Hospitalized Patients with Medically Unexplained Physical Symptoms: Clinical Context and Economic Costs of Healthcare Management
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Socio-Demographics and Clinics
3.2. Evolution of the Diagnostic Criteria from Somatoform Disorder (DSM-IV-TR) to SSD (DSM-5)
3.3. Psychopathological Correlates of SSD Diagnosis
3.4. Healthcare Management Costs
4. Discussion
Author Contributions
Funding
Conflicts of Interest
References
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Male | Female | |||
---|---|---|---|---|
Age (years ± SD) | 47 ± 17.0 | 44 ± 15.9 | ||
Number | % (of 82) | Number | % (of 191) | |
Gender | 82 | 30 | 191 | 70 |
Marital status | ||||
Married | 31 | 37.8 | 75 | 39.3 |
Single | 17 | 20.7 | 47 | 24.6 |
Divorced | 3 | 3.7 | 20 | 10.5 |
Widowed | 1 | 1.2 | 8 | 4.1 |
Not available | 26 | 31.7 | 45 | 23.5 |
Occupation | ||||
Salaried | 29 | 35.3 | 78 | 40.8 |
Retired | 25 | 30.5 | 16 | 8.4 |
Housewife | 0 | 0.0 | 31 | 16.2 |
Unemployed | 10 | 12.2 | 11 | 5.6 |
Student | 4 | 4.9 | 7 | 3.9 |
Invalid | 1 | 1.2 | 6 | 3.2 |
Not available | 15 | 18.3 | 40 | 20.9 |
Ward | Patients (N) | Hospitalizations (N) | Male/Female ratio | Age (Mean) Range | Prevalence |
---|---|---|---|---|---|
Medical Wards | 18–86 | ||||
Neurology | 125 | 144 | 1/3 | 44.0 | 3.87% |
Internal Medicine | 60 | 61 | 1/5 | 49.0 | - |
Short Unit Stay | 51 | 53 | 2/3 | 49.0 | 0.98% |
Infectious Disease | 7 | 7 | 2/5 | 50.0 | - |
Surgical Wards | 19–71 | ||||
Emergency Surgery | 10 | 10 | 1/1 | 42.1 | 0.96% |
Orthopedics | 2 | 2 | 1/0 | 36.5 | 0.02% |
Psychiatry | 12 | 14 | 3/10 | 49.5 22–67 | 0.42% - |
Audiovestibology | 14 | 15 | 2/3 | 43.5 18–60 | 1.51% |
(1) Previous Diagnosis | |||
---|---|---|---|
-Anxiety Disorder | Male | 13 | 25.5% |
Female | 38 | 74.5% | |
-Depressive Disorder | Male | 3 | 17.6% |
Female | 14 | 82.4% | |
-Substance Abuse | Male | 3 | 100.0% |
Female | 0 | 0.0% | |
-Somatoform Disorder | Male | 2 | 70.0% |
Female | 1 | 30.0% | |
-Personality Disorder | Male | 0 | 0.0% |
Female | 2 | 100.0% | |
-Comorbidity | |||
AD1; PD2; SFD3 | Male | 0 | 0.0% |
Female | 3 | 100.0% | |
AD1; SFD3 | Male | 0 | 0.0% |
Female | 2 | 100.0% | |
ED4; PD2; SFD3; AD1 | Male | 1 | 100.0% |
Female | 0 | 0.0% | |
AD1; DD6; SFD3 | Male | 0 | 0.0% |
Female | 1 | 100.0% | |
PD2; SFD3 | Male | 0 | 0.0% |
Female | 1 | 100.0% | |
ED4, SFD3, AD1, SA4 | Male | 0 | 0.0% |
Female | 1 | 100.0% | |
ED4; AD1; SFD3 | Male | 0 | 0.0% |
Female | 1 | 100.0% | |
ED4; PD2; SFD3; AD1 | Male | 0 | 0.0% |
Female | 1 | 100.0% | |
Others | Male | 1 | 9.1% |
Female | 10 | 90.9% | |
-Other | |||
Post-Traumatic Stress Disorder | Male | 0 | 0.0% |
Female | 2 | 100.0% | |
Parasuicide | Male | 0 | 0.0% |
Female | 1 | 100.0% | |
(2) Discharge diagnosis | |||
-Depressive Disorder | Male | 9 | 53.0% |
Female | 8 | 47.0% | |
