Search

Objective: The aim of this review is to illustrate an innovative framework for assessing the psychosocial aspects of medical disorders within the biopsychosocial model. It is based on clinimetrics, the science of clinical measurements. It may overcome the limitations of DSM‐5 in identifying highly individualized responses at the experiential, behavioral, and interpersonal levels. Method: A critical review of the clinimetric formulations of the biopsychosocial model in the setting of medical disease was performed. References were identified through searches from PubMed for English articles on human subjects published from January 1982 to October 2023. Results: Clinimetric methods of classification have been found to deserve special attention in four major areas: allostatic load (the cumulative cost of fluctuating and heightened neural or neuroendocrine responses to environmental stressors); health attitudes and behavior; persistent somatization; demoralization and irritable mood. This type of assessment, integrated with traditional psychiatric nosography, may disclose pathophysiological links and provide clinical characterizations that demarcate major prognostic and therapeutic differences among patients who otherwise seem deceptively similar because they have the same medical diagnosis. It may be of value in a number of medical situations, such as: high level of disability or compromised quality of life in relation to what is expected by disease status; delayed or partial recovery; insufficient participation in self‐management and/or rehabilitation; failure to resume healthy role after convalescence; unhealthy lifestyle; high attendance of medical facilities disproportionate to detectable disease; lack of treatment adherence; illness denial. Conclusions: The clinimetric approach to the assessment of key psychosocial variables may lead to unique individual profiles, that take into account both biology and biography. It may offer new opportunities for integrating psychosocial and medical perspectives. [ABSTRACT FROM AUTHOR]

Nearly 700,000 adults with a purchase of benzodiazepines, Z-drugs (medications acting on benzodiazepine receptors that do not have a benzodiazepine structure, i.e., zolpidem and zopiclone) and melatonin in the Danish National Patient Registry between 2000 and 2018 were included. Not at all: common side effects of benzodiazepines and Z-drugs, such as sedation, slowed reaction time, impaired balance and gait, may indeed facilitate falls, even though no more than other medications. Very often I have been able to successfully address insomnia that was refractory to hypnotics by switching the patient to very low-dose clonazepam (0.25 mg in two divided doses), with the benefit of avoiding a medication bulk at night. [Extracted from the article]

Behavioural lifestyle interventions focused on diet and physical activity are a cornerstone for the treatment of obesity. However, their effects vary substantially across individuals in terms of magnitude and durability. Personalized approaches that target psychological well‐being may be promising to facilitate healthy behaviours and sustained weight loss. This preliminary study aimed to explore whether the sequential combination of behavioural lifestyle intervention (BLI) and well‐being therapy (WBT) may result in more favourable outcomes than BLI alone in promoting weight loss (primary outcome) and improving psychological well‐being, distress, dietary behaviours and physical activity (secondary outcomes). A total of 83 patients with obesity were randomly assigned to BLI/WBT (N = 38) or BLI group (N = 45). The BLI group received a 12‐week behavioural weight loss programme, whereas the BLI/WBT group received the same programme followed by an additional 4‐week WBT, adapted for group interventions. Data were collected at pretreatment (baseline, T1), at the end of BLI/WBT (T2), at 6‐month (T3) and 12‐month (T4) follow‐ups. There was a significant weight loss in both treatment groups at T2, T3 and T4. The BLI/WBT group showed greater improvements in depressive symptoms at T3 and T4, in autonomy at T2, in personal growth at T4 and in global well‐being at T4 compared with BLI group. WBT yielded no additional effect on weight loss. However, the secondary outcomes indicate that WBT may have enduring effects that reduce vulnerability to psychological distress in patients with obesity. In order to confirm these preliminary findings and explore whether a more intensive and individualized WBT can foster sustained weight loss, future studies are needed. [ABSTRACT FROM AUTHOR]

Radstaak, Hüning, and Bohlmeijer (2020) reported on a randomized controlled trial (RCT) of well‐being therapy (WBT) compared to treatment as usual (TAU) in the treatment of residual posttraumatic stress disorder (PTSD) symptoms. No significant differences emerged between treatment conditions. However, our view is that what the authors labeled as WBT did not match the manualized psychotherapeutic strategy, and what was defined as TAU was actually an active control group. Further methodological limitations hinder the interpretation of results and make it difficult to draw conclusions from the study. Radstaak et al. (2020) deserve credit for addressing the vexing and neglected problem of residual symptoms in PTSD. However, the role of WBT in PTSD treatment still needs to be explored via an effectively designed RCT. Given that WBT does not require exposure to a patient's index traumatic event as a means of alleviating PTSD symptoms, WBT may represent a promising alternative to current treatments of PTSD. [ABSTRACT FROM AUTHOR]

