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The effect of sleep deprivation on pain perception: A meta-analysis

  • Österreichischer Bundesverband für Psychotherapie
Decreased pain threshold caused by less
correlation between pain intensity and depression
in chronic pain
Abe T, Kato F, Mizuno Y, Fukunaga M
Department of Psychosomatic and General Internal
Medicine, Kansai Medical University, Osaka, Japan
Introduction: Central sensitization is one of the major conditions
that constitutes chronic pain, and is influenced by various kinds of
biopsychosocial factors. Pain intensity and anxiety will increase
hypersensitivity to experimental pain stimuli, while depression will
decrease it. Although it is well known that there is high
comorbidity between chronic pain and major depressive disorder, it
is still difficult to evaluate the pathological condition of chronic
pain because of its heterogeneity. In this research, we investigated
the relationship between pain intensity and depression which
caused the change of pain threshold. Methods: We studied 76
patients with chronic non-malignant pain. Pain intensity and
depression were assessed by Short-form McGill Pain Questionnaire
(SF-MPQ) and Beck Depression Inventory (BDI). Electrical pain
tolerance thresholds (PTT) were measured at asymptomatic regions,
and subjects were divided into low PTT group and the others group
by 10th percentile values for PTT in controls. Results: The low
PTT group accounted for 22% of the subjects. Within the
demographic and psychological data, there were no significant
differences when compared between two sub-groups. Pain intensity
significantly showed positive correlation with depression in both all
subjects and the others group, but not in the low PTT group.
Conclusions: In this study, the decrease of PTT reflected less
correlation between pain intensity and depression. Thus, PTT at
asymptomatic regions can be a good indicator of the central
sensitization formed by the effects of depression in chronic pain.
Data analysis of psychosomatic medicine consults
from a trauma medical-surgical floor
Aguilar-Zanatta J, Desan HP
Department of Psychological Medicine; Psychiatry-Yale
University School of Medicine
Introduction: There is limited research associating trauma surgery
patients and psychiatric illness. The purpose of this chart review is
finding and classifying characteristics of patients that received a
psychiatric consultation after admission by the trauma surgery
service from 2009 to 2010. Methods: The data source came from
the electronic medical record from Yale New Haven Hospital. The
platform in use at the time was Sunrise Clinical Manager. Eligible
charts required a psychiatric consultation placed by the trauma
surgery service at Yale New Haven’s East Pavilion 6-4. A
retrospective data analysis of the charts with psychiatric consults
was done and common characteristics among the consults recorded
including: nature of trauma event, psychiatric diagnosis associated
with the consult, psychiatric medications received before and/or
after consultation, percentage of alcohol or illicit substances as the
culprit of the psychiatric consultation or trauma event, and
disposition after the consultation. Results: Notable results from this
review include: alcohol involved in some aspect of the consultation
26%, illicit substances 21%, antipsychotic medications were
recommended 24%, and 37% of the consults during this time
interval were delirium evaluations. Limitations: Limitations
included a large variability of information recorded in the
consultation as some consults were more thorough than others.
Prevalence and correlates of depression among
patients attending a HIV/AIDS clinic in a teaching
hospital in South East Nigeria
Aguocha C1, Uwakwe R2, Diwe K3, Enwere O4, Duru C3
1Department of Internal Medicine, Imo State University,
Owerri, Nigeria
2Faculty of Medicine, Nnamdi Azikiwe University, Awka,
3Department of Community Medicine, Imo State University,
Owerri, Nigeria
4Department of Internal Medicine, Imo State University
Teaching Hospital, Orlu, Nigeria
Introduction: Depression is one of the commonest psychiatric
complications associated with HIV/AIDS and is five times more
common among People Living with HIV/AIDS (PLWHA) than in
the apparently healthy population. The aim of this study was to
determine the prevalence and factors associated with depression
among HIV patients attending clinics in a tertiary hospital in South
East Nigeria. Methods: A cross-sectional descriptive survey
carried out on 271 patients aged 18 years and above receiving
Highly Active Antiretroviral Treatment (HAART). Socio-
demographic questionnaire and Patient Health Questionnaire-9
were used to collect information about the patients. Results: About
39.1% of the respondents were identified as depressed, out of which
24.5%% were mildly depressed, 50% moderately depressed, and
24.5% were severely depressed. Mean age of diagnosis was higher
among males (38.7 ± 11.2 years) than females (32.7 ± 7.9years) (p
< 0.002). A higher proportion of males (76.5%) were married while
more of the females were widowed (p < 0.0001). Conclusions:
The relatively high prevalence of depression among attendees at the
HIV/AIDS clinic underscores the need for routine depression
Depression and anxiety as risk factors for bladder
pain syndrome
Amaral AD1, Marques-Pinto A2, Novais C1, Ribeiro AM1,
Costa I1
1Psychiatry Department, Clínica de Psiquiatria e Saúde
Mental do Centro Hospitalar de São João, Oporto, Portugal
2Urology Department, Centro Hospitalar do Porto, Oporto,
Psychother Psychosom 2015;84(suppl 1):1-82
DOI: 10.1159/000438780
Published online: August 18, 2015
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Psychother Psychosom 2015;84(suppl 1):1-82
DOI: 10.1159/000438780
Introduction: Bladder pain syndrome (BPS) is a chronic and
debilitating disorder characterized by pelvic pain/discomfort
accompanied by urinary urgency or frequency. It is considered a
psychosomatic disorder and therefore remains a diagnosis of
exclusion. We aim to study the association between
depression/anxiety and BPS. Methods: Papers about the
association between depression/anxiety and BPS were searched on
the PubMed database. Ninety papers were retrieved, 39 were
deemed relevant and included in this article. Results: Recent
research shows that BPS may constitute a systemic syndrome, as it
is associated with many coexisting psychiatric (i.e., depression,
anxiety, childhood traumatic events) and physical conditions (i.e.,
fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome).
The extent of psychiatric/non-urological physical symptoms
appears to correlate well with BPS symptom severity. Depression
and anxiety disorders tend to occur before the onset of bladder
symptoms. Both depression and anxiety have been implicated in the
pathogenesis of chronic visceral pain, as they enhance bladder
nociceptive responses. Patients with higher activity in the amygdala
complex and right primary somatosensory cortex experience more
mood disorders, central pain amplification, and urological
symptoms. Authors provide a brief illustrative case report.
Conclusions: There seems to be an association between
depression/anxiety and the development of BPS and other
psychosomatic disorders. Maladaptive coping strategies (e.g.,
catastrophizing) are associated with psychosomatic symptoms (e.g.,
BPS and non-urological physical symptoms), sexual/social function
problems, and ultimately quality of life decrement. It remains to be
proven prospectively whether there is progression from BPS to a
systemic pain syndrome.
Psychoeducational training to enable clinical
laboratory technicians who perform medical
examinations to understand the psychological
status of patients
Ando M
Graduate School of Education, Okayama University,
Okayama, Japan
Introduction: Successful communication between patients and
medical staffs is important for high quality health care.
Psychoeducational training for clinical laboratory technicians can
improve communication skills. The objective of this study is to
explore the effectiveness of psychoeducational training to improve
staff ability while performing medical examinations to understand
the psychological status of the patients. Methods: Fifty-three
clinical laboratory technicians attended a two day training program.
”Successful Self”, a psychoeducational program to promote better
mental health, was used to improve communication skills and to
develop teamwork strategies for health care professionals. After a
lecture was given on the importance of understanding the patients’
psychological status, the use of role-playing was practiced to
initiate better counseling methods and communication dialogue.
Afterwards, the participants evaluated their own achievements via a
scale and summarized their future attitudes and behavior
approaches. Results: The participants reported a better
understanding of the importance of patients’ psychological status.
They also acknowledged how improved communication skills
could help when explaining and consulting in medical
examinations. The participants expressed further desires to provide
hope and positive meaning for medical treatment and health care.
Conclusions: The psychoeducational training effectively improved
knowledge about the psychological status of patients, it motivated
clinical laboratory technicians to better communicate with patients,
and increased their ability and confidence to explain medical
Collaborative medical treatment of a patient
suffering from type-1 diabetes mellitus with
Ando S1, Ando M2
1Diabetes Center, Department of Internal Medicine, Okayama
City Hospital, Okayama, Japan
2Department of Clinical Psychology in Education, Graduate
School of Education, Okayama University, Okayama, Japan
Introduction: Consistent self-care for patients suffering from type
1 diabetes mellitus is often difficult. Some patients try to find
alternative medicine to treat their diabetes rather than taking
insulin. In Japan, recently, a collaborative care approach between
primary care physicians and diabetic specialists has been
recommended to improve better adherence of treatment for diabetic
patients. Case description: A sixty-year-old diabetic man suffering
with severe thirst and depression was presented. He had been
diagnosed five years before with type-1 diabetes mellitus and was
being treated with insulin by a primary care physician. Recently, for
two weeks, he decided to treat his diabetes with ion-based water
rather than insulin, which resulted in his being hospitalized with
high blood glucose and depression. A clinical psychologist began
psychotherapy and insulin injections were started again. His blood
glucose returned to near normal levels and his depression gradually
lessened in the following weeks. The patient became more positive
and cooperative in his self-care, and his HbA1c decreased from
13.3% to 6.7% within six months. His continued collaborative
treatment by a primary care physician, a diabetic specialist, and a
clinical psychologist has proved benefits in maintaining better bold
glucose levels. Comment: Psychological treatment for diabetic
patients with depression is important for improving blood glucose
control and mental stress. A collaborative team medical approach
among primary care physicians, diabetic specialists, and clinical
psychologists may help and be effective in the treatment of diabetic
Comorbidity of depression with heart disease
among adults seen in emergency departments in a
large Asian-American and Pacific Islander sample,
Andrade J, Takeshita J, Kunasegaran VKS, Hurtwitz E, Li D,
Geobert D
Department of Psychiatry, University of Hawaii, Honolulu,
Introduction: Coronary heart disease (CHD) is the leading cause
of death in the United States with approximately 450000 people
dying each year from CHD. As many as one in two patients with
cardiovascular disease suffer from a mental illness. Recent studies
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Psychother Psychosom 2015;84(suppl 1):1-82
DOI: 10.1159/000438780
suggest mood disorders are the most common. However, relatively
minimal research has been done in this area, especially regarding
ethnically diverse populations such as Asian Americans, Native
Hawaiians, and Pacific Islanders. There are important implications
for such research given the potential human toll of the comorbidity
of heart disease and depression, and given that the population of
Asian Americans, Native Hawaiians, and Pacific Islanders is the
fastest-growing in the United States. Methods: This study used a
quantitative, epidemiologic methodology that utilized secondary
data from virtually all emergency department admissions (n =
562703) of adult patients in Hawai‘i. The emergency room data
were obtained from the Hawai‘i Health Information Corporation
(HHIC) Emergency Department Database. Emergency department
records from January 1, 2000 to December 31, 2010 were utilized
for adults (18 years of age and above) with a diagnosis of specific
types of heart disease (i.e., heart failure, cardiac arrest,
complications of heart, cardiomyopathy, coronary atherosclerosis,
acute myocardial infarction, and other ischemic heart diseases) and
depression (i.e., major depression, single episode and major
depression, recurrent episode, manic depressive episode). Mental
health and heart disease diagnoses were coded according the
International Classification of Diseases, Ninth Revision, Clinical
Modification (IDC-9-CM). Ethnicity was based on self report of a
single identity. Logistic regression analyses were used to analyze
the data. Results: Heart disease was comorbid with depression
among adults admitted to emergency rooms for Hawai‘i’s
ethnically diverse population. The estimated adjusted odds ratio of
any heart disease diagnosis with depression for adults under 65 was
2.68 (95% CI 2.54 - 2.83) and for adults 65 years and over was 4.31
(95%CI 3.70 - 5.02). In both age groups, association of heart
disease with depression was greatest among Pacific Islanders.
Conclusions: Although the temporal relation between the cardiac
diseases and depression is unclear, the findings are consistent with
recent research showing that heart disease may be predictive of
depressive disorders.
Alleviating somatic symptoms of anxiety using
sulpiride as adjunctive therapy
Andri A
Psychosomatic CIinic Omni Hospital, Tangerang, Indonesia
Faculty of Medicine Krida Wacana Christian University,
Jakarta, Indonesia
Introduction: this clinical case study demonstrates the potential
use of sulpiride as an adjunctive therapy for improving somatic
symptoms in anxiety. Methods: cases presented were chosen from
the patients who visited Psychosomatic Clinic Omni Hospital in
Tangerang, Indonesia, with a diagnosis of Panic Anxiety Disorder
or Generalized Anxiety Disorder with predominant physical or
somatic complaints. We asked 20 patients to fill the somatic
subscales of Depression and Anxiety Somatic Symptoms Scale
(DSSS) before giving them the therapies for anxiety. We only gave
them serotonin antidepressant in the morning and sulpiride 50 mg
at night without using benzodiazepine. After a week treatment, we
asked them again about the somatic complaints using the DSSS.
Results: We founded that 16 patients with somatic complaints
related to gastrointestinal and neurologic symptoms such as
dizziness and vertigo like syndrome were improving. They also
reported the improvement in anxiety symptoms. Conclusions: In
Indonesia, sulpiride is marketed as a drug for relieving somatic
symptoms related to stress. It is also approved for the patient with
functional dyspepsia, vertigo like syndrome and other
psychophysiology symptoms. The present results are consistent
with these indications.
Developing psychosomatic medicine awareness in
developing country
Andri A
Psychosomatic CIinic Omni Hospital, Tangerang, Indonesia
Faculty of Medicine Krida Wacana Christian University,
Jakarta, Indonesia
Psychosomatic Medicine (PM) is a new subject in medical specialty
field in Indonesia. Although it is known as Consultation Liaison
Psychiatry (CLP) in Psychiatry, most of the people in Indonesia
even with medical background do not familiar with the term of
CLP. Before 2008, there was no psychosomatic medicine clinic
conducted by psychiatrist in Indonesia. Omni Hospital opened a
psychosomatic medicine service for public conducted by a
psychiatrist as a chairman in October 2008. We provided services
especially for patients with psychosomatic symptoms. We planned
to get awareness from public about this particular condition. We
had collaboration with media to begin awareness of mind and body
connection. We also encouraged people awareness using social
media like Blog, Facebook, Twitter, Youtube and lately we
launched website Roughly, we tried to measure
the impact of promoting psychosomatic in media using the number
of visiting outpatient to our psychosomatic clinic every year. We
also surveyed social media user about their perspectives of our
social media. There is an increasing amount of visiting patients in
our clinic measured by the number of visiting patients every year.
Most of the respondents in our survey said that our social media
were helpful and had benefits to their knowledge. We found out
that these strategies have some benefits not only to the awareness of
people but also to the number of patients who visit our clinic.
The features of dental treatment in patients with
mental health problems in the outpatient dental
Anisimova EN, Erilin EA
Department of anesthesia in dentistry, University of Medicine
and Dentistry, Moscow, Russia
Introduction: This study has the aim to reveal features of dental
treatment to patients with mental disorders in outpatient dental
department, to analyze the features of history taking in patients with
mental disorders in outpatient dental department, to analyze drug
interactions between medicines, that patients with mental disorders
should take, and medicines, prescribed by a dentist. Methods: One-
hundred and fifty dental patients' medical records for medical
consultation of conflict committee in dental clinics of Moscow
region were analyzed. We also studied the interaction among drugs
prescribed to patients with mental disorders and drugs planned by
dentist for local anesthesia as well as drugs prescribed to treat
dental diseases using Register of medicines in Russia. Results:
Psychological and mental status of dental patients was not
registered in medical records of dental clinics. Drugs, used for
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Psychother Psychosom 2015;84(suppl 1):1-82
DOI: 10.1159/000438780
patient comorbidity, were not registered in 94.3% of the medical
records. Psychotropic drugs, interacting with local anesthetics and
drugs prescribed by the dentist, can increase the effects of local
anesthetic drugs, reduce the effect of epinephrine, lead to blood
pressure's fall, to hemorrhagic syndrome, to convulsive seizures, to
increase toxicity of other drugs. Conclusions: Mental health
problems of patients needing dental treatment should be better
assessed and diagnosed. Psychological and mental status of the
patients should be taken into account and should be inserted in
medical records. Taking into account interactions of
pharmacological agents might avoid complications in the outpatient
dental treatment.
Psychic tension modification techniques for
patients receiving out-patient treatment
Anisimova N, Anisimova E, Sirota N
Moscow State University of Medicine and Dentistry
named after A.I. Evdokimov, Moscow, Russia
Introduction: Dental interventions are often accompanied by pain
both during and after the visit. Distress or fear felt by patients can
lead to the increased blood pressure and heart rate. Patients
suffering dentophobia are often infrequent attenders which can
ultimately lead to the advancement of dental disease. The present
study aims at providing support to the use of motivational
interviewing during therapeutic treatment in order to carry out
complete dental treatment of dental phobic patients. Methods: A
total of 90 people aged from 18 to 57 years experiencing intense
fear and anxiety of dental procedures were enrolled. Patients were
divided into 2 groups: the study group, which consisted of 51
subjects (22 men and 29 women), and the control group of 39
subjects (21 men and 18 women). Spielberger-Hanina scale of
personal and reactive anxiety was administered; OMRON M3
monitor was used to measure blood pressure; and analysis of
salivary catecholamine level before and after each visit was
conducted. Results: Application of motivational interviewing led
to 50.15% ± 4.53 (p ≤ 0.05) reduction of reactive anxiety level in
the study group compared to 21.99% ± 1.42 (p ≤ 0.05) reduction
among patients in the control group after 5 visits. Functional
parameters in both groups did not show significant differences.
The level of salivary catecholamine among study group patients
tended to decrease significantly after the 4th and 5th visits in
contrast to the level of control group patients. Conclusions: The
use of motivational interviewing allows to carry out effective and
safe dental operations. It also generates commitment to future
dental procedures.
