Posts Tagged ‘Kroenke’

Psychosocial Context (1)

Saturday, September 11th, 2010

The health care system has a strong bias toward viewing people as purely biological organisms.  This approach ignores two critical facts:


Screening Questionnaire for Hidden Stress

Thursday, July 1st, 2010

One of the most frequent requests I receive is for a way to screen for the presence of hidden stresses.  Most of those who inquire are interested in administering a questionnaire to patients/clients as they wait to see their clinician.  No suitably brief, scientifically validated questionnaire exists that covers the full range of hidden stresses but I have created a reasonable question set and added it to the Book Overview section of this site.


Stress Illness Screening (2)

Wednesday, May 12th, 2010

In the last post we saw four questions (PHQ – 4) that screen for anxiety and depression.  These are described in the reference below (1).  However, to document that screening questions achieve their intended goals and are scientifically valid, it is not enough merely to come up with what sound like reasonable questions.


Stress Illness Screening (1)

Friday, May 7th, 2010

One of the most frequent questions I get after my talks to medical clinicians is about rapid ways to screen for sources of stress.  A validated questionnaire that revealed stress issues prior to the patient being seen would, theoretically, enable more accurate diagnosis in less time.


1. Medically Unexplained Symptoms in DSM-5

Monday, February 22nd, 2010

The Bible of mental health diagnosis has a glaring omission (1).  The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, used worldwide as a reference for classifying and defining mental health disorders, was first published in 1952, listing 106 disorders in 130 pages.  The last major revision was released in 1994 (297 disorders, 886 pages), followed by a “text revision” in 2000 (365 disorders, 943 pages).  None of these volumes has a diagnostic term appropriate for more than a tiny fraction of Stress Illness patients.  (Stress Illness is my term for physical symptoms not fully explained by diagnostic tests that improve when psychosocial stresses are treated.)


Smith and Dwamena (1)

Thursday, January 21st, 2010

We have seen that diagnosis and treatment of medically unexplained symptoms (MUS) in a primary care clinic is completely inadequate (see the posts tagged Kroenke and Blindspot).  Smith and Dwamena (1) agree.  They point out that MUS patients comprise half or more of all outpatients and often are subjected to the risk and cost of  “ill-advised lab testing and trial treatments” and seldom receive adequate treatment in primary care.  (If the same could be said of, say, diabetes, there would be an international uproar and diabetes isn’t half as common as MUS.)


Kroenke & Mangelsdorff (2)

Friday, January 8th, 2010

To continue discussion of the Kroenke & Mangelsdorff research*, let’s begin by looking at what  became of all 567 symptoms (in 380 patients).  For 2/3 of the symptoms, doctors did diagnostic testing or referred to a specialist.  In the other 1/3, no evaluation was done beyond the initial visit.  Treatment was recommended for only 55% of symptoms, and this took the form of a prescription in over ¾ of cases.  There was nothing to suggest that anyone searched for hidden stresses linked to the symptoms (posts tagged with “Stress History” explain how this is done).


Kroenke & Mangelsdorff (1)

Thursday, January 7th, 2010

Last year marked the 20th anniversary of one of the most frequently quoted studies in the stress illness literature.  The paper reports a discovery that would have shocked me if I had read it during my training years.  Their finding has profound implications for primary care practice.


Mental Health Professionals and Physicians (Letter)

Friday, December 4th, 2009

Building referral pathways from medical to mental health professionals will be a key part of relieving stress illness.  Here is an example of a letter written by a mental health professional  to a medical clinician offering ideas that could help.  (The references below will be discussed in more detail in a future post.)