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To evaluate gender differences in workplace violence (WPV) against physicians and nurses in Latin America. Cross-sectional study. A cross-sectional electronic survey was conducted between January 11 and February 28, 2022. A prespecified gender analysis was performed. Among the 3056 responses to the electronic survey, 57% were women, 81.6% were physicians, and 18.4% were nurses. At least one act of violence was experienced by 59.2% of respondents, with verbal violence being the most common (97.5%). Women experienced more WPV than men (65.8% vs 50.4%; P < 0.001; odds ratio [OR]: 1.89; 95% confidence interval [CI]: 1.63–2.19). Women were more likely to report at least one episode of WPV per week (19.2% vs 11.9%, P < 0.001), to request for psychological help (14.5% vs 9%, P = 0.001) and to experience more psychosomatic symptoms. In addition, women were more likely to report having considered changing their job after an aggression (57.6% vs 51.3%, P = 0.011) and even leaving their job (33% vs 25.7%, P = 0.001). In a multivariate analysis, being a woman (OR: 1.76), working in emergency departments (OR: 1.99), and with COVID-19 patients (OR: 3.3) were independently associated with more aggressive interactions, while older age (OR: 0.95) and working in a private setting (OR: 0.62) implied lower risk. Women are more likely to experience WPV and to report more psychosomatic symptoms after the event. Preventive measures are urgently needed, with a special focus on high-risk groups such as women. [Display omitted] [ABSTRACT FROM AUTHOR]

Dans l'anorexie mentale, les préoccupations corporelles sont un enjeu clé de la pathologie, mais aussi de la thérapeutique. Il est, à ce jour, établi que la perception de soi serait modulable par des interventions centrées sur le toucher. Dans ce contexte et avec l'appui de recherches en psychiatrie et en psychologie, nous posons la question de la place de l'ostéopathie en tant qu'aide à la remédiation physico-psychique. Nous avons réalisé le suivi de 40 patientes souffrant de troubles du comportement alimentaire et réparties en quatre sous-groupes de dix sujets non randomisés durant dix semaines afin d'évaluer la valeur ajoutée de l'ostéopathie vis-à-vis de la psychomotricité sur les préoccupations corporelles. À l'issue de la prise en charge, nous observons une diminution des préoccupations corporelles pour les sujets du groupe psychomotricité (p < 0,05) et ceux du groupe de double suivi ostéopathie-psychomotricité (p < 0,05). Le groupe ostéopathie ne montre pas d'amélioration suffisante vis-à-vis du groupe témoin (p > 0,34). Les résultats et les limites de la présente étude sont discutés, ainsi que les recommandations pour des recherches ultérieures. Anorexia nervosa is a psychosomatic disorder that mainly concerns women where body image and corporal sensations are questioned. For these patients, their morphology is an obsessional issue and they tend to ignore sensorial perceptions such as hunger or pain. Treatment remains extremely complex, in spite of the vast expanse of relevant specialities, and a close coordination of soma and psyche mediations is required. In fact, it has been proven that for anorexics, there is a strong link between the image of their degraded body and sensorial disorders. These phenomena also concern the structures of the interceptive system. Therefore, the body's perceived shape is a key issue not only in the pathology but also in the therapeutic intervention. To date, it has been established that self-perception can be modulated by interventions focused on touch. In this context and with the support of research in child psychiatry and psychology, we raise the question of the place of osteopathy as an aid in physico-psychic remediation. Our goal is to develop a therapeutic mediation covering the somatic phenomena induced by the muscular frame so as to demonstrate a possible improvement in how anorexics perceive their own morphology. We included 40 patients suffering from eating disorders in our experiment forming a heterogeneous age-group and respecting the minimum threshold. During the ten weeks of the trial, the group was divided into 4 subgroups of 10 non-randomized participants each and based on voluntary participation with one subgroup of 10 patients as a control group, one subgroup of 10 patients treated exclusively using psychomotricity, a third subgroup of 10 patients evaluated exclusively using osteopathy, and a fourth subgroup of 10 patients using a mixed approach. We relied on the "Body Shape Questionnaire" (BSQ-34) to conduct our comparative measurements. It is a reference psychometric tool for measuring bodily concerns, and the French version has been validated and is commonly used. At the end of our ten-week treatment period, we observed positive results for psychomotricity (P < 0.05) and a double osteopathy-psychomotricity follow-up (P < 0.05), but osteopathy alone does not show sufficient improvement compared to the control group (P > 0.34). In view of the results obtained with our patients, the modulations of bodily concerns among those participants treated by touch appear to be effective in the intra-group, but our approach could require extended treatment for more than 10 weeks with regard to intergroup comparisons. Osteopathy must, like the other bodily mediations already involved in the follow-up of anorexia nervosa before it, establish the extent of its contribution to and value in this pathophysiology. [ABSTRACT FROM AUTHOR]

Background/purpose: Dentists sometimes struggle with treating patients with unexplained symptoms, known as oral psychosomatic disorders, that do not improve with conventional treatment. Oral psychosomatic disorders do not fit the definition of psychosomatic diseases in internal medicine. To ensure appropriate dental treatment, it is important for general dentists to distinguish between oral psychosomatic disorders and psychosomatic diseases. However, relevant evaluation methods have not yet been developed. The DMFT index is widely used as an indicator of the caries status. The purpose of this study was to compare the DMFT index scores of patients with oral psychosomatic. The DMFT scores of 2202 patients with oral psychosomatic disorders, 145 psychiatric inpatients, and 3940 general dental patients were statistically compared. The DMFT of patients with oral psychosomatic disorders was further compared based on the presence or absence of psychiatric history and disease. The median DMFT scores of oral psychosomatic disorder patients, psychiatric inpatients, and general dental patients were 16, 22, and 10, respectively, showing a significant difference. No significant differences were found in the DMFT scores based on the presence or absence of psychiatric history in oral psychosomatic disorder patients. The intraoral environment of patients with oral psychosomatic disorders was worse than that of general dental patients but better than that of psychiatric inpatients. General dentists could suspect psychiatric and oral psychosomatic disorders based on the state of patients' oral environment. [ABSTRACT FROM AUTHOR]

To verify the Brief Psychosomatic Symptom Scale (BPSS) among patients with psychosomatic-related disorders in general hospitals and determine the threshold of BPSS. The BPSS is a shortened 10-item version of the psychosomatic symptoms scale (PSSS). Data from 483 patients and 388 healthy controls were included for psychometric analyses. Internal consistency, construct validity, and factorial validity were verified. The threshold of BPSS in distinguishing psychosomatic patients from healthy controls were determined using receiver operating characteristic (ROC) curve analysis. The ROC curve of the BPSS was compared with that of the PSSS and patient health questionnaire-15 (PHQ-15) by using Venkatraman's method with 2000 times Monte-Carlo simulations. The reliability of the BPSS was good with Cronbach's α of 0.831. BPSS was significantly correlated with PSSS (r = 0.886, P < 0.001), PHQ-15 (r = 0.752, P < 0.001), PHQ-9 (r = 0.757, P < 0.001) and GAD-7 (r = 0.715, P < 0.001), which indicated good construct validity. ROC analyses demonstrated that the AUC of the BPSS was comparable with that of PSSS. The gender-specific threshold of BPSS was determined as ≥8 in males and ≥ 9 in females. The BPSS is a brief and validated instrument for screening common psychosomatic symptoms. [ABSTRACT FROM AUTHOR]