Effectiveness of a multifactor educational
intervention on delirium incidence and length of
staying in patients with cardiac surgery
Arbabi M1, Zolfaghari M2, Razi SP3, Biat K, Parsafar H, Bavi
1Department of Psychiatry, School of Medicine, Tehran
University of Medical Sciences, Tehran, Iran
2Department of Intensive Care Nursing, Nursing and
Midwifery Care Research Center, School of Nursing and
Midwifery, Tehran University of Medical Sciences, Tehran,
3Department of Medical and Surgical Nursing, School of
Nursing and Midwifery, Tehran University of Medical
Sciences, Tehran, Iran
Introduction: Delirium is a common problem among patients with
open heart surgery admitted to intensive care units. This study
aimed to assess effectiveness of a multifactor intervention on
delirium prevention and length of staying in patients with open
heart surgery. Methods: In this semi-experimental study, we first
recruited 195 patients. Among them, 15 patients were excluded
during the study due to different reasons. Participants were divided
into study groups. The implemented intervention included staff
education, environment changes, and installation of guideline
reminding on ward. Patients were assessed for delirium twice a day
using the CAM-ICU scale. Demographic characteristics as well as
disease and sleep items were completed by the researchers a day
before surgery. Moreover, length of staying was recorded by the
researchers. Data were analyzed using Pearson Chi-Square,
Independent Samples, and the Fisher's Exact Test. Results: A
significant decrease was found in the incidence of delirium in the
intervention group: 11.1% vs 35.6% (p < 0.05). Average length of
staying in the control and intervention groups was 6.23 vs 6.30
days, respectively. Length of staying among patients with delirium
and patients without delirium was 7.5 vs 5.8 days, respectively.
Patients with delirium were aged 55 years and more in both groups.
Conclusions: Multifactor intervention was effective in decreasing
the prevalence of delirium. Educational interventions are
recommended to improve staffs’ knowledge and environment
Prevalence of overweight and obesity among
Mongolian adolescents
Ayurzana A, Amgalanbaatar D, Avirmed A, Purevsuh S
National Medical University of Mongolia, Mongolia
Introduction: Mongolia is experiencing changes in its unique
nomadic lifestyle in the last two decades with accompanying
increase in obesity rate. The aim of this study is to determine the
prevalence of overweight and obesity among Mongolian
adolescents. Methods: The study included a population-
representative sample of 610 students (300 males and 310 females)
between 10 and 17 years of age who are studying at the secondary
and high schools in Mongolia. The sample was selected using
multistage stratified random sampling technique. Anthropometric
measurements including weight, height, and triceps and subscapular
skinfolds were taken on the adolescents. Age was verified against
school records. To minimize inter-observer error, weight and height
were taken by one person while skinfold was taken by two trained
persons (one for each sex). Results: The obesity and overweight in
boys was lower than in girls (14% in males and 17% in females).
Hence, the prevalence of obesity among Mongolia was high in
girls. It was compared with the WHO recommended criteria (which
BMI for age and skinfolds for age percentiles were estimated to
15% in boys and 18% in girls). Conclusions: The overweight and
obesity rate in Mongolia were increasing annually, it could be the
risk factor of the several illnesses.
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Psychother Psychosom 2015;84(suppl 1):1-82
DOI: 10.1159/000438780
Depression and disability in chronic kidney
disease in Nigeria: a case control Study
Azegbeobor J, Lasebikan VO
Consultation Liaison Psychiatric Unit, Department of
Psychiatry, University College Hospital, Ibadan, Nigeria
Introduction: Depression and chronic kidney disease have been
found to frequently coexist, thereby leading to poorer outcome of
both conditions. The objectives of this study were to determine the
prevalence of depression and disability in Chronic Kidney Disease
(CKD) patients and the association between stages of CKD and
depression in the University College Hospital, Ibadan. Methods:
One-hundred and sixty CKD patients were matched by age and
gender with 160 subjects from the General Out Patient Department
(GOPD). CKD patients were staged according to the study center
criteria. The Mini International Neuropsychiatry Interview was
used to elicit the diagnosis of depression, and the WHODAS 2.0 to
assess disability. All analyses were carried out using (SPSS version
16.0). Results: Prevalence of depression was 17.5% in CKD versus
4.4% in control group, p < 0.001. Median disability score was
higher among the cases (p < 0.001), median WHODAS score for
depression in CKD was higher than in GOPD (p = 0.01). There was
no statistically significant difference between stages of CKD and
depression. Predictors of disability were: stages 3 and 4 of CKD
(OR = 1.9; 95% CI 1.3-3.0), and depression (OR = 8.5; 95% CI 1.8-
38.5). Conclusions: There is a need for effective consultation
liaison work in the general medical department in order to assist in
early detection and treatment of patients with depression in CKD.
Illuminating the alexithymia construct using
bifactor modeling and network analysis
Bagby RM1, Watters CA2, Taylor GJ3
1Departments of Psychology and Psychiatry, University of
Toronto and Center for Addiction and Mental Health, Toronto,
2Department of Psychology, University of Toronto, Toronto,
3Department of Psychiatry, University of Toronto and Mount
Sinai Hospital, Toronto, Canada
Introduction: Alexithymia is defined as a multifaceted personality
construct with four salient components: difficulty identifying
feelings (DIF), difficulty describing feelings to others (DDF),
externally oriented thinking (EOT), and restricted imaginal
processes (IMP). Some researchers, however, have debated the
components comprising the construct and suggested that IMP and
EOT may reflect constructs somewhat distinct from alexithymia. In
this investigation we attempt to clarify the components and their
inter-relationships. Methods: Data were obtained from a large
heterogeneous multi-language sample (n = 839) to whom the
Toronto Structured Interview for Alexithymia (TSIA) was
administered. The analyses involved two distinctly different but
complementary methods -- bifactor modeling and network analysis.
Results: The confirmatory bifactor model and related reliability
estimates supported a strong general factor of alexithymia;
however, the majority of reliable variance for IMP was independent
of this general factor. In contrast, the results of the network analysis
were based on a network comprised of only substantive partial
correlations among TSIA items. Modularity analysis revealed three
communities of items, where DIF and DDF formed one
community, and EOT and IMP formed separate communities.
Network metrics supported that the majority of central items
resided in the DIF/DDF community and that IMP items were
connected to the network primarily through EOT. Conclusions:
Taken together, the results suggest that IMP, at least as measured
by the TSIA, may not be as salient a component of the alexithymia
construct as are the DIF, DDF, and EOT components.
The gender paradox of internalizing and
externalizing difficulties in adolescence
Banga CA1, Chan SWY1, Wrate R2, Schwannauer M1,2
1Department of Clinical and Health Psychology, University of
Edinburgh, Edinburgh, Scotland, UK
2CAMHS Lothian, Scotland, UK
Introduction: Gender differences in prevalence rates for common
mental health problems are well established. When there is an
unequal gender ratio in the prevalence rates for a disorder, the
‘gender paradox’ predicts greater severity and poorer outcomes for
the subgroup of individuals from the opposite (i.e., lower
prevalence) gender people who are afflicted by the disorder. In the
case of adolescents with internalizing and externalizing difficulties,
the gender paradox predicts that boys who exhibit internalizing
symptoms, and likewise girls who exhibit externalizing problems,
have a higher probability of being more severely affected. The
current study assessed whether or not this pattern is valid when
assessing common risk factors contributing to comorbid difficulties
in young people. Methods: Structural equation modelling was used
to investigate a common vulnerability etiological model within a
large (N = 1902) adolescent Scottish school sample (age 14 15
years). Risk factors tested include life stressors, interpersonal
discord, and rumination. Results: All of the etiological risk factors
were significantly associated with comorbidity in both genders and
the models were well-fitted to the data observed. Significant gender
differences emerged when comparing the mediational role of
rumination in the path linking interpersonal discord and comorbid
difficulties. Consistent with the gender paradox, boys had higher
levels of rumination than girls and the latter indirect path was
stronger. Conclusions: Gender can be an informative risk factor
when evaluating adolescents with comorbid problems because if an
individual presents with difficulties that are inconsistent with
typical patterns, it may be an indicator of more serious problems.
A new integrative instrument (AIDOC): impact on
teaching and clinical research
Barbosa F1, Ferro A1, Sousa F1, Santos AL1, Lé P1, Barbosa
1Liasion Psychiatry Department, Hospital de Santa Maria,
Lisbon, Portugal
2Faculty of Medicine, University of Lisbon, Lisbon, Portugal
Introduction: Our aim is to use a new assessment instrument in
oncologic patients testing its integrative qualities in order to be used
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DOI: 10.1159/000438780
in teaching and clinical research. Methods: All patients were
collected in inpatient departments in a general hospital. A total of
177 patients with a mean age of 51.85 years were evaluated by
trained psychologists. The patients were referred for the
psychologist by the physicians, nurses, or psychiatrist, and were not
compromised cognitively. The assessment was done by a clinical
interview and AIDOC (Integrative assessment and intervention for
the complex medical ill), based in a bio-psycho-social perspective.
All patients were assessed according to DCPR criteria. Results: We
found that oncologic patients with worse physical condition (by
WHO) present more somatization (25.0%), higher demoralization
(39.7%) and desire for hastened death (27.9%). We did not find any
statistical differences in attachment styles or family support. We
also did find that patients with worse physical condition perceive
less support from the health professionals, and they had more
unmet needs of information concerning treatment and the course of
the disease. The referrals for psychological and psychiatric
evaluation were mainly from nurses in the worse physical condition
group, while in the other group the physicians made more referrals.
Other interesting result is that the psychologist suggests more
interventions in the worse physical condition group. Conclusions:
AIDOC provides useful information in a sequential and practical
way providing a wide and integrative assessment of oncologic
patients, mainly in explicating the main suffering domain of the
person, and allowing an easy case management by a
multidisciplinary team in the frame of biopsychosocial.
Psychosocial factors in systemic lupus
Barbosa F1, Mota C2, Sampaio D1,3, Barbosa A 1,3
1Liasion Psychiatry Department, Hospital de Santa Maria,
Lisbon, Portugal
2Medicine 2 Department, Hospital de Santa Maria, Lisbon,
3Faculty of Medicine, University of Lisbon, Lisbon, Portugal
Introduction: Our aim was to study the prevalence of psychosocial
factors in systemic lupus erythematosus (SLE) patients, and their
relationship with clinical variables. Methods: A total of 97
Sequential SLE patients (ACR criteria) in an faculty ambulatory
specialized consultation, with an average age of 41.20 years were
assessed by means of clinical interview and by the following
questionnaires: AASR, TAS-20, BSI, HADS, ESSS, and SF-36.
All patients were diagnosed according to the criteria adopted
internationally, the clinical variables assessed were: length of
disease, SLICC, SLEDAI, and medication. All patients were not
compromised cognitively. Results: We found high prevalence of
alexithymia (48.9%), depressive symptoms (47.9%), insecure
attachment, and somatization. As in previous studies, we did not
find significant correlations between psychopathological symptoms
and alexithymia with clinical variables. We did find an association
with the need to be dependent and SLEDAI. We also found
interesting results concerning quality of life and SLEDAI, positive
correlations with vitality. We did find a negative correlation
between alexithymia, psychopathological symptoms, and social
support. SLE patients exhibit higher levels of alexithymia and
psychopathological than the healthy volunteer control group.
Conclusions: We found high levels of impairment in psychosocial
factors, such as psychopathological symptoms, alexithymia and
attachment style but we did not find an association with the clinical
Efficacy of a training program in relational skills
Barbosa M1, Guerreiro V1, Barbosa A1,2
1Faculty of Medicine of the University of Lisbon, Lisbon,
1University of Lisbon, Lisbon, Portugal
2University Hospital of Santa Maria, Lisbon, Portugal
Introduction: Relational skills in a psychosomatic framework
assumes an increasingly prominent role in achieving quality care
for patients and their families. There is evidence that
communication/relational skills can be improved by training. We
developed a relational skills training program for the residents of
the University Hospital of Lisbon centered on the principles of
patient-centered care and relational ethics. The aim of this study
was to assess the effects of a communication/relational skills
program. Methods: Fifty-two internal medicine residents were
randomized to a 3-sessions intervention (3 hours each), which
included instruction, role-play techniques with clinical relevant
simulated patients on two main issues (breaking bad news and
discussion direction of care), video-taping and self-appraisal,
discussion constructive feedback, reflexive exercises and formative
assessment, accompanied by written material. Each participant
performed two consultations with simulated patients for each
training session (a total of 6 consultations). Videos-recorded
consultations with simulated patients were analyzed with Verona
Coding Definitions of Emotional Sequences and Health Provider
Responses. Trained residents were compared at baseline, after five
days and three months following training. Results: The results
showed an improve on: 1. gathering data to better understand
lifestyle and psychosocial issues; 2. building a relationship to
development a rapport and responsiveness to the patient´s
emotions, including respond to their concerns with more legitimize
patients´ emotions and empathic statement; 3. facilitation and
patient activation to enhance patients´ capacity to engage in the
consultation; and 4. organizing the consultation sequence based on
the patients´ cognitive understanding and their emotional cues and
concerns. Conclusions: This training program demonstrated to be
effective on residents´ availability to attendance psychosocial
aspects, better preparation for bad news and better ability to
respond empathically to the patient's emotional cues and concerns
in the frame of a biopsychosocial approach.
Prevalence of DCPR syndromes in patients
suffering from various chronic diseases
Basińska MA1, Woźniewicz A1,2
1Department of Psychopathology and Clinical Diagnosis,
Institute of Psychology, Kazimierz Wielki University,
Bydgoszcz, Poland
2Department of Rahabilitation Psychology, Ludwig Rydygier
Collegium Medicum, Nicolaus Copernicus University,
Bydgoszcz, Poland
Introduction: Holistic recognition of human nature within the
biopsychosocial approach leads to a broader perception of the
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DOI: 10.1159/000438780
causes of diseases and their treatment. The Diagnostic Criteria for
Psychosomatic Research (DCPR) proposed by an international
group of psychosomatic investigators are an operationalized tool for
the assessment of psychosomatic syndromes in medical patients.
The aim of the study was to present the occurrence of
psychosomatic syndromes in various groups of Polish patients, with
particular regard to their associations with coexistence of comorbid
diseases, disease duration and age. Methods: A total of 359
patients with heterogeneous medical disorders were administered
an ad hoc polish version of the Structured Interview for DCPR.
Results: A DCPR syndrome was identified in 70% of the subjects.
Health anxiety and illness denial were the most frequently reported
syndromes. A rate of 26% of the patients were diagnosed with one
syndrome, 44% with two or more syndromes. Differences in
occurrence of particular syndromes were found with regard to the
type of the disease. Health anxiety occurred most frequently in the
group of patients with viral hepatitis, illness denial, and conversion
symptoms in cardio-vascular disease and asthma patients, and
alexithymia in asthma and GP patients. The comorbidity of other
diseases differentiates the frequency of particular psychosomatic
syndromes. What is more age correlated positively with the number
of existing syndromes. Conclusions: Psychosomatic syndromes, as
measured by DCPR, occur in Polish patients. These findings
underscore the importance of psychosomatic assessment and the
usefulness of taking DCPR syndromes into consideration during
An efficient and effective use of buprenorphine in
the management of opioid addiction: the West
Virginia model
Berry JH
Department of Behavioral Medicine and Psychiatry, West
Virginia University School of Medicine, Morgantown, West
Virginia, USA
The Centers for Disease Control and Prevention has declared that
opioid drug overdose is a United States epidemic. Over the last two
decades, opioid overdose has become the leading cause of injury,
surpassing both injuries from firearms, and motor vehicle accidents.
Misuse of prescription analgesics accounted for the sharpest rise in
these deaths with rates nearly quadrupling from 1999 to 2013. More
recently, death rates associated with heroin have been sharply
climbing. The U.S. state of West Virginia has been particularly
hard hit by this epidemic, consistently ranking as one of the top two
states suffering from opioid overdose and addiction. From 1999 to
2004, West Virginia experienced the nation’s largest surge in the
drug poisoning death rate with a 550% increase. In 2000, the U.S.
Congress passed the Drug Abuse Treatment Act allowing
physicians to prescribe Buprenorphine for the treatment of opioid
addiction. We describe our experience in the evolution of a
sustainable program using Buprenorphine in a group therapy setting
at West Virginia University. Since 2004 we have treated over 2000
patients and currently are providing care for 400 patients. This
model, which includes individual counseling and twelve step
participation, moves participants through three “stages” of
treatment: Beginner, Intermediate, and Advanced. We have found
this model to be highly effective in keeping patients therapeutically
engaged and increasing the quality of life for those suffering from
the disease of addiction.
Strategies to wean off benzodiazepines
Bingeliene A, Shapiro CM
Toronto Western Hospital/ University of Toronto, Toronto,
Introduction: This 10-case series demonstrates an efficient
method for weaning patients from benzodiazepines. Case
description: This review involves the evaluation of 10 patient case
reports and describes the methods used to wean these individuals
off benzodiazepines. In 5 of these cases, a single-blind
benzodiazepine-placebo trial was initiated. Patients were given a
month’s supply of medication including partial placebo
replacement and were asked to keep a diary detailing how they felt
each day. Patients were seen on a monthly basis. Using information
collected in the diary, a greater number of days were replaced with
an increasing proportion of placebo after each follow-up when it
became clear that the patient could not clearly distinguish between
days with a placebo and days without. In this way, the
benzodiazepine dose was gradually decreased. Following review of
the data, it was found that patients on this weaning method required
less time to reduce their dose to zero and reported feeling greater
wellbeing on more placebo days. This is in contrast to alternative
methods that include replacing the benzodiazepine drug with
zopiclone (2 cases) and simply slow and gradual benzodiazepine
dose decrease (3 cases). Comment: Some individuals are able to
stop taking benzodiazepines without any difficulty, experiencing
only minor withdrawal effects. However, many find too difficult to
cope with withdrawal. Based on this case series, the single-blind
placebo method described above is very successful but also labor
intensive. We are now using this approach in clinical practice quite
Children with somatic symptom disorders: is
attachment investigation a key aspect for the
diagnostic and intervention process?
