BACKGROUND: Somatoform disorders are characterised by chronic, medically unexplained physical symptoms (MUPS). Although different medications are part of treatment routines for people with somatoform disorders in clinics and private practices, there exists no systematic review or meta-analysis on the efficacy and tolerability of these medications. We aimed to synthesise to improve optimal treatment decisions.OBJECTIVES: To assess the effects of pharmacological interventions for somatoform disorders (specifically somatisation disorder, undifferentiated somatoform disorder, somatoform autonomic dysfunction, and pain disorder) in adults.SEARCH METHODS: We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) (to 17 January 2014). This register includes relevant randomised controlled trials (RCTs) from The Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). To identify ongoing trials, we searched ClinicalTrials.gov, Current Controlled Trials metaRegister, the World Health Organization International Clinical Trials Registry Platform, and the Chinese Clinical Trials Registry. For grey literature, we searched ProQuest Dissertation {\&} Theses Database, OpenGrey, and BIOSIS Previews. We handsearched conference proceedings and reference lists of potentially relevant papers and systematic reviews and contacted experts in the field.SELECTION CRITERIA: We selected RCTs or cluster RCTs of pharmacological interventions versus placebo, treatment as usual, another medication, or a combination of different medications for somatoform disorders in adults. We included people fulfilling standardised diagnostic criteria for somatisation disorder, undifferentiated somatoform disorder, somatoform autonomic dysfunction, or somatoform pain disorder.DATA COLLECTION AND ANALYSIS: One review author and one research assistant independently extracted data and assessed risk of bias. Primary outcomes included the severity of MUPS on a continuous measure, and acceptability of treatment.MAIN RESULTS: We included 26 RCTs (33 reports), with 2159 participants, in the review. They examined the efficacy of different types of antidepressants, the combination of an antidepressant and an antipsychotic, antipsychotics alone, or natural products (NPs). The duration of the studies ranged between two and 12 weeks.One meta-analysis of placebo-controlled studies showed no clear evidence of a significant difference between tricyclic antidepressants (TCAs) and placebo for the outcome severity of MUPS (SMD -0.13; 95{\%} CI -0.39 to 0.13; 2 studies, 239 participants; I(2) = 2{\%}; low-quality evidence). For new-generation antidepressants (NGAs), there was very low-quality evidence showing they were effective in reducing the severity of MUPS (SMD -0.91; 95{\%} CI -1.36 to -0.46; 3 studies, 243 participants; I(2) = 63{\%}). For NPs there was low-quality evidence that they were effective in reducing the severity of MUPS (SMD -0.74; 95{\%} CI -0.97 to -0.51; 2 studies, 322 participants; I(2) = 0{\%}).One meta-analysis showed no clear evidence of a difference between TCAs and NGAs for severity of MUPS (SMD -0.16; 95{\%} CI -0.55 to 0.23; 3 studies, 177 participants; I(2) = 42{\%}; low-quality evidence). There was also no difference between NGAs and other NGAs for severity of MUPS (SMD -0.16; 95{\%} CI -0.45 to 0.14; 4 studies, 182 participants; I(2) = 0{\%}).Finally, one meta-analysis comparing selective serotonin reuptake inhibitors (SSRIs) with a combination of SSRIs and antipsychotics showed low-quality evidence in favour of combined treatment for severity of MUPS (SMD 0.77; 95{\%} CI 0.32 to 1.22; 2 studies, 107 participants; I(2) = 23{\%}).Differences regarding the acceptability of the treatment (rate of all-cause drop-outs) were neither found between NGAs and placebo (RR 1.01, 95{\%} CI 0.64 to 1.61; 2 studies, 163 participants; I(2) = 0{\%}; low-quality evidence) or NPs and placebo (RR 0.85, 95{\%} CI 0.40 to 1.78; 3 studies, 506 participants; I(2) = 0{\%}; low-quality evidence); nor between TCAs and other medication (RR 1.48, 95{\%} CI 0.59 to 3.72; 8 studies, 556 participants; I(2) =14{\%}; low-quality evidence); nor between antidepressants and the combination of an antidepressant and an antipsychotic (RR 0.80, 95{\%} CI 0.25 to 2.52; 2 studies, 118 participants; I(2) = 0{\%}; low-quality evidence). Percental attrition rates due to adverse effects were high in all antidepressant treatments (0{\%} to 32{\%}), but low for NPs (0{\%} to 1.7{\%}).The risk of bias was high in many domains across studies. Seventeen trials (65.4{\%}) gave no information about random sequence generation and only two (7.7{\%}) provided information about allocation concealment. Eighteen studies (69.2{\%}) revealed a high or unclear risk in blinding participants and study personnel; 23 studies had high risk of bias relating to blinding assessors. For the comparison NGA versus placebo, there was relatively high imprecision and heterogeneity due to one outlier study. Although we identified 26 studies, each comparison only contained a few studies and small numbers of participants so the results were imprecise.AUTHORS' CONCLUSIONS: The current review found very low-quality evidence for NGAs and low-quality evidence for NPs being effective in treating somatoform symptoms in adults when compared with placebo. There was some evidence that different classes of antidepressants did not differ in efficacy; however, this was limited and of low to very low quality. These results had serious shortcomings such as the high risk of bias, strong heterogeneity in the data, and small sample sizes. Furthermore, the significant effects of antidepressant treatment have to be balanced against the relatively high rates of adverse effects. Adverse effects produced by medication can have amplifying effects on symptom perceptions, particularly in people focusing on somatic symptoms without medical causes. We can only draw conclusions about short-term efficacy of the pharmacological interventions because no trial included follow-up assessments. For each of the comparisons where there were available data on acceptability rates (NGAs versus placebo, NPs versus placebo, TCAs versus other medication, and antidepressants versus a combination of an antidepressant and an antipsychotic), no clear differences between the intervention and comparator were found.Future high-quality research should be carried out to determine the effectiveness of medications other than antidepressants, to compare antidepressants more thoroughly, and to follow-up participants over longer periods (the longest follow up was just 12 weeks). Another idea for future research would be to include other outcomes such as functional impairment or dysfunctional behaviours and cognitions as well as the classical outcomes such as symptom severity, depression, or anxiety.

