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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,
Nigeria
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
screening.
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,
Portugal
Abstracts
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
examinations.
Collaborative medical treatment of a patient
suffering from type-1 diabetes mellitus with
depression
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
patients.
Comorbidity of depression with heart disease
among adults seen in emergency departments in a
large Asian-American and Pacific Islander sample,
2000-2010
Andrade J, Takeshita J, Kunasegaran VKS, Hurtwitz E, Li D,
Geobert D
Department of Psychiatry, University of Hawaii, Honolulu,
USA
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 psikosomatik.net. 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
department.
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
A
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,
Iran
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
changes.
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,
Canada
2Department of Psychology, University of Toronto, Toronto,
Canada
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
A1,2
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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Psychother Psychosom 2015;84(suppl 1):1-82
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
erythematosus
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,
Portugal
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: AAS–R, 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
variables.
Efficacy of a training program in relational skills
Barbosa M1, Guerreiro V1, Barbosa A1,2
1Faculty of Medicine of the University of Lisbon, Lisbon,
Portugal
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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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
treatment.
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,
Canada
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
regularly.
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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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,
Italy
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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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
JADB1,2
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
environment.
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 (β =
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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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,
Germany
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,
Portugal;
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
FX1
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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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,
Canada
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
implications.
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.
Primehypnosis.com, Fremantle, Perth, Western Australia,
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
study
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
diseases?
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
avoidance
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
dependency.
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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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
mechanical.
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
intervention.
Withdrawal symptoms as a consequence of NaSSA
discontinuation
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
erythematosus
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
psychopathology
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
discussed.
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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,
Italy
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,
Japan
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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1Department of Psychiatry, McGill University, Montreal,
Canada
2Douglas Mental Health University Institute, Montreal,
Canada
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 Health—Composite
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,
Canada
2Douglas Mental Health University Institute, Montreal,
Canada
3Département de psychoéducation et de psychologie,
Université du Québec en Outaouais, Gatineau, Canada
4Department of Psychology, Concordia University, Montreal,
Canada
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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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
Nails
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,
Italy
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
dysfunction.
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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,
Russia
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
psychotherapy.
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 practitioner’s 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
CAST
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
perspective–taking 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,
Finland
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
teaching.
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,
Portugal
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
skills.
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 (β = 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 quality of life, depression and
demoralization in oncology. Methods: One hundred and forty-two
women with breast cancer (mean age 53.4 ± 10.8 years; 75.4% with
primitive cancer and 24.6% with metastatic cancer) underwent the
following battery: Structured Clinical Interview for DSM-IV,
demoralization section of the Structured Interview according to the
Diagnostic Criteria for Psychosomatic Research (DCPR), Connor-
Davidson Resilience Scale (CD-RISC), Short Form-36 Health
Survey (SF-36), Beck Depression Inventory (BDI), and
Demoralization Scale (DS). Results: Women with DSM-IV major
depressive disorder (21.8% of participants) and those with
demoralization according to the DCPR (24.6% of participants) had
significantly lower levels of resilience (CD-RISC) than those
without these diagnoses. Lower scores on the CD-RISC were
significantly associated with higher levels of demoralization (DS)
and depressive symptoms (BDI) and with a worse quality of life on
all the SF-36 scales, except for “pain”. Conclusions: Our findings
suggest a protective role of resilience against the development of
depressive symptomatology, which was found to be significantly
associated with a poor outcome in cancer patients. Enhancement of
resilience, through specific psychological interventions, may be
crucial to prevent depressive symptoms and to maintain quality of
life in cancer patients.
The relationship between demoralization and
quality of life in breast cancer patients
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, CT, USA
Introduction: Demoralization is a frequent psychological response
to cancer. However, the impact of demoralization on quality of life
in cancer patients has been virtually neglected by the literature. The
aim of this study was to examine the relationship between
demoralization and quality of life in cancer patients. Methods: A
sample of 142 women with a diagnosis of breast cancer (mean age
53.4 ± 10.8 years; 75.4% with primitive cancer and 24.6% with
metastatic cancer) underwent the demoralization section of the
Structured Interview according to the Diagnostic Criteria for
Psychosomatic Research (DCPR) and completed the following self-
report questionnaires: Demoralization Scale (DS), Psychiatric
Epidemiology Research Interview-Demoralization (PERI-D).,
Subjective Incompetence Scale I and II (SIS-I and SIS-II), and the
Short Form-36 Health Survey (SF-36). Results: Demoralization
according to the DCPR was found in 24.6% of participants and was
significantly associated with lower scores on all the SF-36 scales,
except for “physical functioning” and “role limitations due to
physical health”. The DS, PERI-D, SIS-I, and SIS-II were
negatively correlated with all the SF-36 scales: higher
demoralization scores corresponded to a worse quality of life.
Conclusions: Demoralization seems to play a detrimental role on
satisfaction for one’s own quality of life in breast cancer patients. It
is also possible that a diminished quality of life may increase the
vulnerability to demoralization. The use of psychotherapeutic
treatments for demoralization could enhance quality of life in
patients with a diagnosis of cancer.
The experience of demoralization and dignity in
Italian patients with cancer
Grassi L, Caruso R, Massarenti S, Sabato S, Nanni MG
Institute of Psychiatry, Department of Biomedical and
Specialty Surgical Sciences, University of Ferrara and
University Hospital Psychiatry Unit, Department of Mental
Health, S. Anna University Hospital, Ferrara, Italy
Introduction: Demoralization, as a continuum state from
discouragement to despair has been repeatedly examined in cancer
setting. The aim of the study was to explore the inter-relationship
between demoralization dimensions and dignity among cancer
patients. Methods: A series of patients with cancer (n = 164), were
submitted to a series of psychosocial instruments. Each patient was
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submitted to the DCPR interview - demoralization module, the
Demoralization scale (DS), the Patient Dignity Inventory (PDI), the
FACIT spiritual well-being questionnaire, as well as the Prime MD
Patient Health Questionnaire (PHQ-9) to assess
depression. Results: In loss of meaning and purpose (alpha =
0.893), disheartenment (alpha = 0.864), dysphoria (alpha = 0.653)
and sense of failure (alpha = 0.739) were found as part of the
construct of demoralization. Dignity was associated with all the
dimensions of demoralization, as well as to spirituality and
depression. DS Disheartenment (B = 0.163; p ≤ 0.01) and DS
Helplessness (B = 0.170; p ≤ 0.05) significantly predicted a DCPR
diagnoses of demoralization, while loss of dignity was a predictor
of demoralization and poor spiritual well-being. Conclusions: The
study confirmed that Loss of Dignity was a significant predictor for
development of demoralization and it was positively related with
depression. Demoralization, in turn, represented a significant
condition that a specific scale (DS scale) was able to define in all its
variables (loss of Meaning ; Dysphoria; Disheartenment;
Helplessness; Sense of Failure), more than a semi-structured
interview (DCPR demoralization).
Dignity and spirituality in patients with severe
psychiatric disorders
Grassi L, Caruso R, Massarenti S, Sabato S, Zotos S,
Biancosino B, Nanni MG and the UniFe Psychiatry Working
Group co-authors
Institute of Psychiatry, Department of Biomedical and
Specialty Surgical Sciences, University of Ferrara, Italy and
University Hospital Psychiatry Unit, Department of Mental
Health, S. Anna University Hospital, Ferrara, Italy
Introduction: The concepts of dignity in psychiatry is usually
related to the concept of stigma and the marginalization of mentally
ill patients from the society. Starting from the definition of dignity
as developed in palliative care as “the status of human beings
entitling them to be respected and valued, we analyzed, in a broader
study of chronic medical and psychiatric conditions, dignity and its
related variable, value makes sense” has been investigated in
several fields. The aim of the study was to explore the condition of
dignity and its associated variables among patients with chronic
medical conditions. Methods: Patients with severe psychiatric
conditions (n = 250) (schizophrenia, severe personality disorders,
bipolar and affective disorders) were assessed to a series of
psychosocial instruments, namely the Patient Dignity Inventory
(PDI), the FACIT spiritual well-being questionnaire, the EURO-
QOL to assess QOL, the Ryff Psychological well-being
questionnaire, and the Edmonton Symptom assessment scale
(ESAS). Results: Statistically significant associations (p < 0.001)
were found between dignity (and dignity dimensions) and both
spirituality (meaning and purpose) and psychosocial well-being
clusters. Physical and emotional distress symptoms were associated
with lower dignity. Several dimensions of QOL, in terms of poor
personal care and low performance status were related to lack of
dignity and poorer psychological well-being. Conclusions:
Meaning, purpose in life and sense of personal value were
demonstrated to be significant components of dignity among
mentally ill patients Existential burden faced by is extremely
important and loss of dignity is a significant factor to be taken into
a more specific consideration, as a particular construct, in
psychiatric context hospital as a way to not forget both the physical
component of suffering in psychiatric patients and, at the same
time, a person-centred approach that includes dignity.
Scientific bases that support the relation between
TCA and Obesity : A systematic review
Guerra Gómez E1, Zambrano-Enriquez Ganzolfo D1, Eaton
Iturbide K1, Unzeta Conde B1, Vilariño Besteiro P1, Pérez
Franco C1, Mesón de Arana P2, Baños Martín I1.
1UTCA Hospital Universitario Santa Cristina, Madrid, Spain
2 Facultad de Psicología Universidad Rey Juan Carlos,
Madrid, Spain
Introduction: The relationship between obesity and
psychopathological disorders is fully proven; various papers of the
90s and the present century refer to obesity as a risk factor and/or
associated with TCA. We hypothesized that the Obesity-TCA
association is not just a matter of chance. We conducted a
systematic review of the scientific literature of the last 10 years
directed to show that obesity is a risk factor for developing TCA in
its various clinical pictures. Methods: We used the database
PubMed as main source; we selected papers published in the last 11
years about the relation between obesity and Anorexia Nervosa,
Bulimia Nervosa and Binge Eating. Results: There are 66 papers in
PubMed referring to obesity and eating disorders. In secondary
sources, we found 13 papers about TCA-obesity; only 1 was about
the relation between the two concepts. Conclusions: Many studies
showed that an increase of overweight/obesity barely increased the
prevalence of bulimia. We observed a tendency to use BMI as the
only anthropometric variable in most of the papers. AFINOS study
showed that percentiles >85 of fat increased the risk of developing
an eating disorder. Studies realized with candidates for bariatric
surgery showed this relation with bulimia (4-12%) and TCA (14%).
Studies about rs56149945 and TS6198 genes related to
glucocorticoid receptors and rs9939609 gene implicated in obesity
reinforce the thesis of a strong link between obesity and TCA.
Psychological characterization of hyperandrogenic
states in late adolescent and young women
Guidi J1, Gambineri A2, Zanotti L2, Fanelli F2, Fava GA1,
Pasquali R2
1Department of Psychology, University of Bologna, Bologna,
Italy
2 Division of Endocrinology, Department of Medical and
Surgical Sciences, St. Orsola-Malpighi Hospital, Bologna,
Italy
Introduction: The psychological implications of polycystic ovary
syndrome (PCOS) phenotypes have been investigated in different
patient populations, but little attention has been paid to adolescent
and young women. The aim of this study was to evaluate the
psychosocial correlates of PCOS and other hyperandrogenic states
in a population of late adolescent and young females. Methods:
This was a cross-sectional study involving high school female
students, aged 16-19 years. The study protocol was designed with
three possible levels of participation characterized by an increased
level of commitment. For the specific purposes of this
investigation, we focused on the subsamples of students whose
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clinical state was assessed by medical examination (n = 835) and
for whom additional laboratory tests were available (n = 394).
Psychological evaluation encompassed psychological distress,
levels of stress, well-being, illness behavior, and quality of life (as
measured by the Symptom Questionnaire, the Psychosocial Index,
and the Psychological Well-Being scales). Results: Significantly
higher levels of psychological distress and impaired well-being and
quality of life were found among late adolescent and young women
with isolated clinical hyperandrogenism compared to their normal
counterparts. Furthermore, females with PCOS showed
significantly greater hostility/irritability compared to healthy
control subjects. Conclusions: These findings highlight the
importance of early recognizing and adequately managing
psychological distress in such patients.
Clinical assessment of allostatic overload in
adolescent and young women with
hyperandrogenic states
Guidi J1, Tomei G1, Gambineri A2, Tomba E1, Pasquali R2,
Fava GA1
1Department of Psychology, University of Bologna, Bologna,
Italy
2 Division of Endocrinology, Department of Medical and
Surgical Sciences, St. Orsola-Malpighi Hospital, Bologna,
Italy
Introduction: The psychosocial correlates of hyperandrogenism in
adolescent and young women are getting increasing attention. The
aim of this study was to assess allostatic overload (AO), based on
specific clinimetric criteria, and related psychological distress in a
population of adolescent and young females with hyperandrogenic
states. Methods: This was a cross-sectional study involving high
school female students, aged 16-19 years. For the specific purposes
of this investigation, we focused on the subsample of students
whose clinical state was assessed by medical examination (n= 835).
Psychological evaluation included three self-report questionnaires
(Symptom Questionnaire-SQ, the Psychosocial Index-PSI, and the
Psychological Well-Being scales-PWB). The presence of AO was
determined according to clinimetric criteria. Results: One hundred
eighty-four participants (22.5%) were classified as having AO.
They showed significantly higher levels of psychological distress
(on the SQ) and impaired well-being (on the PWB) compared to
those who did not present with AO. A significant association was
found between the presence of AO and hyperandrogenic states.
Conclusions: These findings lend support to the clinical utility of
the clinimetric criteria for the assessment of AO in medical settings
and highlight the importance of psychosocial aspects of
hyperandrogenism among adolescent and young women.
The effects of physical exercise on symptoms and
quantity of ambulation in Japanese students with
irritable bowel syndrome
Hamaguchi T1, Tayama T2, Saigou T2, Tomiie T3, Kanazawa
M4, Fukudo S4
1Department of Occupational Therapy, Saitama Prefectural
University, Graduate School of Health and Social Services,
Saitama, Japan
2Center for Health and Community Medicine, Nagasaki
University, Nagasaki, Japan.
3School of Psychological Science, Health Sciences University
of Hokkaido, Hokkaido, Japan.
4Department of behavioral medicine, Tohoku University,
Graduate School of Medicine, Miyagi, Japan
Introduction: Irritable Bowel Syndrome (IBS) has been associated
with varying autonomic dysregulation. Physical exercise has begun
to show efficacy in the treatment of IBS. Underlying mechanisms
are unclear, but autonomic dysregulation may be involved in stress-
related gastrointestinal dysfunction. The purpose of this study was
to analyze the intervention outcomes of utilizing exercise in a
university setting by quantity of ambulation and stress related heart
rate variability (sHRV) analyses. Methods: Ten healthy controls
and 20 untreated IBS subjects underwent daily walking and muscle
stretching for 4 weeks. All subjects were underwent a brief lecture
of ambulation, muscle stretching, and recording own ambulation
activity by using pedometer. Changes in the Gastrointestinal
Symptoms Rating Scale (GSRS), sHRV, and ambulation activity
were compared between controls and IBS subjects. An analysis of
variance with period (pre vs post) as the within-subject factor and
group (control v. IBS) as the between-subject factors was carried
out on sHRV, quantitative ambulation, and GSRS. Results: After
the intervention, the IBS symptoms were improved compared with
baseline in IBS with low quantity of ambulation (estimated less
than 7000 steps par day, p < 0.05). sHRV showed no significant
interactions between period and groups. Conclusions: Our results
suggest that ambulation exercise is inefficacious in changing IBS
pathophysiology indicated by sHRV. The intervention seems
particularly tailored to IBS with low to moderate ambulation
quantity baseline levels.
Omega-3 polyunsaturated fatty acids associated
with risk of depressive symptoms in early
pregnancy in a case-control study
Hamazaki K1, Harauma A2, Otaka Y 2, Moriguchi T2, Inadera
H1
1Department of Public Health, Faculty of Medicine, University
of Toyama, Toyama, Japan
2School of Life and Environmental Science, Azabu University,
Kanagawa, Japan
Introduction: Omega-3 polyunsaturated fatty acids (PUFAs),
especially long-chain types such as docosahexaenoic acid (DHA),
are important nutrients in pregnancy. Several epidemiological
studies and clinical trials have investigated the effects of omega-3
PUFAs on perinatal and postnatal depression, but the results remain
controversial. Japanese people are known to consume a large
amount of fish compared to Western populations, although a recent
National Health and Nutrition Examination Survey reported
declining fish consumption in Japan, especially among younger
generations. This study sought to examine the possible relationship
between serum omega-3 PUFA levels and depressive symptoms
among expectant mothers. Methods: The data and specimen
samples examined were obtained in a birth cohort study started in
July 2012 in Toyama prefecture as an adjunct study to the Japan
Environment & Children’s Study. Blood samples were collected
between 9-14 weeks’ gestation (75% of samples) or after 15 weeks’
(25%). Subjects with a Kessler Psychological Distress Scale (K6)
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score >8 were assigned to the depressive symptoms group (n =
283), and the control group (n = 283) was matched for age,
educational level, and family income. Fatty acid composition was
determined from serum samples by gas chromatography.
Associations between fatty acid levels and incident depressive
symptoms were evaluated by logistic regression. Results: After
adjustment for possible confounders, eicosapentaenoic acid (20:5n-
3) and docosapentaenoic acid (22:5n-3) showed inverse
associations with risk of depressive symptoms, with respective odds
ratios of 0.53 (95% CI 0.32 - 0.87) and 0.58 (95% CI 0.36 - 0.94)
for the highest quartile. For DHA, only the third quartile showed a
significantly lower odds ratio (0.59; 95% CI 0.36 - 0.97).
Conclusions: This is the first study to report associations between
some serum omega-3 PUFAs and risk of depressive symptoms in
early pregnancy. Further research is required to verify the causality
of these associations.
Fatty acid composition of the postmortem corpus
callosum of patients with schizophrenia, bipolar
disorder, and major depressive disorder
Hamazaki K1,2, Maekawa M1, Toyota T1, Dean B3 4,
Hamazaki T1, Yoshikawa T1
1Laboratory for Molecular Psychiatry, RIKEN Brain Science
Institute, Saitama, Japan
2Department of Public Health, Faculty of Medicine, University
of Toyama, Toyama, Japan
3The Molecular Psychiatry Laboratory, The Florey Institute of
Neuroscience and Mental Health, Howard Florey
Laboratories, The University of Melbourne, Parkville, Victoria,
Australia
4The Department of Psychiatry, The University of Melbourne,
Victoria 3010 2, Australia
Introduction: Postmortem brain studies have shown abnormal
levels of n-3 polyunsaturated fatty acids (PUFAs), especially
docosahexaenoic acid, in the frontal cortex (particularly the
orbitofrontal cortex) of patients with depression, schizophrenia, or
bipolar disorder. We have previously measured PUFA levels in the
postmortem medial temporal lobe including hippocampus,
amygdala, and entorhinal cortex from patients with these
psychiatric disorders; however, we found no significant differences
between the groups except for small changes in n-6 PUFAs. In this
study we investigated whether patients with schizophrenia, bipolar
disorder, or major depressive disorder have abnormalities in PUFA
levels in the corpus callosum. Methods: Brain tissue samples were
obtained from the Victorian Brain Bank Network at the Florey
Institute for Neuroscience and Mental Health. Fatty acids in the
phospholipids of the corpus callosum were evaluated by thin layer
chromatography and gas chromatography. Specimens were
evaluated for patients with schizophrenia (n = 15), bipolar disorder
(n = 15), or major depressive disorder (n = 15) and compared with
unaffected controls (n = 15). Results: In contrast to previous
studies, we found no significant differences in the levels of PUFAs
or other fatty acids in the corpus callosum between patients and
controls. Sub-analysis by sex also showed no significant
differences. Oleic acid was significantly higher in suicide (n = 20)
cases than in non-suicide (n = 39). Conclusions: These psychiatric
disorders might be characterized by very specific fatty acid
compositions in certain areas of the brain, and corpus callosum
might not be involved in abnormalities of PUFA metabolism.
Experiences of people diagnosed with
psychogenic syncope
Hansen BS1, Frizelle D2, Morley C3
1Department of Clinical Psychology and Psychological
WellBeing, University of Hull, Hull, UK
2Department of Clinical Psychology and Psychological
WellBeing, University of Hull, Hull, UK
3Cardiology, Bradford Teaching Hospitals NHS
Foundation Trust, West Yorkshire, UK
Introduction: Psychogenic syncope (PS) diagnosed via
cardiology is not well investigated compared to non-epileptic
attack disorder (NEAD) or psychogenic non-epileptic seizures
(PNES), diagnosed via neurology specialty. Psychogenic
syncope is a condition of collapsing or ‘blackouts’ that may be
diagnosed within cardiology clinics via a process of exclusion
of cardiac cause. No research to date has explored the
experiences of patients who receive their diagnosis of
psychogenic syncope via cardiac services. We aim to
understand patient experiences in order to help provide better
management of identified needs. Methods: The study utilized
six semi-structured interviews with people who had received a
psychogenic syncope diagnosis via a cardiology service
pathway. Data was analyzed using Interpretative
Phenomenological Analysis (IPA). Results: Peoples’
descriptions highlighted a sense of disconnection between mind
and body. An overarching uncertainty evolved with ‘not
understanding’ a psychogenic syncope diagnosis. Equally, a
“battlefield” was described in relation to fighting a
“dissociative” condition, and experiencing a loss of self-
identity. Conclusions: The insight into people’s experiences of
psychogenic syncope highlighted a harrowing struggle to make
sense of their diagnosis. A new diagnostic term is called for to
legitimize the condition in order to enable a more holistic
person-centered recovery process.
Psychological factors associated with
psychogenic syncope and psychogenic non
epileptic seizures
Hansen BS1, Frizelle D2, Morley C3
1Department of Clinical Psychology and Psychological
WellBeing, University of Hull, Hull, UK
2Department of Clinical Psychology and Psychological
WellBeing, University of Hull, Hull, UK
3Cardiology, Bradford Teaching Hospitals NHS
Foundation Trust, West Yorkshire, UK
Introduction: Psychogenic syncope (PS), psychogenic non-
epileptic seizures (PNES), and non-epileptic attack disorder
(NEAD) or non-epileptic seizures (NES) are a group of
conditions that are medically unexplained that have in common
a temporary loss of consciousness. PS, is diagnosed within
cardiology syncope clinics. The majority of patients are
diagnosed through the epilepsy route in neurology. Studies have
widely acknowledged psychological distress, depression, and
trauma in this patient group. No research to date has explored
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the psychological factors across the unexplained syncope
presentations. We aim to identify these psychological factors
and their impact on people. Methods: This present review
aimed to summarize the psychological factors that are reported
to be associated with these conditions. A systematic review of
four databases (PsycINFO, Medline, CINAHL, Web of
Science) identified 11 studies. Results: The selected studies
identified several factors associated with the conditions:
dissociation, anxiety, stress, abuse, trauma, anger, depression,
somatization, and bereavement. Conclusions: The findings
concur with literature and highlight less investigated
psychological and psychosocial factors. The factors found
across the unexplained syncopal spectrum appear to be
homogenous. There is a need for further research to address
this, specifically within the cardiology specialty.
The relationship of Namake (a state of
maladaptation to schoolwork) tendency and lifestyle
in Japanese university students
Hashimoto H1,Hisamura M2
1Department of Psychology, Sapporo International University,
Sapporo, Japan
2Office of Sapporo Psychosomatic Therapy Research,
Sapporo, Japan
Introduction: This study clarifies the background of maladaptation
to schoolwork by the relationship of Namake tendency and
lifestyle. Methods: A total of 325 students of three universities
were measured by the Laziness Tendency Scale (LTS) and the
questionnaire about daily life. The participants were composed of
students in the department of psychology, economics,
pharmacology, sports. The relation of everyday lifestyle and LTS
points was checked using two-way analysis of variance. Results:
The questions such as “Can you concentrate on the morning
class?”, “Did you finish your home schooling?”, “Do you usually
exercise?”, and “Is there a teacher you can consult about worries?”
showed main effects between departments. The question “Are you
taking part in extracurricular activities?” showed main effects
between departments and an interaction between departments and
answers. Conclusions: Students of economics department showed
the highest points on LTS. They blessed with time and money
because they tend to live with their parents, and work part-time.
Students of sports department showed the lowest points on LTS.
They tend to exercise, engage in extracurricular activities, and learn
quickly and intensively. It is suggested that Namake tendency will
be influenced by environment factors.
Biomarkers derived from human reward system to
guide psychotherapy
Hasler G
Bern, Switzerland
Many patients respond well to psychotherapy. However, it they do
not, clinicians usually do not try a different form of psychotherapy
and provide patients with supportive psychotherapy, which lacks a
clear focus and does not rely on specific therapeutic mechanisms.
This practice may increase the patients’ feelings of failure, lack of
focus and helplessness. Unfortunately, psychotherapies cannot be
switched as easily as pharmacotherapies because each
psychotherapy is based on a different therapeutic rational and
attitude of the therapist. As a result, the identification of markers
that predict response to specific psychotherapies would greatly
enhance the effectiveness of psychosocial interventions. In this talk,
I first will show how experienced psychotherapists tailor their
treatments to individual patients. Second, I will speculate on how to
enhance such psychological strategies by the use of neurobiological
knowledge and biological measures. Since the human reward
system is crucial in the development of both psychosomatic
conditions and psychological resiliency, I will show how various
dysfunctions of the reward system may affect response to
psychotherapy. Such dysfunctions include psychological myopia,
melancholic hyperopia, abnormal responses to social and nonsocial
rewards, impaired habit formation and abnormal dopamine and
oxytocin neurotransmission.
Gut microbiota play a critical role in the production
of gut luminal serotonin
Hata T, Asano Y, Todani T, Yoshihara K, Hiramoto T, Sudo N
Department of Psychosomatic Medicine, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan
Introduction: A series of our previous researches has demonstrated
that gut microbiota modulates stress response and behavior profile
of the host. Serotonin (5-HT) is a possible candidate molecule
involved in such modulation. However, available evidence is
limited because of the lack of actual data regarding the relation
between gut microbiota and luminal 5-HT in vivo. The aim of this
study was to examine the effects of gut microbiota on 5-HT level
and 5-HT related gene expression in the gut lumen and the brain.
Methods: Luminal 5-HT level and 5-HT related gene expressions
were analyzed in germ-free (GF) mice and GF mice and gnotobiotic
mice which were reconstituted with fecal microbiota of specific
pathogen-free (SPF) mice on either 3 days (EX-GF3) or 21 days
(EX-GF21) before the analysis. Monoamines and their metabolite
levels were also measured in several regions of the brain. Result:
The 5-HT level in the gut lumen was lower in GF mice than in EX-
GF3 and EX-GF21 mice. The 5-HT transporter and tryptophan
hydroxylase-1 mRNA levels of the intestinal mucosa were lower in
EX-GF3 mice than in GF mice. The 5-HT type 3 receptor mRNA
levels of the enteric plexus was higher in EX-GF21 mice than in GF
mice. In the brain, monoaminergic turnover rate was changed after
the reconstitution with SPF feces. Conclusions: These results
indicate that gut microbiota affect not only 5-HT related systems in
the gut but also monoaminergic systems in the brain.
Maternal relationship satisfaction during pregnancy
predicts the risk for respiratory infectious disease in
the offspring
Henriksen RE1, Torsheim T2, Thuen F1
1Centre for Evidence-Based Practice, Bergen University
College, Bergen, Norway
2Faculty of Psychology, Department of Psychosocial Science,
University of Bergen, Bergen, Norway
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Introduction: Animal and human studies suggest that maternal
emotional distress during pregnancy affects the offspring’s immune
functioning. Although marital conflict can be a major source of
emotional distress, very few studies have investigated the
relationship between marital quality among pregnant women and
the risk of infectious diseases in their offspring. The aim of this
study was to explore the degree to which relationship satisfaction
during pregnancy predicts the risk of respiratory infectious diseases
in infants. Methods: Data were obtained from the Norwegian
Mother and Child Cohort Study, conducted by the Norwegian
Institute of Public Health. Pregnant women (n = 61700) completed
questionnaires concerning relationship satisfaction in week 30 of
pregnancy. In follow-up questionnaires, the women reported
whether their children had been subject to common cold, throat
infection, bronchitis, RS virus, pneumonia, or croup. Associations
between the predictor and outcome variables were assessed by
logistic regression analyses. Results: After controlling for
socioeconomic factors, social support, smoking, and breastfeeding,
low levels of maternal relationship satisfaction, as compared with
high levels, were found to predict significantly higher odds for all
categories of respiratory infectious diseases. Conclusions: The
results suggest that relationship quality during pregnancy affects the
offspring’s likelihood for respiratory tract infections during their
first year of life.
11-Year stability of alexithymia in general
population
Hiirola A1, Markkula N2, Karukivi M3, Bagby RM4, Joukamaa
M5, Jula A6, Kronholm E6, Saarijärvi S7, Suvisaari J2, Mattila
AK8
1Psychiatric Outpatient Care Unit of Town of Nokia, Nokia,
Finland
2National Institute for Health and Welfare, Department of
Mental Health and Substance Abuse Services, Helsinki,
Finland
3Department of Adolescent Psychiatry, University of Turku,
Turku, Finland, and Unit of Adolescent Psychiatry, Satakunta
Hospital District, Pori, Finland
4Departments of Psychiatry and Psychology, University of
Toronto, Graduate Department of Psychological Clinical
Science, University of Toronto Scarborough, and Campbell
Family Mental Health Research Institute, Centre for Addiction
and Mental Health, Toronto, Canada
5School of Health Sciences, University of Tampere, Tampere,
Finland
6Department of Health, National Institute for Health and
Welfare, Turku, Finland
7Department of Adolescent Psychiatry, University of Turku,
and Unit of Adolescent Psychiatry, Turku University Hospital,
Turku, Finland
8Department of Adult Psychiatry, Tampere University
Hospital, Tampere, Finland
Introduction: Our aim was to investigate if alexithymia, a
personality trait with difficulties in identifying and describing
feelings and an unimaginative and externally oriented way of
thinking, is stable in general population. Methods: In a nationally
representative sample of Finnish people aged 30 and above (1674
women, 1332 men) alexithymia was measured with the 20-item
Toronto Alexithymia Scale (TAS-20) in 2000 and 2011. Stability of
alexithymia was assessed with t-test and linear regression with
following confounders (established in 2000): age, gender, marital
status, years of formal education, physical functional capacity
assessed by physicians, and 12-month depressive and anxiety
disorders measured by diagnostic interviews. Results: The mean
(SD) of the TAS-20 score was 44.2 (10.3) in 2000 and 44.2 (10.9)
in 2011; there was no statistical difference. In crude regression
analysis, TAS-20 score in 2000 (TAS-20-2000) explained a
significant proportion of variance in TAS-20 scores in 2011:
adjusted R2 = 0.50, p < 0.001, standardized beta coefficient for
TAS-20-2000 = 0.71 (p < 0.001). Controlling for all confounders
increased the adjusted R2 only incrementally: R2adj = 0.54, p <
0.001, beta coefficient for TAS-20-2000 = 0.64 (p < 0.001). Other
statistically significant predictors were higher age (beta coeff. =
0.15, p < 0.001), lower education (beta coeff. = 0.10, p < 0.001),
male gender (p < 0.001) and not being married (p = 0.025).
Depressive and anxiety disorders or physical functional capacity in
2000 did not significantly predict TAS-20 score in 2011.
Conclusions: Our finding from the largest follow-up survey so far
attests to the theory that alexithymia is a stable personality trait in
adult general population.
Effectiveness of training infirm elderly people
using a machine with a cognitive dysfunction
improvement system
Hirasawa R1,2, Kaneko F2, Funaki Y1, Okamura H2
1Faculty of Rehabilitation, Department of Rehabilitation,
Hiroshima International University , Hiroshima, Japan
2Institute of Biomedical & Health Sciences, Hiroshima
University, Hiroshima, Japan
Introduction: The decrease in balance control in the elderly is an
important risk factor for falls and markedly influences their
activities of daily living (ADL) and quality of life (QOL). In a
previous study, we reported a correlation between balance control
and mental function in the elderly. In this study, we investigated the
effectiveness of training using a machine with a cognitive
dysfunction improvement system (mirgometer) for improving the
physical and cognitive functions and mental state of infirm elderly
individuals. Methods: The subjects comprised infirm elderly
individuals using elderly facilities. Mirgometer intervention was
monitored for 6 months, and the subjects were evaluated for motor
function (i.e., balance ability and flexibility), mental function (i.e.,
cognitive function and psychological state), ADL, and QOL.
Furthermore, the change of each function over time in the control
group, which synchronized a condition, was compared with that in
the intervention group. Results: At 6 months, the mirgometer score
and cognitive function were significantly improved. The
meaningful drop of the balance function was recognized in the
exercise function in the control group. Conclusions: This
intervention significantly improved cognitive and motor functions
in the infirm elderly. Therefore, continual training could aid in
improving and maintaining the physical and mental functions and
QOL in infirm elderly people.
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Associations between parents’ perception of self-
help groups and their children’s social withdrawal
in Japan
Homma E1, Saitoi M2, Naito M2, TanabeS2, Sato T1
1Department of Clinical Psychology, Graduate School of
Clinical Psychology, Niigata Seiryo University, Niigata, Japan
2Department of Nursing, Niigata Seiryo University, Niigata,
Japan
Introduction: Given the high prevalence of social withdrawal
(hikikomori) in Japan, there are many self-help groups for parents
of children with this condition. Although it is possible that parents’
perceptions of these self-help groups are related to the severity of
social withdrawal in their children, this relationship has not yet
been empirically tested. Methods: A total of 295 parents (204
mothers and 91 fathers) completed questionnaires assessing
parental maladaptation and their children’s social withdrawal.
Participants also indicated their perceptions of self-help groups,
which were divided into the following subcategories:
communication with their children and supportive group members,
acceptance of their children, education regarding social withdrawal,
and information on social resources. Results: In each subcategory
moderately or weak negative correlations were found between
parents’ positive perceptions of the self-help groups and their
children’s degree of social withdrawal. Moreover, children whose
parents perceived improvements in communication and in
acceptance of their children reportedly exhibited less social
withdrawal and the parents showed less maladaptation.
Conclusions: These results suggest that the effects of self-help
groups on parents, particularly improvements in parent-child
communication and supportive self-help group members, might
decrease children’s social withdrawal, as well as parental
maladaptation. Increasing focus of self-help groups on variables
that are influential in parents’ perception, it is useful that the
programs for self-help groups is improved.
The explore of the brain electrical physiological
mechanism in treating cardiac neurosis by the
rigid-gentle syndrome differentiation of Traditional
Chinese Medicine (TCM)
Hongliang L, Zhifu Z
Department of Psychosomatic Medicine of Guang`an men
Hospital, China Academy of TCM, Beijing, China, 100053
Introduction: Cardiac neurosis is due to central nervous system
dysfunction, caused by the impact of cardiovascular autonomic
function disorders arising from a kind of syndrome. Professor Zhao
founds the rigid-gentile syndrome differentiation based on years of
clinical experiences. The curative effect is remarkable in treating
cardiac neurosis. Methods: One-hundred sixty patients with cardiac
neurosis participated in the study. A placebo-controlled, single-
blind design was used. In this study, we evaluated the participants
by the brain electrical function before and after treatments. Results:
There were some differences between the results before and after
treatments. Tis result revealed the significant correlations between
the brain electrical function and cardiac neurosis. Conclusions: The
research aims to the rigid-gentle syndrome differentiation of cardiac
neurosis as the key point. Based on cerebro-electrophysiology, this
research explores the changes of brain neurotransmitters, frequency
band, power of brain region before and after herbal interventional
treatment. It is considered that the changes of cerebro-
electrophysiology may be the objective basis of the treatment of the
rigid-gentle syndrome differentiation of cardiac neurosis.
Moreover, the study gives the scientific evidence for psychosomatic
medicine (emotion pathogenesis) of the rigid-gentle syndrome
differentiation.
Differences between Depressive men with and
without obstructive sleep apnea syndrome
Hori R1,2, Uchida A2, Sasanabe R2, Shiomi T2, Kobayashi F1
1Department of Psychosocial medicine, Aichi Medical
University School of Medicine, Nagakute, Aichi, Japan,
2Department of Sleep Medicine, Aichi Medical University
School of Medicine, Nagakute, Aichi, Japan
Introduction: Not uncommonly, cases were reported to be suffered
from obstructive sleep apnea syndrome (OSAS) and depression.
The patients with depression often visit sleep clinic with suspected
OSAS. The purpose of this study was to verify if there are
differences between depressive people with and without OSAS.
Methods: The subjects were 108 men under treatment for
depression. They were hospitalized for undergoing
polysomnography (PSG) and answered the semi-structured
interviews using the Hamilton Depression Rating Scale (HAM-D)
before PSG. Sleepiness was assessed using the Epworth Sleepiness
Scale (ESS) before hospitalization. Their characteristics were
analyzed by the severity of OSAS. Results: By the apnea-hypopnea
index (AHI) of PSG, these patients were categorized as follows: 23
men (AHI < 5, non-OSAS), 35 men (5 ≤ AHI < 15, mild OSAS),
23 men (15 ≤ AHI < 30, moderate OSAS), and 37 men (30 ≤ AHI,
sever OSAS). Non-OSAS men were younger and firmer than mild
and sever OSAS men, and had more difficulty in getting to sleep
than sever OSAS men. Covariance analysis adjusted for age and
waist length showed sever OSAS men had less difficulty in getting
to sleep than non-OSAS men, although there was no significant
difference in ESS score or HAM-D score. Conclusions: Obese
depressive men in mature stage with depression who have no
difficulty in getting to sleep might suffer from OSAS.
