Cover

The Psychosomatic Assessment

Strategies to Improve Clinical Practice

Editor(s): Fava G.A. (Bologna) 
Sonino N. (Padova) 
Wise T.N. (Falls Church, Va.) 
Table of Contents
Vol. 32, 2012
Section title: Paper

Principles of Psychosomatic Assessment

Fava G.A. · Sonino N. · Wise T.N.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

There is increasing awareness of the limitations of disease as the primary focus of medical care. It is not that certain disorders lack an organic explanation, but that our assessment is inadequate in most clinical encounters. The primary goal of psychosomatic medicine is to correct this inadequacy by incorporation of its operational strategies into clinical practice. At present, the research evidence which has accumulated in psychosomatic medicine offers unprecedented opportunities for the identification and treatment of medical problems. Taking full advantage of clinimetric methods (such as with the use of Emmelkamp’s two levels of functional analysis and the Diagnostic Criteria for Psychosomatic Research) may greatly improve the clinical process, including shared-decision making and self-management. Endorsement of the psychosomatic perspective may better clarify the pathophysiological links and mechanisms underlying symptom presentation. Pointing to individually targeted methods may improve final outcomes and quality of life.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Engel GL: The concept of psychosomatic disorder. J Psychosom Res 1967;11:3-9
  2. Engel GL: The need for a new medical model: a challenge for biomedicine. Science 1977;196:129-136
  3. Lipowski ZJ: Psychosomatic medicine: past and present. II. Current state. Can J Psychiatry 1986;31:8-13
  4. Kissen DM: The significance of syndrome shift and late syndrome association in psychosomatic medicine. J Nerv Ment Dis 1963;136:34-42
  5. Fava GA, Sonino N: Psychosomatic medicine. Int J Clin Pract 2010;64:1155-1161
  6. Wise TN: Psychosomatic medicine: an approach needed now more than ever. Int J Clin Pract 2010;64:999-1001
  7. Fava GA, Sonino N: Psychosomatic medicine: a name to keep. Psychother Psychosom 2010;79:1-3
  8. Gitlin DF, Levenson JL, Lyketsos CG: Psychosomatic medicine: a new psychiatric subspecialty. Acad Psychiatry 2004;28:4-11
  9. Lipowski ZJ: Current trends in consultation-liaison psychiatry. Can J Psychiatry 1983;28:329-338
  10. Wise TN: Consultation liaison psychiatry and psychosomatics: strange bedfellows. Psychother Psychosom 2000;69:181-183
  11. Deter HC: Psychosomatic medicine and psychotherapy. Adv Psychosom Med 2004;26:181-189
  12. Jackson MG, Howe GW, Tapp JT: The psychosocial review: evaluating development and implementation in a family practice residency. Fam Pract Res J 1986;6:37-46
  13. Kroenke K: Psychological medicine. BMJ 2002;324:1536-1537
  14. Fava GA: The decline of pharmaceutical psychiatry and the increasing role of psychological medicine. Psychother Psychosom 2009;78:222-227
  15. Novack DH, Cameron O, Epel E, Ader R, Waldstein SR, Levenstein S, Antoni MH, Wainer AR: Psychosomatic medicine: the scientific foundation of the biopsychosocial model. Acad Psychiatry 2007;31:388-401
  16. McEwen BS: Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev 2007;87:873-904
  17. Fava GA, Guidi J, Semprini F, Tomba E, Sonino N: Clinical assessment of allostatic load and clinimetric criteria. Psychother Psychosom 2010;79:280-284
  18. McCauley J, Kern DE, Kolodner K, Dill L, Schroeder AF, De Chant HK, Ryden J, Derogatis LR, Bass EB: Clinical characteristics of women with a history of childhood abuse. JAMA 1997;277:1362-1368
