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Psychosomatics 44:91-99, April 2003
© 2003 The Academy of Psychosomatic Medicine

Subjective Body Complaints as an Indicator of Somatization in Elderly Patients

Gudrun Schneider, M.D., Michael Wachter, Ph.D., Georg Driesch, M.D., Andreas Kruse, Ph.D., Hans-Georg Nehen, M.D., and Gereon Heuft, M.D.

Received Feb. 15, 2002; revision received June 24, 2002; accepted July 11, 2002. From the Department of Psychosomatics and Psychotherapy, University Hospital Münster; the Institute of Gerontology, University of Heidelberg, Heidelberg, Germany; and the Haus Berge Geriatric Clinic of the St. Elisabeth Hospital, Essen, Germany. Address correspondence and reprint requests to Dr. Schneider, Department of Psychosomatics and Psychotherapy, University Hospital Münster, Domagkstr. 22, D-48129 Münster, Germany; schneig{at}mednet.uni-muenster.de (e-mail).


  ABSTRACT

 
TOP
 ABSTRACT
INTRODUCTION
 METHOD
 RESULTS
 DISCUSSION
 REFERENCES
 
The authors examined the correlation of subjective body complaints (measured by the Giessen Subjective Complaints List) with sociodemographic data, objective health measures, measures of subjective well-being, and clinicians' ratings of somatization and psychological impairment in 251 cognitively unimpaired general hospital inpatients aged >=60 years. The level of subjective body complaints correlated most highly with self-assessed life satisfaction and age-related changes and with the clinicians' rating of somatization. The results suggest that the level of subjective body complaints is determined by subjective well-being rather than by objective health measures, and thus subjective body complaints may be an indicator of somatization in elderly inpatients.


  INTRODUCTION

 
TOP
 ABSTRACT
 INTRODUCTION
METHOD
 RESULTS
 DISCUSSION
 REFERENCES
 
Complaints of psychosomatic symptoms in elderly patients have been receiving increased attention.1–3 Epidemiologic studies have shown that the number of medical diseases and degree of functional impairment increase with age4,5 but that depressive mood, subjective well-being, and subjective assessment of health in elderly persons have no clear association with age.6,7 Subjects over age 70 years have shown a tendency toward a more positive subjective assessment of health than was indicated by objective measures, and this tendency increased with greater age.8

Since the subjective assessment of health has been correlated with subjectively experienced body complaints in subjects aged >=60 years in the general population,9 it seems plausible to assume that subjectively experienced body complaints would show only a weak association with objective health parameters. Because subjective body complaints and medically unexplained symptoms are associated with substantial distress and frequent health care utilization, more information is needed about the predictors of these complaints, particularly in elderly patients.10–15

In a community sample of 764 persons aged >=60 years, an increasing amount of subjective body complaints was associated with greater age in women and in persons with depressive mood.9,16 In this study, the marital or domestic situation had no influence on the amount of subjective body complaints. However, in a study of outpatients in an urban primary care practice, medically unexplained symptoms were more frequent in patients who lived alone.14 In addition, the outpatients with medically unexplained symptoms had more than twice the rate of any current psychiatric disorder, compared to patients without medically unexplained symptoms.14

According to DSM-IV, a common characteristic of somatization or somatoform disorders is the occurrence of medically unexplained symptoms, i.e., physical complaints that cannot be explained by an organic disease or medication and that cause clinically relevant suffering and impairment.17 Lipowsky18 defined somatization as the tendency to experience and communicate psychological distress in the form of physical symptoms unaccounted for by medical findings, to attribute these symptoms to physical illness, and to seek medical help for these symptoms. According to the psychoanalytic paradigm of somatization, subjective body complaints can express conscious and unconscious psychic conflicts and problems or psychiatric disorders;11,14,19–21 they are a means of communication and may develop as a consequence of adverse childhood experiences.22

Measuring somatization presents some problems. Each case requires a careful differential evaluation of the etiology of the symptoms, and the relationship between the subjective physical complaints and the objective medical situation must be considered. This is a special challenge in situations where the likelihood of comorbidity is high, such as in the assessment of elderly patients and in the context of medical disease.23,24 Nevertheless, previous work has confirmed the validity and reliability of clinical diagnoses of somatoform disorders made on the basis of a comprehensive clinical workup, including semistructured interviews, physical examination, routine laboratory tests, radiologic examination, and careful evaluation of available records.25

The aim of this study was to identify predictors of subjective body complaints on the basis of research findings currently available. Subjective body complaints were examined in relation to sociodemographic variables, objective health measures, patients' subjective experience of age-related changes and life satisfaction, and clinicians' ratings of somatization and psychological impairment. We expected that the amount of subjective body complaints would more likely be predicted by subjective experience of age-related changes and life satisfaction and by psychological impairment than by objective medical findings.


