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Introduction: The aim of the present study was (1) to validate the method of guilt-induction by means of a written auto-biographical essay and (2) to test whether experimental pain is apt to alleviate the mental burden of guilt, a concept receiving support from both empirical research and clinical observation., Methods: Three independent groups of healthy male participants were recruited. Group allocation was not randomized but within group pain/sham administration was counterbalanced over the two test-days. Groups were tested in the following consecutive order: Group A: guilt induction, heat-pain/sham, N = 59; Group B: guilt induction, cold-pressure-pain/sham, N = 43; Group C: emotionally neutral induction, heat-pain/sham, N = 39. Guilt was induced on both test-days in group A and B before pain/sham administration. Visual analog scale (VAS) guilt ratings immediately after pain/sham stimulation served as the primary outcome. In a control group C the identical heat-pain experiment was performed like in group A but a neutral emotional state was induced., Results: A consistently strong overall effect of guilt-induction (heat-pain: p < 0.001, effect size r = 0.71; CPT-pain p < 0.001, r = 0.67) was found when compared to the control-condition ( p = 0.25, r = 0.08). As expected, heat- and cold-pressure-stimuli were highly painful in all groups ( p < 0.0001, r = 0.89). However, previous research supporting the hypothesis that pain is apt to reduce guilt was not replicated., Conclusion: Although guilt-induction was highly effective on both test-days no impact of pain on behavioral guilt-ratings in healthy individuals could be identified. Guilt induction per se did not depend on the order of testing. The result questions previous experimental work on the impact of pain on moral emotions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Schär, Vehlen, Ebneter, Schicktanz, de Quervain, Wittmann, Götzmann, grosse Holtforth, Protic, Wettstein, Egloff, Streitberger and Schwegler.)

Objective: Negative mood regulation expectancies (NMRE) describe the expectancies of an individual regarding his or her ability to regulate or reduce negative mood states by certain cognitive or behavioral strategies. NMRE are closely associated with the actual emotion regulation and potentially buffer the negative psychological and physical health consequences of stress. In the context of chronic pain, stress plays a central role, as long-term stress can have additional negative consequences regarding pain and its progression. The present study investigated the relationship of NMRE with treatment outcome, and more importantly, its buffering role in the association between stress and treatment outcomes., Method: Two hundred six chronic pain inpatients (fulfilling the International Classification of Diseases, 10th Revision [ICD-10] diagnosis of F45.41) of an interdisciplinary treatment completed standardized self-report questionnaires at intake and discharge. Hierarchical linear regression analyses were used to test the main effects of the Negative Mood Regulation Scale-Short Form on pain intensity, pain-related disability, and psychological distress as treatment outcomes and its moderating role in the association of stress and the 3 outcome measures., Results: A significant main effect of NMRE on treatment outcome was only found for psychological distress. However, for all 3 outcome measures, a significant moderating effect of NMRE on the association between stress level and treatment outcome was found., Discussion: NMRE appear to play an important role for the outcome of inpatient treatment for chronic pain. Due to their buffering effect on the negative association between stress and therapy outcome, they should be targeted in the treatment of chronic pain., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Impulse control disorders (ICDs) are a frequent side effect of dopamine replacement therapy (DRT) in Parkinson's disease (PD). Reckless generosity might expand the spectrum of known ICDs., Cases: Over 18 months, we encountered three PD patients exhibiting reckless generosity under DRT, leading to disastrous financial and social consequences., Literature Review: Except for another case series describing reckless generosity in three PD patients, only one study has examined generosity in PD patients; with findings suggesting that PD patients with ICDs are less sensitive to the aversive aspects of the lack of reciprocation in social settings. Studies with healthy individuals suggest that increased availability of dopamine might reduce social discounting and promote egalitarian behavior, and thereby increase generous behavior towards strangers. Genetic studies show that polymorphisms in dopamine D4 receptors influence generous behavior., Conclusions: Reckless generosity in PD patients with DRT might be underreported and should therefore be carefully be screened for by clinicians. A potential mechanism underlying this ICD-related behavior might be a sensitization of the mesolimbic and mesocortical dopaminergic system, leading to reduced social discounting and maladaptive reward-learning. Further research is needed to investigate the prevalence and underlying mechanisms of reckless generosity in PD patients., (© 2021 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals LLC. on behalf of International Parkinson and Movement Disorder Society.)