Two years have passed since the 2019 novel coronavirus disease (COVID-19) was first reported. The persistent pandemic might lead to severe psychosomatic problems and fatigue. In addition, the recent rapid rising COVID-19 cases in China have become a trending issue. Therefore, this study aimed to investigate the dynamic changes in psychosomatic problems at the initial and current stages of the pandemic. Three waves of cross-sectional online survey were conducted during the initial COVID outbreak in China. The psychosomatic symptom scale (PSSS), perceived stress scale (PSS), and pandemic fatigue scale (PFS) were used to assess the psychosomatic problems, stress, and fatigue. 4317, 1096, and 2172 participants completed the first, second, and third surveys. The prevalence of psychosomatic disorder was 22 %, 28 %, and 39 %, respectively. The network structure of PSSS symptoms has not significantly changed as the pandemic progresses. However, the global strength of the PSSS networks, indicating the overall connectivity, in the third wave was significantly higher than in the first wave (s = 0.54, P = 0.007). The most central symptoms in the first and third wave networks were depressed mood and tiredness. The PFS score was higher in the people concerned with indirect impact than those concerned with health (P < 0.001). PFS has positive relationships with PSSS and PSS score (R = 0.41, P < 0.001 and R = 0.35, P < 0.001, respectively). The persistence of the pandemic caused critical psychosomatic issues, stress, and indirect burden over time, leading to inevitable fatigue. People endured needing immediate attention to prevent or reduce psychosomatic disorders. • The prevalence of psychosomatic disorder was 22%, 28%, and 39%, which showed a consistently growing during the COVID-19 pandemic. • The overall connectivity of global strength in the psychosomatic symptom scale networks increased in the third wave. • The most central symptoms in the first and third wave networks were depressed mood and tiredness. • The psychological fatigue scale score was high in the people concerned with indirect impact. [ABSTRACT FROM AUTHOR]

Cough is one of the most common presenting complaints in childhood. Chronic cough has many possible causes, and this symptom often results in extensive investigations, treatments and anxiety. Habit (habit-tic) and somatic cough disorder (also known as psychogenic cough) is one of the more common underlying diagnoses eventually reached. Habit cough often follows an upper respiratory infection. It is a dry, repetitive, honking, disruptive cough. Characteristically, habit cough usually reduces with distraction, and disappears in sleep. A good detailed history and physical examination, coupled with (normal) basic investigations will usually suffice in diagnosing habit cough – it is important to avoid extensive investigations and unnecessary treatments. However, it is also imperative to note that some children may have both pathological and habit or psychogenic cough. The mainstay of management of habit cough is education and addressing any underlying psychosocial stressors. Various forms of psychotherapies and physiotherapies (cough suppression techniques) have been shown to be effective. With intervention, most children with habit cough will achieve complete resolution, or at least improvement in symptoms. This short article is aimed at healthcare professionals working with children and gives practical advice about investigation and management of suspected habit cough in children and young people. [ABSTRACT FROM AUTHOR]

Functional Neurological Disorder (FND) is considered a biopsychosocial disorder nowadays, with chronicity in >50% of cases. The INTERMED Self-Assessment Questionnaire (IMSA) assesses the various domains and indicates biopsychosocial complexity. FND patients were compared with a sample of psychosomatic (PSM) patients as well as post-stroke patients. The three samples (N = 287 altogether) were largely in inpatient and day clinic psychotherapeutic treatment or inpatient neurological rehabilitation. The IMSA covers all three biopsychosocial domains as well as health care utilisation in the time frame of the past, the present and the future. In addition, affective burden (GAD-7, PHQ-9), somatoform symptoms (PHQ-15), dissociation (FDS) and quality of life (SF-12) were evaluated. FND and PSM patients scored highly in the IMSA, with ≥70% regarded as complex, compared to 15% of post-stroke patients. Affective, somatoform and dissociation scores were high in FND and PSM patients. Mental and somatic quality of life were lower in these groups compared to post-stroke patients. FND patients showed high biopsychosocial strain, similar to a typical sample of inpatient and day clinic, i.e. severely affected, PSM patients, and they were more affected than post-stroke patients. These data emphasize that FND should be evaluated with a biopsychosocial perspective. The IMSA likely represents a valuable tool, which has to be assessed by further longitudinal studies. • Seventy per cent of patients with FND are biopsychosocially complex. • All domains of the biopsychosocial evaluation show high values in FND patients. • FND patients show lower values of quality of life than stroke patients. • Biopsychosocial evaluation should be used in the initial evaluation of FND. • Prospective longitudinal studies should include a biopsychosocial evaluation. [ABSTRACT FROM AUTHOR]

Artefactual skin disease (ASD) or dermatitis artefacta (DA) is a factitious disorder uncommonly reported in the paediatric population. It is a psychocutaneous condition where patients present with externally induced skin (hair or nail) lesions that do not fit recognised patterns of organic disease. Patients classically deny any involvement in the pathogenesis of their skin lesions and will not be inclined to divulge their origin. Individuals may present with acute (e.g. blistering), intermittent (e.g. petechiae) or chronic (e.g. panniculitis) skin changes often having consulted with different health care professionals in their illness journey. The underlying drivers of the behaviour are variable and sometimes complex, lesions may have been produced consciously or in the dissociated state. When formulating a management plan for this vulnerable group of patients it is important to understand " why " this is happening rather than " how ". The prognosis in children and adolescents is generally good but depends on eliciting the underlying psychosocial precipitators. Establishing a strong physician-patient-family relationship is key in managing this condition. The authors advocate a multidisciplinary team approach in this group of patients. [ABSTRACT FROM AUTHOR]

Psychological stress in a chronic course is implicated in various diseases, such as coronary artery disease, diabetes, ulcerative colitis, and psychosomatic pain disorders. Commensal microbiota in the host tissues interact with each other and maintain overall health. Oral and gut microbiomes are considered as the most ecologically rich and taxonomically diverse microbiota communities in humans. The effects of psychological stress on the gut microbiome have been well documented, and the interaction is commonly referred as the microbiota-gut-brain axis. Like the gut microbiome, the oral microbiome contributes to maintaining both local and systemic health. Although the effects of psychological stress on the oral microbiome have been studied, comprehensive knowledge about the oral-brain axis is lacking. The oral cavity and gut can communicate with each other through the microbiota. Three-way interactions within the oral-gut-brain microbiota might exist in patients with psychological stress and disorders. The effect of psychological stress on the gut and oral microbiomes, and the potential interactions within the oral-gut-brain axis are discussed in this review. [ABSTRACT FROM AUTHOR]

Objective: Wuhan was the first Chinese city to be lockdown for the coronavirus disease 2019 (COVID-19) outbreak in springtime of 2020. The purpose of this study was to investigate the relationship between sleep status, body mass index, anxiety and depression in college students during the post-pandemic era in the universities of Wuhan, China.Methods: A total of 1457 college students completed the online surveys from December 25, 2020 to January 16, 2021. Collected data included gender, age, school name, native place, grade, major, body mass index (BMI), the scores of self-assessment lists of sleep (SRSS), Zung self-rating anxiety scale (SAS) and Zung depression self-rating scale (SDS).Results: 1445 valid questionnaires (99.18%) were received. Of all the respondents, the prevalence of insomnia, overweight and obesity, anxiety and depression were 32.73%, 19.45%, 15.43% and 62.91%, respectively. Female students were more likely to have insomnia and anxiety than male students. The rate of insomnia, overweight and obesity in postgraduates were higher than undergraduates. Non-medical students were more likely to be overweight and obese than medical students. In addition, insomnia severity was positively correlated to anxiety severity, and BMI was positively correlated to anxiety or depression severity. There was also a positive correlation between the severity of anxiety and depression.Conclusion: During the post-pandemic era, insomnia and depression are common problems among college students in Wuhan, suggesting that we should strengthen the sleep education of college students to improve sleeping disorders and psychosomatic health. [ABSTRACT FROM AUTHOR]

