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In this article, the author investigates the wide variation in historical and contemporary understandings of somatization. The article explores the rewards of understanding somatization as a deficit pathology and proposes an integration of deficit pathology theory and Winnicott's theory of self to better understand the causes of somatization. The author postulates a link between the formation of a pathological false self and somatoform symptoms and draws on Killingmo's description of conflict and deficit pathology to integrate the defensive organization (false self) with the concept of deficit. The false self is conceptualized as a defensive organization that is born in a climate of deficit, including early childhood trauma. Therapeutic implications include a focus on experiencing meaning, working with alexithymia, and providing the client an opportunity to confront the painful reality of their unmet needs, in a safe and holding environment not afforded to them in childhood. The author outlines the therapeutic goal of moving toward a renewed sense of 'equilibrium of self', where a person can freely and safely demonstrate vulnerability as well as meet their own needs. This in turn works to reduce the need for the protection of a pathological false self and the tightly bound somatoform symptomatology. [ABSTRACT FROM AUTHOR]

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BackgroundThere is a need for re-designing the health service for children suffering from complex and compound health complaints. Based on a previous register study, we have developed criteria to select patients with complex health complaints eligible for an Intervention with an interdisciplinary professional team. The team consists of a pediatrician, a psychologist and a physiotherapist.MethodTo identify children with complex health complaints who would benefit from this intervention, we have selected a group of patients by using a set of criteria consisting of the following criteria: multi-referred young school age children referred to both mental health service and pediatric service. This study focuses on the feasibility of these criteria by measuring participation and compliance and by gathering feedback from the team members in the interdisciplinary team.ResultsAmong 677 children aged 6−12 years referred to a regional hospital, we found 32 (5%) children eligible for the interdisciplinary Intervention according to the applied criteria. Only 6% of the invited parents declined to participate in the intervention. According to the interdisciplinary team, the intervention was found suitable for 88% of the children.ConclusionThe suggested criteria seemed feasible, in terms of identifying eligible patients for this interdisciplinary Intervention for children with complex health complaints.Clinical Trial RegistrationRetrospectively registered on www.clinicaltrials.gov, ID NCT04652154, on the 3rd of December 2020.

Psychosomatic symptoms are physical manifestations of psychological origin that are not adequately explained by organic causes. For this reason, it is difficult to differentiate them from other conditions, so health sciences must consider their diagnosis and research on them a priority. The PHQ-15 (Patient Health Questionnaire) is an instrument that allows its diagnosis through a list of 15 psychosomatic symptoms. The purpose of this research was to validate the PHQ-15 for the Mexican adult population, obtaining indicators of reliability, construct, and convergent validity. First, the instrument was translated and culturally adapted. This version was evaluated by mental health specialists and doctors. The PHQ-15 and the Hospital Anxiety and Depression Scale (HADS) were applied to 420 Mexican participants through an online survey. A Confirmatory Factor Analysis was performed that rectified the unifactorial structure. The results showed acceptable fit indicators and a significant contribution of all the reagents to the model. The correlations between the PHQ-15 and the HADS showed a directly proportional relationship between psychosomatic symptoms with depression and anxiety, which provides evidence of convergent validity. Regarding internal consistency, it showed adequate levels of reliability. [ABSTRACT FROM AUTHOR]

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Background: The coronavirus disease 2019 pandemic has led to an increase in youth mental health problems worldwide. Studies have revealed substantial variation in the incidence of these problems across different regions. Longitudinal studies of children and adolescents in Italy are lacking. This study aimed to investigate the development of health-related quality of life (HRQoL) and mental health in Northern Italy by comparing surveys conducted in June 2021 and in March 2022. Methods: A representative, large cross-sectional, online survey investigated HRQoL, psychosomatic complaints, and symptoms of anxiety and depression among 5159 and 6675 children and adolescents in 2021 and 2022, respectively, using the KIDSCREEN-10 index, HBSC symptom checklist, SCARED, CES-DC, and PHQ-2 instruments. Statistical analyses included a multivariate linear regression analysis. Results: Baseline characteristics showed significant differences in demographic variables between the two surveys. Girls and their parents reported a significantly lower HRQoL in 2021 than in 2022. Psychosomatic complaints differed significantly between sexes, and the results showed no decrease in psychosomatic complaints, anxiety, or depression between 2021 and 2022. Predictors of HRQoL, anxiety, depressive symptoms, and psychosomatic complaints in 2022 differed from those in 2021. Conclusions: The characteristics of the 2021 pandemic, including lockdowns and home schooling, may have contributed to the differences between the two surveys. As most pandemic restrictions ended in 2022, the results confirm the need for measures to improve the mental and physical health of children and adolescents after the pandemic. [ABSTRACT FROM AUTHOR]

