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	Institution: CLOCKSS  | My Account | E-mail Alerts | Access Rights | Sign In Vol. 3 No. 9, September 1994   Archives  • Online Features Original Contributions  This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal Physical Symptoms in Primary Care Predictors of Psychiatric Disorders and Functional Impairment Kurt Kroenke, MD; Robert L. Spitzer, MD; Janet B. W. Williams, DSW; Mark Linzer, MD; Steven R. Hahn, MD; Frank V. deGruy III, MD; David Brody, MD Arch Fam Med. 1994;3(9):774-779. Abstract Objective To examine how the type and number of physical symptoms reported by primary care patients are related to psychiatric disorders and functional impairment. Design Outpatient mental health survey. Setting Four primary care clinics. Patients One thousand adult clinic patients, of whom 631 were selected randomly or consecutively and 369 by convenience. Main Outcome Measures Psychiatric disorders as determined by the Primary Care Evaluation of Mental Disorders procedure; the presence or absence of 15 common physical symptoms and whether symptoms were somatoform (ie, lacked an adequate physical explanation); and functional status as determined by the Medical Outcomes Study Short-form General Health Survey. Results Each of the 15 common symptoms was frequently somatoform (range, 16% to 33%). The presence of any physical symptom increased the likelihood of a diagnosis of a mood or anxiety disorder by at least twofold to threefold, and somatoform symptoms had a particularly strong association with psychiatric disorders. The likelihood of a psychiatric disorder increased dramatically with increasing numbers of physical symptoms. The prevalence of a mood disorder in patients with 0 to 1, 2 to 3, 4 to 5, 6 to 8, and 9 or more symptoms was 2%, 12%, 23%, 44%, and 60%, respectively, and the prevalence of an anxiety disorder was 1%, 7%, 13%, 30%, and 48%, respectively. Finally, each physical symptom was associated with significant functional impairment; indeed, the number of physical symptoms was a powerful correlate of functional status. Conclusions The number of physical symptoms is highly predictive for psychiatric disorders and functional impairment. Multiple or unexplained symptoms may signify a potentially treatable mood or anxiety disorder. Author Affiliations From the Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Kroenke); the Biometrics Research Department, New York State Psychiatric Institute, and the Department of Psychiatry, Columbia University, New York, NY (Drs Spitzer and Williams); the Departments of Medicine, New England Medical Center, Boston, Mass (Dr Linzer), and Albert Einstein College of Medicine, Bronx, NY (Dr Hahn); the Department of Family Practice, University of South Alabama, Mobile (Dr deGruy); and the Department of Medicine, Mercy Catholic Medical Center, Darby, Pa (Dr Brody). THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES Development and Validation of a Modified Version of the Edmonton Symptom Assessment Scale in a Flemish Palliative Care Population Claessens et al. AM J HOSP PALLIAT CARE 2011;28:475-482. ABSTRACT   Tricyclic antidepressants and headaches: systematic review and meta-analysis Jackson et al. BMJ 2010;341:c5222-c5222. 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