Background: The symptom burden was tremendous and rates of psychological distress were high because of laryngectomy in Laryngeal carcinoma. Anxiety and depression as mainly psychological distress influenced their sleep, pain, and the quality of life (QOL). This study aimed to assess the effiacy of computer-assisted Cognitive Behavioral Therapy (cCBT) for psychological outcomes and QOL in patients with laryngectomy, in addition to overall experience with health care service, during the perioperative period.Methods: A cCBT program was be customized focused on improving anxiety and depressive symptoms among patients with laryngectomy, and then its effectiveness was assessed. Participants were randomly assigned to the TAU (treatment as usual) group (n=40) or CCBT group (cCBT+ TAU, n = 40). The primary outcome measures were the State Anxiety Inventory (SAI), Patients Health Questionnaire-9 (PHQ-9). The secondary outcome measures were the Athens Insomnia Scale (AIS), Visual Analogue Scale-10 (VAS-10). The outcomes were obtained from patients before intervention (T1), 1 hour before surgery (T2), postoperative 3-day (T3), postoperative 7-day (T4), and postoperative 10-day(T5: after intervention completed). Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) and satisfaction for health care service were assessed before discharge.Results: A mixed linear model displayed significant improvement in symptoms of anxiety, depression, insomnia, and pain in the two groups (all p<0.001); and revealed a significant decreasing on the SAI, PHQ-9, AIS, and VAS-10 scores in the CCBT group compared to that of TAU group during the post-intervention periods (all p<0.05). Furthermore, the other QOL of patients were higher except for physical well-being (p=0.176) and the satisfaction scores were higher in the CCBT group than that of TAU group (all p<0.05).Conclusion: The new developed cCBT program has a positive effect on psychosomatic symptoms surgery-related among patients with laryngectomy,. And patients with cCBT program reported high levels of QOL and satisfaction during perioperative period. To minimize face-to-face contact, the computer-assisted intervention may be an attractive approach. [ABSTRACT FROM AUTHOR]

Background: Psychosomatic symptoms are often related with behaviors. However, the association between different behaviors and their latent patterns and psychosomatic health status is unclear. Current study aimed to identify the patterns of six behaviors and explore the association between different patterns and psychosomatic symptoms in a school-based sample of Chinese adolescents.Methods: From November 2015 to January 2016, the study enrolled 22,628 students from six cities in China (15.36 ± 1.79 years). Six behaviors [unintentional injury (UI), non-suicidal self-injury (NSSI), suicidal behaviors (SB), drinking, smoking, screen time (ST)] and psychosomatic symptoms (psychological and physical symptoms) were measured by self-report validated questionnaires.Results: Six behaviors were all related to psychosomatic symptoms, among which SB was the strongest. Four patterns of behaviors were be identified as follows: low-risk pattern (64.0%), substance use pattern (4.5%), injury pattern (28.8%) and high-risk pattern (2.7%). Logistic regression analysis of psychological symptoms indicated that compared with low-risk pattern, high-risk pattern had the highest risk, followed by injury pattern, substance use pattern showed the lowest risk. Compared with low-risk pattern, the results of physical symptoms suggested the degree of risk was high-risk pattern, injury pattern and substance use pattern, respectively.Limitations: Cross-sectional data were used in the study that could not evaluate causal relationships between six behaviors and psychosomatic symptoms.Conclusions: Six behaviors and their latent patterns are related to psychosomatic symptoms among Chinese adolescents differently, so different intervention and prevention protocol need to be taken for different patterns of adolescents. [ABSTRACT FROM AUTHOR]

In psychiatric patients, medication adverse effects are regularly attributed to psychosomatic causes. However, many psychotropic medications are metabolized by cytochrome P450 (CYP450) enzymes. In the setting of polypharmacy, the activity of these enzymes may produce unfavorable drug-drug interactions (DDI) and drug-genotype interactions (DGI) that contribute to morbidity and mortality. This study sought to estimate the risk of adverse DDI and DGI in psychiatric inpatients with polypharmacy. We assessed whether medication changes made after pharmacogenetics (PGx) testing correlated with changes in side effects and overall improvement. Adult psychiatry inpatients with polypharmacy, defined as 5 or more scheduled prescription medications, completed the 24-item Antidepressant Side Effect Checklist (ASEC) questionnaire on enrollment and underwent PGx testing. Analysis of PGx results focused on whether the CYP2D6 and CYP2C19 phenotypes were "extreme," defined as poor, poor to intermediate, or ultrarapid. Approximately 30 days after PGx results were sent to outpatient providers, patients were contacted to obtain their current medication list and ASEC and Clinical Global Impression Improvement (CGI-I) scores. A total of 80 patients were enrolled, and 52 (65%) completed follow-up. ASEC scores improved from 11.5 (±8.1) to 7.2 (±6.0) (p = 0.0009). Mean CGI-I score was 2.7 (±1.4), between "minimal" to "much improved." However, linear regression revealed that these improvements were not correlated with whether medications were changed. We concluded that the impact of drug-genotype interactions in this small sample of inpatients with polypharmacy was low, and that patient improvement was related not to PGx-guided medication changes but to other treatments during hospitalization. [ABSTRACT FROM AUTHOR]

Background: The objective of our study was to evaluate the clinical utility of rapid sequence magnetic resonance imaging (MRI) utilizing diffusion-weighted imaging and fluid-attenuated inversion recovery sequences in children with acute ischemic strokes and nonstroke brain attacks.Methods: We performed a retrospective chart review of patients aged one month to 25 years for whom a pediatric stroke clinical pathway was activated. Diffusion-weighted imaging and fluid-attenuated inversion recovery were obtained followed by a complete MRI. Imaging was interpreted by a pediatric radiologist and the study neurologist. We collected information regarding patient demographics, neuroimaging results, and final diagnosis.Results: The Pediatric Stroke Clinical Pathway was activated for 59 patients of whom 52 were included for analysis. The majority of patients were female (n = 29, 55.8%) and African American (n = 32, 61.5%), with a median age of 12 years (interquartile range 9, 16). Six patients had an ischemic stroke. Seizures, migraines, and psychosomatic disorders (each with n = 7; 13.5%) were the most common nonstroke diagnoses. Diffusion-weighted imaging was more sensitive (100% [55.0% to 100%] versus 80 % [32% to 99%]) and specific (73.9% [68% to 74%] versus 37.2% [32% to 39%]) compared with fluid-attenuated inversion recovery in identification of an ischemic stroke. However, fluid-attenuated inversion recovery was useful in the identification of inflammatory and metabolic disorders.Conclusion: Rapid sequence MRI can be utilized as a screening imaging modality in children with suspected brain attacks in cases where there may be delays in obtaining full sequence brain imaging. [ABSTRACT FROM AUTHOR]

To develop and verify the Psychosomatic Symptom Scale (PSSS) among psychosomatic patients and the cut-off value of PSSS in distinguishing psychosomatic patients from health controls. The PSSS was drafted by an expert workgroup. 996 patients and 366 controls from 14 general hospitals in China were recruited to complete PSSS, Patient Health Questionnaire-15 (PHQ-15) and Symptom Checklist-90 (SCL-90). Student's t -test, Kruskal-Wallis test, Cronbach's α, Spearman's correlation, and confirmatory factor analysis (CFA) were used to verify the PSSS. Receiver operating characteristic (ROC) analyses were used to determine the cut-off value. Cronbach α of PSSS was 0.907. The PSSS was significantly correlated with SCL-90 somatization subscale (r = 0.682, P < 0.001) and PHQ-15 (r = 0.724, P < 0.001). CFA supported the theoretical two-factor structure of the PSSS, with comparative fit index (CFI) = 0.979, Tucker-Lewis index (TLI) = 0.977, root mean square error of approximation (RMSEA) = 0.039 (90% CI: 0.035–0.042), and standardized root mean residual (SRMR) = 0.054. As the sum score of PSSS was significantly higher in female, cut-off values were determined as 11 in females and 10 in males respectively. The PSSS is a reliable and valid instrument for measuring psychosomatic symptoms. [ABSTRACT FROM AUTHOR]

