Modifiable Factors for Somatic Symptom Persistence in Patients with Somatic Symptom Disorder (RU SOMACROSS)

躯体症状障碍（SSD）是一种令人痛苦的精神障碍，其特征是存在至少一种持续的躯体症状，并且由于与躯体症状或相关健康问题相关的过度想法，感觉或行为而造成显著的心理负担。目前SSD的病因学模型将预期视为诱发因素和维持因素。然而，前瞻性的影响，患者的期望作为潜在的可修改的因素，对躯体症状的严重程度和他们与其他相关因素，如躯体comormality.This拟议的研究旨在探讨多变量预测模型，躯体症状持续性SSD患者的相互作用还没有研究。我们假设患者对症状严重程度的预期和不同程度的躯体共病与躯体症状严重程度相关。此外，我们假设这两个因素独立或共同与其他预先指定的生物医学和心理社会因素，如先前的治疗经验，确定长期的症状过程中的12个月的宏观水平，他们是预测每日波动的躯体症状的严重程度在10天的微观水平。探索性地，我们将分析不同的预期措施的影响，以及介质的建议的影响躯体comorrhiza.This是一个前瞻性的，单中心队列研究的躯体症状严重程度作为主要结果在N=240例SSD超过一年的嵌入式生态瞬时10天的日常症状波动的评估。期望测量包括在微观层面上使用两种不同的参考框架对外显期望进行重复评估以及探索性的内隐期望测量。将通过研究医生进行的标准化评分、病历和医学检查来测量躯体共病。多变量预测模型与分层混合模型将被用来检查的期望和躯体共病对症状严重程度的影响，作为微观层面上的主要结果。在微观层面上，关于日常症状波动的假设将使用多变量潜在增长曲线models.To我们的知识，这是第一次调查的角色和时间的影响，期望作为可修改的决定因素的躯体症状严重程度的SSD患者。深入分析宏观层面的症状过程和微观层面的症状严重程度的波动，同时考虑到躯体共病和其他生物医学和心理因素的作用，将提供临床相关的结论，未来有针对性的治疗方案。此外，我们将得出结论，体细胞合并症作为一个潜在的诊断说明SSD的效用。

Somatic symptom disorder (SSD) is a distressing mental disorder characterised by the presence of at least one persistent somatic symptom and a significant psychological burden due to excessive thoughts, feelings, or behaviours related to somatic symptoms or associated health concerns. Current aetiological models of SSD construe expectations both as predisposing and as maintaining factors. However, the prospective influences of patients’ expectations as potentially modifiable factors on somatic symptom severity and their interaction with other relevant factors such as somatic comorbidity have not been studied.This proposed study aims to investigate multivariable prediction models for somatic symptom persistence in patients with SSD. We hypothesise that patients’ expectations of symptom severity and different levels of somatic comorbidity are associated with somatic symptom severity. Furthermore, we hypothesise that these two factors independently or cojointly with other pre-specified biomedical and psychosocial factors such as prior treatment experience determine the long-term symptom course on a 12 months macro level and that they are predictive of daily fluctuations of somatic symptoms severity on a 10-day micro level. Exploratively, we will analyse the impact of different expectation measures as well as mediators of the proposed impact of somatic comorbidity.This is a prospective, single-centre cohort study of somatic symptom severity as primary outcome in N=240 patients with SSD over one year with an embedded ecological momentary 10-day assessment of daily symptom fluctuation. Expectation measures inlcude repeated assessments of explicit expectations using two different frames of reference on the micro level as well as exploratory implicit expectation measures. Somatic comorbidity will be measured via standardised ratings, medical records, and medical exams that are performed by study physicians. Multivariable prediction models with hierarchical mixed models will be used to examine the influence of expectations and somatic comorbidity on symptom severity as primary outcome on the micro level. On the micro level, hypothesis regarding daily symptom fluctuations will be anaylsed using multivariable latent growth curve models.To our knowledge, this is the first investigation of the roles and temporal impacts of expectations as modifiable determinants of somatic symptom severity in patients with SSD. The in-depth analyses of macro level symptom course and micro level fluctuations of symptom severity, while simultaneously considering the role of somatic comorbidity and other biomedical and psychological factors, will render clinically relevant conclusions regarding future targeted treatment options. Furthermore, we will draw conclusions regarding the utility of somatic comorbidity as a potential diagnostic specifier for SSD.