LNSLNS

We are grateful for the positive feedback to our summary of the new clinical practice guideline, “Non-specific, functional and somatoform bodily complaints (NFS)” (1). We thank Dr Hakimi for pointing out iatrogenic chronification factors in the form of assigning pseudo diagnoses. Examining the behaviors of treating physicians also draws attention to the importance of the interaction between treating physician and patient for maintaining as well as treating NFS.

In our opinion, “intestinal mycosis/candidiasis” is indeed a pseudo diagnosis, as the mere confirmation of Candida in a stool specimen (in more than half of the adult population 102–104 KBE/g faeces) should not be equated to intestinal mycosis, and as there is no empirical proof for the existence of clinically relevant “Candida hypersensitivity syndrome” (2). Similarly, we need to take care that for the syndromes “multiple chemical sensitivity (MCS),” “sick building syndrome,” “electromagnetic hypersensitivity,” or “amalgam hypersensitivity” the required awareness of biopsychosocial interactions is not blocked by unilateral externalizing causal attribution (3).

According to the NSF guideline, the range of possible diagnoses—depending on symptoms, severity, course, and psychosocial impairment and on the diagnostic process—covers non-specific symptomatic diagnoses (ICD-10 R00–R99: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified) as well as functional somatic syndromes (FSS) (one or, often, several) and, at the other end of the spectrum, somatization disorders (ICD-10 F45.0–F45.9). Relevant comorbid conditions (for example, depression, anxiety, addiction) need to be coded in addition. Telling the diagnosis to the patient should follow a clear explanation of the complaints within a biopsychosocial explanatory model; the terms “functional” or “bodily stress” are tried and tested. Definitions and information especially for affected persons and their families are offered in a newly published patient version of the guideline (4).

DOI: 10.3238/arztebl.2013.0270b

Dr. med. Rainer Schaefert
Klinik für Allgemeine Innere Medizin und Psychosomatik, Universitätsklinikum Heidelberg

Rainer.Schaefert@med.uni-heidelberg.de

Conflict of interest statement
The author declares that no conflict of interest exists.

1.
Schaefert R, Hausteiner-Wiehle C, Häuser W, Ronel J, Herrmann M, Henningsen P: Clinical Practice Guideline: Non-specific, functional and somatoform bodily complaints. Dtsch Arztebl Int 2012; 109(47): 803–13. VOLLTEXT
2.
Schulze J, Sonnenborn U: Yeasts in the gut: From commensals to infectious agents. Dtsch Arztebl Int 2009; 106(51–52): 837–42 VOLLTEXT
3.
Hausteiner-Wiehle C, Henningsen P, Häuser W, Herrmann M, Ronel J, Sattel H, Schäfert R: Umgang mit Patienten mit nicht-spezifischen, funktionellen und somatoformen Körperbeschwerden. S3-Leitlinie mit Quellentexten, Praxismaterial und Patientenleitlinie. Stuttgart: Schattauer 2013 MEDLINE
4.
Matzat J, Jäniche H, Hausteiner-Wiehle C: „Mein Arzt findet nichts“ – so genannte nicht-spezifische, funktionelle und somatoforme Körperbeschwerden. Eine Leitlinie für Betroffene und ihre Angehörigen. AWMF-Reg.-Nr. 051–001 2012; www.awmf.org/leitlinien/detail/ll/051–001.html (last accessed on 20 January 2013).
1.Schaefert R, Hausteiner-Wiehle C, Häuser W, Ronel J, Herrmann M, Henningsen P: Clinical Practice Guideline: Non-specific, functional and somatoform bodily complaints. Dtsch Arztebl Int 2012; 109(47): 803–13. VOLLTEXT
2.Schulze J, Sonnenborn U: Yeasts in the gut: From commensals to infectious agents. Dtsch Arztebl Int 2009; 106(51–52): 837–42 VOLLTEXT
3.Hausteiner-Wiehle C, Henningsen P, Häuser W, Herrmann M, Ronel J, Sattel H, Schäfert R: Umgang mit Patienten mit nicht-spezifischen, funktionellen und somatoformen Körperbeschwerden. S3-Leitlinie mit Quellentexten, Praxismaterial und Patientenleitlinie. Stuttgart: Schattauer 2013 MEDLINE
4.Matzat J, Jäniche H, Hausteiner-Wiehle C: „Mein Arzt findet nichts“ – so genannte nicht-spezifische, funktionelle und somatoforme Körperbeschwerden. Eine Leitlinie für Betroffene und ihre Angehörigen. AWMF-Reg.-Nr. 051–001 2012; www.awmf.org/leitlinien/detail/ll/051–001.html (last accessed on 20 January 2013).

Info

Specialities