The emotional, personality and autonomic features
of somatoform disorders in Taiwan
Huang WL1,2,3,4, Liao SC2,3
1Department of Psychiatry, National Taiwan University
Hospital, Yun-Lin Branch, Yunlin, Taiwan
2Department of Psychiatry, National Taiwan University
Hospital, Taipei, Taiwan
3Department of Psychiatry, College of Medicine, National
Taiwan University, Taipei, Taiwan
4Graduate Institute of Clinical Medicine, National Taiwan
University, Taipei, Taiwan
Our series researches are performed in Taiwan. The topic is about
the relationship between somatoform disorders (somatic symptom
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Psychother Psychosom 2015;84(suppl 1):1-82
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and related disorders) and emotion, personality, and autonomic
functions. The effects of distinct diagnostic systems and
demographic factors are also explored. Up to now, we have had the
following findings: the degree of anxiety/depression in somatoform
patients is not lower than the one in patients with other
anxiety/depressive disorders (such as panic disorder or major
depressive disorder, MDD). In multivariate regression analysis
which comorbidity is considered, somatoform disorders even show
higher predictive meaning on Beck Depression Inventory-II (BDI-
II) and Beck Anxiety Inventory (BAI) scores than panic disorder or
MDD. For predicting the occurrence of somatoform disorders from
the personality perspective, the most meaningful indexes is harm
avoidance 4 (HA4, fatigability and asthenia) and reward
dependence 3 (RD3, attachment) of Tridimensional Personality
Questionnaire (TPQ). In subjects with somatoform disorders, the
features of TPQ is related with the degree of hypochondriacal
ideation or somatic complaints. The dimension harm avoidance
total (HA) and reward dependence 2 (RD2, persistence) are highly
associated with the severity of hypochondriacal ideation while the
severity of somatic complaints can be estimated with HA4 and
RD2. Heart rate variability (HRV), an index of autonomic
modulations, is related with TPQ in male above 45 years old. Low
parasympathetic function is correlated with high scores of
HA*novelty seeking 2 (NS2). The personality features are similar
to type A personality, which is known to be a risk factor for
developing cardiovascular diseases. High sympathetic modulation
is correlated with high scores of HA*reward dependence 1 (RD1,
sentimentality). These factors are likely with alexithymia or type D
personality. Therefore, our results can provide physiological
explanations to the traditional psychodynamic theories. There are
significant correlations between the diagnosis of somatic symptom
disorder and old age, low educational level, and low sympathetic
activity of HRV. From the standpoint of symptomatology, the
severity of depression but not somatic distress or hypochondriacal
ideation is associated with HRV values. The finding is only obvious
only in male subjects. In other words, the "autonomic dysfunction"
related with depression may be more important than with somatic
complaints. The relationship between Diagnostic Criteria for
Psychosomatic Research (DCPR) and above features are under
gathering in Taiwan. We believe that DCPR will be helpful for the
connection of psychiatric symptoms and biological functions,
which is invaluable for a comprehensive understanding of
somatoform disorders.
The effect of middle school students academic
stress on somatization: affect-regulation ability as
a mediating variable
Hui KS, Gwiyeoroo A
Graduate School of Education, Kangnam University
Korea
Introduction: The purpose of this study was to examine how
emotional regulation that has been raised as one of the major
variables influencing examination stress works in correlation
between middle school students’ examination stress and somatic
symptoms. We formulated study questions for it as follows: first,
what is the relationship between middle school students’
examination stress, somatic symptoms, and emotional regulation?
Second, does emotional regulation mediate in correlation between
middle school students’ examination stress and somatic symptoms?
Methods: This research was a survey to 450 first and second
graders attending middle schools located in Yongin. As measuring
tools, the examination stress scale, K-CSI, and emotional regulation
scale were employed, and the data collected went through statistical
processing with SPSS 18.0K through Cronbach's α, frequency
analysis, average, standard deviation, Pearson’s correlation, and
Sobel test. Results: regarding relationship between middle school
students’ examination stress, somatic symptoms, and emotional
regulation, there was significantly medium and negative correlation
between examination stress and emotional regulation, there was
significantly high and positive correlation between examination
stress and somatic symptoms, and there was medium negative
correlation between emotional regulation and somatic symptoms.
Second, emotional regulation seems to mediate the relationship
between middle school students’ examination stress and somatic
symptoms. Conclusions: This study has verified the mediating
effect of emotional regulation in the relationship between middle
school students’ examination stress and somatic symptoms, thereby
finding the importance of emotional regulation.
Rigid flexible combination of syndrome
differentiation of clinical behavior of cognitive
therapy in the treatment of hypochondriasis
depression syndrome
Hui Z, Zhifu Z
Department of Psychosomatic Medicine of Guang`anmen
Hospital, China Academy of Chinese Medical Sciences,
Beijing, China
Introduction: Hypochondriasis depression syndrome belongs to
hypochondriacal neurosis. The patients are often accompanied by
complicated physical symptoms and poor performance. Professor
Zhao Zhifu have 40 clinical years learning experience, especially
on the psychosomatic disease research, on the original rigid
syndrome differentiation theory of TCM diagnosis and treatment.
The clinical Curative effect is remarkable. Case Description: A 72-
year old male patient suffered from insomnia two months. He has
difficulty falling asleep, he was upset, nervous, very afraid of death,
flustered, ha had shortness of breath, dry mouth, red tongue, thin
yellow tongue coating, slippery pulse string. Zhao Zhifu had
discriminated of heart and liver of yin deficiency and yang
hyperactivity and choose modified Tianwangbuxin Dan. The
patients was offered the traditional Chinese medicine in the
treatment of Zhao, plus cognitive behavior therapy. Conclusions:
Patients with hypochondriasis and depression tend to own health
care too much and over use health facilities. Patients often must
identify a disease to give up. Many social and psychological factors
and personality defects might be involved and the treatment is
relatively complex. Professor Zhao Zhifu psychosomatic disease
treatment together with rigid flexible syndrome differentiation
theory, combined with cognitive behavior therapy, psychosomatic
balance, homology of yin and Yang, treatment heart and body,
seems to ensure clinical efficacy.
A personal proposal for a behavioral classification
of obese patients
Iamandescu IB
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Medicine and Pharmacy University Carol Davila, Bucharest,
Romania
Introduction: Obesity has many roots, among them the psycho-
social factors, being very important. Some literature data have
suggested a mild/medium depressive state, provoking an impulsive
food intake as a recompense response to the varied distresses.
Common clinical observations have highlighted, however, other
affective traits. In order to establish a possible presence of a
behavioral profile of obese patients, there were explored some
affective traits - as anxiety, depression, and resilience - in obese
patients, and the results were correlated with their so-called
“hyperphagic“ behavior. Methods: The HADS (Hospital Anxiety
Depression Scale), the Hyperphagic Behavior (HB) questionnaire,
and a Well Being Scale were administered to 50 obese patients and
50 control (with normal weight) subjects. All obese patients had a
mean increase of weights between 20% and 40%. Correlations of
main indices of HB with anxiety, depression, and Well Being
scores were statistically significant. Results: Anxiety was more
frequently observed than depression, and well-being state was
present in the large majority of anxious obese subjects and mostly
in controls. Based on these results and on clinical observation, the
author proposes a classification of patients with the “premorbid”
obesity as: “cheerful obese” (i.e., with prevalence of anxiety,
optimism, and friendly attitude) and “cramped obese” (i.e.,
depressive more than anxious, pessimistic/skeptical, and with a
reticent attitude). Conclusions This simple classification may allow
therapists to increase the communication possibilities toward obese
patients and their motivation toward treatment acceptance.
Missing memories of death: dissociative amnesia
in the bereaved the day after cancer death
Ishida M, Onishi H
Department of Psycho-Oncology, Saitama Medical University
International Medical Center, Hidaka-city, Saitama, Japan
Introduction: The death of a loved one is one of the most stressful
events in our lives. Such stress affects the physical and
psychological wellbeing of the bereaved. Dissociative amnesia is
characterized by an inability to recall important autobiographical
information. However, dissociative amnesia in the bereaved who
have lost a loved one to cancer has not been reported. Case
description: A 38-year-old woman was referred for psychiatric
consultation because of restlessness and abnormal behavior. Her
44-year-old husband had died of pancreatic cancer the day before
the consultation. On the day of the death, she looked upset and
developed hyperventilation. The next day, she behaved as if the
deceased were still alive, which embarrassed her family. At her
initial psychiatric consultation, she talked and behaved as if her
husband were still alive in the hospital. Her psychiatric features
fulfilled the DSM-V criteria for dissociative amnesia. The death of
her husband had been traumatic for her and was considered to have
been one of the causes of this dissociation. Comment: This report
adds to the list of psychiatric symptoms in the bereaved who have
lost a loved one to cancer. In an oncology setting, we should
consider the impact of death, defense mechanisms, and background
of the families.
Association between religiosity and depression
among elderly Buddhists in India, China, and
Thailand
Ishikawa M1, Yamanaka G1, Kimura Y2, Okumiya K2,
Matsubayashi K2, Otsuka K1, Sakura H1
1Department of Medicine, Tokyo Women’s Medical University
Medical Center East, Tokyo, Japan
2Center for Southeast Asian Studies, Kyoto University, Kyoto,
Japan
Introduction: We previously reported the results of a survey of
depression among residents of 3800m above sea level in Ladakh,
India and 3700m in Qinghai, China who were 60 years of age or
older. The implicit aim was to test the hypothesis that high-altitude
hypoxia causes changes in the brain of residents that lead to higher
rates of depression. We speculated that cultural factors inhibit the
development of depression in these groups. Given that cultural
factors play a role in the development of depression and that
depression rates tend to be lower in Asian populations, a test of the
effect of hypoxia would require a comparison of depression
prevalence between their samples and comparable lowland Asian
populations. Methods: This study investigated the cross-cultural
relationship between depressive state, subjective quality of life
(QOL), and activities of daily living (ADL) among elderly people
in communities in India, China, and Thailand. We studied 430
subjects aged 60 years or older in three Asian communities (114
subjects in Domkhar in India, 173 in Yushu in China, and 143 in
Nakhon Pathom in Thailand). Data were collected from personal
interviews using a structured questionnaire. All the participants
were devout Buddhists. Results: The results showed that few of the
elderly residents in these areas had depression. This finding
suggests that cultural factors such as religious outlook and social
support inhibit the development of depression. Conclusions:
Further research on such factors may help the development of
strategies for preventing depression in elderly adults in the future.
The novel epigenetic research on the
psychosomatic traditional Chinese medicine
Jian L, Zhifu Z
Department of Psychosomatic Medicine, Guang`anmen
Hospital, China Academy of TCM, Beijing, China
Introduction: Nowadays, epigenetic medicine has become an
important subject in biological science, the relevant theory and
research methods provide new perspectives and methods for
psychosomatic medical research. This article summarizes the
epigenetic research on the psychosomatic traditional Chinese
Medicine (TCM). Methods: The epigenetic research on
psychosomatic traditional Chinese Medicine is being researched in
the databases of MEDLINE (1950-2015), Embase (1980-2015),
China biology medicine (CBM) (1994-2015), China national
knowledge infrastructure (CNKI) (1989-2015), Weipu (VIP) (1995-
2015), and Wanfang (1989-2015). Studies were included according
to the presence of a relationship with methylation or acetylation and
depression or anxiety. Results: After preliminary screening, 13
English articles were found in the international databases and 435
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Chinese articles were found in the Chinese databases. Only 1
English article was about the TCM diagnosis, the other ones were
about the TCM drug`s therapeutic effects. Only 4 Chinese articles
were about psychosomatic TCM. Conclusions: These findings
indicate that the epigenetic method is widely used in TCM, which
means it is very suitable for TCM’s theory and clinic system.
Besides the epigenetic method can elaborate the psychosomatic
medicine’s characteristic, it should be improved and popularized in
the psychosomatic traditional Chinese Medicine.
A regulatory perspective on psychological
treatment: improving patient safety or barking up
the wrong tree?
Jonsson U
National Board of Health and Welfare, Sweden
Improved access to psychological treatment in health care
underscores the necessity to ensure that the treatments delivered are
safe. Psychological treatment might intuitively seem harmless, but
the limited research available suggests that unwanted effects can
occur in a significant number of patients. The regulatory agencies
in Sweden are currently addressing this complex issue. Key
questions include how unwanted effects should be defined, detected
and prevented; how patients should be informed; requirements on
training and supervision of therapists; and if the safety culture
needs to be improved. In an initial literature review we found that
adverse effects are not systematically monitored and reported in
randomized controlled trials of psychological treatment. In order to
bring attention to patient safety and stimulate more research we
initiated a dialog with Swedish researchers, psychological
associations, and patient organizations. Several research projects
have been initiated as a result. We are currently preparing a brief
manual on patient safety specifically intended for staff providing
this kind of treatment. Lessons learned from this ongoing work will
be presented.
Buffering effect of spiritual intelligence on suicide
ideation in young adults exposed to childhood
emotional abuse
Ju H, Hyun MH
Department of Psychology, Chung-Ang University, Seoul,
Korea
Introduction: Spiritual intelligence is defined as a set of mental
capacities which contribute to the awareness, integration, and
adaptive application of the nonmaterial and transcendent aspects of
one’s existence, leading to such outcomes as deep existential
reflection, enhancement of meaning, recognition of a transcendent
self, and mastery of spiritual states. The purpose of this study was
to explain the protective effect of spiritual intelligence on suicide
ideation in young adults exposed to childhood emotional abuse.
Methods: A total of 247 undergraduate students in Seoul
completed the instruments assessing childhood emotional abuse,
spiritual intelligence, and suicide ideation. The age ranged from 18
to 27 years, with a mean age 22.81 (SD 1.93) years. The
demographic variables in this study were family income, education
level, and health status. Results: Suicide ideation scores were
entered into a two-way analysis of variance with abuse exposure
(high exposure to emotional abuse vs low) and spirituality level
(high level of spiritual intelligence vs low) as the between-subjects
factors. There was a significant main effect of abuse exposure (F(1,
105) = 21.68; p < 0.001), but no significant main effect of
spirituality level. However, there was a significant abuse exposure
x spirituality level interaction effect (F(1, 105) = 9.59; p < 0.005).
Simple main effect analyses of spirituality level were conducted
with Bonferroni adjustment. For the group of high exposure to
emotional abuse, suicide ideation was significantly lower in high
level of spiritual intelligence (mean = 12.14) than the low level of
spiritual intelligence (mean = 19.76) (F = 7.60; p < 0.01). On the
contrary, for the group of low exposure to emotional abuse, suicide
ideation did not differ significantly in each spirituality level.
Conclusions: Our findings demonstrated an adaptive role of
spirituality in individuals exposed to childhood emotional abuse
and suffering from suicide ideation.
Graded exercise therapy for chronic fatigue
syndrome utilizing behavioral approach using
video game exercise programs
Kanemitsu Y
Department of Psychosomatic Medicine, Fukuoka Dental
College Medical and Dental Hospital, Fukuoka, Japan
Introduction: This clinical case study demonstrates an efficient
method of treating chronic fatigue syndrome (CFS) patients with
continuous graded exercise therapy. Case description: The case
illustrates the combined use of behavioral therapy and video game
exercise programs. The patient recorded daily behavior (e.g., sleep,
bed stay, meals, walking) and the symptoms on a weekly diagram
chart. Meanwhile, the patient played video game fitness exercises,
beginning from easy and light courses, and got feedback of the
calculated energy consumption. Variety of graded exercises in the
program were pursued successively, and graded exercises were
performed constantly for more than three years, which
consequently improved daily activities, activation records, and
severity and frequency of the symptoms. Comment: It is known
that the graded exercise therapy is one of the few possible effective
treatments for CFS patients. However, the graded exercise is often
difficult to continue due to the fatigue symptoms and the burden of
repeated monotonic exercises. Behavioral approach using video
game exercise possibly motives patients providing variety of
attractive exercise experiences with a wide range of energy
consumption as a behavioral reward, encouraging patients to
persevere the long-term succession of graded exercise therapy.
The effect of socio-economic status on mental
health among Korean adolescents
Kang L1, Kim B1, Choi H1, Won C1, Kim S1 , Moon M1
1Department of Family Medicine, Kyung Hee University
Medical Center, Seoul, Korea
Introduction: There are increasing trends in adolescent suicide in
Korea. This study investigated whether socio-economic status
affects mental health, especially depression and suicidal idea or
plan. Method: This study was based on the data from the 2013
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Korea Youth Behavior Web-based Survey (KYRBS). The subjects
included 36655 boys and 35790 girls in middle and high school. To
evaluate the mental health, the questions were as follows: “Over the
past year, did you feel sadness or despair for more than 2 weeks
enough to stop your daily living? Have you ever seriously think
about suicide? Have you ever planned a suicide? Have you ever
tried a suicide?” Results: Smoking, alcohol, drug use experience,
and sexual contact were positively correlated with sadness or
despair and suicidal idea or plan. In socio-economic status, self-
rated “below the middle” group showed higher odd ratio but on the
other hand higher FAS score group demonstrated higher odd ratio
in sadness or despair and suicidal idea or plan. In addition, the more
they feel stressed, unhappy, insufficient sleep and unhealthy, the
more they felt sadness or despair and had suicidal idea and plan.
Conclusions: In this study, the more they feel subjectively poor
although they have high FAS score, the more negative impact on
mental health they had. Therefore, the society needs to pay
attention to adolescent`s mental health regardless of social
economic status and also variable factors including stress, degree of
happiness, sleep sufficiency, and health perception should be
managed.
Influence of alexithymia on brain activity during
rectal distention in subjects with irritable bowel
syndrome
Kano M1,2,5, Muratsubaki T2, Morishita J2, Yagihashi M2, Ly
HG3, Dupont P4, Van Oudenhove L3, Endo Y5, Fukudo S2,5
1Fronteier Research Institute for Interdisciplinary sciences,
Tohoku, Japan
2Behavioral Medicine, Graduated School of Tohoku
University, Sendai. Japan
3Translational Research Center for Gastrointestinal
Disorders, University of Leuven, Leuven, Belgium
4Laboratory for Cognitive Neurology, University of Leuven,
Leuven, Belgium
5Psychosomatic Medicine, Tohoku University Hospital,
Tohoku, Japan
Introduction: We aim to investigate the influence of alexithymia
on the brain activity during visceral perception in Irritable Bowel
Syndrome (IBS) subjects. Methods: Twenty six IBS subjects and
29 controls, matched for age and gender, participated in the study.
Functional magnetic resonance imaging was used to acquire blood
oxygen level dependent contrast images. Data were collected whilst
subjects received balloon distensions to the rectum as well as
during anticipation of the distension. Mechanical balloon distension
at 40 – 60% level of discomfort for each subject was adopted as
visceral stimulation. Alexithymia was assessed in each subject
using the 20-item of Toronto alexithymia scale (TAS-20). Results:
The averaged TAS-20 score of the 26 IBS subjects and controls
were 50.1 ± 10.6 and 46 ± 10.1 (mean ± SD), respectively. During
anticipation interaction of TAS-20 by group (IBS and controls),
analyses revealed that TAS-20 score was correlated positively more
in IBS group than controls in the brain activity in the left
parahippocampal gyrus, left superior orbital gyrus, left insula,
anterior cingulate cortex, middle frontal areas, precentral gyrus,
middle temporal gyrus, and superior temporal gyrus. During
distension, the TAS-20 score was positively correlated with the
brain activity more in IBS than controls in the bilateral insula,
thalamus, right pallidum, right inferior frontal cortex, right
supramarginal gyrus, mid-cingulate cortex, inferior frontal gyrus,
right inferior parietal lobule, and postcentral gyrus. Conclusions:
The influence of alexithymia on the brain activity was different
between controls and IBS. Alexithymia may contribute to abnormal
visceral pain processing in the brain of IBS subjects.
Underlying mechanisms of the interrelationship
between sleep apnoea, depression, and fatigue in
clinical conditions
Karagiannopoulou A
Department of Psychology, Cognitive Neuroscience,
University of Edinburgh, Edinburgh, UK
Obstructive Sleep Apnea (OSA) is a common sleep breathing
disorder characterized by sleep-related decreases (hypopneas) or
pauses (apnea) in respiration. The prevalence of depression in
patients with OSA ranges from 5% to 63%. High comorbidity rates
amongst OSA, depression and fatigue have been detected in clinical
settings. The clinical symptomatology of depression and OSA
overlap, resulting in an under-diagnosis of OSA in depressed
patients. Fatigue, Excessive Daytime Sleepiness (EDS), impaired
alertness, inattention, psychomotor retardation, working memory
deficits, irritability, and mood disturbances are symptoms which are
detected in both OSA and depression. Sleep fragmentation and
hypoxemia, which result from OSA, are considered two main
underlying causes of EDS, fatigue, and depressive phenomenology.
Hypoxia may be associated with depression, as depressive
symptoms are significantly reduced in patients with OSA post
oxygen therapy. CPAP treatment of OSA may alleviate depressive
symptoms however, it is not possible yet to clearly distinguish
improvement of the depressive disorder per se from remitted
fatigue and EDS. Undiagnosed OSA may be responsible for
antidepressant treatment failure. Finally, the clinical
phenomenology of OSA and depression may emanate from a
dysregulated HPA-axis activation which has been detected in both
disorders. A multifaceted clinical approach is proposed in order to
clinically discern OSA from depression as their overlapping
symptoms obscure the accurate diagnosis of the primary disorder.
Increased knowledge of the interrelationship between OSA,
depression, and fatigue may significantly increase the possibility to
treat OSA and its complications.
Shift workers´ job strain and stress biomarkers in
laboratory and field
Karhula K1,2, Härmä M1, Sallinen M1,3, Lindholm H1, Hirvonen
A1, Elovainio M4, Kivimäki M1,2,5, Vahtera J1,6, Puttonen S1,2
1Finnish Institute of Occupational Health, Finland
2Institute of Behavioural Sciences, University of Helsinki,
Helsinki, Finland
3Agora Center, University of Jyväskylä, Jyväskylä, Finland
4National Institute of Health and Welfare, Finland
5Department of Epidemiology and Public Health, University
College London, London, UK
6Department of Public Health, University of Turku and Turku
University Hospital, Turku, Finland
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Introduction: Work-related stress impacts fourth of employees and
over 50% of sickness absences are related to psychosocial factors at
work. Much of knowledge is still lacking how stress contributes to
well-documented adverse health effects, e.g. cardiovascular
diseases. Changes in stress biomarkers can reveal early signs of
negative health effects. This study explored the association of job
strain with salivary cortisol and α-amylase (sAA) in shift working
health care professionals in laboratory and field. Methods: The 95
study participants of an ongoing epidemiological cohort were
recruited from hospital wards belonging either to the top (high job
strain, HJS, n = 42) or bottom quartiles on job strain (low job strain,
LJS, n = 53) by Job Content Questionnaire. Employees´ own
estimation of job strain had to be at least as high or low as their
ward's average estimation. The saliva samples were collected
during the Trier Social Stress Test (TSST) in laboratory and during
pre-selected one morning and one night shift and a day off.
Results: There was a larger increase in salivary cortisol
concentration in the HJS than the LJS group (2.27 vs 1.48-fold,
respectively, non-significant) in the TSST. The HJS group had
higher sAA levels 30 minutes after awakening in the morning shift
(p < 0.05) and lower cortisol awakening response on the day off
than the LJS group (p < 0.05). The other stress biomarker responses
and total secretion were similar in both job strain groups.
Conclusions: In this data, job strain in shift workers is weakly
associated with early signs of negative health effects as indicated by
changes in stress biomarkers.
Relationship between pain tolerance threshold and
psychological trait in patients with chronic pain.
Kato F, Abe T, Kanbara K, Mizuno Y, Ban I, Kiba T,
Kawasima S, Saka Y, Fukunaga M
Department of Psychosomatic and General Internal Medicine
Kansai Medical University, Kansai, Japan
Introduction: Chronic pain is a heterogeneous condition
characterized by heightened sensory sensitivity and cognitive bias.
Fluctuations in sensory thresholds at non-affected locations reflect
central mechanisms responsible for various forms of chronic pain.
The purpose of this research is to study the relationship between
psychological characteristics and pain tolerance thresholds at non-
affected sites in chronic pain patients, and evaluate the usefulness
of pain thresholds in evaluating heterogeneous forms of chronic
pain. Methods: Quantitative sensory testing was used to measure
pain tolerance thresholds (PTT) with electrical stimulation at non-
affected sites in 29 patients with chronic pain, then these patients
grouped with cluster analysis. The Short-Form McGill Pain
Questionnaire was used for self-evaluation of diseased area pain.
The Minnesota Multiphasic Personality Inventory (MMPI) was
used for measuring psychological characteristics. Results:
Participants were grouped into a characteristic low-PTT group and
a non-low-PTT group. The MMPI profile of the neurotic triad was
significantly more common in the low-PTT group, and the
conversion V profile significantly more common in the non-low-
PTT group. Multiple regression analysis of MMPI clinical scales
associated with both groups showed a positive correlation between
hypochondriasis and all participants, but a negative correlation with
those in the low-PTT group. Conclusions: This study demonstrated
that chronic pain patients may be classified according to PTT in
non-affected sites, and that a characteristic psychological profile
exists for the low-PTT group. Therefore, PTT at non-affected sites
is likely useful for evaluating heterogeneous forms of chronic pain.
The outcome of treatment for anorexia nervosa
inpatients who required urgent hospitalization
Kawai K1, Yamashita S1, Takakura S1,
Komaki G2, Kubo C3,
Sudo N1
1Department of Psychosomatic Medicine, Graduate School of
Medical Science, Kyushu University, Fukuoka, Japan
2International University of Health and Welfare, Fukuoka,
Japan
3Kyushu University, Fukuoka, Japan
Introduction: This study was done to determine which
psychosocial factors are related to the urgent hospitalization of
anorexia nervosa patients (AN) due to extremely poor physical
conditions and to evaluate their outcome after inpatient treatment.
Methods: A total of 133 hospitalized AN patients were classified
into an urgent hospitalization (n = 24) or a planned hospitalization
(n = 109) group. Multiple regression analysis was done of clinical
features, body mass index (BMI), psychological tests (the
Minnesota Multiphasic Personality Inventory - MMPI),
alexithymia, relationship with parents, and the Eating Disorder
Inventory (EDI). The effectiveness of treatment was prospectively
determined two years after discharge by the Global Clinical Score
(GCS). The hospitalized weight gain and the frequency of
outpatient visits were evaluated. Results: Of the factors assessed,
only BMI at admission was related to the necessity of urgent
hospitalization ( = - 1.063; p < 0.001). The urgent group had
significantly more weight loss after discharge and poorer social
adaptation on the GCS, even when the patient had a sufficient
increase in body weight during inpatient treatment and an
equivalent number of outpatient consultations. Conclusions: None
of the parameters of the psychosocial tests studied were
significantly different between the groups. The outcome of the
urgent group was poor. Two years after discharge they had
difficulty maintaining weight and continued to have poor social
adaptation.
The association of abuse experience and
independence among aged people in Korea
Kim H, Kim B, Choi H, Won C, Kim S
Department of Family Medicine, Kyung Hee University
Medical Center, Seoul, Korea
Introduction: Korean society has been rapidly aging for decades
and elder abuse is on the increase along with the growth of elder
population. The purpose of this study was to investigate the
association between abuse experience and independence in aged
people in Korea. Methods: This study was based on the data from
the Living Profiles of Aged People Survey 2011. The study subjects
were 3962 males and 5924 females older than 60. For the
assessment of the independence, K-IADL was used. The group who
answered not needing any assistance at all according to the K-IADL
items referred to as “independent” group. The questions about the
abused experience were physically abused, emotionally abused, and
family neglect. Results: The total number of any abuse experienced
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group was 1144 (11.6%), emotionally abused group 1010 (10.2%),
family neglect group 306 (3.1%) and physically abused group 46
(0.5%). Physically abused experience did not show significant
correlations with independence (p=0.257). However, emotionally
abused experience, family neglect, and any abused experience were
significantly associated with dependency. Family neglect group had
higher odd ratio (OR = 2.00, 95%CI 1.51 - 2.65 ; p < 0.001) on
dependency than emotionally abused group (OR = 1.40, 95%CI
1.16 - 1.68; p < 0.001) and any abuse experienced group (OR =
1.44, 95%CI 1.20 - 1.72, p < 0.001). Conclusions: We verified that
any abuse experience gave lack of independence, especially abuse
from family. Because of an increasing number of elderly people
living alone with rapidly aging phenomenon, we keep watch elderly
abuse and give support to remain independence of the elderly that is
necessary for living alone, especially from family.
Integrative Medicine and Yoga Therapy
Kimura KK
Japan Yoga Therapy Society, Japan
Introduction: The number of yoga therapy research papers is
increasing on the PubMed site, from 1927 papers in 2012 to 2439 in
2013. In December 2014, there were 2798. All the papers examine
the effects of Yoga practice such as asana (physical practice),
pranayama (yogic breathing exercises), and other various yogic
meditation methods. From the clinical Integrative Medical
perspective, we need more analysis of the causes of illnesses as
they relate to the mind-body relationship of each patient who
suffers from psychosomatic disorders. Methods: In traditional yoga
philosophy there are theories of the human structure, such as the
Five Sheath Theory in the Taittiriya Upanishad and the Human
Function Theory in various yogic scriptures such as the Yoga
Sutras of Patanjali. We used these theories to develop our new
Semi-Structured Interview Manuals (SSIM) and used them to
clinically assess psychosomatic patients, and then
counseling/treatment was designed based on the
assessments. Results: This traditional yogic assessment-treatment
method using SSIM for psychosomatic patients is in its beginning
stage. We will introduce some case studies. Conclusions: The
mental assessment of psychosomatic patients is complex and needs
an Integrative Medicine approach using both Western
psychotherapy and traditional methods from Asian and other
traditions. We need statistical analysis to develop more tangible and
effective assessment methods using traditional yoga philosophy.
Alexithymia, social stress and desire for alcohol in
social drinkers
Knapton C, Bruce G, Williams L
Division of Psychology, University of the West of Scotland,
UK
Introduction: Alexithymia is a complex personality construct
comprising difficulty in identifying and describing emotions and
externally oriented thinking. Its role in heavy and problematic
alcohol consumption is well documented, together with its
relationship with social distress. However, little research has
investigated alexithymia in social (non-problem) drinkers, and its
possible links with social stress and desire for alcohol. In this
experimental study, we explored the relationship between
alexithymia and desire for alcohol in anticipation of, and response
to, an experimental stressor. Methods: One hundred and thirty
eight social drinkers (56.53% females, mean (SD) age 31.76
(10.71)) completed a self-rating measure of alexithymia, and a
stress-inducing task. Desire for alcohol was measured at three time
points (baseline (Time 1), anticipation of stressor (Time 2) and
recovery (Time 3)). Results: Repeated Measures ANOVA
demonstrated a significant group effect of alexithymia, F(2, 135) =
15.65; p < 0.001; together with a significant time x alexithymia
interaction effect on desire for alcohol F(3.0, 202.7) = 7.30; p <
0.001. Post hoc tests revealed that alexithymics presented
significantly higher desire for alcohol at anticipation of the stressor
task compared to non-alexithymics (49.88 (SD 32.81) versus 17.11
(SD 22.50)). Conclusions: The findings demonstrate increased
desire for alcohol in anticipation of a social stressor among
alexithymics. This offers some explanation for the relationship
between alexithymia and alcohol consumption, and may serve as a
pathway to intervention to prevent problematic alcohol
consumption in this personality type.
Effective management of somatization
Koh KB
Department of Psychiatry, Yonsei University College of
Medicine, Seoul, Korea
Chronic somatization is common in non-psychiatric settings.
However, treatment of somatization is challenging because it
cannot be treated according to the existing biomedical model.
Therefore, special skills and strategies are required by non-
psychiatric physicians to facilitate acceptance of psychiatric
treatment for managing chronic somatizing patients effectively.
Literature related to this topic was reviewed. Somatizing patients
need explanations and understanding, above expectations for
support and for tests and diagnosis. Psychological interventions for
somatizing patients include referral by physicians and management
by trained physicians or psychiatrists using cognitive behavioral
techniques. The importance of interview techniques has been
stressed in the identification and management of these patients. In
particular, medical students and non-psychiatric physicians should
learn how to refer the patient for psychiatric or psychological
assessment. The educational programs include positive criteria for
somatization, understanding the role of anger management style
and mood in somatization, and skills training in biopsychosocial
history taking. Role playing can be effectively used to improve
communication skills for assessing and managing patients with
somatization. Psychiatric consultation can also be used as
therapeutic strategy. In addition, psychopharmacological
intervention needs to be included in management of somatization.
Physicians need to adopt patient-centered care with an emphasis on
illness experience as a way of helping somatizing patients. A
combination of cognitive behavioral therapy and
psychopharmacotherapy along with psychiatric consultation is
recommended in management of somatization.
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Cross-cultural differences in the processing of
fearful and painful vocalizations by Japanese and
Canadian listeners
Koeda M1, Belin P2, Hama T3, Matsuda T4, Matsuura M3,
Okubo Y1
1Department of Neuropsychiatry, Nippon Medical School,
Tokyo, Japan
2Faculty of Medicine, Aix Marseille University, Marseille,
France
3Department of Biofunctional Informatics, Tokyo Medical and
Dental University, Tokyo, Japan
4Faculty of Symbiotic Systems Science, Fukushima
University, Fukushima, Japan
Introduction: In psychosomatic medicine, understanding cross-
cultural differences in the recognition for fear and pain would be
very important for accurately understanding the mental state in
different cultures. However, to our knowledge, no study has
investigated cross-cultural differences of fearful and painful
vocalizations. We aimed to investigate cross-cultural differences in
the processing of fearful and painful recognition in different
cultures. Methods: Thirty Japanese and 30 Canadian listeners
participated in the present study. The Montreal Affective Voices
(MAVs), consisting of a database of non-verbal affect bursts
portrayed by Canadian actors, were used to evaluate fearful and
painful vocalizations. The subjects rated emotional intensity,
valence, and arousal for each vocalization. Results: Regarding
arousal, no significant difference was observed for the recognition
of fearful and painful vocalizations between Japanese and Canadian
listeners. Notably, for intensity and valence, a significant difference
was observed in the recognition of fearful vocalizations, whereas no
significant difference was found in terms of painful vocalizations.
Conclusions: Our results demonstrate that painful vocalizations are
a sharable emotion beyond the culture, whereas fearful
vocalizations are culture-dependent. These findings suggest that we
have to consider the influence of cross-cultural effects in the
evaluation of recognition of fearful emotions for different cultures.
Psychological factors that characterize PTSD and
depression in high school students affected by the
Great East Japan Earthquake
Koseki S1, Koseki M2, Ono H3, Sogabe Y3, Tachibana M3,
Ohtani T4, Ito D5
1Faculty of Psychology and Education, J F Oberlin University,
Japan
2Special Support Education Division, Saitama Prefecture,
Japan
3M A Program in Clinical Psychology, J F Oberlin University,
Japan
4The General Education Center of Iwate
5 Faculty of Education, University of the Ryukyus, Ryukyus,
Japan
Introduction: We examined which psychological factors
characterize Post-Traumatic Stress Disorder (PTSD) and depression
in students affected by the Great East Japan Earthquake.
Specifically, we examined automatic thoughts, negative appraisals
of post-traumatic stress symptoms, and post-traumatic growth.
Methods: We administered an inventory assessing these factors to
289 high school students (139 boys and 150 girls) of Iwate
Prefecture who had been affected by the Great East Japan
Earthquake. We then performed a discriminant analysis to examine
which patterns of these factors predicted PTSD and depression.
Results: Fifty-eight students showed high PTSD levels greater than
the cut-off of 19. Similarly, 63 students exhibited severe depression
levels higher than the cut-off (> 16 points). Both the PTSD and
depression scores were significantly higher than normal levels. Our
results suggested that negative appraisals of post-traumatic stress
symptoms and post-traumatic growth predicted PTSD, while
automatic thoughts and post-traumatic growth predicted depression.
Conclusions: The present results can inform the development of
preventive approaches; for example, cognitive restructuring would
be useful for decreasing students’ negative appraisals of their post-
traumatic stress symptoms and increasing post-traumatic growth,
which would facilitate their recovery from disaster traumas and
reduce the likelihood of their developing PTSD.
The contribution of psychosomatic medicine to
psycho-oncology in Japan
Koyama A, Okumi H, Matsuoka H, Ohtake Y, Murata M,
Ichitani N, Hayashi M
Department of Psychosomatic Medicine, Kinki University
Faculty of Medicine, Japan
Introduction: Psycho-oncological practice is carried out mainly by
psychiatrists as a part of liaison psychiatry all over the world. In
Japan, psychosomatic medicine has been developed specifically in
internal medicine. We set up a new outpatient service for cancer
patients in our department. The aim of this study was to evaluate
the contribution of psychosomatic medicine to psycho-oncology by
analyzing the role of this specified outpatient service. Methods:
Multiple factors such as age, sex, cancer site, clinical symptoms,
main reasons for consultation, psychiatric diagnosis (according to
DSM-IVTR) of cancer patients who visited our specified outpatient
service for psycho-oncology during the period of April 2013 to
December 2014 were analyzed. Hospital Anxiety Depression Scale
(HADS) was completed by the patients for the assessment of
psychological distress. Results: Breast cancer and lung cancer
patients most frequently visited the psycho-oncology outpatient
service. Main physical symptoms were appetite loss, general fatigue
and pain, whereas depressive mood, anxiety and insomnia were the
most frequently reported psychiatric symptoms. In addition,
psychological support for receiving bad news, operation and
chemotherapy, and for spiritual pain and family care were requested
for psychosomatic medical doctors. Conclusions: These findings
support that psychosomatic medical doctors can serve an important
role for both the physical and psychological aspects of cancer
treatment. The advantage of a specific outpatient service for
psycho-oncology is that it can provide an open door to both cancer
patients and their family members.
