual’s physical and existential suffering.