L'enfant traumatisé par un meurtre au sein du couple parental est exposé à une multitude de complications post-traumatiques spécifiques à la nature du traumatisme (PTSD, processus de deuil pathologique, troubles de l'attachement), et aspécifiques (troubles anxieux, troubles de l'humeur, troubles du sommeil, troubles du comportement, troubles psychosomatiques) ainsi qu'à des altérations du développement et des processus de structuration de la personnalité. Le traumatisme a par ailleurs un retentissement sur son état de santé physique et sur son niveau de fonctionnement global, scolaire et social. L'enfant témoin de féminicide dans un contexte de violences conjugales est à haut risque de complications post-traumatiques, si l'on fait l'hypothèse qu'il s'agit du traumatisme le plus grave qui soit pour un enfant. Ce traumatisme, par exposition à de la violence extrême, est sévère par son caractère interpersonnel et intentionnel, mais aussi et surtout, parce que non seulement la responsabilité émane d'un être humain contre un semblable, mais elle émane d'un parent contre l'autre parent. L'enfant va perdre brutalement ses deux figures d'attachement, sans « externalisation » possible de la responsabilité, et il ne pourra chercher de soutien auprès d'aucun de ses deux parents. Nous présentons dans l'article une grille d'évaluation de la situation clinique qui nous semble utile pour aider les professionnels qui seraient confrontés à cette rencontre particulière et rare avec ces enfants. Nous montrons également que l'évaluation de l'accompagnement professionnel (socio-éducatif, judiciaire et thérapeutique) fait partie intégrante de cette évaluation des facteurs de risque et des facteurs de protection (de résilience) pour l'évolution et le devenir à long terme de ces enfants. Children traumatized by a murder within the parental couple may develop a multitude of post-traumatic complications both specific to the nature of the traumatism (PTSD, pathological mourning process, attachment disorders) and nonspecific (anxiety disorders, disorders mood, sleep disorders, behavioral disorders, psychosomatic disorders) as well as alterations in the development and processes of personality structuring. The trauma also has an impact on physical health and on overall level of functioning, school and social. Children witnessing feminicide in a context of domestic violence are at high risk of post-traumatic complications, assuming that this is the most serious trauma for the child. This trauma, by exposure to extreme violence, is severe by its interpersonal and intentional character but also, and above all, because not only does responsibility come from one human being against another but it comes from one parent against the other parent. The child will suddenly lose his two attachments, without the possible "outsourcing" of responsibility and will be unable to seek support from either of the parents. We present a grid of evaluations of the clinical situation which we deem helpful for professionals who may be confronted with this particular and rare encounter with these children. We also show that evaluation of professional support (socioeducational, legal and therapeutic) is an integral part of this assessment of risk factors and protective factors (resilience) for evolution and long-term future of these children. [ABSTRACT FROM AUTHOR]

• „Conceptual endophenotypes" have been proposed as a means to identify subgroups of patients affected by stress-related disorders. • Neuropattern, based on conceptual endophenotypes, is a diagnostic instrument that integrates psychological and biological data. • MR gene variation was associated with the endophenotype CRF-hypoactivity , characterized by features of atypical depression. • MR gene variation might serve as a biomarker for subgrouping patients with stress-related disorders. Recently, the „conceptual endophenotype" approach has been proposed as a means to identify subgroups of patients affected by stress-related psychiatric disorders. Conceptual endophenotypes consist of patterns of psychological, biological, and symptomatic elements. We studied a sample of patients seeking help for psychosomatic and stress-related disorders (total N = 469), who were evaluated with a diagnostic instrument that integrates psychological and biological data to derive 13 endophenotypes, or Neuropattern. The goal of this study was to explore associations between common variations of the mineralocorticoid receptor gene (MR, NR3C2), and the 13 conceptual endophenotypes of Neuropattern, as well as with the respective biological and symptom measures. A common haplotype of the MR, comprised of two functional single nucleotide polymorphism (rs2070951 G/C & rs5522 A/G), was associated with the conceptual endophenotype CRF-hypoactivity, characterized by low cortisol levels at awakening and a symptom constellation often observed in atypical depression. Homozygous carriers of the G-A haplotype (haplotype 1), previously associated with reduced dispositional optimism, increased levels of rumination and higher risk for depression, more frequently endorsed this Neuropattern. In addition to the overall association between MR variation and CRF hypoactivity, we observed in the whole sample significant associations between MR haplotypes and cortisol awakening response patterns, as well as with symptoms that characterize the CRF hypoactivity endophenotype. If replicated, MR haplotype 1 might serve as a vulnerability marker for a disorder class characterized in biological terms by reduced cortisol levels, and in terms of symptom constellation by features often observed in atypical depression. [ABSTRACT FROM AUTHOR]

This article introduces the concept of a "biographical gaze" based on two dimensions: On one hand, I draw on findings from my qualitative empirical research on psychotherapists' practice and their interpretation of patients' suffering. The case study was conducted in psychosomatic hospitals in Germany and focused on psychotherapists based on different kinds of data (supervision transcripts, interviews, medical records, and questionnaires). On the other hand, I connect this research with theories on the clinical gaze, as well as Bourdieu's critique of the "biographical illusion." In the article's first section, I discuss the theories that contribute to the clinical gaze, knowledge, and medicine. In the second section, I present methods and condensed findings from my research. In the third section, I connect these findings to theories on biographies and their critics. Finally, I conclude with my theorization of the biographical gaze and its problems. • Concept of the "biographical gaze" as another dimension of the "clinical gaze". • Professionals' understanding of their patients' symptoms. • Professional therapists contribute to privatisation of social suffering. [ABSTRACT FROM AUTHOR]

Background: Temporal lobe epilepsy (TLE) and psychogenic non-epileptic seizures (PNES) are conditions frequently associated with dysfunction in emotional regulation leading to increased risk of affective disorders. This study investigates emotional processing with an objective measure of emotional reactivity in patients with TLE and patients with PNES.Methods: 34 patients with TLE and 14 patients with PNES were evaluated on skin conductance responses (SCR) to emotions induced by short films and compared to 34 healthy controls. An attention and a suppression condition were performed while viewing the films.Results: The both groups of patients disclosed lower SCR to emotions compared to controls, mainly in suppression condition. While TLE patients had lower SCR in attention condition than controls for fear, sadness and happiness, PNES had lower SCR only for happiness. In suppression condition, both had lower SCR than controls except for peacefulness in both groups and sadness in PNES. Subjective evaluations revealed that both patient's groups scored a higher intensity for sadness than controls in attention and lower for in fear and disgust in suppression only in TLE.Limitations: The sample size in the PNES group and the lack of a control group with similar levels of mood symptoms limited the interpretation of our results.Conclusion: As no correlation were found between SCR to emotions and scores of affective disorders, this pattern of responses might be underpinned by specific pathophysiological and cognitive mechanisms related to TLE and to PNES. Thus, therapeutic approaches targeting emotional autonomic responses can be of interest in the management of these conditions. [ABSTRACT FROM AUTHOR]

Background: To examine the association between posttraumatic stress symptoms (PTSS) and substance use among Asian Americans and the influence of a culturally-relevant moderator, shame.Methods: From 2016 to 2017, 199 participants from Amazon Mechanical Turk and a university subject pool completed an online survey. Chi-square and Kruskal-Wallis tests explored demographic and clinical differences among three Asian American ethnic subgroups (East Asians, South Asians, and Southeast Asians). Generalized linear models assessed the association between PTSS and substance use (alcohol, tobacco, and other drugs) and the moderation of this relationship by shame.Results: Ethnic subgroups significantly differed on all three substance use variables. The severity in PTSS was significantly associated with hazardous drug use (IRR = 1.03, (1.01, 1.05), p = .003). The association between PTSS and days of tobacco use and binge drinking was significantly moderated by shame. Low levels of shame increased the effect of PTSS on binge drinking (IRR = 1.05, (1.00, 1.10), p = .035) and tobacco use (IRR = 1.15, (1.11, 1.19), p < .001). High levels of shame had no effect of PTSS on binge drinking (IRR = 1.01, (0.99, 1.03), p = .54) and a reduced effect on tobacco use (IRR = 1.07, (1.05, 1.09), p < .001).Conclusions: Among Asian Americans, the association of PTSS and substance use depends on shame. Lower levels of shame are a risk factor, increasing the effect of PTSS on substance use. Culturally-modified addiction treatments should assess for shame among Asian Americans and attend to ethnic sub-group diversity in substance use. [ABSTRACT FROM AUTHOR]