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Personality correlates of breast cancer patients
Kreitler S1,2, Kreitler MM1
1School of Psychological Sciences, Tel-Aviv University, Tel-
Aviv, Israel
2Psychooncology Research Center, Sheba Medical Center,
Tel Hashomer, Israel
Introduction: Previous studies about personality correlates of
cancer patients led to inconclusive results Studies by Kreitler et al.
showed that focusing on theoretically-relevant factors provides new
insights into personality correlates of cancer patients. The study
was done in the framework of the Cognitive Orientation (CO)
theory of health behavior and wellness which enables identifying
relevant factors in cancer patients. The goal was to examine
whether personality tendencies grounded in the CO theory can be
identified in breast cancer patients. Methods: The participants
were 250 breast cancer patients and 180 matched healthy controls.
They were administered the CO questionnaire of breast cancer. The
questionnaire included items assessing beliefs of four types (i.e.,
about oneself, others and reality, norms, and goals) referring to
themes identified in pretests as relevant in regard to breast cancer.
Results: Discriminant and logistic regression analyses showed that
patients and controls differed significantly in the scores of the four
types of beliefs and in most themes, including concern with
controlling oneself and others, dependence on others’ evaluations,
emotional blocking, perfectionism, and conflicts about self identity
and giving to others. Some of these variables were related to
medical features, none to demographic ones. Conclusions: There
exists a relevant set of psychological correlates of breast cancer
patients that could serve as basis for psychological interventions
accompanying medical treatments and needs to be examined in
other cultural settings.
PRISM as a valid measure for assessing suffering
in the context of palliative care
Krikorian A
Pain and Palliative Care Group, Universidad Pontificia
Bolivariana Medellin, Colombia
As a person-centered model of care has gained more acceptance in
health care contexts, suffering assessment has become of increased
interest. Particularly, in palliative care (PC), as it deals with chronic
and advanced conditions and emphasizes on suffering prevention
and relief from a bio-psycho-social and spiritual perspective.
Suffering entails a severe stress experience associated with threats
to integrity and a feelings of exhaustion as regulatory processes
become insufficient to cope. Thus, accurate assessment of suffering
is essential to accomplish the goals of PC. Pictorial Representation
of Illness and Self Measure (PRISM) is a commonly used
instrument for the assessment of the impact of the illness on the
self. It is a nondirective instrument regularly used for assessment of
suffering in multiple populations with acute and chronic illnesses
and other health problems. Its psychometric properties have been
repeatedly confirmed. PRISM methodology is conceptually
coherent with current definitions of suffering and has showed, not
only to be the most valid and reliable instrument to assess suffering,
but to have characteristics particularly important when assessing
suffering in frail patients with advanced illnesses. Two aspects will
be discussed in detail: 1. its psychometric properties and unique
characteristics, and 2. its use within the palliative care field.
Anaphylactoid reaction as a conversion disorder
following anaphylactic shock: a case report
Kuramochi M
Sano Kosei General Hospital, Tochigi, Japan and Oyama
Fujimidai Hospital, Tochigi, Japan
Introduction: Anaphylactic shock is a serious allergic reaction and
diagnosed on the basis of the presenting symptoms. Some patients
having experienced anaphylactic shock, later go on to mimic their
previous symptoms. It is important to identify the authenticity of
such symptoms before deciding any treatment strategy; this can be
difficult. Case description: A 28 year-old woman developed
anaphylactic shock. She suffered from the typical symptoms of
anaphylactic shock and was admitted for treatment; after receiving
drug treatment she again developed the same symptoms. After this
incident, she feared that she would suffer from anaphylactic shock
in the future and became depressed. During the treatment of her
depression, she showed anaphylactoid reactions many times. Her
condition showed the typical symptoms but it looked like
conversion disorder. However, despite many diagnoses by
specialists, we were unable to completely rule out anaphylactic
shock, and physical treatment was carried out many times. On the
premise that such anaphylactoid reactions would happen in the
future, we discussed with the patient and her family how to deal
with such possible situations. Also, we contacted her local hospital
and discussed a strategy whereby, in the event of her experiencing
an anaphylactoid reaction, they would accept and treat her
symptoms as anaphylactic shock. As a result, the incidents of
anaphylactoid reaction decreased and her depression improved.
Comment: Anaphylactic shock treatment is usually started without
careful investigation. This strategy might be promoting frequent
anaphylactoid reaction as a conversion disorder. Psychiatric
intervention would be needed to prevent this process.
The mental health of pregnant women in Japan
Kusakabe N
Department of Psychology, Fukuyama University, Fukuyama,
Japan
Introduction: It has become clear that 10-20% of women have
post-partum depression, and many mothers rearing infants felt
strong stress. Moreover, pregnant women having problems with
mental health were considered to increase. In this study, the mental
health of pregnant women in Japan was studied, and the
relationship between depression and other factors was examined.
Methods: The Scales used were Edinburgh Postnatal Depression
Scale (EPDS), General Self-Efficacy Scale (GSES), Stress Coping
Scale (SCS), and Help-seeking Preference Scale
(HSPS). Edinburgh Postnatal Depression Scale was used to
measure depression of women after birth. Following the previous
studies, EPDS was used to measure depression of pregnant women.
The participants were 49 pregnant women (M = 31.82, SD = 4.28
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years), and 78% was primipara, and 60% not employed. Results:
The mean score of EPDS was 5.73 (SD = 5.15), and the result of
EPDS suggested that 18% of participants were suspected of
depression. The result of t-test showed that SCS scores of
“avoidance” was higher and “social support seeking” was lower in
the participants who felt more depression (avoidance: t = 0.27; p <
0.01; social support seeking: t = 2.38, p < 0.02). Also, “concerning
to help-seeking” and “concerning to achievement” were higher in
those participants (concerning to help-seeking: t = -2.24; p < 0.03;
concerning to achievement: t = -2.93; p < 0.01). It became clear
from this study that depressive pregnant women took coping
behaviors which increased stress. The result of regression analysis
indicated that “concerning to help-seeking” and “social support
seeking” were influenced to depression. It was also suggested that
avoidance to help-seeking and social support affected the
depression of pregnant women.
No pain, no gain: objective and subjective adverse
effects in the behavioral treatment of insomnia
Kyle SD, Espie CA
Sleep and Circadian Neuroscience Institute, Nuffield
Department of Clinical Neurosciences, University of Oxford
Historically, there has been little systematic investigation of
adverse effects in psychotherapy. Cognitive Behavioural Therapy
for Insomnia (CBT-I) is the most effective treatment for chronic
poor sleep, and involves targeting thoughts and behaviors presumed
to maintain insomnia. One component of CBT-I is Sleep
Restriction Therapy, which standardizes bed and risetimes and
limits time in bed to help promote consolidated sleep. Recent work
by our group reveals that Sleep Restriction Therapy, while
effective, engenders subjective and objective daytime impairment
during acute implementation. Our work has important implications
for patient safety and suggests there may be an element of "no pain,
no gain" in the behavioral treatment of insomnia.
Hyper arousal of central nervous system in
insomnia during daytime: resting state qEEG study
Kwan YN, Oh DY, Kim SW, Lee IJ, Nam SJ, Choi SW
Laboratory of Clinical Psychology, Department of
Psychology, Duksung Women’s University, Seoul, Korea
Introduction: Hyperarousal theory is the most promising theory of
insomnia. The theory emphasizes 24 hour hyperarousal of CNS is
not only a source of the insomnia, it also is a maintenance factor.
Numerous studies confirmed CNS hyperarousal in sleep. Still,
evidence of daytime hyperarousal is unsatisfactory. Thus, in the
present study we identified daytime cortical hyper arousal in
insomniacs through resting state qEEG of whole scalp area.
Method: Age, sex matched 13 comorbid-free insomniacs (mean
age: 28, SD 7.21 years) and 7 healthy controls(mean age: 24.14, SD
1.57 years) participated to the study. We exclusively recorded EEG
from 11 AM to 3 PM for appropriate data of daytime EEG pattern.
Resting state EEG was recorded on both eye open and eye closed
conditions. Results: There was no difference on low frequency
range oscillation of insomniacs and healthy controls. However,
Insomnia patients showed significantly higher amplitude of high
frequency EEG over 15Hz than healthy controls on whole scalp
area. This showed on both eye open and eye closed conditions.
Conclusions: High frequency EEG is considered as index of
neuronal activation. The elevation of high frequency amplitude on
whole brain area of insomnia could be considered as a strong
evidence for 24-hour hyperarousal theory.
Effects of balance in possible selves on motivation
for the anxiety students
Jeon W, Hyun M, Kim DR
Department of Psychology, Chung-Ang Univeristy, Seoul,
Korea
Introduction: Individuals with public speaking anxiety, a subtype
of social anxiety, present themselves and their performance
negatively. The possible selves is the self-concept related to
motivation which accelerates the process on selective information
to achieve the goal and connect the future regarding cognition and
motivation. Therefore, the possible selves activates the effort on
behavior, and by connecting the attention and plan, it becomes the
potential stimulant to the behavior. Methods: After screening 162
individuals, 62 who rated high on public speaking anxiety
participated in the study. They were first asked to complete PSQ,
then randomly assigned to 3 conditions to activate the possible
selves. In each condition, participants watched a video of a person
delivering public speaking exceedingly (positive), poorly
(negative), or decently (balanced). The video was showed 3 times
total. After every session, participants completed K-SAS, STA, and
VAS. Finally, participants rated public speaking anxiety. Results:
Individuals with high public speaking anxiety reported lower
positive self and motivation than those who score low. There was a
significant difference on public speaking anxiety before and after
activating the possible selves. Throughout 3 sessions, anxiety and
motivation increased significantly. The thoughts on public speaking
remained the same, but the biased perception on public speaking
was decreased. Conclusions: By activating the possible selves, the
biased socially-anxious-self becomes balanced. Balancing the
possible selves does not only decrease the perceived anxiety, but
also increases the motivation. This study claims that the possible
selves could be applied to treat other mental disorders besides
anxiety.
Prevalence of depression and impact of social
support on glycemic control in diabetic patients
Lavaie Y, Nabavizadeh P
Department of Psychiatry, Shahid Beheshti University of
Medical Sciences,Tehran, Iran
Introduction: Prevalence of depression in patients with diabetes is
higher than in the general population, different studies have
reported rates of up to twice of depression in diabetic patients than
in the normal population. The aim of this study was to investigate
the relationship between depression and social support and their
impact on glycemic control and quality of life in diabetic patients.
Methods: A total of 158 type-2 diabetic patients who attended
outpatient health clinics and endocrinology clinics were enrolled in
this study. The patients were under treatment. Methods: We used a
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questionnaire that consists of four section. In the first section
education, monthly income, type of medication (i.e., insulin,
metformin, glibenclamide, Gliclazid), age, sex, marital status, race,
hemoglobin A1C and the number of doctor visits were asked. In the
second section signs of depression are investigated using a
standardized Patient Health Questionnaire (PHQ-9) that consists of
9 questions based on nine symptoms of depression according to the
DSM-IV. In the third section, social support was measured using a
standard MOS social support survey. In the fourth section the
amount of drug adherence was measured using the Morisky
Medication-Taking Adherence Scale-MMAS (4 item) . Results: In
the present study it is showed that the MOS score and the score of
the PHQ-9 are associated. But the correlation between the scores
obtained from the Morisky scale and these two points are not found,
Also it is showed that women had less social support, In fact, the
average MOS scores were significantly lower in women than men.
MOS scores with the scores of the PHQ-9 had negative correlation
and solidarity (R = -0.408; p = 0.001). In other words in person
with higher rate of social support the chance of getting depression
was lower. Conclusions: Based on this study, the prevalence of
depression is higher in diabetic patients, especially in people
suffering from chronic diseases. However, in those with higher
social support the rate of depression is lower and glycemic control
is better and have a lower number of doctor visits. Regarding the
relation between quality of life and mental health, a high prevalence
of psychological problems was found in diabetic people. Thus,
improving mental health of these patients can improve their quality
of life.
Relationship between stop drinking controllability,
hopelessness, social activity, and suicidality
Lee HY1, Hyun MH1, Jeong DE2
1Department of Psychology, Chung-Ang University of Seoul,
Seoul, Korea.
2Department of Business Administration, Chung-Ang
University of Seoul, Seoul, Korea
Introduction: Alcohol use disorder (AUD) relates to suicide and
AUD patients suffer from suicide problem more than general
population. Hopelessness is a determinant factor for AUD suicide
behavior. Stop drinking being at the center of AUD patients’ life is
important in AUD patients’ mental health. Social activity is a
protection factor which increases the sense of belonging which is a
well-known risk factor for suicide. This study aimed to examine the
relationship of suicidality with stop drinking controllability,
hopelessness, and social activity in an alcohol use disorder
population sample and identify how AUD subjects attempt the
suicide. Methods: All participants had a diagnosis of AUD and
answered questionnaires assessing stop drinking controllability,
hopelessness, social activity, and suicidality. The data of 252 were
analyzed through regression analyses. Results: The hopelessness
was shown to fully mediate the relationship between stop drinking
capability and suicidality. The stop drinking capability had only an
indirect effect on suicidality. The social activity was shown to
adjust significantly the relationship between hopelessness and
suicidality just in lower level of hopelessness.
Conclusions: The AUD patients losing control at their drinking
problem and stop drinking were more likely to feel hopelessness.
Hopelessness can lead to suicidal ideation or suicide attempt.
However, participating in social activity moderated AUD patients
suicidality. These findings suggest that hopelessness needs to be
treated and stop drinking capability should be considered as
preventing suicide behavior among AUD patients.
Comorbidity of anxiety with heart disease among
adults seen in emergency departments in a large
Asian-American and Pacific Islander population
Lee JC, Vinogiri DO, Kunasegaran KS, Hurtwitz E, Li D,
Geobert D, Takeshita J
Department of Psychiatry, University of Hawaii, Honolulu,
USA
Introduction: Coronary heart disease (CHD) is the number one
cause of death for women and men in the United States. Recent
studies suggested that depression and anxiety are strongly
associated with an increased risk of CHD. However, there have
been relatively few studies on the role of anxiety in CHD,
especially in ethnically diverse populations such as Asian
Americans and Pacific Islanders. Methods: This study used a
quantitative epidemiologic methodology that utilized secondary
data from emergency department admissions (N = 790934) of adult
patients in Hawai‘i. 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, cardiomyopathy, coronary
atherosclerosis, acute myocardial infarction, and other ischemic
heart diseases) and anxiety (i.e., anxiety states, panic disorder
without agoraphobia, generalized anxiety disorder, phobic
disorders, obsessive-compulsive disorder, and posttraumatic stress
disorder).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. Results: Heart disease was
comorbid with anxiety among adults admitted to emergency rooms
for Hawai’i’s ethnically diverse population. The estimated adjusted
odds ratio of any heart disease diagnosis with anxiety for adults
under 65 was 2.72 (95% CI 2.65-2.79) and for adults 65 years and
over was 3.33 (95% CI 3.17-3.50). In both age groups, association
of heart disease with anxiety was greatest among Pacific
Islanders. Although the temporal relation between the cardiac
diseases and anxiety is unclear, the findings are consistent with
recent research showing that heart disease may be predictive of
anxiety disorders. Conclusions: This study provides further support
to previous findings that anxiety is strongly associated with
cardiovascular disease. There are important prevention and
intervention implications for this finding. In addition, special
consideration should be given to efforts regarding Pacific Islanders,
given our finding of a stronger association between heart disease
and anxiety for this ethnic group in our study.
Psychosomatic epigenetic education of medical
students
Leigh H
Department of Psychiatry, University of California, San
Francisco & UCSF Fresno, USA
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Medical Students experience stress daily, thus the role of stress in
health and disease has an immediacy for them. The role of genetics
and epigenetics (e.g., SERT gene and childhood abuse vs learning
good coping skills) in stress vulnerability and resilience can be
taught with maximum effect as well as the role of memory (memes)
arising from culture and personal experience. Changes in telomere
length associated with stress and stress management can illustrate
the psychosomatics of longevity itself. As applied to patients, this
approach is best illustrated through a narrative story of the patient's
life rather than the traditional inventory of disparate story lines such
as present illness, past psychiatric history, past medical history,
substance use history, social history. The narrative story leads to an
integrated biopsychosocial formulation of the patient as a person,
with emphasis to the intertwined causal gene x meme x
environment interaction leading to the present, and a rational three-
dimensional management plan.
Turkish Baths: eliminating real or imagined toxins
in a psychotic, vulnerable adult
Leigh V, Lencioni L
Kaiser Permanente Medical Center, Fresno, California USA
Introduction: This clinical case demonstrates the effectiveness of
exercise combined with a culturally sanctioned therapy, the Turkish
Bath, for a patient who had the delusion that a person caused him to
lose muscle mass by giving him estrogens. Case description: A 28-
year old practicing Muslim male was admitted for trying to burn
down a Mosque. The patient was delusional that his muscles were
wasting away. He claimed he developed fatigue and weakness
because he was poisoned by its athletic director. When admitted, he
was very remorseful of his inability to control his anger. However,
he still felt that his career was ruined by the poisoning and that his
muscles continued to waste away. He decided to seek solace by
going to the gym daily followed by long visits to the Turkish Bath
(suggested by the family). He "understood" that this was a way to
cleanse the blood, eliminate poison from the body. While staff
expressed concern over the possible dangers, the patient and family
felt relieved that his muscles would be revitalized, that his body
would be cleansed of this poison, and allow him to get some needed
sleep. He was also able to take small doses of antipsychotics, which
may have attained higher concentration due to volume loss due to
the baths. He gradually improved to baseline. Comment: A
literature review and history of Turkish Baths (often built next door
to Mosques) is presented as well as a more in depth case study of
this young man.
Inpatient psychosomatic medicine for the whole
family – An example from Germany
Leinberger B, Mumm R, Tritt K, Loew T
Universitätsklinikum Regensburg, Psychosomatik,
Regensburg, Germany and Heiligenfeldklinik Waldmünchen,
Psychosomatik, Waldmünchen, Germany
Introduction: The Psychosomatic clinic Waldmünchen is
Germany's only psychosomatic hospital with a treatment plan for
families. Admitted are parents with psychosomatic diseases with
their children or vice versa both being burdened from age of 3 and
older. Methods: The present survey shows in the period from
01/2013 to 06/2014 both somatic and psychological diagnoses of
the total of 820 hospitalized patients aged 3-73 years. The division
of different age groups allows the monitoring of age-related change
of somatic and psychological diagnostics according to ICD-10.
Results: The first diagnosis of most of the children and young
people up to the age of 14 is "disturbances of the social behavior".
The age group of 14-18 year old young people shows a "transition
phase" of the "disturbances of the social behavior" (20%) to major
depressive disorders" (70% ). Than, already over 90% of the adult
patients from the age of 19 to the age of 73 have "depressive
disorders" and half of them get second diagnoses like “personality
disorders”. Conclusions: The results relating to diagnosis in
childhood and adolescence suggest that behind the diagnoses of the
social behavior disorder a beginning or existing affective and/or
personality disorder is hidden. Both the special behavior of children
and young people with psychological symptoms and special
behavior of adults with psychological symptoms can be rather
inadequately covered.
A psychosomatic perspective on end of life care
medical training
Leombruni P
Department of Neuroscience, University of Turin, Turin, Italy
Psychosomatic Medicine, as a novel approach to health and disease,
is now widely accepted from the scientific community, nevertheless
when speaking about it as a scholarly discipline there is less
consensus. It is often considered as an argument or an approach to
discuss when teaching about Psychiatry. At the same time, though
palliative care education has recognized as a priority in many
European countries, that should be integrated to undergraduate
medical curricula, there remains a lack of consensus on how to do
that. The Psychosomatic Model (PM) can provide fundamental
guidelines to design useful undergraduate courses for the teaching
of palliative medicine. First of all, the PM highlights the
importance of the bio-psycho-social approach, that allows us to
fight the biological reductionism of the “oncologist view” on
palliative medicine. In addition, the PM underlines that, especially
in palliative care, we have to take in account not only the disease
but the individual goals of the patient. As a third point, the PM
remember to us that a future doctor have to acquire non only
knowledge but also (non technical) skills and personal attitudes. At
the University of Turin (Italy) the Medical School proposes an
integrated academic curriculum on these issues through two
didactic modules: 1. a mandatory course on doctor- patient
relationship, communication, end of life care and clinical ethics at
the second year; 2. an elective didactic training on clinical aspects
in psycho-oncology and palliative care within a psychosomatic
model of medicine at the fourth year. Both modules consist of
lectures, interactive lessons, role playing, supervised focus groups,
and clerkships in hospice. With a pre-post methodology, we
administered an anonymous questionnaire to ask the students their
opinion on usefulness of the mandatory course, and a specific
questionnaire to evaluate the attitude to care for the dying patient.
The course emerged as feasible and useful (from the perspective of
the student and as measured by the specific test). In the lecture
these results will be discussed in detail.
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ICF guided inpatient treatment for psychosomatic
patients
Linden M
Research Group Psychosomatic Rehabilitation at the Charité
University Medicine Berlin, Berlin, Germany and Department
of Psychosomatic Medicine at the Rehabilitation Center
Seehof, Teltow/Berlin, Germany
Psychosomatic medicine follows a holistic, person centered, or bio-
psycho-social concept, as outlined in the ICF (International
Classification of Functioning, Disability, and Health) of the World
Health Organization. An example of how to translate this concept
in daily practice can be found in “inpatient psychosomatic
rehabilitation hospitals”. There are about 25000 beds in
psychosomatic rehabilitation hospitals in Germany, which admit
per year approximately 5 per 1000 persons of the general
population. Patients suffer from chronic psychological disorders
like affective, anxiety, adjustment, or personality disorders.
Psychosomatic treatment aims at the prevention, treatment, and
compensation of the present illness and life problems including a
multilevel psychosomatic assessment and multidimensional
treatment, enclosing the modification of psychodynamic processes,
the amelioration of symptoms, the training of capacities, the coping
with the chronic illness and impairment, the restoration of
wellbeing and normal life, and the occupational reintegration
including the search for a workplace which allows work in spite of
impairment. Scientific studies have shown that the psychological
status, the motivation to work, the number of days on sickness
absence and occupational reintegration can be improved, and that
the system pays for the patients themselves, but also pension, and
health insurance.
Controlled trial of UE in occupational therapy and
cognitive behavioral group therapy in anxiety
patients
Linden M1,2, Muschalla B1,2,3, Flöge B1
1Research Group Psychosomatic Rehabilitation at the
Charité University Medicine Berlin, Berlin, Germany
2Department of Behavioral Medicine at the Rehabilitation
Center Seehof, Teltow/Berlin, Germany
3Department of Psychology, Free University of Berlin, Berlin,
Germany
Introduction: Psychotherapy can have negative effects, which is
especially true for group psychotherapy because of the group
setting, therapeutic content, or interaction not only between patient
and therapist but also between patients. In this sense group sessions
per se can have negative effects. To study treatment specific side
effects an unspecific group control is needed.
Methods: Sixty-two patients with workplace-related anxieties were
randomized to cognitive behavioral group therapy or an unspecific
group encounter aiming to increase recreational activities. Patients
filled in the Unwanted Events in Group Therapy Scale (UE-G
scale). Results: In the anxiety therapy group, 41.9% of the patients
reported at least one relevant side effect, as compared to 28.9% in
the recreational group. Significant differences are found for “I feel
trapped in the room”, “My problem was not touched”, “It is all too
complicated”, “I got additional problems”, “I felt criticized”, I will
get further problems, when I do what has been recommended in the
group therapy”. Conclusions: Anxiety treatment in groups has
specific negative effects, when compared to group encounters as
such. Of special importance is that the group can induce further
feelings of helplessness and anxiety. Group psychotherapists should
be aware of potential side effects.
Resilience and regeneration orientation in stress
management: the ReRe scale
Linden M1,2, Otto J1
1Research Group Psychosomatic Rehabilitation, Charité
Universitäty Medicine Berlin, Berlin, Germany
2Department of Psychosomatic Medicine, Rehabilitation
Centre Seehof, Teltow/Berlin, Germany
Introduction: Psychosomatic patients often have the idea that they
need regeneration, in order to “reload their batteries“. This means
avoidance of stressors, self-care, distraction or in general salute-
therapy. The alternative is to improve “resilience“, hardiness, or
stress tolerance. An open question is which approach is best for
which patient and how to proceed therapeutically. Methods:
Regeneration and resilience orientation was measured with the
ReRe scale. It has 10 items for resilience and 10 for regeneration.
The rating is done on a 5 step Likert scale from 1 = “do not agree“
to 5 = “agree fully“. A total of 342 unselected patients from a
psychosomatic rehabilitation unit (67.5% female, age 49.8 years)
filled in the ReRe scale and the SCL-90. Results: The average
score for regeneration was 3.35 (Range: 1-5; SD = 0.79) and
resilience 3.43 (Range: 1-5; SD = 0.69), with means per item
varying from 2.55 to 4.37 for regeneration and 2.96 to 3.82 for
resilience. Cronbach’s Alpha was 0.85 for regeneration and 0.82 for
resilience. There were significant negative correlations of
regeneration orientation with all subscales of the SCL-90 and
significant positive correlations with resilience orientation in
respect to “social insecurity“, “phobic anxiety“, and “psychoticism“
and a significant negative correlation with the intensity of the
answers in the SCL-90. There were no differences in respect to
gender or age. Conclusions: The study shows that resilience and
regeneration orientation can be separated and measured.
Regeneration is positively associated with subjective wellbeing in
contrast to resilience orientation. Further studies will have to show
whether this is positive or the result of an avoidance behavior and
what is best for coping with stressful situations.
Understanding co-occurring pain and emotion: a
transdiagnostic approach to treatment
Linton SJ, Schrooten M, Lind M, Flink IK
Center for Health and Medical Psychology, Department of
Law, Psychology and Social Work, Örebro University,
Örebro, Sweden
The mystery of the relationship between emotional distress and
persistent pain is at the dawn of being unraveled. Their co-
occurrence is common and associated with many negative
outcomes, but poorly understood. While historically viewed as
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separate entities, modern psychology suggests a more delicate
relationship. Indeed, one need not assume that distress is a reaction
to pain or that it causes it. An alternative is to explore
transdiagnostic processes that underlie both. Emotion regulation is
a transdiagnostic condition that strives to produce appropriate
responses to the ever-changing demands of the environment. To be
effective this process must be in tune with the situation and
“context sensitivity” may explain why distress and pain may persist
beyond their usefulness. To promote treatment that addresses
transdiagnostic emotion regulation processes, we studied the role of
reducing negative affect to enhance treatment effects. First, we
present work isolating the effects of employing a communication
style that addresses negative affect via emotional “validation”.
Second, we present a hybrid treatment for patients suffering long-
term distress and pain that in part addresses negative affect and in
part addresses avoidance of movements. We conclude that
emotions are intrinsically entwined with pain. Indeed, underlying
processes such as avoidance and catastrophizing may fuel both.
Understanding this relationship opens new avenues for treatment.
Bodily complaints and mood concurrency in
patients with severe chronic somatoform disorder
Lipovsky MM1, Houtveen JH2,Sorbi MJ3, Buhring MEF1, van
Broeckhuysen-Kloth S1
1Altrecht Psychosomatic Medicine Eikenboom, Zeist, the
Netherlands
2University of Groningen, University Medical Center
Groningen, Interdisciplinary Center Psychopathology and
Emotion Regulation, Groningen, the Netherlands
3Department of Clinical and Health Psychology, Utrecht
University, Utrecht, the Netherlands
Introduction: Based on the concept of somatization, psychological
distress is supposed to be experienced as symptoms of physical
illness. This suggests a close-fitting intra-individual association
between bodily complaints and mood in patients with somatoform
disorder (SFD). The aim of the present study was to investigate the
contemporaneous day-to-day complaints-mood association in
patients with severe chronic SFD using an ecological momentary
assessment (EMA) design. Methods: Eleven patients, who had
recently received specialized tertiary care treatment for severe
chronic SFD, kept an online electronic diary for 4 consecutive
weeks. They were prompted at intervals throughout the day to
complete questions on their momentary primary symptoms (i.e.,
pain and fatigue), and mood state (i.e., negative and positive). For
each measure, day-mean aggregated values were computed and
analyzed using linear multilevel (mixed model) regression analysis.
Results: Fixed factor results showed that symptoms were
associated with both negative mood state (β = 0.47) and positive
mood state (β = -0.59). Random results, however, indicated large
inter-individual differences, with correlations varying between 0.17
and 0.99 for negative affect, and between -0.88 and 0.14 for
positive affect. Conclusions: This study demonstrates a substantial
day-to-day contemporaneous association between bodily symptoms
and affect across subjects with severe chronic SFD. In accordance
with the literature for less severe patient-subgroups, there are large
inter-individual differences. In this study, data showed a
relationship between both negative and (inverse) positive mood and
complaints, which has potential clinical relevance: providing SFD
patients with feedback consisting of their personal day-to-day
concurrency graph may promote understanding of their own
complaints in a broader context than the somatic area.
The moderating impact of gender in the association
between alexithymia and craving in alcohol
dependent patients: a vulnerability factor for
women but a protective factor for men?
Luminet O1,2, Cordovil de Sousa Uva M1, Fantini C2, de
Timary P1,2
1Research Institue for Psychological Sciences, Université
catholique de Louvain, Louvain, Belgium
2Fonds de la Recherche Scientifique, Brussels, Belgium
3Université libre de Bruxelles, Brussels, Belgium
4Unité d’Hépatologie Intégrée, Department of Adult
Psychiatry and Institute of Neuroscience, Academic Hospital
Saint-Luc, Université catholique de Louvain, Louvain,
Belgium
Introduction: Alexithymia is a multifaceted personality trait that
involves difficulties in identifying and describing feelings to others,
a poor fantasy life and an externally oriented cognitive style.
Alexithymia has been described as a vulnerability factor for mental
and physical diseases. Methods: We investigated in a group of 158
alcohol-dependent patients (103 males, 55 females) the association
between depression and craving for alcohol when these patients
were starting a detoxification program, and the moderating impact
of gender and alexithymia on this relation. Results: We first found
an interaction between depression and gender in the prediction of
craving in the sense that only for women an increase in depressive
mood was related to an increase in total craving. When examining
the gender separately, we found that alexithymia factors acted as
moderators. For women, the link between depression and craving
was strengthened for the ones scoring higher on “difficulties
describing feelings”. But, for men, the link between depression and
craving was reduced for the ones scoring higher on “externally-
oriented thinking”. Conclusions: These findings suggest that in
some cases that need to be identified more systematically in the
future, alexithymia can exert – at least in the short term – some
protective effects.
iSee – development of PRISM for use by groups
and giving feedback in real time
Marien B, Marien W
Positive Group, London, UK
Positive Group is a specialist consultancy, working predominantly
with large corporations but also with health service providers,
aiming to optimize individual and group performance at work, and
to promote individual wellbeing. We have developed iSee, an
instrument derived from the PRISM measure developed by Büchi,
Sensky and colleagues, to elicit individual and group feedback. iSee
is substantially more versatile than the original PRISM measure,
allowing PRISM to be completed electronically, on smart phones,
tablets or computers, and the resultant data can be instantaneously
captured via the internet. We have applied data collected using iSee
to contribute to group decision-making, consensus development,
and other types of meetings, and to inform organizational change.
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This presentation will introduce the properties and methodology of
iSee, and outline two examples of its application in an occupational
setting. Study 1: iSee was used by the leadership team of a large
company to appraise the relative importance of a range of
factors/variables known to be linked to organizational success.
Study 2: iSee was used to identify a range of individual and
organizational (contextual) variables known to be linked to
psychological wellbeing and performance at work. To further
enhance the potential of iSee, we are developing methods of
displaying and manipulating group data from iSee in real time, so
that data can be interrogated as well as collected during meetings.
This will allow iSee to be used even more effectively within
groups, for example to enhance nominal group techniques and other
forms of consensus development or change management.
Clinical model of buprenorphine/naloxone therapy
in a multidisciplinary, group-based stetting for
high-risk chronic pain patients
Marshalek, PJ
Pain Resource Management, West Virginia University
Hospital, Morgantown WV, United States
The prescription drug epidemic has made it increasingly difficult
when treating chronic pain patients with opioids. Accurately
assessing patients for risk factors that could complicate
management of chronic pain with opioids is challenging and can be
time consuming. Fear of risks related to chronic opioid therapy can
limit access to quality pain management. Providers often overlook
the fact that risk factors such as psychiatric comorbidities such as
depression and anxiety and depression are modifiable and treatable.
The same can be said for risk factors related to addiction. The
climate is one that is still permeated with fear these risks, and
patient care is currently suffering. Buprenorphine/naloxone can
assist in mitigating some of the risks related to chronic pain
management with opioids while providing benefit. We will describe
a clinical model involving medical management of chronic pain
with buprenorphine/naloxone and other adjuvants that takes place
in a multidisciplinary, group-based setting focused on longitudinal
assessment and treatment of comorbid risk factors in a population
deemed high risk as efficient and effective.
Effects of improvisational music therapy on
enhancing communication skills in children with
global developmental delay
Masiak E, Smotrycka A
Institute of Psychology, The John Paul II Catholic University of
Lublin, Lublin, Poland
Introduction: The case study demonstrates the potential for
improvisational music therapy in the treatment of children with
global developmental delay. Case description: The case illustrates
the use of improvisational music therapy in a 3-year old boy with
severe physical health problems since his birth including liver
dysfunction, ongoing hearing and vision problems, as well as global
developmental delay with communication delay (no speech), and
challenging behavior. The child received three months of
improvisational music therapy process on a weekly basis. Pre- and
post-music therapy measures were obtained, the progress was
monitored using J. Robertson’s rating scales: The Relationship
Continuum & The Musical Communicativeness Continuum. There
was a significant improvement in the scores (from 3.8 to 6.4 out of
7, and from 4 to 6.5 out of 9, respectively). Vocalization evoked by
music therapy led the child to gain the early single words level
during the therapeutic process. Comment: The findings of the case
study are encouraging and suggest beneficial effects of
improvisational music therapy on communication, emotional, and
behavioral disorders in children with global development delay.
Establishing the meaningful therapeutic relationship provides
musical and emotional space for the child as a secure base - which
results in evoking interpersonal responses and initiatives, creativity
in musical and emotional expression, as well as a supporting speech
development.
Serum BDNF as a treatment biomarker for response
to docosahexaenoic acid in traumatized people
vulnerable to developing psychological distress: a
randomized controlled trial
Matsuoka Y, Nishi D, Tanima Y, Itakura M, Kojima M,
Hamazaki K, Noguchi H, Hamazaki T
CREST, Japan Science and Technology Agency, Kawaguchi,
Japan
Introduction: Our open-label pilot study showed that
supplementation with docosahexaenoic acid (DHA) increased
serum brain-derived neurotrophic factor (BDNF) levels and that
there might be an association between changes in serum BDNF
levels and reduced psychological distress. Animal research has
indicated that a DHA-enriched diet increases BDNF in the brain. In
this randomized double-blind controlled trial of severely injured
patients vulnerable to Post Traumatic Stress Disorder (PTSD) and
depression, we examined whether DHA increases serum BDNF
levels and whether changes in BDNF levels are associated with
subsequent symptoms of PTSD and depression. Methods: Patients
received 1470 mg/d of DHA plus 147 mg/d of eicosapentaenoic
acid (EPA; n = 53) or placebo (n = 57) for 12 weeks. Serum levels
of mature BDNF at baseline and 12-week follow-up were measured
using ELISA kits. At 12 weeks, we used the Clinician-
Administered PTSD Scale to assess PTSD symptoms and
depressive symptoms by the Montgomery-Åsberg Depression
Rating Scale. Results: At 12 weeks, there were no differences in
the CAPS total score between the DHA and placebo groups. We
found a significant increase in serum BDNF levels during the trial
in the two groups with no interaction between time and group.
Changes in BDNF levels were not associated with PTSD severity
but negatively associated with depression severity (Spearman’s ρ =
-0.257, p < 0.05). Conclusions: We found no specific effects of
DHA on increased serum levels of BDNF; however, evidence in
this study suggests that increased BDNF and pro-BDNF have a
protective effect by minimizing depression severity.