  METHOD

 
TOP
 ABSTRACT
 INTRODUCTION
 METHOD
RESULTS
 DISCUSSION
 REFERENCES
 
Measures
Subjective body complaints were assessed with the short form of the Giessen Subjective Complaints List,16 which consists of 24 items representing complaints related to exhaustion, gastric symptoms, pain, cardiovascular complaints, and other symptoms. The level of impairment associated with the respective complaint is recorded on a 5-point scale ranging from none to extreme. The Giessen Subjective Complaints List was standardized in 1975 and again in 1994 by using samples representative of the population of Germany. The factor structure and the internal consistency of the subscales have largely remained constant. The sum of the scores for the 24 items represents the total score for body complaints. Age- and gender-specific norms for elderly persons were obtained in a sample of 764 elderly subjects aged >=60 years.9

The physical state of the study participants was measured with the following three somatic variables, which served as objective health measures: the number of medical ICD-10 diagnoses, the Objective Overall Health Burden (German: Objektiver Grad gesundheitlicher Belastung) score, and the Activities of Daily Living Scale score.

The Objective Overall Health Burden26 is a clinician-rated assessment of the degree of impairment caused by somatic illnesses. Because of the high level of comorbidity usually found in elderly patients, an assessment limited to ICD-10 diagnoses does not provide enough information about the severity of an elderly person's medical condition. The Objective Overall Health Burden provides an overall clinical rating of the severity of a patient's somatic condition on the basis of all available information, not only the content or number of diagnoses. The Objective Overall Health Burden is rated by two experienced clinicians, first independently on a 5-point scale ranging from 0, no health burden, to 4, extreme health burden, according to clinical examples; the independent ratings are followed by a consensus rating.26 Interrater reliability for the Objective Overall Health Burden was satisfactory (reliability coefficient=0.74).

The classic Activities of Daily Living Scale27 was used to measure functional impairment in daily life. This scale allows assessment of whether basic and instrumental daily activities (e.g., grooming, eating, etc.) are possible only with great difficulty or cannot be carried out independently. The maximum score of 46 points represents a condition needing intensive care. Since its publication in 1969, the original scale has been modified in a variety of ways, and many new scales for measuring functional impairment have been published;28 however, the newer scales have not proved to be superior to the original scale.29 The Activities of Daily Living Scale correlates significantly with other instruments measuring functional impairment, thus supporting the scale's validity.27,30 The test-retest reliability31 and interrater reliability of this instrument are good (0.85 to 1.00 for single items).27,31–33

Two self-assessment scales—the Nuremberg Self-Rating List and the Philadelphia Geriatric Center Morale Scale—were used to measure the participants' subjective experience of age-related changes and life satisfaction.

The Nuremberg Self-Rating List (German: Nürnberger Selbsteinschätzungsliste) records self-evaluated changes in the areas of general and social activities, cognitive performance, and state of health by means of 20 items.34 The items are process-oriented and represent a general factor of subjective change, which can be divided into three subfactors: vitality–capability, cognitive performance, and social contacts. The authors calculated the scale's internal consistency at 0.92; test-retest reliability was 0.87. The scale's validity was supported by correlation with other scales measuring performance and self-image.34

The Philadelphia Geriatric Center Morale Scale includes 17 items measuring actual life satisfaction by means of three subscales for inner peace, attitude toward aging, and satisfaction with relationships and looking back on life.35 The three subscales have been shown to have high degrees of internal consistency, with Cronbach's alphas ranging from 0.81 to 0.85. Test-retest reliability has ranged from 0.75 to 0.90. Validation or cross-validation was achieved by correlation with clinical rankings and psychologists' ratings on other instruments measuring life satisfaction.36–38

Psychological impairment was assessed through clinicians' rating by using the Impairment Score (German: Beeinträchtigungs-Schwere-Score).39 The instrument measures impairment caused by nonorganic ("psychogenic") illnesses on the three dimensions of physical, psychic, and social communicative impairment. Each of these dimensions is rated on a 5-point scale from 0, none, to 4, extreme. The sum of the scores constitutes the overall Impairment Score rating (range=0–12), with higher ratings corresponding to more severe impairment.