Bizzi F, Castellano R, Cavanna D
Department of Educational Sciences, University of Genoa,
Genoa, Italy
Introduction: somatic symptom disorders (SSD) are characterized
by multiple and variable physical symptoms without demonstrable
pathophysiological processes. Literature has investigated the role of
several psychological variables in SSD, with inconclusive data.
Moreover, there is a paucity of studies on middle-childhood and
early adolescence. The aim of this study was to evaluate the role of
attachment as indicator of socio-emotional functioning in a sample
of young patients with SSD. Specifically, we examined quality of
attachment using different measures: 1) a narrative, evaluating the
‘state of mind’ of children; 2) a projective measure examining the
‘style’ of attachment; 3) a questionnaire, evaluating the perception
of security to parents. Methods: Sixty consecutive Italian patients
aged from 8 to 15 years, previously diagnosed with SSD, were
administered a battery of tools to investigate the attachment: Child
Attachment Interview, Separation Anxiety Test, Security Scale,
Inventory of Parent and Peer Attachment. Furthermore, they were
administered WISC-IV to have a homogeneous sample on verbal
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DOI: 10.1159/000438780
comprehension index. Results: Insecure attachment was found in
more than half of the patients with SSD. In addition, an over-
representation of disorganized state of mind was observed. The
perception of security to parents was not high. Conclusions: these
findings support the utility to further investigate the attachment for
a better evaluation of the disorganization aspects surrounding the
SSD in children and adolescents. The clinical implications for
future research directions are discussed.
Psychological features in adolescent with
medically unexplained cutaneous sensory
symptoms: a single case study
Bizzi F, Cavanna D
Department of Educational Sciences, University of Genoa,
Introduction: this single case study aims to consider psychological
features as fundamental elements to be assessed in the evaluation of
“pseudo” dermatological disorders. Case description: the case
illustrates a rare skin disease, which occurs in comorbidity with
somatic symptom disorders in a young patient, aged 15. It was
administered a battery of tools to investigate the personality profile,
Child Attachment Interview (CAI), Separation Anxiety Test (SAT),
Inventory of Parent and Peer Attachment (IPPA), Emotion
Regulation Questionnaire (ERQ-CA), Trauma Symptom Checklist
for Children (TSCC-A), and WISC-IV. Comment: somatization,
defined as the “conversion” of psychological conflicts and
overwhelming emotions into more acceptable physical symptoms,
is encountered among a wide range of syndromes in dermatology.
These syndromes include medically unexplained cutaneous sensory
symptoms, which represent the sensory component of a traumatic
experience, and may be associated to dermatological
manifestations. This case was carried out to demonstrate that the
psychological side of this clinical condition has been poorly
investigated and further evaluations are required. The clinical
implications for pediatric care are discussed.
The Cognitive Behavioral Analysis System of
Psychotherapy (CBASP) for chronically depressed
elderly patients
Bollmann S1, Radtke M2, Normann C2, Zimmermann J3,
Kessler EM4, Brakemeier EL1
1Berlin University of Psychology, Berlin, Germany
2Department of Psychiatry and Psychotherapy, University of
Freiburg Medical Center, Freiburg, Germany
3Department of Clinical Psychology and Psychotherapy,
University of Kassel, Kassel, Germany
4Department of Clinical Psychology and Psychotherapy,
University of Heidelberg, Heidelberg, Germany
Introduction: Specific psychotherapeutic interventions turned out
feasible and effective for the treatment of elderly patients. In
addition, the amount of non-responder is substantial. Hence, by the
use of recently developed psychotherapy procedures especially
designed for the non-responder to traditional psychotherapies
enlarged possibilities of treatment also arise for older patients.
CBASP is the first treatment tailored to the particular needs of
chronically depressed patients and has proven efficacy in
randomized controlled trials and case studies. Currently no study
could be found regarding the feasibility and effectiveness of
CBASP in older chronically depressed patients. Methods: A first
analysis addressing this question uses the data of an open study in a
CBASP inpatient program. Results: The analysis of the subgroup
55-70 years (n = 14) revealed that one patient in the treatment
dropped out (7.1%), 8 patients reached remission (57.1%) and 5
showed response (overall response 92.8%). In addition, only 4
patients (28.6%) at 6 months and 5 (35.7%) at 12 months had a
relapse. The correlation between chronological age and the
percentage improvement in HAMD proved to be significant (r =
0.283; p = 0.023). Conclusions: These first results emphasize
clinical experience and point out that CBASP might be indeed
useful and effective in elderly patients.
A validation study of the Pain Self-Efficacy
Questionnaire in dental care patients
Bonafé FSS1, Maroco J2, Campos JADB1
1Faculdade de Odontologia de Araraquara, Universidade
Estadual Paulista, Araraquara, São Paulo, Brazil
2Instituto Universitário de Ciências Psicológicas, Sociais e da
Vida, Lisboa, Portugal
Introduction: self-efficacy can be defined as the degree of
confidence that the individual has to perform something
successfully. This is important in determining behavior of people
with pain. Individuals with higher self-efficacy are more active and
present better resources to deal with pain. The aim of the study was
to evaluate the psychometrics properties of the Pain Self-Efficacy
Questionnaire (PSEQ) when applied to dental care patients.
Methods: Two-hundred and sixty-four patients seeking dental care
at the Brazilian public university (83.7% women, mean age 39.4 ±
11.1 years) completed the PSEQ. This instrument is composed of
10 items (unifactorial). The validation study was conducted using
confirmatory factor analysis. The psychometric sensitivity was
indicated by the skewness (Sk) and kurtosis (Ku). The fit indices
chi-square over degrees of freedom (2/df), comparative fit index
(CFI), goodness of fit index (GFI), and root mean square error of
approximation (RMSEA) were used. The convergent validity was
performed by the average variance extracted (AVE) and the
reliability by Cronbach's alpha coefficient () and composite
reliability (CR). Results: the sensibility of the items was adequate
(|Ku| and |Sk| < 3). The fit indices of PSEQ to the sample were
inadequate ( = 0.54 - 0.87; 2/df = 5.088; CFI = 0.929; GFI =
0.875; RMSEA = 0.125). After inserting two correlations between
the errors of the items (LM > 20.0; p < 0.001), the fit of the model
was adequate ( = 0.54 - 0.88; 2/df=3.462; CFI = 0.960; GFI =
0.923; RMSEA = 0.097). The PSEQ presented adequate convergent
validity (AVE=.57) and reliability ( = 0.94; CR = 0.93).
Conclusions: the Pain Self-Efficacy Questionnaire showed
adequate psychometric properties when applied to the sample of
patients seeking dental care.
Psychometric characteristics of the Portuguese
version 20-item Toronto Alexithymia Scale when
applied to adults - preliminary study
Bonafé FSS1, Maroco J2, Campos JADB1
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Psychother Psychosom 2015;84(suppl 1):1-82
DOI: 10.1159/000438780
1 Faculdade de Odontologia de Araraquara, Universidade
Estadual Paulista UNESP, Araraquara, São Paulo, Brazil
2 ISPA-IU, Instituto Universitário de Ciências Psicológicas,
Sociais e da Vida -, Lisboa, Portugal
Introduction: alexithymia integrates many investigative models in
psychosomatic. The 20-item Toronto Alexithymia Scale (TAS-20)
is the most widely used instrument to measure this variable. The
objective of this study was to estimate the metric properties of the
TAS-20 in Brazilian adults. Methods: Two-hundred and four
individuals seeking dental care at the Brazilian public university
participated in this study. The average age of participants was 40.0
± 11.2) years and 83.2% were females. The TAS-20 was applied by
personal interview. The psychometric sensitivity of the items was
estimated. The confirmatory factor analysis was estimated using the
indices chi-square over degrees of freedom (2/df), comparative fit
index (CFI), goodness of fit index (GFI), and root mean square
error of approximation (RMSEA). The convergent validity was
evaluated by the average variance extracted (AVE). The internal
consistency was estimated by Cronbach's alpha coefficient (α).
Results: The sensitivity of the items was adequate (|Ku| e |Sk| < 3).
The fit of the three-factor model (Difficulty Identifying Feelings-
DIF, Difficulty Describing Feelings to Others-DDF, Externally
Oriented Thinking-EOT) was inadequate to the sample ( = 0.13 -
0.74; 2/df = 1.754; CFI = 0.855; GFI = 0.876; RMSEA = 0.061).
The fit of model improved ( = 0.35 - 0.69; 2/df = 1.677; CFI =
0.926; GFI = 0.915; RMSEA = 0.058) when five items were
removed ( < 0.35) and one correlation was inserted between the
errors of the items (LM = 18.27; p < 0.001). The scale showed low
convergent validity (AVE = 0.21 - 0.38). EOT-factor showed low
internal consistency ( = 0.39 0.83). Conclusions: The factorial
validity was satisfactory but there was limitation of convergent
validity in the refined three-factor model of TAS-20 when applied
to Brazilian adults. This result corroborates what has been reported
in the literature.
Satisfaction with Social Support Scale: validation
study in the prison environment
Bonafé FSS1, Schneider V2, Oliveira RV2, Maroco J3, Campos
1Faculdade de Odontologia de Araraquara, Universidade
Estadual Paulista UNESP, Araraquara, São Paulo, Brazil
2Faculdade de Ciências Farmacêuticas, Universidade
Estadual Paulista UNESP, Araraquara, São Paulo, Brazil
3ISPA IU, Instituto Universitário de Ciências Psicológicas,
Sociais e da Vida, Lisboa, Portugal
Introduction: Satisfaction with Social Support Scale (ESSS) is an
instrument used to assess satisfaction with the support that
individuals receive from family and friends. Social support can be a
protective factor towards labor adversity. Methods: A total of 339
employees (age: 40.2 ± 8.8years; male: 81.0%) of two Brazilian
detention centers completed the Satisfaction with Social Support
Scale (ESSS). Of the participants, 20.8% worked as prison escort
and surveillance agents, 64.0% as correctional security officer,
3.9% as health care professional, and 11.3% as
operational/administrative officer. The construct validity was
estimated by factorial, convergent and discriminant validity.
Confirmatory factor analysis was performed using the indices chi-
square over degrees of freedom (2/df), comparative fit index
(CFI), goodness of fit index (GFI), and root mean square error of
approximation (RMSEA). The convergent validity was evaluated
by the average variance extracted (AVE) and the discriminant
validity by correctional analysis. The reliability was assessed by
Cronbach's alpha coefficient () and composite reliability (CR).
Results: The sensibility of the items was adequate (|Ku| and |Sk| <
3). The fit of the original four-factor model (Satisfaction with
friendships; Intimacy; Satisfaction with family; Social activities)
was inadequate to the sample ( = 0.38 - 0.82; 2/df = 3.340; CFI =
0.873; GFI = 0.896; RMSEA = 0.083). To obtain adequate fit of the
model ( = 0.45 - 0.86; 2/df = 2.759; CFI = 0.914; GFI = 0.923;
RMSEA = 0.073), one item was removed ( < 0.40) and one
correlation was inserted between the errors of the items (LM =
20.397; p < 0.001). The convergent validity (AVE = 0.41 - 0.49)
and the discriminant validity (2 = 0.04 - 0.28) were adequate. The
ESSS was reliable ( = 0.71 - 0.76; CR = 0.72 - 0.76).
Conclusions: the Satisfaction with Social Support Scale showed
adequate psychometric properties for use in the prison working
Influence of combat related post-traumatic stress
symptoms on quality of pain in Croatian war
veterans with PTSD and chronic pain
Brajkovic L1, Bras M2, Djordjevic V2
1University Hospital Centre Zagreb, Department of
Psychiatry, Zagreb, Hungary
2University Hospital Centre Zagreb, Department of
Psychological Medicine, Zagreb, Hungary
Introduction: Posttraumatic stress disorder (PTSD) is an extreme
response to a traumatic event. Chronic PTSD is associated with
various somatic illnesses including chronic pain, and up to 80% of
PTSD veterans suffer from chronic pain state. The aim of this
research was to investigate the influence of PTSD symptoms on
quality of pain in Croatian war veterans who suffer from post-
traumatic stress disorder and chronic pain. Methods: Study
included 320 male war veterans. McGill Questionnaire for pain and
Trauma Symptom Inventory were used for this purpose. Results:
significant correlations were found between intensity of PTSD
symptoms and affective and sensory pain (re-experience and
sensory pain: r = 0.32; p < 0.05; avoiding and sensory pain: r =
0.21; p < 0.05; emotional arousal and sensory pain: r = 0.46; p <
0.001; re-experience and affective pain: r = 0.49; p < 0.001;
avoiding and affective pain: r = 0.57; p < 0.001; emotional arousal
and affective pain: r = 0.6; p < 0.001). The regression model
indicates that re-experiencing the traumatic event, avoiding
reminders, and emotional trauma were predictive of sensory pain
(R= 0.525; p < 0.001) as well as of affective pain (R = 0.676; p <
0.001). The most predictive factor in explanation of sensory pain is
emotional arousal (β = 0.365; p < 0.05), and the most predictive
factor in affective pain is re-experiencing the traumatic events (β =
0.634; p < 0.001). Avoidance as a symptom of PTSD was not a
predictive factor neither of sensory pain nor of affective pain =
0.011; p = n.s.; β = 0.15; p = n.s.). Conclusions: The results
showed a synergistic effect of PTSD symptoms on quality of
chronic pain and multidisciplinary while the effects of multimodal
programme for treating PTSD patients with chronic pain must still
be established.
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Psychother Psychosom 2015;84(suppl 1):1-82
DOI: 10.1159/000438780
A chronically depressed patient with personality
problems being treated with CBASP: Advantages
of using the alternative DSM-5 model for
diagnosing and tailoring treatment
Brakemeier EL1, Zimmermann J2, Benecke C2
1Department of Psychology and Psychotherapy, University of
Psychology, Berlin, Germany
2Department of Psychology, University of Kassel, Kassel,
Introduction: Chronically depressed patients often show comorbid
personality disorders (PD). The fifth edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5) features in Section
III an alternative model for the diagnosis of PD focusing on
impairments in personality functioning and maladaptive personality
traits. The case example demonstrates how the alternative DSM-5
model converges with diagnostic and therapeutic strategies of the
Cognitive Behavioral Analysis System of Psychotherapy (CBASP).
Case description: The case is a 52-year old female patient with
chronic depression (early onset, early trauma) and chronic pain
disorder. In addition, she could be labeled as treatment-resistant.
Concerning DSM-IV-TR / DSM-5 Section II, she fulfilled criteria
for four PDs (i.e., avoidant, obsessive-compulsive, paranoid, and
depressive PD). In contrast, the alternative DSM-5 model suggests
the diagnosis of a PD trait-specified, with severe impairments in
personality functioning (especially in the domains intimacy und
empathy) and specific maladaptive personality traits (especially the
domains detachment and disinhibition). The patient was treated
within a research project and received 12 weeks of inpatient
CBASP. By applying situational analysis with Interpersonal Circle
and disciplined personal involvement, the problems concerning
personality functioning and personality traits were directly
addressed. These CBASP-strategies will be demonstrated (by video
tapes). Comment: As CBASP is conceptualized as an integrative
interpersonal learning therapy, there appear many theoretical and
empirical links to the alternative DSM-5 model. The case highlights
the clinical utility and the integrative potential of the alternative
DSM-5 model from a psychotherapeutic perspective.
Psychological adaptation to breast cancer: A
systematic review of longitudinal studies
Brandão T1, Schulz MS2, Matos PM1
1Faculty of Psychology and Education, University of Porto
and Center for Psychology at University of Porto, Porto,
2Department of Psychology, Bryn Mawr College, Bryn Mawr,
Pennsylvania, USA
Introduction: Breast cancer (BC) can be a traumatic and stressful
experience for women. Individual differences in the way women
respond and adapt to BC may be associated with a wide range of
factors. This review examined the extent to which demographic,
disease-related, and psychosocial factors are associated with
psychological adaptation to BC. Methods: A systematic review
following PRISMA criteria was conducted. Database searches were
conducted in 9 different health-related databases from 2000 to
September 2014 using relevant search terms. English, peer-
reviewed articles with longitudinal designs that explored potential
predictors of psychological adaptation were considered for
inclusion. Results: Of 1453 abstracts, 31 studies fulfilled inclusion
criteria. Results on demographic and disease-related variables were
mixed. In regard to psychosocial factors, personality traits, namely
optimism and trait-anxiety, and perceived social support were
found to be statistically significantly related to depression, anxiety,
psychological distress, and quality of life. Other psychosocial
variables were related to psychological adaptation but were
explored only by very few studies. Conclusions: Most of the
studies established a significant relationship between psychosocial
factors and psychological adaptation. These results point to factors
that can help to identify women who are at risk for long-term
psychological distress and to refer them to adequate psychological
support after diagnosis in order to promote their psychological
adaptation to BC.
The role of psychosocial moderator factors in the
relationship between stress and multiple sclerosis:
a case-control study
Briones-Buixassa L1, Milà R1, Aragonès JM2, Bufill E2, Arrufat
1Research group in Mental Health and Social Innovation
(SaMIS), UVic-UCC-CHV, Catalonia, Spain
2Department of Neurology, Consorci Hospitalari de Vic,
Catalonia, Spain
Introduction: Many studies have shown that stress could be a risk
factor for multiple sclerosis (MS) and affects disease progression,
although it depends on different moderator factors, some of them
potentially modifiable. These are the first analyses for “PsychoMSS
Study: Stress and Psychosocial moderator factors in Multiple
Sclerosis” a project developed in Osona, a region with increasing
incidence of MS. The aim of this study was to investigate the role
of different psychosocial moderator factors in the stress-multiple
sclerosis relationship. Methods: Nineteen MS patients, paired by
age and sex with healthy controls, were evaluated for early life
stress (CTQ), coping style (Hofboll), alexithymia (TAS-20),
anxiety (STAI), perceived social support (PSS), and stressful life
events throughout their lives (SRRS). Results: Significant
differences with higher scores in MS patients were found in
alexithymia (55.8 vs 40.6; p < 0.001) and anxiety (STAI-S 12.32 vs
22.93; p < 0.05 and STAI-T 16.16 vs 26; p < 0.05). Risk for MS
was increased 11-fold in people with alexithymia (OR 11.70; 95%
CI 2.08 - 65.6). Moreover, it was observed a significant tendency to
use more avoidant coping strategies in MS patients. No significant
differences were found in early life stress, social support, and
stressful life events. Conclusions: The psychosocial moderator
factors related with MS were those regarding to psychological
individual characteristics. Noteworthy, alexithymia, anxiety, and
coping style are factors potentially modifiable by psychological
clinical therapy. More prospective observational and interventional
studies focused on specific moderating factors are needed to
elucidate these effects on the onset and progression of MS.