It is not how much, what it feels like or where it
comes from that matters: it’s what you do with it
McCracken LM
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Institute of Psychiatry, Psychology & Neuroscience, King’s
College London, London, UK and INPUT Pain Management,
Guy’s and St Thomas’ NHS Foundation Trust, London, UK
Thoughts and feelings can appear to intimidate, threaten,
overwhelm, and “cause” us to do one thing or another. This
experience seems so obvious that it is rarely questioned – most of
us just go along with it. More than that, we do not just resign
ourselves to the inevitability of this scenario, we also participate in
it. Our efforts to reach our goals in life include considerable efforts
to assure that the content of our thoughts and feelings agree with or
facilitate our reaching these. Calm, comfortable, certain, positive,
and encouraging thoughts and feelings become the recipe for
success, so much so that we experience the absence of these
ingredients as distressing and itself a kind of failure. A question
approached in this short talk is whether this scenario is inevitable,
or might there be another way for us humans, with all of our
painful, discouraging, and distressing experiences, to succeed. The
framework applied to this question is the psychological flexibility
(PF) model, the model underlying a form of Cognitive Behavioral
Therapy (CBT) called Acceptance and Commitment Therapy
(ACT). This model includes a focus on performance regulation
rather than content of thoughts and feelings. This talk will present
data from people seeking treatment in a specialty pain service (n =
573; 66.3% women; age M = 46.7 years) to highlight some less
well known facets of PF. Measures included the Acceptance and
Action Questionnaire-II, Cognitive Fusion Questionnaire,
Committed Action Questionnaire, and Experiences Questionnaire.
In confirmatory factor analyses, a model with unitary underlying
factor emerges in addition to five separate factors, including
acceptance, cognitive defusion, and committed action. In further
analyses both the unitary and separate factors correlate with
important aspects of daily functioning. The results support the
simultaneous unidimensional and multidimensional nature of PF,
and its role in health and wellbeing, consistent with the model.
Effectiveness of an early intervention for panic
symptoms: results from a randomized controlled
trial
Meulenbeek P1,3, Willemse G², Smit F2,3, Cuijpers P2,3
¹GGNet, the Netherlands; UTwente
²Trimbos Instituut, Netherlands Institute of Mental Health and
Addiction
³Vrije Universiteit van Amsterdam, Amsterdam, The
Netherlands
Introduction: Panic disorder (PD) is a serious DSM-IV axis I
disorder affecting 2.2% of the Dutch population each year. It is
associated with a large burden of disease, considerable medical
consumption and extensive loss of productivity. A substantial
proportion of the population suffers from subsyndromal PD and is
at risk of developing a full-blown PD. We developed a public
mental health intervention for panic symptoms, called the “Don’t
Panic” course. The intervention consists of 8 weekly sessions of 2
hours each in groups of 6 to 12 participants following the protocol
of the “Don’t panic” course. It contains psycho-education about
anxiety and panic attacks, changing life-style, managing stress,
relaxation training, cognitive restructuring, interoceptive exposure,
“in vivo” exposure, and relapse prevention. Methods: A multi-site
randomized trial (the course “Don’t Panic” versus waiting list
control group), with a baseline measurement and 2 follow-up
measurements (at the end of the intervention and 6 months later).
Subjects were recruited from the general population. A total of 217
subjects entered the study and were randomized to the experimental
group (N=109) and the control group (N=108). Results: People
presenting with subthreshold and mild PD benefit from this brief
intervention: escalation toward more severe manifestations of PD is
avoided and panic symptom levels were much reduced. These
beneficial effects were maintained over time. Conclusions: The
target group is known to be reticent in asking professional help and
it is therefore good to see that a low threshold intervention is
apparently effective and regarded as accessible and acceptable.
Klinefelter syndrome and testosterone substitution
therapy; the need for psychiatric evaluation
Michielsen P
Mental Health Center Western Brabant, Bergen op Zoom, the
Netherlands.
Introduction: Klinefelter Syndrome (KS) is an endocrine disorder
in boys and men marked by an extra X-chromosome (47,XXY).
About 1 in 500-700 males suffer from the disorder, although it
remains largely underdiagnosed. From mid-puberty testosterone
substitution is advised as testosterone levels are lower than normal
in about 80% of adults with KS. KS has been associated with an
increased rate of several psychiatric disorders (e.g., depression,
attention deficit/hyperactivity disorder, schizophrenia). As it is
illustrated in the present case, little is known about psychiatric
adversities when embarking on a lifelong testosterone substitution
therapy. Case description: A 53-year old male was referred to the
psychiatrist because he often suffered from temper attacks and
verbal assaults. He was diagnosed with KS at the age of 30 because
of infertility and subsequently was prescribed testosterone to
improve his bone density. Annual evaluations of testosterone levels,
estrogens, FSH, LH were performed by the endocrinologist.
However, on psychiatric assessment it appeared that the temper
attacks worsened and as a child he also suffered from conduct
disorder and learning difficulties. Transdermal testosterone gel (50
mg/day) was discontinued after discussion with the endocrinologist.
The patient stopped having temper attacks while his energy levels
remained stable. Comment: It is advisable for boys/adults with KS
diagnosis to be seen by a psychiatrist to weigh risks and benefits of
testosterone substitution therapy both on commencement and
during a follow-up program. Detailed information should be
obtained about psychiatric comorbidity and psychological
wellbeing in cooperation with the endocrinologist.
Response of amitriptyline to atypical odontalgia
Miura A, Watanabe M, Shinohara Y, Yoshikawa T,
Takenoshita M, Toyofuku A
Department of Psychosomatic Dentistry, Graduate School of
Medical and Dental Sciences, Tokyo Medical and Dental
University, Tokyo, Japan
Introduction: Atypical odontalgia (AO) is a condition
characterized by tooth pain or pain at the site of tooth extraction
with no apparent radiographic or tooth pathology. Although
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pharmacotherapy with tricyclic antidepressants such as
amitriptyline might be effective, pain relief is not attained in some
cases. The aim of this study was to investigate the clinical features
of AO and the response of amitriptyline in AO. Methods: We
retrospectively collected data of 136 outpatients presenting with AO
at the department of psychosomatic dentistry, TMDU, between
January 2013 and June 2014. The dataset included, among the
others, the following variables: sex, age, history of headache or
insomnia. Results: Our study included 136 patients (25 men, 111
women; mean age of onset was 53.20 ± 14.66 years). Forty-one
patients out of 136 patients were prescribed amitriptyline. Twelve
patients were treated with only amitriptyline, while 13 patients
added other psychotropic medications, and 7 patients changed to
others. Twelve patients (12/41; 29.3%) with monotherapy, nine
(9/41; 22.0%) with combination therapy, and three (3/41; 7.3%)
with other antidepressants reported clear improvement; nine
patients (9/41; 22.0%) discontinued pharmacotherapy. In the
monotherapy group, six patients (6/12; 50.0%) had a history of
headache and four (4/12; 33.3%) had insomnia. Conclusions:
Because of variations in AO pathophysiology, the response of
amitriptyline may not be consistent. History of headache or
insomnia may become predictors of therapeutic response to
amitriptyline of AO.
What makes patient’s expectation for improvement
of functional somatic syndromes increase?
Mizuno Y, Kato F, Abe T, Kanbara K, Fukunaga M
Department of Psychosomatic and General Internal Medicine
Kansai Medical University, Osaka, Japan
Introduction: Psychosocial factors often influence functional
somatic syndromes (FSS), so active participation of patients to the
treatment seem to be effective. Expectation for improvement is the
important factor to increase patient’s motivation for altering
themselves, therefore identification of the psychosocial factors
affecting the expectation must be helpful in clinical practice.
Methods: One-hundred eight outpatients with FSS completed
Sense of Coherence (SOC) questionnaire, MMPI, and three
numerical rating scales assessing symptoms intensity, frequency,
and expectation for improvement. SOC is regarded as a health
promoting resource. It has three components: comprehensibility,
manageability, and meaningfulness. These three components, three
validity scales and ten clinical scale of MMPI, intensity, and
frequency were analyzed using a stepwise multiple regression
analysis to determine which factors predict patient’s expectation for
improvement. Results: Participants were 36 males and 72 females
(47.6±18.7 years old). Median score and interquartile range of
expectation was 5 (2 - 8). Meaningfulness (β= 0.24, r = 0.32), scale
2(D) of MMPI (β= -0.16, r = -0.33), and frequency (β= -0.28, r = -
0.30) were revealed to be predictors of expectation. With this
model, |R| value was 0.46. Conclusions: The results suggest that
the attempt to change the patient’s attitude toward symptoms from
refuse to acceptance is effective clinical approach. Elevation of
MMPI scale 2 means tendency to pessimistic and depressive that
probably change when patients acknowledge their symptoms to be
meaningful. Acceptance, that is to say distracting the attention from
symptoms to one’s ordinary life, probably increases expectation for
improvement through reducing subjective frequency of symptoms.
Effect of social participation on cognitive function
among aged people in Korea
Moon M, Kim B, Choi H, Won C, Kim S, Kang L
Department of Family Medicine, Kyung Hee University
Medical Center, Seoul, Republic of Korea
Introduction: Many studies have been conducted to find out the
way to prevent cognitive dysfunction in later life but the effect of
the non-pharmacological therapies remains largely uncertain.
Therefore, this study investigates the influence of social
participation on cognitive function in a 3-year follow-up period
among aged people in Korea. Methods: Data were from the Living
Profiles of Aged People Survey, a national survey of community-
dwelling Koreans aged more than 60 in 2008 who underwent a 3-
year follow-up evaluation in 2011. Social participation was
questioned in each year of the survey and the groups were divided
into “both year participating group” and “none participating group”
based on 5 categories (i.e., friendship group, cultural activities,
sports leisure activities, volunteer groups, social learning activities).
Cognitive function was evaluated by MMSE-KC score in 2011
after adjusting education level. Multivariate logistic regression
analysis was used to analyze the effect of social participation on
cognitive function, adjusting for socio-demographic variables and
health-related factors. Results: The total number of participants
involved in this analysis was 5389 (2310 men, 3079 women).
Compared to both year participating group, none participating
group demonstrated significantly increased odds ratio on cognitive
function impairment (men: OR = 3.739; p-value < 0.001; women:
OR = 3.197; p-value 0.001). This result was confirmed even after
adjusting for many other covariates. (men: OR = 2.823; p-value <
0.001; women: OR = 2.090; p-value < 0.001). Conclusions:
Among aged people in Korea not participating in social groups, the
risk of cognitive impairment is significantly elevated in both men
and women.
Factors of dropouts from outpatient treatment for
eating disorders; based on questionnaire survey to
dropout patients
Moriya J, Takimoto Y, Yoshiuchi K
Department of Stress Sciences and Psychosomatic
Medicine, Graduate School of Medicine, The University of
Tokyo, Tokyo, Japan
Introduction: Dropout from outpatient treatment is relatively
common among patients with eating disorders (ED). However, the
reason remains unclear. The aim of the present study was to
investigate factors associated with dropout from treatment in ED
patients. Methods: We analyzed outpatients (n = 342) who first
visited our department of The University of Tokyo Hospital
between January 2009 and July 2012. A total of 53 patients
(15.5%), out of 342 patients, dropped out. We conducted them
under questionnaire survey (close-ended and open-ended
questionnaire) via postal mails. The comments for open-ended
questions were analyzed by the Modified Grounded Theory
Approach. Results: Respondent rate was 45.3%(n = 24; 23 women,
1 man). The median age was 25 years old (from 16 to 50). The type
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of ED were Anorexia Nervosa (n = 14), Bulimia Nervosa (n = 5),
and ED-Not Otherwise Specified (n = 5). According to the close-
ended questions, the most common factor of their dropout was “a
matter of chemistry” with their doctors (n = 12). The other answers
were "nothing has changed even after visit to hospital” (n = 6),
"that was not a therapy that they expected” (n = 6), "I became busy”
(n = 5), and "a symptom has improved” (n = 5). Analyzing the
open-ended answers, description about "personality and behavior of
the therapist", "treatment regimen", and "burden for going to
hospital" were relatively frequent. Conclusions: Not only factors
on patients’ side, but also factors on the medical side as well as the
treatment environment were identified as the major reasons for
dropout from treatment in ED patients.
The relation of fatigue related psychological
factors and exercise capacity to heart drawings of
patients with cardiovascular disease
Nagy A1, Szabados E2, Mezey B2, Toth K2, Csatho A1
1Institute of Behavioral Sciences, University of Pécs, Pécs,
Hungary
2 First Department of Internal Medicine, Pécs, Hungary
Introduction: Patients’ beliefs about their heart disease might have
an important influence on their recovery and rehabilitation success.
One of the measurements to get an indication about illness beliefs
might be pictorial representations. The aim of our study was to
examine whether the heart drawings of Cardiovascular Disease
(CAD) patients are associated with their psychological (i.e.,
subjective fatigue) and clinical status (i.e., exercise capacity)
Methods: Patients with stable coronary artery disease (n = 126; 70
male, 56 female; mean age 64.30 ± 6.42 years) participated in the
study. All patients underwent a maximal exercise stress test and
completed a package of questionnaires, including the Shortened 9-
item Vital Exhaustion Questionnaire, FIS Fatigue Questionnaire,
SF-36 Health Survey, Shortened 9-item Beck Depression Inventory
and Spielberger State and Trait Anxiety Questionnaire. In addition,
patients were asked to draw a sketch of their hearts. Results: Our
results indicate relations of exercise capacity and physical
functioning to the size of the hearts drawn by the patients. Larger
hearts were associated with worse exercise capacity and everyday
physical functioning. Neither myocardial infarction nor bypass
surgery was found to be related to the drawings. PTCA, however,
showed a strong association with it. In addition, a gender difference
was found: in men, the size of the hearts was related to exercise
capacity and state-anxiety. In women, it was rather associated with
physical and social fatigue, vital exhaustion, and depression.
Conclusions: As a conclusion, drawings might be simple
assessments of patients’ perceptions of their illness, giving an
indication about their exercise capacity, physical functioning, and
fatigue.
Dignity and spirituality in patients with chronic
medical conditions
Nanni MG, Caruso R, Massarenti S, Sabato S, Grassi L and
the UniFe Psychiatry Working Group co-authors
Institute of Psychiatry, Department of Biomedical and
Specialty Surgical Sciences, University of Ferrara, Italy and
University Hospital Psychiatry Unit, Department of Mental
Health, S. Anna University Hospital, Ferrara, Italy
Introduction: Dignity, is “the status of human beings entitling
them to be respected, a status which is first and not to be taken for
granted”. It refers to their highest value or to the fact that human
beings are a presupposition for value, as they are those to whom
value makes sense”. Dignity has been investigated in several fields,
particularly in patients affected by terminal illnesses. The aim of
the study was to explore the condition of dignity and its associated
variables among patients with chronic medical conditions.
Methods: Patients with chronic medical conditions (n = 290) (i.e.,
cancer, neurological, cardiac, and rheumatic illnesses) were
assessed submitted to a series of psychosocial tools. More
specifically each patient completed the Patient Dignity Inventory
(PDI), the FACIT spiritual well-being questionnaire, the EURO-
QOL to assess QOL, and the Ryff Psychological well-being
questionnaire. Results: Statistically significant associations (p <
0.001) were found between dignity (and dignity dimensions) and
both spirituality and psychological well-being. Also QOL, in terms
of the dimensions of good personal care, high performance status,
low pain, and low emotional symptoms were related to high dignity
and psychological well-being. Conclusions: Existential burden
faced by medically ill patients with chronic conditions is extremely
important and loss of dignity is a significant factor to be taken into
consideration in general hospital in order to both implement person-
centered approach that include dignity and to possibly early
intervene to avoid loss of dignity.
The effect of short-term counselling for the
bereaved family of crime victim
Narisawa T, Nakajima S
National Center of Neurology and Psychiatry
Introduction: The bereaved families of crime victims face severe
distress and various psychiatric conditions. We practiced five and a
follow-up sessions counselling to the bereaved adult man whose
mother died of medical error. Case description: The contents of
this counselling was identifying the complaint, setting of the
treatment goal, psycho-education, talk about the traumatic event
and its influence on everyday life, and looking back of five
sessions. We asked the client to answer four questionnaires IES-R
(Impact of Event Scale-Revised); PTSD symptoms, PTCI (Post
Traumatic Cognitive Inventory); traumatic cognition, ICG
(Inventory of Complicated Grief; complicated grief; cut off score
29/30), and BDI-Ⅱ(Beck Depression Inventory; depression; cut off
score 13/14) before every session. The process of the score of IES-
R was 27-33-12-16-12-21, PTCI was 132-141-112-97-78-107, ICG
was 42-38-28-17-22-31, BDI-Ⅱ was 16-20-14-10-10-8. The client
said he had never talked about his traumatic event and emotion to
anyone other than this counselling, so this counselling had made
him feeling easier. Comment: According to each questionnaire, the
patient did not exceed the cut-off point of psychiatric diagnosis
after successful five sessions but an increase of the IES-R, PTCI
and ICG scores was observed at follow-up visit. We found some
favorable effect of short-term counselling in this case, but the effect
did not seem to sustain for 3 months. We should observe its course
in the future.
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Predictors of the dental anxiety
Navarrete ARF, Bonafé FSS, Campos JADB
Faculdade de Odontologia de Araraquara, Universidade
Estadual Paulista, Araraquara, São Paulo, Brazil
Introduction: The dental anxiety is prevalent condition in clinical
dental and important to management of the dental patients. This
study was conducted to identify predictors of this condition.
Methods: Participants were 352 Brazilian adults (74.4% female;
age: 45.1 ± 19.2 years). The Dental Anxiety Scale (DAS) was used.
The socio-demographic information and presence/absence of
disagreeable previous dental experience were collected. The
interviews were conducted by phone. The validity and reliability of
the DAS were assessed. 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
reliability was evaluated by Cronbach's alpha coefficient (). A
predictive model was developed using structural equation
modeling. Results: The fit of the one-factor model was inadequate
to the sample ( = 0.65 - 0.83; 2/df = 14.802; CFI = 0.949; GFI =
0.958; RMSEA = 0.198). The fit was adequate ( = 0.58 - 0.88;
2/df = 1.494; CFI = 0.999; GFI = 0.998; RMSEA = 0.038) after
insert correlation between error of the items (LM > 11.0; p <
0.001). The DAS was reliable ( = 0.83). The fit of the predictive
model was adequate (2/df = 1.244; CFI = 0.995; GFI = 0.989;
RMSEA = 0.026). Socioeconomic status (β = -0.145; p = 0.010),
gender (β = 0.120; p < 0.05), age (β = -0.225; p < 0.05) and
disagreeable previous dental experience lived by the individual (β =
0.212; p < 0.05) was significant predictors of the dental anxiety.
The model explained 11% of the dental anxiety. Conclusions: The
DAS was valid and reliable to the sample. Individuals with lower
socioeconomic level, female, younger, and who lived disagreeable
dental experience in the past, have higher anxiety toward the dental
treatment.
Effectiveness of a specific work-related treatment
for employees in health care
Neu R1,2, Brendel C3, Köllner V1,3
1Department of Psychosomatic Medicine, MediClin Bliestal
Kliniken, Blieskastel, Germany
2Department of Clinical Psychology and Psychotherapy,
University of Trier, Trier, Germany
3Faculty of Medicine, Saarland University, Homburg/Saar,
Germany
Introduction: Elevated rates for psychological disorders –
especially depression – are common among employees working in
health care. This study evaluates the effectiveness of a specific
work-related treatment for these jobholders. Methods: A total of
316 patients (mean age = 50.33 years) with mainly depressive
disorders (90.2%), sampled from a psychosomatic rehab hospital,
were divided into two groups. Group A primarily consisting of
employees in health care received a treatment specifically adapted
to their profession (n = 156), Group B received a common disorder-
specific treatment (n = 160). Impairment rates, as well as work-
related behavior and experience patterns, were measured with
Health-49, BDI-II, and AVEM before (T0) and after the treatment
(T1). Results: Regarding impairment rates, there were no
significant differences between the two groups, neither at T0 nor at
T1. Concerning work-related patterns, at T0 the two groups differed
in terms of willingness to work until exhausted, striving for
perfection, and tendency to resignation, with Group A scoring
significantly higher (p < 0.05, d = 0.64). At T1 Group A showed a
significant reduction in their willingness to work until exhausted (p
< 0.05, d = 0.32), however less improvement in proactive problem-
solving could be observed (p < 0.05, d = 0.27). Conclusions: Our
data reflect the specific struggles this occupational group is
confronted with. The results show that both types of treatment are
effective in reducing patients’ symptoms. The tightly scoped
discussion and reflection of occupational problems with other
patients from the same profession can be seen as a benefit of a
work-related treatment. However, such a treatment seems to be
more effective in reducing dysfunctional work-related patterns.
Is the Type D personality construct valuable for
psychosomatic rehabilitation?
Neu R1,2, Müller P1, Roth P1, Grande G3, Köllner V1 4
1Department of Psychosomatic Medicine, MediClin Bliestal
Kliniken, Blieskastel, Germany
2Department of Clinical Psychology and Psychotherapy,
University of Trier, Trier, Germany
3Department of Applied Social Sciences, HTWK Leipzig,
Leipzig, Germany
4Faculty of Medicine, Saarland University, Homburg/Saar,
Germany
Introduction: Type D personality, defined as a combination of
negative affectivity (NA) and social inhibition (SI), is associated
with negative health outcomes such as coronary heart disease, but
has been less examined in connection to other diseases or other
contexts. This study evaluates 1. the association between Type D
personality and work-related behavior and experience patterns, 2.
whether Type D personality changes over the process of
psychosomatic rehabilitation, and 3. if Type D personality predicts
the outcome of such a treatment. Methods: The sample consisted
of 1132 patients (male = 163, female = 969; mean age = 53.26
years) from a rehab hospital with chronic pain and the diagnoses
“persistent somatoform pain disorder” and “fibromyalgia”. Type D
personality was assessed by Type D Scale 14 (DS14) and work-
related behavior and experience patterns were measured with the
questionnaire AVEM. Results: The results indicated low to
moderate correlations between Type D personality and work-
related patterns, in which the correlations between NA and these
patterns were slightly stronger in comparison to SI. In contrast to
SI, a significant reduction of NA could be observed at the end of
the treatment (p < 0.001, d = 0.26). Furthermore, the distinction
between Type D versus not-Type D personality significantly
predicted a minor improvement concerning the following work-
related patterns: willingness to work until exhausted (p = 0.001),
striving for perfection (p = 0.001), distancing ability (p < 0.05),
tendency to resignation (p < 0.05), experience of success at work (p
< 0.05) as well as satisfaction with life (p < 0.05). Conclusions:
Altogether, the Type D personality construct proves to be relevant
to psychosomatic rehabilitation.
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Are omega-3 PUFAs effective for depression during
pregnancy in countries where fish consumptions
are high?
Nishi D1, Matsuoka Y1, Su KP2,3
1National Center of Neurology and Psychiatry, Japan
2Graduate Institute of Neural and Cognitive Sciences, China
Medical University, Taichung, Taiwan
3Mind-Body Interface Laboratory and Department of
Psychiatry, China Medical University Hospital, Taichung,
Taiwan
Maternal depression can have a significant harmful influence on
both mothers and children. Considering the possibility of adverse
effects of antidepressants and limited accessibility to
psychotherapy, the role of evidence-based nutritional approach
have been paid attention. Although meta-analyses have suggested
that omega-3 PUFAs are effective for depression, the evidence
regarding depression during pregnancy have not been established.
Moreover, the prevalence of depression during pregnancy in Japan
is much lower than that in most other countries. In Taiwan, it is also
relatively low, possibly due to high consumption of fish. Whether
omega-3 PUFAs is effective for depression during pregnancy in
these countries is thought to be an important issue. Thus, we
implemented an open trial by omega-3 PUFAs in Taiwan and
Japan, showed safety and potential effectiveness, and are going to
carry out a randomized controlled trial.
The effect of docosahexaenoic acid on quality of
life among traumatized people: a randomized,
placebo-controlled trial
Noguchi H1,2, Nishi Y2,3, Matsumura K2,4, Hamazaki K2,5,
Hamazaki T2,6, Matsuoka Y 2,3
1Distance Learning Division, Faculty of Human Sciences,
Musashino University, Tokyo, Japan
2CREST, Japan Science and Technology Agency, Japan
3Department of Psychiatry, National Disaster Medical Center,
Japan
4Division of Bioengineering and Bioinformatics, Graduate
School of Information Science and Technology, Hokkaido
University, Hokkaido, Japan
5Department of Public Health, Faculty of Medicine, University
of Toyama, Toyama, Japan
6Department of Clinical Sciences, Institute of Natural
Medicine, University of Toyama, Toyama, Japan
Introduction: Health-related quality of life (QOL) reflects disease-
induced changes in physical and psychosocial functioning. Severe
accidental injury not only causes physical impairments but also
psychiatric disorder. Psychiatric morbidity has an adverse effect on
QOL. Prevention for psychiatric disorder and improving QOL is an
important issue in traumatic stress research. In the experimental
studies, the association between n-3 polyunsaturated fatty acid
(PUFA) and QOL is controversial. The aim of this study was to
investigate the effect of docosahexaenoic acid (DHA)
supplementation on QOL in traumatized people. Methods: We
conducted a double-blind, randomized controlled trial. Patients
received 1470 mg/d of DHA plus147 mg/d of eicosapentaenoic acid
(EPA) (n = 45) or placebo (n = 54) for 12weeks. We used the
Medical Outcomes Study 36-Item Short Form Health Survey (SF-
36) to assess QOL (i.e., physical functioning, role-physical
functioning, bodily pain, general health perception, vitality, social
functioning, role-emotional functioning, and mental health) at 12-
week follow up. Results: Mean age of the participants was 39.6 and
81.8% were male. Erythrocyte level of DHA and EPA in DHA
group was significantly elevated compared to placebo group (p <
0.01). We found no significant effects of supplementation with
DHA-EPA on all eight domains of QOL after 12 weeks
unfortunately. Conclusions: Supplementation with DHA for 12
weeks did not influence the QOL of traumatized individuals.
A single session of integrated yoga program as a
stress management education for the teachers at
schools
Nosaka M, Okamura H
Institute of Biomedical & Health Sciences, Hiroshima
University Japan
Introduction: In Japan, it is important to prevent mental health
problems related to stress, and the Government has made guidelines
of stress management. We had developed a single session of
integrated yoga program as a stress management education and
reported the benefits of the yoga program. The aim of this study
was to assess the benefits of the yoga program for teachers at
schools. Methods: The subjects (n = 37) participated in a stress
management education based on the integrated yoga program at
their school. The program included psychological education about
stress and yoga theories as well as practices of asanas, pranayama,
relaxation, and cognitive structure from Indian philosophy.
Assessments were carried out before and after the program using
the Subjective Units of Distress (SUD) about mind and body and
the Two-Dimensional Mood Scale (TDMS). Results: The calmness
(p < 0.001), comfort (p < 0.001), and cheerfulness (p < 0.001)
significantly increased, and cognitive mind (p < 0.001) and body (p
< 0.001) stress significantly decreased after the integrated yoga
program. After the intervention, most people had an incentive to
practice the program in their daily life. Conclusions: The results
suggest that a single session of the integrated yoga program as a
stress management education is effective in reducing stress and
promoting mood in a training workshop at their work places and is
acceptable for Japanese ordinary teachers who are typically not
interested in yoga.
Psychiatric intervention in amyotrophic lateral
sclerosis: a case report
Novais C1, Ribeiro AM1, Peixoto MJ1, Gonçalves E2, Côrte-
Real A1, Coelho R1
1Department of Psychiatry, Clínica de Psiquiatria e Saúde
Mental do Centro Hospitalar de São João, Oporto, Portugal
2Department of Palliative Care, Centro Hospitalar de São
João, Oporto, Portugal
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Introduction: Amyotrophic Lateral Sclerosis (ALS) is a
neurodegenerative disorder associated with progressive physical
disability that inexorably results in death. Patients with ALS require
a multidisciplinary and palliative approach to maximize their
independence, function and quality of life. In this whole-person
approach, psychiatric intervention must be considered. With this
clinical case, our main purpose is to reflect about the role of
psychiatric expertise along the disease process with regard to
possible psychiatric symptoms and eventually cognitive impairment
interfering with quality of life but also end of life decisions. Case
description: We report the case of a 65 years old woman, without
psychiatric background, who developed progressive tetraparesis,
followed by dysphagia, anarthria, and finally respiratory muscle
weakness with need of non-invasive ventilation. Psychiatry was
involved as part of the multidisciplinary approach we are
developing to ALS patients. The patient was followed through the
disease progression, until she died at 69 years old at home after
deciding not to proceed with tracheostomy. Comment: Given the
progressive nature of ALS, appropriate interventions must be
applied at each stage. With this case we intend to discuss the
importance of psychiatric intervention as part of a multidisciplinary
approach in ALS patients, in providing support not only for patients
but also for caregivers and other family members, along with the
management of possible psychiatric symptoms as the disease
progresses, which can have a severe impact in quality of life,
functionality, and even interfere in the process of end of life
decisions.
The Possibility of Kampo Application for the initial
treatment of medically unexplained symptoms
Okada H
Department of Medical Education, Faculty of Medicine,
Kagawa University, Japan
Introduction: Many patients describe to their general practitioners
(GPs) medically unexplained symptoms (MUS) such as headaches,
fatigue, back, chest, and other pains which cannot be explained by
recognized physical diseases. The GPs are required to treat the
patients with MUS properly. Without adequate treatment, patients
suffer from persistent MUS that may ultimately impair their
physical and social functions as well as reduce their quality of life
(QOL). Another problem is the high cost associated with these
symptoms because of the frequency of doctor visits. The
recommended therapy of MUS is cognitive behavioral therapy
(CBT). This intervention is more effective than usual treatments.
But in severe cases, the initiation of this therapy might be
difficult. Kampo, a Japanese herbal medicine, has been used for the
treatment of unidentified complaints or functional disorders.
Several reports show beneficial effects of Kampo on functional
disorders. For example, Rikkunshito is reported to be effective for
functional dyspepsia, Daikenchuto for chronic constipation,
Kamishoyosan and Keishibukuryogan for climacteric syndromes,
Yokukansankachimpihange for pediatric psychogenic dizziness,
Orengedokuto for fever of unknown origin. Kampo has been shown
to relieve mild symptoms of some diseases without CBT and may
also reduce medical costs. In moderate to severe cases, this herbal
medicine can reduce many symptoms of some diseases. Moreover,
a good doctor-patient relationship is essential for the treatment of
MUS and Kampo may help establishing the relationship. From
those points, the role of Kampo in treatment of MUS warrants
further investigation.
The effects of living-donor transplant recipients’
physical status on donors’ physical perception — A
study of 117 living-donor liver transplant donors
Okada T, Yasuda M, Kobayashi T, Kato S
Department of Psychiatry, Jichi Medical University, Tochigi,
Japan
Introduction: Living-donor liver transplant (LDLT) donors have
been reported to experience various psychological problems. A
number of case reports have investigated the relation between the
physical status of recipients and the psychological and physical
perceptions of donors. The aim of this study was to statistically
clarify this phenomenon. Methods: In this cross-sectional study,
167 persons who underwent a pediatric LDLT donor operation
from 1 to 10 years ago were surveyed with Short Form 36 (SF36), a
self-administered evaluation scale for quality of life. Information
about recipient outcomes was gathered for the 117 participants
from whom valid responses were received, and the presence of any
relations were investigated. Results: The donor was the recipient’s
mother in 50.4% of cases and the recipient’s father in 46.2% of
cases. In 76.9% of cases, the recipient progressed favourably; in
19.7% of cases, postoperative complications occurred; and in 3.4%
of cases, the recipient died. The mean scores for all of the 8 sub-
items of SF36 (i.e., physical-functioning, role-physical, bodily-
pain, general-health-perception, vitality, social-functioning, role-
emotional, and mental-health) were all better than national
averages. However, general-health-perception, a scale for physical
health, was lower in cases where the recipient developed
postoperative complications, and mental-health was lower for cases
where the recipient died (p < 0.05, Steel-Dwass method).
Conclusions: The results suggested that donors feel the recipient’s
poor physical condition as their own (the “Siamese-twin” effect).
Furthermore, it seems that psychosomatic problems may develop in
response to poor outcomes in recipients, indicating the necessity of
offering mental support.
Type A behavior pattern in relation to obesity: a
cross-sectional study in Japanese workers.
Ogawa S1,2, Saigo T1,2, Takeoka A2, Yamasaki H1, Hamaguchi
T3, Shirabe S1, Tayama J1, 4
1Center for Health and Community Medicine, Nagasaki
University, Nagasaki, Japan
2Unit of Preventive Medicine, Graduate School of Biomedical
Sciences, Nagasaki University, Nagasaki, Japan
3Department of Occupational Therapy Saitama Prefectural
University, Saitama, Japan
4Graduate School of Education, Nagasaki University,
Nagasaki, Japan
Introduction: Obesity is associated with personality of accumulate
psychological stress. Type A behavior pattern (TABP), which has
been characterized as hostility, hard-driving, competitive behavior,
and time urgency, is related to psychological stress. In previous
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study, TABP is a risk factor for lifestyle related diseases. However,
the relationships between obesity and TABP have not been
examined. Therefore, we conducted a cross-sectional study that aims
to investigate the relationship between obesity and TABP in the
Japanese workers. Methods: Participants were 3099 Japanese
workers (1505 males, 1594 females). All participants completed a
questionnaire that collected data on past history, present illness,
smoking state, exercise habit, drinking status, eating habit, and
quality of sleep. TABP was measured with a Maeda questionnaire
(cutoff 16/17). Data were analyzed using univariate and multivariate
logistic regression. Results: Univariate odds ratios were calculated,
TABP resulted as a risk factor for obesity (OR = 1.83; 95% CI 1.47 -
2.26). Multivariate odds ratios were calculated and TABP was a risk
factor for obesity after adjustments for age, sex, smoking status,
drinking status, exercise status, and occupation (OR = 1.59; 95% CI
1.27 - 1.98). Conclusions: These findings suggest that TABP may
be an independent risk factor for obesity. Because of the hostility
and aggression components of the TABP increases psychological
stress, this stress might induced overeat, thus weight tend to
increase.
Integrative psychosomatic approach for the school
refusal in Japan
Okumi H, Murata M, Takahashi H, Ichitani N, Hayashi M,
Shirasaki A, Koyama A
Department of Psychosomatic Medicine, Kinki University,
Faculty of medicine Osaka-Sayama, Osaka, Japan
Introduction: Most of patients of the school refusal suffer from
several psychosomatic symptoms. This clinical case study
demonstrates the psychosomatic approach to school refusal depend
on grade in Japan. Case description: The report illustrates several
cases of integrative psychosomatic approach with oriental
medicine, psychotropic drugs, and psychotherapy in the
management of symptoms referring to school refusal during
elementary schoolchild to high school student. Oriental “Kampo”
medicine is often prescribed to children with psychosomatic
symptom because it is hard to use the psychotropic drug for them.
Additionally, the combination of “Kampo” medicine and
psychotropic drugs may reduce the number of the prescriptions. In
the elementary school, children are mainly treated on
environmental adjustment including the correspondence in the
communal living in the school. In junior high students, ratios to
handle a problem with the progression of the study and the change
of pubertal personal relationships. For the senior high student who
left a compulsory education, the progression of studies and days
attended become more important. In particular, it must be noted by
an environmental change by repeating the same grade and the
transfer. Comment: This report was carried out to illustrate the
effects of examining patients in school refusal from pre-puberty to
the puberty with integrative psychosomatic approach. Demand for
consultation of patients of the school refusal is high, but there are
few medical institutions to install the outpatient department for
them in Japan. More facilities which can examine them with
psychosomatic approach should be founded in the future.
Somatic symptom disorder and depression – when
it becomes a challenge
Oliveira M, Costa AS, Amaral AD, Santos C
Clínica de Psiquiatria e Saúde Mental, Centro Hospitalar São
João, Oporto, Portugal
Introduction: Somatic Symptom Disorder introduced in DMS-5
seems to be a high prevalent, debilitating condition that brings
significant healthcare cost. In this condition, the psychosocial stress
manifests through somatic symptoms and when present, depressive
symptoms worsens prognosis. Case description: The patient is a
man of 59 years old, married, presenting with generalized chronic
pain (i.e., limbs, neck and head), associated with fatigue, causing
significantly distress (i.e., fear of having a serious and deadly
disease) and social impairment. The patient already had sought out
help in other medical specialties (i.e., orthopaedics, rheumatology,
and neurology). He underwent an electromyography, magnetic
resonance imaging, and blood tests with negative results.
Progressively, the patient stopped walking and became clinically
depressed. Pharmacological treatment with antidepressants was
optimized and a psychoeducational approach was made towards the
family and patient. Cognitive and physical stimulation were
recommended, including participation in a physical rehabilitation
programme. The multidisciplinary approach culminated in the
improvement of depressive and somatic symptoms. Comment:
This clinical case demonstrates the importance of the differential
diagnosis between functional disorders and other medical causes.
The authors highlight the importance of the involvement of the
family and other healthcare professionals in the therapeutic process.
Dental care for patients with white-coat syndrome
Orekhova IV, Anisimova EN, Ryazancev NA
Department of anesthesia in dentistry Moscow State,
University of Medicine and Dentistry named after A.I.
Evdokimov, Moscow, Russia
Introduction: Patients with arterial hypertension at the dental care
are about 30-70%. High blood pressure values could be due to the
visit to the medical office. This phenomenon is called White-Coat
Hypertension (WCH) - a persistently elevated blood pressure,
measured in the medical office, in the presence of a normal blood
pressure outside of the office. The present study had the aim to
detect patients with WCH during dental care. Methods: A total of
17 patients from 35 to 65 years, who came in for primary dental
care, had their blood pressure (BP) measured before dental
interaction with the help of a tonometer AND TM-2655P. All
patients received a prescription of ambulatory blood pressure
monitoring (ABPM) to detect cases of white-coat hypertension.