Abstract The classification systems DSM-5 and ICD-10/11 are predominantly based on a phenomenological description of psychic disorders. Psychological and neurobiological findings are only marginally considered. In a conceptual framework, the article proposes a classification system for psychosomatic disorders encompassing descriptive, psychological, and neurobiological aspects. We suggest "connectivity" (neurobiological term)/"conversion" (psychological term) as the common factor which translates emotional distress into physical symptoms. Three types of "conversion disorder" can clinically be distinguished: 1.) The dissociative type comprises a down-regulation of emotionality. 2.) In the asymbolic-operational type, only the physical part of distress is perceived. 3.) The symbolic-expressive type is characterized by the fact that unconscious, mostly conflict-laden images are presented with the aid of symbolic physical symptoms. In a mixed form, the aforementioned conversion types may occur simultaneously or at different times. This multidimensional classification – against the background of the connectivity/conversion paradigm - might become a prerequisite for specific psychotherapeutic interventions tailored to the respective conversion types. Highlights • Psychosomatic classification requires a new approach, encompassing descriptive, psychological and neurobiological aspects. • Against the background of the "connectivity/conversion paradigm" psychosomatic disorders may be better understood. • Clinically, three subtypes of conversion disorders (dissociative, asymbolic-operational, symbolic-expressive) are proposed. [ABSTRACT FROM AUTHOR]

Abstract Mothers can recognize the odor of their baby and typically adore this odor. In line with this observation, infant body odors activate reward-related brain areas in the mothers. In some mother-child-dyads however, the mutual bond is impaired and mothers have trouble engaging in interaction with their child. We aimed to examine how mothers with bonding difficulties perceive their child's body odor. In total, 75 mothers of babies aged 0–12 months were examined: Twenty-five of those were recruited in a psychosomatic day hospital ward, which is specialized for mother-child bonding disorders. Fifty age-matched healthy women and their babies served as controls. Body odor samples of each baby were collected from bodysuits in a highly standardized procedure. Thereafter, each mother rated the samples of her own and two other infants in a blind and randomized design. In addition, general olfactory function in terms of threshold and identification ability was tested and the mother reported the bonding to her baby in a standardized questionnaire. Healthy mothers showed a clear preference of their own compared to odors of other infant's, while mothers with bonding difficulties did not. Furthermore, the degree of preference was negatively correlated to self-reported bonding difficulties. Mothers with bonding difficulties could not identify their own infant's odor above chance, while control mothers could. Both groups did not differ in general olfactory function. We assume that reduced close body contact and interaction time associated with bonding difficulties may lead to reduced exposure and hinder the recognition of the infantile body odor. Within a vicious cycle, a reduced hedonic experience smelling their own baby may prevent women from deliberately approaching the baby. Thus, the positive and bond-building consequences of bodily and sensory interaction cannot unfold. As the baby's odor is normally perceived as very pleasant and rewarding, the conscious perception of the infantile body odor may be an additive therapeutic approach for mothers with bonding difficulties. Highlights • Healthy mothers showed a clear preference of the own infant's body odor. • Mothers with bonding difficulties did not • The degree of odor preference was negatively correlated to bonding difficulties. • Mothers with bonding difficulties could not identify their own infant's odor. [ABSTRACT FROM AUTHOR]

Research on child sexual abuse increasingly focuses on sexually offending females; however, there is a lack of research that focuses on the individuals being affected. Studies have suggested that the consequences for those affected by sexually offending males and females are comparable. The aim is to compare mental health consequences of sexual abuse perpetrated by women versus men in quantity and type. Data was anonymously retrieved from the German-wide contact point "help line sexual abuse" from 2016 to 2021. Details of abuse cases, gender of the offending individuals, and reported mental disorders of the person affected were analyzed. The sample consisted of N = 3351 callers with experiences of child sexual abuse. The relationship between gender of the perpetrating person and mental disorders of the victimized person was computed using logistic regression models. To account for rare events data, Firth's logistics regression model was used. The consequences were similar in quantity, albeit different in type. Callers with experiences of female-perpetrated abuse were more likely to report suicidality, non-suicidal self-injury behavior, personality disorders, dissociative identity disorders, alcohol/ drug addiction, and schizophrenia, while people with experiences of male-perpetrated abuse rather reported post-traumatic stress disorder, affective disorders, anxiety disorders, dissociative disorders, eating disorders, externalized disorders, and psychosomatic disorders. The differences may be due to stigmatization leading to dysfunctional coping mechanisms. Societal gender stereotypes must be reduced, especially within the professional helping system to ensure support for people who have experienced sexual abuse, regardless of gender. [ABSTRACT FROM AUTHOR]

Consultation psychiatrists are often asked to assess factitious disorder (FD), yet this is challenging as confirmation depends on rarely achieved direct evidence of illness-inducing behaviors. Diagnosis is thus based on other variables, such as atypical features of the medical presentation and certain patient behaviors. This study sought to assess a cohort of patients with FD for demographic and clinical variables, but also psychological and behavioral ones unexamined in previous studies. 49 previously-identified FD patients at a single site were reviewed retrospectively and variables collected included demographic, medical, psychiatric, social, behavioral, and treatment-related. Descriptive statistical analysis was used. Patients were mostly: 1) under age 40 (82%), 2) female (90%), 3) with past psychiatric (92%), family psychiatric (78%), and traumatic (69%) histories; 4) direct intravenous access (67%); and 7) some exposure to healthcare training (67%). All (100%) subjects had an identifiable family dynamic issue, including household abuse, parental divorce, parental influence/enmeshment, grief, and/or significant other conflict. Financial, emotional, or social incentives were common, and most patients (88%) exhibited at least 4 FD-related behaviors. FD represents a complex disorder of abnormal illness behaviors with predisposing developmental and perpetuating sociobehavioral variables previously unexplored. Future investigational, educational, and quality improvement directions are considered. [ABSTRACT FROM AUTHOR]

Abstract Chronic pruritus (CP) is a bothersome symptom of many different diseases and is often associated with psychosomatic and psychiatric comorbidity. This review gives an overview of psychologic factors that influence the perception and modulation of pruritus based on the well-known biopsychosocial model. Not only psychic comorbidities, such as anxiety and depression, play an important role in the etiology and perception of pruritus, but also internal factors, including personality, mentalization, suggestibility, and external factors, as well as stress. Expectations concerning the intensity of pruritus can also play a role in itch perception that can be modulated by cognitions and behavior of the patient. Obsessive rituals of scratching and skin manipulation with instruments present challenges in the treatment of CP. Initial studies on the efficacy of psychotherapeutic approaches to different problems, such as scratching, comorbidity, or stress-associated itch, show that these might be very useful additions to the multidisciplinary treatment of pruritus. [ABSTRACT FROM AUTHOR]

Abstract Dermatologists often find themselves treating patients with psychiatric disorders, most commonly anxiety and depression, in the context of skin disease. The psychiatric condition may either be present before the skin condition developed and exacerbate it or, in some cases, even create it (eg, delusions of parasitosis). Alternatively, the psychiatric condition may occur subsequent to the development of the dermatologic condition. The treatment of psychodermatogic disorders requires collaboration between psychiatrists and dermatologists. Dermatologists should be able to recognize primary psychiatric disorders and refer patients to psychiatrists for appropriate treatment; however, the patient may encounter delays in accessing psychiatric care, and dermatologists should be familiar with the basic use of psychotropic drugs. This review describes common psychiatric disorders encountered in a dermatology practice and their treatment with psychotropic drugs. For each commonly used drug, dose range, side effects, and how to initiate and terminate treatment are described. Although psychotherapy is an important part of the treatment of most psychiatric disorders, we have limited our focus to psychotropic drugs in this review. [ABSTRACT FROM AUTHOR]

Abstract Psychologic and social effects of scalp hair are more important than its biologic significance. Etiology of alopecia areata (AA) suggests a predominantly autoimmune reaction. Correlation between AA and psychologic disorders is reciprocal. Psychiatric disorders can trigger the onset of AA and its negative consequences may develop or exacerbate psychologic problems. The high incidence of a neurotic personality, depression, anxiety, and deficiency in coping with stress strengthen the role of psychic factors in the pathogenesis of AA. Strategies to assess these patients are often not apparent for the clinician and identifying patients in need of extra psychologic support should be a mainstay for successful treatment. Women, young patients, and those with significant AA or previous psychiatric disorders are at greater risk, requiring careful monitoring. Proper awareness and consciousness about the close relationship between AA and psychologic factors are essential. [ABSTRACT FROM AUTHOR]