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Chronic pain is one of the biggest health problems concerning public healthcare at present. It is often associated with other complaints like fatigue, anxiety and depression and one of the major causes for inability to work and loss of productivity in general. Conventional therapy of chronic pain consists of elaborated treatment approaches that are often costly and limited in their generalizability as they come with severe risks and side-effects when employed long-term. Concerns about feasibility, sustainability and effectiveness raise the need for better understanding the processes involved with long-term pain and developing innovative treatment concepts. This narrative review aims at giving an overview of emerging fields of research like psycho-neuro-immunology, stress economy and fascial tension that are relevant to modern pain therapy, thus stressing the importance of including stress response, increased inflammatory activity, adverse childhood events, lack of personal resources and proprioceptive identity into a sustainable treatment approach. It further explores those clinical strategies and practices like manual therapy, acupuncture, body awareness techniques and psychotherapy which have already been well-researched and found effective, but are not part of regular treatment yet. Especially the intersection of trauma, ongoing psychological stress and pain can be understood by the idea of crystallization of inner tension into fascial adhesions and the modulation of the proprioceptive self. These avenues of experimental and clinical research are then discussed within the framework of integrative therapy that allows to include aspects of psychosomatics, salutogenesis, spirituality and traditional medical knowledge in an inclusive and approachable way. [ABSTRACT FROM AUTHOR]

Functional disorders (FD) are common medical problems both in primary and in secondary health care. The mechanisms that cause symptoms such as primary pain, fatigue, and dizziness are still unknown. Various classifications, including ICD-10 and DSM-5, describe these conditions differently, and new proposals are being developed, e.g., in ICD-11, RDoC. Many controversies are evoked by a lack of unequivocal explanatory theory. The early psychoanalytical concept has been modified by other explanations, such as immunological abnormalities, dysfunction of the vegetative system and HPA axis, central sensitization, diverted processes of perception or predictive processes within cognitive homeostasis dysregulation. Insufficient scientific evidence makes therapies unsuccessful and justifies further study. Psychotherapy, pharmacotherapy and complementary medicine are supplemented by new experimental methods of treatment connected with progress in neuroscience. The recently developed non-invasive transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS) and EEG neurofeedback (EEG-NF), based on EEG registration, are undergoing tests. Applying complex mathematical algorithms to localized bioelectrical signal sources makes it possible to modulate and reshape connections of neuronal networks within specific cortex areas. This article presents the current state of knowledge concerning functional disorders, highlighting the ways in which different definitions of FD have an impact on approaches to treatment. [ABSTRACT FROM AUTHOR]

Skin diseases have a significant effect on various aspects of patients' life and can cause psycho-emotional and psychosocial problems, as well as social maladaptation. Typical personality traits and personality types of the patients have been reported for a number of skin disorders. Psychological or even psychiatric disorders associated with the effects of chronic psycho-emotional stress prevail in patients with acne. These patients often suffer from depression and anxiety disorders. The type D personality characteristics are typical for patients with psoriasis: these patients experience strong negative emotions that are not, however, demonstrated due to fear of disapproval and rejection. This results in discomfort, selfdoubt, propensity for anxiety, and self-recrimination. Studying innate personality traits in patients with certain disorders is important for health care providers to understand the features of the patients' responses and their adherence to treatment, as well as to detect the concomitant psycho-emotional disorders and mental diseases. Better understanding of the patients' psychological features makes it possible to use targeted approaches to treatment of the disease-associated psychosocial problems, as well as to increase the disease. The paper reports a clinical case of psoriasis personality shown by the patient with acne.