  19. Romans S, Cohen M: Unexplained and underpowered: the relationship between psychosomatic disorders and interpersonal abuse. Harvard Rev Psychiatry 2008;16:35-44
  20. McEwen BS, Stellar E: Stress and the individual. Mechanisms leading to disease. Arch Intern Med 1993;153:2093-2101
  21. Rozanski A, Blumenthal JA, Kaplan J: Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999;99:2192-2217
  22. Sonino N, Tomba E, Fava GA: Psychosocial approach to endocrine disease. Adv Psychosom Med 2007;28:21-33
  23. Wright RJ, Rodriguez M, Cohen S: Review of psychosocial stress and asthma. Thorax 1998;53:1066-1074
  24. Picardi A, Abeni D: Stressful life events and skin disease. Psychother Psychosom 2001;70:118-136
  25. Mokdad AH, Marks JS, Stroup DF, Gerberding JL: Actual causes of death in the United States, 2000. JAMA 2004;291:1238-1245
  26. Rose G: Sick individuals and sick populations. In J Epidemiol 1985;14:32-38
  27. Daniels SR, Greer FR: Committee on nutrition, lipid screening and cardiovascular health in childhood. Pediatrics 2008;122:198-208
  28. World Health OrganizationWorld Health Organization Constitution. Geneva, World Health Organization, 1948;28
  29. Ryff CD, Singer B: Psychological well-being. Psychother Psychosom 1996;65:14-23
  30. Caprara GV, Alessandri G, Barbaranelli C: Optimal functioning. Psychother Psychosom 2010;79:328-330
  31. Pressman SD, Cohen S: Does positive affect influence health?. Psychol Bull 2005;131:925-971
  32. Chida Y, Steptoe A: Positive psychological well-being and mortality. Psychosom Med 2008;70:741-756
  33. Eriksson M, Lindstrom B: Antonovsky's sense of coherence scale and the relation with health: a systematic review. J Epidemiol Community Health 2006;60:376-381
  34. Shah SU, White A, White S, Littler WA: Heart and mind: (1) relationship between cardiovascular and psychiatric conditions. Postgrad Med J 2004;80:683-689
  35. Taylor GJ: Affects, trauma, and mechanisms of symptom formation. A tribute to John C. Nemiah, MD (1918-2009). Psychother Psychosom 2010;79:339-349
  36. Mischel W, Shoda Y: A cognitive-affective system theory of personality. Psychol Rev 1995;102:246-268
  37. Nater UM, Jones JF, Lin JM, Maloney E, Reeves WC, Heim C: Personality features and personality disorders in chronic fatigue syndrome: a population-based study. Psychother Psychosom 2010;79:312-318
  38. Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, Rahman A: No health without mental health. Lancet 2007;370:859-877
  39. Pohle K, Domscheke K, Roehrs T, Arolt V, Baune BT: Medical comorbidity affects antidepressant treatment response in patients with melancholic depression. Psychother Psychosom 2009;78:359-363
  40. Sonino N, Fava GA, Fallo F: Psychosomatic aspects of Cushing's syndrome. Rev Endocr Metab Disord 2010;11:95-104
  41. Mitchell AJ, Vaze A, Rao S: Clinical diagnosis of depression in primary care: a meta-analysis. Lancet 2009;374:609-619
  42. Mitchell AJ, Rao S, Vaze A: Do primary care physicians have particular difficulty identifying late-life depression? A meta-analysis stratified by age. Psychother Psychosom 2010;79:285-294
  43. Katon WJ: Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biol Psychiatry 2003;54:216-226
  44. Schulz R, Drayer RA, Rollman BL: Depression as a risk factor for non-suicide mortality in the elderly. Biol Psychiatry 2002;52:205-225
  45. di Matteo MR, Lepper HS, Croghan TW: Depression is a risk factor for noncompliance with medical treatment. Arch Intern Med 2000;160:2101-2107