Abstract Psoriasis is a chronic inflammatory disorder characterized by substantial psychiatric comorbidity. Historically, anecdotal observations have suggested that psychosocial distress can trigger flares of psoriasis, but over the past several decades, high-quality data from experimental studies support the assertion that stress plays a critical role in the pathogenesis of psoriasis. There may be a subset of patients unable to elicit an appropriate immunosuppressive response to stress through upregulation of cortisol, with resultant exacerbation of their psoriasis. Other notable studies revealed that key neuromodulators, including substance P, calcitonin gene–related peptide, vasoactive intestinal peptide, and nerve growth factor may be potent regulators of neurogenic inflammation that induce psoriasis flares through a stress-mediated mechanism. Preliminary trials in humans that examine psychosocial interventions to reduce stress, as well as animal studies targeting specific neuropeptides, provide support for the concept that alteration of pathways mediated by the stress response represents novel forms of therapy in the management of psoriasis. [ABSTRACT FROM AUTHOR]

Résumé Cet article présente les premiers résultats d'une recherche se déroulant dans un service de neurologie en centre hospitalier régional universitaire. La migraine concerne environ 15 % de la population générale et représente un enjeu de santé publique. Mal connue dans son étiologie, nombre d'études ont tenté de s'intéresser à divers facteurs (aspects génétiques, anxiété, dépression, stress perçu...), sans toutefois réussir à saisir globalement les enjeux liés à sa survenue. Par ailleurs, il a été mis en avant que, statistiquement, les patients migraineux présentent significativement plus souvent un prototype d'attachement insécure que la population générale, mais sans réussir à spécifier précisément le type d'attachement insécure. Selon l'École psychosomatique de Paris et P. Marty, la somatisation – telle que la migraine par exemple – peut être le signe de difficultés de mentalisation chez le sujet. Dans la continuité de ces travaux, notre recherche propose une approche originale de la migraine, à partir de données liées à la nature de l'attachement, des relations précoces et la qualité de mentalisation du sujet. Nous faisons l'hypothèse qu'un attachement insécure craintif chez le sujet est en lien avec de faibles capacités de mentalisation, facteur favorisant l'émergence du symptôme migraineux. Nous exposons un cas clinique emblématique du fonctionnement psychosomatique de patients migraineux rencontrés, caractérisé notamment par des difficultés dans les relations précoces, des facultés de mentalisation défaillantes et un recours à l'agir important. Abstract Around fifteen per cent of the general population suffers from headaches. A lot of medical and psychological researches have raised the links between headaches and genetic, depression, anxiety, perceived stress and insecure attachment. The headache group has statistically significant higher percentage of subjects with an insecure attachment compared to the general population. Otherwise, literature shows links between insecure attachment and mentalization. Based on these concepts, we propose an original approach of headache. We assume that a fearful insecure attachment is correlated with low mentalization process, factor influencing headache. We report a representative clinical case of headache patients we meet during our research in a University Hospital. This case is marked with difficulties in early relations, uncertain mentalization faculties and resort to activities. [ABSTRACT FROM AUTHOR]

Abstract The adverse impact of skin diseases on an individual's physical and emotional well-being is well recognised, particularly in children as it is reflected in their growth and development. Conversely, the psychological and psychosocial issues that a child or young person may face, can manifest as a skin problem. Cutaneous manifestations of an underlying primary psychiatric problem are a poorly recognised entity amongst paediatricians. Limited knowledge and experience in this realm increases diagnostic and management challenges. The discipline of Psychodermatology attempts to address these problems by relating skin disease to intrinsic and extrinsic mental health factors. This review summarises the current literature on Psychocutaneous conditions with expert opinion from the authors own experience. The importance of a holistic approach in a multidisciplinary setting to manage this vulnerable group of children and young people cannot be over-emphasised. [ABSTRACT FROM AUTHOR]

Background The reflexive startle- and orienting-response have been widely studied in psychiatric disorders. Existing evidence in patients with borderline personality disorder (BPD) is mixed, and limited to adults. The present study addressed clinical correlates of the psychophysiological orienting response in adolescents with BPD. Methods Female adolescents (13–19 years) with BPD (n = 30), healthy controls (HC; n = 34), and psychiatric clinical controls (CC; n = 53) participated in the trial. Orienting response was induced using acoustic startle-probes (sinus tones) while heart rate (HR) and skin conductance (SCR) were continuously recorded. Besides clinical interviews, the assessment included self-reports on depressive symptoms, anxiety, dissociation and psychopathological distress. Results On a group level, relative habituation of the HR-response (regression slope) significantly differed between groups (F (2,114)  = 3.74, p  = 0.027), with significant contrasts ( p  = 0.026, Sidak corrected) comparing CC ( slope 0.04 ± 0.41) and BPD ( slope 0.28 ± 0.40). On a dimensional level, relative HR habituation was significantly correlated with the number of BPD diagnostic criteria endorsed (r (117)  = 0.183, p  = 0.049) and symptoms of dissociation (r (116)  = 0.193, p  = 0.038), indicating that delayed HR habituation across probes was associated with greater BPD symptom severity. Analyses of SCR showed no significant findings. Conclusion Findings provide preliminary support for altered habituation of the HR orienting response in adolescent BPD, associated with BPD severity – in particular dissociative experiences. Dissociative experiences may alter the automatic defensive response early in the course of BPD, providing a potential pathway to exaggerated emotional responding in BPD. [ABSTRACT FROM AUTHOR]

Rationale Shame related to childhood violence can be detrimental to mental and physical health. Shame may erode social bonds. Objective In this study we tested whether loneliness is an important pathway between violence-related shame and health problems. Method Individuals who reported exposure to childhood violence in a telephone interview survey in 2013 (wave one) were re-contacted 12–18 months later (wave two), as part of a more general survey of the Norwegian adult population. In total, 505 adolescent and young adult participants (mean age = 21 years) responded to questions about violence exposure, violence-related shame, loneliness, anxiety/depression symptoms, and somatic health complaints. We used counterfactually based causal mediation analysis within the structural equation modelling framework to test whether loneliness mediated a potential association between shame and health. Results Shame had a profound effect on anxiety/depression symptoms and we identified both direct and indirect effects. Loneliness mediated about one third of the relationship between shame and anxiety/depression symptoms. The relationship between shame and somatic health complaints was weaker in total, but this more modest effect largely occurred indirectly through loneliness. Conclusions Our results add to the literature by highlighting the role of loneliness in the relationship between shame and health. Shame may have the potential to break down social connectedness, with a detrimental effect on health. Clinicians may find it helpful to pay close attention to the way shame regulates social interaction. Preventing social isolation and loneliness may promote good health in violence victims. [ABSTRACT FROM AUTHOR]

Activity-based anorexia (ABA) is a well-established animal model mimicking the eating disorder anorexia nervosa (AN). Since the pathophysiology of AN is yet poorly understood and specific drug treatments are lacking so far, animal models might be useful to further understand this disease. ABA consists of time-restricted access to food for 1.5 h/day and the possibility to exercise in a running wheel for 24 h/day. This combination leads to robust body weight loss as observed in AN. Here, we investigated the activation of brain corticotropin-releasing factor (CRF) neurons, a transmitter involved in the response to stress, emotional processes and also food intake. After development of ABA, rat brains were processed for c-Fos and CRF double immunohistochemistry. ABA increased the number of c-Fos/CRF double labeled neurons in the paraventricular nucleus (PVN) and the dorsomedial hypothalamic nucleus (DMH) compared to the ad libitum (AL, ad libitum fed, no running wheel) and activity (AC, ad libitum fed, running wheel, p  < 0.05) but not to the restricted feeding (RF, food for 1.5 h/day, no running wheel, p  > 0.05) group. Also the number of CRF neurons was increased in the DMH of ABA rats compared to AL and AC ( p  < 0.05). In the Edinger-Westphal nucleus (EW) the number of c-Fos positive neurons was increased in ABA and RF compared to AC ( p  < 0.05), while the number of double labeled neurons was not different ( p  > 0.05). Taken together, brain CRF activated under conditions of ABA might play a role in the development and maintenance of this animal model and possibly also in human AN. [ABSTRACT FROM AUTHOR]

