Journal of Psychosomatic Research (J PSYCHOSOM RES)

Despite previous investigation, uncertainty remains about the nature of the associations of major depression (MD) with type 2 diabetes mellitus (T2DM), particularly in adult Chinese, and the relevance of generalized anxiety disorder (GAD) for T2DM. Cross-sectional data from the China Kadoorie Biobank Study, a sample of approximately 500,000 adults from 10 geographically defined regions of China, were analyzed. Past year MD and GAD were assessed using the Composite International Diagnostic Inventory. T2DM was defined as either having self-reported physician diagnosis of diabetes at age 30 or later ("clinically-identified" cases) or having a non-fasting blood glucose≥11.1mmol/L or fasting blood glucose≥7.0mmol/L but no prior diagnosis of diabetes ("screen-detected" cases). Logistic regression was used to assess the relationship between MD and GAD with clinically-identified and screen-detected T2DM, adjusting for demographic characteristics and health behaviors. The prevalence of T2DM was 5.3% (3.2% clinically-identified and 2.1% screen-detected). MD was significantly associated with clinically-identified T2DM (odds ratio [OR]: 1.75, 95% confidence interval (CI): 1.47-2.08), but not with screen-detected T2DM (OR: 1.18, 95% CI: 0.92-1.51). GAD was associated with clinically-identified (OR: 2.14, 95% CI: 1.60-2.88) and modestly associated with screen-detected (OR: 1.44, 95% CI: 0.99-2.08) T2DM. The relationship between MD and GAD with T2DM was moderated by obesity. MD is associated with clinically-identified, but not screen-detected T2DM. GAD is associated with both clinically-identified and screen-detected T2DM. The relationship between MD and T2DM is strongest among those who are not obese.

Epidemiological evidence suggests an association between psychological factors and functional dyspepsia (FD). Yet few randomized controlled trials (RCTs) of psychological interventions have been conducted for FD. We conducted an RCT to evaluate the efficacy of psychotherapy among chronic FD. One hundred fifty-eight consecutive patients with FD were randomized to medical therapy plus psychotherapy consisted in 8 group and 2 individual sessions focused on teaching techniques for coping with FD (intensive treatment (IT); n=76) or medical therapy alone (conventional treatment (CT); n=82). Patients completed validated self-reported questionnaires before and after the 10-week treatment and 6months later. Linear mixed-effects models were used, in intention-to-treat analysis. At the end of treatment period, statistically significant improvements were observed for IT compared with CT for dyspepsia-related quality of life (DRQoL). DRQoL mean changes of 6.09 and 3.54 were obtained in IT and CT patients, respectively (p=<0.0001); and SS mean changes of 11.55 and 4.57 were obtained in IT and CT patients, respectively (p=0.0013). Those improvements, measured by minimum clinically important difference (MCID), were clinically significant (DRQoL: 77% of the IT patients exceeded the MCID vs the 45% of the CT; SS: 75% vs 48%). Six months after treatment, those statistically significant improvements persisted for DRQoL (p=0.0067) and for SS (p=0.0405). Clinical improvements persisted for SS (63% vs 41%). These findings suggest that adding psychotherapy to standard medical therapy improves short-term outcomes in patients with FD and may have long-term effects as well. The cost-effectiveness of intensive therapy needs to be evaluated. Registration number and name of trial registry: NCT01802710. Copyright © 2015 Elsevier Inc. All rights reserved.

In a longitudinal developmental study, 90 boys and girls participated in a psychological investigation and were medically examined when they were 11, 13, 15 and 18 years old. Habitual somatic discomfort was assessed by means of a questionnaire. Frequency of reported symptoms reached a peak at age-level 13. Females reported more symptoms than males at age 15 and 18, and the constancy over age of the symptoms was greater in the female group. Frequency of discomfort symptoms was unrelated to the variables of the medical examinations, but positively related to measures of anxiety, and negatively related to satisfaction with the situation at home and (at some age levels) to self-esteem and to experienced attractiveness and body-image satisfaction. At age-level 18, frequency of symptoms was (a) negatively related in the male and positively in the female group to overachievement in school, and (b) negatively related, in both sexes, to neuroendocrinological reactivity to examination stress in subjects taking the matriculation examinations.

The objectives of this study were (a) to elucidate the methodological problems arising when examining lifetime symptom data by exploring the accuracy of recall of medically unexplained symptoms (MUS) and medically explained symptoms (MES) in the general population, based on interviews using the Composite International Diagnostic Interview (CIDI) Somatoform Section C, in 1990 and 2001, and (b) to find predictors for failure at follow-up to recall symptoms reported previously at baseline (i.e., symptoms "lost"). Four hundred twenty-one persons (response rate, 69.6%; 242 women and 179 men) were reinterviewed in 2001 from a baseline population of 605. Thirty-eight clinically significant MUS and MES were assessed. Linear multiple regression analyses with the numbers of MUS-lost (medically unexplained symptoms lost to recall) and MES-lost (medically explained symptoms lost to recall) as dependent variables were undertaken to find factors affecting symptom loss. A wide range of individual symptoms (22-100%) were lost to recall at follow-up, indicating a large degree of measurement error, mainly due to faulty recall. The number of symptoms recalled when they were grouped was better (approximately 50% for "1-3" symptoms). Recall variability and MUS/MES transition over time undermined the credibility of this distinction. Gender and age emerged as significant (P<.01) predictors for MUS-lost, and a decrease in physical morbidity for MES-lost. Men tended to forget more symptoms than women, and younger respondents with high levels of baseline MUS remembered slightly better at follow-up. Lifetime symptom data elicited in community surveys by such instruments as the CIDI should be viewed with caution. Methodological errors weakening data credibility could lead to false impressions of true change over time. A MUS/MES distinction is difficult to maintain.