Despite the fact that today most of the patients with psychological disturbances assume some form of psychotropic drug treatment, clinical psychologists may have little familiarity with psychopharmacology and are substantially unaware of subtle and yet pervasive potential effects of medications in clinical presentations. In their training, psychologists are generally exposed, at best, to some general principles of drug action. Standard psychopharmacology textbooks tend to omit the subtle psychological changes that may occur during psychotropic drug treatment. Clinical pharmacopsychology consists of the application of clinical psychology to the full understanding of pharmacological effects. The domains of clinical pharmacopsychology encompass the clinical benefits of psychotropic drugs, the characteristics that predict responsiveness to treatment, the vulnerabilities induced by treatment (side effects, behavioural toxicity, iatrogenic comorbidity), and the interactions between drug treatment and psychological variables. The DSM‐5 refers to a patient population that no longer exists: subjects who display various manifestations of psychological distress who do not receive any form of drug treatment for it. Any type of psychotropic drug treatment, particularly after long‐term use, may increase the risk of experiencing additional psychopathological problems that do not necessarily subside with discontinuation of the drug. The changes may be persistent and not limited to a short phase, such as in the case of withdrawal reactions, and cannot be subsumed under the generic rubrics of adverse events or side effects. [ABSTRACT FROM AUTHOR]

The olive oil industry is a sector of high relevance in the economy of the European Union; indeed, three quarters of the world production is concentrated in the South Europe. Unfortunately, the commonly used milling techniques generate huge amounts of highly polluting olive mill wastewater (OMWW) as a side-product. If released in the environment, untreated OMWW have a detrimental impact on land and water because of the large amount of phytotoxic phenolic compounds contained. At the same time, due to their powerful antiradical properties, polyphenols represent the center of a very valuable market niche, where they find application in cosmetic and nutraceutic fields. Consequently, the mandatory (for evident environmental reasons) depollution of OMWW associated with an efficient and selective recovery of the phenolic fraction could be economically very advantageous. In the present study, a new methodology employing activated charcoal as the adsorbent phase was developed in order to depollute OMWW and simultaneously recover a fraction enriched in hydroxytyrosol, the most abundant and valuable phenolic compound present in this matrix. Moreover, to evaluate the technical and economic feasibility of the process at a pre-industrial level, this strategy was submitted to a scale-up process and a pilot plant prototype was developed. [ABSTRACT FROM AUTHOR]

The precipitating role of emotional stress in the development of congestive heart failure (CHF) is a long‐standing clinical observation. We employed new clinimetric criteria for the assessment of allostatic overload (AO) in a sample of CHF patients, with regard to its associations with psychological distress and health status. Allostatic overload was assessed by a semi‐structured interview based on clinimetric criteria in 70 consecutive outpatients with CHF. One observer‐rated scale and two self‐rating questionnaires for psychological distress were administered. Cardiac variables were also collected at intake. Twenty‐three patients (32.9%) were classified as having AO according to clinimetric criteria. Significant differences were found with regard to gender, with women being more likely to report AO than men (23.5% versus 57.9%). Patients with AO presented significantly higher levels of psychological distress (based on scales administered) compared with those who did not. Among cardiac risk factors, hyperglycaemia was found to be significantly associated with the presence of AO. The use of the clinimetric criteria provides a global index for identifying distress that might adversely influence the course and progression of CHF. It may be of use in clinical practice, leading to therapeutic suggestions such as lifestyle modifications and psychotherapy to help patients deal with their difficulties. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective The psychosocial implications of polycystic ovary syndrome (PCOS) phenotypes have been investigated in different patient populations, but little attention was paid to adolescent and young women. The aim of this study was to evaluate the psychosocial correlates of PCOS and other hyperandrogenic states in a population of late adolescent and young females and to provide a psychological characterization of specific clinical hyperandrogenic phenotypes. Design This was a cross-sectional study. Patients High school female students, aged 16 19 years. Measurements The study protocol was designed with three possible levels of participation characterized by an increased level of commitment. For the specific purposes of this investigation, we focused on the subsamples of students whose clinical state was assessed by medical examination (n = 835) and for whom additional laboratory tests were available (n = 394). Psychological evaluation encompassed psychological distress, levels of stress, well-being, illness behaviour and quality of life (as measured by the Symptom Questionnaire, the Psychosodal Index and the Psychological Well-Being scales). Results Significantly higher levels of psychological distress and impaired well-being and quality of life were found among late adolescent and young women with isolated clinical hyperandrogenism compared to their normal counterparts. Furthermore, females with PCOS showed significantly greater hostility/irritability compared to healthy control subjects. Conclusions These findings highlight the importance of early recognizing and adequately managing psychological distress in such patients. [ABSTRACT FROM AUTHOR]