Results: Seven out of 17 patients did not show any increase in
blood pressure rates during the day. Conclusions: Patients with
WCH need psychological and pharmacological distress correction
during dental care.
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Socio-economic pathways in coronary heart
disease
Orth-Gomer K1, Weber CS2, Herrmann-Lingen C3, Albus C4,
Deter HC2
1Karolinska institute, Department of clinical Neuroscience,
Stockholm, Sweden
2Charité – Universitäts medizin Berlin, Campus Benjamin
Franklin, Medical Clinic Psychosomatics, Berlin, Germany
3Department of Psychosomatic Medicine & Psychotherapy,
Univetsity of Göttingen Medical Center, Göttingen, Germany
4Department of Psychosomatics & Psychotherapy, University
of Cologne, Cologne, Germany
Introduction: Low Socio Economic Status (SES) is known to
increase risk of both cardiac morbidity and mortality; psychological
factors such as depression worsens prognosis in patients with
Coronary Heart Disease (CHD). Autonomic, inflammatory,
hemostatic/thrombolytic, and metabolic imbalance have been
proposed as mediating pathways of depression in patients with
coronary heart disease. Similar findings were observed in both
Scandinavian and US male and female adult patients. Methods:
The current study is part of a comprehensive set of analyses of
pathogenic SES pathways in CHD in a well-defined large cohort of
German CHD patients. This SPIRR-CAD study is a DFG funded
multi-center trial on 570 CHD patients with a depression score of 8
and more on the Hospital Anxiety Depression Scale (HADS). In the
present paper, we analyzed baseline data of SES, defined as
educational attainment, as well as autonomic dysfunction, defined
as low heart rate variability (HRV) and other biological data. The
relative importance for SES gradients of the psychobiological
pathways -mentioned above- are estimated. Results: About 24% of
the patients were academics (i.e., high SES) and 42% belong to
lower SES classes (i.e., mandatory or low education).Patients of
lower SES classes showed higher depression scores (HADS; p <
0.05).Frequency domain indices of HRV were low and the
inflammatory, hemostatic, and metabolic risk factor levels were
high in low social class. Conclusions: Bio-psycho-social-
physiological pathways (i.e., autonomic and metabolic dysfunction,
inflammation, coagulation) need to be considered, together with
lifestyle (i.e., BMI, smoking, physical activity).Although the
current cross sectional design does not allow causal interpretations
and the study cohort may not be regarded as representative of
German CHD patients (due to the selection process and the
recruitment at university clinics), the data may give further insights
into the socio-economic causality of CHD.
Psychological reaction to cancer – The burden of
an internalized stigma?
Ouakinin S, Bernardo M, Nabais I, Gonçalves G, Eusébio S
Introduction: According to literature on psycho-oncology distress
and other psychiatric comorbidities varies in different types of
cancer and in different stages of the disease. Although clinical
evaluation emphasizes these aspects of the disease, for patients, the
overwhelming impact of cancer associated stigma and the
anticipated consequences can determine a deep psychological
disturbance. The aim of this research is to analyze emotional
distress and stress vulnerability, in different stages of the disease,
facing specific diagnosis and treatments. Methods: Patients were
assessed after admission in a day care oncology department
(Hospital Cuf Infante Santo, Lisbon), before chemotherapy, in a
first episode or cancer relapse. After their informed consent, they
completed a questionnaire including socio-demographic and
medical data, the Distress Thermometer, the Stress Vulnerability
Questionnaire, the Brief Symptom Inventory (BSI), and the Quality
of Life Questionnaire. Results: Sample included 205 subjects, 99
with local (G1) and 106 with advance disease (G2). Breast (54.5%)
and Digestive (23.2%) were the most common cancers in G1,
whereas Hematologic (36.4%) and also Digestive cancer (30.8%)
were more prevalent in G2. Comparing G1 with G2, distress, global
symptoms index (BSI), and stress vulnerability total score were not
significantly different, although higher in advance patients. As
expected, significant differences were found in QoL indexes, higher
in local disease patients. Conclusions: Despite the importance of
medical and prognostic factors to health professionals, patients can
react to diagnosis in a more unspecific approach, reflecting mostly
the stigma associated to the word cancer and the experienced
immediate threat.
Maintaining flexibility and tolerance in the face of
chronic (emotional) pain
Overholser JC
Department of Psychology, Case Western Reserve
University, Cleveland, Ohio USA
There may be important similarities across physical pain and
emotional pain. Strategies that have been found useful in the
management of chronic physical pain may be adapted for the
treatment of persistent emotional pain (and vice versa). Some of the
most useful treatment strategies include: reducing catastrophic
interpretations, accepting current situations, cultivating positive
expectations, reducing coping by avoidance, and remaining flexible
in movement and attitude. These strategies appear useful in the
management of most types of chronic pain. Hopefully, the lives of
patients can be improved through a cross fertilization of ideas,
adapting strategies found useful for managing physical pain and
applying similar procedures for emotional pain.
The treatment of psychogenic non epileptic
seizures (PNES) using eclectic short-term
psychotherapy: a case report
Pana M
Department of Medical Psychology, University of Medicine
and Pharmacy, “Carol Davila”, Bucharest, Romania
Introduction: This clinical case report reveals the potential of
eclectic short-term psychotherapy in modern treatment of
psychogenic non epileptic seizures (PNES). Case description: The
case emphasizes the psychological treatment of psychogenic non
epileptic seizures (PNES) using eclectic short-term psychotherapy
in only 2 sessions. In 2004, a 45-year-old woman came to the
psychotherapist because she was having 2-3 seizures per week.
Prior to psychotherapy, she went to the hospital and the epilepsy
was ruled out. Her problems appeared 4 months after her father’s
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death. In eclectic short-term psychotherapy the following
techniques were used: reframing, making symbolic connections,
linking, narrative, and the labor of mourning (a technique from the
E.S.P.E.R.E. method). The results of the 2 sessions were positive,
with full disappearance of the symptoms. Eradication of PNES lasts
for 11 years so far (2004-2015). Comments: psychogenic non
epileptic seizures (PNES) are common symptoms of conversion
disorder, which is a type of somatoform disorder (DSM IV-TR) or a
somatic symptom disorder in the classification of DSM-5.
Evidence-based treatments for PNES are limited and mostly
focused on cognitive-behavioral therapies. This is the first report of
an eclectic short-term psychotherapy used in PNES. Due to the very
good relation between the socio-economical investment and the
favorable results, in this case we recommend this form of
psychotherapy in modern treatment of PNES.
Alexithymia predicts risk-taking in aggressive and
academic behaviors
Panno A1, Lauriola M2
1Department of Education, Experimental Psychology
Laboratory, Roma Tre University, Rome, Italy
2Department of Social & Developmental Psychology,
University of Rome “Sapienza”, Rome, Italy
Introduction: Risk-taking is a major determinant of health playing
a central role in many diseases and is related to several health risk
factors. For example, risky behavior may be the cause of injury
(i.e., traffic accidents and self-inflicted injuries), is associated with
public health hazards (i.e., unprotected sex and alcohol use). The
present study aimed at investigating the relationship between
alexithymia and risk-taking. Methods: One hundred and thirteen
participants (Mage = 21; SD= 3.54; Women = 69%) filled out the
alexithymia scale (Toronto Alexithymia Scale – TAS-20),
impulsivity and venturesomeness measures (I7 scale) and a risk-
taking questionnaire (Cognitive Appraisal of Risky Events –
CARE). The CARE questionnaire was designed to assess risk
preferences in 6 domains (i.e., illicit drug use, heavy drinking, risky
sexual activities, aggressive and illegal behaviors, high risk sports,
and academic/work behaviors). Results: Six hierarchical regression
analyses were performed to investigate whether alexithymia was a
significant contributing factor for the explanation of risk
preferences, controlling for impulsivity and venturesomeness.
These analyses showed that alexithymia tendency positively
predicted risk preferences in two domains (aggressive/illegal, β =
0.36, p < 0.001; and academic/work behaviors, β = 0.33, p < 0.001).
We also found a marginally significant effect of alexithymia on sex
and drinking domains (risky sexual activities, β = 0.16, p = 0.08;
and heavy drinking, β = 0.15, p = 0.09). Conclusions: The results
of the present study point out the role of the alexithymia as a key
factor in predicting risky behaviors. Future studies should shed
light on mechanisms underlying this relationship.
Give me feedback. Outcome phases of punishment
and reward processes during a Monetary Incentive
Delay task (MID)
Papalini S1,2, Cosci F2, Schruers K1, Lange I1, Michielse S1,
Bakker J1 , Goossens L1
1Department of Psychiatry and Psychology, School for
Mental Health and Neuroscience, Maastricht University The
Netherlands
2Department of Health Sciences, University of Florence,
Florence, Italy
Introduction: Brain processes in reward consummation and
punishment are linked to the subjective feeling of (dis-)satisfaction.
An appropriate emotional reaction to external feedback is an
important evolutionary function and is often impaired in
psychopathology. One’s reaction towards rewarding feedback can
be dependent on the entity: directly receiving reward versus
avoidance of loss. To date, most studies did not differentiate
between the entity of the reward/punishment: it is unclear if
positive and negative reward and punishment outcomes share the
same neural correlates. Methods: Sixty healthy subjects (age = 16-
25 yrs, M/F = 14/46) underwent an fMRI scan with the monetary
incentive delay task. Image pre-processing and statistical analyses
were done in SPM8. Results: There was a significant main effect of
feedback value in bilateral caudate nucleus, frontopolar prefrontal
cortex, and right insula (pcorr < 0.01). Post hoc T-test showed
higher activation to reward outcome in caudate bilaterally, left
dorsal anterior cingulate cortex (ACC) and frontopolar prefrontal
cortex activity (pcorr < 0.01); the insula bilaterally was
significantly more activated during punishment (pcorr < 0.01).
There was no interaction effect between feedback and entity.
Conclusions: insula’s role in negative feeling perception is
extended to the punishment outcome. The caudate, dorsal ACC, and
prefrontal cortex seem to be designed for coding and response to
positive feedback. Since, the caudate nucleus seems involved in the
consummatory phase of reward in relation to anhedonia, in future
analyses we will assess the stability of the interaction between
feedback and entity taking into account the effect of anhedonia.
Use of PRISM to evaluate schoolchildren’s
perceptions of natural hazards and responses to
them in Dominica, Eastern Caribbean
Parham M1, Day S2, Teeuw R1, Solana C1, Sensky T3
1School of Earth and Environmental Sciences, University of
Portsmouth, Portsmouth, UK
2Institute for Risk and Disaster Reduction, University College
London, London, UK
3Centre for Mental Health, Department of Medicine, Imperial
College London, London, UK
PRISM (the Pictorial Representation of Illness and Self Measure)
has been used predominantly to measure and understand suffering
due to illness. Through its properties as a visual metaphor, PRISM
can be applied to elicit personally salient information about other
concepts and relationships. In the present study, PRISM has been
applied to assess the understanding by a cohort of 11-year old
schoolchildren of natural hazards (such as hurricanes and landslips)
in Dominica, where such natural hazards are prevalent. The
children were also asked their views regarding sources of
information about the natural hazards investigated, and what can be
done to mitigate their effects. The data presented represent the start
of a 5-year prospective study, aiming to evaluate how young
people’s knowledge and attitudes develop over time, and
comparing a cohort of students from a range of schools in
Dominica given structured hazard education teaching as part of
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their Geography course with a matched control group of students
not taking Geography. Results to date have indicated that the
children have understood and engaged well with PRISM, and the
patterns of results support the validity of data obtained using
PRISM. Because PRISM is essentially non-verbal, it lends itself to
this project because data obtained using the PRISM measure are
less likely than interview methods to be distorted by the developing
verbalization and literacy skills of the students over the 5 years of
the project.
Stress and inflammation in pregnancy: relevance
for psychopathology in the mother and in the
offspring
Pariante CM
Institute of Psychiatry, Psychology and Neuroscience, King’s
College London, London, UK
Stress and depression in pregnancy increase the risk of the offspring
developing psychopathology in adolescence and young adults. For
example, our own research has shown that offspring of mother who
were depressed in pregnancy are more likely to develop depression
and antisocial behavior in adolescence and adulthood, and to be
exposed to additional life adversities. Interestingly, stress and
depression are also associated with increased inflammation, which
in turn may affect brain function and program the individual on a
trajectory toward future psychopathology. Consistent with this
notion, our data have shown that stress and depression in pregnancy
are associated with increased inflammation in mothers during
pregnancy as well as increased inflammation in the offspring.
Taken together, this evidence points at inflammation as a possible
biological mechanism transmitting the risk of psychopathology
from the mother to the offspring.
Body image and illness perception in cancer
patients
Pasternak A, Schier K
Faculty of Psychology, University of Warsaw, Warsaw,
Poland
Introduction: Cancer and cancer treatment can change a patient’s
appearance and their way of experiencing the body. There is
research demonstrating a link between the specificity of treatment
(e.g., surgery, chemotherapy) and the patient’s body image. The
aim of this study was to assess the relationship between a cancer
patient’s body image and their perception of their own illness.
Methods: A total of 226 patients diagnosed with cancer and
hospitalized in Polish hospitals participated in the study. The
following tools were used: the Multidimensional Body- Self
Relations Questionnaire (MBSRQ) designed to measure self –
attitudinal aspects of body image and The Revised Illness
Perception Questionnaire (IPQ – R) both of which assess illness
perceptions. Results: The results demonstrate a relationship
between illness perception and body image in terms of appearance
and body weight evaluation, as well as orientation towards fitness
and the illness itself. Illness perception consists of several factors
which appeared essential when taking into account the body image
of cancer patients. These include: illness identity, duration
(acute/chronic), timeline cyclicality, personal control over illness,
treatment control, and emotional representations of the illness.
Conclusions: Cancer can leave a permanent trace on the “body
self” of a person. By understanding the link between body image
and illness perception, the impact of body image changes can be
appreciated. Therapeutic work with cancer patients should include
work on illness representation as well as work on body image.
The Relationship between stress, personality and
acne vulgaris in adults
Peixoto MJ, Oliveira M, Costa AS, Timóteo S
Psychiatry Department, Clínica de Psiquiatria e Saúde
Mental do Centro Hospitalar de São João, Oporto, Portugal
Introduction: Acne vulgaris, one of the most prevalent skin
disorders, is characterized by inflammation of the pilosebaceous
follicle. There is a strong believe in the role of stress as well as
certain personality traits in the development of this disease in adults
and we aim to study this relationship. Methods: Papers about the
association between stress, personality, and acne vulgaris in adults
were searched using PubMed database. Results: The possibility of
a causal influence of emotional stress on the development or
exacerbation of acne vulgaris has long been postulated and studies
have demonstrated that a marked percentage of adults reported
worsening of lesions during stressful periods, however the
mechanisms underlying the triggering or exacerbation of acne by
stress remain unclear. On the other hand neurotic personality
features are observed more frequently in these patients. In one
study, patients with severe acne had higher trait anger than those
with milder forms of the disease, suggesting a cause-effect relation,
but in another study this association was not found. Authors
provide a brief illustrative case report. Conclusions: Acne may be a
cause of anxiety and stress in those who suffer from it, however
strong evidence is lacking for a causal association. Neuroticism and
trait anger appear more frequently in adult patients with acne
vulgaris. This review shows that adult patients with acne vulgaris
are experiencing a psychosomatic disease, and a better
understanding of the relationship between psycho-emotional-
personality-acne functioning could lead to a better knowledge of
pathogenetic mechanisms as well as treatment improvements.
Prevalence and correlates of depression amid
patients living with HIV infection
Pereira M
Faculty of Psychology and Educational Sciences, University
of Coimbra, Coimbra, Portugal
Introduction: Depression is one of the most common psychiatric
comorbidities of HIV infection and has been recognized as a
significant predictor of negative outcomes, such as decreased
adherence to antiretroviral therapy and impaired quality of life
(QoL). The purpose of this study was to assess the prevalence and
severity of depressive symptoms in a sample of HIV-infected
patients and to identify their sociodemographic and HIV-related
correlates. Methods: The sample of this prospective study
consisted of 1194 HIV-infected patients, recruited from 10
Portuguese hospitals. The Beck Depression Inventory (BDI) was
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used to assess the prevalence and severity of depressive symptoms.
Logistic regression was used to determine the sociodemographic
and HIV-related factors associated with risk of moderate-to-severe
depressive symptoms. Results: Symptoms of moderate-to-severe
depression (BDI score ≥ 17) in 462 patients (38.7%). In the
univariate analyses, the factors significantly associated with
increased likelihood of depressive symptoms were: gender,
education, unemployment, HIV stage, CD4+ T-cell count, time
since HIV diagnosis, other co-infections, and sexual activity. In the
multivariate model, female gender, advanced HIV stage, diagnosis
of HIV for longer time, presence of other co-infections, and not
being sexually active were independently associated with risk of
symptoms of depression. Discussion: This study shows that a
significant proportion of HIV-infected patients reported moderate-
to-severe depression symptoms. As depressive symptoms are often
under-diagnosed among these patients, a systematic screening of
depression and of its correlates is critical to decrease the risk of
non-adherence and to improve patients’ QoL and treatment
outcomes.
Does psychological distress differ between
younger and middle-aged and older women living
with HIV
Pereira M, Monteiro F, Canavarro MC
Faculty of Psychology and Educational Sciences, University
of Coimbra, Coimbra, Portugal
Introduction: Adults aged 50 years and older constitute an ever-
growing proportion of HIV cases worldwide. According to the
latest Portuguese report of HIV/AIDS (2014), middle-aged and
older adults represent 14.4% of all HIV cases, with about 26% of
new infections occurring in this population. Middle-aged and older
women represent 15.1% of all women living with HIV. The aim of
this study was to examine if psychological distress differs between
younger and middle-aged and older women living with HIV.
Methods: The sample of this prospective study consisted of 388
HIV-infected women, of which 63 (16.2%) were aged 50 years and
older. Participants completed the Brief Symptom Inventory (BSI)
and the Beck Depression Inventory (BDI). Results: Middle-aged
and older women were more likely to be less educated, widowed,
and to have other comorbidities; in addition, they were less likely to
be single, employed or currently working, to report sexual
transmission of HIV, and to be diagnosed for longer time than their
younger counterparts. Moderate-to-severe symptoms of depression
were observed in 170 women (43.8%). No significant differences
were found in the proportion of women reporting clinically
significant psychological distress (18.9% vs 10.8%) and severe-to-
moderate depressive symptoms (42.4% vs 50.8%). However,
middle-aged and older women reported significantly more somatic
symptoms of depression. Conclusions: This study shows that
middle-aged and older women do not differ substantially from
younger women in terms of psychological distress, although a
significant proportion of women reported moderate-to-severe
depression symptoms. Interventions that improve mental health in
HIV-infected women are increasingly needed.
Genetic vulnerability, alexithymia and depression in
patients with hepatitis C virus (HCV) during antiviral
treatment
Porcelli P1, Cozzolongo R2, Cariola F3, Giannuzzi V2,
Lanzilotta E2,4, Gentile M3, Sonnante G5, Leandro G2,6
1Psychosomatic Unit, IRCCS De Bellis Hospital, Castellana
Grotte, Italy
2Department of Gastroenterology 1, IRCCS De Bellis
Hospital, Castellana Grotte, Italy
3Medical Genetic Unit, IRCCS De Bellis Hospital, Castellana
Grotte, Italy
4Clinical Pathology Unit, IRCCS De Bellis Hospital,
Castellana Grotte, Italy
5Institute of Biosciences and Bioresources, Bari, Italy
6Department of Liver and Digestive Health, University College
of London, London, UK
Introduction: Depression triggered by treatment with an
exogenous inflammatory cytokine as interferon (IFN) is a
paradigmatic model for prospectively examining vulnerability to
depressive symptoms. For alexithymia, controversial were obtained
in investigating the functional gene polymorphisms in the serotonin
(5-HT) network regulating a variety of brain functions. To our
knowledge, no study investigated the associations between
alexithymia and gene polymorphisms regulating the availability of
brain 5-HT and their role in developing depressive symptom in
HCV patients undergoing antiviral treatment with IFN. Methods:
The functional gene variants of the 5-HT1A receptor (HTR1A), 5-
HT transporter (5-HTTLPR), and tryptophan hydoxylase-2 (TPH2)
and their role in IFN-induced depression were evaluated in 130
HCV patients. The 20-item Toronto Alexithymia Scale (TAS-20) at
baseline and the depression subscore of the Hospital Anxiety and
Depression Scale (HADS-D) during the treatment period were
used. Results: As expected, depressive symptoms increased during
the treatment period and decreased back to the baseline level at the
6-month follow-up evaluation, and the TAS-20 was significantly
associated to HADS-D. Analysis of co-variance (ANCOVA) for
repeated measures showed that the significant increase over time of
depression was due to the interaction between alexithymia and
baseline depression scores. Patients carrying HTR1A-G allele and
5-HTTLPR double long allele had higher levels of alexithymia.
After controlling for sociodemographic and disease-related factors,
alexithymia and HTR1A-G polymorphism, both separately (20-
22%) and jointly (14-16%), significantly and independently
predicted the development of IFN-induced depression, during and
after treatment. Conclusions: Two main findings were obtained by
this study. First, subjects with homozygosis for HTR1A-G and 5-
HTTLPR-l/l alleles showed higher vulnerability to alexithymia.
Second, HTR1A-G polymorphism interacted with alexithymia,
particularly the facets of difficulty identifying and describing
feelings, in explaining the expected increase of IFN-induced
depression in HCV-infected patients, controlled for socio-
demographic and HCV-related factors.
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Longitudinal course of depression, demoralization,
type A behavior and biological correlates in
patients with acute myocardial infarction
Rafanelli C, Gostoli S
Laboratory of Psychosomatics and Clinimetrics, Department
of Psychology, University of Bologna, Bologna, Italy
Introduction: Few studies have considered the longitudinal course
of depression and its association with biological correlates. The
objectives were: to evaluate the presence of current/past depression
(i.e., major/minor depression, dysthymia, demoralization) and type
A behavior in patients with a first episode of Acute Myocardial
Infarction (AMI); to identify specific subgroups of patients based
on current comorbidity and history of depression, associations with
blood parameters and stress biomarkers. Methods: One month
post-AMI, 84 patients were administered the structured interviews
for DSM and DCPR. Blood parameters (i.e., blood count and
glucose, serum electrolytes, lipid profile, creatinine, glycated
hemoglobin, PCR, PTT, PT, fibrinogen, d-dimer) and stress
biomarkers (DHEAs, urinary cortisol, epinephrine, and
norepinephrine) were recorded. Results: Risky levels of
homocysteine were associated with current minor depression (72%)
and demoralization (76%). Risky values of HDL and LDL
cholesterol were associated with current demoralization with
previous demoralization (HDL = 63.6%, LDL = 81.8%). Risky
levels of d-dimer were mainly found in patients with current minor
depression (81.3%), while those of urinary cortisol in both
demoralized patients with a positive anamnesis for demoralization
(76%) and depressed and/or demoralized patients with type A and a
positive history of depression (44.4%). A total of 5.3% of the
patients showed risky levels of epinephrine. They all presented with
both current and past depression. Conclusions: This study
highlights the usefulness of a clinimetric approach taking into
account the longitudinal course of clinical ad subclinical
depression. A positive anamnesis for depression/demoralization, in
fact, is associated with specific biological changes and allows the
identification of subgroups of patients at greater risk.
Allostatic overload among depressed patients, with
or without type A behavior, after acute coronary
syndrome
Rafanelli C1, Gostoli S1, Sirri L1, Guidi J1, Buzzichelli S2,
Abbate Daga G2, Roncuzzi R3
1Department of Psychology, University of Bologna, Bologna,
Italy
2Department of Neuroscience, University of Turin, Turin, Italy
3Division of Cardiology, Bellaria Hospital, Bologna, Italy
Introduction: The role of stress in the development of acute
coronary syndrome (ACS) is well-established. However, only few
studies clearly defined and investigated stress and its association
with depression and type A behavior. The objective was to evaluate
in depressed patients at their first episode of ACS: allostatic
overload (AO) and the association between AO and (current/past)
depression, with or without comorbid type A. Methods: One month
after ACS, 97 patients were administered the structured interviews
for DSM-IV-TR (i.e., major/minor depression, dysthymia) and
DCPR (i.e., demoralization, type A), Symptom Questionnaire,
Psychological Well-Being scales, and stressful life events format.
Results: A total of 16.5% of the total sample presented with AO,
women more often than men (28.6% vs 11.6%). A positive
anamnesis of depression was associated with AO more often than
that of demoralization (81.3% vs 56.3% of the total cases of AO).
Of the total sample with AO, 50% included patients with type A,
whereas 30.8% of the total cases of type A showed AO. A total of
23.3% of depressed patients presented AO, while 41.2% of
depressed patients with type A had AO; 17.4% of demoralized
patients presented AO, whereas 30.4% of demoralized patients with
type A showed AO. Similarly, the frequency of AO among patients
with comorbid depression and demoralization, increased from 26%
to 40% in the presence of type A. Conclusions: This study shows
that the presence of a dysfunctional lifestyle such as type A
behavior might increase AO in depressed and demoralized patients
with ACS, making their psychological, and physical clinical profile
more complex.
Assessment of allostatic overload in patients with
congestive heart failure
Rafanelli C1, Guidi J1, Roncuzzi R2, Offidani E1, Fava GA1,3
1Laboratory of Psychosomatics and Clinimetrics, Department
of Psychology, University of Bologna, Bologna, Italy
2Division of Cardiology, Bellaria Hospital, Bologna, Italy
3Department of Psychiatry, State University of New York at
Buffalo, Buffalo, New York, USA
Introduction: The precipitating role of emotional stress in the
development of congestive heart failure (CHF) has been well
established. However, there is paucity of studies in which stress has
been clearly defined and investigated. The aim of this study was to
evaluate the feasibility of the clinimetric criteria for allostatic
overload (AO) in a sample of CHF patients, with particular regard
to its associations with psychological distress and health status.
Methods: Seventy consecutive outpatients with CHF underwent an
ad hoc structured clinical interview for the assessment of
psychopathology (according to DSM-IV-TR) and psychosocial
syndromes (based on DCPR), and completed two self-rating
questionnaires for the assessment of stress and psychological
distress. Cardiac variables were also collected at intake. Results:
Mood and anxiety disorders were the most frequently reported
psychiatric diagnoses, whereas syndromes concerned with
abnormal illness behavior and irritability were predominant.
Twenty-three patients (32.9%) were classified as having AO.
Significant differences were found with regard to gender between
CHF participants with and without AO, with women being more
likely to report AO than men. Patients reporting AO presented also
significantly higher levels of psychological distress compared to
those who did not. Among cardiac risk factors, only hyperglycemia
was found to be significantly associated to the presence of AO.
Conclusions: These findings support the utility of the clinimetric
criteria for the assessment of AO in medical settings. These criteria
may thus be considered as a global index for identifying distress
manifestations that might adversely influence course and
progression of a medical disease.
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The effects of Pennebaker’s writing technique on
treatment success and alexithymia in couples
subjected to assisted reproductive treatment
Renzi A, Di Trani M, Solano L.
Department of Dynamic and Clinical Psychology, “Sapienza”
University of Rome, Italy
Introduction: WHO considers that 15-20% of couples suffer of
fertility problems. Aim of this study was to assess the effects of
Pennebaker’s writing technique on alexithymia and treatment
success (pregnancy) in couples subjected to an assisted
reproductive treatment (ART). Methods: Through randomization
54 women admitted for ART in a medical center were divided into
two groups: an experimental one, where women wrote for three
times about their deepest thoughts and emotions concerning the
infertility experience, and a control group where women did not
write. Women and men of both groups completed a socio-
demographic questionnaire and the TAS-20 before and after the
writing sessions. Results: Separated analysis for groups of men and
women were conducted. Regarding alexithymia, analysis showed a
significant reduction in the “Difficulty Identifying Feelings” score
(p < 0.01) in the group of women after writing. Reductions on
TAS-20 Total score (p = 0.06) and on the “Externally-Oriented
Thinking” score (p = 0.01) were also found in the group of men
whose wives wrote. After ART 8 successes in the experimental
group versus 4 of the control group were reported (p = n.s.). The
number of treatment successes of couples who refused to
participate in the study (n = 0) was compared with total success of
both experimental and control groups (n = 12) and a trend in the
expected direction emerged (p = 0.08). Conclusions: Findings
support the usefulness of writing technique in promoting emotional
awareness in ART treatment. No significant results were reported
for treatment success, probably because of small sample size.
Further data will be collected to support these preliminary results.
Cushing’s syndrome: more than physical impact
Ribeiro AM1,2, Peixoto MJ1, Oliveira M1, Costa A1,2, Coelho
R1,2
1Psychiatry and Mental Health Clinic, São João Hospital
Center, Porto, Portugal
2Department of Clinical Neurosciences and Mental Health,
Medical School of University of Porto, Portugal
Introduction: Cushing’s syndrome was first described by Harvey
W. Cushing in 1932, who was a pioneer in the psychosomatic
approach to endocrine disease. It results from chronic exposure to
excess glucocorticoids and classical clinical features include
specific physical signs and symptoms, but also psychiatric
disturbances, regardless of its etiology. For these reasons, patients
show functional impairment and reduced quality of life. Following
successful treatment, features of Cushing’s syndrome often
disappear. However, patients may present residual features and
persistence or even worsening of psychological distress upon
adequate endocrine treatment. We present a clinical case of
Cushing´s syndrome with psychiatric symptoms. Case description:
We report a case of a woman, with 48 years old, who presented
psychiatric symptoms some years before the diagnosis of Cushing’s
syndrome. She was referred to psychiatric appointment at the time
of diagnosis and was followed since then. After medical and
surgical treatment of Cushing’s syndrome, we could observe
psychiatric worsening, with the need for prompt psychiatric
intervention until clinical improvement. Comment:. With the
presentation of a clinical case of Cushing´s syndrome, we underline
the importance of psychiatric evaluation and intervention through
the illness course, even prior to the diagnosis, and until full
recovery is achieved. Moreover, multidisciplinary treatment of
Cushing’s syndrome can be more effective in improving patients’
quality of life.
Request of care in psychosomatic medicine and
ethical implications in the psychopharmacological
prescriptions
Riolo A1, Minutolo G2, Signorelli MS2, Aguglia E2
1Department of Mental Health of Trieste, Trieste, Italy
2University of Catania, Catania, Italy
Introduction: The psychosomatic occurrences alert general
practitioners, various specialists, and diagnostic systems. The
psychopharmacological prescription is one of the possible answers
but often the drug is prescribed for palliation or placebo, as
simulacrum of care, because of the lack of an organic cause. The
request of care is thus circumvented. Psychiatrists continue to
prescribe anxiolytics, antidepressants, or neuroleptics without
specific evidences, routinely, maybe off-label, regardless of the
ethical implications. Methods: To stimulate a discussion about a
very complex problem, we have examined, from 2010 to 2014 all
the prescriptions in a cohort of consecutive outpatients suffering
from psychosomatic disorders sent by general practitioners or other
specialists to medical district where some psychiatrists act. This
study concerns 40 cases out 250 patients referred. We try to find a
rational or the sense of various prescriptions for a population
without organic causes demonstrated that accepted a psychiatric
examination and a psychopharmacological therapy, without enough
awareness. Results: Psychiatrists tend to confirm or replace those
already prescribed with other molecules, but prefer an integrated
approach about psychological medicine. However, they are not
likely to understand the problem of drugs in a prescriptive ethical
view. Conclusions: In the field of psychosomatic medicine,
perhaps, there is an ethical attention less than severe mental
disorders about psychopharmacological prescriptions. The role of
psychiatrists should be to avoid unnecessary diagnostic test (TAC
or RMN) and unnecessary prescriptions. The discussion is open.
Midwifery: A complex intervention to reduce stress
in childbirth?
Ross-Davie M
NHS Education for Scotland, UK
Introduction: The Lancet series on Midwifery identified the
central role of midwifery in ensuring high quality maternal and
neonatal care in high, middle and low-income countries. Cochrane
Library systematic reviews of the evidence demonstrate the
significant impact of midwife-led continuity models of care and
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continuous support during labor on a range of birth outcomes.
Government policy throughout the UK supports the provision of a
named midwife for every woman during her childbirth journey. The
reality of care is far from this, with the majority of women not
knowing the midwife who cares for them in labor and rarely seeing
the same midwife through their antenatal care. The aim of the
present research was to explore the evidence for the hypothesis that
midwifery is a complex intervention with the potential, when
implemented in line with best evidence, to significantly reduce
stress in childbirth. Methods: A review of the current evidence and
a description of an observational study undertaken in four maternity
units in Scotland to measure the impact of the quantity and quality
of intrapartum support. Results: Continuity of midwifery care has
been found to have a very positive impact in a wide range of
quantitative and qualitative studies on a wide range of birth
outcomes, including women’s experience. Conclusion: High
quality midwifery care, including continuity models of care, should
be consistently implemented across NHS maternity services in the
UK.
Readiness to experience chronic pain as part of
satisfaction with clinical treatment in relation to
five personality factors
Rus Makovec M1, Vintar N2, Makovec S3
1University Psychiatric Hospital Ljubljana & Medical faculty
Ljubljana, Ljubljana, Slovenia
2University Clinical Centre Ljubljana, Clinical Department of
Anesteziology, Ljubljana, Slovenia
3Medical faculty Ljubljana, Ljubljana, Slovenia
Introduction: Readiness to suffer the highest pain and
simultaneously be satisfied with its treatment is one of the basic
practical aspects of the treatment of chronic pain. Methods: A
questionnaire with 228 variables was applied to 109 random chosen
patients who were treated at outpatient pain clinic of the University
Clinical Centre Ljubljana (May - June 2013). A total of 87 patients
responded the questionnaire (79.8%). The five BFI (Big Five
Inventory) personality factors were taken into account as dependent
variables (i.e., extrovertism, agreeableness, consciousness,
neuroticism, openness); level of depression (Zung) and level of
anxiety (Zung) were treated as covariates in the framework of
multivariate analysis of variance. Independent variable was the
evaluation of the highest pain, which respondent is ready to suffer
and to be satisfied with the treatment at the same time. Primary 11-
point scale from 0 to 10 (maximal pain) was recorded into 3-point
scale. Results: Average age of participants was 52.7 years (SD
13.9), 70.9% of subjects were female and 29.1% males. Significant
multivariate differences in set of dependent variables and of
covariate measuring self-evaluated depression were found.
Regarding three levels of the independent variable, the significant
difference in factor BFI “agreeableness” is particularly expressive
on univariate level. For other personality factors, the null
hypotheses were accepted. The BFI factor “openness” is a variable
with relatively strong predictive value. Conclusions: the results of
the research show the need to take also the personality factors into
account in treatment of chronic pain.
Cluster analysis of dignity therapy
Ryo S, Chihiro M, Airi S, Fumihiko T, Yoichi O, Atsuko K
Department of Medical Oncology, Division of Psychosomatic
Medicine, Faculty of Medicine, Kinki University
Introduction: Patients in the end stages of cancer often experience
spiritual pain. Dignity therapy (DT) is reportedly effective in many
such patients. However, the medical records of patients who have
undergone DT have not been previously analyzed. We used cluster
analysis to analyze the medical records of patients who underwent
DT in our department. The records of two or more patients who
underwent DT were analyzed in the cluster, and the differences in
the content of the DT records were assessed. Methods: This study
included 3 patients who underwent consultation and DT at the
palliative care departments of the Department of Medicine, Kinki
University Hospital from April 2013 to March 2014. Cluster
analysis was performed using the patients’ DT records and KH
Coder software. Results: DT was classified into four categories:
“role, I, adult, friend, and brought up a child”, “importance,
consultation, and money”, “health, marriage, and hobby”, and
“family, feelings, child, and life”. Important aspects of DT for
families were an adult role that includes oneself, especially a role in
bringing up a child; consultation regarding money; and hobbies that
center on health and married life, the event accomplished by
feelings especially to the child. Conclusions: Focusing on these
aspects of DT may help to reduce the spiritual pain felt by patients
with end-stage cancer.
Relationship between interpersonal tension and
social life of socially withdrawn young Japanese
people (Hikikomori)
Saito M1, Homma E2, Naito M1, Tanabe S1, Sato T2
1Department of Nursing, Niigata Seiryo University, Niigata,
Japan
2Department of Clinical Psychology, Graduate School of
Clinical Psychology, Niigata Seiryo University, Niigata, Japan
Introduction: Socially withdrawn young Japanese people
(Hikikomori) often have difficulty in smoothly performing social
actions due to experiencing strong interpersonal tension. In this
study, we investigated the relationships between social anxiety
disorder (SAD) in Hikikomori and its effects on their social life.
Methods: We performed a questionnaire-based survey concerning
SAD and social activities with 43 Hikikomori attending a
rehabilitation facility fostering “a place of being” (ibasho) and
investigated the correlation between these two items. Results:
“Participation as a volunteer” and “going out for shopping and
hobbies” were found to be weakly negatively associated with
avoidance behavior in daily life. In addition, overall SAD was
found to be negatively associated with social life in Hikikomori
undergoing treatment. Further, especially for ibasho, a negative
association was observed with sites where the Hikikomori
interacted with staff such as “conversing with staff” and “doing
activities together with staff”. Conclusions: Our conclusions
suggest that Hikikomori can reduce their avoidance behavior by
going out to pursue volunteer, shopping, or hobby-related activities
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while having social resources for supporting ibasho. Our results
also suggest that, for Hikikomori undergoing treatment, the
promotion of social activities, particularly in relation with staff at
their ibasho, might be linked with a reduction of their interpersonal
tension.