Maternal stress during pregnancy has been reported to have an adverse influence on fetal growth. The terrorist attacks of September 11, 2001, on the United States have provoked feelings of insecurity and stress worldwide. Our aim was to test the hypothesis that maternal exposure to these acts of terrorism via the media had an unfavorable influence on mean birth weight in the Netherlands. We compared birth weights of 1885 Dutch neonates who were in utero during the attacks with those of 1258 neonates who were in utero exactly 1 year later. In the exposed group, birth weight was lower than in the nonexposed group (difference, 48 g; 95% confidence interval=13.6, 82.9; P=.006). The difference in birth weight could not be explained by tobacco use, maternal age, parity, or other potential confounders or by shorter pregnancy durations. These results provide evidence supporting the hypothesis that exposure of Dutch pregnant women to the 9/11 events via the media has had an adverse effect on the birth weight of their offspring.

The association between women's overall experience of labor and birth and a range of possible explanatory variables were studied in a group of 1111 women who participated in a birth center trial. Data were collected by a questionnaire in early pregnancy (demographic background, parity, personality traits, and expectations), hospital records (pharmacological pain relief, induction, augmentation of labor, duration of labor, operative delivery, and infant outcome), and a follow-up questionnaire 2 months after the birth (the principal outcome "overall experience of labor and birth," pain, anxiety, freedom in expression, involvement, midwife, and partner support). Logistic regression was conducted by including all variables that were associated with the birth experience when analyzed one by one. In a second regression analysis, only explanatory variables measured independently of the principal outcome were included; that is, only data collected from the pregnancy questionnaire and the hospital records. The first regression analysis identified five explanatory variables: involvement in the birth process (perceived control) and midwife support were associated with a positive experience; anxiety, pain, and having a first baby with a negative experience. Parity remained a significant predictor in the second regression analysis, but the others were replaced by augmentation of labor, cesarean section, instrumental vaginal delivery, and nitrous oxide (Entonox), which were all associated with a negative birth experience.

One-hundred and twelve cadets attending the 141st training course for reserve officers of the 'Scuola Transmission' of the Italian Army were administered, 10 days after incorporation, a battery of personality tests and measures of stressful events in the preceding year. Test scores were considered both individually and grouped into factors. During the 6 months of the course all disease episodes for each cadet were recorded. Total episodes infections and traumas were considered. A significantly higher number of total episodes and, specifically, of infections was present in subjects reporting a higher number of stressful events, in interaction with attitudes towards parent figures, hardiness, loneliness, and an alienation factor. A younger age of subjects also appeared predictive of a higher number of total episodes and infections, as a main effect and in interaction with attitudes to mother, hardiness, and alienation. Very few effects were obtained for traumas, suggesting that the effects of variables are mediated through a biological route rather than through behaviour, as would be the case if traumas were involved. No effect was shown by measures of stressful events alone. Results are discussed in the light of a reconsideration of the notion of stressful events.

A number of recent studies suggest that diabetes mellitus confers a high risk for the development of anorexia nervosa or bulimia nervosa. In order to test this hypothesis, 56 women with IDDM and 60 non-diabetic female controls were studied. All subjects completed the Eating Attitudes Test (EAT), and the Bulimic Investigatory Test, Edinburgh (BITE). The subjects were interviewed in order to obtain clinical and demographic information as well as to determine test validity. The DSM-III-R criteria of anorexia nervosa and bulimia nervosa were used. Four items were removed from the original EAT in order to eliminate possible bias related to IDDM. The results did not support the hypothesis that eating disturbances occur more frequently in IDDM-patients. Six criteria are proposed to improve the methodological standards of future studies in order to facilitate comparison of results.

Information about sexual activity, enjoyment and libido was obtained at intervals from 119 primiparous women during a longitudinal survey of maternal emotional health in pregnancy and for a year after delivery. Most subjects described some reduction in the frequency of sexual intercourse and a diminution of libido and sexual enjoyment during pregnancy; this was most marked in the third trimester. After delivery, about a third of subjects had resumed intercourse by 6 weeks and nearly everyone had done so by 3 months. Nevertheless, 77% of the women were having intercourse less often at 3 months post-natally in comparison with the month before they became pregnant. A few subjects described very marked and persistent reductions in sexuality and, overall, at a year post-natally about a fifth of the sample were having intercourse less than once weekly as compared with 6% in the 3 months before they conceived. Except during the third trimester when most women reported having infrequent or no intercourse, individual levels of sexual activity and enjoyment remained very firmly related to the subjects' own pre-pregnancy “baselines”.Selected variables (personal, social, medical) were examined for relationships with a low, or reduced frequency of intercourse and with a lack of enjoyment. Significant associations were found with particular measures at different times before conception, in pregnancy and post-natally; such variables included aspects of maternal personality and childhood relationships, marital conflict, maternal depression, previous miscarriages, difficulties in conceiving and fears of harming the foetus. Factors such as nausea and vomiting during pregnancy, the mode of delivery and related obstetric and medical variables, breast-feeding, characteristics of the baby, did not appear to significantly influence maternal sexuality.