-Anxiety Disorder | Male | 3 | 18.8% |
Female | 13 | 81.2% | |
-Somatoform Disorder | Male | 2 | 28.5% |
Female | 5 | 71.5% | |
-Substance Abuse | Male | 0 | 0.0% |
Female | 2 | 100.0% | |
-Personality Disorder | Male | 1 | 50.0% |
Female | 1 | 50.0% | |
-Comorbidity | |||
AD1; SFD3 | Male | 1 | 100% |
Female | 0 | 0.0% | |
DD6; SFD3 | Male | 0 | 0.0% |
Female | 1 | 100.0% | |
(3) No diagnosis | |||
Male | 43 | 34.1% | |
Female | 83 | 65.8% |
Hospital Ward | Symptoms |
---|---|
Short Stay Unit | Syncope (N = 13); Pain (N = 16); Paraesthesia (N = 5); Headache (N = 9); Vertigo (N = 4); Motor deficit (N = 2); Neurological dysfunction (N = 1); Postural instability + Loss of consciousness (N = 1); Fainting (N = 1); Aphasia (N = 1); Headache + Paraesthesia (N = 1) |
Neurology | Headache (N = 50); Paraesthesia (N = 19); Pain (N = 8); Neurological dysfunction (N = 14); Motor deficit (N = 9); Loss of consciousness (N = 4); Motor deficit + Paraesthesia (N = 2); Headache + Vertigo (N = 3); Fainting (N = 2); Headache + Paraesthesia (N = 4); Vertigo (N = 2); Aphasia (N = 1); Headache + Pain (N = 1); Headache + Motor deficit (N = 1); Headache + Fainting (N = 1); Dysphagia (N = 1); Fibromyalgia (N = 1)Postural instability (N = 1); Hypochondria (N = 1); General malaise (N = 1); Blurring (N = 1); Paresis (N = 1); Loss of consciousness + Pain + Paraesthesia (N = 1) |
Infectious Disease | Pain (N = 4); Urinary disorders (N = 1); Enteritis (N = 1); Fever (N = 1) |
Internal Medicine | Pain (N = 9); Syncope (N = 5); Headache (N = 5) Fainting (N = 3); Paraesthesia (N = 3); Vertigo (N = 3); Fever (N = 3); Vomit (N = 2); Absence (N = 2); Dyspnoea (N = 2); Asthenia (N = 2); Asthenia + Vertigo + Fainting (N = 1); Pain + Impotence (N = 1); Weight loss + Night sweats (N = 1); Headache + Pain (N = 1); Haemorrhage (N = 1); Headache + Aphasia (N = 1); Fainting + Paraesthesia (N = 1); Pain + Nausea (N = 1); Fainting + hypokalaemia (N = 1); Vertigo + Nausea (N = 1); Pain + Nausea (N = 1); Chest tightness (N = 1); Pain + Nausea + Haemorrhage (N = 1); Weight loss (N = 1); Blood pressure increase + Palpitation (N = 1); Dysphagia (N = 1); Syncope + Headache (N = 1); Drowsiness (N = 1); Agitation (N = 1); Tremor (N = 1); Vertigo + Malaise (N = 1); |
Emergency Surgery | Pain (N = 8); Pain + Fever (N = 1); Headache + Paraesthesia (N = 1) |
Orthopedics | Pain (N = 2) |
Psychiatry | Agitation (N = 5); Anxiety (N = 4); Syncope (N = 2); Paraesthesia (N = 1); General malaise (N = 1); Cognitive impairment (N = 1) |
Audiovestibology | Hypoacusis (N = 6); Vertigo (N = 5); Vertigo + Pain (N = 1); Chronic Dizziness (N = 1); Postural instability (N = 1); Fainting (N = 1); Fainting + Vertigo (N = 1); |
OR | CI for OR | SE1 | Wald χ2 (df = 1) | |
---|---|---|---|---|
MEDICAL DISEASE 2 | ||||
Fibromyalgia | 0.39 | [0.05, 3.35] | 1.09 | 0.72 |
