12 Indeed, specific effects of depression, panic, and somatic symptoms on illness behavior must be considered.92 Various causal illness interpretations, a tendency to amplify somatic selleck chem Olaparib distress, and difficulties

In Identifying and communicating emotional distress, all have an impact on the form and extent of a somatic mode of presentation.93-95 Again, regarding the course of Illness, depressive and anxiety disorders following somatoform disorders may significantly contribute to the chronlflcatlon and complication of the latter.39,96 From a perspective of etiologically relevant risk new product factors It Is a well-established epidemiological finding that the extent and severity of early adverse events, especially manifold traumatic experiences, are Inhibitors,research,lifescience,medical tightly connected with the mental and somatic state of adults. This general disposition may be detected In a series of psychiatric disorders, as In conversion and somatization Inhibitors,research,lifescience,medical syndromes,97-103 several chronic pain conditions,104-106 hypochondriacal attitudes,107 factitious disorders,98 and depressive, anxiety, and substance disorders.108-110 One can draw a basic conclusion

from many epldemiologlcally designed longitudinal studies that the more a person has been exposed to severe and early trauma, the higher the risk will be that she/he will suffering from recurrent or chronic depression with pronounced suicidality, multiple Inhibitors,research,lifescience,medical medically unexplained somatic symptoms, especially Inhibitors,research,lifescience,medical chronic physical pain conditions with an onset already during adolescence or young adulthood, the more her/his psychic and somatic state as a whole will be negatively affected, and the more she/he will demonstrate abnormal illness behavior.61,111 Culture and society are other factors that may have an important impact on the way a depressive mood

is presented Inhibitors,research,lifescience,medical in a predominantly somatic way.25 Interestingly, the comprehensive international WHO study on depression in primary care, conducted in 12 countries on different continents, was not able to identify clear cultural influences on the somatic mode of presenting a depression. A somatic presentation was much more common at centers where patients lacked an ongoing relationship with a primary care physician than at centers where most patients had a personal physician. This variable had a robustly differentiating effect beyond the various cultural settings.24 Entinostat Besides gender, culture, and type of patient-physician relationship, there may be many other factors influencing a more somatic mode of presentation, such as different ages in life cycle, association with medical conditions, earning a lower income, and imprisonment.7,112 Burden of somatic symptoms in depression Most patients who are psychopharmacologically treated for depression fail to reach full remission.113-114 A majority of patients may respond to antidepressants (by definition a reduction of symptoms by some 50% or more), but still suffer from residual symptoms.