The development of ICD-11 provides an opportunity to update the description of delirium according to emerging data that have added to our understanding of this complex neuropsychiatric syndrome. Synthetic article based on published work considered by the authors to be relevant to the definition of delirium. The current DSM-IV definition of delirium is preferred to the ICD-10 because of its greater inclusivity. Evidence does not support major changes in the principal components of present definitions but a number of key issues for the updated definition were identified. These include better account of non-cognitive features, more guidance for rating contextual diagnostic items, clearer definition regarding the interface with dementia, and accounting for illness severity, clinical subtypes and course. Development of the ICD definition of delirium can allow for more targeted research and clinical effort.

Few studies have investigated relationships between psychological variables and survival after bone marrow transplantation (BMT). There is some evidence that psychological variables play a role in the course of cancer, and also after BMT. The present study focused on relationships between psychological variables and survival after BMT, in addition to prognostic disease, treatment, and demographic variables. In a consecutive sample of 123 patients undergoing BMT between 1987 and 1992, psychological variables were assessed before BMT. None of the psychological variables was univariately related to survival when entered into a Cox proportional hazards model as continuous variables. When divided into four groups of equal size, based on the 25th, 50th, and 75th percentiles, low self-esteem tended to be related to shorter survival. In multivariate analyses, none of the psychosocial variables measured before BMT was significant. Our data do not support the view that psychological variables influence survival after BMT.

Light is a powerful synchronizer of the biological clock and of the sleep/wake cycle. Blind people have more sleep disturbances than people without eyesight problems. However, whether visually able people who are underexposed to bright natural light suffer from sleep wake disorders has never been examined. This study tried to assess the prevalence of sleep and wake disorders in subjects working in environments that are not exposed to natural light. A setting-controlled cross-sectional epidemiological study was carried out. A representative sample of 13,296 French employees of a single transportation company participated in the study. During working hours, 4635 subjects (34.9%) experienced no light exposure (NLE) and 8661 were partially or completely exposed (LE) to natural light. Sleep disorders, sleep quality, and sleepiness were assessed using subjective tools: the Sleep Disorders Questionnaire-French version (SDQFV) and the Epworth Sleepiness Scale (ESS). Light exposure was estimated on workers' schedules and by objective measurements of light intensity (lux meter). On a univariate analysis, complaints of poor sleep and sleepiness were significantly higher in NLE workers compared to LE: nonrestorative sleep (36.8% vs. 29.5%; P<.0001), insomnia (28.8% vs. 24.8%; P<.0001), severe insomnia (14.1% vs. 10.9%; P<.0001), and daytime somnolence (6.8% vs. 4.3%; P<.0001). After multivariate analysis, NLE has shown more insomnia (OR=1.8, 95% CI 1.3-2.3, P<.01) and hypersomnia (OR=1.9, 95% CI=1.3-2.4, P<.01) than LE. These data suggest that underexposure to natural light at work may significantly impair sleep and wake disorders in non-light-exposed workers.

7 of 13 patients (12 were males) with chronic renal failure adjusted well to hemodialysis while the other 6 adjusted poorly. Retrospective analysis of pretreatment interviews found the following predictors of successful adjustment: a closer relationship to mother than to father when an adult, childhood dependency on both parents rather than on one, little irritability, and good adaptability to previous life changes. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

To investigate maternal and child emotional symptoms, physical health problems, and negative life events measured at children's age 18 months and 12 years as potential predictors for self-reported recurrent abdominal pain (RAP) in adolescents (14 years). A population-based prospective study conducted at child health clinics (preventive health care) in Norway followed a cohort of 916 mothers with children from children's age 18 months until adolescence. Child self-report was obtained from 12 years of age. Outcome measure was adolescent self-reported RAP. Of 456 adolescents, 58 (13%) reported RAP. Of these, 36 (62%) were girls. By multivariate analyses, the following maternal factors predicted RAP in adolescence: psychological distress at children's age 18 months (OR, 2.5; 95% CI, 1.3-4.8) and a maternal history of psychological distress at children's age 12 years (OR, 3.2; 95% CI, 1.7-6.2). The following child factors measured at age 12 years predicted RAP in adolescence: abdominal (OR, 2.5; 95% CI, 1.3-4.9) and extraintestinal pain (OR, 2.3; 95% CI, 1.2-4.4) by maternal report, self-reported frequent extraintestinal pain (OR, 2.9; 95% CI, 1.4-5.9), and self-reported depressive symptoms (OR, 2.4; 95% CI, 1.1-5.1). Negative life events and physical health in mothers and toddlers did not predict RAP. This is the first cohort study that finds maternal psychological distress in early childhood to predict RAP in their offspring 13 years later. Our results support that maternal psychological distress and preadolescent children's depressive and somatic symptoms may play a role in the development of RAP.

OBJECTIVES Sleep-disordered breathing has been hypothesized to have a close relationship with hypertension but previous studies have reported mixed results. This is an important health issue that requires further clarification because of the potential impact on the prevention and control of hypertension. The relationship between hypertension and three forms of sleep-disordered breathing (chronic snoring, breathing pauses and obstructive sleep apnea syndrome (OSAS)) was assessed using representative samples of the non-institutionalized population of the UK, Germany and Italy (159 million inhabitants). The samples were comprised of 13,057 individuals aged 15-100 years who were interviewed about their sleeping habits and their sleep symptoms over the telephone using the Sleep-EVAL system. OSAS was found in 1.9% (95% CI: 1.2% to 2.3%) of the UK sample, 1.8% (95% CI: 1.4% to 2.2%) of the German sample and 1.1% (95% CI: 0.8% to 1.4%) of the Italian sample. OSAS was an independent risk factor (odds ratio (OR): 9.7) for hypertension after controlling for possible confounding effects of age, gender, obesity, smoking, alcohol consumption, life stress, and, heart and renal disease. Results from three of the most populated countries in Western Europe indicate that OSAS is an independent risk factor for hypertension. Snoring and breathing pauses during sleep appeared to be non-significant predictive factors.