Long-term consequences of aversive childhood experiences: effects on cerebral structures Abstract. Early childhood stress experiences due to neglect, and physical, psychological or sexual abuse can lead to permanent changes in central nervous structures. The central nervous system generally shows a very high plasticity in early childhood. Objectively, these influences are reflected in functional and structural-morphological changes in certain brain areas. Subjectively, they are manifested through changes in cognitive, emotional, perceptive and social experiencing. This review aims to summarize the current status of the limited number of studies with human subjects on the consequences of early childhood stress experiences with focus on the central nervous system.

Long-term consequences of aversive childhood experiences: effects on pain processing Abstract. Childhood experiences of stress due to neglect, physical, psychological or sexual abuse often lead to lasting changes in pain processing. Clinically, this is shown, among other things, in an increased sensitivity to pain, a stronger negative-affective connotation of pain and ultimately an increased risk of pain disorders in adulthood. George L. Engel already postulated in the 1960s a child's experience of stress can affect later pain behaviors. This narrative review sets out to summarize the current state of knowledge.

Consequences of aversive childhood experiences: effects on the neuroendocrine system Abstract. Childhood experiences of stress due to neglect, physical, psychological or sexual abuse lead in many cases to permanent changes in the stress-regulating neuroendocrine processes. Epidemiological studies already showed 20 years ago that the extent of childhood stressors correlates with the occurrence of various somatic, functional and psychological diseases in adulthood and that cumulative stressors are also reflected in a significantly reduced average life expectancy. The altered stress-related endocrine system is of major importance with regard to the pathogenesis of the secondary somatic, functional and psychological disorders mentioned above.

Long-term consequences of aversive childhood experiences: effects on the incidence of psychiatric illnesses Abstract. Early childhood stress experiences through physical, psychological and sexual abuse as well as emotional or physical neglect often lead to permanent changes in the psychological well-being. Clinically, this is shown among other things in an increased incidence of various psychiatric disorders. This narrative survey aims to summarize the current status of existing studies on early childhood stress experiences and related psychiatric consequences. Scientific publications from the online libraries PubMed, PsycINFO and GoogleScholar served as the database. The search was conducted under the keywords Adversive Childhood Events (ACE), Adverse Childhood, Childhood Trauma, Psychiatric Disorders, Health Consequences as well as their German translations. The search resulted in 46 studies to be considered.

Purpose: Diagnostic criteria for fibromyalgia have been subject to debate and controversy for many years. The preliminary diagnostic criteria introduced in 2010 and 2011 have been criticized for different reasons, including questionable diagnostic specificity and a lack of an etiopathogenetic foundation. The "ABC indicators" presented in this study reflect a further development of the 2011 criteria and refer to (A) algesia, (B) bilateral, axial-symmetric pain distribution, and (C) chronic distress., Patients and Methods: We compared the diagnostic performance of the ABC indicators with that of the 2011 criteria by analyzing the data of 409 inpatients with chronic functional pain divided into two subgroups of pain patients: Those with whole-body pain and those with pain not involving the whole body. Under the premise that FM phenotypically represents a whole-body pain disorder, sensitivity, specificity, correct classification and diagnostic odds ratios were calculated., Results: The 2011 criteria demonstrated a specificity of 68.1%, a sensitivity of 75.5%, a correct classification of 71.0% and a diagnostic odds ratio of 6.56 (CI: 4.17-10.31). The ABC indicators achieved a specificity of 88.3%, a sensitivity of 62.3%, a correct classification of 78.6%, and a diagnostic odds ratio of 12.47 (CI: 7.30-21.28)., Conclusion: The ABC fibromyalgia indicators demonstrated better specificity, lower sensitivity, and better overall diagnostic effectiveness than the original 2011 criteria., Competing Interests: NE has developed a method of peg algometry. Importantly, the here implemented method is not patentable (since the peg existed beforehand) and is replicable anywhere without extensive technical effort.43 The authors report no other conflicts of interest in this work.