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Psychother Psychosom 2015;84(suppl 1):1-82
DOI: 10.1159/000438780
Visual illness narratives using PRISM to elicit and
understand the subjective experience of suffering
Büchi S
Clinic for Psychotherapy and Psychosomatics, Hohenegg
Clinic, Meilen, Switzerland
Suffering, according to the seminal definition of Eric Cassell, is the
experience of severe distress due to a severe impending threat to the
person. For more than 15 years, we have used PRISM (the Pictorial
Representation of Illness Measure) to assess suffering
(quantitatively and qualitatively) due to illness or significant loss.
This presentation will focus on three studies in particular. 1. In a
study of people with systemic lupus erythematosus (SLE), PRISM
identified three distinct patterns of adaptation to the diagnosis,
differing in level of suffering, personal resilience, and post-
traumatic growth. 2. In a sample of couples who had lost a baby
born prematurely, the extent of suffering was inversely related to
reported post-traumatic growth. Differences were found between
some parents but importantly mothers‘ suffering was inversely
related to the extent to which they perceived their partners to be
empathic. 3. A recent study of people with chronic tinnitus used
PRISM and EEG power analysis. Contrary to expectations,
suffering did not correlate with perceived volume of the tinnitus,
but correlated with pre-frontal brain activity. All three studies
highlight ways in which PRISM can be used to elicit personally
salient information to contribute to the understanding of suffering
and the experience of illness. Drawing from these studies,
implications for the treatment of suffering will be discussed. Using
PRISM to visualize complex personal changes can enhance a
person’s capacity to adapt to illness or loss.
How do dentally anxious patients account for the
onset of their dental anxiety?
Burgess D, Holmes R, Wilson K
Department of Conscious Sedation, Dental hospital,
University of Newcastle, Newcastle-upon-Tyne, England
Introduction: The incidence, causative factors, and consequences
of dental anxiety are well documented, and the link between
traumatic dental experiences and the onset of dental anxiety widely
is accepted. The process of anxiety acquisition and whether dental
anxiety onset can be intercepted through appropriate aftercare
following traumatic dental experiences is less well understood. The
aim of this study was to explore the concept of anxiety interception
through examining experiences of dentally anxious patients.
Methods: A random sample of 362 adult patients attending a
general dental practice completed questionnaires designed to obtain
data regarding levels of dental anxiety, predisposing factors, and
traumatic dental experiences. Nineteen dentally anxious
participants were than interviewed and thematic analysis used to
explore emergent trends. Results: About 9% of participants were
classed as extremely anxious using the Modified Dental Anxiety
Scale. The numbers of existing fears, and experience of traumatic
dental events, were significantly greater (p < 0.001) in extreme
anxiety compared to lower anxiety groups. The impact of attitude
and manner of dentists, and lack of communication and aftercare
were also highly prevalent in subjects with greater dental anxiety.
Conclusions: These findings support suggestions that personality
type and exposure to traumatic dental events are important
predisposing factors in dental anxiety acquisition. Additionally, this
study suggests that the manner and attitude of dentists, and lack of
communication and aftercare also contribute to this process.
According to dental patients, dentists do little to help alleviate
anxiety onset following traumatic events while appropriate
aftercare immediately after such events would reduce likelihood of
dental anxiety formation.
How are depressive symptoms and social support
associated over time in adults with diabetes? A
test of competing models
Burns RJ1,2, Deschênes SS1,2, Schmitz N1,2,3
1Department of Psychiatry, Faculty of Medicine, McGill
University, Montreal, Canada
2Douglas Mental Health University Institute, Montreal,
3Department of Epidemiology and Biostatistics, Faculty of
Medicine, McGill University, Montreal, Canada
Introduction: Individuals with diabetes are at increased risk of
elevated depressive symptoms, and social support has been
identified as a key factor in promoting the health of this population.
Associations between depressive symptoms and social support have
been demonstrated in individuals with diabetes. Three classes of
theoretical models differentially describe the direction of this
association: 1. social support influences depressive symptoms; 2.
depressive symptoms influence social support; and 3. a reciprocal
association exists between depressive symptoms and social support.
The aim of this study was to compare these three theoretical
models. The model containing reciprocal associations between
depressive symptoms and social support was expected to best fit the
data. Methods: Depressive symptoms and social support were
measured via telephone survey in a large cohort study of
individuals with diabetes (n = 1754) in Quebec, Canada. After
baseline, data were collected annually for four years. The fit of four
path models were compared with Akaike’s information criterion
(AIC). The first path model was a stability model, which contained
only autoregressive effects. The remaining three path models
represented each of the theoretical models. Results: The reciprocal
model had the lowest AIC, so it was selected as the best fitting
model. At all time points depressive symptoms predicted
subsequent social support, and at most time points social support
predicted subsequent depressive symptoms. Conclusions: It
appears that the association between depressive symptoms and
social support in people with diabetes is best characterized as a
reciprocal relationship. Results underscore the importance of
comparing competing models.
The cyclic relationship between depressive
symptoms and diabetes distress: results from the
Montreal evaluation of diabetes treatment study
Burns RJ1,2, Deschênes SS1,2, Schmitz N1,2,3
1Department of Psychiatry, Faculty of Medicine, McGill
University, Montreal, Quebec, Canada
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2Douglas Mental Health University Institute, Montreal,
Quebec, Canada
3Department of Epidemiology and Biostatistics, Faculty of
Medicine, McGill University, Montreal, Quebec, Canada
Introduction: Individuals with type-2 diabetes are at increased risk
of depression. Individuals with elevated depressive symptoms tend
to interpret events more negatively, and thus may view diabetes as
more distressing. People with some health conditions, including
diabetes, are more likely to exhibit depressive symptoms,
suggesting that distress specific to the health condition may
influence general affect. This study sought to determine if
longitudinal cyclic relationships exist between depressive
symptoms and diabetes distress in individuals with type-2 diabetes.
Methods: Data came from the Montreal Evaluation of Diabetes
Treatment study, which is a cohort study of individuals with type-2
diabetes (n = 1691). Depressive symptoms and diabetes distress
were assessed at baseline, 1 year, and 2 years. A cross-lagged path
model analysis with all autoregressive effects was utilized.
Results: Across all consecutive time points, depressive symptoms
were positively associated with diabetes distress and diabetes
distress was positively associated with depressive symptoms. The
effect of depressive symptoms at baseline on depressive symptoms
at year 2 was mediated by both depressive symptoms and diabetes
distress at year 1. The effect of diabetes distress at baseline on
diabetes distress at year 2 was also mediated by both depressive
symptoms and diabetes distress. Conclusions: The current study is
the first to demonstrate that depressive symptoms and diabetes
distress are cyclically related; one condition contributes to the
maintenance and exacerbation of the other. Stress related to
diabetes may contribute to the increased prevalence of depression
among individuals with type-2 diabetes. Results may have clinical
Biological dimension and comorbidities in
psychosomatic medicine
Byung-il WC
Medical College of Wisconsin, Milwaukee, WI, USA
In traditional medical education, the term psychosomatic medicine
alluded that psychological stress might have been major cause of
somatic manifestation of disease, without clear mechanism of
somatization process could be explained. It has been a clinical
challenge how the disease manifest as illness when the pathology is
invisible, or often illusive. In traditional sense of medical education,
anatomical structure of pathology has been considered as disease,
thus absence of morphological disease has been attributed as
psychosomatic. As we redefine and expand the concept of disease
to molecular and genetic level, invisible pathology becomes clearer
as it manifest as clinical presentation. For instance, white coat
hypertension or labile hypertension has been often interpreted as
psychogenic due to lack of morphological presence of pathology,
whereas essential hypertension was defined in the presence of
microvascular pathology in the end organ. Similar analogy can be
applied in Prinzmetal angina and coronary vasospasm causing chest
pain in contrast to structural coronary atherosclerosis and stenosis.
No longer is lack of visible pathology be looked at as absence of
pathology, when the molecular level of functional abnormalities
could be a part of disease, i.e. endothelial dysfunction causing
vasospasm, due to inappropriate NOS activities. Receptor
physiology and distribution of beta 1 and 2 receptors causing
cardiac dysfunction to catecholamine surge is becoming more
plausible explanation for stress induced cardiomyopathy. Many
invisible elements of pathogenesis have been revealing itself, which
used to be often considered as psychogenic. Therefore, future
psychosomatic education has to address how somatization process
manifests itself to stressful stimulation leading biological
manifestation of symptoms on the basis of demonstrable somatic
pathogenesis. Moreover, it has to be reemphasized that
comorbidities which have been often neglected in psychosomatic
process as it reveals itself as clinical manifestation.
Associations between happiness and behavioral
factors among school adolescents in Korea
Byung-Sung K
Department of Family Medicine, Kyung Hee University
Medical College, Seoul, Korea
Introduction: Happiness has been associated with several
behavioral and social factors. Even though there are a couple of
studies about happiness, however few of them showed the
relationship among Korean adolescents. The purpose of this study
was to investigate the association between happiness and behavioral
factors in adolescents. Methods: The subjects were 72435 middle
and high school students (36655 boys and 35780 girls) recruited
from stratified random cluster sampling of 800 Korean middle and
high schools in 2013, Korea Youth Risk Behavior Web-based
Survey (KYRBWS). Chi-square test and logistic regression
analysis were ran to find out the relating factors with happiness.
Results: The average age was 14.9 years in both sex, the boys tend
to be more smokers, alcohol drinkers, obese, taking breakfast and
adequate sleep, and happier than girls. Girls had depressed mood
and stress more than boys. Adolescents who are under stress,
drinkers, smokers, drug users, and depressed were less happier
(OR=0.240, 0.939, 0.849, 0.633, 0.504, respectively, p < 0.001),
and those who took breakfast, physical activity, adequate sleep,
having both parents, being in higher family affluence scale and
socioeconomic status were more happier (OR = 1.221, 1.344,
1.152, 1.121, 1.248, 2.214, respectively, p < 0.001). Conclusions:
Happiness was associated with a variety of behavioral factors,
stress and depression had most negative relations with it.
The spectrum of fear specific phobias and their
relationship to wellbeing
Campbell NB
Kalamunda Dental Care, Perth, Western Australia, Australia., Fremantle, Perth, Western Australia,
Specific phobias are a fairly common complaint, but receive
academic short shrift relative to agoraphobia and social phobias,
which are often considered to be more debilitating, and therefore
more worthy of treatment. Helping patients to “work through” as
opposed to circumnavigate specific phobias can yield profound,
wide ranging, and sometimes-unexpected benefits. The DSM
Classification of phobias, and what this means for the clinician, will
be illustrated. Current advances to evidence based treatment
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modalities will be considered, and the meta-analytic findings
concluding the superiority of in vivo exposure (relative to
alternative modes of exposure) will be considered. With this in
mind, techniques for ethically and effectively exposing patients to
the different types of specific phobia (including animal, natural
environment, blood-injection-injury, situational and other) will be
outlined. Case studies of clients who have successfully overcome
their specific phobias and the wide-ranging benefits this has
conferred will be presented.
Depression Anxiety Stress Scales: validation study
Campos JADB1,2, Bonafé FSS1, Carvalho JS2, Maroco J3
1Faculdade de Odontologia de Araraquara, Universidade
Estadual Paulista UNESP, Araraquara, São Paulo, Brazil
2Faculdade de Ciências Farmacêuticas, Universidade
Estadual Paulista UNESP, Araraquara, São Paulo, Brazil
3Instituto Universitário de Ciências Psicológicas, Sociais e da
Vida, Lisboa, Portugal
Introduction: Psychometric scales have been widely used in
epidemiological studies that aim to identify evidence of
psychosomatic conditions. It is necessary to check the quality of
measurement of variables such as the Depression, Anxiety and
Stress. The aim of this study was to estimate the validity, reliability,
and stability of the Portuguese version of the 21- Depression
Anxiety Stress Scales (DASS-21) when applied to dental patients.
Methods: Two-hundred and five adult patients seeking dental care
at the Brazilian public university participated in this study (age:
40.0 ± 11.2years; female: 83.2%). The DASS-21 was completed by
personal interview. The confirmatory factor analysis was performed
using the indices chi-square over degrees of freedom (2/df),
comparative fit index (CFI), goodness of fit index (GFI), and root
mean square error of approximation (RMSEA). The convergent
validity was evaluated by the average variance extracted (AVE).
The reliability was assessed by internal consistency () and
composite reliability (CR). The invariance of the model was tested
in independent samples (6:4) by multi-group analysis (2).
Results: The sensibility of the items was adequate (Ku < 7; Sk <
3). The items 2 and 4 were removed ( < 0.50) and was inserted
correlations between the errors of the items 7-15 e 1-12 (LM > 11;
p < 0.001). The fit of the refined three-factor model was adequate
to the sample ( = 0.53 - 0.79; 2/df = 1.956; CFI = 0.931; GFI =
0.868; RMSEA = 0.069). The convergent validity (AVE = 0.50 -
0.75) and the reliability ( = 0.79 - 0.88; CR = 0.78 - 0.89) were
adequate. The DASS-21 presented metric (2 = 12.001; p: =
0.744) and scalar (2 = 18.332; p:Cov = 0.686) invariance.
Conclusions: The refined three-factor model of the DASS-21
presented adequate psychometric properties and was stable in
independent samples of Brazilian dental patients.
Impact of body image in the quality of life of
university students according to nutritional status
Campos JADB1, Silva WR1, Martins BG1, Maroco J2
1Department of Food and Nutrition, State University of Júlio
de Mesquita Filho, Faculty of Pharmacy of Araraquara, São
Paulo, Brazil
2Department of Psychological Sciences & William James
Center for Research, Instituto Universitário de Ciências
Psicológicas, Sociais e da Vida, Lisbon, Portugal
Introduction: Studies show a significant impact of nutritional
status on the perception/satisfaction with body image in specific
contexts of life. We conducted this study to compare the impact of
body image in different contexts of life of students with
underweight, eutrophic, and overweight/obesity. Methods: a total
of 264 students of Pharmacy-Biochemistry of a Brazilian public
university (Mage: 20.9 [SD = 2.5] years; 81.8% female) participated
in study. The Body Image Quality life Inventory (BIQLI) (2/df =
3.50; CFI = 0.91, NFI = 0.88, RMSEA = 0.09) was used to evaluate
the self’s body image and related quality of life. The body weight
(kg) and height (m) were self-reported for the calculation of body
mass index (BMI: kg/m2). The nutritional status was classified by
BMI in accordance with World Health Organization. The average
scores of the impact of body image in the contexts of life were
compared according to nutritional status by Analysis of Variance
(ANOVA) followed by Tukey's test with = 5%. Results:
Regarding nutritional status, 8.4% of students were underweight,
71.4% eutrophic, and 20.2% overweight/obesity. The individuals
with overweight/obesity reported effect negative and significant of
body image perception in relation to the following contexts:
feelings of personal adequacy and self-worth (p < 0.05), feelings of
femininity/masculinity (p < 0.05), interactions with people of the
other sex (p < 0.05), sexual life (p < 0.001), ability to control
feeding (p < 0.001), body weight (p < 0.001), attention with
appearance (p < 0.001), and satisfaction/happiness about life (p <
0.05). Conclusions: the individuals with overweight/obesity had an
effect negative and significant low perception of their body image
in different contexts of life.
Influence of body image in specific contexts of life
of students of Pharmacy-Biochemistry: a validation
Campos JADB1, Silva WR1, Martins BG1, Maroco J2
1Department of Food and Nutrition, State University of Júlio
de Mesquita Filho, Faculty of Pharmacy of Araraquara, São
Paulo, Brazil
2Department of Psychological Sciences & William James
Center for Research, Instituto Universitário de Ciências
Psicológicas, Sociais e da Vida, Lisbon, Portugal
Introduction: The body image is an important aspect for
understanding the behaviors and emotions that individuals have in
certain life situations. The Body Image Quality of Life Inventory
(BIQLI) is an instrument, composed by 19 items, used in several
studies to evaluate the influence of body image in specific contexts
of life. The aim of this study was to estimate the validity and
reliability of the BIQLI when applied in a sample of Brazilian
college students of Pharmacy-biochemistry. Methods: The students
completed the Portuguese version of the BIQLI. Psychometric
properties of BIQLI were estimated using confirmatory factor
analysis (CFA). The fit of model was evaluated by factor weights
() and by goodness-of-fit indices (Chi-square by the degrees of
freedom [2/df], comparative fit index [CFI], normed fit index
[NFI], and root mean square error of approximation [RMSEA]).
The reliability was estimated by composite reliability (CR) and by
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Cronbach's coefficient alpha (). Results: A total of 264 students
(81.8% female) with mean age 20.9 (SD=2.5) years answered the
BIQLI. The BIQLI presented an inadequate fit to the gathered data
( = 0.46 0.81; 2/df = 8.60; CFI = 0.70; NFI = 0.67; RMSEA =
0.17) in the Brazilian sample. To improve the goodness, Item 15 (
= 0.46) was removed and were insert 9 correlations between the
errors of the items (LM > 11; p < 0.001). The refined BIQLI
presented and adequate fit ( = 0.54 0.80; 2/df = 3.50; CFI =
0.91; NFI = 0.88; RMSEA = 0.09), and good reliability (CR = 0.94;
α = 0.94) in the present study on a Brazilian sample. Conclusions:
The BIQLI presented adequate validity and reliability to Brazilian
university students of Pharmacy-biochemistry.