  46. Frasure-Smith N, Lesperance F: Depression and other psychological risks following myocardial infarction. Arch Gen Psychiatry 2003;60:627-636
  47. Lemogne C, Nabi H, Zins M, Cordier S, Ducimetière P, Goldberg M, Consoli SM: Hostility may explain the association between depressive mood and mortality: evidence from the French GAZEL cohort study. Psychother Psychosom 2010;79:164-171
  48. Dirmaier J, Watzke B, Koch U, Schulz H, Lehnert H, Pieper L, Wittchen HU: Diabetes in primary care: prospective associations between depression, nonadherence and glycemic control. Psychother Psychosom 2010;79:172-178
  49. Kojima M, Hayano J, Suzuki S, Seno H, Kasuga H, Takahashi H, Toriyama T, Kawahara H, Furukawa TA: Depression, alexithymia and long-term mortality in chronic hemodialysis patients. Psychother Psychosom 2010;79:303-311
  50. Roy-Byrne PP, Davidson KW, Kessler RC, Asmundson GJG, Goodwin RD, Kubzansky L, Lydiard RB, Massic MJ, Katon WJ, Laden SK, Stein MB: Anxiety disorders and comorbid medical illness. Gen Hosp Psychiatry 2008;30:208-225
  51. Fava GA, Porcelli P, Rafanelli C, Mangelli L, Grandi S: The spectrum of anxiety disorders in the medically ill. J Clin Psychiatry 2010;71:910-914
  52. Beutel ME, Bleichner F, von Heymann F, Tritt K, Hardt J: Anxiety disorders and comorbidity in psychosomatic inpatients. Psychother Psychosom 2010;79:58
  53. Fava GA, Fabbri S, Sirri L, Wise TN: Psychological factors affecting medical condition: a new proposal for DSM-V. Psychosomatics 2007;48:103-111
  54. (eds) Porcelli P, Sonino N: Psychological Factors Affecting Medical Conditions. A New Classification for DSM-V. Basel, Karger, 2007;
  55. Wise TN: Diagnostic criteria for psychosomatic research are necessary for DSM-V. Psychother Psychosom 2009;78:330-332
  56. Porcelli P, Bellomo A, Quartesan R, Altamura M, Luso S, Ciannameo I, Piselli M, Elisei S: Psychosocial functioning in consultation-liaison psychiatry patients. Psychother Psychosom 2009;78:352-358
  57. Fava GA, Wise TN: Psychological factors affecting either identified or feared medical conditions: a solution for somatoform disorders. Am J Psychiatry 2007;164:1002-1003
  58. Kellner R: Psychosomatic syndromes, somatization and somatoform disorders. Psychother Psychosom 1994;61:4-24
  59. (eds) Engel GL: Conversion symptoms. (eds) Mac Bryde CM, Blacklow RS: Signs and Symptoms. Philadelphia, Lippincott, 1970;650-669
  60. Goldbeck R: Denial in physical illness. J Psychosom Res 1997;43:575-593
  61. Cockram CA, Doros G, de Figueiredo JM: Diagnosis and measurement of subjective incompetence: the clinical hallmark of demoralization. Psychother Psychosom 2009;78:342-345
  62. Mangelli L, Fava GA, Grandi S, Grassi L, Ottolini F, Porcelli P, Rafanelli C, Rigatelli M, Sonino N: Assessing demoralization and depression in the setting of medical disease. J Clin Psychiatry 2005;66:391-394
  63. Mangelli L, Fava GA, Grassi L, Ottolini F, Paolini S, Porcelli P, Rafanelli C, Rigatelli M, Sonino N: Irritable mood in Italian patients with medical disease. J Nerv Ment Dis 2006;194:226-228
  64. Sensky T: Chronic embitterment and organisational justice. Psychother Psychosom 2010;79:64-72
  65. Härter M, Baumeister H, Reuter K, Jacobi F, Höfler M, Bengel J, Wittchen HU: Increased 12-month prevalence rates of mental disorders in patients with chronic somatic diseases. Psychother Psychosom 2007;76:354-360
  66. Tinetti ME, Fried T: The end of the disease era. Am J Med 2004;116:179-185
  67. Tinetti ME, Bogardus ST, Agostini JV: Potential pitfalls of disease- specific guidelines for patients with multiple conditions. N Engl J Med 2004;351:2870-2874