Previous medical history | 1.20 | [0.52, 2.79] | 0.42 | 0.18 |
Neurological disorders | 0.34 | [0.13, 0.90] | 0.50 | 4.75* |
Neoplasms | 1.04 | [0.26, 4.13] | 0.70 | 0.00 |
Metabolic disorders | 2.11 | [0.76, 5.91] | 0.52 | 2.05 |
Autoimmune diseases | 0.70 | [0.16, 3.06] | 0.75 | 0.22 |
Endocrine diseases | 2.41 | [0.62, 9.31] | 0.69 | 1.63 |
Infectious diseases | 1.83 | [0.41, 8.13] | 0.76 | 0.63 |
Medical diseases | 2.10 | [0.86, 5.13] | 0.46 | 2.64 |
Surgical diseases | 0.41 | [0.14, 1.21] | 0.55 | 2.62 |
Accident | 1.44 | [0.42, 4.88] | 0.62 | 0.34 |
PSYCHIATRIC DISEASE 3 | ||||
Depressive Disorder | 1.54 | [0.40, 5.95] | 0.69 | 0.39 |
Anxiety Disorder | 2.43 | [0.94, 6.26] | 0.48 | 3.39 |
Personality Disorder | 16.18 * | [2.42, 108.03] | 0.97 | 8.26 * |
MUPS | Overall | % | |||||
---|---|---|---|---|---|---|---|
Ward | Hosp | ALOH (days) | Total | Each | Exams | Total | MUPS/ Overall |
Neurology | 144 | 9 | 328,192.09 | 2,263.4 | 71,441.89 | 17,474,510 | 1.9% |
Internal Medicine | 61 | 8 | 147,976.16 | 2425.8 | 13,704 | 43,509,770 | 0.3% |
Short Stay Unit | 53 | 4 | 71,853.8 | 1335.72 | 10,383.95 | 6,529,696 | 1.1% |
Infectious Disease | 7 | 8 | 13,482.65 | 1926.1 | 9782.80 | 31,259,630 | 0.04% |
Emergency Surgery | 10 | 5 | 12,393.54 | 1652.47 | 2375.58 | 12,403,892 | 0.09% |
Orthopedics | 2 | 3 | 2101.6 | 1050.82 | 791.86 | 76,801,450 | 0.002% |
Psychiatry | 14 | 8 | 34,129.61 | 2437.83 | 5541.03 | 11,539,717 | 0.3% |
Audiovestibology | 15 | 7 | 9965.88 | 664.72 | 5905.23 | 6,648,790 | 0.1% |
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Poloni, N.; Caselli, I.; Ielmini, M.; Mattia, M.; De Leo, A.; Di Sarno, M.; Isella, C.; Bellini, A.; Callegari, C. Hospitalized Patients with Medically Unexplained Physical Symptoms: Clinical Context and Economic Costs of Healthcare Management. Behav. Sci. 2019, 9, 80. https://doi.org/10.3390/bs9070080
Poloni N, Caselli I, Ielmini M, Mattia M, De Leo A, Di Sarno M, Isella C, Bellini A, Callegari C. Hospitalized Patients with Medically Unexplained Physical Symptoms: Clinical Context and Economic Costs of Healthcare Management. Behavioral Sciences. 2019; 9(7):80. https://doi.org/10.3390/bs9070080
Chicago/Turabian StylePoloni, Nicola, Ivano Caselli, Marta Ielmini, Michele Mattia, Alessandra De Leo, Marco Di Sarno, Celeste Isella, Alessandro Bellini, and Camilla Callegari. 2019. "Hospitalized Patients with Medically Unexplained Physical Symptoms: Clinical Context and Economic Costs of Healthcare Management" Behavioral Sciences 9, no. 7: 80. https://doi.org/10.3390/bs9070080
APA StylePoloni, N., Caselli, I., Ielmini, M., Mattia, M., De Leo, A., Di Sarno, M., Isella, C., Bellini, A., & Callegari, C. (2019). Hospitalized Patients with Medically Unexplained Physical Symptoms: Clinical Context and Economic Costs of Healthcare Management. Behavioral Sciences, 9(7), 80. https://doi.org/10.3390/bs9070080