The analysis of heart rate variability (HRV) is becoming widely used in clinical research to provide a window into autonomic control of HR. This technique has been valuable in elucidating the autonomic underpinnings of panic disorder (PD), a condition that is marked by reports of heart palpitations. A body of research has emerged that implicates a relative reduction in HRV and cardiac vagal tone in PD, as indicated by various HRV measures. These data are consistent with the cardiac symptoms of panic attacks, as well as with developmental evidence that links high vagal tone with enhanced attention, effective emotion regulation, and organismic responsivity. Implications of these findings for nosology and pathophysiology are discussed. Reports of reduced HRV in PD contrast with portrayals of excess autonomic lability in anxiety. This contradiction is addressed in the context of traditional homeostatic models versus a systems perspective that views physiologic variability as essential to overall stability.

To investigate whether different types of exposure to the 2004 tsunami were associated with physical symptoms 14 months after the disaster and to study correlations between survivors' physical and psychological symptoms. Using a cross-sectional design, 1505 survivors from the 2004 Indian Ocean Tsunami, tourists from Stockholm, who had been present in the disaster areas, responded to a postal questionnaire. Eight groups based on type of exposure were created. Physical symptoms occurring on a daily or weekly basis over the past year were investigated in four indices: musculoskeletal, cardiorespiratory, neurological, and gastrointestinal. Mental health symptoms (General Health Questionnaire-12) and posttraumatic stress symptoms (Impact of Event Scale-Revised) were also investigated. Multiple logistic regression analyses were conducted with controls for background variables and exposure, with physical symptoms as outcome variables. The association between physical and psychological symptoms was studied with the Spearman Rank Order Correlation. Different types of exposure during the disaster were associated with physical symptoms 14 months later for survivors both with and without severe physical injury. The single exposure of life threat, also in combination with other exposures, was associated with a higher risk for reporting of physical symptoms. Physical symptoms showed modest yet significant correlation with psychological symptoms. It is important to pay attention to both physical and psychological symptoms among disaster survivors whether they have been injured or not. A relatively simple questionnaire about physical symptoms may be a good complement to the scales used to assess psychological problems after disaster.

A comprehensive training program for reliable use of the ICD/10 in Consultation-Liaison (C-L) psychiatry was conducted with 220 psychiatrists and psychologists from 14 European countries. The training included rating of written test cases and development of a coding manual to avoid diagnostic pitfalls not addressed in the ICD-10 manual. Following this training, all consultants rated 13 written case histories. One hundred sixty-seven consultants (76%) had a kappa (kappa) of at least 0.70. Only 13 (6%) had a kappa 0.40. The percentage of high reliability raters was evenly distributed among the different countries. Consultants had some problems in the differentiation between adjustment disorders and depressive disorders, and in the classification of disorders where ICD-10 differs from the DSM-III-R system. National biases in diagnostic practice were found with regard to the "case" concept and the role of alcohol in confusional states. Finnish consultants coded "no psychiatric disorder" significantly more often, whereas German and Italian consultants attributed delirious state more often to alcohol than consultants from other European countries. The study demonstrates that it is possible to achieve acceptable interrater reliability in applying the ICD-10 guidelines, through training programs designed for C-L psychiatrists and psychologists. Nevertheless, this first cross-national study shows the importance of addressing differences in national diagnostic practice.

The Type D Scale-14 (DS14) measures distressed (also, Type D) personality by assessing the medium-level trait negative affectivity that encompasses the low-level traits dysphoria, anxiety, and irritability, and the medium-level trait social inhibition that encompasses the low-level traits social discomfort, reticence, and lack of social poise. The literature discusses three different structural models of the DS14. The goal of this study was to investigate which of the three models best describes the internal structure of the DS14. We used three methods to investigate the internal structure of the DS14 items using data collected in representative samples from the Dutch general population (N=3,181). The methods were exploratory factor analysis, confirmatory factor analysis, and Mokken scale analysis. Exploratory factor analysis suggested a two-factor structure without evidence of the low-level factors, and the other two methods showed evidence of a three-level structure including the low-level factors. A two-factor model with correlated errors for items defining low-level traits adequately describes the data. The results support the three-level hierarchical model as a conceptual model for Type D personality, and support the interpretation of DS14 scores on item subsets representing medium-level traits and low-level traits.