The Impairment Score physical subscale rating was used to measure psychogenic (nonorganic) physical complaints; it can be considered a measure of somatization. To rate the Impairment Score physical subscale, the rater carefully evaluated the relationship between the patient's subjective physical complaints and the objective medical situation. Only subjective somatic complaints that were judged to have no somatic explanation, i.e., did not fit the patient's medical diagnoses or were not judged to be drug effects, were included in the Impairment Score physical subscale rating. Thus this rating represented medically unexplained symptoms. The differential evaluation of the etiology of symptoms required for rating the Impairment Score called for careful clinical judgment in each case and included consideration of all available information from the extensive medical diagnostic services of the internal medicine hospital, checking for signs of various medical illnesses, and assessing the effects of various medications. The procedure is described in the Impairment Score manual.39 The characteristics of elderly subjects assessed with this procedure have been previously published.23,40

The Impairment Score was developed in an epidemiologic field study (the Mannheim study41) and has been applied in many research projects42–44 as well as in clinical routine in many hospitals in Germany. The instrument's reliability is good to excellent (0.72 to 0.90).41 The validity of the Impairment Score has been demonstrated in relation to the Goldberg-Cooper Interview (for diagnosis of neurotic disorders)45 and in relation to clinical psychiatric interviews.46 The instrument was adapted for use with patients aged 60 years and older.23 To determine the point prevalence, psychogenic impairment in the last 7 days was determined by two raters independently and then again in a consensus rating.

The Impairment Score interviews were performed by two physicians with psychiatric, psychotherapeutic, and geriatric experience. Consensus ratings for the Objective Overall Health Burden were carried out by these interviewers as well as by the chief physician of the geriatric hospital, who was trained in internal medicine, geriatrics, and psychotherapy. Consensus ratings of the Impairment Score were carried out by the physician who had interviewed the patient and, independently, by a second physician or a psychologist who listened to the entire tape-recorded interview and reviewed the available clinical information. In approximately 80% of the cases, the raters agreed on the overall Impairment Score rating. This proportion is in the range of interrater reliability reported previously for the Impairment Score.41 In cases of initial disagreement, agreement was achieved after further discussion.

If the Impairment Score interview revealed severe cognitive impairments or addiction to drugs or alcohol, the patient was excluded from the study. If the interview revealed signs of discrete cognitive impairment only, the patient was seen by a psychiatrist from the hospital's memory clinic, which specializes in the differential diagnosis of dementia/depressive pseudodementia. In case of doubt, the clinical psychiatric investigation was supplemented with administration of the Structured Interview for the Diagnosis of Dementia,47 and scales acknowledged to be useful in the diagnosis of dementia (Mini-Mental Status Examination,48,49 Syndrom-Kurztest,50 and Mehrfachwahl-Wortschatz-Intelligenztest51) were administered. It was thus possible to distinguish between dementia and depressive pseudodementia.52

Participants
The study design required a clear distinction between subjective physical complaints and objective medical findings, and therefore the study participants required a thorough medical examination. Inpatients aged 60 years and older who were consecutively admitted to a general medical hospital and who had given their consent were included in the study. Exclusion criteria were conditions implying cognitive impairment (dementia, psychosis), the appearance of doubtful credibility (for example, suggested by the presence of a substance addiction with manifest abuse), and physical conditions that made participation impossible (severe physical illness such as cardiac insufficiency with dyspnea at rest, malignant disorders not treated curatively). The last of these criteria was clarified by a medical examination, and the first two were assessed by means of a psychiatric interview. The investigation was carried out during the last part of inpatient treatment, when acute medical symptoms had for the most part subsided and discharge was being considered. We thus tried to measure not acute but lasting physical impairments and disabilities.