Pharmacological interventions for somatoform disorders in adults.

This critical review presents a comprehensive study of transition-metal carboxylate clusters which may serve as secondary building units (SBUs) towards construction and synthesis of metal–organic frameworks (MOFs). We describe the geometries of 131 SBUs, their connectivity and composition. This contribution presents a comprehensive list of the wide variety of transition-metal carboxylate clusters which may serve as secondary building units (SBUs) in the construction and synthesis of metal–organic frameworks. The SBUs discussed here were obtained from a search of molecules and extended structures archived in the Cambridge Structure Database (CSD, version 5.28, January 2007) which included only crystals containing metal carboxylate linkages (241 references).

/pdf/secondary-building-units-nets-and-bonding-in-the-chemistry-o0m4ttzsgz.pdf

Secondary building units, nets and bonding in the chemistry of metal–organic frameworks

J-aggregates are of significant interest for organic materials conceived by supramolecular approaches. Their discovery in the 1930s represents one of the most important milestones in dye chemistry as well as the germination of supramolecular chemistry. The intriguing optical properties of J-aggregates (in particular, very narrow red-shifted absorption bands with respect to those of the monomer and their ability to delocalize and migrate excitons) as well as their prospect for applications have motivated scientists to become involved in this field, and numerous contributions have been published. This Review provides an overview on the J-aggregates of a broad variety of dyes (including cyanines, porphyrins, phthalocyanines, and perylene bisimides) created by using supramolecular construction principles, and discusses their optical and photophysical properties as well as their potential applications. Thus, this Review is intended to be of interest to the supramolecular, photochemistry, and materials science communities.

J-aggregates: from serendipitous discovery to supramolecular engineering of functional dye materials.

Research on relationships between anxiety and depression has proceeded at a rapid pace since the 1980s. The similarities and differences between these two conditions, as well as many of the important features of the comorbidity of these disorders, are well understood. The genotypic structure of anxiety and depression is also fairly well documented. Generalized anxiety and major depression share a common genetic diathesis, but the anxiety disorders themselves are genetically hetergeneous. Sophisticated phenotypic models have also emerged, with data converging on an integrative hierarchical model of mood and anxiety disorders in which each individual syndrome contains both a common and a unique component. Finally, considerable progress has been made in understanding cognitive aspects of these disorders. This work has focused on both the cognitive content of anxiety and depression and on the effects that anxiety and depression have on information processing for mood-congruent material.

https://sites.oxy.edu/clint/physio/article/comorbidityofanxietyandunipolarmooddisorders.pdf

Comorbidity of anxiety and unipolar mood disorders

Photoluminescence Properties of Multinuclear Copper(I) Compounds.

The aim of this study was to evaluate whether specific cognitive aspects are present in patients suffering from somatoform disorders. With a sample of 493 patients from a center for behavioral medicine, the authors evaluated a questionnaire assessing typical cognitions concerning body perception, illness behavior, and health. The authors further examined 225 participants, including patients with a somatization syndrome, patients with somatization syndrome and additional hypochondriasis, patients with hypochondriasis, patients with other mental disorders (clinical control group), and nonclinical controls. The results showed that not only patients with hypochondriasis but also patients with somatization syndrome had cognitive concerns and assumptions that were specific for the disorder. These patients had a self-concept of being weak and unable to tolerate stress. A catastrophizing interpretation of minor bodily complaints found in hypochondriacal patients in earlier studies was also found for patients with multiple somatization symptoms.