Comorbidity is a well-established and documented phenomenon in mental disorders and medicine with heuristic value. The concept of comorbidity remains however poorly defined and lacks a comprehensive and coherent theoretical framework. There is a need to develop coherent methodological strategies in order to promote a fuller understanding of the implications of comorbidity and to exploit its potential value with regard to etiopathogenic and therapeutic issues. This position paper makes recommendations of improved methodological standards and procedures and discusses a range of options that can provide incremental information that is likely to improve therapeutic outcomes. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A specific psychotherapeutic strategy for increasing psychological well-being and resilience, well-being therapy (WBT), based on Ryff's conceptual model, has been developed and tested in a number of randomized controlled trials. The findings indicate that flourishing and resilience can be promoted by specific interventions leading to a positive evaluation of one's self, a sense of continued growth and development, the belief that life is purposeful and meaningful, the possession of quality relations with others, the capacity to manage effectively one's life and a sense of self-determination. A decreased vulnerability to depression, mood swings and anxiety has been demonstrated after WBT in high-risk populations. School interventions based on the principles of WBT have been found to yield both promotion of well-being and decrease of distress compared with control groups. The differential technical characteristics and indications of WBT are described, with a special reference to the promotion of an individualized and balanced path to achieve optimal human functioning, avoiding the polarities in positive psychological dimensions. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message A specific psychotherapeutic strategy, well-being therapy, for modifying the levels of psychological well-being has been developed and tested., In controlled trials, it has yielded significant benefits in clinical populations, particularly as to vulnerability to affective alterations., Well-being therapy may help in achieving flexibility and balance in psychological dimensions that underlie optimal human functioning., Best results are achieved when it is applied to the sub-acute phase of mood and anxiety disorders, in a sequential model., Well-being therapy may have a preventive role in general populations and particularly in children. [ABSTRACT FROM AUTHOR]

A specific psychotherapeutic strategy for increasing psychological well-being and resilience, well-being therapy, has been developed and validated in a number of randomized controlled trials. The findings indicate that flourishing and resilience can be promoted by specific interventions leading to a positive evaluation of one's self, a sense of continued growth and development, the belief that life is purposeful and meaningful, the possession of quality relations with others, the capacity to manage effectively one's life, and a sense of self-determination. A decreased vulnerability to depression and anxiety has been demonstrated after well-being therapy in high-risk populations. There are important implications for the state/trait dichotomy in psychological well-being and for the concept of recovery in mood and anxiety disorders. [ABSTRACT FROM AUTHOR]

Well-being therapy (WBT) aims to enhance psychological well-being based on Ryff's (1989) six dimensions: autonomy, personal growth, environmental mastery, purpose in life, positive relations, and self-acceptance. Previous studies have documented the efficacy of this psychotherapy in treating patients with mood and anxiety disorders and in preventing relapse in recurrent depression. We discuss and illustrate the use of WBT in generalized anxiety disorder. We present a case of a patient suffering from generalized anxiety disorder treated with cognitive-behavioral therapy followed by WBT. © 2009 Wiley Periodicals, Inc. J Clin Psychol: In Session 65: 1–10, 2009. [ABSTRACT FROM AUTHOR]