BackgroundEffective consultation-liaison psychiatry (CLP) is proactive, collaborative, and requires providers to have proficiency with therapeutic skills beyond nosology and medication management. Motivational interviewing (MI) is an evidenced-based intervention that should be considered essential for CLP trainees to learn. Given that the demands of training and patient care are already experienced as stressful for many psychiatry trainees, the authors endeavored to create a MI training program that was integrated into trainees’ normal CLP workflow.MethodTwenty-two trainees on an inpatient CLP rotation participated in a six-week MI training program that was incorporated into their regular workflow. The program included didactic sessions with role-playing, as well as on-demand between-session coaching via an expert in MI. Trainee participation and perceptions of MI were measured via a questionnaire that was administered prior to each training session.ResultsTrainee participation in the didactic sessions was inconsistent. Questionnaire data revealed positive baseline perceptions of motivational interviewing and its usefulness in inpatient medical settings. Additionally, as trainees participated in the program, perceived knowledge of motivational interviewing as well as awareness of motivational issues among their patients increased. Finally, participation in program was not perceived as disruptive to daily workflow for the participants.DiscussionThis the first documented attempt at implementing a MI training program for CLP trainees that was integrated into their regular workflow. Preliminary data identified some encouraging trends, but also unexpected challenges. These lessons could inform how these types of training programs are implemented moving forward.

There is a growing recognition that emotional problems are important to physical health outcomes. In response, primary care clinics have introduced self-report checklists to identify patients with emotional disorders such as depression or anxiety. Yet psychodynamic theory posits that certain emotional problems may be unconscious and unspoken, and thus not discernible on self-report checklists, and studies show that checklists do not identify every patient who needs treatment. New clinical tools are needed to identify subtle and complex presentations. We aimed to develop an innovative mixed-methods approach characterizing different types of verbal expression of feelings, drawing on psychodynamic theory and empirical research. We outline the development of the mixed-methods approach, including our theoretical framework and use of semi-structured interview data from Partners in Care (PIC), a randomized controlled trial of quality improvement for depression. We then illustrate the approach with one case: an older female PIC participant who screened positive for depression on all study self-reports. The approach delineates three qualitatively different categories of words-specific feeling words, vague feeling words, and physical words-that were quantified to define a measurable pattern for our participant. Clinicians could be trained to identify these categories of words in the context of a discussion of feelings to better detect and understand subtle emotional problems in patients who have difficulty talking openly about their feelings. Next steps include furthering face and construct validity and test-retest reliability, examining the prevalence of these patterns in a larger sample, and assessing correlates of patterns.

This article reviews the essential themes of Christian David's work. The contribution of this French psychoanalyst is deeply rooted in anti-intellectualistic convictions and a definite opposition to Lacan. His contribution to psychoanalytical theory can be seen as a full recognition of the work of affect, even in terms of representation as well as a relative lessening of the role of language. It is original in the interpretation it proposes of psychosomatic disorders, due to the role his theory gives to affect in the sublimating intention of the drive. His fundamental convictions go hand in hand with a distrust of any position that would tend to privilege a systematic and ready-made description of the diversity of psychic life. For him dream is more a function than a content and the good assessment of 'psychic bisexuality' opposes destiny' while being the shibboleth of true sublimation. [ABSTRACT FROM AUTHOR]

I examine human destructiveness looked at from the angle of a destruction of thought process which leads to different forms of destruction: external, internal, social, political and even bodily. The proposed clinical material concerns an analytic work with a psychosomatic patient. [ABSTRACT FROM AUTHOR]

The BMI classification of obesity is a widely used system. However, when it comes to occupational participation restrictions, the BMI-classification is of little value. Modern work environments do not pose high physical demands, allowing people of every BMI group to fulfil common job requirements. Objective: The objective was to explore the differences of the three body mass index (BMI) obesity classes regarding sociodemographic data, medical and psychological well-being, but especially participation restrictions at work. Methods: A specialist in psychosomatic medicine reported on the health and occupational status of 190 patients (BMI >30), who were treated as inpatients in a psychosomatic rehabilitation unit. Results: Significant increases in severity or work limitations were found for higher BMI groups concerning metabolic, cardiologic, and orthopedic comorbidity. There were no differences regarding indicators of occupational participation. Independent of the obesity status, about three quarters were seen as fit for work. Conclusions: The initial hypothesis is rejected, as no difference concerning objective parameters of work participation were found between the BMI classes. The data suggest that BMI class I to BMI class III do not allow predictions of the ability to work. [ABSTRACT FROM AUTHOR]

