Page 17 - JCBP-2-2

Journal of Clinical and
Basic Psychosomatics Allostatic overload in the medically ill

which allow to formulate the diagnosis of current mental 79 items with a yes/no answer format. This tool assesses
disorders (i.e., major depressive episode/disorder, suicidal 14 psychosomatic syndromes (i.e., AO, health anxiety,
behavioral disorder, bipolar disorder, panic disorder, disease phobia, hypochondriasis, thanatophobia, illness
agoraphobia, social anxiety disorder, generalized anxiety denial, persistent somatization, conversion symptoms,
disorder, obsessive-compulsive disorder, post-traumatic anniversary reaction, somatic symptoms secondary to
stress disorder, alcohol/substance use disorder, psychotic a psychiatric disorder, demoralization, irritable mood,
disorder, anorexia/bulimia nervosa, eating disorder, type A behavior, and alexithymia) through four diagnostic
and antisocial personality disorder) and past/lifetime modules (i.e., stress, illness behavior, psychological
mental disorders (i.e., past/recurrent major depressive manifestation, and personality). The DCPR-R-SSI has
episode/disorder, past bipolar disorder, lifetime suicidal shown good incremental validity over DSM-5. 29
behavioral disorder, panic disorder, and psychotic
disorder). Each module has a diagnostic box at the end in 2.3. Statistical analyses
which the interviewer can flag whether the mental disorder The Kolmogorov–Smirnov test and the Levene’s test
investigated in the module can be diagnosed; thus, at the were used to evaluate normality and heterogeneity of
end of the interview, the interviewer will have a list of continuous variables, respectively. Comparisons of
30
mental disorder diagnosed. The MINI showed a moderate- normally distributed variables between subjects with or
almost perfect concordance with experts’ diagnoses and without DCPR-R AO were conducted using the t-test for
other diagnostic tools and substantial almost-perfect independent samples. Comparisons between subjects with
inter-rater agreement. 22,24 For the present study, the MINI or without DCPR-R AO regarding categorical variables were
7.0, which allows to formulate diagnoses according to the run via the Chi-square test or Fisher’s test when more than
DSM-5, was used. 20% of cells had expected frequencies of <5 and Z statistic.
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The Structured Clinical Interview for DSM-5 Disorders, Cramer’s V was calculated to estimate the magnitude of
Clinical Version (SCID-5-CV), was used among subjects association between categorical variables for a contingency
23
31,32
with migraine. The SCID-5-CV is a semi-structured table larger than 2 × 2. Phi coefficient and odds ratios
interview guiding the clinician step-by-step through the were calculated to estimate the magnitude of association
31,32
DSM-5 diagnostic process. Interview questions are provided between categorical variables in 2 × 2 contingency tables.
conveniently along each corresponding DSM-5 criterion, Age was treated as covariate variable.
which aids in rating each as either present or absent. The DSM-5 and DCPR-R diagnoses were grouped not
SCID-5-CV is an abridged and reformatted version of the to have frequencies <5% in contingency tables. DSM-5
Research Version of the SCID, the structured diagnostic social anxiety disorder, generalized anxiety disorder,
interview most widely used by researchers for making DSM obsessive-compulsive disorder, and post-traumatic stress
diagnoses for the past 30 years. The SCID-5-CV covers the disorder now belong to “other DSM-5 diagnoses,” whereas
DSM-5 diagnoses most commonly seen in clinical settings: DCPR-R health anxiety, disease phobia, hypochondriasis,
depressive and bipolar disorders; schizophrenia spectrum thanatophobia, illness denial, persistent somatization,
and other psychotic disorders; substance use disorders; conversion symptoms, and anniversary reaction are now
anxiety disorders (panic disorder, agoraphobia, social anxiety under “DCPR-Rillness behavior”. DCPR-R secondary
10
disorder, and generalized anxiety disorder); obsessive- somatic symptoms and irritable mood belong to “DCPR-R
compulsive disorder; posttraumatic stress disorder; psychological manifestations”. DCPR-R demoralization
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attention-deficit/hyperactivity disorder; and adjustment with hopelessness was subsumed under “DCPR-R
disorder. It also screens for 17 additional DSM-5 disorders. demoralization,” with hopelessness being the only specifier
Each module follows the DSM diagnostic algorithm and of the diagnosis. Due to the high number of comparisons,
10
end with a diagnostic box in which the interviewer can flag Bonferroni post hoc correction was applied. 33
whether the mental disorder investigated in the module can Binary regression analyses were performed to define
be diagnosed. Once again, at the end of the interview, the the model of the multiple logistic regression. Subjects’
interviewer will have a list of mental disorder diagnosed. status (i.e., with vs. without DCPR-R AO) was used as
The SCID-5 has shown high reliability, good test–retest reference variable. Sociodemographic variables and
validity, good sensitivity, excellent reliability, and high DSM-5 or DCPR-R diagnoses were used as independent
27
26
specificity. 28 variables (data not shown). Only variables surviving
The DCPR-R-SSI is a tool used for facilitating diagnosis the Bonferroni correction were included in the binary
10
of psychosomatic syndromes according to the DCPR-R. regression analyses as independent variables. Thereafter,
10
It focuses on signs and symptoms occurring in the 6- to a multiple logistic regression analysis was conducted.
12-month period leading up to the interview and contains In this analysis, subjects’ status was set as the reference,

Volume 2 Issue 2 (2024) 3 https://doi.org/10.36922/jcbp.2758