A total of 522 consecutively admitted patients met the inclusion criteria. Of these, 76 (14.6%) refused to participate. Of the 522 persons who met inclusion criteria, 184 were able to participate only in a restricted version of the investigation. The reasons for restricted participation in the 2-hour investigation were in most cases old age and functional impairment. The complete study design included 262 participants. Because of missing data, only 251 of these 262 participants were included in the final analysis. The data sets from these 251 participants constituted the results presented in this paper.

For control of sociodemographic and health-related bias, the gender distribution, age distribution, mean values for functional impairment (Activities of Daily Living Scale score), and psychogenic impairment (overall Impairment Score rating) were compared between the participants in the extended study, the participants in the restricted investigation, and, as far as data were available, the patients who refused to participate. No significant differences could be found between the subgroups in marital status, vocational training/education, or composition of the household.

The sociodemographic data for the participants are shown in Table 1.


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TABLE 1. Sociodemographic Characteristics of Cognitively Unimpaired General Hospital Inpatients Aged >=60 Years Who Participated in a Study of Subjective Body Complaints and Somatization



Data Analysis
For analysis of continuous variables, we used Student's t tests when comparing two groups (study participants versus nonparticipants) and one-way analysis of variance in combination with Scheffé tests for comparison of the three groups. In the analysis of categorical variables, we used chi-square tests. To evaluate linear connections between continuous variables, we used Pearson product-moment correlations. For the evaluation of the influence of different variables on the target variable of subjective body complaints, we used stepwise multiple regression analysis.


  RESULTS

 
TOP
 ABSTRACT
 INTRODUCTION
 METHOD
 RESULTS
DISCUSSION
 REFERENCES
 
No significant group differences in subjective body complaints were found between men and women, between age groups, between the education groups, and between the marital and household status groups.

The correlations between subjective body complaints and the continuous variables are presented in Table 2. There was no correlation between subjective body complaints and age, and the correlations with the objective health-related variables (Activities of Daily Living Scale score, Objective Overall Health Burden score, number of diagnoses) were not substantial. The highest correlations existed between subjective body complaints and the scores on the self-assessment scales of life satisfaction (Philadelphia Geriatric Center Morale Scale) and age-related changes (Nuremberg Self-Rating List) and also between subjective body complaints and scores on the measure of somatization (Impairment Score physical subscale rating). The direction of the associations could not be concluded from the correlations.


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TABLE 2. Pearson Product-Moment Correlation of Measures of Subjective Well-Being, Clinician-Rated Psychogenic Impairment, Objective Health Status, and Age in 251 Cognitively Unimpaired General Hospital Inpatients Aged >=60 Years



Stepwise multiple regression analysis was used to assess the predictive value of the variables with regard to the target variable of subjective body complaints. The tested models are shown in Table 3. When significance of the F values was restricted to 0.05 for inclusion and 0.10 for exclusion from the model, only three variables held significant predictive value for subjective body complaints (up to model 3): self-assessment of life satisfaction (Philadelphia Geriatric Center Morale Scale score), self-assessment of age-related changes (Nuremberg Self-Rating List score), and the clinicians' rating of somatization (Impairment Score physical subscale rating). Although high levels of life satisfaction showed a protective effect, high levels of age-related perceived changes and also high levels of somatization as rated by the clinician predicted higher levels of subjective body complaints. Stepwise inclusion of the variables of health burden (Objective Overall Health Burden score), psychogenic impairment (overall Impairment Score rating), number of medical diagnoses, age, and functional impairment (Activities of Daily Living Scale score) did not substantially increase the explained variance (R2=0.29, adjusted R2=0.26 after inclusion of all mentioned variables in the eighth step). However, the fraction of the variance explained by the models was not very high (R2=0.26 to 0.29).