Psychometric properties of the Multidimensional
Pain Inventory and its application in different
orofacial pain conditions
Campos JADB1, Zucoloto ML1, Maroco J2
1Faculdade de Odontologia de Araraquara, Universidade
Estadual Paulista, Araraquara, São Paulo, Brazil
2Instituto Universitário de Ciências Psicológicas, Sociais e da
Vida, Lisbon, Portugal
Introduction: The presence of pain may have psychosocial and
economic impacts, bringing damages to quality of life and to health
of individuals. The pain has been evaluated using psychometric
scales. The aim of this study was to assess the psychometric
properties of the Multidimensional Pain Inventory (MPI) in
Brazilian patients with orofacial pain. Methods: A total of 436
adult patients, with some type of orofacial pain, participated (74.5%
female; age = 39.9 ± 13.6 years). The Portuguese version of the
MPI was used. This version consists of 50 items divided in three
orthogonal parts. Confirmatory Factor Analysis (CFA) was
conducted using 2/df, CFI, GFI and RMSEA. Convergent validity
was estimated by the Average Variance Extracted (AVE) and
internal consistency by Cronbach's alpha coefficient (). The
stability of the models was tested between independent samples
(test and validation) and between patients with dental pain and
other types of orofacial pain. The factorial invariance was estimated
by multigroup analysis (Δ2). Results: Factorial, convergent
validity, and internal consistency were adequate in all three parts of
MPI. For this, it was necessary to exclude the item 15 of Part 1 ( =
0.13). Discriminant validity was committed between factors
"Activities outside the home" and "Social Activities" of the Part 3
of MPI in the total sample, validation sample and among patients
with dental pain and with orofacial pain. A strong invariance was
detected in the three parts of MPI between different samples.
Conclusion: The MPI produced valid, reliable, and stable data for
pain assessment among Brazilian patients with different orofacial
pain conditions.
Examining the relationship between physical
illness and depression: is there a difference
between inflammatory and non-inflammatory
Caneo C1, 2, King M1, Bellon J3
1Division of Psychiatry, University College London, London,
United Kingdom
2Psychiatry Department, Pontificia Universidad Católica de
Chile, Santiago de Chile, Chile
3El Palo Health Centre, Department of Preventive Medicine,
Malaga, Spain
Introduction: Depression is probably the most well researched
disorder in mental health. Nonetheless, the underlying
pathophysiology has not yet been fully understood. Recent studies
have proposed inflammation as an etiologic factor of depression.
This study aims to examine the differences in the association
between inflammatory versus non-inflammatory disorders and
depression, in a sample composed of primary care attendees.
Methods: Cross-sectional analysis was conducted in a subsample
of the PREDICT study database. The sample included 5437
subjects from 9 primary care centers in Andalucía, Spain. Major
depressive disorder was measured using CIDI and physical illness
using the International Classification of Primary Care (ICPC-2).
Analysis was adjusted by quality of life, age, gender, alcohol and
drug misuse, lifetime depression, and socioeconomic status.
Results: Three groups were identified: 1781 subjects with an
inflammatory disease, 1699 with non-inflammatory illnesses, and
1897 healthy subjects. The disorders identified as inflammatory
were: cancer, autoimmune diseases, metabolic syndrome, HIV,
Hepatitis C and B, atopic, asthma, thyroiditis, and hypertension.
The disorders identified as non-inflammatory were: GERD, OSAS,
COPD, anemia, functional disorders, and chronic pain disorders.
Neuropsychiatric disorders were excluded from the analysis (60
participants). The groups differed in the prevalence of known risk
factors for depression, which will be accounted during the analysis.
Specific measures of the strength of the association between
depression and physical illness will be presented, including
subgroup analysis. Conclusions: This is the first study that
attempts to assess the association between physical illness,
depression, and psychosocial risk factors by incorporating
inflammation as a risk factor.
Non-cardiac chest pain and physical activity
Castonguay J1, 2, Foldes-Busque G1, 2, Roy M1, 2, Denis I2,
Poitras J2, 3, Fleet R2, 3, Archambault P2, 3, Dionne C4
1Laboratoire de recherche sur l’anxiété et les symptômes
médicalement inexpliqués, École de psychologie, Université
Laval, Québec, Canada
2Centre de santé et de services sociaux Alphonse-
Desjardins, Centre hospitalier affilié universitaire de Lévis,
Québec, Canada
3Département de médecine familiale et de médecine
d’urgence, Université Laval, Québec, Canada
4Centre de recherche FRQS du Centre hospitalier
universitaire de Québec, Hôpital du Saint-Sacrement,
Québec, Canada
Introduction. Non-cardiac chest pain (NCCP) affects 15 to 30% of
the general population and accounts for more than 2.5% of
emergency department consultations. NCCP limits the patients’
ability to perform their activities of daily living, including physical
activity. Compared to the unaffected population, patients with
NCCP are reportedly twice as likely to be sedentary (10% vs 23%).
These observations could be explained by physical activity
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avoidance due to NCCP or its impact on patients’ capacity for
exercise. We run the present study to determine the prevalence of
physical activity avoidance in patients with NCCP; to document the
impact of NCCP on their engaging in physical activity; and to
describe the psychological characteristics associated with physical
activity avoidance. Methods: This study involved 445 patients who
visited an emergency department for NCCP. Data were collected by
a structured clinical interview and validated questionnaires.
Results: About 33% of the patients reported that they avoided
physical activity at least sometimes. NCCP limited the physical
activity level in 30% of the sample. The patients who avoided
physical activity had higher level of anxiety sensitivity and
presented greater anxious and depressive symptoms scores than the
patients who did not avoid it. Conclusions: NCCP appears to be
associated with physical activity avoidance, a factor that may
contribute to the persistence of symptoms. Such avoidance may be
a marker of psychological distress in patients with NCCP.
Somatic complaints, depressive symptoms and
functional disability: a study in school aged
children and adolescents
Cerutti R¹, Presaghi F², Spensieri V¹, Valastro C¹, Guidetti V³
¹Department of Dynamic and Clinical Psychology, Sapienza
University of Rome, Rome, Italy
²Department of Psychology of Developmental and Social
Processes, Sapienza University of Rome, Italy
³Department of Paediatrics and Child and Adolescent
Neuropsychiatry, Sapienza University of Rome, Italy
Introduction: There is evidence that somatic complaints are often
associated with psychopathological symptoms and activity
limitations in childhood and adolescence. The purpose of the
present study was to assess prevalence of somatic complaints as
well as to examine the relationship between somatization,
functional disability and depressive symptoms. Methods: Six-
hundred and eighty-eight children and adolescents aged 7 to 14
years (mean age = 11.09; SD = 2.13) were recruited from primary
and middle public schools of central Italy. Among youth
participants, only 257 subjects reported a Children’s Somatization
Inventory (CSI) score higher than cut-off (≥ 4 somatic symptoms)
and were included in the final sample along with their parents. All
students completed measures on somatization (CSI), on functional
disability (Functional Disability Inventory; FDI), and on depression
(Children’s Depression Inventory; CDI). Parents (n = 236) fill out
the parental forms of CSI (P-CSI) and FDI (P-FDI), as well as the
Child Behavior Checklist (CBCL). Results: Positive correlations
between somatic complaints and functional disability were found
both in C-FDI (ρ = 0.504; p < 0.01) and P-FDI scores (ρ = 0.456; p
< 0.01). Significant correlation between CDI and C-FDI (ρ = 0.379;
p < 0.01) as well as between CDI and C-CSI (ρ = 0.319; p < 0.01)
confirmed our hypothesis of a presence of depressive symptoms in
somatizer children. Furthermore, significant correlations between
P-CSI, P-FDI, and CBCL were found. Conclusions: Findings of
our study highlight a strong association between somatic
complaints, emotional distress and functional disability in children
and adolescents. Results indicate the need to promote physical and
psychological wellbeing through health prevention programs,
especially in school settings.
Exploration on clinical diagnosis and treatment
features of cardiac neurosis with Yin deficiency
syndrome of heart and liver
Chen Y, Zhifu Z
Department of Psychosomatic Medicine of Guang`anmen
Hospital, China Academy of Chinese Medical Sciences,
Beijing, China, 100053
Cardiac neurosis belongs to psychosomatic disease, which is
characterized by physical symptoms and neurological disorders in
clinical. Based on Professor Zhao Zhifu drawing on predecessors'
theory and experience, it is useful that psychosomatic disorder is
treated with the theory of rigid-gentle differentiation of TCM in the
clinical practice, especially in the treatment of Yin deficiency
syndrome of heart and liver has a set of clinical features. The
course of the disease in patients with more than one year and
mainly because of the external social environment influence and
inner affective disorder, leads to the pathogenesis of liver. Many
negative stress resources are the leading incentives of the disease.
So it is necessary to explore in detail psychosocial background and
personality endowment of the incidence in collecting clinical data.
The principle of treatment is based on soften the liver and nourish
Yin and Calm the nerves. The characteristics of medication
preferred pair-herb compatibility and attach great importance to
nature flavor and channel tropism. It is selected as the medicine of
suan gan hua Yin, xian han zi yin, gan han yang yin and
harmonizing stomach and spleen.
Mediation effect of social withdrawal on the
relation between maltreatment/neglect and
victimization in adolescents
Cho Y1, Ju H21, Hyun MH1, Na EB2
1Department of Psychology, Chung-Ang University of Seoul,
Seoul, Korea
2Department of Business Administration, Chung-Ang
University of Seoul, Seoul, Korea
Introduction: There are many studies showing that
maltreatment/neglect may predict peer victimization in
adolescence. However, there is a paucity of studies explaining
specific mechanisms between the variables. These variables are
known to cause long lasting and severe harms to adolescents, and
thus, it is important to investigate them further. The aim of this
study was to examine the role of social withdrawal as a mediator in
explaining the relationship between maltreatment/neglect and
victimization, as well as to investigate the trajectories of the
variables as a function of time. Methods: The participant sample
was taken from Korean Child and Youth Panel Survey (KCYPS)
and the data of 2311 adolescents in the period between 8th and 10th
grade were analyzed through multivariate latent growth curve
(LGM). Results: The trajectories of maltreatment/neglect and
victimization have shown a decreasing trend with time. Also, all
three variables represented significant individual differences in
terms of initial value and rate of change. Furthermore, the initial
value of social withdrawal was shown to partially mediate the
initial effects of maltreatment/neglect on victimization. The initial
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value of social withdrawal also partially mediated the effects of
maltreatment/neglect on the rate of change in victimization.
Conclusions: The adolescents who have experienced
maltreatment/neglect were more likely to be socially withdrawn and
victimized in the beginning. However, the influence of
maltreatment/neglect on victimization decreased with time.
Issues in benzodiazepine and agonists use:
selection, continuous high-dose use and new first
line antianxiety
Chouinard G
McGill University, Montreal, Canada
Benzodiazepines and benzodiazepine receptor agonists are
frequently used for the treatment of insomnia and anxiety in the
medical setting, and they continue to rank among the most
prescribed drugs of any class. Their several therapeutic effects,
anxiolytic, hypnotic, anticonvulsant, and muscle relaxant,
associated with low toxicity have led to their wide use. High-
potency benzodiazepines have also been effective in treating panic
disorder and panic attacks with or without agoraphobia and as add-
on therapy to selective serotonin reuptake inhibitors in the
treatment of obsessive-compulsive disorder, panic disorders and
agitation. In contrast, benzodiazepine receptor agonists, zaleplon,
zolpidem and eszopiclone have been given in the treatment of
insomnia, and share as agonists on GABA A receptor complexes
close or coupled to benzodiazepine receptor, a similar mechanism
of action to the benzodiazepines. Differences in pharmacological
potency, distribution and elimination half-life, and rate of
absorption are important considerations when choosing a
benzodiazepine or a benzodiazepine receptor agonist. Although as a
class benzodiazepines and benzodiazepine receptor agonists are
well tolerated, their use presents important clinical issues such as
dependency, rebound anxiety/insomnia, memory impairment, and
discontinuation syndromes. Clinicians must take these issues into
consideration when prescribing and choosing a benzodiazepine or a
benzodiazepine receptor agonist. Typically, long distribution and
elimination half-lifes are
preferred for long-term use, while in short-term use the issues are
more complex and their use should be guided by the risk of
Treating cardiac neurosis of liver depression and
spleen deficiency type by the rigid-gentle
syndrome differentiation of TCM: a case report
Chunye W, Zhifu Z
Department of Psychosomatic Medicine of Guang`anmen
Hospital, China Academy of Chinese Medical Sciences,
Beijing, China, 100053
Introduction: Cardiac neurosis is a typical psychosomatic disease.
Clinical symptoms include flustered, chest tightness, chest pain,
insomnia, and so on. It takes serious psychological and economic
burden, several medical resources for patients and their families.
Professor Zhao Zhifu, founder of psychosomatic medicine of
Traditional Chinese Medicine (TCM), uses rigid-gentle syndrome
differentiation treating psychosomatic disease, and treatment of
cardiac neurosis effect is remarkable. Case description: Female, 51
years old, palpitations from more than 1 year, an accountant. About
1 year before, heart palpitations began to appear, and dream more,
flustered, chest pain, shortness of breath, insomnia. But, cerebral
ultrasound, electroencephalogram, electrocardiogram and coronary
CT did not show exceptions. Furthermore, she had job pressure and
chronic stress for a long time. Western medicine diagnosis was
cardiac neurosis. Symptoms were significant relieved after taking
medicine for 8 weeks. Comments: Clinicians who treat cardiac
neurosis should pay attention to psychological social factors and
physical factors. The rigid-gentle syndrome differentiation
completely conforms to the pathogenesis. A correct cognitive and
behavior style is also very important and need to be treated as soon
as possible.
Type-2 diabetes psychosomatic disease
approachable through music therapy
Cioca IE
Department of Medical Psychology and Psychosomatics,
University of Medicine and Pharmacy Carol Davila,
Bucharest, Romania
Introduction: Medical literature shows that there are numerous
aspects in which stress is linked to diabetes. Type-2 diabetes
implies that the abnormalities in glucose levels as a result of stress,
are associated, on one side, with hormones who are involved in the
metabolism of glucose, and on the other side, with stress-induced
changes in eating habits. Methods: We investigated the variations
of glycaemia after listening to music, on type-2 diabetic patients
(40 subjects - experimental group) in comparison to healthy people
(40 subjects - control group) and to diabetic patients who have not
listened to music (40 subjects - control group). Results: There is a
statistic difference (t = 6.585; df = 39; p < 0.001) between glucose
levels before (M = 197.75; SD = 61.05) and after listening to music
(M = 158.93; SD = 52.80). The difference between the average
level of glucose before listening to music (M = 105.68; SD = 21.96)
and afterwards is of 1.95 among healthy subjects (M = 103.73; SD
= 15.89).There is not a statistically significant difference (1.68%)
between average glucose levels measured before (M = 177.80; SD
= 45.78) and after (M = 174.80; SD = 39.24) for diabetic patients in
relaxed conditions but without listening to music. Conclusions:
The results of our study prove the obvious hypoglycemic role of
classic music for type-2 diabetic patients, not taking into
consideration the natural variations of glycemia. There is no doubt
that besides psychological parameters altered through music, the
improvement of somatic markers (glycemia) stands by the idea of
using music in therapeutic purposes, for type-2 diabetic patients.
Attachment and coping style at parents of children
with somatoform complaints
Cioca IE, Truţescu C, Diaconescu L, Popa-Velea O
University of Medicine and Pharmacy Carol Davila,
Bucharest, Romania and Faculty of Medicine,
Department of Medical Psychology, Bucharest, Romania
Introduction: About 15% to 25% of all children report recurrent or
continuous “medically unexplained symptoms”, such as dizziness,
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DOI: 10.1159/000438780
headaches and fatigue. One of the hypotheses is connected to early
attachment dysfunctional experiences to parental figures. This
association seems to have an impact on a long run, as in adults,
frequent somatic complaints have been reported to be connected to
anxious attachment style and behaviors. Methods: Sixty
participants, aged between 12-18 yrs, sex ratio females/males: 5/3,
were admitted in the Obregia Psychiatric Hospital - Bucharest
without major psychiatric diseases. The somatoform symptoms
were screened through the Giessner Bogen Beschwerden
Questionnaire (GBB-24), while the coping and attachment style of
their parents was measured through te Cope Questionnaire and the
Adult Attachment Style Questionnaire. Results: Secure parents
used relatively more support-seeking strategies (p < 0.05) whereas
avoidant parents used more disengagement strategies. Insecure
anxious attachment style of parents was significantly associated
with more somatic complaints of their children (p < 0.05). A
passive coping style of parents correlated with higher scores of their
children at the GBB (p < 0.05). Conclusions: These results indicate
a possible association between the less secure attachment style of
parents and their children’s attachment and vulnerability to
somatoform disorders. This is supported by previous literature data
which show that an abused or neglected child may be particularly
prone to develop an image of the self as unworthy of support from
others and an image of caregivers as unreliable and even dangerous
images that form the basis of fearful attachment style.
Temporomandibular disorder pain treated with
behavioral therapy
Cosci F
Department of Health Sciences, University of Florence,
Florence, Italy
Introduction: Temporomandibular disorder (TMD) pain has a
multifactorial aetiology. Sleep bruxism, daytime clenching,
together with psychological stress, seems to contribute to it. Only a
minority of studies have tested the effectiveness of psychological
interventions in TMD patients. Case description: F. is a 39-year-
old woman with no history of physical or psychiatric disorders. Six
months after the birth of her son, she went to the dentist because of
jaw muscle tenderness, jaw opening limitations, morning headache,
tooth hypersensitivity. The dentist diagnosed TMD and encouraged
F. to stop clenching and reduce the daily stress. After 2 weeks
symptoms were unchanged and F. asked for a psychological
evaluation. At assessment, no diagnosis emerged via the MINI
International Neuropsychiatric Interview while allostatic overload
was diagnosed according to the clinimetric approach. The patient
was informed about the negative effects of distress on her
neuromuscular habit patterns, of which clenching was a
consequence, and invited to take note of the daily level of distress.
At second session, F. referred to be always distressed since she has
to balance her job with family duties and referred to have hired a
domestic worker to reduce it. The next step was to teach F. to
observe her neuromuscular patterns at specific times of the day and,
if this was the case, switch from muscle tension to relaxation by
dynamic muscle contraction. One month later, F. was free of
symptoms and maintained this condition at 2 years follow-up.
