Autori: Yuri Battaglia (1), Elena Martino (2), Giulia Piazza (2), Elena Cojocaru (1), Sara Massarenti (2), Luana Peron (3), Alda Storari (1), Luigi Grassi (2,3)
Affiliazioni: (1) Nephrology Unit, St. Anna University Hospital, Ferrara; (2) Institute of Psychiatry, S. Anna University, Ferrara; (3) University Hospital Psychiatry Unit, S. Anna University, Ferrara
Background: Data have shown a 20-75% prevalence of psychiatric comorbidity in kidney transplant recipients(KTRs), while a higher prevalence of other psychosocial disorders was found in medically ill patients by using the Diagnostic Criteria for Psychosomatic Research(DCPR).
Aims: To expand the range of information for sub-typing medical patients, identifying sub-threshold or ICD undetected syndromes, by using the DCPR.
Methods: A consecutive sample of 134 patients were individually administered the DCPR Interview and the MINI International Neuropsychiatric Interview 6.0(M.I.N.I. 6.0)to explore the rate of DCPR and ICD diagnoses.
DCPR investigates a set of 12 syndromes organized in 3 different clusters, namely abnormal illness behavior (AIB) (i.e. disease phobia, thanatophobia, health anxiety, illness denial), somatization and its different expressions(i.e., persistent somatization, functional somatic symptoms secondary to a psychiatric disorder, conversion symptoms, anniversary reaction), irritability(i.e. irritable mood, and type A behavior), and other relevant clinical constructs(i.e., demoralization and alexithymia).
M.I.N.I. 6.0 is a short, structured diagnostic interview that has been validated against both the Structured Clinical Interview for DSM diagnoses and the Composite International Diagnostic Interview for ICD-10 diagnoses.
We used the same statistical methodology applied in other DCPR studies by examining the rate of DCPR and ICD diagnoses and the differences and overlap between the two nosological systems
Results: Socio-demographic and clinical characteristics of the sample are shown in Table 1.
Among 134 KTRs, 41 (30.6%)patients reported previous psychological disorders, of which adjustment disorders(28.5%)were the most prevalent diagnosis.
63.4% patients presented symptoms meeting the criteria for at least one DCPR diagnosis(DCPR cases), 32.1% with one DCPR diagnosis(DCPR=1), and 31.3% more than one(DCPR>1). The distribution of the DCPR and ICD diagnoses are presented in Table 2.
With regard to the MINI, 46 patients(34.3%)met the criteria for an ICD diagnosis, specifically adjustment disorders(15.7%), anxiety disorders(10.4%),and mood disorders(8.2%: major depression 2.2% and other mood disorders 6%).
There was an overlap between DCPR and ICD diagnoses for 43 patients(43/46 patients with an ICD-10 diagnosis were also DCPR cases, 93.5%; while 43/85 patients with a DCPR diagnosis were also ICD-10 cases, 50.6%).
Among those who had no formal ICD psychiatric diagnosis, “ICD no-cases”(n=88, 65.7% of the total sample), 42 received a DCPR diagnosis(42/88 = 47.7%, false ICD-10 negative), of whom 31 subjects (35.2%)were DCPR=1 and 12 (13.6%)were DCPR>1.
Only 3 patients with a formal ICD diagnosis were not identified by the DCPR(3/46 “DCPR no-cases”, 6,5%).
The overlap between the DCPR and the ICD-10 diagnoses and the type of DCPR syndrome among the main ICD-10 diagnoses are presented in Table 3. Patients receiving an ICD-10 diagnosis of adjustment disorders reported mainly a DCPR diagnosis of demoralization(42.8%)and irritable mood(33.3%); those with anxiety and stress-related disorders mainly had a DCPR diagnosis of health anxiety(57.1%)and irritable mood(57.1%); those with a mood disorder mainly had an equal distribution of demoralization, alexithymia, irritable mood, Type a and illness denial(27.3% each).
Previous history of psychopathological conditions was associated with both DCPR diagnosis (DCPR=1 and DCPR>1) (c2 =10.58, df2, p=0.005)and ICD-10 diagnosis(c2=39.3df1, p< 0.001).
Conclusions: The study, by using for the first time the DCPR approach in the setting of kidney transplantation, confirmed data from other studies among medically ill patients(including heart transplant patients)in showing a high prevalence of DCPR diagnoses in KTRs and in identifying KTRs who resulted no-cases according to the MINI(ICD-10 diagnoses).
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