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TABLE 3. Stepwise Regression Analysis of Predictors of Subjective Body Complaints in 251 Cognitively Unimpaired General Hospital Inpatients Aged >=60 Years




  DISCUSSION

 
TOP
 ABSTRACT
 INTRODUCTION
 METHOD
 RESULTS
 DISCUSSION
REFERENCES
 
The results should be interpreted in light of some study limitations. The subjects for this study consisted of inpatients in a general hospital with presumably lower levels of health and functioning than in the general population (negative selection). The participants in the extended assessment, whose results were presented in this paper, represented a positive selection within the group of all inpatients after application of the exclusion criteria of dementia, psychotic states, and very severe physical illness. The participants in the extended assessment were also younger and functionally less impaired than the participants in the shorter version of the study. Therefore, the results of this study may not apply to all elderly inpatients or to the elderly population as a whole, and generalizations from the results should be made with caution. In addition, because of the cross-sectional study design, it was possible to evaluate relationships but not causalities. It was not possible to decide whether subjective body complaints were the cause or the effect of the other measured variables.

Despite these limitations, the study found relationships between a small set of variables and subjective body complaints in older general hospital inpatients. Among 251 cognitively unimpaired elderly inpatients in a general hospital, the level of subjective body complaints showed no relation to gender, age, or marital or household status. The correlation between subjective body complaints and objective health-related variables was not substantial. The highest intercorrelation could be found between subjective body complaints and scores on the self-assessment scales measuring life satisfaction and age-related changes, as well as the clinician's rating of somatization (Impairment Score physical subscale rating). In a stepwise multiple regression analysis, only these three variables held significant predictive value for subjective body complaints.

Comparable results have been published by Hermann et al.,53 who found that patients with thoracic pain but normal vessels as shown by coronary arteriography reported more subjective body complaints after 2 years than patients in whom coronary heart disease had been proven by coronary arteriography. Personality traits proved to be the most important predictors of subjective heart complaints in this group.53 In another study, the subjective assessment of memory disturbances showed a strong correlation with depressive disorders but no correlation with objective cognitive impairment.54

We found no correlations between subjective body complaints and age or gender, although Gunzelmann et al.9 described such correlations for a representative sample of the German population aged >=60 years. These contradictory findings can be explained by the selection effects in our study group, which consisted of hospital inpatients. However, potential participants who were cognitively impaired or too ill to participate were excluded from the extended study. These exclusions may have resulted in a positive selection effect, especially in the higher age groups. We therefore do not recommend uncritical generalization of our results to the overall older population.

Marital status and household status also seemed to have no substantial influence on the subjective experienced body complaints, as was also demonstrated in the general population study by Gunzelmann et al.9 and in a study by Hessel et al.55 In contrast, outpatients in an urban primary care practice who were living alone demonstrated medically unexplained symptoms more frequently than those who were not living alone.14

The strongest correlations in our study were those of subjective body complaints with subjective well-being and with the clinician's rating of somatization. These variables also held the highest predictive value for subjective body complaints in the multiple regression analysis. However, the low proportion of the variance in subjective body complaints that was explained by the variables indicates that other factors influencing somatization may not have been considered in our study. These factors may include personality traits, biographical experiences, or coping styles.56 Our results confirm those of other studies that have shown a correlation between subjective body complaints, subjective well-being, depressive mood, and psychiatric disorders.9,14

These results suggest that in elderly inpatients the level of subjective body complaints is determined by subjective well-being rather than by objective health measures, and thus subjective body complaints may be an indicator of somatization in elderly inpatients. The results suggest that implementation of a psychosomatic consultation service in the general hospital, which would include complex care integrating both medical and psychosomatic services, could prove to be beneficial.57–60 Such services, once implemented, would then have to be evaluated for their efficacy.

This study was supported by grants He 1898/2-1 and He 1898/2-2 from the German Research Association (Deutsche Forschungsgemeinschaft).