Functional body disorders Abstract. By definition, functional disorders cannot be conceptualized bio-morphologically at the organ level. They originate on the basis of dysregulated control processes and perceptional alterations at a superordinate level of the organism. Under excessive stress, any vegetatively regulated system might develop functional disorders. Hence they can also be observed in veterinary medicine. The «incongruence» between the organic findings and the symptoms reported represents a diagnostic challenge, which general practitioners, due to the high prevalence of functional disorders are confronted with on a daily basis. Therefore a comprehensible explanatory model is needed in order to build trust and to motivate the patient for treatment. The new S3 guidelines «functional disorders» provide constructive and pragmatic information for the adequate treatment of patients with functional disorders.

While much is known about immediate brain activity changes induced by the confrontation with emotional stimuli, the subsequent temporal unfolding of emotions has yet to be explored. To investigate whether exposure to emotionally aversive pictures affects subsequent resting-state networks differently from exposure to neutral pictures, a resting-state fMRI study implementing a two-group repeated-measures design in healthy young adults (N = 34) was conducted. We focused on investigating (i) patterns of amygdala whole-brain and hippocampus connectivity in both a seed-to-voxel and seed-to-seed approach, (ii) whole-brain resting-state networks with an independent component analysis coupled with dual regression, and (iii) the amygdala's fractional amplitude of low frequency fluctuations, all while EEG recording potential fluctuations in vigilance. In spite of the successful emotion induction, as demonstrated by stimuli rating and a memory-facilitating effect of negative emotionality, none of the resting-state measures was differentially affected by picture valence. In conclusion, resting-state networks connectivity as well as the amygdala's low frequency oscillations appear to be unaffected by preceding exposure to widely used emotionally aversive visual stimuli in healthy young adults., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

The dorsolateral prefrontal cortex (DLPFC) plays a key role in working memory. Evidence indicates that transcranial magnetic stimulation (TMS) over the DLPFC can interfere with working memory performance. Here we investigated for how long continuous theta-burst stimulation (cTBS) over the DLPFC decreases working memory performance and whether the effect of cTBS on performance depends on working memory load. Forty healthy young subjects received either cTBS over the left DLPFC or sham stimulation before performing a 2-, and 3-back working memory letter task. An additional 0-back condition served as a non-memory-related control, measuring general attention. cTBS over the left DLPFC significantly impaired 2-back working memory performance for about 15 min, whereas 3-back and 0-back performances were not significantly affected. Our results indicate that the effect of left DLPFC cTBS on working memory performance lasts for roughly 15 min and depends on working memory load.

Cognitive functions, such as working memory, depend on neuronal excitability in a distributed network of cortical regions. It is not known, however, if interindividual differences in cortical excitability are related to differences in working memory performance. In the present transcranial magnetic stimulation study, which included 188 healthy young subjects, we show that participants with lower resting motor threshold, which is related to higher corticospinal excitability, had increased 2-back working memory performance. The findings may help to better understand the link between cortical excitability and cognitive functions and may also have important clinical implications with regard to conditions of altered cortical excitability.