  68. Fava GA, Sonino N: Psychosomatic assessment. Psychother Psychosom 2009;78:333-341
  69. Sonino N, Peruzzi P: A psychoneuroendocrinology service. Psychother Psychosom 2009;78:346-351
  70. Feinstein AR: Clinical Judgment. Baltimore, Williams & Wilkins 1967;
  71. Feinstein AR: The Jones criteria and the challenge of clinimetrics. Circulation 1982;66:1-5
  72. Feinstein AR: Clinimetrics. New Haven, Yale University Press 1987;
  73. Feinstein AR: The pre-therapeutic classification of comorbidity in chronic disease. J Chronic Dis 1970;23:455-468
  74. deGroot V, Beckerman H, Lankhorst GJ, Bouter LM: How to measure comorbidity: a critical review of available methods. J Clin Epidemiol 2003;56:221-229
  75. Zimmerman M, Chelminski I, McDermut W: Major depressive disorder and Axis I diagnostic comorbidity. J Clin Psychiatry 2002;63:187-193
  76. Cloninger CR: Implications of comorbidity for the classification of mental disorders: the need for a psychobiology of coherence. (eds) Maj M, Gaebel W, Lopez-Ibor JJ, Sartorius N: Psychiatric Diagnosis and Classification. Chichester, Wiley, 2002;79-105
  77. Fava GA, Ruini C, Rafanelli C: Psychometric theory is an obstacle to the progress of clinical research. Psychother Psychosom 2004;73:145-148
  78. Emmelkamp PMG, Bouman TK, Scholing A: Anxiety Disorders. Chichester, Wiley 1993;55-67
  79. Emmelkamp PMG: The additional value of clinimetrics needs to be established rather than assumed. Psychother Psychosom 2004;73:142-144
  80. Joosten EAG, De Fuentes-Merillas L, de Weert GH, Sensky T, van der Staak CPF, de Jong CAJ: Systematic review of the effects of shared-decision making on patient satisfaction, treatment adherence and health status. Psychother Psychosom 2008;77:219-226
  81. Joosten EAG, de Jong CAJ, de Weert-van Oene GH, Sensky T, van der Staak CPF: Shared decision making reduces drug use and psychiatry severity in substance-dependent patients. Psychother Psychosom 2009;78:245-253
  82. Fava GA, Kellner R: Staging: a neglected dimension in psychiatric classification. Acta Psychiatr Scand 1993;87:225-230
  83. Feinstein AR: An analysis of diagnostic reasoning. I. The domains and disorders of clinical macrobiology. Yale J Biol Med 1973;46:212-232
  84. Lipowski ZJ: Physical illness and psychopathology. Int J Psychiatry Med 1974;5:483-497
  85. Aaron LA, Buchwald D: A review of the evidence for overlap among unexplained clinical conditions. Ann Intern Med 2001;134:868-881
  86. Fava GA, Tomba E: New modalities of assessment and treatment planning in depression. CNS Drugs 2010;24:453-465
  87. Fava GA, Grandi S, Rafanelli C, Fabbri S, Cazzaro M: Explanatory therapy in hypochondriasis. J Clin Psychiatry 2000;61:317-322
  88. Fava GA, Tomba E: Increasing psychological wellbeing and resilience by psychotherapeutic methods. J Personality 2009;77:1903-1934
  89. Feinstein AR: An analysis of diagnostic reasoning. II. The strategy of intermediate decisions. Yale J Biol Med 1973;46:264-283
  90. Feinstein AR: Basic biomedical science and the destruction of the pathophysiological bridge from bench to bedside. Am J Med 1999;107:461-467
  91. Dantzer R: Somatization: a psychoneuroimmune perspective. Psychoneuroendocrinology 2005;30:947-952
  92. Price DD, Finniss DG, Benedetti F: A comprehensive review of the placebo effect. Annu Rev Psychol 2008;59:565-590
  93. Walach H, Bosch H, Lewith G, Naumann J, Schwarzer B, Falk S, Kohls N, Haraldsson E, Wiesendanger H, Nordmann A, Tomasson H, Prescott P, Bucher HC: Effectiveness of distant healing for patients with chronic fatigue syndrome. Psychother Psychosom 2008;77:158-166