  REFERENCES

 
TOP
 ABSTRACT
 INTRODUCTION
 METHOD
 RESULTS
 DISCUSSION
 REFERENCES
 

  1. Heuft G: Persönlichkeitsentwicklung im Alter—ein psychoanalytisches Entwicklungs—paradigma. Z Gerontol Geriatr 1994; 27:116-121
  2. Heuft G, Kruse A, Radebold H: Lehrbuch der Gerontopsychosomatik und Alterspsychotherapie. Munich, Ernst Reinhardt, 2000
  3. Kipp J: Hysterische Symptome und der Körper im Alter. Z Psychosom Med Psychother 2001; 47:167-178[Medline]
  4. Steinhagen-Thiessen E, Borchelt M: Morbidität, Medikation und Funktionalität im Alter, in Die Berliner Altersstudie. Edited by Mayer KU, Baltes PB. Berlin, Akademie-Verlag, 1996, pp 151-183
  5. Harwood RH, Pince MJ, Mann AH, Ebrahim S: The prevalence of diagnoses, impairments, disabilities, and handicaps in a population of elderly people living in a defined geographical area: the Gospel Oak Project. Age Ageing 1998; 27:707-714[Abstract/Free Full Text]
  6. Smith J, Baltes PB: Profiles of functioning in the old and oldest old. Psychol Aging 1997; 12:458-472[CrossRef][Medline]
  7. Staudinger UM, Freund A, Linden M, Maas I: Self, personality, and life regulation: facets of psychological resilience in old age, in The Berlin Aging Study: Aging From 70 to 100. Edited by Baltes PB, Mayer KU. New York, Cambridge University Press, 1999, pp 302-328
  8. Borchelt M, Gilberg R, Horgas AL, Geiselmann B: On the significance of morbidity and disability in old age, in The Berlin Aging Study: Aging From 70 to 100. Edited by Baltes PB, Mayer KU. New York, Cambridge University Press, 1999, pp 450-474
  9. Gunzelmann T, Schumacher J, Brähler E: Körperbeschwerden im Alter: Standardisierung des Giessener Beschwerdebogens GBB-24 bei über 60 jährigen. Z Gerontol Geriatr 1996; 29:110-118[Medline]
  10. Hollifield M, Paine S, Tuttle L, Kellner R: Hypochondriasis, somatization, and perceived health and utilization of health care services. Psychosomatics 1999; 40:380-386[Abstract/Free Full Text]
  11. Fink P, Sørensen L, Engberg M, Holm M, Munk-Jørgensen P: Somatization in primary care: prevalence, health care utilization, and general practitioner recognition. Psychosomatics 1999; 40:330-338[Abstract/Free Full Text]
  12. Jyvasjarvi S, Youkamaa M, Vaisanen E, Larvaara P, Kivela S, Keinaanen-Kiukaanniemi S: Somatizing frequent attenders in primary health care. J Psychosom Res 2001; 50:185-192[CrossRef][Medline]
  13. Vedsted P, Fink P, Olesen F, Munk-Jørgensen P: Psychological distress as a predictor of frequent attendance in family practice: a cohort study. Psychosomatics 2001; 42:416-422[Abstract/Free Full Text]
  14. Feder A, Olfson M, Gameroff M, Fuentes M, Shea S, Lantigua R, Weissmann MM: Medically unexplained symptoms in an urban general medicine practice. Psychosomatics 2001; 42:261-268[Abstract/Free Full Text]
  15. Smith GC, Clarke DM, Handrinos D, Dunsis A, McKenzie DP: Consultation-liaison psychiatrists' management of somatoform disorders. Psychosomatics 2000; 41:481-489[Abstract/Free Full Text]
  16. Brähler E, Scheer J: Der Gießener Beschwerdebogen (GBB): Handbuch. Bern, Switzerland, Hans Huber, 1983
  17. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC, APA, 1994, p 445
  18. Lipowsky ZJ: Somatization: the concept and its clinical application. Am J Psychiatry 1988; 145:1358-1368[Abstract/Free Full Text]
  19. Sheehan B, Banerjee S: Review: somatization in the elderly. Int J Geriatr Psychiatry 1999; 14:1044-1049[CrossRef][Medline]
  20. Carbone LA, Barsky AJ, Orav J, Fife A, Fricchione GL, Minden SL, Borus JF: Psychiatric symptoms and medical utilization in primary care patients. Psychosomatics 2000; 41:512-518[Abstract/Free Full Text]
  21. Küchenhoff J: Perspektiven der psychoanalytischen Psychosomatik. Z Psychosom Med Psychother 2001; 47:396-410[CrossRef][Medline]