Remembering painful incidents has important adaptive value but may also contribute to clinical symptoms of posttraumatic stress disorder and chronic pain states. Because glucocorticoids are known to impair memory retrieval processes, we investigated whether cortisol affects recall of previously experienced pain in healthy young men. In a double-blind, placebo-controlled crossover study, 20 male participants were presented pictures, half of them combined with a heat-pain stimulus. The next day, the same pictures were shown in the absence of pain. Cortisol (20 mg) administered 1h before retention testing reduced recall of explicit contextual pain memory, whereas it did not affect pain threshold or pain tolerance., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Questions Under Study: In recent years, distress and alexithymia have been recognised as psychosocial factors related to both somatic and psychosomatic diseases. In this study distress and alexithymia and their associations with physical parameters were investigated in lung recipients., Methods: The study, which included 76 patients after a lung transplant, measured psychological distress (Symptom Checklist, SCL-K-9) and alexithymia (Toronto Alexithymia Scale, TAS-20). Physical health was assessed by means of lung function (FEV1), exhaled nitric oxide (eNO), and comorbidity (CCI) at the time of the questionnaire survey. A bronchiolitis obliterans syndrome (BOS) was assessed at the time of the questionnaire survey and one year later., Results: Mean values of distress were found to be significantly higher in lung recipients than in a normal community sample, and mean values of alexithymia were significantly higher in lung patients than in healthy persons. There is a significant positive correlation between distress and BOS at the time of the questionnaire survey (p = .008). Distress is a predictor for new-onset BOS one year after the questionnaire survey (p = .026). No significant correlations were found between alexithymia and physical parameters., Conclusions: Lung transplants go hand-in-hand with increased alexithymia and psychological distress. In addition, psychological distress may contribute to the development of BOS. This association underlines the importance of psychosocial support after lung transplantation.

This article approaches the process of symbolization with a formalized framework that aims to integrate psychoanalytic and neurobiological findings. The authors propose a framework consisting of unconscious and conscious areas. Each of the areas provides networks for storing memories. Psychoanalytically, mental networks contain memories either unconscious or conscious. Neurobiologically, there are subunits of neuronal networks crucial for the storage and recall of memories. Communication between these networks is based on selective memory recall in order to form, for example, figurative representations.

Chronic stress is a well-known consequence of somatic diseases. In this study, we investigated whether physical, sociodemographic, or transplant-related psychological factors were associated with the patient's chronic stress level. A cross-sectional study enrolling 76 patients measured chronic stress (Screening Scale, Screening Subscale of Chronic Stress of the Trier Inventory for the Assessment of Chronic Stress) and the emotional effects of the transplant (Transplant Effects Questionnaire), as well as physical and sociodemographic conditions (lung function, bronchiolitis obliterans syndrome, working status, and parenting). Chronic stress after a lung transplant was significantly lower than in a normal community sample. In the multiple regression analysis, worries concerning the transplant were significantly associated with the patient's chronic stress, but not with physical or sociodemographic parameters, nor with interactions between physical and psychological parameters. These results underscore the importance of transplant-related worries, regardless of the patient's current state of health.

Objectives: Lung recipients undergo a complex psychological process, including organ integration and processing of attitudes towards the organ donor., Design: Seventy-six lung recipients were asked to participate in a cross-sectional questionnaire study on the psychological processing of lung transplants., Methods: The questionnaire consisted of statements describing aspects of organ integration and the patient's relationship with the donor. Furthermore, chronic stress/psychological distress (Screening Scale of the Trier Inventory; Symptom Checklist SCL-K-9) and the emotional effects of transplantation/immunosuppression (Transplant Effects Questionnaire; Medication Experience Scale for Immunosuppressants) were assessed., Results: In general, lung recipients perceive the transplant as part of themselves (97.4%) and not as a foreign object (90%). One-third of patients still have frequent thoughts about the donor, whilst the majority (80.3%) do not believe that they have adopted the donor's characteristic traits. Factor analysis reveals the two-dimensional structure of the questionnaire items 'organ integration' (factor 1) and 'relationship to the donor' (factor 2). Poor organ integration predicts low adherence, low disclosure and high feelings of guilt, whilst a close donor relationship predicts chronic stress and psychological distress., Conclusions: Poor organ integration and a close relationship to the donor should be borne in mind in psychosocial treatment regarding the patient's adherence behaviour and psychological distress.