Objective To verify whether patients with pituitary disorders in remission and on appropriate treatment display significant differences in psychological distress compared to healthy controls and other patients treated for nonpituitary endocrine disorders. Design A single-centred, controlled study. Patients Eighty-six outpatients cured or in remission for at least 9 months following appropriate treatment by surgery, irradiation and/or pharmacological interventions for pituitary disease were compared with 86 healthy subjects. A sample comprising 60 outpatients cured or in remission from nonpituitary endocrine disorders was also compared. Measurements (1) A modified version of the Structural Clinical Interview for DSM-IV; (2) a shortened version of the structured interview for the Diagnostic Criteria for Psychosomatic Research (DCPR); (3) the Psychosocial Index (PSI); and (4) the Medical Outcomes Study (MOS) short form General Health Survey (SF-20) were employed. Results Patients with pituitary disease displayed a higher prevalence of psychiatric disease ( P < 0·001) compared to controls, but not when compared to nonpituitary endocrine patients. They also showed a higher prevalence of DCPR clusters compared to controls ( P < 0·001), but not when compared to nonpituitary endocrine patients. At PSI and MOS (SF-20), patients with endocrine disease, whether pituitary or not, reported more psychological distress, and less well-being ( P < 0·001) compared to controls. Conclusions At follow-up after appropriate treatment, we documented a high prevalence of psychopathology in patients with pituitary disease, which was however, similar to that found in nonpituitary endocrine patients. This is consistent with an increasing body of literature that reports difficulties in obtaining full recovery in patients treated for endocrine disorders. [ABSTRACT FROM AUTHOR]

Aim: The aim of this review was to survey the available literature on prodromal symptoms of unipolar major depression. Methods: Both a computerized (Medline) and a manual search of the literature were performed. Results: In a substantial proportion of patients with depression a prodromal phase can be identified. There is a relationship between residual and prodromal symptomatology (the rollback phenomenon). Conclusions: Appraisal of prodromal phase of major depression has important implications as to pathophysiological models of disease and relapse prevention. It may allow a staging system of depressive illness that may yield more enduring results in the therapeutic efforts. [ABSTRACT FROM AUTHOR]

Objective Psychological distress does not always disappear upon proper endocrine treatment of Cushing's syndrome, and quality of life may still be compromised. Little is known on the personality correlates that may be involved. The aim of this study was to provide a controlled assessment of personality characteristics and quality of life in patients successfully treated for Cushing's syndrome. Design A single-centred, controlled, prospective study. Patients Twenty-four consecutive outpatients who were in remission upon proper treatment of Cushing's syndrome for at least 1 year and no more than 3 years (20 with pituitary-dependent Cushing's disease and four with a cortisol-secreting adrenal adenoma; 5 M/19 F; mean age 34·5, SD = 10·6; range 18–57 years) were compared with 24 healthy control subjects matched for sociodemographic variables. Measurements Both patients and controls were administered two self-rating scales: (a) tridimensional personality questionnaire (TPQ), a 100-item inventory that yields three scales: novelty seeking, harm avoidance and reward dependence. (b) symptom rating test (SRT), a 46-item scale for assessing psychological distress and quality of life with six subscales (anxiety, depression, somatic symptoms, anger-hostility, cognitive symptoms, psychotic symptoms). Results There were no significant differences in personality dimensions, as measured by the TPQ, between patients and controls. The results did not change when the four patients with an adrenal adenoma were excluded and only the 20 with pituitary-dependent Cushing's disease were considered. As to the SRT scale, patients with Cushing's syndrome displayed significantly higher scores in anxiety ( P= 0·046), depression ( P= 0·013), and psychotic symptoms ( P= 0·006), with a generalized compromised quality of life ( P= 0·02). Again, no differences were found in evaluating the 20 patients with Cushing's disease separately. Conclusions Even though personality traits other than those explored here may be involved, the results seem to exclude the presence of latent dysfunctional attitudes and beliefs contributing to long-standing psychological disturbances, even in the pituitary-dependent form of Cushing's syndrome. Data from larger populations might provide further insight in this field. The findings of a compromised quality of life are in agreement with the recent literature and have implications for the long-term management of patients. [ABSTRACT FROM AUTHOR]

