Mainstream cognitive behavioural theory stipulates that clinically significant health anxiety persists over time at least partially due to negatively reinforced health-related behaviours, but there exists no broad and psychometrically valid measure of such behaviours.

To draft and evaluate a new self-report scale – the Health Anxiety Behavior Inventory (HABI) – for the measurement of negatively reinforced health anxiety behaviours.

We drafted the HABI from a pool of 20 candidate items administered in a clinical trial at screening, and before and after cognitive behaviour therapy (n=204). A psychometric evaluation focused on factor structure, internal consistency, convergent and discriminant validity, test–retest reliability, and sensitivity to change.

Based on factor analysis, the HABI was completed as a 12-item instrument with a four-dimensional factor structure corresponding to the following scales: (i) bodily preoccupation and checking, (ii) information- and reassurance-seeking, (iii) prevention and planning, and (iv) overt avoidance. Factor inter-correlations were modest. The internal consistency (α=.73–.87) and 2-week test–retest reliability (r=.75–.90) of the scales was adequate. The bodily preoccupation and checking, and information- and reassurance-seeking scales were most strongly correlated with the cognitive and emotional components of health anxiety (r=0.41, 0.48), and to a lower extent correlated to depressive symptoms and disability. Change scores in all HABI scales correlated with improvement in the cognitive and emotional components of health anxiety during cognitive behaviour therapy.

The HABI appears to reliably measure negatively reinforced behaviours commonly seen in clinically significant health anxiety, and might be clinically useful in the treatment of health anxiety.

Research has shown that patients with somatoform disorders (SFD) have difficulty using medical reassurance (i.e. normal results from diagnostic testing) to revise concerns about being seriously ill. In this brief report, we investigated whether deficits in adequately interpreting the likelihood of a medical disease may contribute to this difficulty, and whether patients’ concerns are altered by different likelihood framings.

Patients with SFD (N = 60), patients with major depression (N = 32), and healthy volunteers (N = 37) were presented with varying likelihoods for the presence of a serious medical disease and were asked how concerned they are about it. The likelihood itself was varied, as was the format in which it was presented (i.e. negative framing focusing on the presence of a disease v. positive framing emphasizing its absence; use of natural frequencies v. percentages).

Patients with SFD reported significantly more concern than depressed patients and healthy people in response to low likelihoods (i.e. 1: 100 000 to 1:10), while the groups were similarly concerned for likelihoods ⩾1:5. Across samples, the same mathematical likelihood caused significantly different levels of concern depending on how it was framed, with the lowest degree of concern for a positive framing approach and higher concern for natural frequencies (e.g. 1:100) than for percentages (e.g. 1%).

The results suggest a specific deficit of patients with SFD in interpreting low likelihoods for the presence of a medical disease. Positive framing approaches and the use of percentages rather than natural frequencies can lower the degree of concern.

Pseudocyesis and Delusion of Pregnancy are often conflated. Both presentations are associated with false beliefs of pregnancy in patients who are not pregnant. Pseudocyesis is associated with physiological changes of pregnancy such as amenorrhea, galactorrhea, abdominal distention, and hyperprolactinemia. Delusion of Pregnancy is not associated with physiological signs/changes. We describe a case to demonstrate the phenomenological and physiological differences between these entities and how these influence treatment considerations.

1.Phenomenology of Pseudocyesis vs Delusion of Pregnancy 2.Elucidate the physiological underpinnings of both 3.Treatment considerations

Comprehensive literature review following a 29-year-old-female with no known psychiatric history presenting to the emergency department with mixed complaints of twin-pregnancy, menorrhagia, and concern for threatened abortion. Psychiatry was consulted for decisional capacity to leave against-medical-advice due to concerns for ectopic pregnancy. Patient reported a recent ultrasound with fetal heartbeat and sensation of fetal “kicks”. She was concerned the menorrhagia was threatening her pregnancy. The patient appeared irritable, paranoid, endorsed ideas of reference and a fixed false belief that she was pregnant with twins, despite quantitative HCG, abdominal and transvaginal ultrasounds being negative. On examination, while there was vaginal bleeding, there were no stigmata of pregnancy.

Diagnosis- Delusion of Pregnancy.

Delusion of Pregnancy have been associated with polythematic content. Pseudocyesis may be confounded by conditions such as abdominal neoplasms, leiomyoma, and endocrinologic changes (eg- hyperprolactinemia). Potent D2R antagonists carry increased risk of hyperprolactinemia and subsequent galactorrhea which may paradoxically exacerbate misattributions of pregnancy. Careful consideration of psychotropic choice is therefore needed in the management of these conditions.

No significant relationships.

In 2013, the diagnosis of somatic symptom disorder (SSD) was introduced into the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This review aims to comprehensively synthesize contemporary evidence related to SSD.

A scoping review was conducted using PubMed, PsycINFO, and Cochrane Library. The main inclusion criteria were SSD and publication in the English language between 01/2009 and 05/2020. Systematic search terms also included subheadings for the DSM-5 text sections; i.e., diagnostic features, prevalence, development and course, risk and prognostic factors, culture, gender, suicide risk, functional consequences, differential diagnosis, and comorbidity.