This study aims to examine the hypothesis that psychological factors may contribute to the aetiology of migraine, in that 1.(i) specific personality traits may serve as predisposing factors,2.(ii) stressful emotional experiences may serve as precipitating factors.Epidemiological methods were used to obtain a random sample, in order to avoid the bias which may result from study of selected groups.Indeed, evidence was obtained in this study, that patients presenting themselves for treatment at special Migraine Clinics are not fully representative of migraine sufferers in general.From a survey of 1895 members of the Civil Service, comprising a wide range of ages, and all social strata, a random sample of 50 men and 50 women migraine subjects were taken. These were matched for control purposes with similar groups who suffered non-migraine headaches, and groups who were not affected by headaches. Further matched groups were also studied; these were, 18 women Migraine Clinic patients, to ascertain whether their characteristics were similar to those of unselected migraine subjects; and 19 asthmatic male Civil Servants, to ascertain whether they as sufferers from a different psychosomatic disorder, displayed similar personality characteristics to the migraine subjects. Two hundred and thirty seven individuals were interviewed in order to obtain details of personal history, medical history, and family history.Three psychometric tests: 1.(1) the Eysenck Personality Inventory,2.(2) an abridged form of the Minnesota Multiphasic Personality Inventory,3.(3) the Buss Durkee Hostility/Guilt Inventory were completed by each participant.The following main items were found to be correlated at statistically significant levels with the occurrence of migraine. 1.(1) Increase in ‘N’ scores of EPI (and this was confirmed in an additional 166 Migraine Clinic patients).2.(2) Increase in anxiety and somatisation scores on MMPI (women only).3.(3) Increase in hostility scores on Buss Scale.4.(4) Evidence of increased emotionality, in that migraine sufferers had significantly more psychological symptoms than controls.No objective evidence of greater past or present emotional stress was found in migraine subjects as compared with controls. It is suggested that these findings are evidence for increase reactivity of the automatic nervous system in migraine subjects and that this may provide a predisposing factor for the development of migraine attacks.Evidence is also presented that emotional stress can act as a precipitating factor in migraine, since over one half of 120 attacks recorded during a two month period of observation, were related in time to an overtly stressful event; and in half of the random sample, migraine began for the first time ever, during a period of emotional stress.

Dental amalgam has been suggested to cause long-term physical and mental problems. Claims that removal of the amalgam may lead to dramatic improvements in health have not been tested empirically in controlled studies with a long follow-up period. To investigate the long-term effects of removal of dental amalgam on physical and mental symptoms in self-referred patients who complained of multiple somatic and mental symptoms attributed to dental amalgam fillings. In a quasi experimental study, changes in the mental and physical symptoms in 76 patients who had their dental amalgam removed 7 years ago were compared with changes in symptoms among patients with known chronic medical disorders seen in alternative (n=51) and ordinary (n=51) medical family practices and noncomplaining patients with similar amounts of dental amalgam fillings (n=44) seen in an ordinary dental practice. The assessments included written self-reports, a 131-item somatic symptom checklist, Eysenck Personality Questionnaire (EPQ), the General Health Questionnaire (GHQ) and Toronto Alexithymia Scale (TAS). Subjects who removed their dental amalgam reported reduced physical and mental symptom load compared to status prior to removal, but only to a level comparable with that reported by the other groups with chronic medical disorders. The dental control group consistently reported lower symptom load during the whole period. In a hierarchical three-step regression model, pretreatment physical symptom load (P<.01), age (P<.10) and removal of dental amalgam (ns) predicted 26% of the variance in posttreatment physical symptom load. In a self-referred group of subjects with health complaints attributed to dental amalgam who remove their dental amalgam, the symptom load at follow-up corresponds to the level seen in chronic medical disorders despite the strong implicit placebo effect of the present quasi-experimental design. The finding does not support the hypothesis that removal of dental amalgam will reduce health complaints to normal levels and seriously questions the hypothesis that dental amalgam is an important cause of distress and health complaints.

Relationships between psychiatric morbidity and interpersonal conflict at work among 15,530 Finnish employees aged 24 to 64 years were studied in a prospective follow-up: 4 years for all psychiatric hospitalizations, 5 years for suicide, and 6 years for long-term medication due to chronic psychosis. The association between interpersonal conflict at work and physician-diagnosed psychiatric morbidity was significant (RR 2.18, 95% CI 1.34-3.54) when results were adjusted for general health status, social class, and mental instability/stress. Results remained significant in additional models adjusted for neuroticism, marital status, conflict with spouse, and high alcohol consumption. The results were similar for both sexes.

This study evaluated the distinctive clinical and biological manifestations of depressive symptom subtypes (i.e., cognitive-affective and somatic) in Veterans with hepatitis C viral infection (HCV) before and during interferon-alpha (IFN) based antiviral therapy. Thirty-two Veterans with HCV and no prior history of IFN therapy were followed prospectively during the first 16weeks of therapy to evaluate depressive symptoms and to determine if baseline cytokine and serotonin levels predicted subsequent changes in depressive scores. IFN therapy resulted in a significant increase in total depressive symptoms from baseline (week 0) to week 16, with neurovegetative and somatic symptoms of depression including loss of appetite, fatigue and irritability increasing within the first two weeks of therapy and continuing to increase throughout IFN therapy. When depressive symptoms were evaluated using a two-factor (i.e., Cognitive-Affective and Somatic) model, the Cognitive-Affective factor score did not change significantly following IFN therapy initiation, while the Somatic factor score showed a significant increase from week 0 to week 16. Veterans with the largest increases in somatic symptoms from week 0 to week 2 had significantly higher levels of tumor necrosis factor-alpha (TNF-α) and lower levels of serotonin at baseline, as compared to Veterans with minimal or no increase in somatic symptoms. Somatic symptoms of depression can be significantly exacerbated during IFN therapy and may be predicted by higher TNF-α levels and lower serotonin levels at baseline.

The Cattell “Sixteen Personality Factors” Questionnaire (16PF) was administered to 68 asthmatics selected at random from registers of known cases, 14 asthmatics referred for psychiatric treatment, 22 neurotic and 22 healthy controls. No significant differences were found between the random asthmatics and the healthy controls. However, the data from the random asthmatics indicated that they were significantly more submissive and humble (low factor E), yet more tough-minded (low factor I) and more radical (high factor Q1) than a large sample of the general population for whom comparable normative data was available. Apart from a slight association between more severe asthma and more forthrightness (low factor N), there was no evidence of a relationship between personality factors and the index of asthma severity. A striking feature of the results was the wide variability of scores indicating that some asthmatics were as likely to be distressed by certain personality traits as by their pulmonary pathology.