There is insufficient research on rating psychological well-being and distress in clinical populations. The aim of this study was to evaluate the differential characteristics of instruments assessing well-being and distress in 20 remitted patients with affective (mood and anxiety) disorders and 20 healthy control subjects matched for sociodemographic variables. Remitted patients displayed significantly higher levels of psychological distress - as measured by Paykel's Clinical Interview for Depression (CID), Van Praag's Scale for Personality Disturbances and Kellner's Symptom Questionnaire (SQ) - and significantly less well-being - as measured by Ryff's Scales of Psychological Well-Being (PWB) and the SQ - than control subjects. The correlations between scales of psychological distress and well- being were found to be complex in both patients and controls. Psychotherapeutic treatment of residual symptomatology in patients disclosed a differential sensitivity of the scales to changes. The results thus suggest that well-being cannot be equated to lack Of distress (as implicitly endorsed by current psychiatric paradigms), and the need for a multidimensional assessment in stress medicine. [ABSTRACT FROM AUTHOR]

Relapse and recurrence are vexing problems of unipolar depression. Awareness of their frequent occurrence has led to the development of pharmacological long-term strategies. A substantial proportion of patients with mood disorders still display residual symptoms upon successful treatment of their illness. Such symptoms were found to entail prognostic value in the prediction of relapse in the entire range of affective disorders. Specific psychotherapeutic strategies for this stage of illness have been developed. One involves cognitive-behavioral treatment of residual symptoms after successful pharmacological therapy of acute depression. This strategy has resulted in a lower relapse rate at a four-year follow-up compared to a clinical management group. The other strategy, based on Ryff's conceptual model, was developed to enhance well-being (well-being therapy). Results from recent pilot studies indicate that well-being therapy may be a promising strategy for decreasing residual symptomatology in affective disorders and thus as a relapse-preventive strategy. Copyright © 1999 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Psychological distress and illness attitudes were investigated in women undergoing thermography and mammography by means of two self-rating scales: the Symptom Questionnaire (SQ) and the Illness Attitude Scales (IAS). After receiving normal results from thermography, a significant decrease in anxiety, depression, somatic symptoms, hostility, worry about illness, concern about pain, and fear of dying took place. Women who, because of the thermography results, required mammography, displayed significantly less distress and fewer fears before mammography than before thermography. [ABSTRACT FROM AUTHOR]

The role and features of irritable mood in the medically ill have eluded systematic investigation. Irritability may be a non-specific manifestation of another psychiatric disturbance, such as depression, or part of the emotional reaction to hospitalization, pain and diagnostic procedures. Irritability, however, may also be a mood state relatively independent of other major moods of anxiety and depression. It may characterize a specific organic affective syndrome; it may be a major side effect of treatment; or it may be associated with abnormal illness behavior. The diagnosis and treatment of irritable mood in the medically ill are reviewed. Hostility and irritability appear to be worthy of clinical and research attention in psychosomatic medicine. [ABSTRACT FROM AUTHOR]

The article focuses on a study carried out in northern Italy in order to examine the validity of the CES-D self-rating scale for depression in non-English-speaking populations. The scale was used with 40 depressives and 40 normals who were matched for age, sex, marital status, and social class. In both the groups Hamilton Rating Scale for Depression (HRSD) was used. The CES-D was administered after the research interview and-in the patients' group-before antidepressant treatment. The scale was given in its Italian translation prepared by the author. The results of the study show that the CES-D is a valid measure in that it sensitively discriminates between depressed patients and normals and also presents satisfactory correlations with the observer rating scale, HRSD, in both the groups. The scale in its Italian translation is likely to be helpful in the assessment of depression of Italian immigrants in North America and Australia, especially in those whose English is poor. The CES-D can be used as a checklist by clinicians for a rapid review of the more serious depressive symptoms reported by the patient.

A possible role of anxiety in the pathogenesis of essential hypertension is still controversial. We included the new concept of anxiety sensitivity (ie fears of anxiety symptoms) in the psychometric evaluation of hypertensive patients. Twenty patients with essential hypertension successfully managed by nifedipine and 20 normal subjects were administered two self-rating scales, the Symptom Questionnaire (SQ) and the Anxiety Sensitivity Index (ASI). Compared to controls, hypertensive patients showed significantly (p < 0.05) higher levels of anxiety sensitivity measured by ASI, and no differences in anxiety and well-being measured by SQ. Increased anxiety sensitivity could be a consequence of the diagnosis of hypertension or constitute itself a predisposing factor for its development. [ABSTRACT FROM AUTHOR]

Provides information regarding secondary amenorrhea. Definition of the said condition; Potential causes; Psychological reasons for amenorrhea.