Disrupted white matter integrity in anterior corona
radiata of patients with anorexia nervosa
Sato Y1, Aizawa E2, Sekiguchi A3,4, Kotozaki Y5, Sugiura M4,
Taki Y3,6, Hashizume H4, Kochiyama T7, Kawashima R4,
Fukudo S1,8
1Department of Psychosomatic Medicine, Tohoku University
Hospital, Sendai, Japan
2Department of Mental Disorder Research, National Center of
Neurology and Psychiatry, Tokyo, Japan
3Department of Community Medical Supports, Tohoku
Medical Megabank Organization, Tohoku University, Sendai,
Japan
4Department of Advanced Brain Science, Smart Ageing
International Research Center, Institute of Development,
Aging and Cancer Tohoku University, Sendai, Japan
5Devision of Clinical Research, Fukushima Medical
University, Fukushima, Japan
6Division of Developmental Cognitive Neuroscience, Tohoku
University Graduate School of Medicine, Sendai, Japan
7Primate Research Institute, Kyoto University, Kyoto, Japan.
8Department of Behavioral Medicine, Tohoku University
Graduate School of Medicine, Sendai, Japan
Introduction: Patients with Anorexia Nervosa (AN) show
structural change in the brain such as atrophy. Although white
matter of AN patients has been evaluated with Diffusion Tensor
Imaging (DTI) technique, results were inconsistent and
inconclusive. Methods: A total of 19 AN patients (14 restrictive
type and 5 binge-purge type) and 22 healthy controls (HC) were
participated in this study. All were female and right-handed. This
study was approved by the Ethics Committee of Tohoku University
Graduate School of Medicine. Images of all participants were
acquired with 3.0 T MRI scanner. Fractional Anisotropy (FA) was
calculated and compared between two groups. Results: There was
no difference in age between AN patients (20 ± 4 years) and HC
(19 ± 2 years). Body Mass Index of AN patients (14.4 ± 1.9 kg/m2)
was lower than that of HC (20.0 ± 1.5 kg/m2) (two sample t-test, p
< 0.01). Eating Attitude Test (EAT)-26 of AN patients (19.5 ±
15.9) was lower than that of HC (6.4 ± 5.7 kg/m2) (p < 0.01). FA in
the anterior corona radiata and corpus callosum were significantly
lower in AN patients than in HC. Conclusions: Anterior corona
radiata is a component of the limbic-thalamo-cortical circuit, which
plays an important role for cognitive and emotional regulation.
Disrupted white matter integrity in anterior corona radiata of
patients with anorexia nervosa may be relevant with the onset and
maintenance of the disease.
Involvement of hippocampus in chronic fatigue
syndrome
Saury JM
ME/CFS rehabilitation unit, Danderyd University Hospital,
Stockholm
In this presentation, we concentrate on the role of the hippocampus
in the development and perpetuation of chronic fatigue syndrome
(CFS) and attempt to show that this focus provides an
understanding of some puzzling facets of patients’ difficulties to
follow treatments and improve and guide us in the need for
rehabilitation strategies. New knowledge of hippocampal function
has shown that impairment not only disturb the capacity to encode
and retrieve new events but also the ability to navigate in the
environment, to think forward, to imagine new scenarios, and make
predictions about the future. The hippocampus is also an important
actor in the regulation of stress and chronic stress has a detrimental
effect on its integrity and on neuroplasticity. There are several co-
morbidities in CFS associated with defective function of the
hippocampus formation, namely subjective memory impairments,
one of the most common complaints of patients with CFS,
infections and inflammation, especially if they are chronic, are
detrimental for the functional integrity of the hippocampus. Chronic
stress, one of the main active components of CFS, is known to
affect the hippocampal regulation of the hypothalamic-pituitary-
adrenal (HPA) axis. There is also a connection between inactivity,
which is a major consequence of the illness, and neurogenesis in the
hippocampus. Sleep disturbances and the presence of depressive
thoughts are also known to affect the hippocampus. We discuss the
implications of these results for the rehabilitation of patients with
chronic fatigue syndrome.
Changes in self-reported symptoms of depression
and physical wellbeing in healthy individuals
following a Taiji beginner course – Results of a
randomized controlled trial
Schitter AM1, Nedeljkovic M1, Ausfeld-Hafter B1, Fleckenstein
J1,2
1University of Bern, Institute of Complementary Medicine
IKOM, Bern, Switzerland
2Goethe-University Frankfurt, Department of Sports Medicine,
Institute of Sports Medicine, Frankfurt, Germany
Introduction: Taiji is a mind-body practice being increasingly
investigated for its therapeutic benefits in a broad range of mental
and physical conditions. The aim of the present study was
to investigate potential preventive effects of Taiji practice in
healthy individuals with regard to their depressive symptomatology
and physical wellbeing. Methods: A total of 70 healthy Taiji
novices (mean age 35.5 years) were randomly assigned to a Taiji
intervention group, i.e. Taiji beginner course (Yang-Style Taiji, 2
hours per week, 12 weeks) or a waiting control group. Self-reported
symptoms of depression (CES-D) and physical wellbeing (FEW-
16) were assessed at baseline, at the end of the intervention, as well
as two months later. Results: Physical wellbeing in the Taiji group
significantly increased when comparing baseline to follow up
(FEW-16 sum scale T(27) = 3.94, p = 0.001, 95% CI 0.17 - 0.55).
Pearson’s correlation coefficients displayed a strong negative
relationship between self-reported symptoms of depression and
physical wellbeing (p’s < 0.001, r‘s ≥ -.54). Conclusions: In this
randomized controlled trial we found significant evidence that a
Taiji beginner course of three months duration elicits positive
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effects with respect to physical wellbeing in healthy individuals,
with improvements pronouncing over time. Physical wellbeing was
shown to have a strong relationship with depressive symptoms.
Based on these results, the consideration of Taiji as one therapeutic
option in the development of multimodal approaches in the
prevention of depression seems justifiable.
The effect of sleep deprivation on pain perception:
A meta-analysis
Schrimpf M1, Liegl G1, Boeckle M1, Geisler P2, Leitner A1,
Pieh C1,3
1Department of Psychotherapy and Biopsychosocial Health,
Danube-University Krems, Krems, Austria
b Department of Psychiatry and Psychotherapy, University
Hospital Regensburg, Regensburg, Germany
c Department of Psychosomatic Medicine, University Hospital
Regensburg, Regensburg, Germany
Introduction: There is large evidence for an interaction of sleep
and pain. However, the size of this effect and thereby the clinically
relevance is vague. We conducted a meta-analysis to quantify the
effect of sleep deprivation on pain perception. Methods: PubMed,
Cochrane, Psyndex, PsycInfo, and Scopus was searched for Sleep
AND pain AND (“sleep restriction“ OR “sleep deprivation“ OR
“sleep loss” OR “sleep interruption” OR “hyperalgesia” OR “total
sleep deprivation” OR “partial sleep deprivation” OR sleep
fragmentation”). Studies were included that investigated 1. sleep
deprivation (total or partial) or sleep restriction and 2. pain (any
kind of pain measurement, e.g., VAS or pain threshold). Results:
Five eligible studies (190 subjects) for the between-group analysis
and 10 studies (266 subjects) for the within-group analysis were
identified. Sleep deprived conditions showed a medium effect to
non-sleep deprived conditions in the between group analysis (SMD
= 0.62 95% CI 0.12 - 1.12; z = 2.43; p < 0.05) and a large effect in
the within-group analysis (SMD = 1.49 95% CI 0.82 - 2.17; z =
4.35; p < 0.0001). Test for heterogeneity was not significant in the
between-group analysis (Q = 5.29; df = 4; p = n.s.) and significant
in the within-group analysis (Q = 53.49; df = 9; p < 0.0001).
Conclusions: This meta-analysis confirms the effect of sleep
deprivation on pain perception. A medium effect (SMD = 0.62) was
found for the between group analysis and a large effect (SMD =
1.49) for the within group analysis. Although this meta-analysis is
based on experimental studies, a medium to large effect on pain
perception seems clinically relevant.
The influence of psychotherapy on the outcome of
patients with rheumatoid arthritis – A case study
Schueler-Schneider A
Frankfurt, Germany
Introduction: The effectiveness of a psychoanalytic psychotherapy
in the treatment of rheumatic diseases is clearly illustrated by the
case at hand. Case description: A today 58-year-old Turkish
patient was treated in 1987 at a psychosomatic ward in Frankfurt
for the first spurt of chronic polyarthritis. Severe pain in the fingers
and wrists with radiological changes, max. ESR, RF, and CRP
confirmed the diagnosis. She could no longer work in her
profession as a precision engineer. The 6-month hospitalization
included three sessions per week psychoanalysis, physical, and
antiphlogistic therapy. The basic therapy with gold and
methotrexate had to be cancelled due to incompatibility. The
trusting doctor-patient relationship corresponded to the good father-
daughter relationship. The patient had lived 11 years in Germany
and married a German one year before the admission to the hospital
without their parents' knowledge. She feared that she would
therefore be expelled from the Turkish family. After solving the
conflict, the journey was prepared despite pain symptoms. The
patient returned after six weeks without symptoms. The parents
accepted the marriage which is still in existence today. She takes
antiphlogistics occasionally and travels annually to Turkey for a spa
treatment. A rheumatoid thrust has never reoccurred. Comment:
Chronically rheumatic diseases often (20% to 91%) associates with
anxiety- and depression disorders. Only medical treatment leads to
a better outcome, improves the quality of life and reduces the
treatment costs. In many cases there is no psychotherapeutic
treatment. There should be further research into the reasons for this.
Do patients in rehabilitation with adjustment
disorder differ from patients with depression while
and after psychosomatic rehabilitation?
Schweiberer D1 2, Neu R1, Köllner V1 2
1Department for Psychosomatic Medicine, Mediclin
Bliestalkliniken, Blieskastel, Germany
2Faculty of Medicine, Saarland University, Homburg/Saar,
Germnay
Introduction: Adjustment Disorders (AD) are often used as a
residual category of diagnosis. Especially relating to job strain AD
are often used in context with the experience of burnout or
mobbing. We observed whether patients with AD differ from those
with depression. Methods: A total of 100 patients in
psychosomatic rehabilitation, treated on a special station for
workplace related strain (71 female/ 29 male; age 49.84 ± 8.73
years), attended this study. Seventy-three achieved the criteria of a
depressive disorder, 23 of AD. To measure psychiatric symptoms
we used Health-49, BDI-II, and Burnout-Screening-Scales I-III
(BOSS I-III) which detect job strain, somatic disorders, and
resources, at admission of rehabilitation (T0), at discharge (T1), and
six month after discharge (T2). Results: Patients with AD showed
at T0 and T1 less strain than patients with depressive disorder. Both
groups could benefit from the psychosomatic rehabilitation in the
same degree despite of the different base levels. Relating to the
inability to work both groups did not differ at any time. Those who
were inability to work decreased from 45% at T0 to 9.5% at T2.
Conclusions: Patients with AD have as expected less
psychopathology strain at T0 and T1 than patients with depressive
disorders. Regarding the state of employment both groups are
similar strained and both groups benefit equal and lasting from the
psychosomatic rehabilitation. Future studies should research
whether patients in psychosomatic rehabilitation with AD have
more specific strains and whether they need the same treatment in
rehabilitation as patients with depressive disorders.
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PRISM, a novel visual metaphor measuring
personally salient appraisals and attitudes
Sensky T
Centre for Mental Health, Department of Medicine, Imperial
College London, London, UK
PRISM (the Pictorial Representation of Illness and Self Measure)
was discovered by serendipity to measure suffering. PRISM is
essentially non-verbal, and the instructions for its use are brief and
simple, and almost always understood without further explanation.
It can be completed very rapidly. Of the publications reporting data
using PRISM, the majority have focused on applying PRISM to
measure and describe suffering. However, novel applications of
PRISM have also been reported, including assessing the attitudes to
alcohol of problem drinkers, perceived support among people
subjected to political turmoil, and stress among anesthetists. The
performance of PRISM in these apparently diverse applications can
be explained by its properties as a visual metaphor of the
relationship of object(s) (e.g., “my illness” or “my medical
treatment”) to a subject (e.g., “myself”) in a defined context (e.g.,
“my life at the moment”). Adequate and appropriate definition of
subject, object, and context are crucial to the successful use of
PRISM. Like all metaphors, it is presented to participants in a
deliberately imprecise manner, and to complete the PRISM task,
participants have to apply their own understanding and attitudes.
Because of this, and in contrast to questionnaires, PRISM yields
data, qualitative as well as quantitative, which are personally salient
to each participant. Because of its properties as a visual metaphor,
and its combination of qualitative and quantitative methods, PRISM
is likely to have wide applications in assessing beliefs, attitudes,
and decision-making, including as a person-centered outcome
measure in healthcare.
Interplay between depression and sleep in general
and specifically in medical conditions
Shapiro CM
Department of Psychiatry, University of Toronto, Toronto,
Canada
The interplay of sleep and depression has been appreciated for
centuries. That this interaction is a reciprocal one has gained
credence recently and this has been explored particularly in relation
to insomnia and sleep apnea. At this point in time, we appreciate
that the odds ratio for having depression in patients with sleep
apnea is higher than any of the widely recognized clinical features
of sleep apnea and in treatment resistant depression, rates of apnea
are up to 70%. A resolution of treatment resistant depression occurs
in half of those with apnea when treatment for sleep apnea is
initiated. If hypothetically 20% of all patients with PTSD had
hypothyroidism we would be testing the thyroid function in all
PTSD patients. We have reached that point vis-a-vis the interplay
of sleep apnea and depression and with the new and surprisingly
wise approach of DSM5 the same applies with insomnia. In many
medical conditions (e.g., diabetes, cardiac arrhythmia and
glaucoma) there are very high rates of sleep apnea which may be
factors in causing depression. Finally, we found a method to use
sleep macro and micro-architecture markers to detect depression
and this biological tool may help to titrate treatment, predict
suicidal behavior and decrease stigma of depression.
Pathological grief and suicide bereavement: cases
from clinical psychiatry in Japan.
Shimizu K
Department of Psychiatry, Jichi Medical University, Tochigi,
Japan
Introduction: Per head of population Japan ranks 13th in the world
suicide table and each year about 30000 people commit suicide.
Suicide is an act with an enormous impact on the family of the
deceased. We present 2 cases of bereavement by suicide leading to
mental illness. Case description: The first case is a woman in her
60’s whose husband, a company manager, committed suicide while
she was in hospital for a physical disease and was thus apart from
her spouse at this critical time. After her discharge she was busy
dealing with the aftermath of his death with no time to mourn, and
after completing the formalities concerning his death, she suddenly
developed panic disorder and underwent psychiatric treatment. The
second case is a woman in her 50’s who lost her daughter by
suicide. After her daughter’s death, she had to care for her husband
who was suffering from terminal cancer. Upon his death, she
presented such symptoms as numbness of the lower body and after
visiting hospital was finally seen by a psychiatrist. Comment: The
two cases have certain common features namely the process of
mourning is frozen with strong feelings of guilt, and they are unable
to describe the deaths as suicide to other people. Their pathology
seems to be complicated grief which is proposed in DSM-5. We
examine the pathological grief of the suicide bereaved from the
view point of clinical psychiatry and also in relation to the cultural
background and social situation of Japan.
Development of Teachers’ Job Adaptation Model
with resilience as a mediator variable
Shimizu Y
International Christian University, Tokyo, Japan
Introduction: The number of reported teachers’ mental illness has
steeply increased in the last two decades in Japan and over 5000
teachers has left their job because of their illness every year since
2007. The hypothesis of this study is that psychological resilience
is one of the crucial keys to teachers’ coping with stress. The aims
were to develop Teachers’ Specific Resilience Assessment Scale
(TSRAS) and to examine the hypothetical model based on TSRAS,
School Job Adaptation Scale (SJAS), and Teachers’ Stressor
Inventory (TSI). Methods: The subjects of 412 school teachers
(mean age: 45.15, SD: 9.58) were asked to answer a questionnaire
composed of question items about teachers’ resilience, school job
adaptation and teachers’ stressors. Exploratory and confirmatory
factor analyses and reliability analyses were conducted to develop
TSRAS. Structural covariance analysis was employed to examine
the hypothetical model. Results: The results yielded a 4-factor
model for TSRAS. The structural validity and Cronbach’s alpha
reliability of TSRAS were statistically acceptable. The
hypothetical structural equation model showed that the pass
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coefficient from TSI to SJAS via TSRAS is significantly smaller
than the direct pass coefficient from TSI to SJAS. Conclusions:
The results above suggest that teachers with a high degree of
resilience have a low risk of maladaptation. This implies that
appropriate psychological interventions to promote their resilience
(e.g., enhancing the positive coping style and cognitive
modification) can help teachers to better adapt to their workplace
and prevent their burnout.
The effect of self-help cognitive behavior therapy
program on psychological factors for Japanese
healthy workers
Shirotsuki K1, Nonaka Y2, Abe K2, S, Adachi3, S, Adachi3, T,
Kuboki4, & Nakao, M5.
1Faculty of Human Sciences, Musashino University Tokyo,
Japan
2Innovation Development Department, Suntory Global
Innovation Center Limited, Osaka, Japan.
3Medical corporation So-bun-kai, Clinic Adachi, Gifu, Japan
4Professor Emeritus, Tokyo University, Tokyo, Japan
5Department of Psychosomatic Medicine, Teikyo University
Hospital, Tokyo, Japan
Introduction: Self-help Cognitive Behavior Therapy (CBT) is a
useful approach for the treatment of psychological problem.
Previous studies showed that self-help CBT approach has moderate
effect on the improvement of depression, insomnia, and anxiety.
Present study examined whether supplement drink enhance the
effect of self-help CBT on psychological values. Methods: Eighty-
seven participants were randomly allocated to control group (n =
29), self-help CBT group (n = 29), and self-help CBT with
supplement drink group (n = 29). CBT group and CBT with
supplement drink group received 6 weekly self-help CBT program,
consisted of psycho-education of stress management, behavior
activation, and cognitive restructuring. Present program was
delivered by e-learning system on demand and self-help guidebook.
The Japanese version of Profile of Mood Scale (POMS) was
administered before and after the program. This study was
approved by the Institutional Review Board of Suntory Ltd.
Results: Finally, 72 participants completed the program (control
group: n = 23; CBT group: n = 25; CBT with supplement drink
group: n = 24). Differences among three groups of all measures
were examined using ANOVA. The results showed that there were
significant interaction on the POMS tension-anxiety (F(2,
69)＝3.04，p = 0.05) and fatigue (F(2, 69) ＝ 5.01，p < 0.01).
Post hoc tests revealed that CBT group significantly improved on
tension-anxiety (p < 0.05) and CBT with drink group significantly
improved on fatigue (p < 0.01).Conclusions: The results showed
that self-help CBT program improved tension anxiety.
Additionally, supplement drink enhanced self-help CBT effect on
fatigue. These findings suggested the points of improvement on
self-help CBT program.
Patient profile for management of pediatric
dental/needle phobia - a retrospective audit
Simpson CD1, Campbell C2
1University of Glasgow, Glasgow, UK
2Glasgow Dental Hospital and School, Glasgow, UK
Introduction: Various management strategies exist for treating
dental phobic and/or needle phobic pediatric patients, including
needle desensitization (ND) plus relaxation, hypnosis, The Wand
STA system, Cognitive Behavior Therapy (CBT) and psychology
referral. The aim of this audit was to establish a profile of patients
for whom dental treatment was completed. Methods: Case records
for 30 dentally phobic patients in GDH&S were selected.
Information was recorded on patient demographics, MCDASf
(Faces version of the modified children’s dental anxiety scale)
scores, anxiety etiology, patient information seeking/blunting and
management strategy. Results: Twenty four case records were
evaluated. Demographics: 58% female, median age 13, 79% ASA I,
92% high caries risk. Anxiety: median MCDASf was 33.5, etiology
medical needle phobia 46%/ dental needle phobia 62%, (not
recorded 21%), 25% information seeking. Of patients treated
successfully, the following treatment modalities were used: ND
(with relaxation) in 50% of cases, hypnosis 31%, The Wand 81%,
CBT in 25%, and psychology referral 25%. Conclusions: Many
dentally phobic adolescents present with needle phobia and almost
half also have a medical fear of needles. A combined approach,
with more than one management strategy used was evident in this
group. The wand STA system and ND (with relaxation) were
effective with CBT and hypnosis. Children were referred to
psychology services and a quarter of patients benefitted from this.
From the small pilot sample evaluated a complete data set was not
always documented. A standardized assessment sheet has now been
introduced and this will help in future audit and database
management.
Guidelines for utilizing psychopharmacotherapy
for primary care patients with psychosomatic
disorders
Singh AN
Department of Psychiatry, Pharmacology, Toxicology &
Neurosciences, Queen’s University, Kingston, Ontario,
Canada
Introduction: Patients suffering from psychosomatic disorders
constitute a formidable portion of primary care. One of the main
armaments for the management of these patients is
psychopharmacotherapy. Because of an increase of
psychopharmacological agents, it has become important to follow
guidelines that can help patients suffering from one or multiple
disorders. Methods: The ideal goal of the guidelines should be
optimal therapeutic benefit with minimal adverse reactions.
Gathering information on target symptoms and formulating the
correct diagnosis is the first vital step of utilizing
psychopharmacotherapy. Monotherapy as a management tool is the
ideal choice, although polytherapy can become necessary for
satisfactory management. Results: Psychopharmacotherapy in
psychosomatic disorders comprises the following groups of
medications: anti-depressants, anti-anxiety agents, hypnotics, anti-
psychotics, anti-migraine agents, and other miscellaneous groups of
medications. Compliance of medications and education for patients
about managing the adverse reactions of short or long term duration
are very helpful. Potential for toleration and drug abuse as well as
pharmacokinetic and pharmacodynamics based drug-to-drug
interaction with psychotropic drugs should always be taken into
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account. In order to provide total therapy, psychopharmacotherapy
should be combined with medications for managing physical
disorders and with Oriental or Western psychotherapies, or the
combination of both. Conclusions: The management of patients
suffering from psychosomatic disorders in primary care is complex
and usually needs health services based on total care based on a
research paradigm. At present, management is less than optimal.
Thus, extensive research activities are needed to improve
therapeutic results and the quality of care.
Behavioral Intervention Team (BIT) Study: results
from the two-year implementation of a Proactive CL
Psychiatric Service at the Yale New Haven Hospital
Sledge WH, Lee HB
Department of Psychiatry, Yale University School of
Medicine, New Haven, Connecticut, USA and Yale-New
Haven Hospital, New Haven, Connecticut, USA
Introduction: Mental illness correlates with an increased length of
stay (LOS) for patients hospitalized for medical conditions. While
psychiatric consultations help manage mental illness among those
hospitalized for medical conditions, consultations initiated by non-
psychiatric mental health practitioners may lack maximum
effectiveness. Methods: With a before-and-after design and in 3
contiguous years, LOS for internist-initiated, conventional
psychiatric consultation (CC) as usual treatment was compared to
LOS of a proactive, mental health professional-initiated,
multidisciplinary intervention delivered by the behavioral
intervention team (BIT) on the same hospital nursing units. The
patient populations included general medical patients with a variety
of illnesses. Patients were treated in these 3 different inpatient
settings with a total capacity of 92 beds serving 15,858 patient
visits over 3 comparison years. BIT was comprised of a
psychiatrist, a nurse, and a social worker, each of whom performed
the specific tasks of their professional discipline, while
collaborating among themselves and their health-care colleagues.
BIT provided timely, appropriate, and effective patient care in
addition to consultative advice and education to their corresponding
professional peers. BIT was compared to CC on the outcome of
LOS. Results: There was a statistically significant reduction of
LOS favoring BIT over CC for patients with an LOS of <31 days
which persisted while controlling for multiple co-morbid factors.
Also, a statistically significant spillover effect was suggested by the
overall improvement of LOS on units implementing
BIT. Conclusions: BIT is a promising means of lowering LOS on
general medical units while providing a high level of care and staff
support and it is economically cost effective when compared to
CC.
Biopsychosocial reasons of premenstrual
syndrome among young women
Smotrycka A, Kulik A
Department of Psychotherapy and Health Psychology, The
John Paul II Catholic University of Lublin, Lublin, Poland
Introduction: Premenstrual syndrome is a group of psychological
and physiological symptoms (e.g., irritability, anxiety, depressed
mood, breast tenderness, headaches) which start before period and
stop within a few days of bleeding. Symptoms interfere with
different fields of life, like work efficiency, relationships, or social
life. The aim of this study was to find biopsychosocial reasons of
premenstrual syndrome which is an important problem of many
women. Methods: Participants were 154 young women: 82 patients
with PMS or PMDD, measured by the premenstrual symptoms
screening tool (PSST) and 72 controls without diagnosis. The
patients and controls answered the questionnaires concerning the
personality (NEO-FFI), the temperament (PTS), the negative
emotions (TPI), and the social approval (KAS - Social Approval
Questionnaire). Results: Patients had significantly higher
neuroticism and negative emotions and lower strength of excitation
and mobility of neural process than controls. The result of using a
stepwise regression revealed that the most significant reasons of
premenstrual syndrome are neuroticism and depression.
Conclusions: The knowledge of PMS reasons should enable to
improve the treatment of premenstrual syndrome and rise women's
quality of life.
The family physician and the psychologist together
in primary care: an effort towards integration
Solano L, Di Trani M, Ferri R, Renzi A
Department of Dynamic and Clinical Psychology, University
“Sapienza”, Rome, Italy
Introduction: About 50% of requests brought to family physicians,
though expressed as physical symptoms, often derive from
relational/existential problems: seldom, however, is the physician in
a condition to meet this demand adequately. Differentiation of
models between medicine and psychology makes co-operation
through referral to a psychologist quite problematic. Acceptance of
psychological referral is in any case difficult, due to the social
stigma that still surrounds contact with mental health operators.
Methods: An experience implemented by the postgraduate Health
Psychology School of the Rome University ‘Sapienza’, entails
joint, direct co-operation between primary care physicians and
psychologists during consultations. Such an arrangement allows
access to a psychologist’s listening and intervention in the absence
of any filter and without the need for a formal request on the
patient’s part, so overcoming the fear of social stigma. In a small
number of cases, more formal consultation with the psychologist is
proposed. This setting allows exploration of the meaning of any
complaint brought by patients in the context of the individual’s past
and/or present relational situation, in a very early phase. Results:
The experience, beginning in 2000, has until now involved 18
psychologists for a period of 3 years each: it appeared as entirely
feasible, though requiring several months for adaptation; patients
have welcomed the presence of the psychologist and, took a
broader approach in reporting their distress. In two cases where
data were available, a substantial (17% and 14%) reduction of drug
prescription on part of the physician was recorded. Illustrative
clinical vignettes will be presented.
"I tried to get a bug out of my ear": a case report of
a patient with delusional parasitosis
Spariosu M, Coira D
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Hackensack University Medical Center, Hackensack, New
Jersey, USA
Introduction: Primary or secondary delusional parasitosis is a
phenomenon that often has a clear and memorable presentation. We
are reporting a case of one patient with delusions of parasitic
infestation, with history of stimulant (i.e., amphetamines and
cocaine) use disorder and diagnosis of schizoaffective disorder,
who self-inflicted a trauma to his ear by attempting to remove "a
bug". Case description: The patient is a 52-year old man who
presented to the emergency department for right ear pain due to
laceration. Pt was picking at his right ear with various instruments
because he felt like "bugs were in his ear”. He complained of a 2-
week history of infestation resulting in bites all over his body.
Patient appeared disheveled and had multiple skin ulcers, scabs,
and scratches on the extensor surfaces of his arms, the front of his
shoulders, and the anterior surfaces of his thigh and leg, with an
increase in frequency on his left side. There were no lesions on the
medial surfaces of his arms, posterior surfaces of his legs, chest,
abdomen, or back. Patient was evaluated by infection disease
physician and no signs of infestation were identified. During
psychiatric hospitalization patient was treated with antipsychotics
and his symptoms resolved within one week. Comment: Patients
with delusions of parasitic infestation might cause significant self-
mutilation during the attempts to remove “a parasite”, therefore a
prompt diagnosis trough a multidisciplinary approach (i.e.,
dermatologists, psychiatrists, parasitologists) and adequate
treatment are of great value.
Skills Not Pills: outcomes of a chronic pain
rehabilitation program utilizing cognitive
behavioral skills and opioid abstinence
Sperry J, Craner J, Pestka J, Loukianova L
Department of Psychiatry and Psychology, Mayo Clinic,
Rochester, Minnesota, USA
Introduction: Mayo Clinic’s Pain Rehabilitation Center is a
longstanding interdisciplinary chronic pain functional restoration
program. Based on cognitive-behavior theory, this 3-week program
includes patient education on medication safety, daily physical and
occupational therapy, pain self-management instruction, and
tapering of all controlled substances. Methods: Patients complete
survey measures at admission, discharge, and 6-month-follow up.
Of the 949 patients who completed the program in 2013 and 2014,
215 participants have completed 6-month follow up surveys. The
majority of patients were female (89.9%) and Caucasian (94.9%).
Repeated measures ANOVA compared survey measures across the
three time points. We hypothesized that gains made in the program
would persist at follow up. Results: A total of 132 patients (61.1%)
reported using opioids on admission; 116 (87.9%) reported they
were not using opioids at 6 month follow up. Perceived quality of
life improved from admission (M = 31.52, SD = 14.03) to discharge
(M = 59.97, SD = 19.28) and 6-month follow up (M = 46.02, SD =
21.38). Depression improved significantly from admission (M =
25, SD = 8.43) to discharge (M = 20.01, SD = 6.46), and continued
to improve from discharge to 6-month follow up (M = 15.48, SD =
12.39). Conclusions: Patients benefit from comprehensive
programs that aim to improve functioning, reduce medication use,
and employ cognitive behavioral skills in a self-management
approach to chronic pain management. Positive gains in physical
functioning, psychosocial functioning, and perceived quality of life
are demonstrated in three weeks and may continue to improve six
months after program completion.
Tranceformation: hypnosis in brain and body
Spiegel D
Department of Psychiatry & Behavioral Sciences and Center
for Integrative Medicine, Stanford University School of
Medicine, Stanford, California, USA
Hypnosis was the first Western form of psychotherapy, yet it
remains underutilized in part because of insufficient understanding
of its neural basis. Hypnosis involves highly focused attention,
coupled with dissociation of aspects of awareness, relatively
automatic response to social cues, and an enhanced ability to
modulate perception. New evidence regarding this sensory
processing ability will be presented, including studies employing
event-related potentials, PET and fMRI. Our recent resting state
fMRI data demonstrate functional connectivity between the
executive control and salience networks among high but not low
hypnotizable individuals. New data from fMRI activity and
connectivity analyses in hypnosis compared to control conditions
will be presented. This hypnotic ability to modulate perception has
clear clinical application, especially in pain and anxiety control.
Randomized clinical trials that we have conducted demonstrate the
efficacy of hypnosis in reducing pain, anxiety, somatic
complications, and procedure duration during radiological
interventions. Other RCTs show that hypnosis provides relief of
chronic cancer pain. In addition, techniques employing hypnosis
are effective in controlling various neuromuscular disorders.
Hypnosis is a brain-based tool that can be easily taught for
controlling a variety of psychological and somatic problems.
Learning Objectives: 1) Understand the nature of hypnosis; 2)
Recognize the importance of hypnotizability and its assessment in
the clinical setting; 3) Learn effects of hypnosis on brain function;
4) Learn how to combine hypnosis with psychotherapeutic
techniques, 5) Learn how hypnosis can be utilized in the treatment
of patients with comorbid psychiatric and medical problems.
Inpatient Cognitive Behavioral Analysis System of
Psychotherapy (CBASP) for treatment resistant
and chronically depressed patients: adverse
effects related to response and relapse
Spies J1, Zimmermann J2, Radtke M3, Becker M1, Jacobi F1,
Normann C2 , Berking M3, Brakemeier EL1
1Department of Clinical Psychology and Psychotherapy,
Berlin University of Psychology, Berlin, Germany
2Department of Clinical Psychology and Psychotherapy,
University of Kassel, Kassel, Germany
3Department of Psychiatry and Psychotherapy, Center for
Mental Disorders, University Medical Center Freiburg,
Freiburg, Germany and Department of Clinical Psychology
and Psychotherapy, University of Erlangen, Erlangen,
Germany
Introduction: Inpatient psychotherapy might trigger specific
adverse effects due to short but intensive treatment. In this study,
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the adverse effects of the multidisciplinary inpatient Cognitive
Behavioral Analysis System of Psychotherapy (CBASP) concept
for chronically depressed patients are examined. Methods: A total
of 70 patients with chronic depression completed the structured 12-
weeks inpatient treatment program and were followed up for 24
months. Adverse effects were assessed by: 1. deterioration of
depressive symptoms and 2. a self-report questionnaire Adverse
Effects of Inpatient Psychotherapy (ADEFIP). ADEFIP measures
transient deterioration of depressive symptoms during treatment,
interpersonal conflicts, and serious changes in psychosocial
domains induced by CBASP. Results: While 76% met response
criterion and 40% remission criterion at discharge, none of the
patients deteriorated after 12 weeks of treatment. First results
concerning adverse effects show that approximately two thirds of
the patients reported transient deterioration of symptoms. Patients
with transient deterioration had equal response rates compared to
patients without but were less likely to achieve remission. Over
50% reported conflicts with treatment team members or other
patients without any relation to outcome. More than half of the
patients reported significant changes in psychosocial domains after
discharge. Patients without these changes are more likely to relapse.
Conclusions: The findings suggest that the CBASP inpatient
program entails specific adverse effects but these are predominantly
not associated with negative treatment outcome. Future studies
should examine whether these adverse effects are specific for the
inpatient CBASP concept.
Psychosomatic patients in integrated care - which
treatment mediators do we have to focus?
Stastka K1, Rosar A2, Grassl R2, Rohm C2, Löffler-Stastka H2
1Medical University Vienna, Vienna, Austria
2Psychiytric General Hospital, Otto Wagner Hospital, Vienna,
Austria
Introduction: Psychosomatic diseases represent a challenge to
their treatment and care due to their broad spectrum and the
frequency of their occurrence. With the aim to improve existing
therapeutic approaches, the question has been focused, whether an
8-week inpatient treatment for psychosomatically ill people in a
psychiatric department with regional mandatory supply contract,
provides an improvement concerning the patients’ complaints and
whether patient-specific predictors have influence on the treatment
outcome. Methods: A total of 127 patients with ICD10: F4
diagnoses were hotspot recruited and included in a naturalistic
study. Using a prospective study design structured interviews
assessed socio-demographic data, subjective symptom presentation,
and the Symptom Checklist-90-R (SCL-90-R), the Inventory of
Interpersonal Problems (IIP-D), the Counter Transference
Questionnaire (CTQ), the Psychotherapy Relationship
Questionnaire (PRQ) were applied pre- and post-interventional and
compared in a 6-months-follow up. Statistical analysis was
performed using the SPSS 19.0 using paired t tests, Wilcoxon test,
and a binary regression analysis. Results: The pre-post comparison
showed a significant reduction of symptoms described by all
completers immediately after intervention (p < 0.001, d = 0.49),
which, however, in the 6-months-follow up subsided in intensity.
General, statistically significant negative predictors towards the
success of therapy were taking multiple medications (r = 0.50) as
well as the death of a close person (r = 0.32). Conclusions: Since
the studied intervention is considered successful, an inpatient
intensive therapy in the context of psychosomatic illnesses can be
formulated as a treatment recommendation because of some
generalizability of the results; it should be noted that patient-related
predictors can predict the success of therapy.
Therapy and cost effectiveness of an 8-week
psychosomatic treatment integrated in psychiatric
regional mandatory supply within a 1-years-follow
up
Stastka K1, Schiffinger M2, Löffler-Stastka H3
1General Psychiatric Hospital, Vienna, Austria
2Interdisziplinäres Institut für verhaltenswissenschaftlich
orientiertes Management & Kompetenzzentrum für
empirische Forschungsmethoden, Wirtschaftsuniversität,
Vienna, Austria
3Medical University Vienna, Vienna, Austria
Introduction: Because of the heterogeneity of psychosomatic care
data and the large number of possible objectives (in this case
efficiency of care strategy) an established tool for comparison (EQ-
5D) is extended by meaningful and highly cost-related single items
to allow statements about the longer-lasting effectiveness of
regional community-based psychosomatic therapy initiation.
Therefore, statements can be derived for profound stabilizing
effectiveness of community-based care settings. It is to assess the
effectiveness in a 1-year pre-post catamnestic comparison for
reasons of practicability. The outcome survey makes it possible to
focus on the costs of the 8-weeks psychosomatic integrated care
and relate them to medical, socio-therapeutic, and
psychotherapeutic treatment effects and its duration, necessary for
further planning of regional care. Methods: EQ-5D (EuroQol
health index), Mini-ICF-APP (for activity and participation
disturbances in mental illness), CGI, GAF, socio-demographics,
and disease characteristics (before starting and 1 year after
discharge). Results: In addition to statistically significant
improvements in the ICF Global Core, in the general health-
condition EQ5, and GAF found in the one-year pre-post
comparison, a reduction of the amount of medication, of physician
contacts and sick-leave-days for one-third compared to the year
before the integrated psychosomatic treatment. The hospitalization
days declined in the year after the treatment for an amount of 70%.