1.(1)The plasma 17 OHCS levels of 35 depressives, 34 schizophrenics and one manic were examined.2.(2)19 depressives were examined in an admission ward before and after treatment.3.(3)12 depressive were examined in a metabolic ward during short-term metabolic studies.4.(4)4 depressives, 1 manic and 2 schizophrenics were examined during long-tem metabolic studies.5.(5)32 chronic schizophrenics were wxamined over different periods of time.6.(6)It was found that although more disturbed depressives tended to have higher 17 OHCS levels, milieu appeared to have an effect overriding clinical state.7.Treatment in the depressives affacted clinical state more than it did 17 OHCS levels.8.(8)Some relationship of 17 OHCS levels environmental changes appeared in two metabolic ward depressives.9.(9)In all the subjects, a pattern of variability of 17 OHCS levels in time was found which appeared independent of diagnostic category, degree of behavioural disturbance, treatment or time interval.10.(10)This was interpreted as indicating the variability of 17 OHCS levels to be on either a damped or an augmented sine wave pattern.

1.1. The excretion of urinary 17-hydroxycorticosteroids was measured by means of the method of Appleby et al. [13] on admission to hospital and one month later, in 28 patients suffering from mental depression.2.2. On admission, corticoid values exceeding the normal upper limit of 16 mg/24 hr were found only in 6 patients. One month later there was no consistent reduction in the corticoid excretion.3.3. According to the scores obtained by Beck's Depression Inventory, 26 of the 28 patients studied suffered from depression. After one month of treatment a renewed examination with the test showed a decrease of the scores down to the ‘no depression” range in all except 8 patients.4.4. In many patients with decreased post-treatment depression scores, no decrease in 17-OHCS excretion was observed. This observation indicates that subjectively assessed improvement of depression can take place without reduction of corticoid excretion.5.5. It was not possible to differentiate depression patients with a high degree of anxiety from depression patients with low anxiety by the administration of Taylor's Manifest Anxiety Scale, because patients with high scores on the Depression in Inventory also tended to have high scores on the Manifest Anxiety Scale.6.6. When the patients were divided into “high excretors” and “low excretors”, the dividing line being 10 mg/24hr 17-OHCS, it was found after one month of treatment that the high excretors had lower scores on the two psychometric tests.7.7. The male patients as a group were found to be “high excretors” who also showed the high excretors' post-treatment ratings in the diagnostic tests. However, the female patients with high excretion values behaved similarly to the male patients.8.excretion and another with no elevationof 17-OHCS excretion, and that the subjective recovery measured by the Depression Inventory took place in some patients with high 17-OHCS excretion before a decrease in 17-OHCS excretion was observed.

SIGNS of increased pituitary-adrenal activity are frequently encountered in affective disorders. Increased plasma or urinary corticoid levels have repeatedly been observed also in depressive states and have by some authors been related to the anxiety associated with the depression [I, 21. We have previously investigated the urinary excretion of derivatives of adrenocortical hormones in a group of depressive patients who were mainly suffering from neurotic depression. The excretion of urinary total 17-hydroxycorticoids as well as the excretion of II-oxygenated steroids which were determined by means of thin layer chromatography were found to be increased in a part of the depressive patients although no conclusions could be made on the basis of psychometric tests regarding the relationship between anxiety and adrenal steroid excretion [3, 41. Adrenocortical secretion is known to have a 24-hr or circadian rhythm peak plasma corticosteroid levels occurring early in the morning shortly before awakening. After this there is a sharp decline until noon and a more gradual decline until about 10 p.m. when the values begin to rise again between 2 a.m. and 4 a.m. [5]. Disturbances of the normal circadian rhythm are known to occur in Cushing’s syndrome and in association with organic brain damage and have recently also been described in affective psychotic disorders [6]. It is conceivable that emotional influences might induce alterations of the 24-hr cycle or superimpose themselves on the cycle. Diurnal variations of adrenocortical secretion were therefore studied in a group of depressive patients by determining plasma 17-OHCS levels four times daily on admission to the hospital and following recovery. The diurnal variation of the urinary I7-OHCS excretion was studied at the same time by determining the amount of urinary corticoids in three consecutive 8-hr urine collections and an attempt was made to correlate the results of the steroid determinations to depression and anxiety ratings as well as other psychological parameters obtained in the depressive patients. During recent years a relatively simple new test has been advocated for the clinical assessment of pituitary-adrenal function. The release of corticotrophin from the anterior pituitary involves a humoral factor from the hypothalamus (corticotrophinreleasing factor, C.R.F.) which is a low-molecular polypeptide. Vasopressin has been shown to have C.R.F.-like activity in experimental animals and the administration of natural or synthetic Lysine-Vasopressin (L.V.P.) in man is also followed by an increase