Eight hundred and eighty-two articles were identified, of which 59 full texts were included for analysis. Empirical evidence supports the reliability, validity, and clinical utility of SSD diagnostic criteria, but the further specification of the psychological SSD B-criteria criteria seems necessary. General population studies using self-report questionnaires reported mean frequencies for SSD of 12.9% [95% confidence interval (CI) 12.5–13.3%], while prevalence studies based on criterion standard interviews are lacking. SSD was associated with increased functional impairment, decreased quality of life, and high comorbidity with anxiety and depressive disorders. Relevant research gaps remain regarding developmental aspects, risk and prognostic factors, suicide risk as well as culture- and gender-associated issues.

Strengths of the SSD diagnosis are its good reliability, validity, and clinical utility, which substantially improved on its predecessors. SSD characterizes a specific patient population that is significantly impaired both physically and psychologically. However, substantial research gaps exist, e.g., regarding SSD prevalence assessed with criterion standard diagnostic interviews.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced somatic symptom and related disorders (SSD) to improve the diagnosis of somatoform disorders. It is unclear whether existing questionnaires are useful to identify patients with SSD. Our study investigates the diagnostic accuracy of the Patient Health Questionnaire-15 (PHQ-15) and the Somatic Symptom Scale-8 (SSS-8) in combination with the Somatic Symptom Disorder – B Criteria Scale (SSD-12).

For this cross-sectional study, participants were recruited from a psychosomatic outpatient clinic. PHQ-15, SSS-8, and SSD-12 were administered and compared with SSD criteria from a diagnostic interview. Sensitivity and specificity were calculated for optimal individual and combined cutpoints. Receiver operator curves were created and area under the curve (AUC) analyses assessed.

Data of n = 372 patients [31.2% male, mean age: 39.3 years (s.d. = 13.6)] were analyzed. A total of 56.2% fulfilled the SSD criteria. Diagnostic accuracy was moderate for each questionnaire (PHQ-15: AUC = 0.70; 95% CI = 0.65–0.76; SSS-8: AUC = 0.71; 95% CI = 0.66–0.77; SSD-12: AUC = 0.74; 95% CI = 0.69–0.80). Combining questionnaires improved diagnostic accuracy (PHQ-15 + SSD-12: AUC = 0.77; 95% CI = 0.72–0.82; SSS-8 + SSD-12: AUC = 0.79; 95% CI = 0.74–0.84). Optimal combined cutpoints were ⩾9 for the PHQ-15 or SSS-8, and ⩾23 for the SSD-12 (sensitivity and specificity = 69% and 70%).

The combination of the PHQ-15 or SSS-8 with the SSD-12 provides an easy-to-use and time- and cost-efficient opportunity to identify persons at risk for SSD. If systematically applied in routine care, effective screening and subsequent treatment might help to improve quality of life and reduce health care excess costs.

To investigate oxidative stress parameters [total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), paraoxonase (PON), arylesterase (ARE) and thiol-disulphide homeostasis] in patients who were diagnosed as having somatic symptom disorder in accordance with Diagnostic and Statistical Manual of Mental Disorders-5.

The study included 41 medication-free patients with somatic symptom disorder and 47 age, sex, and sociodemographic-matched healthy individuals. The patients were administered the Patient Health Questionnaire-15, Somatic Symptom Amplification Scale, Beck Depression Inventory, and Beck Anxiety Inventory. TOS, TAS, OSI, PON, ARE thiol, disulphide levels, and routine biochemical parameters were compared between the two groups.

TOS, OSI, disulphide levels, disulphide/native thiol, and disulphide/total thiol ratios were found significantly higher in the patient group compared with the control group (p < 0.001). There was no significant difference in PON, ARE, and TAS parameters between the two groups (p > 0.05).

This study showed that the level of oxidants increased and oxidative balance was impaired in somatic symptom disorder. Oxidative stress may play a role in the aetiopathogenesis of this disorder. This is the first study to report an association between oxidative stress and somatic symptom disorder.

Not all patients referred for evaluation of multiple sclerosis (MS) meet criteria required for MS or related entities. Identification of markers to exclude demyelinating disease may help detect patients whose presenting symptoms are inconsistent with MS. In this study, we evaluate whether patients who present a self-prepared list of symptoms during an initial visit are less likely to have demyelinating disease and whether this action, which we term the “list sign,” may help exclude demyelinating disease.

Using chart review, 300 consecutive new patients who presented for evaluation to a neurologist at a tertiary MS referral center were identified retrospectively. Patients were defined as having demyelinating disease if diagnosed with MS or a related demyelinating condition.

Of the 233 enrolled subjects, 157 were diagnosed with demyelinating disease and 74 did not meet criteria for demyelinating disease. Fifteen (8.4%) subjects had a positive list sign, of which 1 patient had demyelinating disease. The 15 subjects described a mean of 12.07 symptoms, and 8 of these patients met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for somatic symptom disorder. The specificity and positive predictive value of the list sign for non-demyelinating disease were 0.99 (95% confidence interval (CI) 0.96–0.99) and 0.93 (95% CI 0.66–0.99), respectively.

A positive list sign may be useful to exclude demyelinating disease and to guide diagnostic evaluations for other conditions. Patients with a positive list sign also have a high incidence of somatic symptom disorder.