The number of diagnostic consultations decreased for more than a
half. In particular, the number of treatment changes decreased for
an amount of by 80% while psychotherapy sessions increased on
the double. Conclusions: Support is given for a highly sustainable
therapy effectiveness and cost-effectiveness of an 8-week
psychosomatic integrated treatment in a psychiatric department
with mandatory regional supply and with a focus on high dose
psychotherapy combined with community-based socio- and milieu
therapy in social-psychiatric case.
Medical culture and chronic pain management
Streltzer J
University of Hawaii, Honolulu, USA
In some countries, strong opioids are rarely used to treat chronic
pain, but in others, including the United States and Canada, there
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has been a rapid increase in the frequency and dose with which
opioids are used in such patients over the last 2 decades. It has
becoming increasingly clear that treating patients with large doses
of opioids is frequently counter-productive to controlling pain. In
many cases, it is quite clear that the opioids have been ineffective in
treating the pain, but it is difficult to stop this treatment, which is
typically accompanied by physical and psychological dependence.
Thus, clinicians who treat chronic pain need to learn techniques to
manage these difficult patients. Clinicians need to understand the
neuroadaptations that occur under the influence of chronic opioid
intake. Eliminating the dependence on opioids while managing
pain at the same time requires proper detoxification strategies,
psychological support, and attention to the patient’s social context.
Treatment of the opioid-dependent chronic pain
patient in an outpatient pain clinic
Streltzer J
Department of Psychiatry, University of Hawaii, Honolulu
Hawaii, United States
We report 20 years of experience treating chronic pain patients in
an outpatient pain clinic. Referrals to this pain clinic were excepted
if psychological issues were thought to be important in the pain
problem or there were medication management problems. Follow
up results have been published describing cases before the use of
buprenorphine and after such use. Opioid dependent chronic pain
patients were treated with a protocol that has been published.
When patients were educated about the adaptation that occurs with
chronic opioid intake, most acknowledged this seem to fit their case
and it often inspired hope that the chronic pain condition could be
improved. Chronic pain generally improved when the opioid
dependence was treated, and the use of buprenorphine made such
treatment easier, faster, and more effective.
Major depressive episodes during pregnancy: a role
of omega-3 polyunsaturated fatty acids
Su KP
Graduate Institute of Neural and Cognitive Sciences, China
Medical University, Taichung, Taiwan and Mind-Body
Interface Laboratory and Department of Psychiatry, China
Medical University Hospital, Taichung, Taiwan
Clinical depression is common in women during pregnancy, which
has drawn public attention due to its significant consequences of
morbidity and mortality for both mother and neonate. Several
clinical factors are associated with the risk of perinatal depression,
including stressful life events, past and family history of
depression, lack of social support, unintended pregnancy, lower
socio-economic status, alcohol and substance abuse, domestic
violence, having anxiety or depression before and during
pregnancy, lower education, smoking, single status, and poor
nutritional status. Pharmacotherapy for pregnant women with
depression is still a clinical dilemma. To date, the US Food and
Drug Administration approves no psychotropic drugs during
pregnancy. Omega-3 polyunsaturated fatty acids (PUFAs) are
essential nutrients for pregnant women and fetal brain development.
So far, two double blind, placebo-controlled RCTs have been
conducted to investigate omega-3 PUFAs’ therapeutic efficacy in
pregnant women with major depression, but the results are not
consistent. In conclusion, the application of omega-3 PUFAs in
pregnant women with depression seems to be promising, but the we
need more supportive evidence from the RCTs.
The conceptual question of the mental disorders
classification: somatoform disorders.
Sukiasyan SG, Tadevosyan MY
Mental Health Rehabilitation department STRESS of Medical
Rehabilitation Center ARTMED and Department of Mental
health and Psychiatry, Armenian Medical Institute, Yerevan,
Armenia
Introduction: There is a wide debate over the problem of
classifications in any area of science and psychiatry is not an
exception. Especially urgent seems to us classification of
somatoform (SDs) disorders, as SDs are residing between medicine
and psychiatry settings. The aim of the present study is to find the
most adequate approach to the classification of SDs. Methods: This
study is based on more than 30 years of clinical, research,
educational experience which allows us to make some
generalizations and conclusions. Results: Neurotic, stress-related,
and SDs (ISD10) are united in one (F4) group in view of historical
connection to conception of neurosis and psychogenic causality of
disorders, which in this case is necessary but not sufficient
condition. ICD10 united mental disorders according to general
characteristics, description/similarity. This is why we find it
necessary to revise F4, that is to separate SDs according to
description/similarity aspects which are reflected the pathological
processes of perception, emotions, associations. This group
includes: somatic disorders, undifferentiated SDs (numerous
senestopathy-like physical manifestations), dysautonomia
(prevalence of vegetative disorders), SDs (prevalence of physical
symptoms), hypochondriasis (e.g., hypochondriasis, nosophobia,
dysmorphophobia), Somatoform pain disorders, somatoform-
physiological disorders (i.e., anorexia nervosa, bulimia, atypical
forms). Conclusions: This is a preliminary study which needs to be
revised and completed. We think that this approach will facilitate
the identification and delineation of neurotic disorder and a number
of mental disorders in primary care.
The efficacy of buprenorphine/naloxone as a pain
relief agent in patients self-identified as having co-
morbid chronic pain who are being treated in a
general office-based opioid addiction treatment
program
Sullivan CR
Department of Behavioral Medicine and Psychiatry, West
Virginia University School of Medicine, Morgantown, West
Virginia, USA
In 2013, we surveyed our general buprenorphine/naloxone (bup/nx)
clinic to see what percentage of patients self-identified as having a
chronic painful condition prior to entering into addiction treatment
and how the chronic use of bup/nx affected their perception of pain.
Patients were asked 1. prior to starting Suboxone® did you have
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chronic pain? and 2. does Suboxone® help with pain? Two hundred
forty one (241) surveys were administered and 150 patients
acknowledged a history of chronic pain treatment. Three data points
were evaluated: 1. patients with less than 90 days abstinent (n =
17); 2. patients with 90-365 days abstinent (n = 37); and 3. patients
with more than 365 days abstinent (n = 96). Abstinence was
described as being free from alcohol and all drugs of addiction with
exception of nicotine and caffeine. The average time in opioid
treatment was 33 months and 60% were women. All three groups
showed improvement in their perception of having decreased pain
while on bup/nx. This improvement persisted over time without any
need for dosage escalation.
Development of Behavioral Checklist of
Depression Symptoms in the workplace
Suzuki SI1, Shimizu K2, Yada S3, Tanoue A1
1Faculty of Human Sciences, Waseda University, Tokyo,
Japan
2The University of Tokyo, Tokyo, Japan
3Koishikawa Mental Clinic, Tokyo, Japan
Introduction: Prevention of depression is very important in the
workplace. However, the symptoms of depression are often
subjectively experienced and incomprehensible to others.
Therefore, it is necessary to develop a behavioral checklist that a
colleague and/or boss can easily make use of in the workplace.
Methods: A semi-structured interview of 10 workers who took
sick-leave due to depression and their bosses (5 people) or
colleagues (6 people) were conducted to obtain data about their
work-related behaviors just prior to taking sick-leave. From the
results of qualitative analysis, a 45-item behavioral checklist was
prepared. Following that, a total of 816 employees (mean age: 45.1
± 9.8, female: 29.1%) were requested to fill out a set of
questionnaires, including our behavioral checklist, and the Beck
Depression Inventory-II (BDI-II). Results: The results of factor
analysis revealed that our behavioral checklist consists of three
factors (“Difficulty with business-related behavior” - DBB, “Poor
expression and interpersonal communication” - PEI, and
“Expression of irritation and anger” - EIA). These subscales show a
significant correlation with the BDI-II (DBB = 0.72, PEI = 0.65,
and EIA = 0.53). The results of item analysis showed that the BDD
items had a high response rate for severely depressed people, the
PEI items had a high response rate for moderately depressed
people, and the EIA items had a high response rate for mildly
depressed people. Conclusions: The behavioral checklist
developed in this study is expected to be useful for evaluating the
severity of an employee’s depression by a colleague or a boss in the
workplace.
Alexithymia and stress in the development of
mental health disorders.
Tadevosyan MY, Sukiasyan SG
Mental Health Rehabilitation department STRESS of Medical
Rehabilitation Center ARTMED and Department of Mental
health and Psychiatry, Armenian Medical Institute,Yerevan,
Armenia
Introduction: A positive correlation of somatization severity with
depression severity exists as well as a negative correlation of
somatization severity with anxiety among primary care patients
with mental disorders. In addition, a negative correlation was
observed between somatoform disorders and situational anxiety. In
this framework, the relationship between somatization level of
mental disorders and an anxiety in primary care patients was
examined. Methods: The aim of the present study was to conduct
the quantitative and qualitative analysis of alexithymia and stress in
somatic patients and compare with data received from
psychological and psychiatric institutions. A total of 122 patients
from “Diagnostic” center, 111 patients from “Artmed”
rehabilitation center, and 148 patients from mental health center
“Stress” were observed. Results: Alexithymia was observed as a
risk factor for many mental (and physical) disorders since 5-23% of
healthy population has different level of alexithymia features.
According to our research the observed population was
characterized by high pathologic level of alexithymia (60%). It was
indicated that alexithymia and psychic trauma have impact on
somatization process of mental disorders and anxiety
manifestations. Significant increase of alexithymia was found in
patients with pathologic level of somatization. Our research data
verified that stress increased the level of situational anxiety:
pathological levels of alexithymia (over 74) and situational anxiety
were statistically significant (t = 4,8E-136) and a negative
correlation between them was found (r = -1). Conclusions: Severe
stress may lead to mental disorders while not severe, long-term
stress correlated with development of somatic pathology.
Appendicitis with anorexia nervosa under weight
gain
Takakura S1, Yokoyama H1, Suzuyama C1, Tatsushima K2,
Yamashita M1, Morita C1, Hata T2, Takii M1, Kawai K1, Sudo
N1,2
1Department of Psychosomatic Medicine, Kyushu University
Hospital, Kyushu, Japan
2Department of Psychosomatic Medicine, Graduate School of
Medical Sciences, Kyushu University, Kyushu, Japan
Introduction: Little is known about the occurrence of appendicitis
during the weight-gain period in Anorexia Nervosa (AN). Cases
description: We report three cases of appendicitis in patients with
AN that occurred after hospitalization for treatment of AN. Case 1
is a 34-year-old female, case 2 is a 17-year-old female and case 3 is
a 38-year-old female. Constipation was observed in all three cases.
Careful management of constipation might be important to prevent
appendicitis among AN patients during the weight-gain period. In
addition, mild and diffuse symptoms and atypical laboratory
findings were observed in all three cases. Therefore, diagnosis
proved to be difficult to make and abdominal computed
tomography was particularly helpful in all cases. As the symptoms
were diffuse, the condition of appendicitis turned out to be more
severe in one of the cases. Because lack of interoceptive awareness
was observed to be elevated in all three cases, their perception of
bodily signals might be reduced. Comment: These findings suggest
that appendicitis should be considered as one of the critical
complications in the therapy for AN.
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Type A behavior pattern as risk factor of
cardiovascular disease
Tanigawa T1, Deshpande GA2, Takahashi O2, Yamada U3
1Internal Medicine Department, St. Luke’s International
Hospital, Tokyo, Japan
2St. Luke’s Life Science Institute, St. Luke’s International
Hospital, Tokyo, Japan
3Psychosomatic Internal Medicine Department, St. Luke’s
International Hospital, Tokyo, Japan
Introduction: Cardiovascular Disease (CVD), including Coronary
Heart Disease (CHD) and stroke, is a leading cause of death around
the world. Type A behavior pattern (TABP) is a purported
psychosocial factor related to CHD. While several prior
investigations have examined the relationship between TABP and
CHD alone, the current study aims to assess the association
between TABP and CVD using a more comprehensive definition
including both CHD and stroke. Methods: We retrospectively
examined cross-sectional data from 54721 individuals aged 40 to
74 years old, who visited our facility in Tokyo between 2009 and
2013 for an annual health check. TABP was evaluated with
validated scale for Japanese TABP. Both TABP and CVD were
assessed via a standardized and self-reported questionnaire. CVD
included CHD (i.e., myocardial infarction and angina) and stroke
(i.e., cerebral infarction, TIA, intracranial hemorrhage, and
subarachnoid hemorrhage). Results: The mean age of the study
population was 52 years old and 26102 subjects (47.7%) were male.
A total of 1185 subjects (2.2%) had history of CVD; 614 for CHD,
599 for stroke, and 28 for both. A total of 7495 (13.7%) subjects
were categorized as Typical TABP. Bivariate analysis of the
association between TABP and CVD showed 237 (3.2%) subjects
in the Typical TABP group reported CVD event compared to 948
(2.0%) in the others (p < 0.01). Logistic regression showed
multivariate-adjusted odds ratio of CVD associated with Typical
TABP was 1.26 (95% CI, 1.08 - 1.46). Conclusions: Typical
TABP was significantly associated with CVD, conferring an
approximately 30% increased risk. TABP would be helpful for risk
assessment of CVD and stroke.
Irritable Bowel Syndrome in university students is
associated with higher experiencing maladjustment
and employment anxiety
Tayama J1,2, Nakaya N3, Hamaguchi T4, Saigo T2,5, Ogawa
S2,5, Sone T6, Fukudo S7, Susumu S2.
1Graduate School of Education, Nagasaki University,
Nagasaki, Japan
2Center for Health and Community Medicine, Nagasaki
University, Nagasaki, Japan
3Tohoku Medical Megabank Organization, Tohoku University,
Miyagi, Japan
4Department of Occupational Therapy Saitama Prefectural
University, Saitama, Japan
5Unit of Preventive Medicine, Graduate School of Biomedical
Sciences, Nagasaki University, Nagasaki, Japan
6Department of Rehabilitation, Faculty of Health Science,
Tohoku Fukushi University, Sendai, Japan
7Department of Behavioral Medicine, Tohoku University
Graduate School of Medicine, Miyagi, Japan
Introduction: The present study tested our hypothesis that
university students with Irritable Bowel Syndrome (IBS) may
experience unsatisfactory academic life than those of students
without IBS. We also verified an additional hypothesis that
university students with IBS may have higher employment anxiety
than that observed in students without IBS. Methods: We
conducted a cross-sectional study of 1686 university students.
Presence or absence of IBS was assessed via the Rome III
Questionnaire. Two original items were used to evaluate academic
life. Results: The prevalence of IBS with diarrhea, IBS with
constipation, mixed IBS, and unsubtyped IBS in the study
population were 5%, 2%, 10%, and 3%, respectively. Regarding
academic life, the proportions of participants who experienced
maladjustment and employment anxiety were 29% and 50%,
respectively. After adjusting for age, sex, and faculty, the odds
ratios for maladjustment and employment anxiety were
significantly higher in students who screened positively, relative to
those who screened negatively, for IBS (OR = 1.62; 95% CI 1.24 –
2.21; OR = 2.16; 95% CI 1.68–2.81, respectively). Conclusions:
In conclusion, maladjustment and anxiety over future employment
were higher in university students with IBS relative to those
without.
Proactive consultation-liaison psychiatry: Lessons
learned from developing the Behavioral
Intervention Team program at the Dartmouth-
Hitchcock Medical Center
Thakur DS1,2 , Finn CT1,2
1Department of Psychiatry, Geisel School of Medicine,
Dartmouth College, Hanover, New Hampshire, USA
2Dartmouth-Hitchcock Medical Center (DHMC), Lebanon,
New Hampshire, USA
Following the success of a proactive psychiatric consultation
service developed for a busy, short-stay, hospitalist-staffed general
medical unit at Yale, our group at DHMC have developed a
Behavioral Intervention Team (BIT) which includes nursing, social
work, and psychiatric support. During the initial phase of our BIT
development, we proactively screened all patients admitted to two
particular medical units and identified those with psychiatric or
behavioral needs which could interfere with delivery of care. Once
these cases were identified, nursing, social work, and/or psychiatric
intervention was offered. Over the 7 months of this phase, we
followed various outcomes including length of stay, use of
restraints, staff injury, and others. At the conclusion of the pilot
phase we determined that our method was targeting the desired
population (i.e., patients with acute psychiatric issues requiring
psychiatric disposition). For that reason we shifted to screening all
adult inpatients at DHMC (excluding psychiatric inpatients). As it
is not feasible to screen every new admission to a nearly 400-bed
hospital in person, we developed an EMR-based screening tool
which identified patients most likely to benefit from psychiatric
intervention. With implementation of BIT we have seen more
timely psychiatric involvement, decreased length of stay, reduced
use of restraints, increased staff satisfaction, and potential for
reduced costs. “Lessons learned” include the practical difficulties of
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developing an EMR-based screening tool, determining which
patient criteria are most useful in using such a tool, and also the
practical challenges as well as rewards of implementing proactive
consultation in identified cases.
Potential biological pathways linking Type-D
personality and poor health: a cross-sectional
investigation
Thayer JF1, Koenig J1, Jandackova V2, Jarczok M3, Fischer
JE3
1The Ohio State University, Ohio, USA
2University of Ostrava, Ostrava, Czech Republic
3Mannheim Institute of Public Health, Mannheim, Germany
Introduction: The Type D personality is defined as a combination
of high negative affect (NA) and high social isolation (SI) and has
been associated with poor health outcomes. However, the biological
and behavioral pathways via which Type-D produces its deleterious
effects are largely unknown. Therefore, the present study was
designed to investigate the relationship between Type-D personality
and several biological and behavioral pathways including the ANS,
the immune system, glucose regulation and sleep in a large,
apparently healthy sample. Methods: Data from a total of 647
respondents (age 41.6 (11.48) years, 73 women) were available for
analysis. Persons with Type-D (NA and SI trait score ≥10) were
compared with those without Type-D. Measures of plasma
fibrinogen levels, white blood cell count, high sensitivity C-reactive
protein, fasting plasma glucose (FPG), cholesterol, high-density
and low-density lipoprotein, glycated hemoglobin (HbA1c),
creatinine, triglycerides, and albumin were derived from fasting
blood samples. Urine norepinephrine and free cortisol were
determined by high-performance liquid chromatography. The mean
IBI (in ms), the standard deviation of IBI (SDNN), the root mean
square of successive differences (RMSSD), and the percentage of
differences between adjacent NN intervals differing by more than
50 ms (pNN50 in %) were calculated for the 24 hr recording period
and for nighttime separately. Results: Persons with Type-D had
significantly higher HbA1c, FPG, and fibrinogen, and significantly
lower nighttime RMSSD, SDNN, and pNN50 than those without
Type D. In addition, those with Type D reported less social support
and greater sleep difficulties. Conclusions: These results provide
some of the first evidence for multiple biological and behavioral
pathways between Type D personality and increased morbidity and
mortality.
Screening for mitochondrial dysfunction in chronic
fatigue syndrome using Near Infrared
Spectroscopy: a preliminary study
Tobback E1, Celie B2, Mariman A1, Boone J2,3, Delesie L1, De
Backer T1, Vogelaers D1, Van Coster R4, Bourgois J2,3
1Department of Internal medicine, Ghent University Hospital,
Ghent, Belgium
2Department of Movement and Sports Sciences, Ghent
University, Ghent, Belgium
3Centre of Sports Medicine, Ghent University Hospital,
Ghent, Belgium
4Department of Pediatrics, Division of Pediatric Neurology
and Metabolism, Ghent University Hospital, Ghent, Belgium
Introduction: Chronic Fatigue Syndrome (CFS) is characterized
by chronic fatigue persisting for at least 6 months, myalgia, post
exertional malaise, and the absence of any sufficiently explanatory
medical condition. Mitochondrial dysfunction and oxidative
damage may underline the typically experienced exercise
intolerance, myalgia, and weakness. Previous work showed that
Near Infrared Spectroscopy (NIRS) distinguishes mitochondrial
myopathy with documented mitochondrial dysfunction, from
healthy controls by reliably measuring deoxyhaemoglobin and –
myoglobin in forearm muscles during an Incremental Cyclic
Contractions Protocol (ICCP). This study aimed to screen for
mitochondrial dysfunction in CFS. Methods: Twelve CFS patients
and 12 matched healthy controls underwent the ICCP consisting of
rhythmic handgrip contractions with increasing intensity. Muscle
tissue oxygen extraction was measured with NIRS. Patients with an
abnormal profile were invited for further examination by muscle
biopsy, the gold standard for diagnosis of mitochondrial diseases.
Results: Only subtle differences were detected by NIRS between
the patient and control group. Looking into the individual results,
four CFS patients showed no increase in deoxyhaemoglobin and –
myoglobin during ICCP, similar to the profile observed in
mitochondrial myopathy and significantly different from healthy
controls. Muscle biopsy in these patients confirmed mitochondrial
abnormalities in two out of three CFS patients. Conclusions: Four
out of 12 CFS patients showed altered peripheral oxygen extraction
during ICCP, suggesting mitochondrial dysfunction. This finding
was confirmed by muscle biopsy in two out of three patients.
Research in a large cohort is needed to further investigate a possible
role of mitochondrial dysfunction in post exertional malaise
experienced by CFS patients.
A new health care model for patients with abnormal
fatigue and chronic fatigue syndrome
Tobback E1, Mariman A1, Delesie L1, Vermeir P1, Heytens S2,
Declercq T2, Bouwen A3, Spooren D1, Snoeck P4, Vogelaers
D1
1Department of General Internal Medicine, University
Hospital Ghent, Gent, Belgium
2Department of Family Medicine and Primary Health
Care of Ghent University, Ghent University, Gent,
Belgium
3Kliniek voor Onverklaarde Lichamelijke Klachten en
Dienst Fysische Geneeskunde, AZ Sint-Jan Brugge-
Oostende AV, Brugge, Belgium
4AZ Delta, Roeselare, Belgium
Introduction: The organization of care for patients with the
Chronic Fatigue Syndrome (CFS) in tertiary care referral centers
from 2002 onwards, was negatively evaluated by the Belgian
Health Care Knowledge Centre on the endpoint of socio-
professional reintegration. Subsequently, the reference center of the
University Hospital Ghent took the initiative of recruiting partners
in the Belgian provinces of East and West-Flanders to guarantee the
care for patients with medically unexplained symptoms, in
particular abnormal fatigue and CFS. A new health care model: A
new and innovative care model, in which general practitioners play
a central role, emphasizes the importance of early recognition of the
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patients ‘at risk’, correct diagnosis and timely referral. Early
detection and intervention is essential in order to avoid or minimize
illness progression towards chronicity, to safeguard opportunities
for significant health improvement as well as to enhance successful
socio-professional reintegration. This approach covers both the
large sample of patients developing somatic complaints without
obvious disease in an early phase as well as the more limited group
of patients with chronic illness, including CFS. Cognitive
behavioral therapy and graded exposure/exercise therapy are the
evidence based main components of therapy in the latter.
Conclusions: The presented care path for abnormal fatigue presents
a conceptual framework for early detection and prevention on the
one hand and timely referral for adequate diagnostic screening and
treatment on the other hand. The use of a biopsychosocial model
and interdisciplinary interaction between different caregivers are
key features.
Psychological distress, well-being and personality
traits in patients with different severity of
psoriasis: a clinimetric assessment approach
Tomba E1, Offidani E2, Del Basso D3, Prignano F3
1Laboratory of Psychosomatics and Clinimetrics, Department
of Psychology, University of Bologna, Bologna, Italy
2Center for Integrative Medicine, Weill Cornell Medical
College, New York, US
3Department of Surgical and Traslational Medicine, Section
of Clinic Preventive and Oncology Dermatology, University of
Florence, Florence, Italy
Introduction: Psoriasis is a chronic dermatologic disease that
negatively impacts not only the physical health of patients but also
their mental health and social and work life. Indeed, it has been
estimated that at least 30% of dermatologic patients present
significant psychiatric comorbidities. A number of studies have
found a correlation between the occurrence of psoriasis and
psychiatric disorders such as depression and anxiety. However,
major psychiatric disorders and life dissatisfaction have not been
proved to differ across severity levels of the illness. The aim of this
study is to illustrate, according to a clinimetric approach, the
presence of differences between patients with mild versus moderate
to severe psoriasis in psychological distress and well-being.
Methods: A total of 70 patients suffering with psoriasis were
recruited during follow up visits at Dermatology Clinic of Florence.
Patients were evaluated using the Structured Clinical Interview for
DSM-IV (SCID-I), the Diagnostic Criteria for Psychosomatic
Research (DCPR) interview, along with the following self-report
instruments: the Symptoms Questionnaire (SQ), the Psychological
Well-being scales (PWB), and the Temperament and Character
Inventory (TCI). Illness severity was evaluated as mild or moderate
to severe using the Psoriasis Area and Severity Index (PASI).
Results: According to PASI (> 10), 18.6% (n = 13) of patients
reported moderate to severe psoriasis while 81.4% (n = 57) did not.
No differences were reported between groups in rates of mood and
anxiety disorders, but patients with greater severity presented
greater rates of demoralization (61.5%; p < 0.05) and Type A
behavior (53.8%; p < 0.05) than subjects with mild severity (17.5%
and 21.1%, respectively). Patients with moderate/severe psoriasis
also reported impaired levels of psychological well-being in terms
of lower autonomy (p< 0.05), environmental mastery (p < 0.05),
personal growth (p < 0.05) and purpose in life (p < 0.05), along
with greater anxiety (p < 0.05), depressive (p < 0.05) and somatic
symptoms (p < 0.05) than patients with milder severity of illness.
Furthermore, according to TCI, severe patients reported greater
harm avoidance (p< 0.05) and lower self-directness (p < 0.05) than
individuals with milder psoriasis levels. Conclusions: Overall
results highlighted the need in patients suffering with psoriasis of a
more comprehensive psychological and psychosomatic assessment
not limited to the customary diagnostic criteria.
Psychological distress and family functioning in
stroke patients and their caregivers: changes over
time and associations with outcomes.
Tomba E1, Staccini L1, Farinelli M2, Grandi S1
1Laboratory of Psychosomatics and Clinimetrics, Department
of Psychology, University of Bologna, Bologna, Italy
2Rehabilitation Hospital "Villa Bellombra", Bologna, Italy
Introduction: The aim of this longitudinal study was to explore
change over time in psychological distress and family functioning
of stroke patients and their caregivers and to verify if and which
dimensions of family functioning were significantly associated with
patients' functional recovery and caregivers' psychological distress.
Methods: A sample of 40 Italian stroke survivors (age: 71.8 ± 12.5;
52.5% male) and 36 family caregivers (age: 58.8 ±9.0; 41.7% male)
completed the Symptom Questionnaire (SQ) and the Family
Assessment Device (FAD) at the admission to the rehabilitation
hospital and 6 months after discharge. Stroke survivors' functional
status was measured using the Functional Independence Measure
(FIM) on admission to and discharge from rehabilitation. Results:
Six months after hospital discharge, both patients and caregivers
reported a significant decrease in SQ anxiety (p ≤ 0.05), with stroke
patients showing a reduction in SQ somatic symptoms (p ≤ 0.05) as
well. A significant deterioration over time in FAD general family
functioning, roles, behavior control, and affective involvement was
observed only in patients who reported also an association between
FAD behavior control at hospital admission and recovery in the
FIM cognitive domain at discharge (p ≤ 0.05). In caregivers,
perception of family functioning at hospital admission significantly
predicted caregivers' SQ hostility at 6 months after discharge (p ≤
0.05), while FAD affective involvement was associated with SQ
somatic symptoms (p ≤ 0.05). Conclusions: These data highlight
the utility in the Italian setting of the adoption of a psychosocial
assessment and a family-systems approach in stroke rehabilitation.
Response to diagnosis, family functioning,
psychological distress, and well-being in mothers
and fathers of children with type-1 diabetes
Tomba E1, Tecuta L1, Novelli B2, Suprani T2, Artale M1,
Buonvino L1
1Laboratory of Psychosomatics and Clinimetrics, Department
of Psychology, University of Bologna, Bologna, Italy
2M. Bufalini Hospital, Cesena, Italy
Introduction: Reactions to the diagnosis of a chronic pediatric
illness may impact parents in different ways. The study explores
differences between mothers and fathers of children with type-1
diabetes mellitus (DMTI) in family functioning, psychological
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distress, and well-being in relation to their diagnosis responses and
perceptions. Methods: A total of 110 parents (mean age 43.5 ± 4.5)
of children with DMTI (mean age 6.4 ± 3.4; mean glycated
hemoglobin 7.11 ± 0.89) were evaluated using an ad hoc
questionnaire for reactions to diagnosis, Family Assessment
Functioning Device (FAD), Symptom Questionnaire (SQ),
Davidson Trauma Scale (DTS), and Psychological Well-being
scales (PWB). Bivariate correlational analyses and t-tests were run.
Results: No differences between mothers and fathers were found in
FAD, PWB, and DTS scores. One significant difference emerged in
SQ-somatization with mothers reporting significantly higher total
scores (p = 0.001). In mothers, SQ-anxiety (r = 0.31; p < 0.05), SQ-
depression (r = 0.38; p < 0.05) and SQ-somatization (r = 0.32; p <
0.05) correlated positively with feeling lonely. However, in fathers
the scales SQ-anxiety (r = -0.36; p < 0.05), SQ-depression (r = -
0.47; p < 0.05) as well as SQ-hostility (r = -0.363; p< 0.05)
correlated negatively with feeling prepared in managing the illness.
Concerning positive aspects, in mothers acceptance of the diagnosis
correlated with better scores in FAD-distribution of roles scale (r =
-0.373; p < 0.05). Differently, in fathers it correlated with lower
FAD-communication scores r = 0.333; p< 0.05). Conclusions: The
findings indicate that distress may be associated with different
aspects of the reaction to diagnosis depending on the parent in
question. Such differences between mothers and fathers may be due
to gender differences in coping and adjusting to illness and thus
warrant further consideration.
The importance of supportive Shiatsu touch in
childbirth
Trend L
Shiatsu Society UK and Complementary and Natural
Healthcare Council, UK
Introduction: Eastern bodywork has been increasing in popularity
in the UK. Shiatsu is a traditional Japanese bodywork which was
central to traditional Japanese midwifery care and is highly
adaptable for use from basic home use to advanced professional
level. The pioneering teaching and research work of Suzanne Yates
(Well Mother Bristol, UK) has brought the value of Japanese
Shiatsu to the awareness of those working in both holistic and
mainstream maternity care in the UK. Her valuable research,
training courses and publications have provided a grounding for
integrated health care and a model for training primary care
workers to implement this valuable tool which contributes to
reducing intervention in childbirth through the positive support
model. The aim of the present study was supporting women to have
positive birth experiences and reducing interventions in childbirth.
Methods: Offering Shiatsu touch training to midwives,
physiotherapists, doctors, birth partners, and all who support
women during the childbearing year. Offering post graduate
maternity care training to Shiatsu Practitioners. Results: Increasing
awareness of positive outcomes was found as a result of holistic
support model. Conclusions: Positive touch and informed,
considered choice is a valuable contribution to improving
experience and outcomes in obstetric care.
Demand, control, and social support in the
workplace: the role of job strain on ovarian cancer
risk
Trudel-Fitzgerald C 1, Kubzansky LD1, Poole EM2, Ichiro
Kawachi1, Tworoger SS2-3
1Department of Social and Behavioral Sciences, Harvard T.C.
Chan School of Public Health, Harvard, Massachusetts, USA
2Channing Division of Network Medicine, Department of
Medicine, Brigham and Women's Hospital and Harvard
Medical School, Harvard, Massachusetts, USA
3Department of Epidemiology, Harvard T.C. Chan School of
Public Health, Harvard, Massachusetts, USA
Introduction: Ovarian cancer (OvCA) is one of the leading causes
of cancer death for women. Thus, the identification of modifiable
risk factors is critical for reducing incidence and mortality.
Research suggests that low social support is related to progression
and survival in OvCA, but less is known about other forms of
chronic psychosocial stress, such as job strain. Methods: Women
(n = 31946; mean age 55 years) from the Nurses’ Health Study
completed a job questionnaire in 1992 and 1996. They were
grouped according to their job type (i.e., low demand/high control =
“low-strain”; low demand/low control = “passive”; high
demand/high control = “active”, and high demand/low control =
“high-strain”) and level of social support provided by the
coworkers and the supervisor (i.e., low/moderate/high). OvCA
incidence was evaluated through 2012. Cox regression models,
adjusting for potential covariates (e.g., demographics, health status,
ovarian cancer risk factors, and behaviors), were used to estimate
hazard ratios (HR) of OvCA risk. Results: There were 196 OvCA
cases during follow-up. Compared to the “low-strain” jobs
(reference group), the “passive” (HR = 1.35; 95% CI 0.91 – 2.01),
“active” (HR = 1.22; 95% CI 0.80 – 1.86) and “high-strain” (HR =
1.06; 95% CI 0.70 – 1.62) jobs were not significantly associated
with an increased risk of OvCA. Levels of social support were not
related to cancer risk. Conclusions: Among the current sample of
midlife nurses, no significant association was observed between job
strain and OvCA incidence. These findings might be due to lack of
statistical power and the relatively late age at job strain assessment.
Further research on such modifiable factors is encouraged,
particularly in younger populations.
Closing the mental health educational gap of
primary care providers in low and middle income
countries
Van Dyke C
Department of Psychiatry, University of California San
Francisco, San Francisco, CA, USA
Psychiatric illness is the major cause of years lived with disability.
But in low and middle-income countries (LMICs), 70-95% of
individuals with these conditions go untreated. The primary reason
is a severe shortage of mental health professionals. The only
practical approach to closing the treatment gap is through primary
care providers (PCPs). But most medical and nursing schools in
LMICs provide little or no training in mental health. Students are
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provided a few readings and/or lectures, but there is usually no
practical experience in interviewing mentally ill patients, treating
them, or following their clinical course. The lack of formal training
reinforces stigmatized conceptions that these patients are difficult to
interview, impossible to diagnose, and untreatable. Without
adequate knowledge and skills, PCPs feel overwhelmed and ill
prepared to respond to their needs. Several steps are needed to
address the mental health educational gap of PCPs. For the existing
workforce, videotape lectures delivered via the Internet provide a
cost effective first step. A next step is role-playing scripts with
supervision by mental health professionals. In addition,
consultation by mental health professionals of ongoing cases can be
provided through the Internet. However, the long–term solution is
to augment mental health training as a core educational experience
in LMIC medical and nursing schools. This will require increased
time in the curriculum and resources to augment the supply of
mental health faculty.
The relationship between fatigue, insomnia and
depression in chronic medical conditions:
approaches to assessment and management
van Zyl LT
Department of Psychiatry, Queen’s University, Kingston,
Canada
About 1 in 5 patients complains of suffering from fatigue when
visiting their family physician’s office. However, often no etiology
is found and no specific treatment is offered to them. Insomnia,
depression, and fatigue may be characterized as a triad of
symptoms occurring concurrently in a wide spectrum of physical
illness and mental disorders. This presentation illustrates guidelines
for basic medical assessment, and attempts to highlight
pharmaceutical treatment options available with regard to managing
several of these conditions. The importance of understanding the
connection and symptom overlap with regard to sleep disorders,
mood disorders and fatigue will be discussed. Approaches to
diagnostic assessment and pharmacological management of
symptoms and associated disorders will be outlined.
Positive expectations and happiness in healthy
women (the iMIND study)
Veloso T1,2, Monteiro A2, Figueiredo-Braga M2
1USF Garcia Orta/West Porto Group of Health Centers,
Porto, Portugal
2Faculty of Medicine of the University of Porto, Porto,
Portugal
Introduction: Human mind is able to process both negative and
positive thoughts and emotions. Although psychology aims to
understand human mind as a whole, research has disproportionately
(17:1) focused on negative dimensions of life. This study intends to
bring some light on mind's positive dimensions of healthy women
and how optimism and happiness, conveying a positive perception
of reality, are thought to contribute to their health. Methods: A
cohort of healthy women from a primary health care setting is being
studied by a team including internal medicine, psychology, and
psychiatry professionals. We aim to investigate the relationship
between physical and mental well-being with a focus on
cardiovascular risk and depression, taking into account personal
and contextual variables. Assessments include a semi-structured
interview, standardized evaluation (i.e., subjective well-being,
happiness, optimism, coping, personality) and monitoring of health-
related behaviors. Biological and physiological measures (i.e.,
cardiovascular and metabolic monitoring) are repeatedly collected.
Results: Happiness is negatively correlated with depressive mood
(r = -0.739; p < 0.05), but not with anxiety. Happiness (r = -0.778;
p< 0.05) and optimism (r = -0.826; p < 0.05) also presented a
negative association with perceived stress. Happiness and optimism
showed similar correlations with personality dimensions – both
were positively associated with extroversion (r = 0.655; p < 0.1 and
r = 0.755; p < 0.05, respectively) and negatively associated with
neuroticism (r = -0.882; p < 0.05 and r = -0.840; p < 0.05).
Happiness and dispositional optimism were correlated (r = 0.826; p
< 0.05). Conclusions: Positive dimensions of mind processes,
whether inborn or learned, can be protective and reduce the
deleterious effects of psychological suffering on health. Present
work brings some data to promote scientific discussion on positive
psychology.