  22. Stuart S, Noyes R: Attachment and interpersonal communication in somatization. Psychosomatics 1999; 40:34-43[Abstract/Free Full Text]
  23. Schneider G, Heuft G, Senf W, Schepank H: Die Adaptation des Beeinträchtigungs-Schwere-Score (BSS) für die Gerontopsychosomatik und Alterspsychotherapie. Z Psychosom Med Psychother 1997; 43:261-279
  24. Fava GA, Mangelli L, Ruini C: Assessment of psychological distress in the setting of medical disease. Psychother Psychosom 2001; 70:171-175[CrossRef][Medline]
  25. Schuepbach WMM, Adler RH, Sabioni MEE: Accuracy of clinical diagnosis of "psychogenic disorders" in the presence of physical symptoms suggesting a general medical condition: a 5-year follow-up in 162 patients. Psychother Psychosom 2002; 71:11-17[CrossRef][Medline]
  26. Schneider G, Nehen HG, Heuft G: Der Grad Objektiver Gesundheitlicher Belastung (OGB)—ein Expertenrating zur diagnoseü bergreifenden Schweregradeinschätzung somatischer Erkrankungen in der Geriatrie. Z Gerontol Geriatr 1999; 32:231-238[CrossRef][Medline]
  27. Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9:179-186[Medline]
  28. Chong KHD: Measurement of instrumental activities of daily living in stroke. Stroke 1995; 26:1119-1122[Abstract/Free Full Text]
  29. Feinstein AR, Josephy BR, Wells CK: Scientific and clinical problems in indexes of functional disability. Ann Intern Med 1986; 105:413-420
  30. Nikolaus T, Bach M, Oster P, Schlierf G: Prospective value of self-report and performance-based tests of functional status for 18-month outcomes in elderly patients. Aging 1996; 8:271-276[Medline]
  31. Green CR, Mohs RC, Schmeidler J, Aryan M, Davis KL: Functional decline in Alzheimer's disease: a longitudinal study. J Am Geriatr Soc 1993; 41:654-661[Medline]
  32. Edwards M, Feightner J, Goldsmith CH: Inter-rater reliability of assessments administered by individuals with and without a background in health care. Occupational Therapy J Res 1995; 15:103-110
  33. Hokoishi K, Ikeda M, Maki N, Nomura M, Torikawa S, Fujimoto N, Fukuhara R, Komori K, Tanabe H: Interrater reliability of the Physical Self-Maintenance Scale and the Instrumental Activities of Daily Living Scale in a variety of health professional representatives. Aging Ment Health 2001; 5:38-40[CrossRef][Medline]
  34. Oswald WD, Fleischmann UM: Nürnberger-Selbsteinschätzungs-Liste NSL, in Nürnberger-Alters-Inventar (NAI). Göttingen, Germany, Hogrefe, 1995, pp 266-276
  35. Lawton MP: The Philadelphia Geriatric Center Morale Scale: a revision. J Gerontol 1975; 30:85-89
  36. Granick S: Morale measures as related to personality, cognitive and medical functioning of the aged, in Proceedings of the 1973 Annual Convention of the American Psychological Association. Washington, DC, American Psychological Association, 1973, pp 785-786
  37. Lawton MP: The dimensions of morale, in Research Planning and Action for the Elderly. Edited by Kent D, Kastenbaum R, Sherwood S. New York, Behavioral Publications, 1976, pp 144-165
  38. Lohmann N: Correlations of life satisfaction, morale, and adjustment measures. J Gerontol 1977; 32:73-75
  39. Schepank H: Der Beeinträchtigungs-Schwere-Score (BSS): Ein Instrument zur Bestimmung der Schwere einer psychogenen Erkrankung. Göttingen, Germany, Beltz Test, 1995
  40. Schneider G, Kruse A, Nehen HG, Senf W, Heuft G: The prevalence and diagnostics of subclinical depressive syndromes in inpatients 60 years and older. Psychother Psychosom 2000; 69:251-260[CrossRef][Medline]
  41. Schepank H: Epidemiology of Psychogenic Disorders: The Mannheim Study: Results of a Field Study in the Federal Republic of Germany. Berlin, Springer, 1987
  42. Schepank H: Verläufe: Seelische Gesundheit und psychogene Erkrankungen heute. Berlin, Springer, 1990