  94. Thayer JF, Brosschot JF: Psychosomatics and psychopathology. Psychoneuroendocrinology 2005;30:1050-1058
  95. Tak LM, Janssens KA, Dietrich A, Slaets JP, Rosmalen JG: Age-specific associations between cardiac vagal activity and functional somatic symptoms: a population-based study. Psychother Psychosom 2010;79:179-187
  96. Zachariae R, Paulsen K, Mehlsen M, Jensen AB, Johansson A, von der Maase H: Chemotherapyinduced nausea, vomiting and fatigue. Psychother Psychosom 2007;76:376-384
  97. Bech P: Fifty years with the Hamilton Scales for anxiety and depression. Psychother Psychosom 2009;78:202-211
  98. Carroll BJ: Brain mechanisms in manic depression. Clin Chem 1994;40:303-308
  99. Fava GA: Irritable mood and physical illness. Stress Med 1987;3:293-299
  100. Kamarck TW, Haskett RF, Muldoon M, Flory JD, Anderson B, Bies R, Pollock B, Manuck SB: Citalopram intervention for hostility. J Consult Clin Psychol 2009;77:174-188
  101. Charney DS: Psychobiological mechanisms of resilience and vulnerability. Am J Psychiatry 2004;161:195-216
  102. Cloninger CR: Systematic method for clinical description and classification of personality. Arch Gen Psychiatry 1987;44:573-588
  103. Tabibnia G, Zaidel E: Alexithymia, interhemispheric transfer, and right hemispheric specialization. Psychother Psychosom 2005;75:81-92
  104. Ogrodniczuk JS, Piper WE, Joyce AS, Abbass AA: Alexithymia and treatment preferences among psychiatric outpatients. Psychother Psychosom 2009;78:383-384
  105. Heinzel A, Schäfer R, Müller HW, Schieffer A, Ingenhag A, Eickhoff SB, Northoff G, Franz M, Hautzel H: Increased activation of the supragenual anterior cingulate cortex during visual emotional processing in male subjects with high degrees of alexithymia: an event-related fMRI study. Psychother Psychosom 2010;79:363-370
  106. Fava M, Littman A, Halperin P: Neuroendocrine correlates of the type A behavior pattern. Int J Psychiatry Med 1987;17:289-307
  107. Rapp MA, Rieckmann N, Lessman DA, Tang CY, Paulino R, Burg MM, Davidson KW: Persistent depressive symptoms after acute coronary syndrome are associated with compromised white matter integrity in the anterior cingulate: a pilot study. Psychother Psychosom 2010;79:149-155
  108. Lichtenberg P, Belmaker RH: Subtyping major depressive disorder. Psychother Psychosom 2010;79:131-135
  109. Bech P: The struggle for subtypes in primary and secondary depression and their mode-specific treatment or healing. Psychother Psychosom 2010;79:331-338
  110. Baumeister H, Parker G: A second thought on subtyping major depression. Psychother Psychosom 2010;79:388-389
  111. Narayan KMV, Kanaya AM, Gregg EW: Lifestyle intervention for the prevention of type 2 diabetes mellitus. Treat Endocrinol 2003;2:315-320
  112. Djoussé L, Driver JA, Graziano JM: Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA 2009;302:394-400
  113. Forman JP, Stampfer MJ, Curhan GC: Diet and lifestyle risk factors associated with incident hypertension in women. JAMA 2009;302:401-411
  114. Stone NJ: Focus on lifestyle change and the metabolic syndrome. Endocrinol Metab Clin North Am 2004;33:493-508
  115. Compas BE, Haagon DA, Keefe FJ, Leitenberg H, Williams DA: Sampling of empirically supported psychological treatments from health psychology: smoking, chronic pain, cancer, and bulimia nervosa. J Consult Clin Psychol 1998;66:89-112