This paper seeks to describe how a three-year-old boy´s infantile trauma was actualized in the transference and recounts the work required to contain his primitive infantile states. The author explores the self-protective and communicative function of the child's adhesive and omnipotent behaviour and the appearance of somatic reactions in the sessions. Somatic symptoms were linked to raw, abrupt, and hostile feelings in the child towards the analyst in the transference, followed by a sense of acute danger. Understanding and surviving a shared experience led to a dream and a dawning recognition and tolerance of separation in the child. His unintegrated infantile parts were gradually able to enter the playroom where they could be addressed in the transference. Being separate and unable to possess the analyst triggered intense ambivalence and physical attacks on the analyst and led to the emergence of a fatherly attitude in the analyst. Working through his oedipal ambivalence with the help of a third, an internal father, paved the way to symbolization, the creation of a 'recycling machine' and the depressive position. The author will discuss the somatic reactions linked to his infantile states, the dream and the symbolic meaning of the recycling machine. [ABSTRACT FROM AUTHOR]

The influence of psychological health in the etiology of chronic diseases is nowadays a central topic of scientific debates (Eikeseth et al., 2020; Martino et al., 2021a; Sardella et al., 2021). Patients coping with a chronic condition experience complex emotional distress that is frequently overlooked when medical care is considered (Gatchel, 2004; Turner Kelly, 2000).

Introduction: According to the revised version of the Diagnostic Criteria for Psychosomatic Research (DCPR‐R), this study explored the prevalence and clinical correlates of DCPR‐R psychosomatic syndromes in the elderly and tested whether DCPR‐R provide an incremental contribution to the prediction of psychosocial functioning over and above DSM‐5. Method: One hundred seven elderly subjects were recruited. Participants received a clinical assessment, which included the DCPR‐Revised Semi‐Structured Interview (DCPR‐R SSI), the Structured Clinical Interview for DSM‐5‐Clinician Version (SCID‐5‐CV), the Psychological Well‐Being (PWB) Scales, the Geriatric Anxiety Scale (GAS) and the Geriatric Depression Scale (GDS). Analyses of covariance (ANCOVA) and hierarchical regression analyses were run. Results: Twenty‐two (20.6%) subjects had at least one DSM‐5 diagnosis, and 62 (57.9%) reported at least one DCPR‐R diagnosis. Subjects with at least one DCPR‐R diagnosis showed lower PWB Personal Growth and PWB Purpose in Life than those without DCPR‐R diagnoses. When the incremental validity of the DCPR‐R was tested using PWB Personal Growth, PWB Purpose in Life, PWB Self‐acceptance, GAS Cognitive symptoms and GAS affective symptoms subscales as criterion variable, the DCPR‐R increased up to 0.135–0.263 the explained variance. Conclusion: The DCPR‐R might be implemented together with the DSM‐5 to have a comprehensive assessment of elderly subjects. [ABSTRACT FROM AUTHOR]

The current research aims to identify the relationship between the degree of psychosomatic disorders (gastrointestinal disorders, diabetes mellitus and reproductive system disorders) and Nationality among a sample size of (97) Saudi, Sudanese and Egyptian female faculty and administrators at the College of Education and Arts, University of Tabuk, they were selected by simple random method, The correlative descriptive approach was used, and a scale prepared by the researcher was applied to psychosomatic disorders, and the research resulted in the following results: The presence of a significant correlation between the degree of prevalence of digestive disorders and nationality, and the study revealed the prevalence rate in order from highest among Sudanese nationality, then Egyptian, then Saudi, and there was no significant correlation between diabetes disorder and nationality, and the highest prevalence rate of diabetes disorder came in Egyptian nationality, then Saudi and Sudanese And the existence of a significant correlation between reproductive and sexual disorders, and the highest prevalence rate of Sudanese nationality, then Saudi Arabia and then Egyptian, emerged. [ABSTRACT FROM AUTHOR]