Comment: Therapy for TMD should be behavioural rather than
Well-Being Therapy: next-step strategy in panic
disorder patients who failed to complete CBT
Cosci F
Department of Health Sciences, University of Florence,
Florence, Italy
Introduction: Cognitive Behavioural Therapy (CBT) is first line
choice to treat panic disorder. Treatment response is 65%. Non-
responders are usually those who did not complete the intervention.
Next-step strategies in the treatment of patients who failed to
complete CBT should be found. Case description: L. is a 64-year-
old woman who had two lifetime episodes of panic disorder with
agoraphobia comorbid with major depression. The first episode was
treated with paroxetine and the second with levosulpiride, in both
episodes depressive symptoms and panic attacks disappeared but
mild agoraphobia remained. L. asked for the visit because of panic
attacks, after the assessment the following diagnoses were
formulated: panic disorder with agoraphobia (according to DSM),
Health Anxiety and Thanatophobia (according to DCPR).
Clonazepam and CBT were prescribed. During the first 3 CBT
sessions, a behavioral therapy was administered to reduce
avoidance. Thereafter, cognitive restructuring was proposed to
reduce panic, Health Anxiety, and Thanatophobia. However, after 2
sessions of cognitive restructuring, L. worsened: she was so
engaged in identifying negative automatic thoughts to be always
thinking to anxiety and having it. Thus, Well-Being Therapy
(WBT) was proposed to increase her general level of well-being.
After 6 WBT sessions, L. was improved and became able to run 3
sessions of cognitive restructuring after which she was completely
free of symptoms. She maintained this condition at one year follow-
up. Comment: WBT should be considered as next-step strategy in
the treatment of patients who failed to complete the CBT
Withdrawal symptoms as a consequence of NaSSA
Cosci F
Department of Health Sciences, University of Florence,
Florence, Italy
Introduction: Selective serotonin reuptake inhibitors and
serotonin-noradrenaline reuptake inhibitors are widely used in
clinical practice although they can induce withdrawal symptoms
similarly to other CNS drugs. The present case shows that also the
discontinuation of noradrenergic and specific serotonergic
antidepressant (NaSSA) might induce withdrawal symptoms.
Case description: S. is a 32-year-old woman. At 30 years of age,
she presented depressed mood, panic attacks, avoidance. She was
first treated with psychodynamic therapy and later with drugs (i.e.,
alprazolam, aloperidol, quetiapine, escitalopram, citalopram,
fluvoxamine, venlafaxine, mirtazapine, valproic acid) with poor
results. At first visit she was under valproic acid (1000 mg/die),
sertraline (75 mg/die), mirtazapine, (30 mg/die), lorazepam (1
mg/die) from a 6-month period. Via the MINI International
Neuropsychiatric Interview the diagnoses of panic disorder with
agoraphobia and major depressive episode were formulated. The
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patient did not have a history of bipolar disorder or recurrent
depression. She complained about intense anxiety, nightmares, low
mood. The psychiatrist discontinued valproic acid and lorazepam,
tapered slowly and discontinued mirtazapine at the rate of 7.5 mg
every other week, prescribed clonazepam (2 mg/die), and referred
her to CBT. Despite slow tapering, once mirtazapine was
discontinued, the patient experienced post-withdrawal disorders
consisting of nocturnal panic attacks, agitation, mood swings,
nightmares. The introduction of clonazepam faded away mood
swings and panic attacks. After three months, S. still had
nightmares, thus 2 CBT sessions were proposed to let her identify
daytime thoughts on threatening situations and interrupt them.
Nightmares slowly disappeared. Comment: NaSSA can induce
withdrawal symptoms at discontinuation.
The contribution of general psychological
acceptance and acceptance of pain to explain
adjustment in females with endometriosis
Cosci F1, Bernini O2, Belviso C2, Berrocal C2
1Department of Health Sciences, University of Florence,
Florence, Italy
2Department of Surgical, Medical, Molecular and Critical Area
Pathology, University of Pisa, Pisa, Italy
Introduction: A number of studies demonstrate that “acceptance of
pain” is a significant predictor of different measures of adjustment
in patients with chronic pain. One previous research suggests that
“general acceptance” acceptance of undesirable private
experiences outside of the pain itself (e.g., negative thoughts and
emotions) - may contribute to explain a significant percentage of
the variation in adjustment beyond “acceptance of pain”. The
objective of this study was to further examine the incremental
validity of “general acceptance”, beyond “acceptance of pain”, to
explain adjustment in females with endometriosis. Methods:
Participants were 125 females with endometriosis and illness-
related pain (M = 33.8 years; SD = 5.8) recruited through the
Endometriosis Association of Italy. Participants completed
measures of general acceptance, acceptance of pain, distress,
psychological well-being, and daily functioning. Results:
Hierarchical Multiple Regression analyses showed that “acceptance
of pain” explained 5% to 19% of the variation across all measures
of adjustment, over and above that accounted for background
variables, and these increases were statistically significant for all
criteria. “General acceptance” contributed significantly to increase
the percentage of explained variance across all criteria (from 2% to
42%), over and above the variance accounted for by background
variables and “acceptance of pain”. Conclusions: These findings
support the unique role of “general acceptance”, beyond
“acceptance of pain”, in the prediction of suffering and disability in
females with endometriosis, and raise the question whether a
broader approach to acceptance may increase the effectiveness of
acceptance-based interventions in chronic pain settings.
Psychosis in patients with systemic lupus
Costa AS1, Amaral AD1, Novais C1, Moreira R1,2
1Psychiatry Department, Clínica de Psiquiatria e Saúde
Mental do Centro Hospitalar de São João, Porto, Portugal
2Department of Clinical Neurosciences and Mental Health,
Faculty of Medicine, University of Porto, Porto, Portugal
Introduction: Systemic Lupus Erythematosus (SLE) is a chronic
relapsing-remitting autoimmune disorder affecting multiple organ
systems. Neuropsychiatric SLE (NPSLE) may affect patients
physically, mentally and have an important impact on their quality
of life. NPSLE may be highly prevalent, with studies reporting rates
of 14% - 75%. Common neuropsychiatric manifestations in SLE
are cognitive deficit, lupus headache, psychoses, seizures and
cerebrovascular events. Authors aim to clarify the characteristics of
psychosis in patients with SLE. Methods: Literature review using
the PubMed/MEDLINE database with the keywords “systemic
lupus erythematosus” and “psychotic disorders”. Results: The
pattern of psychotic spectrum disorders in SLE is not systemically
studied, but the most common form appears to be acute psychosis.
These patients may have acute psychoses as a primary
manifestation of central nervous system involvement or
corticosteroid induced psychosis. Psychosis as a manifestation of
NPSLE usually occurs early in the course of the disease and is
associated with other clinical and biological features of SLE. Long-
term outcome appears to be favorable after intensive
immunosuppressive treatment. Corticosteroid-induced psychiatric
disorders tend to occur in the first 6 weeks of treatment and are
dose-dependent (uncommon at doses of < 40mg/d but increasingly
more common at doses of > 80mg/d). Conclusions: Psychosis as a
manifestation of NPSLE may primarily originate from the disease
itself or the complications of the disease or be secondary to the
therapy. More studies are needed to improve our knowledge and
establish guidelines for the treatment of this complication of SLE.
The role of demoralization in the spectrum of
de Figueiredo JM
Department of Psychiatry, Yale University School of Medicine,
New Haven, Connecticut, USA
Various descriptions of demoralization have been offered and
various scales have been proposed for its assessment. Recent
research supports the view that demoralization involves two
components, distress and subjective incompetence. As the stressful
situation increases in severity or duration, subjective incompetence
may progress to helplessness, hopelessness, and suicidality. This
lecture will describe the clinical progression of demoralization and
explain the differences between demoralization and passing or
transient distress, non-specific distress and sub-threshold
depression or anxiety, as well as the differences between
demoralization and mental disorders such as major depressive
disorder, dysthymic disorder, acute stress disorder, posttraumatic
stress disorder, and adjustment disorder. Demoralization can occur
by itself, and can be a risk factor for the manifestation of
psychopathology, the prodromal phase of a mental disorder, or a
trigger for exacerbation or recurrence of psychiatric distress
symptoms. Recent research on the occurrence of demoralization in
various clinical seetings, such as oncology, cardiology,
gastroenterology and endocrinology will be reviewed and
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DOI: 10.1159/000438780
A study of subjective incompetence in patients with
breast cancer
de Figueiredo JM1, Chung J1, Duane JA1, Dove E1,Gostoli S2,
Ramponi T1, Vitti J1
1Department of Psychiatry, Yale University School of
Medicine, New Haven, Connecticut, USA
2Department of Psychology, University of Bologna, Bologna,
Demoralization has been described as the state of mind of a person
deprived of spirit or courage, disheartened, bewildered, and thrown
into disorder or confusion, and recognized as the common
denominator of complaints of many people who seek psychotherapy,
whatever their diagnostic label. Demoralization has been interpreted
as involving two components, subjective incompetence and distress
as expressed by symptoms such as depression, anxiety or anger.
Subjective incompetence has been identified as the clinical hallmark
of demoralization. Ambulatory patients with breast cancer were
studied using a number of scales to measure demoralization,
subjective incompetence, depression, perceived social support,
perceived stress, and resilience. Regression analyses were used to
control for demographics and a number of clinical variables.
Subjective incompetence and depression were found to be more
likely to occur together when perceived social supports were weak
or perceived stress was high, the converse being true when perceived
social supports were strong or perceived stress was low. Resilience
was found to be inversely correlated with subjective incompetence.
Patient-reported outcomes in endocrinology
De Sanso S1, Guidi J1, Fava GA1,2, Sonino N2,3
1Laboratory of Psychosomatics and Clinimetrics, Department
of Psychology, University of Bologna, Bologna, Italy
2Department of Psychiatry, State University of New York at
Buffalo, Buffalo, New York, USA
3Department of Statistical Sciences, University of Padova,
Padova, Italy
Self-administered questionnaires that allow detection of
subjects’ perspectives on a wide range of health domains,
such as symptom severity, functional capacity, psychological
well-being and quality of life, have been introduced in the
evaluation of patients with endocrine diseases. According to
the guidance issued by the US Food and Drug
Administration, these instruments can be considered as
“patient-reported outcome measures” (PROs). PROs may
refer to the general health status (e.g., SQ, SF-36, PSI) or to
distinct clinical manifestations of each condition. A number
of clinimetric instruments have been designed and validated
for evaluating self-perceived health status in patients with
specific endocrine conditions. In the setting of endocrine
disease, most of the available instruments refer to diabetes
mellitus, while only few indexes are specifically tailored for
the assessment of the impact of particular endocrine
disorders. These include AcroQoL for acromegaly,
ThyDQoL for hypothyroidism, AddiQoL for Addison's
disease, and HDQoL for growth hormone deficiency.
Administration of PROs may be of use in assessing patients’
illness behavior, whose health-related quality of life does not
always go together with normalization of hormonal
parameters. Their use is intended to support planning of
therapeutic strategies according to patients’ needs and
priorities, thus promoting treatment adherence. PROs
provide an important contribution for the development and
licensing of new medications, with special reference to
patients’ global functioning. PROs data may supplement
biomedical outcomes by providing incremental information
both in clinical research and medical practice, with important
diagnostic, therapeutic, and prognostic implications.
A clinical study of eating disorders in childhood
and adolescence from the viewpoints of mood and
developmental disorders
Denda K, Miyajima M, Arai K
Faculty of Health Science, Hokkaido University, Sapporo,
Introduction: Eating disorders in childhood and adolescence often
coexist with mood disorders and autism spectrum disorder (ASD).
Eating disorders should be re-examined from the viewpoints of
these disorders. Methods: The present study investigated 16
patients who were diagnosed with eating disorders that developed
when they were 14 years old or younger. The patients’ diagnoses,
comorbidities, clinical characteristics, treatment, and outcomes
were examined. Patients were divided into a childhood-onset group
and an adolescence-onset group. Results: In childhood-onset
group, all patients received pediatric inpatient treatment. These
diagnoses did not change during the course of treatment. ASD was
diagnosed in 5 patients. Other comorbidities comprised major
depressive disorder, generalized anxiety disorder, and selective
mutism. Effective treatment was achieved with antidepressant drugs
in 2 patients and atypical antipsychotic drugs in 1 patient.
Remission and improvement were achieved in 4 and 1 patient,
while 1 patient showed no change. In adolescence-onset group, all
patients were initially diagnosed with restricting-type anorexia
nervosa. Final diagnoses comprised restricting-type (5), binge-
eating/purging-type (2), and non-purging bulimia nervosa (3). Five
patients underwent inpatient treatment. ASD was diagnosed in 3
patients, and major depressive disorder in 5 patients. Effective
treatment was achieved with antidepressant drugs in all 5 of these
patients. Remission and improvement were achieved in 5 and 2
patients, while 2 patients showed no change. Conclusions: The
appropriate diagnosis of mood and developmental disorders in
those who also have eating disorders enables a better understanding
of each case, more specific therapeutic strategies, and more
comprehensive approaches to treatment.
Interactive effects of chronic physical health and
mental health conditions on disability: a
population-based study
Deschênes SS1,2, Burns RJ1,2, Schmitz N1,2,3
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DOI: 10.1159/000438780
1Department of Psychiatry, McGill University, Montreal,
2Douglas Mental Health University Institute, Montreal,
3Department of Epidemiology and Biostatistics, McGill
University, Montreal, Canada
Introduction: Independent associations exist between chronic
physical health conditions and disability as well as with mental
health conditions and disability in the general population. While
chronic physical conditions and mental health conditions are
uniquely disabling, individuals with comorbid physical and mental
health conditions may be particularly vulnerable to experiencing
disability. Yet, little research has examined this possibility. The
present study has the aim to examine the interactions between
chronic physical conditions and mental health conditions on general
functional disability in a community sample. Methods: Participants
were from the Epidemiological Catchment Area of Montreal South-
West Study (n = 2202). Mental health conditions included 12-
month major depressive disorder and 12-month generalized anxiety
disorder, assessed with the World Mental HealthComposite
International Diagnostic Interview. Physician-diagnosed chronic
physical conditions were assessed via self-report. Disability was
assessed with the World Health Organization Disability Assessment
Schedule 2.0. Results: About 12% of the sample reported moderate
to severe disability. Individuals with either mental health conditions
or physical health conditions were approximately 2-3 times more
likely than those without either condition to have moderate-to-
severe disability; interestingly, those with comorbid physical and
mental health conditions were almost 12 times more likely to report
moderate-to-severe disability (OR = 11.96; 95% CI 5.86 - 24.42; p
< 0.001). The synergy index for a biological interaction was SI =
2.99, 95% CI 1.17 - 7.69. Conclusions: A synergistic interaction
was found between the presence of chronic physical health and
mental health conditions, suggesting that having both types of
conditions considerably increases the likelihood of disability.
Intolerance of uncertainty predicts decreases in
heart rate variability during worry-inducing tasks
Deschênes SS1,2, Dugas MJ3, Gouin JP4
1Department of Psychiatry, McGill University, Montreal,
2Douglas Mental Health University Institute, Montreal,
3Département de psychoéducation et de psychologie,
Université du Québec en Outaouais, Gatineau, Canada
4Department of Psychology, Concordia University, Montreal,
Introduction: Heart Rate Variability (HRV) refers to the temporal
variations between consecutive heart beats. Low HRV and greater
reductions in HRV during stress are autonomic indicators of
emotion-regulation difficulties and of poor cardiovascular health.
Low HRV is associated with elevated worry, though there is
considerable between-person variability in HRV reactivity to
worry. The goal of the present study was to examine the extent to
which intolerance of uncertainty, a cognitive correlate of worry,
predicts decreased HRV during worry-inducing tasks. Methods:
Seventy six undergraduate students completed the Intolerance of
Uncertainty Scale (IUS) and had their HRV monitored during a
resting period, a free worry period, and a worry Catastrophizing
Interview (CI). The CI is a structured task that assesses feared
worry consequences using a downward arrow technique. HRV data
were log-transformed to ensure a normal distribution. Multilevel
modeling was used to examine whether IUS scores predicted
patterns of change in HRV during the tasks, controlling for age and
sex. Results: There was a significant reduction in HRV from the
resting period to the worry-inducing tasks (β = -0.07(0.02), 95% CI
-0.10 - -0.03; p = 0.001). A significant interaction was found
between IUS scores and change over time in HRV (β = -0.002
(0.001); 95% CI -0.004 - -0.001; p < 0.05), such that individuals
with higher IUS scores had greater decreases in HRV than
individuals with lower IUS scores. Conclusions: Individual
differences in the extent to which people tolerate uncertainty
predict autonomic responses during worry, which may be a
potential pathway linking worry with cardiovascular risk.
Negative affectivity and procoagulant markers in
depressed patients with coronary artery disease
baseline findings from the SPIRR-CAD trial
Deter HS1, Orth-Gomér K2, Herrmann-Lingen C3, Albus C4,
Grün AS1, Weber C1 for the SPIRR-CAD Study Group
ICharité - Universitätsmedizin Berlin, Campus Benjamin
Franklin, Medical Clinic Psychosomatics, Berlin, Germany
2Karolinska institutet Department of clinical Neuroscience,
Stockholm, Sweden
3Department of Psychosomatic Medicine & Psychotherapy,
University of Göttingen Medical Center, Göttingen, Germany
4University of Cologne, Department of Psychosomatics &
Psychotherapy, Cologne, Germany and Department of
General Internal and Psychosomatic Medicine, University of
Heidelberg, Heidelberg, Germany
Introduction: Negative affectivity influences cardiovascular risk
factors and seems to be an independent risk factor for incidence and
mortality of CAD. It has been argued that depression stimulates
autonomic imbalance or higher coagulation and influences different
pathways of coronary sclerosis progression. In the present study,
we wanted to examine associations of levels of anxiety and
depression and procoagulant markers in the peripheral blood.