Twenty-one pairs of healthy monozygotic male twins of college age have been observed in an attempt to correlate individual personality structure with characteristic and relatively enduring patterns of pituitary adrenocortical function. Ten pairs of comparable dizygotic male twins have been studied by the same methods.High levels of 17-OHCS excretion were found in individuals with forceful yearnings for close personal involvement or with active defenses against the threat of intimacy. Individuals with low 17-OHCS levels were more effectively isolated by well-organized neurotic defenses. High 17-KS levels were found in energetic, ambitious individuals with strong aggressive drives and equally strong defenses against them. Those with low 17-KS were over-controlled with apparently limited innate drive endowment.A one way analysis of variance was computed for both monozygotic and dizygotic. twins. The F ratio indicated that height, 17-KS mean values, and day-to-day variation in 17-KS might be influenced by genetic factors. The intra-class correlation in 17-OHCS means was just as great in dizygotic as in monozygotic pairs but the correlation in 17-KS means in monozygotic pairs was much higher than in dizygotic pairs.A contingency table was constructed by grouping the variation in 17-OHCS and 17-KS into quartiles. In 14 out of the 21 pairs of monozygotic twins both members of the pair were in the same quartile for 17-OHCS and 17-KS and both members of all the other pairs were in adjoining quartiles. The pyschological characteristics shared by all of the subjects in each contrasting quartile suggest meaningful correlations of steroid patterns with different but interrelated quantifiable ranges of psychological response corresponding respectively to the mean levels of the 17-OHCS and of the 17-KS.

To examine the personality trait conscientiousness as a risk factor for mortality and to identify candidate explanatory mechanisms. Participants in the Whitehall II cohort study (N=6800, aged 34 to 55 at recruitment in 1985) completed two self-reported items measuring conscientiousness in 1991-1993 ('I am overly conscientious' and 'I am overly perfectionistic', Cronbach's α=.72), the baseline for this study. Age, socio-economic status (SES), social support, health behaviours, physiological variables and minor psychiatric morbidity were also recorded at baseline. The vital status of participants was then monitored for a mean of 17 years. All-cause and cause-specific mortality was ascertained through linkage to a national mortality register until January 2010. Each 1 standard deviation decrease in conscientiousness was associated with a 10% increase in all-cause (hazard ratio [HR]=1.10, 95% CI 1.003, 1.20) mortality. Patterns were similar for cardiovascular (HR=1.17, 95% CI 0.98, 1.39) and cancer mortality (HR=1.10, 95% CI 0.96, 1.25), not reaching statistical significance. The association with all-cause mortality was attenuated by 5% after adjustment for SES, 13% for health behaviours, 14% for cardiovascular risk factors, 5% for minor psychiatric morbidity, 29% for all variables. Repeating analyses with each item separately and excluding participants who died within five years of personality assessment did not change the results materially. Low conscientiousness in midlife is a risk factor for all-cause mortality. This association is only partly explained by health behaviours, SES, cardiovascular disease risk factors and minor psychiatric morbidity in midlife.

(Received 7 December 1966) FESSEL [l] in an investigation of the precipitate formed when dextran solution is added to plasma obtained from patients with a wide range of psychiatric diagnoses, concluded that the precipitate consisted mainly of fibrinogen and that the amount of precipitate varied directly with the degree of disturbance showed by the patients, and was not related to psychiatric diagnosis. The hypothesis’was advanced that as part of the stress reaction, fibrinogen was altered in some way so that it became precipitable with dextran. Fante and Ward [2] in an investigation of the molecular weight of human fibrinogen derived from phosphorus determinations found that 1 g atom of phosphorus was present in from 304,000-383,000 g fibrinogen. In one case, however, in which the subject showed signs of stress during the blood collection, the separated fibrinogen contained 1 g atom phosphorus per 425,000 g fibrinogen. This, it is suggested, is due to partial fibrinolysis having taken place. Previous work reviewed in Anderson and Dawson [3] suggested that another manifestation of stress was the variation of plasma 170H steroid levels (chloroform soluble 17,21 dihydroxy-20 ketosteroids). The present investigation is concerned with studying the relationship between plasma 170H steroid levels and the precipitability of fibrinogen by dextran to determine how far these two measures covary and are sensitive to alterations in mental state produced by treatment.

The effectiveness of psychosomatic therapy for asthma patients is difficult to prove. We tried to solve this problem in a new way by means of a cost-benefit analysis. To draw up such an analysis, we selected 22 patients capable of working out of a total of 57 patients with asthma bronchiale at the Heidelberg Medical Hospital, who were interested in participating for one year in a psychosomatic coping group therapy. These 22 patients were divided into two groups. The distribution of the relevant individual parameters in both groups was similar. We subjected the patients to three medical and psychodiagnostic examinations: one before treatment was started, a second after the first year of treatment and a third one and a half years later. Additional data were gathered from health insurance organisations and General Practitioners. Despite the bad prognoses of our patients, those treated, when compared to the untreated patients, had a significant reduction in the number of working days lost and a considerable decrease in the number of working days hospitalized. The savings resulting from these reductions were compared with the sum expended for group therapy; we found a cost-benefit ratio of 1:5. These results indicate that a cost-benefit analysis may be very helpful in evaluating the effectiveness of some psychosomatic treatment techniques. Moreover, coping group therapy completes the medical standard therapy of patients with bronchial asthma and is thus a means of reducing the high medical treatment costs of asthma patients.

Interleukin-6 protein has been suggested as a mediator connecting chronic stress and cardiovascular diseases. We investigated whether the functional G174C polymorphism (rs1800795) of interleukin-6 gene is associated with vital exhaustion, a measure of chronic stress, or with preclinical atherosclerosis. Associations between the interleukin-6-174G>C polymorphism, preclinical atherosclerosis, and vital exhaustion were examined in 1673 women and men aged 24-39years participating in the Cardiovascular Risk in Young Finns study. Vital exhaustion was measured using Maastricht Questionnaire. Preclinical atherosclerosis was assessed by carotid intima-media thickness using ultrasound techniques. DNA was genotyped for the interleukin-6-174G>C polymorphism (rs1800795). The GG genotype of the interleukin-6-174G>C polymorphism was associated with higher vital exhaustion. Moreover, higher vital exhaustion was associated with greater intima-media thickness in men carrying G alleles, adjusted for cardiovascular risk factors. Our findings support a role for the interleukin-6-174G>C polymorphism in increased risk of atherosclerosis in individuals with chronic stress. In addition, individuals carrying the G allele of the interleukin-6-174G>C polymorphism may be more prone to adverse effects of psychosocial stress.

