***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We tested the hypotheses that an abridged somatization construct that we had developed would be associated with use of health services , preferential use of medical over mental health services , and an index of disability . These hypotheses were tested using structured interview data from 3,132 r and omly selected community respondents . We found that : respondents meeting criteria for somatization reported a heavier use of health services than non-somatizers ; of those respondents meeting criteria for a psychiatric diagnosis , somatizers preferentially used medical over mental health services whereas non-somatizers reported the opposite trend ; and somatizers were more likely than non-somatizers to report recent sick leave or restricted activity 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 question naire 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 non clinical 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 Objectives To determine prospect i ve changes in clinical status related to chronic fatigue over an 18-month period , and to test demographic and clinical predictors of outcome . Methods A cohort of 100 patients with unexplained chronic fatigue ( UCF ) , which encompasses both chronic fatigue syndrome ( CFS ) and idiopathic chronic fatigue ( ICF ) , completed question naire measures and medical and psychiatric evaluations on four occasions , each six months apart . Results Approximately 21 % of the sample did not meet criteria for either CFS or ICF at their last research appointment 1.5 years after their index visit . Vitality increased over time , and physical functioning tended to improve , but UCF symptoms did not decrease significantly . Less education , being unemployed , worse mental health , more use of sedating and antidepressant medications , and more somatic attributions for their symptoms were associated with worsening symptom severity over time . Older age , current depression , and more somatic attributions predicted worsening physical functioning . Better mental health , less use of sedating medications , and fewer somatic attributions for illness were significant predictors of increases in vitality . Conclusions Demographic and clinical variables predict outcomes over time among a cohort of patients with unexplained chronic fatigue Somatization is a common phenomenon that has been defined in many ways . The two most widely used diagnoses , Somatization Disorder ( SD ) and Abridged Somatization Disorder ( ASD ) , are based on lifetime unexplained symptoms . However , reports indicate instability in lifetime symptom recall among somatizing patients . Multisomatoform disorder ( MSD ) is a new diagnosis based on current unexplained symptoms . To underst and how knowledge about SD and ASD translates to MSD , we examined the diagnostic concordance , impairment and health care utilization of these groups in a sample from the Somatization in Primary Care Study . The diagnostic concordance was high between MSD and SD , but lower between MSD and ASD . All three groups reported considerable physical impairment ( measured using the PCS subscale of the SF-36 ) . The mental health ( MCS ) scores for the three groups were only slightly lower than those of the general population . Over the course of one year , physical functioning fell significantly for all three groups . Mental functioning did not change significantly for any of the three groups over this period . Utilization patterns were very similar for the three groups . The high prevalence , serious impairment , and worsening physical functioning over the course of one year suggest the importance of developing interventions in primary care to alleviate the impaired physical functioning and reduce utilization in somatizing patients . MSD should be a useful diagnosis for targeting these interventions because it identifies a sizable cohort of somatizing patients reporting impairment of comparable severity to full SD , using a more efficient diagnostic algorithm based on current symptoms OBJECTIVES To test the effect of psychological intervention on multiple medically unexplained physical symptoms , psychological symptoms , and health care utilization in addition to medical care as usual . To identify patient-related predictors of change in symptoms and care utilization . METHODS In a r and omized controlled trial , subjects were assigned to one of two conditions : psychological intervention by a qualified therapist plus care as usual by a general practitioner ( GP ) or care as usual only .  Participants ( N=98 ) were administered a st and ardized interview and several outcome measures at intake and after 6 months and 12 months after intake . GPs rated medically unexplained and explained symptoms and consultations over a period of 1 1/2 years . RESULTS ANOVAs for repeated measures showed that self-reported and GP-registered unexplained physical symptoms decreased from pretest to posttest to follow-up . Psychological symptoms and consultations decreased from pretest to posttest . GP-registered explained symptoms did not decrease . However , intervention and control groups did not differ in symptom reduction . Path analysis revealed two paths to a decrease in self-reported unexplained physical symptoms : from more negative affectivity via more psychological attribution and more pretreatment anxiety , and from more somatic attribution via more psychological attribution and more pretreatment anxiety . CONCLUSION Intervention and control groups did not differ in symptom reduction . Reduction of self-reported medically unexplained symptoms was well predicted by patient-related symptom perception variables , whereas the prediction of change in registered symptoms and consultations requires a different model 
    Output:
    
RESULTS Of all diagnostic proposals , only complex somatic symptom disorder and the Conceptual Issues in Somatoform and Similar Disorders ( CISSD ) example criteria reflect all dimensions of current biopsychosocial models of somatization ( construct validity ) and go beyond somatic symptom counts by including psychological and behavioral symptoms that are specific to somatization ( descriptive validity ) .
However , the number of somatic symptoms has been found to be a strong predictor of disability .
Some evidence indicates that psychological symptoms can predict disease course and treatment outcome ( e.g. , therapeutic modification of catastrophizing is associated with positive outcome ) .
Lengthy symptom lists , the requirement of lifetime symptom report ( as in abridged somatization ) , complicated symptom patterns ( as in current somatization disorder ) , and imprecise definitions of diagnostic procedures ( e.g. , missing symptom threshold in complex somatic symptom disorder ) reduce clinical utility .
Results from the review ed studies suggest that , of all current and new diagnostic suggestions , complex somatic symptom disorder and the CISSD definition appear to have advantages regarding validity and clinical utility .
The integration of psychological and behavioral criteria could enhance construct and descriptive validity , and confers prospect ively relevant treatment implication s. The incorporation of a dimensional approach that reflects both somatic and psychological symptom severity also has the potential to improve predictive validity and clinical utility