Methods: In this multi-center psychotherapy trial, 450 men
(78.94%) and 120 women (age 18-75 years) with HADS depression
scores > 7 and any manifestation of CAD, were randomized into
the intervention or control group. In this sub study we analysed 143
CAD patients (age < 61 y, 32 w, 111 m) at baseline focused on
fibrinogen and D-dimer as well as other clotting factors and their
correlations with anxiety and depression (HADS, PHQ, HAMD-
21). Results: We found a highly significant correlation of
fibrinogen with HADS anxiety (r = 0.27; p < 0.001) but no
statistically significant correlations of fibrinogen and D-Dimer with
depression. In a regression analysis prediction of clotting factors
was influenced by heart failure severity (NYHA), age and gender.
Conclusions: As in former studies, we could show correlations of
negative affectivity with clotting factors in CAD patients, which
were influenced also by cardiac factors, age and gender. In a second
step, we will examine if the reduction of anxiety and depression in
a psychosocial intervention trial had positive effects on coagulation,
as a possible mediator for CAD progression.
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DOI: 10.1159/000438780
Non-pharmacological therapy of functional
gastrointestinal disorders
Dumitrascu DL, Baban A
Iuliu Hatieganu University of Medicine and Pharmacy &
Babes=Bolyai University Cluj-Na[oca, Romania
Introduction: The functional gastrointestinal disorders (FGID)
represent a burden for both patient and physician. This category of
conditions is susceptible to answer well not only to
pharmacotherapy but also to psychotherapy and sometimes to
alternative therapies. Methods: We present data obtained from a
literature search on the use of psychotherapy in FGID and mainly
Irritable Bowel Syndrome (IBS). We also present own data on
counselling, expressive writing, psychotherapy and education in
FGID. Beside this, we look on the evidence available on the use of
probiotics in IBS and offer personal data. Results: Different trials
including our experience recommend diverse psychotherapeutic
interventions in patients with FGID and mainly in IBS. The role of
probiotics is also increasing, as more data are available.
Conclusions: Psychotherapy and administration of probiotics are
useful in FGID and IBS. The efficiency of these interventions are
however sometimes marginal, needing more insight and newer data.
Hypnosis and trainer appliance therapy replaces
patient’s DIY denture made from Ladies Acrylic
Dunlop D
Department of Restorative Dentistry, Glasgow Dental
Hospital and School, Scotland, UK
Introduction: This clinical case study demonstrates the use of
hypnosis to reduce the sensitivity of the patient to this invasion of
their personal space and their phobia in relation to dental treatment
by a combination of prosthodontics and hypnotherapy techniques.
Case description: Following the loss of a strategic tooth, the
patient’s removable partial denture was no longer retentive and
impressions were required for a new appliance. To her great
distress she found herself unable to tolerate impressions. After
several unsuccessful attempts her dentist told her “not to come
back”, failing to offer comfort or onward referral. Feeling cast off
by the dental profession and facing the embarrassing consequences
of no longer having any upper teeth, this resourceful lady made an
upper “dental appliance” out of modified ladies acrylic nails and
pink denture repair acrylic. For the next 12 years she wore this
arrangement 24/7, but it was far from ideal and had a deleterious
effect on her wellbeing, making eating and all aspects of social
interaction difficult. Via the internet, she was able to find a dentist
to assist her in building up tolerance of a prosthesis constructed by
a modified pour copy technique. A programmed schedule of
exposure led to developing an ability to tolerate a normal design of
complete upper denture. Comment: Hypnotherapy skills and dental
anxiety management in conjunction with good prosthodontic
practice increase the chances of success in overcoming a
hypersensitive gag reflex.
Effects of pre-transplant depression and anxiety
symptoms on mortality post-heart transplant: a
retrospective cohort study
Epstein F1, Lucero A2, Parker M3, Song E4
1Heart Transplant Department, Santa Clara, Kaiser
Permanente Northern California, USA
2Primary Care Department, Santa Clara, Kaiser Permanente
Northern California, USA
3Department of Research, Oakland, Kaiser Permanente
Northern California, USA
4Department of Graduate Medical Education, Santa Clara,
Kaiser Permanente Northern California, USA
Introduction: According to the 2012 United Network for Organ
Sharing’s report, one-year survival after heart transplant in the
United States is 88%.This retrospective cohort study was designed
to evaluate the effects of depression and anxiety on all-cause
mortality after heart transplant. Methods: One-hundred thirty
patients with heart transplants enrolled at Kaiser Permanente, a
large, integrated health care delivery system in Northern California,
between June 2005 and December 2013, were included in a
retrospective electronic chart review. Baseline variables included
depression, anxiety, and cardiac risk factors in the year before heart
transplant. Depression and anxiety were determined by diagnosis,
psychotropic medication, and/or self-report instruments when
available. Statistical tests included chi-square, t-tests, and a Kaplan-
Meier survival analysis. Results: In unadjusted analyses, overall
survival at one-year post-heart transplant was 93.1%. The one-year
survival for 50 patients with no depression and no anxiety was
100%, for 13 patients with anxiety only was 92.3% (p = 0.05), for
22 patients with depression only was 90.9% (p < 0.05), and for 45
patients with both depression and anxiety was 86.7% (p< 0.05). The
patients with both depression and anxiety before heart transplant
had worse outcomes after transplantation. Conclusions: These
findings suggest that depression and anxiety symptoms before heart
transplant are associated with survival in the first year after heart
transplant. A comprehensive evaluation and treatment of these
symptoms before heart transplant are recommended.
Rational use of antidepressant drugs
Fava GA
Department of Psychology, University of Bologna, Bologna,
Italy and Department of Psychiatry, State University of New
York at Buffalo, Buffalo, New York, USA
A rational use of drugs depends on the balance of potential benefits
(emerging primarily from randomized controlled trials) and adverse
effects (with observational studies as the main source of
information) applied to the individual patient. The aim of this
update was to suggest a rational use of antidepressant drugs (AD)
based on such awareness that departs from current popular trends.
Even though AD are effective in treating acute depressive episodes,
they are less efficacious in recurrent depression and in preventing
relapse. In a substantial percentage of cases, AD have been
described inducing adverse events such as withdrawal symptoms
upon discontinuation, onset of tolerance, resistance phenomena, and
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switch and cycle acceleration. Unfavorable long-term outcomes and
paradoxical effects (depression inducing and symptomatic
worsening) have also been reported. The neglect of these
phenomena in treatment selection leads to an irrational and often
inappropriate use of AD, that is likely to yield iatrogenic
comorbidity and chronicity. A rational use of antidepressant drugs
that incorporates all potential benefits and harms is suggested. It
consists in targeting their application only to the most severe and
persistent cases of depression, avoiding their utilization in anxiety
disorders (unless a major depressive disorder is present), and
limiting their use to the shortest possible time.
Iatrogenic comorbidity in mental health
Fava GA1, Cosci F2, Tomba E1
1Department of Psychology, University of Bologna, Bologna,
2Department of Health Sciences, University of Florence,
Firenze, Italy
A specific treatment may cause or precipitate lasting adverse effects
on the course of illness. Such vulnerabilities, that are subsumed
under the definition of “iatrogenic comorbidity”, may manifest
themselves during treatment administration and/or after its
discontinuation. The changes are persistent and not limited to a
short phase, such as in the case of withdrawal reactions. Iatrogenic
comorbidity plays an important and yet neglected role in mental
health. There are several examples in psychopharmacology: bipolar
course induced by antidepressant drugs in depressed patients who
presented with allegedly unipolar features; persistent post-
withdrawal disorders after long term use of SSRI and/or SNRI;
tardive dyskinesia after long term use of antipsychotics. Iatrogenic
comorbidity may occur also as a result of failed psychotherapies. It
is thus of crucial importance to incorporate treatment history in
mental health assessment. The concept of “iatrogenic comorbidity”
may demarcate major prognostic and therapeutic differences among
patients who otherwise seem to be deceptively similar since they
share the same psychiatric diagnosis.
Emotional and instrumental marital support, pain,
fatigue, and resistance to psychological suffering
in women with systemic lupus erythematosus
Figueiredo-Braga M1, Figueiredo M1, Mesquita R1, M
Bernardes2, Abelha-Aleixo J2, Fonseca R2, Terroso G2
1Medical Psychology Unit, Department of Clinical
Neurosciences and Mental Health, Faculty of Medicine,
University of Porto, Porto, Portugal
2 Rheumatology Department, Hospital of São João EPE,
Porto, Portugal
Introduction: Lupus Erythematosus Systemic (SLE) is a chronic
and disabling autoimmune disease predominantly affecting women.
Physical and psychological burden clinically expressed by
tiredness, fatigue, pain, anxiety, and depressive symptoms represent
a crosstalk between diverse pathophysiologic mechanisms.
Although SLE challenges patient’s psychosocial balance,
occasionally women with severe manifestations remain free of
psychiatric disorders and reveal a remarkable capacity to deal with
the negative impact of the disease. Our aim is to study the role of
marital satisfaction and doctor-patient relationship as resilience
factors in a population of female SLE patients. Methods:
Satisfaction with intimate relationship, fatigue, pain, anxiety, and
depression was assessed in 81 female SLE patients trough
standardized instruments. Women’s perspective of doctor’s ability
to communicate and support them during regular visits was also
evaluated. Clinical and laboratory data were obtained from the
clinical records. Results: Pain, fatigue, and depression were
negatively correlated with marital satisfaction and the appraisal of
partner as supportive (r = 0.435; p < 0.05; r = 0.467; p < 0.001; r =
0.387 p < 0.05, respectively). Longer relationships were less
satisfactory. No association was found between the quality of
doctor-patient communication and psychological, clinical, and
laboratorial SLE assessment. Conclusions: The perception of the
partner as trustful and caring contributes to better psychological
health in women with SLE. Moreover, marital satisfaction also
seems to be associated with lower levels of pain and fatigue.
Although these effects need further clarification, interventions
aiming to enhance the supportive quality of marital relationship
appear encouraging.
Oxytocin and depression in the perinatal period a
systematic review
Figueiredo-Braga M1, Moura D1, Canavarro MC2
1Department of Clinical Neurosciences and Mental Health,
Faculty of Medicine, University of Porto, Porto, Portugal
2Faculty of Psychology and Education Sciences, University of
Coimbra, Coimbra, Portugal
Introduction: Postpartum depression (PPD) is the most common
postnatal psychiatric disorder and represents a considerable
problem to the health and well-being of women and their families.
Several pathogenic mechanisms have been identified in PPD, and
recently oxytocin, known to be involved in childbirth and lactation
has drawn attention as a possible diagnostic and therapeutic target
in this disorder. The aim of this review was to assess and
summarize the current literature on the relationship between
oxytocin and depression in the perinatal period. Methods: We
conducted a literature search on four electronic databases (Pubmed,
PsycINFO, Web of Science and Science Direct) by applying the
following search terms: oxytocin AND (postpartum OR postnatal
OR perinatal OR peripartum) AND (depression OR depressive).
Results: Five studies were included, with a total of 612 pregnant
women that were recruited and completed the follow-up.
Depressive symptoms were evaluated using self-report scales, and
in two studies the diagnosis of major depression was additionally
confirmed using semi-structured interviews. Peripheral OT levels
and depression were assessed during pregnancy and/or in the first
weeks after delivery. Higher OT levels were associated with lower
depressive symptoms, even if this association lacked statistical
significance in two studies. Conclusions: Although some studies
are beginning to shed light upon the complex nature of OT effect in
depression, its role as a diagnostic and therapeutic tool in PPD is
still unclear. Future research is needed to clarify the
neuroendocrinological and psychosocial particularities of mothers
with PPD and define a specific profile associated with OT
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Psychometric evaluation of psychopathologic
disorders in patients with atypical facial pain
Fofanova Y1, Medvedev V1, Frolova V1, Drobishev A2
1Peoples’ Friendship University of Russia, Moscow, Russia
2Moscow State Medical Stomatological University, Moscow,
Introduction: Maxillofacial surgeons and dentists often (up to
10%) deal with the phenomenon of atypical facial pain (AFP)
painful condition of maxillofacial area without clear organic
pathology. Psychopathological studies of this disorder are almost
lacking. The purpose of this study was to reveal symptoms of
psychopathological disorders in patients with AFP. Methods: The
study used psychometric method. The validated scales used were
HADS, STAI, Hypochondria WI, BPI, VAS, PCS. We included all
patients with AFP examined in the clinic from October 2014 to
February 2015, who gave Inform Consent. Patients with severe
somatic disorders, psychoses, substance abuse were excluded.
Results: Study sample consists of 48 patients: 42 women (87.5%)
and 6 men (12.5%), 18-70 years old (mean age 39.6 ± 17.4 years).
The severity of pain on average was moderate: 5.5 ± 2.05 (VAS)
and 5.5 ± 1.5 (BPI max). Symptoms of anxiety and depression were
detected in 79.2% and 64.6% of patients, respectively. High rates of
reactive and personal anxiety were registered in 72.9% and 81.3%,
respectively. Symptoms of hypochondria were found in 77% of
patients. The mean pain catastrophizing score was 39.7 ± 7.1.
Conclusions: Our data suggest that patients with AFP often have
symptoms of anxiety, depression, and hypochondria. Further
clinical psychopathological investigation with the assistance of
psychiatrist are needed in order to determine nosological diagnosis
and to elaborate an approach for psychopharmacotherapy and
Daily activity level and health related quality of life
in nine patients with severe chronic fatigue
syndrome/myalgic encephalomyelitis (CFS/ME)
Fryxell Westerberg A, Saury JM
Department of Rehabilitation Medicine Stockholm,
Danderyds Hospital, Stockholm, Sweden
Introduction: chronic fatigue syndrome/myalgic encephalomyelitis
(CFS/ME) is a severe, systemic, acquired illness characterized by a
profound, debilitating sensation of fatigue, not ameliorated by rest,
which results in a substantial decrease in the amount and quality of
occupational, social and recreational activities disability and loss of
work. Severe ME/CFS patients are homebound and often
bedridden. This study aims to describe a few patients’ daily activity
level in relation to their health-related quality of life. Methods:
Nine patients with severe ME/CFS were assessed with SF-36, EQ-
5D, HADS and fulfilled a daily activity log for a week. Results:
The patients (mean age: 32 years) were characterized by an
extremely passive activity pattern. They had been ill between 2 and
12 years. Their overall health-related quality of life was extremely
poor with a mean of 12.6/100 on EQ5D-VAS and -0.07 on EQ-5D.
SF-36 outcome average were very low in all areas except emotional
role and mental health. Anxiety scores were in the average range
for all patients. Five patients were independent in their self-care
activities, but all needed assistance in daily activities such as food
preparation. Seven patients did not perform any activity at all other
than self-care and some leisure activity (i.e., watching TV).
Conclusions: Patients with severe CFS/ME symptoms show an
extremely poor quality of life and spend most of their time resting.
Even though being extremely limited in the daily life, the patients
did not have complaints regarding their mental health.
Smoking and post-infectious etiology in prevalence
of irritable bowel syndrome
Fukudo S, 1,2, Muratsubaki T1, Kano M1,2, Endo Y2, Shoji T2,
Sato Y2, Kanazawa M1,2
1Department of Behavioral Medicine, Tohoku University
Graduate School of Medicine, Tohoku, Japan
2Psychosomatic Medicine, Tohoku University Graduate
School of Medicine, Tohoku, Japan
Introduction: Irritable Bowel Syndrome (IBS) is a representative
stress-related disorder. Smoking is one of maladaptive coping
behaviors to psychosocial stress and smoking as risk factors for IBS
is controversial. By contrast, acute gastroenteritis is an independent
predictor for IBS. We hypothesized that smoking and acute
gastroenteritis synergistically increase prevalence of IBS.
Methods: Subjects were 1081 individuals in the general
population. They were randomly sampled via mail all over Japan.
Surveillance was performed with Rome III diagnostic questionnaire
and demographic data including smoking status, post-infectious
episode on acute gastroenteritis, and sleep quality. Results:
Prevalence of IBS in the general population in Japan was 15.4%.
There was no direct association between smoking status (non-
smoker, past smoker, or present smoker) and IBS. However,
prevalence of IBS was significantly associated with smoking status
and duration after acute gastroenteritis (p < 0.001). Especially high
prevalence of IBS is evident within a half year of post-infectious
episode. Multiple regression analysis showed that post-infectious
state, smoking state, smoking free years, cigarette per day, and poor
sleep were significantly independent variables for IBS (R = 0.283;
p < 0.001). Conclusions: These findings support the hypothesis
that smoking and acute gastroenteritis synergistically increase
prevalence of IBS. In smokers, smoking cessation just after the
infectious episode of acute gastroenteritis is likely to be critical to
supress the onset of IBS. Further studies on the mechanism how
smoking synergistically with acute gastroenteritis increase the
prevalence of IBS are warranted.
A survey on the problems Japanese occupational
therapists perceive when diagnosing dementia
Funaki Y1, Hirasawa R1, Okamura H2
1Department of Rehabilitation, Faculty of Rehabilitation,
Hiroshima International University, Hiroshima, Japan
2Institute of Biomedical & Health Science, Hiroshima
University, Hiroshima, Japan
Introduction: In Japan, the aging population is growing rapidly.
Healthcare providers working in eldercare facilities currently face
difficulties sharing client information. In this study, we surveyed
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occupational therapists working in eldercare facilities to identify
problems related to information sharing regarding patients with
dementia diagnoses and to determine how the occupational
therapists felt about these problems. Methods: A questionnaire
was sent to 300 occupational therapists working within eldercare
facilities in Japan. Names were sampled randomly from an
applicable association list. Questionnaires were returned
anonymously by mail. Results: There was a response rate of
36%. Only about 20% reported that most of their medical records
contained the correct diagnosis for the patient’s condition, while
57% stated the diagnosis was correct in only half of their medical
records; 21% responded by saying the patient’s condition was
diagnosed inaccurately in almost all of the medical records.