  116. Bodenheimer T, Lorig K, Holman H, Grumbach K: Patient self-management of chronic disease in primary care. JAMA 2002;288:2469-2475
  117. Jackson JL, de Zee K, Berbano E: Can treating depression improve disease outcomes?. Ann Intern Med 2004;140:1054-1056
  118. Pigott HE, Leventhal AM, Alter GS, Boren JJ: Efficacy and effectiveness of antidepressants. Psychother Psychosom 2010;79:267-279
  119. Balon R: Cognitive-behavioral therapy, psychotherapy and psychosocial interventions in the medically ill. Psychother Psychosom 2009;78:261-264
  120. Kaupp JW, Rapaport-Hubschman N, Spiegel D: Psychosocial treatments. (eds) Levenson JL: Textbook of Psychosomatic Medicine. Washington, American Psychiatric Press, 2005;923-956
  121. Abbass A, Kisely S, Kroenke K: Short-term psychodynamic psychotherapy for somatic disorders. Psychother Psychosom 2009;78:265-274
  122. Andersen BL, Yang HC, Farrar WB, Golden-Krentz DM, Emery CF, Thornton LM, Young DC, Carson WE: Psychologic intervention improves survival for breast cancer patients. Cancer 2008;113:3450-3458
  123. Herschbach P, Berg P, Waadt S, Duran G, Engst-Hastreiter U, Henrich G, Book K, Dinkel A: Group psychotherapy of dysfunctional fear of progression in patients with chronic arthritis or cancer. Psychother Psychosom 2010;79:31-38
  124. Grassi L, Sabato S, Rossi E, Marmai L, Biancosino B: Effects of supportive-expressive group therapy in breast cancer patients with affective disorders: a pilot study. Psychother Psychosom 2010;79:39-47
  125. Tulipani C, Morelli F, Spedicato MR, Maiello E, Todarello O, Porcelli P: Alexithymia and cancer pain: the effect of psychological intervention. Psychother Psychosom 2010;79:156-163
  126. Turk DC, Swanson KS, Tunks ER: Psychological approaches in the treatment of chronic pain patients. Can J Psychiatry 2008;53:213-223
  127. Lahmann C, Nickel M, Schuster T, Sauer N, Ronel J, Noll-Hussong M, Tritt K, Nowak D, Rohricht F, Loew T: Functional relaxation and guided imagery as complementary therapy in asthma: a randomized controlled clinical trial. Psychother Psychosom 2009;78:233-239
  128. Frisina PG, Borod JC, Lepore SJ: A meta-analysis of the effects of written emotional disclosure on the health outcomes of clinical populations. J Nerv Ment Dis 2004;192:629-634
  129. van Middendorp H, Geenen R, Sorbi MJ, van Doornen LJ, Bijlsma JW: Health and physiological effects of an emotional disclosure intervention adapted for application at home: a randomized clinical trial in rheumatoid arthritis. Psychother Psychosom 2009;78:145-151
  130. Sirri L, Grandi S, Fava GA: The illness attitude scales. Psychother Psychosom 2008;77:337-350
  131. Hart JT: Clinical and economic consequences of patients as producers. J Pub Health Med 1995;17:383-386
  132. Heath I: Combating disease mongering: daunting but nonetheless essential. PLoS Med 2006;E e146
  133. Leventhal H, Weinman J, Leventhal EA, Phillips LA: Health psychology: the search for pathways between behavior and health. Annu Rev Psychol 2008;59:477-505
  134. Sonino N, Fava GA: Rehabilitation in endocrine patients: a novel psychosomatic approach. Psychother Psychosom 2007;76:319-324
  135. Layard R: The case of psychological treatment centres. BMJ 2006;332:1030-1032
  136. Marks I: Mental health clinics in the 21st century. Psychother Psychosom 2009;78:133-138
  137. Testa MA, Simonson DC: Assessment of quality of life outcomes. N Engl J Med 1996;334:835-840
  138. De Fruyt J, Demyttenaere K: Quality of life measurement in antidepressant trials. Psychother Psychosom 2009;78:212-219


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50