Phychiatric Profiles of Patients With Oral Psychosomatic Disorders-A 16-Year Study in Japan's Liaison Psychiatric Clinic
Umemura E, Ito M, Nagashima W, Tokura T, Kimura H, Arao M, Kobayashi Y, Miyauchi T, Ozaki N, Kurita K.
Statement of the problem
Recently, the role of liaison psychiatry has become increasingly important in Japan. For example, it is not unusual to encounter patients with medically unexplained oral symptoms of pain or discomfort. However, clinicians who specialize in both oral and maxillofacial medicine and psychiatry are rare.
Materials and methods
In 1999, a Liaison Psychiatric Clinic was established in Aichi Gakuin University Hospital for diagnosis and treatment of oral psychological disorders. This clinic consists of both dentists and psychiatrists. Initially, a dentist examined each patient and diagnosed his/her oral psychosomatic disorder. Subsequently, a psychiatrist made a psychiatric diagnosis based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-Ⅳ-TR). The categories of oral psychosomatic disorder and psychiatric diagnosis were examined.
Method of data analysis
The study was conducted at the Liaison Psychiatric Clinic in Aichi Gakuin University Hospital from January 1999 to February 2014 among 906 new oral psychosomatic patients. Initially, a dentist made an oral psychosomatic diagnosis as BMS (burning mouth syndrome), AO (atypical odontalgia), Oral paresthesia, Taste disorder, TMD (temporomandibular disorder), Xerostomia, Dental phobia, Trigeminal neuralgia, Halitosis and Others. And a psychiatrist made a psychiatric diagnosis as Psychotic disorders, Mood disorders, Anxiety disorders, Somatoform disorders, Personality disorders and no diagnosis. The oral psychosomatic disorder and psychiatric diagnosis were examined as percentages for categorical variables.
Results of investigation
Among 906 patients, 154(18.2%) were men while 741(81.8%) were women. The average age of men and women were 58.9±16.8 and 59.4±12.3 respectively. The broad categories of oral psychosomatic disorders seen were: 370(40.8%) with BMS, 185(20.4%) with AO, 146(16.1%) with Oral paresthesia, 43(4.7%) with Taste disorder, 42(4.6%) with TMD, 24(2.6%) with Xerostomia, 18(2.0%) with Dental phobia, 6(0.7%) with Trigeminal neuralgia, 4(0.5%) with Halitosis and 68(7.5%) with Others. The broad categories of oral psychiatric diagnosis seen were: 712(78.6%) with Somatoform disorders, 53(5.8%) with Mood disorders, 33(3.6%) with Psychotic disorders, 33(3.6%) with Anxiety disorders, 7(0.8%) with Personality disorders and 60(6.6%) with no diagnosis. Among 712 Somatoform disorder patients, 516(72.5%) were Pain disorder patients and 174(24.4%) were Conversion disorder patients. And more than 90% of BMS and AO patients suffered from Pain disorder, while 70 % of Oral Paresthesia and Taste Disorder patients suffered from Conversion disorder. Among 33 Anxiety disorder patients, 13(39.4%) were Specific phobia patients and 6(18.2%) were Social anxiety disorder patients. Among 33 Psychotic disorder patients, 3(9.1%) were Paranoid disorder patients. Approximately 55% of Dental phobia patients suffered from Specific phobia, while 40% of Halitosis suffered from Paranoid disorder and 40% suffered from Social anxiety disorder.
Conclusion
Liaison psychiatry based on a link between psychiatry and dentistry provides a very useful diagnostic and treatment service for medical practitioners. Although oral psychosomatic disorders occur in the absence of any organic cause, the psychiatric diagnosis can differ substantially. In understanding the different types of psychiatric disorders and the corresponding treatment needs, clinicians can better manage patients with the condition. We believe this 16-year clinical data would contribute to the understanding and treatment of oral psychosomatic disorders.
Reference
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2. Effectiveness of duloxetine for the treatment of chronic nonorganic orofacial pain. Nagashima W, Kimura H, Ito M, Tokura T, Arao M, Aleksic B, Yoshida K, Kurita K, Ozaki N. Clin Neuropharmacol. 2012 Nov-Dec;35(6):273-7.