  43. Franz M, Lieberz K, Schmitz N, Schepank H: A decade of spontaneous long-term cause of psychogenic impairment in a community population sample. Soc Psychiatry Psychiatr Epidemiol 1999; 34:651-656[CrossRef][Medline]
  44. Junkert-Tress B, Schnierda U, Hartkamp N, Schmitz N, Tress W: Effects of short-term dynamic psychotherapy for neurotic, somatoform, and personality disorders: a prospective 1-year follow-up study. Psychother Res 2001; 11:187-200[CrossRef]
  45. Goldberg DP, Cooper B, Eastwood MR, Kedward HB, Sheperd M: A standardized psychiatric interview for use in community surveys. Br J Prev Soc Med 1970; 24:812-835
  46. Manz R: Gütekriterien der Instrumente zur Fallidentifikation, in Psychogene Erkrankungen der Stadtbevölkerung: Eine epidemiologisch-tiefenpsychologische Feldstudie in Mannheim. Edited by Schepank H. Berlin, Springer, 1987, pp 235-238
  47. Zaudig M, Hiller W: SIDAM: Handbuch. Bern, Switzerland, Huber, 1995
  48. Folstein MF, Folstein SE, McHugh PR: "Mini-Mental State": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189-198[CrossRef][Medline]
  49. Alpert JE, Uebelacker LA, McLean N, Abraham M, Rosenbaum H, Fava M: The Mini-Mental State Examination among adult outpatients with major depressive disorder. Psychother Psychosom 1995; 63:207-211[CrossRef][Medline]
  50. Erzigkeit H: The SKT: a short cognitive performance test as an instrument for the assessment of clinical efficacy of cognitive enhancers, in Diagnosis and Treatment of Senile Dementia. Edited by Bergener W, Reisberg B. Heidelberg, Springer-Verlag, 1989, pp 164-174
  51. Lehrl S: Mehrfachwahl-Wortschatz-Intelligenztest (MWT-B). Erlangen, Perimed, 1977
  52. Foy JM, Starr JM: Assessment and treatment of dementia in medical patients. Psychother Psychosom 2000; 69:59-69[CrossRef][Medline]
  53. Hermann C, Buss U, Lingen R, Kreuzer H: Persönlichkeitsfaktoren und Beschwerdepersistenz bei Patienten mit thorakalen Beschwerden und angiographisch freien Koronarien. Z Psychosom Med Psychother 1998; 44:37-53
  54. Riedel-Heller SG, Schork A, Matschinger H, Angermeier MC: Subjektive Gedächtnisstörungen—ein Zeichen für kognitive Beeinträchtigung im Alter? ein Überblick zum Stand der Forschung. Z Gerontol Geriatr 2000; 33:9-16[CrossRef][Medline]
  55. Hessel A, Geyer M, Plottner G, Schmidt B, Brähler E: Subjektive Einschätzung eigener Gesundheit und subjektive Morbidität in Deutschland. Psychother Psychosom Med Psychol 1999; 49:264-274[Medline]
  56. Doering S, Mumelter C, Bonatti J, Oturanlar D, Gaggl S, Pachinger O, Müller L, Schüßler G: Zur Variabilität des Coping bei Patienten mit aortokoronarer Bypass-Operation. Z Psychosom Med Psychother 2001; 47:262-276[Medline]
  57. Kishi Y, Kathol RG: Integrating medical and psychiatric treatment in an inpatient medical setting: the type IV program. Psychosomatics 1999; 40:345-355[Abstract/Free Full Text]
  58. Diefenbacher A: Implementation of a psychiatric consultation service: a single-site observational study over a 1-year period. Psychosomatics 2001; 42:404-410[Abstract/Free Full Text]
  59. de Jonge P, Huyse FJ, Slaets JPJ, Herzog T, Lobo A, Lyons JS, Opmeer BC, Stein B, Arolt V, Balogh N, Cardoso G, Fink P, Rigatelli M, van Djick R, Mellenbergh GJ: Care complexity in the general hospital: results from a European study. Psychosomatics 2001; 42:204-212[Abstract/Free Full Text]
  60. de Jonge P, Huyse FJ, Herzog T, Lobo A, Slaets JPJ, Lyons JS, Opmeer BC, Stein B, Arolt V, Balogh N, Cardoso G, Fink P, Rigatelli M: Risk factors for complex care needs in general medical inpatients: results from a European study. Psychosomatics 2001; 42:213-221[Abstract/Free Full Text]




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