Objective To describe the use of prescription drugs and their association with patient characteristics in patients with multiple functional somatic syndromes (FSS) focusing on drugs generally recommended and not recommended in FSS treatment. Method Using data from a national prescription registry, we describe the drug use during a two-year period for 239 trial participants. Using regression models, we analyse the associations of patient characteristics with the patterns of use of antidepressants, anticonvulsants, opioids and sedatives. Results The use of prescription drugs was highly heterogeneous. Antidepressants were used at least temporarily by 34% (88/239), anticonvulsants by 7% (16/239), opioids by 26% (61/239) and sedatives by 20% (47/239) of the patients. Severe impairment due to multiple FSS was associated with use of opioids or sedatives (OR 6.49 (95% CI 2.68–15.68; p < 0.001)) but also with use of antidepressants or anticonvulsants (OR 3.42 (95% CI 1.35–8.65; p = 0.009)). Poor self-reported physical health, additional physical comorbidities and low socioeconomic status were associated with use of opioids or sedatives only. Conclusion Antidepressants and anticonvulsants were modestly used. Opioids and sedatives were especially used by the severely affected patients. Balancing treatment expectations and enhancing patients' understanding of FSS may direct treatments towards more generally recommended drugs. [ABSTRACT FROM AUTHOR]

Mental well-being is of great importance for emotional, psychological and social functioning, particularly in adolescence, a period characterized by significant physical, social, and emotional changes. The extant literature examining the relationship between temporal attitudes and mental and psychosomatic health outcomes is increasing rapidly. Using Latent Transition Analysis (LTA) of Adolescent and Adult Time Inventory-Time Attitude Scale scores across three waves of data ( N = 1667; 13–15 years; 42.0% female), we sought to examine the predictive power of time attitudes profile membership on mental well-being and psychosomatic symptomatology at distal wave four. Results indicated that staying in the Positive or Ambivalent profile was associated with more favorable distal outcomes at + 9 months; whereas staying in Negative or Moderately-Negative profile was strongly related to more somatic and psychological symptomatology, and lower mental well-being. Given the potential to modify time attitudes, these findings have several implications for interventions targeting adolescent mental and physical health. [ABSTRACT FROM AUTHOR]

Background: Little is known about somatic and psychiatric symptoms and perceived peer relationships of patients with psychogenic nonsyncopal collapse.Objective: This study aimed to compare somatic and psychiatric symptoms and other elements potentially related to functional neurological symptom disorders between youth with psychogenic nonsyncopal collapse and those with neurally mediated syncope.Methods: Before testing, patients completed a structured interview and questionnaire addressing current symptoms, previous psychiatric diagnoses, referrals, diagnostic testing, prescribed medications, and patient self-ratings of anxiety, depression, and perceived peer relationships.Results: Compared with patients with syncope (n = 60), patients with psychogenic nonsyncopal collapse (n = 60) had higher ratings for lightheadedness and vertigo, more abdominal pain, more chronic headaches, more fatigue, more sleep disturbances, more prescriptions for antidepressant medicines, more encephalograms performed, more referrals to psychiatry, and more psychiatric diagnoses including anxiety, depression, posttraumatic stress disorder, previous nonfainting conversion disorders, and eating disorders (all p < 0.05). Patients with psychogenic nonsyncopal collapse rated their anxiety (10.5 ± 7.7 versus 5.9 ± 5.8, p < 0.001) and depression (8.7 ± 8.3 versus 3.1 ± 5, p < 0.001) symptoms higher and their peer relationships (37 ± 12.3 versus 47.6 ± 7.9, p < 0.001) lower than patients with syncope. Peer relationships remained significantly lower (p = 0.001) when analyzed with anxiety and depression.Conclusion: Patients with psychogenic nonsyncopal collapse have more symptom complaints and perceptions of poorer peer social interactions than patients with syncope. These results broaden our understanding of the biopsychosocial profile that increases an individual's vulnerability to psychogenic nonsyncopal collapse specifically and to functional neurological symptom disorders in general. [ABSTRACT FROM AUTHOR]

In young adults, recollection-sensitive brain regions exhibit enhanced connectivity with a widely distributed set of other regions during successful versus unsuccessful recollection, and the magnitude of connectivity change correlates with individual differences in recollection accuracy. Here, we examined whether recollection-related changes in connectivity and their relationship with performance varied across samples of young, middle-aged, and older adults. Psychophysiological interaction analyses identified recollection-related increases in connectivity both with recollection-sensitive seed regions and among regions distributed throughout the whole brain. The seed-based approach failed to identify age-related differences in recollection-related connectivity change. However, the whole-brain analysis revealed a number of age-related effects. Numerous pairs of regions exhibited a main effect of age on connectivity change, mostly due to decreased change with increasing age. After controlling for recollection accuracy, however, these effects of age were for the most part no longer significant, and those effects that were detected now reflected age-related increases in connectivity change. A subset of pairs of regions also exhibited an age by performance interaction, driven mostly by a weaker relationship between connectivity change and recollection accuracy with increasing age. We conjecture that these effects reflect age-related differences in neuromodulation. [ABSTRACT FROM AUTHOR]

Background: Psychophysiological symptoms (e.g., pounding heart) are known to be a prominent feature of post-traumatic stress disorder (PTSD). Although omega-3 polyunsaturated fatty acids (PUFAs) have a beneficial potential pharmacological effect of preventing these psychophysiological symptoms, no clinical data is yet available. Therefore, we conducted a randomized, double-blind, placebo-controlled trial of Japanese accident survivors.Methods: A total of 83 participants received either omega-3 PUFAs (1470mg docosahexaenoic acid and 147mg eicosapentaenoic acid per day) or placebo within 10 days of the accidental injury. After 12-week supplementation, participants performed script-driven imagery of their traumatic event during monitoring of their heart rate and skin conductance.Results: Analysis revealed that heart rate during both rest and script-driven imagery was significantly lower in the omega-3 group than the placebo group, whereas baseline heart rate was comparable between the two groups.Limitations: The present trial was conducted at a single-center in Japan and psychophysiological symptoms of PTSD in most participants were not serious.Conclusion: These findings suggest that post-trauma supplementation of omega-3 PUFAs might be effective for the secondary prevention of psychophysiological symptoms of PTSD. [ABSTRACT FROM AUTHOR]

Objective: Current models assume somatoform pain disorder (SPD) to be the result of a complex interaction between bio- and psychosocial factors, but the etiology is still not well understood. This study aimed to investigate the distribution of attachment style and the frequency of traumatic life events, especially childhood adversities, in patients with SPD compared to healthy controls.Methods: We compared 65 patients with SPD (confirmed by Structured Clinical Interview, SCID-I) to 65 age- and gender-matched healthy controls. The following questionnaires were employed: Relationship Scale Questionnaire (RSQ), Essen Trauma Inventory (ETI), Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-15). A logistic regression analysis was used to identify the association between SPD and psychological factors.Results: Insecure attachment was significantly more prevalent (60%) in patients with SPD compared to healthy subjects (14%; p<0.001). Overall, 70.4% of patients with SPD reported three or more traumatic events in their life, compared with healthy subjects who reported predominantly one (40%). Patients with SPD scored significantly higher in all CTQ subscales compared to the healthy controls. The factor most strongly related with SPD was the insecure attachment style (OR=11.20, 95% CI: 1.32-94.86). Other significant predictive factors were depression (OR=3.35, 95% CI: 1.84-6.11) and number of traumatic events (OR=2.04, 95% CI: 1.06-3.92). Insecure attachment, depression symptoms and the number of traumatic events explained 86.2% of the variance.Conclusions: The high predictive value of insecure attachment style and cumulative traumatic events emphasize their importance as risk factors of SPD. [ABSTRACT FROM AUTHOR]

This article outlines how a core concept from theories of homeostasis and cybernetics, the inference-control loop, may be used to guide differential diagnosis in computational psychiatry and computational psychosomatics. In particular, we discuss 1) how conceptualizing perception and action as inference-control loops yields a joint computational perspective on brain-world and brain-body interactions and 2) how the concrete formulation of this loop as a hierarchical Bayesian model points to key computational quantities that inform a taxonomy of potential disease mechanisms. We consider the utility of this perspective for differential diagnosis in concrete clinical applications. [ABSTRACT FROM AUTHOR]