The case of an adolescent referred to the Huntington's Unit for psychiatric assessment is selected. Objectives: To make a differential diagnosis between the symptoms of juvenile Huntington's disease (JHD) and the usual behaviors of an adolescent. To present the complexity of the dividing line between neurological and psychiatric disease. To detail the clinical-epidemiological profile of the patients seen in the Functional Huntington's Disease Unit of reference. [ABSTRACT FROM AUTHOR]

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Addressing the psychosomatic aspects of the pandemic gives rise to a wide range of questions. National experience in addressing these issues is analyzed here in the light of classical concepts of somatoperception and body experience recognition. The results, obtained from following COVID-19 patients samples have been taken into consideration: affected patients, recovered patients and those who have not come across this disease directly. To describe somatoperceptual characteristics in a pandemic, the term “Illness representations in COVID-19” is proposed. During the comparison of the degree of study in different levels, it was found that the sensitive level has not yet received sufficient lighting, unlike the other levels. The analysis of the literature data led to the identification of future research directions of illness representations in COVID-19. In addition to the features of the sensitive level, interlevel mutual influence and structural-dynamic characteristics of illness representations in COVID-19 depending on the person’s own experience in dealing with COVID-19 may be the subject of such studies.

Objective: This study aimed to demonstrate the potential influence of psychiatric disorders on the development and course of ophthalmic diseases. Methods: A literature search was performed in the PubMed medical publication database using the following keywords: ophthalmology; glaucoma; psychiatrists; psychology; acute anterior uveitis; psychosomatics; health. Results: Stress and psychiatric disorders are underestimated risk factors in the course of ophthalmic diseases. Understanding the relationship between them is crucial to ensuring proper patient care. This is because vision loss has serious consequences for the patient, ranging from difficulties in everyday life to disability, loss of livelihood and dependence on others. The stress reaction is associated with long-term persistence of high cortisol levels, stimulation of the autonomic system and, consequently, vascular dysregulation and neuropathy. The result is a progression of visual disturbances, which causes further stress and anxiety. Conclusions: Effective psychiatric intervention, the correct physician approach, or relaxation techniques can speed up recovery or reduce the risk of recurrence.

Objective: to analyze the diagnostic significance of clinical and phenomenological characteristics of affective disorders in patients with chronic somatic pathology.Patients and methods. The analysis included the results of a clinical evaluation of 131 patients with chronic somatic pathology, including 96 patients suffering from cardiovascular diseases and 35 patients with cerebral small vessel disease. Clinical assessment included Primary care evaluation of mental disorders (PRIME-MD) and Hamilton Depression Rating Scale.Results and discussion. Despite the significant frequency and transparent clinical symptoms, general practitioners diagnosed mental disorders in only 30% of patients with depression. We observed a higher prevalence of somatic rather than psychological complaints during the clinical survey. According to the screening using PRIME-MD, 74% of patients were diagnosed with mood disorders, anxiety, and somatoform disorders. We also noted their significant comorbidity with a predominance of a depression and anxiety combination (p < 0.001). Hypertensive patients had the highest depression prevalence (87%) and severity. Moderate depression was the most frequent diagnosis in the study participants, corresponding to major depressive disorder (61.5%).Conclusion. In general, the symptoms of anhedonia, depression, and anxiety were most pronounced in patients with affective disorders. The high prevalence of somatic symptoms complicates depression evaluation. It is possible to highlight depression and anhedonia as significant symptoms for the detection of depression in patients with somatic disorders.

This article explores the psychical expression of autoimmunity in the analytic situation; it is informed by biological theories of autoimmunity in contemporary immunology. Several of my patients developed autoimmune conditions in the course of their analyses, leading me to consider the role of psychical change in disrupting one's somatopsychic equilibrium. In the psychoanalytic literature, autoimmunity is used metaphorically for attack against what is foreign or unwanted in ourselves. Contemporary immunology, however, suggests a somewhat different metaphor. "Self-reactive" cells present in the body may attack self unless suppressed by inhibitory mechanisms. Biologically, limited self-destructiveness is necessary, but in autoimmune disease it becomes excessive and pathological. I suggest that the presence of biological "self-reactivity" implies an inherent self-destructiveness in line with Freud's thinking on the death instinct; the notion that this self-destructiveness also has adaptive aspects may contribute to our understanding of Freud's ideas. In three vignettes I illustrate clinical application of a modified metaphor of autoimmunity, finding that not only is the fusion of life and death instincts important for psychic development, but so is defusion when contained within the analytic relationship. The analytic task is to restore the balance between constructive and pathological self-destructiveness. Implications regarding controversies in psychosomatic theory are briefly considered. [ABSTRACT FROM AUTHOR]