Principles: Various non-specific questionnaires were used to measure quality of life and psychological wellbeing of patients after organ transplantation. At present cross-organ studies dealing specifically with the psychological response to a transplanted organ are non-existent in German-speaking countries., Methods: The Transplant Effects Questionnaire TxEQ-D and the SF-36 Quality of Life Questionnaire were used to examine the psychological response and quality of life of 370 patients after heart, lung, liver or kidney transplantation. The organ groups were compared with regard to psychosocial parameters., Results: 72% of patients develop a feeling of responsibility for the received organ and its function. This feeling is even stronger towards the patient's key relationships i.e. family, friends, the treatment team and the donor. 11.6% worry about the transplanted organ. Heart and lung patients report significantly fewer concerns than liver and kidney patients. Overall, only a minority of patients report feelings of guilt towards the donor (2.7%), problems in disclosing their transplant to others (2.4%), or difficulties in complying with medical orders (3.5%). Lung transplant patients show significantly better adherence., Conclusions: A feeling of responsibility towards those one is close to and towards the donor is a common psychological phenomenon after transplantation of an organ. Conscious feelings of guilt and shame are harboured by only a minority of patients. The fact that heart and lung patients worry less about their transplant might have primarily to do with the greater medical and psychosocial support in this group.

Objectives: The present study investigates a) whether the German version of the Transplant Effects Questionnaire (TxEQ-D), which measures the emotional response to an organ transplantation, has the same factorial structure as the English original version and b) whether the psychometric properties as well as the correlations with the scales of the SF-36 are comparable., Methods: The questionnaire TxEQ was translated into German and filled out by 370 heart, lunge, liver and kidney transplant patients. Subsequently, factor and item analyses were conducted. The SF-36 was used to test validity., Results: The TxEQ-D has the same factorial structure as the English version as well as comparable psychometric properties. The TxEQ-D factor "worry about transplant" shows the highest correlations with the 10 scales of the SF-36, the lowest correlations with the 10 scales of the SF-36 scales are found for the factor "adherence"., Conclusions: The TxEQ-D is a useful screening instrument in psychosomatic research and in the psychotherapy practice to detect patients with problematic emotional responses to an organ transplantation.

Anxiolytic therapy with the benzodiazepine alprazolam is an established therapy in patients with panic disorder. Normally, panic-like anxiety and its concomitant physical symptoms quickly disappear under such treatment. Therefore we investigated whether there is a difference in sympathetic nervous system in patients with panic disorder compared to healthy controls. Three groups of subjects were included: ten patients with panic disorder, who received alprazolam and 20 healthy control subjects who were given either alprazolam (n=10) or matching placebo (n=10). Muscle sympathetic nerve activity (MSNA) and heart rate did not differ at baseline but significantly increased both in patients and healthy controls after intake of alprazolam (1 mg). However, in both groups both MSNA and heart rate were significantly elevated when compared to both baseline and the placebo control group. This study demonstrates (1) that anxiolytic therapy with alprazolam increases muscle sympathetic nerve activity and heart rate not only in patients with panic disorder but also in healthy controls and (2) that a significant difference in sympathetic nervous system activity between patients and controls, at baseline and during the therapy with alprazolam could not be demonstrated.