This research investigated the substances employed by and experiences of patients who come to acute treatment after self-poisoning. A retrospective search of the Toxicology Investigators Consortium Registry was performed to characterize a large cohort of patients. A detailed prospective study of one inpatient toxicology service was also conducted. Patients chose readily available agents for self-poisoning. Most cases involved at least one substance that affects the central nervous system (CNS). The majority were prescription psychotropics and narcotics. When they had access to both CNS-active and CNS-inactive medications, patients almost invariably ingested a mind-altering agent. After recovering neurocognitive function, most patients were not actively experiencing suicidal thoughts. However, more than half of patients without CNS toxicity continued to have suicidal ideation after coming to care. These findings are consistent with the hypothesis that many suicidal patients may be seeking an altered psychosomatic state rather than death per se . [ABSTRACT FROM AUTHOR]

This study examines psychophysiological and subjective reactivity to anxiety-provoking situations in relation to social anxiety and public speaking fear. We hypothesized that social anxiety symptoms would be associated with similar reactivity across types of imaginary anxiety scenes and not specifically to social anxiety-related scenes. This would be attributed to co-existing depression symptoms. Public speaking fear was expected to be associated with more circumscribed reactivity to survival-threat scenes, due to its association with fearfulness. Community participants imagined standardized anxiety situations, including social anxiety and animal fear scenes, while their physiological reactivity and self-reported emotions were assessed. Findings supported that social anxiety was associated with undifferentiated physiological reactivity across anxiety-provoking situations, except with regards to skin conductance level, which was higher during social anxiety imagery. Public speaking fear was associated with increased reactivity to animal phobia and panic scenes. Covariance analyses indicated that the lack of response specificity associated with social anxiety could be attributed to depression levels, while the specificity associated with public speaking fear could be explained by fearfulness. Findings highlight the need to assess not only primary anxiety symptoms but also depression and fearfulness, which likely predict discrepant reactions of individuals to anxiogenic situations. [ABSTRACT FROM AUTHOR]

Studies examining the rates of negative effects of psychotherapy are rare and the reported rates differ widely. To be able to calculate adequate benefit-cost ratios in conjunction with different samples and settings, we need a deeper understanding of these effects. We therefore investigated whether different treatment settings would reveal varying rates and kinds of negative effects by recruiting patients from a psychiatric (n=93) and a psychosomatic rehabilitation (n=63) hospital. Negative effects of psychotherapy were assessed with the Inventory for the Assessment of Negative Effects of Psychotherapy post-treatment. To investigate whether patients’ pre-treatment expectations have an influence on reported negative effects, patients filled in the Patient Questionnaire on Therapy Expectation and Evaluation prior to treatment begin. Patients from the psychiatric hospital reported an average 1.41 negative effects, with 58.7% reporting at least one negative effect. Those from the psychosomatic hospital reported 0.76 negative effects on average, with 45.2% of patients reporting at least one negative effect. The differences between these samples are significant. The two samples' top three reported types of negative effects are that patients had experienced more downs during or just before the end of the therapy, that patients had difficulty making important decisions without the therapist, and that patients were concerned that colleagues or friends might find out about the therapy. A regression analysis revealed that the clinical setting (psychosomatic rehabilitation hospital vs. psychiatric hospital) and expectations in the form of hope of improvement were significant predictors for negative effects of psychotherapy. Our study highlights the need to examine the negative effects of psychotherapy in different settings and samples to better evaluate the benefit-cost ratios of treatments for different patient groups. It also shows that we need guidelines for assessing and reporting negative effects. [ABSTRACT FROM AUTHOR]

Objective: Cancer patients need information provision to cope with their disease. However, only 20-60% of information provided during consultations is remembered. This study aimed to investigate whether oncologists' use of trust-conveying communication, characterized by communicating competence, honesty and caring, enhances patients' memory. Moreover, we aimed to investigate if this hypothetical relationship is mediated by a reduction in psychophysiological arousal during the consultation.Methods: An experimental design was used, allowing for conclusion about causality. Two versions of a scripted video-taped consultation were used in which the oncologist adopted either a standard or a trust-conveying communication style. 97 cancer-naive individuals acted as analogue patients and were randomly assigned to watch one of the consultations.Results: Free recall, assessed 24-28h after viewing, was higher (p=0.039) in the trust-conveying condition (65.3% versus 59.5%). Recognition did not differ (p=0.502). Psychophysiological assessment during watching showed a smaller heart rate response in the trust-conveying condition (p=0.037). No mediation effect nor an effect on electrodermal activity was found.Conclusion: These results suggest that oncologists' use of trust-conveying communication could increase patients' free recall of information and diminish their cardiovascular response.Practice Implications: The underlying mechanisms by which oncologists' communication influences information recall warrants further investigation. [ABSTRACT FROM AUTHOR]

Objective: Cognitive behaviour therapy (CBT) is an effective treatment for chronic fatigue syndrome (CFS). Main aim was to determine whether treatment effects were maintained up to 10years after treatment.Methods: Participants (n=583) of previously published studies on the effects of CBT for CFS were contacted for a long-term follow-up assessment. They completed questionnaires on main outcomes fatigue severity (CIS) and physical functioning (SF-36). The course of these outcomes since post-treatment assessment was examined using mixed model analyses.Results: Between 21 and 125months after finishing CBT, 511 persons (response rate 88%) completed a follow-up assessment. At follow-up, mean fatigue severity was significantly increased to 37.60 (SD=12.76) and mean physical functioning significantly decreased to 73.16 (SD=23.56) compared to post-treatment assessment. At follow-up still 37% of the participants had fatigue scores in the normal range and 70% were not impaired in physical functioning.Conclusion: Positive effects of CBT for CFS on fatigue and physical functioning were partly sustained at long-term follow-up. However, a subgroup of patients once again reported severe fatigue, and compromised physical functioning. Further research should elucidate the reasons for this deterioration to facilitate the development of treatment strategies for relapse prevention. [ABSTRACT FROM AUTHOR]

Dermatologic symptoms can be associated with posttraumatic stress disorder (PTSD) in several situations: (1) as features of some core PTSD symptoms, such as intrusion symptoms manifesting as cutaneous sensory flashbacks, as autonomic arousal manifesting as night sweats and idiopathic urticaria, and as dissociation manifesting as numbness and dermatitis artefacta; (2) the cutaneous psychosomatic effects of emotional and physical neglect and sexual abuse (eg, infantile eczema, cutaneous self-injury, and body-focused repetitive behaviors such as trichotillomania and skin picking disorder) and eating disorders, which can have dermatologic effects; (3) the direct effect of physical or sexual abuse or catastrophic life events (eg, earthquakes) on the skin; and (4) as a result of significant alterations in hypothalamic-pituitary-adrenal and sympatho-adrenal medullary axes, which can affect neuroendocrine and immune functions, and can lead to exacerbations of stress-reactive inflammatory dermatoses such as psoriasis, chronic urticaria, and atopic dermatitis. Elevated levels of inflammatory biomarkers and impaired epidermal barrier function have been reported in situations involving sustained psychologic stress and sleep deprivation. Some PTSD patients show hypothalamic-pituitary-adrenal axis hyporesponsiveness and higher circulating T lymphocytes, which can exacerbate immune-mediated dermatologic disorders. PTSD should be considered an underlying factor in the chronic, recurrent, or treatment-resistant stress-reactive dermatoses and in patients with self-induced dermatoses. [ABSTRACT FROM AUTHOR]

Sensitive skin is a syndrome defined by the occurrence of unpleasant sensations (stinging, burning, pain, pruritus, and tingling sensations) in response to stimuli that normally should not provoke such sensations. The worldwide prevalence of sensitive skin is approximately 40%. Clinical, histologic, biochemical, and therapeutic data show that this condition is related to changes in epidermal nerve endings with subsequent hyperreactivity and neurogenic inflammation; hence, sensitive skin is not a psychosomatic disorder, although psychologic consequences are possible. [ABSTRACT FROM AUTHOR]