Cognitive aspects of hypochondriasis and the somatization syndrome.

: The crystal and molecular structure of the compound catena-micron-oxo-hemiporphyrazinatoiron(IV), (Fe0N8C26H14n), has been determined from single-crystal, three-dimensional X-ray diffraction counter data. The compound crystalizes as blue-black needles in space group P2/n with Z = 2 and having unit cell dimensions (at 210 K) a = 16.090 (3) angstroms, b = 3.975 (2) angstroms, c = 16.070 (3) and beta = 92.97 (1). The structure was refined by full-matrix least-squares techniques to a conventional R value of 0.054. Distorted hemiporphyrazinatoiron units stack along the b axis and are linked into polymeric, uniformly spaced, linear chains by axially-bound oxygen bridges. The oxygen atoms are disordered into two crystallographically distinct sites lying about a central location which is normal to the C2 axis collinear with the chain. The Fe-0-Fe angles are 158.2 and 170.5, and the Fe-0 bond distances range from 1.973 angstroms to 2.030 angstroms, Mossbauer spectral studies at 4.2 K, room temperature and at 420 K reveal that there are two iron sites in the chain as a result of the disorder of the oxygen atoms, and the spectrum is essentially temperature independent. Magnetic susceptibility studies reveal that the iron ions are antiferromagnetically coupled in an alternating chain with J = -133 per cm, g = 2.3 and an alternation parameter of 0.4.

Synthesis, Structure and Magnetic Properties of Catena-Micron-Oxo-Hemiporphyrazinatoiron(IV), the First Polymeric Micron-Oxo-Bridged Complex of Iron.

Background The DSM-IV definition of hypochondriasis is contrasted with hypochondriacal dimensions as provided by the Whiteley Index (WI) and Illness Attitude Scales (IAS). Methods Exploratory factor analysis was conducted on self-report data from 570 patients with mental and psychophysiological disorders. Of these, 319 were additionally diagnosed according to DSM-IV by structured interviews. Results The three 'classic' factors of the WI labelled disease phobia, somatic symptoms and disease conviction were confirmed. The IAS consisted of two dimensions indicating health anxiety and illness behaviour. The overall scores of both instruments were highly correlated (0.80). Optimal cut-off points for case identification yielded sensitivity/specificity rates of 71/80% (WI) and 72/79% (IAS). The IAS was superior to the WI when patients with hypochondriacal disorder were to be discriminated from non-hypochondriacal somatizers. Largest group differences were found for scales related to affective components (health anxieties), smallest for illness behaviours. Affective components of hypochondriasis explained more variance of diagnostic group membership than somatization symptoms. The subscales of disease phobia (WI) and health anxiety (IAS) were most sensitive to treatment-related changes. Conclusions The self-rating scales are valid for screening, case definition and dimensional assessment of hypochondriacal disorder, including the differentiation between hypochondriasis and somatization. The existence of distinguishable affective and cognitive components was confirmed.

Dimensional and categorical approaches to hypochondriasis

A psychometric study of complaints in chronic tinnitus.

Oxo-phthalocyaninato-titan(IV) (PcTiO) shows weak electrical conductivity of 5 · 10~ Ω\" 1 cm\" 1 at room temperature. Doping of PcTiO with I2 is accompanied by an increase of conductivity up to 5· 10\" Ω \" 1 cm\" 1 . PcTiO was found to exist in two modifications built up by monomeric complexes: Phase I crystallizes monoclinic in the space group Ρ 2 l /c with the lattice constants a = 1341.1(6) pm, b = 1323.0(3) pm, c = 1381.0(4) pm, β = 103.72(3)°, Ζ = 4. Phase II forms a triclinic structure in space group PT and an unit cell of dimensions a = 1216.6(4)pm, b = 1258.4(5)pm, c = 864.1 (3)pm, α = 96.28(3)°, β = 95.03(4)°, y = 67.86(4)°, Ζ = 2. In both modifications the Ti-atom exhibits a square pyramidal coordination with a short Ti — Ο distance of 165 pm and 163 pm, respectively. Close contacts exist between the phthalocyaninato planes of neighbouring molecules.

Wolfgang Hiller

Papers

Cognitive aspects of hypochondriasis and the somatization syndrome.

Synthesis, Structure and Magnetic Properties of Catena-Micron-Oxo-Hemiporphyrazinatoiron(IV), the First Polymeric Micron-Oxo-Bridged Complex of Iron.

Dimensional and categorical approaches to hypochondriasis

A psychometric study of complaints in chronic tinnitus.

Polymorphie, Leitfähigkeit und Kristallstrukturen von Oxo-phthalocyaninato-titan(IV)