Sleep, depression, and blood pressure in healthy
women (the iMIND study)
Veloso T1,2, Monteiro A2, Figueiredo-Braga M2
1USF Garcia Orta/West Porto Group of Health Centres,
Porto, Portugal
2Faculty of Medicine of the University of Porto, Porto,
Portugal
Introduction: Sleep is a vital phenomenon. Disorders of sleep
disrupt psychological and physiologic functions and have been
associated with increased risk of cardiovascular events. The
causality is not established, though disturbed sleep is supposed to
cause deleterious changes in sympathetic tonus and neuro-humoral
activity. Methods: A cohort of 350 women between 55 and 65
years of age was randomly selected from a Primary Health Care
database. They were free of major medical or neurological disease.
The study is based on a primary health care setting and involves the
Medical Psychology Unit of the local medical school, and is being
supervised by a psychiatrist and an internal medicine physician.
Assessments included a semi-structured interview, standardized
psychometric instruments and laboratory determinations:
psychosocial variables (i.e., perception of stress, anxiety and
depressive symptoms, personality), health-related behaviors, quality
of life, blood pressure, glucose, lipid, renal and hepatic profile and
further metabolic monitoring. Results: Sleep features in a
Portuguese sample of healthy middle-age women are described.
Anxiety level was correlated with the time needed to fall asleep (r =
0,755; p < 0.05). Depressive symptoms were inversely correlated
with the total hours of sleep (r = -0.836; p < 0,05). Moreover, hours
of sleep were inversely correlated with physiological dimensions
such as Systolic Blood Pressure (r = 0,748; p < 0.05). Conclusions:
Sleep is an accessible measure related with psychological suffering
and with cardiovascular physiology. Identification of sleep patterns
and its bidirectional relationship with other health variables is of
paramount importance if health and disease is to be thoroughly
understood.
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Schizophrenia psychosomatically assessed. In
need of an integrated concept as prerequisite of
integrated care
von Boetticher D
Department of Psychosomatic Medicine and Psychotherapy,
University Medical Center Göttingen, Göttingen, Germany
Introduction: Schizophrenia is a severe mental illness that has
strong impact both on mental experience and on somatic well-
being. However, an appropriate integrated care has not been
established, yet. Methods: The presentation (1) refers to currently
published scientific data about somatic morbidity and mortality of
schizophrenic patients and reasons for their poor physical health,
and (2) relates these findings to an integrative psychosomatic
assessment. Results: Schizophrenia is a life shortening disease. Life
expectancy of schizophrenic patients in industrial countries is
reduced by about 20 years. This mortality gap has probably
widened in recent decades. About 60% of this excess mortality is
due to physical illness, by which 30-50% of schizophrenics are
affected to a relevant degree. Many diseases are associated with
schizophrenia, but cardiovascular, metabolic and infectious
diseases, and carcinosis seem to be the most important ones.
Besides illness, lifestyle and treatment factors, also the organization
of health care access and organization account for much of the poor
physical health. Although there is strong scientific evidence that
schizophrenia is a multi-causal disease, a one-dimensional
biological perspective has academically prevailed and prevented
comprehensive treatment. Conclusions: Schizophrenia is generally
a severe and complex to mind and body pertaining disease. Both
biological and psychosocial factors essentially influence individual
vulnerability, onset, course, and outcome of this disease.
Schizophrenia has been termed the “central disease of psychiatry”
(Finzen) - but is not a “psychiatric”, but a human disease, that only
psychosomatically assessed is well understood and appropriately
treated.
Towards an anthropological conception of
emotions in psychosomatic medicine
von Boetticher D
Department of Psychosomatic Medicine and Psychotherapy,
University Medical Center Göttingen, Göttingen, Germany
Introduction: Emotions are historically and epistemologically of
central concern in psychosomatic medicine and philosophical
anthropology for the understanding of the embodied self. Yet,
depending on the field of study, the term is imbued with distinct
and often unrelated meanings. Methods: Drawing on concepts and
findings of emotions applied in psychosomatic medicine and
theories of emotions developed in philosophical anthropology, this
presentation explores the compatibility of findings of current
empirical and hermeneutic research. Results: From Antiquity in
various historical concepts the cause and cure of many diseases
were ascribed to the agency of emotions (“passions”). At the onset
of modern psychosomatic medicine a basically linear-causal role of
emotions was postulated by mainly psychogenic approaches (i.e.,
conversion, actual neurosis, specific unconscious conflict,
resomatization, alexithymia). The introduction of the
biopsychosocial model and the concept of multicausality, which
constitute basic postulates of present psychosomatic medicine,
replaced the ideas of a unidirectional impact of emotions on bodily
changes. But, the biopsychosocial model not only implicates a
change of the understanding of the emotions’ function, but also of
their meaning. Empirical research on emotions has generated a
plenty of neurobiological, physiological, and epigenetic facts.
Hermeneutic research has developed a wealth of anthropological
considerations just as well, concerning mainly the meaning of
emotions for ethics, identity-formation and inter-subjectivity.
Conclusions: The biopsychosocial model implies the necessity of
different and complementary methods. Only a connection of
empirical with hermeneutic considerations may provide a more
comprehensive and anthropological conception of the emotions’
functions and meanings in psychosomatic theory and clinical
practice.
Is distress reduction necessary in chronic pain? A
session-by-session analysis of distress change
trajectories in relation to treatment outcomes
following interdisciplinary Acceptance and
Commitment Therapy
Vowles KE1, Witkiewitz K1, Levell J2, Sowden G2, & Ashworth
J2
1Department of Psychology, University of New Mexico,
Albuquerque, USA
2IMPACT Pain Service, Stoke & North Staffordshire Primary
Care Trust, National Health Service, Stoke-on-Trent, UK
Introduction: Chronic pain is common, costly, and debilitating.
The high levels of distress that typically occur are regularly targeted
for treatment, based on the assumption that decreases are an
essential prerequisite for a successful reduction in pain-related
disability and dysfunction. Conversely, Acceptance and
Commitment Therapy (ACT) assumes that distress reduction is not
necessary, rather responses to pain must change, such that
functioning improves in clearly specified areas (e.g., engagement in
valued activities, decreased disability in social activity). This study
expands upon previous work supporting the effectiveness of
interdisciplinary ACT for chronic pain through follow-ups of as
long as three years. Methods: First, session-by-session trajectories
of change in distress over the course of treatment were examined.
Second, trajectories of change across patients were examined in
relation to changes in functioning (i.e., values engagement;
disability) at three-month follow-up. In total, data were collected
from 148 consecutive participants (68% female; mean age: 46.6
years, SD = 11.2), who provided weekly levels of distress over a 4-
week course of treatment and also completed measures of values
engagement and disability at treatment onset and follow-up.
Results: Treatment outcomes were consistent with previous work
in that they indicated statistically significant reductions in disability
and increases in values engagement (range partial η2 = 0.29 to
0.44). Latent Growth Modeling indicated three trajectories of
change in distress over the four weeks of treatment: 1. linear
decrease; 2. slight parabolic increase, and 3. pronounced parabolic
increase with return to baseline. When these trajectories of change
were analyzed in relation to changes in functioning at follow-up, a
lack of significant differences in treatment-related improvements
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were indicated for psychosocial disability (e.g., social, familial
functioning), success in values-based action, and the values
importance/values success discrepancy. A significant difference
was indicated for physical disability, such that the third
“pronounced parabolic” trajectory, which comprised only a
minority of individuals, reported lesser improvements in this
domain compared to the other two trajectories. Conclusions:
Overall, these data suggest the following: there are different
patterns of change in distress across treatment; decreases in distress
are not a necessary prerequisite for change; support is provided for
the somewhat counterintuitive hypotheses posited by the ACT
model in relation to distress.
Comparison of cerebral blood flow in oral somatic
delusion in patients with and without a history of
depression
Watanabe M1, Umezaki Y2, Miura A1, Shinohara Y1,
Yoshikawa T2, Takenoshita M1, Toriihara A3, Uezato A4,
Nishikawa T4, Motomura H1, Toyofuku A1
1Department of Psychosomatic Dentistry, Graduate School of
Medical and Dental Sciences, Tokyo Medical and Dental
University, Tokyo, Japan
2Psychosomatic Dentistry Clinic, Tokyo Medical and Dental
University Dental Hospital, Tokyo, Japan
3Department of Diagnostic Radiology and Oncology,
Graduate School of Medical and Dental Sciences, Tokyo
Medical and Dental University, Tokyo, Japan
4Department of Psychiatry and Behavioral Sciences,
Graduate School of Medical and Dental Sciences, Tokyo
Medical and Dental University, Tokyo, Japan
Introduction: Oral Somatic Delusion (OSD) is an unusual, strange,
and bizarre sensation in the oral area without any corresponding
abnormality. OSD may be either primary (i.e., monosymptomatic)
or secondary to another disease (e.g., depression, cerebral
infarction). Although the presenting complaints of patients with
primary and secondary OSD are nearly indistinguishable,
symptoms in patients with secondary OSD seem to be resistant to
treatment. The aim of this study was to assess the differences in
clinical characteristics and CBF distribution between patients with
monosymptomatic OSD (non-depression group) and OSD in
conjunction with remitted depression (depression group). Methods:
Participants comprise 17 patients in the non-depression group and
10 patients in the depression group. CBF was examined using
single-photon emission computed tomography. Results: There was
no difference in clinical presentation between the two groups. A
significant right dominant asymmetry in the temporal and posterior
cerebral regions was observed in both groups. In the central region,
a right dominance was seen in the non-depression group, while a
left dominance was seen in the depression group. Moreover, the
mean regional CBF values for patients in the depression group were
significantly lower in several regions (including bilateral
callosomarginal, precentral, angular, temporal, posterior cerebral,
pericallosal, lenticular nucleus, thalamus, and hippocampus; and
right central and cerebellum) than for patients in the non-depression
group. Conclusions: These results suggest that the temporal and
posterior cerebral regions are involved in the pathophysiology of
OSD, regardless of depression history, and that widespread CBF
reduction is a characteristic of remitted depression.
Type-2 diabetes and depressive symptoms: results of
applying a Mendelian randomization in the Cardiovascular
Risk in Young Finns Study
Wesołowska K1, Elovainio M1, 2, Hintsa T1, Jokela M1, Lehtimäki T3,
Raitakari OT4, 5, Juonala M5, 6, 7, Keltikangas-Järvinen L1
1Department of Psychology, Institute of Behavioral Sciences,
University of Helsinki, Helsinki, Finland
2National Institute for Health and Welfare, Helsinki, Finland
3Department of Clinical Chemistry, University of Tampere School of
Medicine and Tampere University Hospital, Tampere, Finland
4Research Centre of Applied and Preventive Cardiovascular
Medicine, University of Turku, Turku, Finland
5Division of Medicine, Turku University Hospital, Turku, Finland
6Department of Medicine, University of Turku, Turku, Finland
7Murdoch Children Research Institute, Melbourne, Australia
Introduction: The causal role of type-2 diabetes in the
development of depressive symptoms remains unclear. We applied
instrumental variables regression analysis (Mendelian
randomization) to examine the association between type-2 diabetes
and depressive symptoms. Methods: The study was based on
information collected from 2063 individuals who participated in the
2011 follow-up of the prospective Cardiovascular Risk in Young
Finns Study. The diagnosis of type-2 diabetes was based on fasting
glucose or the concentration of glycated hemoglobin or self-
reported diabetes, or use of medications for diabetes. Depressive
symptoms were assessed using the modified Beck Depression
Inventory (mBDI-I). The genetic risk score of 34 single nucleotide
polymorphisms previously identified as genetic markers of type-2
diabetes/hyperglycemia were used as an instrument for type-2
diabetes and glucose. Results: In standard linear regression, type-2
diabetes (B = 0.21; 95% CI 0.05 – 0.37, p < 0.05) and glucose (B =
0.04; 95% CI 0.01 – 0.08, p < 0.05) were associated with increased
depressive symptoms independently of sex and age. The results of
instrumental variables regression showed no sex- and age-adjusted
association of type-2 diabetes or glucose with depressive symptoms
(p > 0.05). The differences in estimates between the linear and the
instrumental variables regression analyses were non-significant (p >
0.05). Conclusions: The study provides evidence for a non-casual
role of type-2 diabetes in increasing depressive symptoms. The
association between type-2 diabetes and depressive symptoms is
more likely to be due to reverse causality or confounding.
How do we understand and treat depression in
people with persistent pain?
Williams AC, Schafer G
Research Department of Clinical, Educational & Health
Psychology, University College London, London, UK
Psychologically-based interventions for persistent pain are
essentially pragmatic combinations of cognitive and behavioral
methods of known efficacy. For participants with significant
anxiety and depression associated with their pain, cognitive and
behavioral methods target those as well as other pain-related
problems. The theoretical basis is unclear. Simple theories of
causality evolved into more sophisticated versions invoking early
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vulnerability, and cognitive processing and emotion regulation.
Meta-analysis of cognitive and behavioral interventions for chronic
pain showed small benefits for distress, but with variation in
baseline depression and quality of treatment. Outside these
interventions, a review of the longitudinal studies on chronic pain
and depression in adults from clinical populations provided weak
evidence that depression worsens pain outcomes, and pain worsens
depression outcomes. Most studies used unsuitable measures of
depression, assessing depression with instruments developed and
standardized in physically healthy populations. This issue is widely
neglected. There are 227 different ways to achieve the DSM-5
diagnosis of major depression, a far from homogeneous
classification. Attention to specific symptoms and their (lack of)
associations with persistent pain would build more specific models
to address in psychological treatment.
Care matters in maternity – enabling staff to
provide compassionate woman centred care for
vulnerable women
Willocks C
NHS Education Scotland and BSPOGA
Introduction: Maternity care has become increasingly complex
and this itself can be stressful for the caregiver. Educational
resources developed by NHS Educations Scotland that combine
stories and learning have been found to be useful tools to empower
staff to provide care that is safe and effective, sensitive to a
women’s needs and which result in improved clinical outcomes and
the health and wellbeing of vulnerable pregnant women and infants.
Methods: A multi-agency and multidisciplinary national working
group met and developed a range of resources including a short e-
learning resource and workshops for the One out Of Four
Resource, developed to ensure that healthcare staff provide is
sensitive to the needs of the one out of four women in Scotland
who are survivors of sexual violence. The workshop resources
include four short films depicting women survivors talking about
their experiences of healthcare. The resources support facilitators
to engage professionals in group work discussion using the films as
a springboard. The workshops aim to support professionals to
become more aware of the impact of their care on women, the
impact of a history of sexual violence on women's responses to
their care and to consider ways to improve the care provided to
women in our services. A Maternal Mental Health e-learning
resource is now under development – its aims are to provide an
introduction to understanding and supporting mental health during
pregnancy and in the postnatal period. Results: One out of Four
workshop facilitators have been trained all over Scotland to provide
workshops to health, social care and third sector staff and the e-
learning resource is freely available on the NES website.
Conclusions: Care that is sensitive to a woman’s needs results in
increased satisfaction to those receiving and providing care and
may result in improved clinical outcomes.
Psychosomatic Medicine: populations and
paradigms
Wise TN
Medical Director of Behavioral Health , Inova Health Systems
Johns Hopkins University School of Medicine
Psychosomatic medicine denotes many things. As a research
strategy, it suggests incorporation of psychosocial variables. As a
clinical approach, it strives for inclusion of biopsychosocial
elements in understanding the patient’s problems. Most commonly,
it is the new designation for consultation liaison psychiatry. The
traditional models for psychiatric consultation-liaison have not
greatly changed medical practice as evidenced by data that many
physicians continue to underdiagnose common comorbid
psychiatric syndromes. The recognition that health care is
increasingly costly has led to a renewed focus upon population
health due to the lackluster outcomes for psychiatric disorders.
Solutions offered include “top-down” strategies such as
INTERMED or “bottom up” initiatives utilizing screening of
primary care patients for depression and anxiety or careful
psychometric evaluation of delirium in intensive care settings. This
has renewed interest in how to best integrate mental health care into
primary and specialty care. The use of collaborative stepped care
models, behavioral team interventions, and co-location strategies
are discussion. The widespread introduction of the Electronic
Health Record is an integral feature of such new systems but has
significant drawbacks if the biopsychosocial model is to be
preserved. At present, these models and others are being tested to
see which population is best served for detection and treatment of
comorbid behavioral health disorders. The current evidence would
seem to suggest the new paradigm for consultation psychiatry as
well as psychosomatic medicine is comorbidity medicine as
initially discussed by Feinstein who delineated the necessity of co-
morbidity but also the dangers of pure reliance upon technology.
Students at the Medical University at Graz –
motivation, social support and mental health over
the first semester
Wisiak UV1, Tschernegg M1, Fazekas C1, Matzer F1, Plötz
U2, Wiesmann U2, Hannich HJ2
1Medical University of Graz, Graz, Austria
2Ernst Moritz Arndt University of Greifswald, Greifswald,
Germany
Introduction: Motivation, social support, independent life-time
organization and coping strategies are essential conditions for
subjective wellbeing, mental health, and for productivity and
satisfaction. Students have to deal with much more emotional stress
than comparable young adults without academic education. Two
out of 10 students suffer from extensive emotional stress during
studying. The present study focuses on the balance between
emotional stress because of workload and coping strategies as well
as social support. Methods: We used the questionnaire Mental
Health of Students in Greifswald to measure parameters like
wellbeing, motivation, social support, self-organization skills, and
conditions like critical life-events, workload, psychosomatic
affections, and emotional states like stress because of studying. We
asked 350 students at the beginning and at the end of the first
semester at the Medical University of Graz. Results: Students at
the Medical University of Graz are highly motivated and show a
high level of competences in different coping strategies.
Furthermore, these self-organization skills and social support are
positively related to motivation and emotional and physical
wellbeing. Conclusions: It is important to enable self-organization
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and social support to preserve student’s motivation and wellbeing.
Facilitating social support and time management could encourage
productivity as well as mental health.
Computer-assisted Cognitive-Behavior Therapy:
Can Technology Enhance Treatment Delivery in
Psychosomatic Medicine?
Wright JH
Department of Psychiatry and Behavioral Medicine,
University of Louisville, USA
The goals of computer-assisted cognitive-behavior therapy (CCBT)
are: 1. increase access to evidence-based treatment; 2. reduce cost
of therapy; and 3. enhance the therapeutic process for both patients
and clinicians. CCBT programs that could improve treatment
delivery in psychosomatic medicine include those for treatment of
depression and anxiety, in addition to methods for helping people
better manage specific medical illnesses or symptoms. This
presentation reviews key research findings for CCBT, illustrates
programs available for clinical use, and discusses opportunities for
future development of computer technology in psychosomatic
medicine.
The association between alexithymia and
hypothalamic-pituitary-adrenal axis reaction in
irritable bowel syndrome
Yagihashi M1, Kano M2, Muratsubaki T1, Kanazawa M1,
Morishita J1, Tanaka Y3, Fukudo S1
1Department of Behavioral Medicine, Tohoku University
Graduate School of Medicine, Sendai, Japan
2The Frontier Research Institute for Interdisciplinary
Sciences, Tohoku University, Sendai, Japan
3Tohoku Megabank Organization, Tohoku University, Sendai,
Japan
Introduction: The function of Hypothalamic-Pituitary-Adrenal
(HPA) axis is important in stress-related disorders including
Irritable Bowel Syndrome (IBS). Previous studies suggested an
association between IBS and alexithymia, which is a personality
trait characterized by difficulties in identifying and describing one’s
emotions. The purpose of this study is to test the hypothesis that
alexithymic factors affect Adrenocorticotropic Hormone (ACTH)
and cortisol reactions after administering Corticotrophin-Releasing
Hormone (CRH) in subjects with IBS. Methods: Twenty seven
IBS subjects diagnosed by Rome III criteria and age- and sex-
matched 33 healthy controls participated in the study. CRH
(2μg/kg) was administered intravenously after a viscerosensory
examination of the colorectum. Plasma ACTH and cortisol were
measured at baseline and at 15, 30, 60, and 120 min after the
administration of CRH. Alexithymia was assessed with the 20-item
of Toronto alexithymia scale (TAS-20). Results: There was no
significant difference in TAS-20 total score and the subscales
between IBS subjects and controls. In IBS subjects, the area under
curve (AUC) of ACTH was positively correlated with TAS total
score (r = 0.47, p < 0.05), difficulty identifying feelings (DIF) (r =
0.48, p < 0.05), and externally oriented thinking (EOT) (r = 0.49, p
< 0.05). There was no significant association between TAS-20 total
and its subscale scores and AUC of ACTH in controls. Neither IBS
subjects nor controls showed significant correlation between
cortisol AUC and TAS scores. Conclusions: These findings
suggest that alexithymic factors may affect hypothalamic-pituitary
reactivity in IBS subjects.
Delirium in the Japanese Intensive Care Units:
application of the new guideline.
Yamada U1, Koni R2, Yoitsu E3, Okuno F4, Sheidou Y3,
IkedaM2, Ochiai N2, Mikami A4, Aoki K3, Ishimatsu S4, Ohta D1
1Psychosomatic Medicine Department, St. Luke’s
International Hospital, Tokyo, Japan
2Psychiatry Department, St. Luke’s International Hospital,
Tokyo, Japan
3Intensive Care Unit Department, St Luke’s International
Hospital, Tokyo, Japan
4Emergency Medical Care Center, St. Luke’s International
Hospital, Tokyo, Japan
Introduction: Delirium is a prevalent organ dysfunction associated
with increased lengths of hospital stay and mortality. In our
hospital, psychosomatic medicine specialists, psychiatrists, and
ICU staff formed a multidisciplinary team to systematic delirium
monitoring within the Pain, Agitation, and Delirium (PAD)
Guideline. However, the validity of PAD guideline in Japanese
clinical setting is controversial due to differences in ICU system
and staff training systems among countries. Methods: We
retrospectively researched clinical features of ICU delirium and
usefulness of the PAD guideline based screening in a Japanese
educational hospital. ICU patients were screened for presence of
delirium by using Confusion Assessment Method for Intensive
Care Unit (CAM-ICU), and those found positive on CAM-ICU
were further evaluated by specialists to confirm the diagnosis of
delirium as per DSM-IV-TR criteria. Results: Subjects were 563
intensive care patients (326 males, mean age 65.5 ± 18.6 years old).
Ninety-nine patients (17.6%) were diagnosed delirium according to
DSM-IV-TR criteria, and the positive predictive value of CAM-
ICU screening was 91.7％. The major risk factors identified for
delirium were currently receiving opioids, mechanical ventilation,
infections, heart failure, surgery, benzodiazepines, steroids,
dementia, and cancer. About one fourth (28.3%) of the patients who
developed delirium died during the hospital stay in contrast to 7.3%
mortality in the non-delirious group. Those with delirium also had
longer ICU stay (7.3 ± 3.5days vs 3.5 ± 3.4 days) and hospital stay
(52.72 ± 55.6 days vs 21.4 ± 28.0 days). Conclusions: Screening
within PAD guideline appropriately diagnosed ICU delirium
associated with high mortality in our clinical setting.
Effects of mindful walking and qigong
Yamaji H
Department of General Rehabilitation, Hiroshima
International University, Hiroshima, Japan
Introduction: Mindful walking is regarded as major relaxation
activities in Japan. Qigong is an exercise based on the traditional
Chinese health medicine. These activities enhance your perception
of the world through the five senses and decrease stress and
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anxiety. However, its effects are yet to be completely clarified. The
purpose of this study was to evaluate the psychological effects of
mindful walking and qigong. Methods: The subjects comprised 46
university students who agreed to participate in the study. The
students engaged in mindful walking (for 1 hour) and qigong (for
30 minutes). The results were evaluated using the Profile of Mood
states (POMS) and the State-Trait Anxiety Inventory A-State Scale
(STAI-A). The students filled out questionnaires before and after
this study. All the analyses were performed using SPSS 15.0.
Results: in the survey after the study, the scores for tension,
depression, anger, fatigue, and confusion decreased significantly (p
< 0.01), while those for vigor increased significantly (p < 0.01).
The STAI-A scores also improved significantly (p < 0.01).
Conclusions: These results suggest that mindful walking and
qigong reduce stress and anxiety and make people feel good.
System of consultation liaison service in Japanese
University Hospital
Yamamoto K, Yano H, Onishi Y, Maehara M, Takahashi Y,
Yamada K, Kimoto K, Tamai Y, Mikami K, Matsumoto H
Department of Psychiatry, Tokai University School of
Medicine, Tokai, japan
Introduction: Consultation Liaison Service (CLS) is required to
construct the efficient system for the change of medical
environment. The aim of this study was to clarify recent situation of
CLS in Japanese University Hospital, and to consider the system
for efficient CLS. Methods: We conducted a survey on medical
records of patients who had been admitted to, and received CLS at,
the Tokai University Hospital in 2014. We investigated the
departments which referred the patients to psychiatry and classified
their psychiatric disorders according to the DSM-IV-TR. Results:
A total of 1110 cases received CLS in 2014, 400 cases of which
were suicidal and/or delirium patients in emergency medical center,
396 cases were cancer patients who showed delirium, adjustment
disorder, and depression. The remaining 314 cases were mental
disorders due to a general medical condition, adjustment disorder,
and the existing mental disorders such as schizophrenia and mood
disorder. Conclusions: Recently, we have constituted three CLS
teams named “Trauma and critical care psychiatry”, “Psycho-
oncology”, and “Consultation liaison psychiatry”. These teams, not
only corresponds to the routine requests from other departments, it
is possible to provide a structured liaison services such as liaison
conference. These systems of CLS might be best suited to a recent
Japanese University Hospital.
Relation between personality traits, including
sensitivity to reward, and self-control
Yoshihara K, Eto S, Nozaki T, Sudo N
Department of Psychosomatic Medicine, Graduate School of
Medical Sciences, Kyushu University, Kyushu, Japan
Introduction: Little is known about the relation between reward
systems and self-control. The aim of this study was to examine the
relation between personality traits, including sensitivity to reward,
and anger control. Methods: The participants were 12 healthy
volunteers. The stimuli were six anger-eliciting episodes by a
provocative person. Cognitive reappraisal of the mental state of the
provocative person was used for anger control. While imaging the
anger-eliciting episodes, the participants were instructed to write
their feelings both from their own perspective and from the other
person's perspective using cognitive reappraisal. Evaluation of the
self-rating of anger was by visual analogue scale. Self-completed
questionnaires were used to evaluate their personality traits,
including sensitivity to reward. We then examined the relation
between the subscales of the personality traits and the ratings of
anger and the change of the rating of anger when using cognitive
reappraisal. Results: The self-rating of anger when the participants
imaged the anger-eliciting episodes using cognitive reappraisal was
significantly lower than that from their own perspective. The rating
of anger when they imaged the anger-eliciting episodes from their
own perspective was significantly correlated with the scores of
Reward Responsiveness, Neuroticism, and Openness. There was no
significant correlation between the subscales of the personality
traits and the change of rating of anger when using cognitive
reappraisal. Conclusions: Our findings suggest that the degree of
anger evoked by a stressful situation is related to reward
responsiveness and the personality traits neuroticism and openness.
Depressed patients’ preference for type of
psychotherapy: a preliminary study
Yrondi A1, Rieu J1, Massip1, Bongard V2, Schmitt L1
1Department of Psychiatry and Medical Psychology, CHU
Toulouse, Toulouse, France
2Public Health Service, CHU Toulouse, Toulouse, France
Introduction: The treatment recommendations for depressed
patients by the American Psychiatric Association encourage a focus
on the patient's preferences. The focus of this study was the
preference of depressed inpatients for the type of psychotherapy.
Methods: Twenty-nine subjects of both sexes who were
hospitalized with a major depressive episode were interviewed at 5-
day intervals with the same questions after the depressive episode
resolved, as indicated by a score less than 7 on the Hamilton
Depression Rating Scale (HDRS). The selection of items was
performed by expert consensus. Patients responded according to a
scale ranging from 0 to 4. Regarding cognitive and behavioral
therapies, we included items related to thought and emotion
patterns. Regarding psychodynamic psychotherapy: the items
included "parent relationships" in reference to oedipal concepts,
"identity evidence about self-image,” and “aspects of the ideal self"
were included. Supportive psychotherapy section included
questions related to "the relationship between the couple,"
"transitions in various life situations," "the development of
conflict", "thinking about the attitude of children or relatives in
reference to the person", and "the fact we can develop or talk about
these difficulties”. Results: The supportive psychotherapy scores
were the highest (25.6 ± 8.56), followed by analytical-inspired
psychotherapy (18.6 ± 6.43) and CBT (10.2 ± 4.13). The two
sessions conducted at 5-day intervals showed no significant
difference, which reflected the stability of choices and preferences
of patients. Conclusions: In this study, the depressed patients’
preferred support psychotherapy as first-line therapy compared to
psychodynamic and cognitive-behavioral therapy.
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The relationship among fatigue, insomnia, and
depression from a cognitive behavioural
perspective
Zalai D
Department of Psychology, Ryerson University, Toronto,
Canada
Fatigue, insomnia and depressions are often intertwined and each of
them is ubiquitous in patients with medical disorders. The cognitive
behavioral perspective represents a theoretical and clinical
approach that highlights specific psychopathological factors and
mechanisms that perpetuate depression, insomnia, and fatigue. The
co-occurrence of these conditions opens the opportunity of
combined treatment interventions that target both the specific and
the shared mechanisms maintaining these conditions. This approach
has been pioneered in comorbid insomnia and depression. The
specific cognitive and behavioral links between fatigue and
insomnia/depression are less explored but there is preliminary
evidence to suggest that fatigue – specific cognitions may provide a
link between these conditions. The symposium presents new
research concerning fatigue cognitions and on the combined
treatment of insomnia and depression.
Does cannabinoid really improve sleep? Testing the
sleep effects of nabilone in chronic pain patients: a
placebo-controlled, randomized, pilot study
Zalai D, Chung SA, Hussain N, Shapiro CM
Sleep Research Laboratory, Department of Psychiatry,
Toronto Western Research Institute, Toronto, Canada
Introduction: Naboline improves pain and subjective sleep quality
but there have been no studies investigating the objective effect of
naboline on sleep. The aim of this trial was to obtain objective
information on the effects of naboline on sleep, sleepiness, and
alertness using gold-standard measures. Methods: Eleven patients
with chronic pain and insomnia participated in this double blinded,
placebo-controlled, randomized, pilot study. Participants received
placebo and naboline (each for 4 weeks) in a cross-over pattern.
Overnight polysomnography measured sleep parameters (at
baseline, 4 weeks, and 8 weeks). Multiple Sleep Latency Tests and
Maintenance of Wakefulness Tests provided objective assessment
of sleepiness and alertness at each time point. Pain, fatigue,
subjective sleepiness, and alertness were assessed via
questionnaires. Results: Sleep efficiency and total sleep time
increased (3.8% and 5.5%) and arousal index decreased (24.3%)
during treatment (not significant). Sleep onset latency increased
during treatment (from 29.6 ± 25.5 and 61.4 ± 45.2 minutes), which
is a clinically significant delay in sleep onset. There were no
treatment-related changes in sleep stages or in measures of
sleepiness, fatigue, or alertness. Pain improved (from 16.8 ± 2.5
with placebo to 13.8 ± 7.3 with treatment on the McGill Pain
Questionnaire) in all participants. Conclusions: The pilot results
suggest that naboline may not be efficient to objectively improve
sleep in patients with chronic pain.
Treatment for major depressive disorder
Zhang X
Beijing Mental Home, Beijing, China
Introduction: Nowadays psychiatric drugs or psychotherapy could
not satisfactorily stop major depressive disorder (MDD) destroying
human life gradually (i.e., social withdrawal, psychomotor
retardation) or abruptly (i.e., suicide). Homeostatic psychology can
cure it by strengthening their exhausted brain and eliminating the
stimuli. Case description: More than 20 of adolescents and young
adults of MDD get full remission without any drugs (some of them
withdrew drugs successfully) during the last 3 years. The treatment
of process is in the following: 1. improve their close relationship
with parents and/or spouses by forgiving the traumas caused by
them since their birth, resolve family conflicts; 2. consume
adequate amounts of animal protein and fat to nourish brain; 3. cure
their constipation or diarrhea completely with natural food; 4. cure
their sleep disorders without any drugs; 5. require them do some
exercises, such as singing loudly, hand writing, rope skipping,
jogging; 6. help them gradually join social activities. The consultant
time is from 6 hours to 40 hours. The duration is from 2 days to 12
months. Generally, the more hardly forgive their parents and/or
consume enough nutrition, the longer time they take to get full
remission. Comment: MDD is the symptom of exhaustion of
people’s brain, which are mainly caused by innutrition, conflicts,
trauma, and hate that their parents pay little attention to. During the
process of remission, the overcorrect behavior must appear, such as
anger, attack, hypomania, mania, so they need to be treated
patiently, tolerantly. Persuading some of them to eat adequate
animal protein and fat is difficult.
Family live-in therapy for adolescents and young
adults’ mental disorders
Zhang X1, Liu J2, Zhang R3, Lv M1, Zhang D1,
1Beijing Mental Home, Beijing, China
2 Chronic Centre, Beijing Youan Hospital, Beijing, China
3 Beijing Health Consultancy, Beijing, China
Introduction: Nowadays more and more adolescents and young
adults suffer from mental disorders. Side effects of psychiatric
drugs affect their whole life more or less. Family live-in therapy
includes the advantage of both traditional family therapy and live-in
therapy and avoids their limitations. Methods: Parents and children
live in an apartment at least one month. Psychotherapists observe
their communication, behaviors, and conflicts around clock. They
are formed three interactive groups – parents, children, and parents-
children. Group therapy for them gets excellent results. People in
groups are encouraged to reflect on their life and focus their
feelings and conflicts. The therapists can help them immediately
when their problems exposed. Bad appetite, sleepless, and
constipation are main symptoms for nearly all mental disorders.
Children need to eliminate above symptoms during therapy.
Results: Beijing Mental Home makes a family live-in program and
has helped more than 50 families for 3 years. Adolescents and
young adults who suffered from anxiety, major depression, bipolar
disorder, alcohol abuse, mania, obsession, anorexia nervosa
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achieved full commission without drugs and became better and
better in the aftermath. Five youths of autism age from 18 to 26
have been reducing symptoms gradually. One of 5 young adults of
schizophrenia achieved full commission. Another one reduces the
doses of drugs. Three of them remained unchanged because they
take drugs for prolonged period of time or their parents do not
change themselves. Conclusions: Family live-in therapy is very
effective. However, it is expensive and could not continue unless it
gets financial sponsorship.
Psychosomatic Medicine and Traditional Chinese
Medicine (TCM) in China
Zhifu Z1, Peng Z2, Cheng Z1, Jian L1, Chen Y1, Hui Z1,
Hongliang L1
，
Chun ye W1
1Department of Psychosomatic Medicine of Guang`anmen
Hospital, China Academy of TCM, Beijing, China
2Dongzhimen Hospital, Beijing University of Chinese
Medicine, Beijing, China
During the 1970s and 1980s, China began study and research on
modern psychosomatic medicine. To combine this with the
traditional culture of Chinese medicine, a psychosomatic medicine
section of the TCM society was established in 1988.
Based on a summary of the thoughts of psychosomatic medicine in
TCM in combination with the characteristics of modern
psychosomatic medicine, "The Rigid-Gentle Syndrome
Differentiation of TCM Theory" was founded. This theory is that
psychosomatic disease first injures the liver according to the
patients’ temperament, rigid or gentle, which results in liver
dysfunction. In terms of both clinical and basic scientific research,
we have successively finished 10 subjects, for example, cardiac
neurosis, chronic cholecystitis, and menopausal syndrome. We
would like to introduce some of this research in this presentation.
From the aspect of domestic and international academic
communication, 25 conferences have been held, including annual
Chinese psychosomatic medicine seminars and forums on new
progress. In 2010, the 14th Asian Conference of Psychosomatic
Medicine achieved great success.
The cultural construction of illness symbolism - A
medical anthropological analysis of interacting
biomedical and alternative explanatory models of
illness
Zörgő S
Semmelweis University, Budapest, Hungary
Introduction: Biomedicine interacts with other medical systems,
whether it retains the status of a culture’s conventional medicine or
serves as an alternative to indigenous remedies. Medical pluralism
signifies a cultural milieu, a junction of distinct worldviews from
which various, oftentimes conflicting, concepts of body and illness
derive. The aim of this research is to investigate how illness-
interpretations are altered vis-à-vis concepts of alternative medicine
among patients/practitioners primarily socialized in a biomedical
setting. Methods: Medical anthropological methods offer a hands-
on perspective in mapping explanatory models of illness, the
foundation of therapy choice and evaluation. The results are based
on anthropological fieldwork commencing in September 2014, at 3
Traditional Chinese Medicine clinics in Hungary, functioning as
“social hubs” for alternative medicine. During the on-going
research, thus far 15 in-depth interviews have been conducted with
patients and practitioners. Results: Typically, explanatory models
possess the premise of vitalism, mind-body unity, and illness
having psychosocial etiology. Most models expand into the realm
of illness-symbolism, identifying correlates between illnesses and
psychosocial factors. A symbolic illness-interpretation is contingent
on the symbolism of the effected body part/organ (i.e., an inference
of its physiology, cultural usage, relating idioms, personal
association/memories, and pertinent concepts of various alternative
medical systems). Conclusions: There is a prevalent need for a
symbolic psychosocial interpretation of illness among patients
lacking allopathic diagnosis or cure, acceptable prognosis or a
(personally meaningful) biomedical explanation of their illness.
Grasping culture’s determining role in shaping the understanding of
psyche-body interaction may enrich the field of psychosomatics.
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