Background and Objective: Sleep disturbances are prevalent but often overlooked or underestimated. We suspected that sleep disorders might be particularly common among pharmacy customers, and that they could benefit from counselling. Therefore, we described the prevalence and severity of symptoms associated with sleep and wakefulness disorders among Swiss pharmacy customers, and estimated the need for counselling and treatment., Methods: In 804 Swiss pharmacies (49% of all community pharmacies) clients were invited to complete the Stanford Sleep Disorders Questionnaire (SDQ), and the Epworth Sleepiness Scale (EPW). The SDQ was designed to classify symptoms of sleep and wakefulness into the four most prevalent disorders: sleep apnoea syndrome (SAS), insomnia in psychiatric disorders (PSY), periodic leg movement disorders/restless legs (RLS) and narcolepsy (NAR). Data were entered into an internet-linked database for analysis by an expert system as a basis for immediate counselling by the pharmacist., Results: Of 4901 participants, 3238 (66.1%) were female, and 1663 (33.9%) were male. The mean age (SD) of females and males was 52.4 (18.05), and 55.1 (17.10) years, respectively. The percentages of female and male individuals above cut-off of SDQ subscales were 11.4% and 19.8% for sleep apnoea, 40.9% and 38.7% for psychiatric sleep disorders, 59.3% and 46.8% for restless legs, and 10.4% and 9.4% for narcolepsy respectively. The prevalence of an Epworth Sleepiness Scale score >11 was 16.5% in females, and 23.9% in males. Reliability assessed by Cronbach's alpha was 0.65 to 0.78 for SDQ subscales, and for the Epworth score., Conclusions: Symptoms of sleep and wakefulness disorders among Swiss pharmacy customers were highly prevalent. The SDQ and the Epworth Sleepiness Scale score had a satisfactory reliability to be useful for identification of pharmacy customers who might benefit from information and counselling while visiting pharmacies. The internet-based system proved to be a helpful tool for the pharmacist when counselling his customers in terms of diagnostic classification and severity of symptoms associated with the sleeping and waking state.

Objective: To compare the effect of acute psychosocial stress on glucose concentrations in the fasting state and following food intake in patients with type 1 diabetes., Research Design and Methods: In study 1, 20 patients were exposed to moderate psychosocial stress by means of the Trier Social Stress Test (TSST) in the fasting state. In study 2, the TSST was applied to 20 additional patients 75 min after intake of a standard meal. Glucose concentrations (by continuous glucose monitoring system), blood pressure, and heart rate were monitored on the control day and on the stress testing day., Results: In both studies, blood pressure increased in response to TSST from 122/77 +/- 14/9 mmHg at baseline to a maximum of 152/93 +/- 21/13 mmHg (P < 0.001), and heart rate increased from 80 +/- 11 to 99 +/- 19 bpm (P < 0.001). In the fasting state (study 1), glucose concentrations remained unchanged during the control day as well as during the stress testing day. In study 2, glucose concentrations were similar on both days before and up to 75 min after the intake of the standard meal. However, a significant delay (of 45 min) in the decrease of glucose concentrations was induced by psychological stress. A two-factor repeated-measures ANOVA revealed a significant difference of glucose concentrations over time (F = 646.65/P < 0.001)., Conclusions: In the postprandial period, acute psychological stress induced a significantly delayed decrease of glucose concentrations, whereas in the fasting state, no effect on poststress glucose concentrations was observed.

The field of semiotics, established by Charles S. Peirce, is characterised by its recognition of non-linguistic signs and embedment in a communicative interaction; for this reason, it is especially well suited for a semiotic investigation of intersubjective processes. In this paper, the authors show how these intersubjective processes can be understood in semiotic terms within the transference-countertransference setting. Based on a case vignette, the relationship between the 'real object' (e.g. an unconscious fantasy) and the sign (e.g. a particular facial expression) is first demonstrated. In this mediation between sign and referent, an important role is played by the 'immediate object', by which Peirce understood the mental concept of a sign. However, a further component of the Peircian sign is responsible for the emergence of the countertransference, namely, the 'interpretant'. The core of Peircian semiotics, namely the concept of an (infinite) process of signification, sheds light in semiotic terms on the dialectical movement between transference-signs and countertransference-signs, the interpretation and encounter between two subjects. The paper concludes with a discussion of both the interdisciplinary applicability of Peircian semiotics, for example in the context of the neurosciences, and the differences between the Peircian epistemological position and psychoanalytical conceptions of the objective cognition of mental processes.