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New Syndrome Links Anxiety And Physical Disorders

Saturday 25 July 2015


From Medscape Multispecialty:



New Syndrome Links Anxiety and Physical Disorders

Liam Davenport
July 22, 2015

Patients with anxiety disorder may suffer from a range of comorbid physical conditions that constitute a novel syndrome, say US researchers, who claim that the syndrome has been overlooked by physicians who have previously dismissed the connections as simply somatic disorders.

ALPIM (anxiety, laxity, pain, immune, mood) is an acronym for anxiety and the domains of its most commonly occurring comorbidities: joint laxity, pain disorders, immune disorders, and mood disorders.

Testing the prevalence of the comorbid domains in patients with anxiety disorder, it was found that their prevalences were far higher than those seen in the general population. Furthermore, there were a number of significant associations between disorders within the domains.

"Our results provide further evidence to support a possible common pathophysiologic pathway toward the development of a related set of psychiatric and physical conditions, which were previously considered and, in certain instances, were unrelated," the investigators write.

Noting that several disorders that were previously labeled as purely somatic symptoms in psychiatry are now recognized as bona fide disorders in other medical fields, the researchers note: "Patients are entitled to receive a medical diagnosis that has a biological basis and facilitates effective and, in certain instances, Food and Drug Administration–approved treatments."

"Viewing patients as sharing a psychological propensity toward somatizing behavior essentially denies patients access to care for the diagnosable medical conditions with which they present," they add.

The research was published in the Journal of Neuropsychiatry and Clinical Neurosciences.

The team had previously observed through clinical experience and the literature that there are a number of relationships between anxiety disorders and physical illnesses.

From this, they formulated a domain-defined clinical syndrome, termed ALPIM, in which comorbidites exist along a spectrum; patients may experience anything from one disorder under one domain to multiple disorders under multiple domains.

The anxiety domain, for example, includes panic disorder, generalized anxiety disorder, and social anxiety disorder; the laxity domain includes joint laxity, mitral valve prolapse, scoliosis, double jointedness, and easy bruising.

The pain domain comprises fibromyalgia, chronic daily headaches, interstitial cystitis, and prostatitis. Asthma, hypothyroidism, chronic fatigue syndrome, and allergic rhinitis make up the immune domain. Finally, the mood domain contains bipolar I, bipolar II, and bipolar III disorders, major depressive episodes, and antidepressant medication tachyphylaxis.

The researchers then developed the ALPIM Inventory Questionnaire, which was designed to identify the conditions that fall within the ALPIM spectrum. Performing a cross-sectional, naturalistic study, they administered the questionnaire to 72 patients with anxiety disorder (average age, 43.19 years; 76% women).

Compared with studies carried out in the general population, the prevalence of the comorbid conditions was consistently higher in the study group. For example, the prevalence of joint laxity and mitral valve prolapse was 59.3% and 32.9%, respectively, vs 10% - 15% and 2.4%, respectively, in the general population.

The prevalence of fibromyalgia and irritable bowel syndrome in the study population was 80.3% and 76.3%, respectively, compared with 2.1% - 5.7% and 17%, respectively, in the general population.

Similar differences were seen for immune conditions such as allergic rhinitis and chronic fatigue syndrome. Furthermore, the prevalence of major depressive disorder in the study population was 92.2% vs 16.6% in the general population. The respective figures for bipolar II and III disorders were 71.1% vs 3.9% and 67.1% vs 0.56%; and for tachyphylaxis, 92.1% vs 9% - 57%.


The above, with comments, originally appeared here.


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