Sociocultural factors are important in the pathogenesis of eating disorders. We examined some core (DSM IV) features of eating disorders, i.e., drive for thinness and dissatisfaction with the weight of the abdomen, hips, and thighs among women in Canada and India. A total of 65 Canadian (mean+/-S.D. age: 21.4+/-2.0 years) and 47 Indian (mean+/-S.D. age: 18.7+/-4.1 years) women completed the Drive for Thinness (DT) and Body Dissatisfaction (BD) subscales of the Eating Disorder Inventory (EDI) and in addition rated the degree to which they believed all major regions of their body were overweight. After the effects of body mass index (BMI) were partialled out statistically, the DT (EDI) and BD (EDI) scores were not significantly different between the two countries. In both groups, concerns about the weight of the abdomen, hips, thighs, and legs loaded on a factor that essentially described the 'body dissatisfaction' construct. After the effects of BMI were partialled out, however, the factor scores from this factor correlated with BD (EDI) in the Canadian but not the Indian sample. In contrast to the Canadian women, the Indian women did not overestimate the 'fatness' of their abdomen, hips, thighs, and legs. Among the Indian women, concerns about the weight of the upper torso (i.e., face, neck, shoulders, and chest) emerged as a distinct body image construct. In conclusion, after the effect of BMI was controlled for statistically, the Canadian and Indian women scored similarly on some of the core features of eating disorders, as measured by the DT (EDI) and BD (EDI) subscales, however, the nature of the underlying body image construct was different between the two groups.

Selected demographic, behavioral and psychophysiological variables (sex of the subject, exercise, coffee and cigarette consumption, baroreceptor stimulation-dependent pain dampening, initial blood pressure, body mass index, daily stress rating, reactivity to mental stress as measured by change in stress rating and heart rate and blood pressure from resting to mental arithmetic conditions) were entered into a stepwise multiple-regression equation to predict changes of oscillometrically self-measured tonic blood pressure in 80 normotensives over a 19 month period. The prediction equation (r = 0.55) associated increases in diastolic blood pressure with baseline diastolic blood pressure, more baroreceptor stimulation-dependent pain inhibition, and less heart rate change during mental arithmetic. There were no significant predictors of systolic changes, and no sex differences. Results are discussed in terms of the learned model of hypertension.

RCTs are the gold standard for the evaluation of mental health care [WHO Scientific Group on Treatment of Psychiatric Disorders, 1991]. All RCTs in the Journal of Psychosomatic Research to date (October 1993) were identified. A profile of the geographical origin, content, interventions under investigation, and methodological quality (as measured by reporting of randomization) of every trial is described. The prevalence of trials from Europe in the Journal is increasing. The frequency of trials regarding the psychotherapies in this journal is also increasing whilst that of drug trials is constant. High quality reporting of randomization is rare. This pilot study generates many disturbing questions regarding the content and quality of RCTs within psychosomatic medicine that urgently need to be answered. Trials in this journal may well not be representative of all RCTs relevant to psychosomatic medicine. If all such trials are to be made accessible to those interested in evidence-based practice, however, much methodical searching must be undertaken, and this study can then be repeated and the questions answered with more authority.

Early age at menarche has been found to be associated with higher oestrogen levels among girls around the onset of puberty and in early adulthood. The role of oestrogen in depression is not clear, although it affects serotonergic functions in the central nervous system (CNS). We wanted to test the hypothesis that age at menarche is associated with depression in young adulthood. The material consisted of 3952 women born in 1966 in Northern Finland. Depression was defined by the Hopkins Symptom Checklist-25 (HSCL-25), the use of antidepressants and by self-reported lifetime depression diagnosed by physician. Menarcheal age was divided as 9-11, 12-15 and 16 years or over. The prevalence of depression was 1.8-fold in current depression, 2.8-fold in the use of antidepressants and 2.1-fold in self-reported physician-diagnosed depression in women with menarche at the age of 16 years or later. After adjusting for confounders, the significant positive association between current depression and late menarche remained, but the use of antidepressants and depression diagnosed by physician had not statistically significant association with the age of menarche. A possible explanation for the result may be oestrogen as a protective factor against depression.

Three decades ago, results from a proportionate scaling study of life change events was published in this journal. The events, listed by rank order of their mean life change values, comprised the Social Readjustment Rating Scale (SRRS). Ten years later, 42 of the 43 original events were rescaled. In this second study, an additional 44 events were added to the original list. In the present report, the original plus the later-developed events were scaled once again by persons chosen to closely approximate subjects enrolled in the initial study. Comparing the average life change intensity scores across 30 years, a 45% increase in mean values was seen. These recently derived life change magnitudes, for both the original list of events plus the later-developed events, provide values appropriate for use in the 1990s. In the original study, effects of subjects' demographic characteristics were noted briefly in a table. In the present investigation, varying influences of gender, age, marital status, and education were explored in more detail. Several significant differences were discovered, with gender showing a very pronounced influence on scaling results. Discussion of these results included composition requirements for a life changes questionnaire.