Additionally, only 12% of the respondents were familiar with late
paraphrenia. In contrast, 40% of the therapists had examined a
patient with a condition consistent with late paraphrenia. In their
comments, occupational therapists who worked in facilities without
doctors said coordinating with patients’ doctors was difficult. They
also felt uncomfortable questioning the doctors about diagnoses the
doctors had already made. Conclusions: It was clear that the
diagnosis rate of what was clearly dementia was not accurate within
the eldercare facilities that were surveyed. Further, occupational
therapists felt anxiety over these miscommunications but they were
afraid to provide the patient’s information and ask the doctor to
diagnose the patient again.
The relationship between yoga involvement,
mindfulness, and psychological well-being
Gaiswinkler L1, Unterrainer HF1,2,3
1University clinic of Psychiatry, Medical University of Graz,
Graz, Austria
2Department of Psychology, Karl-Franzens-University Graz,
Graz, Austria
3Center for Integrative Addiction Research (Grüner Kreis
Society), Vienna, Austria
Introduction: The interest in complementary and alternative
methods such as yoga for psychosomatic medicine has grown in
recent years, as the positive effects for mental and physical health
have become clearly established. As yoga practice is
conceptualized as a way of living more than a mere relaxation
technique, the positive connection of yoga with health might
depend on how deeply an individual is involved with yoga. The aim
of this study was therefore to examine how different levels of yoga
involvement are related to different parameters of mental health and
illness. Methods: A total of 455 participants (410 females) were
investigated. A group of 362 yoga practitioners (327 females) rated
their degree of yoga involvement on the Yoga-Immersion scale. A
control group comprised 93 gymnastics practitioners (83 females).
Furthermore, all participants completed the Multidimensional
Inventory for Religious/Spiritual Well-Being, the Freiburger
Mindfulness Inventory, and the Brief Symptom Inventory for
psychiatric symptoms. Results: Highly involved yoga practitioners
exhibited a significantly increased amount of mindfulness and
religious/spiritual well-being (both p < 0.01) and lower psychiatric
symptoms such as depression (p < 0.01) compared to those who
were only marginally/moderately yoga-involved or were
gymnastics practitioners. Conclusions: In accordance with the
literature, yoga practice might have its biggest impact on mental
health when it is part of a practitioners world-view. Further
research focusing on the impact of yoga involvement in clinical
groups is encouraged.
Transcultural adaptation of the Dental Environment
Stress Questionnaire DES
Garcia PPNS1, Silva IM1, Pimenta F2, Campos JADB1
1Faculdade de Odontologia de Araraquara, Universidade
Estadual Paulista, Araraquara, São Paulo, Brazil
2Instituto Universitário de Ciências Psicológicas, Sociais e da
Vida, Lisbon, Portugal
Introduction: During the course of under-graduation, dental
students experience high levels of stress for the acquisition of
cognitive, clinical, and interpersonal skills. Thus, the identification
of stress levels is an important strategy to minimize their damage.
We conducted this work in order to perform the cross-cultural
adaptation of the Dental Environment Stress Questionnaire (DES)
so that it can be used in Portuguese-speaking countries. Methods:
The face validity was analyzed through the translated version in
English to Portuguese followed by back translation. A
multidisciplinary team of knowledge area did review idiomatic,
semantic, cultural, and conceptual instrument and the instrument
was pre- tested for the misunderstanding index of items. Content
validity was evaluated by 20 judges who reviewed the essentiality
of each item of the instrument. Sixty students of Dentistry answered
the questionnaire on two occasions with an interval of one week to
evaluate reproducibility of the items. Reproducibility was estimated
using kappa statistics with linear weighting (kp). Results: All items
showed misunderstanding index 20%. Of the 38 items, 17 were
not classified as essential by the judges. Reproducibility was
adequate for all items (kp = 0.96 - 1.00). Conclusions: The cross-
cultural adaptation process resulted in an instrument easy to
understand with idiomatic and cultural equivalence suitable for
Portuguese and with adequate reproducibility.
Comorbidity of bipolar disorder and heart disease
among adults in Hawaii
Gavero G
Department of Psychiatry, University of Hawaii John A Burns
School of Medicine, Honolulu, Hawaii, USA
As many as one in two patients with cardiovascular disease suffer
from mental illness and mortality in patients with bipolar disorder
is greater compared to the general population. The diverse
population of Hawaii provides a unique opportunity to investigate
the relationship between heart disease and mental illness such as
bipolar disorder in various ethnic groups and develop interventions
to address the increasing rates of cardiovascular disease and mental
illness in the US and the pacific islands. We conducted a
quantitative, secondary data analysis using retrospective emergency
room data with cardiac disease from January 1, 2000 December 31,
2010. These include medical records for adults 18 years of age and
above with a diagnosis of specific types of heart disease (i.e., heart
failure, cardiac arrest, complications of heart, cardiomyopathy,
coronary atherosclerosis, acute myocardial infarction, and other
ischemic heart diseases) and bipolar disorder. This allowed us to:
compare the relationship of heart disease with bipolar disorder in
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various age groups, compare the comorbidity of heart disease-
bipolar disorder with depression and anxiety, and identify possible
effects of ethnicity in patients with bipolar disorder and heart
disease. Adults aged 26-34 years had the highest rate of bipolar
disorder and adults aged 55-64 years had the highest rate of cardiac
arrest, complications for heart disease, coronary atherosclerosis,
acute MI, and other ischemic issues. As more evidence links these
two conditions together, one can posit that some patients diagnosed
with bipolar disorder in early adulthood may develop factors that
can cause heart disease at a later age. Among adults below 65 years
of age, the odds ratio of having cardiac arrest/ heart complications/
coronary atherosclerosis AND bipolar disorder is higher than in
those with depression or anxiety. Among adults above 65 years of
age with bipolar disorder, the odds ratio of having heart failure was
higher compared to those with depression/anxiety. The nature of
bipolar disorder as a disease may be unique from other mental
illness (i.e., unipolar depression or anxiety), which may shed light
to these observations. Lastly, regardless of the type of heart disease
and age group, persons of European descent in Hawaii were more
likely to have bipolar disorder. Given the ethnic diversity in
Hawaii, one may wonder if psychiatric illness such as bipolar
disorder is under/mis-diagnosed. Stigma on mental health in non-
European population, somatization of psychiatric symptoms (i.e.,
those presenting as cardiac symptoms), and barriers on access to
health care are among many issues that may contribute to diagnosis
and treatment of psychiatric illness and comorbid medical
conditions. It remains important to understand cultural factors that
may influence attitudes towards mental illness in all ethnic groups
in Hawaii.
Philosophical framework of Integrative
Enhancements of perspective taking and Virtual
(ex-) bodiment in schizophrenia by psychosomatic
Gerner A
Philosophy of Human Technology, Center for Philosophy of
Science, Science Faculty, Universidade de Lisboa, Lisbon,
Portugal and Computer Assisted Schizophrenia Therapy,
Philosophy of Personalized Medicine, Center of Philosophy
of Science, University of Lisbon, Portugal
Introduction: Pharmacological efficacy in schizophrenia has
limitations (one of four patients fail to respond to treatment with
antipsychotics). Psychosomatic wellbeing is enhanced in
Integrative Avatar schizophrenia Therapies by CAST (Computer
Assisted Schizophrenia Therapy) that also develops a philosophical
psychosomatic framework. Methods: Externalization of a
“socialized” schizophrenic self by the exeroception of the patient in
contact with his external avatar is the proposed method of this
research: an alteration of embodied techniques of self-other.
Already the Rubber Hand Illusion showed the reintegration of
external artifacts as part of the body schema, bringing new insights
into plasticity of the body image and plasticity of embodiment of
self by strong influence of exteroception followed in Avatar
enhancement therapy. Results: Schizophrenia is best analyzed as
alienation of its own body. Disturbances of embodiment may be
classified in two fundamental categories: 1. primarily affecting the
subject body, prereflective embodied sense of self; 2. being related
to the body-image, the explicit body awareness. CAST introduces
modifications in the plasticity of both notions of the self in
embodiment and self-other relation. Selves can be socially
embedded or exbodied by self-technologies introducing change by
Avatar-self technology. Conclusions: Every encounter is based on
capacities to switch between your own embodied perspective and
the perspective of others and at the same time to distinguish both
perspectives to assert yourself in front of the other. CAST
envisions, we technically inhabit and alter our own embodied
“Avatar” of self, enhancing the distinction between me and an
exbodied schizophrenic Avatar.
Philosophical notes on Enhancement of
perspectivetaking and embodiment in Avatar
based schizophrenia therapy
Gerner A
Center for Philosophy of Sciences of the University of Lisbon
Integrative psychosomatic approaches convey the idea of
enhancement in concepts of health that include quantifiable medical
treatment and subjective qualitative wellbeing. One of these recent
developments is what can be called “Avatar Enhancements” in
which we include as well Avatar Therapies in Virtual Clinical
Reality in schizophrenia. This paper investigates the mechanisms
that lie behind the fact that schizophrenia patients can improve their
condition by the relation with a modelled externalized virtual agent
with the philosophy of embodiment and perspective taking of the
phenomenologist Thomas Fuchs and his concept of schizophrenia
that is best analyzed as the alienation of its own body or as a
"disembodiment". We will combine the insights of Fuchs with
recent neuroscientific research on the plasticity of perspective-
taking and the body image and perspective-taking. Disturbances of
embodiment may be classified according to Fuchs & Schlimme in
two fundamental categories: 1. as primarily affecting the subject
body or prereflective embodied sense of self; 2. as being related to
the body image or explicit body awareness. For Thomas Fuchs
every encounter is based on the capacity to switch between your
own embodied perspective and the perspective of the other and at
the same time to distinguish both perspectives that is to assert
yourself in front of the other even in empathy to virtual agents. An
avatar is usually seen as “medium through which one can inhabit a
virtual world”. What if we inhabit our own “Avatar” of self that we
permanently “reboot” and as such consider our “permanent” own
body image, body ownership and mineness, existential feeling and
affective tuning, own internal voice? The disconnected
hallucinatory intervention of an schizophrenic self and the method
of externalization of this schizophrenic self and re-embodiment of
an virtual avatar by the exteroception of the patient as well as the
patient´s the altered re-immersion after this experience of the
contact with this external avatar (that can be altered by the
therapist/doctor) is the proposed method of this research as an
alteration of embodied techniques of the self and their external
representations. Already in the classical Rubber-Hand-Illusion
(RHI) the reintegration of external artefacts as part of the body
schema while synchronically stimulating the hand and the visual
rubber hand has brought new insights in the plasticity of the body
image and the embodiment of self by a strong influence of
exteroception that we will follow in Avatar enhancements in
schizophrenia therapy. RHI is an illusion in the coordination of
vision, touch, and posture, another form would be the coordination
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of touch and proprioception that have to be considered as reasons
why Leffs Avatar enhancement therapy can be successful.
Recovery experiences and sleep problems as
mediating mechanisms in the relationship between
work stress and teacher burnout
Gluschkoff K1, Elovainio M2, Keltikangas-Järvinen L1,
Hintsanen M3, Mullola S1, Hintsa T1
1Institute of Behavioural Sciences, Unit of Personality, Work
and Health Psychology, University of Helsinki, Helsinki,
2National Institute of Health and Welfare, Helsinki, Finland
3Unit of Psychology, University of Oulu, Oulu, Finland
Introduction: Although the relationship between stressful work-
related psychosocial factors and mental health problems has been
well documented in previous studies, more research examining the
mechanisms explaining this relationship is needed. The aim of this
study was to examine potential mediating mechanisms in terms of
recovery experiences and sleep problems in the relationship
between effort-reward imbalance (ERI) and teacher burnout (BO).
Methods: Seventy-six primary school class teachers (87% female)
aged 44 years on average participated in the study. The participants
completed questionnaires for the assessment of ERI, recovery
experiences, sleep problems, and BO. Results: Adjusted for age,
gender, and total working hours, the results of linear regression
analyses showed that ERI was positively associated with BO and its
three components (exhaustion, cynicism, and reduced professional
efficacy). Additionally, ERI was negatively associated with
relaxation experiences during leisure time, and positively associated
with sleep problems in terms of nonrestorative sleep. Bootstrap
analysis indicated that poor relaxation experiences mediated the
association between ERI and reduced professional efficacy by 16%,
and nonrestorative sleep mediated the association between ERI and
exhaustion by 34% (calculated as ratio of indirect effect to total
effect). Conclusions: Our findings suggest that ERI can be a risk
factor for teacher BO, and that this association may be partly
mediated by poor recovery experiences and sleep problems. Lack of
restorative sleep and poor relaxation during leisure time can be
considered potential warning signs for the development of BO in
Temperament and metabolic control in patients
with type-2 diabetes without depression
Gois C1, Mestre M1, Carvalho AR1, Heitor MJ1, Valadas C2,
Pratas S2, Costa JV2
1Department of Psychiatry and Mental Health, Beatriz Ângelo
Hospital, Loures, Portugal
2Clinic of Endocrinology, Beatriz Ângelo Hospital, Loures,
Introduction: Long lasting characteristics, such as temperament, of
persons with type-2 diabetes need to be more evaluated in its
independent influence on metabolic control in populations without
psychiatric diagnosis. The aim of this study was to search into the
influence of excessive affective temperament by its own (adjusting
for socio-demographic data, psychological adjustment to diabetes,
and coping). Methods: At the out-patient clinic of endocrinology
has been unfolding a prospective 6 months study, enrolling patients
with type-2 diabetes, aged between 18 and 65 years and able to self
fill in the questionnaires. Those with severe chronic complications,
any psychiatric diagnosis and pregnancy were excluded.
Questionnaires used were TEMPS-A affective temperament,
ATT18 psychological adjustment to diabetes, HADS Hospital
Anxiety Depression Scale, Brief Cope coping and MINI
Structured Interview to Psychiatric Diagnosis. Results: We have
yet preliminary results at baseline evaluation with 34 patients. The
patients are 64.7% males, aged 54.56 ± 7.84 years, with BMI 31.74
± 5.47; 46.9% taking insulin, 58.8 % with 3 or more years of
diagnosed diabetes and HbA1c 8.12 ± 2.11. Patients with more
excessive temperament have better metabolic control, but none
significantly: depressive (8.81 ± 2.56 vs 7.59 ± 1.55), hyperthymic
(8.36 ± 2.24 vs 7.21 ± 1.29), irritable (8.34 ± 2.28 vs 7.29 ± 0.99),
anxious (8.46 ± 2.27 vs 7.19 ± 1.26) and cyclothymic (8.17 ± 2.29
vs 8.02 ± 1.71). Depressive symptoms were not related to metabolic
control (Spearman’s rho = -0,001; p = n.s.). Conclusions: Although
not significantly, the results point toward a baseline association
between excessive temperament and better glycemic control,
particularly with the depressive one.
Hypnosis and simple techniques in rapport,
communication and language
Gow MA, Kit K
The Berkeley Clinic, Private Dental Practice, Glasgow, UK
The impact of dental phobia is wide ranging and dynamic. In the
UK, the General Dental Council guidance states that: “Dentists
have a duty and patients have a right to expect adequate and
appropriate pain and anxiety control [and also that] in assessing the
needs of an individual patient, due regard should be given to all
aspects of behavioral management before deciding to prescribe or
proceed with treatment”. There are a plethora of techniques and
methods available to dentists that can help manage dental pain and
anxiety, however historically there may have been missed
opportunities for those focused on only a narrow range of these
There is increasing evidence supporting hypnosis as being effective
in pain and anxiety control yet the numbers of dentists who have
trained in its use remain low. One author (MAG) has demonstrated
a number of surgical dental procedures carried out under hypnosis
with no local anesthetic, in each case the patients’ reports of pain
are low, which was supported by no significant change in heart rate
throughout the procedures. It is considered that effective hypnosis
requires the cornerstones of good rapport, communication and
language skills, however it is also understood these factors also
have a significant influence in the entire dentist/patient relationship
and ultimately therefore, effective anxiety and pain control
regardless of which other techniques are employed. The authors
therefore conclude that basic rapport, communication and language
skills should be more widely taught to dentists and dental students.
Conditions of health behaviors among Polish
female students
Grądziel J, Smotrycka A, Kulik A
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Department of Psychotherapy and Health Psychology, The
John Paul II Catholic University of Lublin, Poland
Introduction: These studies demonstrate how health behaviors are
associated with self-esteem, emotional intelligence, and coping
with stress among Polish young women. Methods: The study
sample consisted of 135 Polish female students aged from 19 to 23
years (M = 19.76). The following methods were applied: The
Rosenberg Self-Esteem Scale, The Emotional Iintelligence
Questionnaire (INTE), The Inventory for Measuring Coping with
Stress (Mini-COPE), and The Catalogue of Healthy Behaviour
(IZZ). Results: In the examined group of female students, health
behaviors are chosen rarely or very rarely by 60.7%, sometimes by
27.4%, and often by only 11.8%. Three groups were distinguished
by using K-means Clustering Analysis (named: A, B, and C). The
clusters B and C are connected with low level of health behaviors.
The cluster A is connected with high level of health behaviors and
distinguishes itself by: high level of emotional intelligence, self-
esteem, coping strategies (active coping, searching for support,
acceptance, sense of humor), low level of other coping strategies:
helplessness and religious coping. The results demonstrate that the
assumed model explains 25% of health behaviors variability in the
examined group and, as far as health behaviors of young women is
concerned, the most conditioning factors are: coping with stress by
using sense of humor (β = 0.23) and using emotions in thinking
and action = 0.30). Conclusions: The obtained results indicate,
that the control of own and other emotions and making jokes with
difficult situations are associated with health behaviors among
Polish young women.
Psychological correlates of resilience in women
with breast cancer
Grandi S1, Sirri L1, Tomba E1, Duane JW2, Fava GA1, de
Figueiredo JM2
1Laboratory of Psychosomatics and Clinimetrics, Department
of Psychology, University of Bologna, Bologna, Italy
2Department of Psychiatry, Yale University School of
Medicine, Cheshire, Connecticut, USA
Introduction: A diagnosis of cancer is a stressful event which has
the potential to elicit psychological disturbances, especially
depressive symptoms, and to decrease quality of life. Resilience
may be crucial to preserve mental health in patients coping with
cancer. The aim of this study was to examine the relationship
between resilience and