Objective: Irritable bowel syndrome (IBS) is a psychosomatic gastrointestinal disorder involving the dysfunctional activation of specific brain regions crucial for interoception and disgust processing. Yet, no study has ever investigated the link between this socio-affective/visceral experience and IBS. Method: The present study investigated whether disgust sensitivity and disgust propensity, which can be socially relevant, relate with IBS symptoms in a nonclinical population. 105 healthy participants were asked to complete the Disgust Propensity and Sensitivity Scale-Revised (DPSS-R), the Irritable Bowel Syndrome-Quality of Life Measure (IBS-QOL), and the Chronic Urticaria Quality of Life Measure (CUQ2OL), as control condition. Results: Results showed higher disgust sensitivity scores in individuals with high IBS-QOL score, compared to individuals with low IBS-QOL score. The correlation analysis corroborates this result by showing a positive relationship between disgust sensitivity and respective IBS-QOL scores. Conclusions: This research provides new insights into understanding the etiopathogenesis of IBS, suggesting the relevance of a socially relevant personality trait such as disgust sensitivity as a potential trigger and / or predisposition factor for this chronic inflammatory disease. [ABSTRACT FROM AUTHOR]

Readmission rates are under growing scrutiny as an indicator of quality of care as much as a potential source of savings. Patients with comorbid psychiatric conditions are more likely to be readmitted, so Consultation-Liaison Psychiatry (CLP) may play a role in lowering readmission rates. In this retrospective cohort study conducted in a general hospital in Paris, France, all consecutive adult inpatients referred for the first time to CLP from January 2008 to December 2016, were included. The main outcomes were 30-day and 7-day readmissions in the same hospital, excluding iterative and planned stays. The objective of this study is to determine whether the timing of psychiatric consultations is associated with 30-day and 7-day readmission rates. A total of 4498 inpatients (2298(51·1%) women, age = 59·8(±19·3) years) were referred to CLP. Adjusting for age, sex, place of residence, year of admission, type of ward, psychiatric diagnosis and disease severity, later consultation was associated with higher 30-day and 7-day readmission rates (adjusted Odds Ratio [95% confidence interval]:1.21[1·10–1·33] and 1·26[1·11–3·13], respectively). Further adjusting for length of stay, the association remained significant for 7-day readmission (1.28[1·05–1·57]). After stratification on the length of stay, for stays in the highest tercile (i.e., >21 days) an intervention after day 3 (versus before) was associated with 30-day and 7-day readmission rates of 15·8% versus 8·6%(1·81 [1·11–3·13]) and 4·9% versus 1·8%(2·98[1·16–9·88]), respectively. Earlier psychiatric consultation was associated with fewer 30-day and 7-day readmissions. Interventional studies are needed to show that proactive CLP teams could help general hospitals to improve quality of care and make significant economic savings. [ABSTRACT FROM AUTHOR]

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Background: The coronavirus disease 2019 (COVID-19) pandemic was accompanied by new challenges for psychosocial health care to enable the support of affected patients, their families, and staff in general hospitals. In this study, we aimed to describe the structures and procedures put in place by psychosomatic, psychiatric, and psychological consultation and liaison (CL) services in German, Austrian, and Swiss general hospitals, and to elucidate the emerging needs for cooperation, networking, and improvement. Methods: We conducted a cross-sectional online survey between December 2020 and May 2021, using a 25-item questionnaire derived from relevant literature, professional experience, and consultation with the participating professional societies. The survey was disseminated via national professional societies, relevant working and interest groups, and heads of the above-mentioned CL services. Results: We included responses from 98 CL services in the analyses, with a total response rate of 55% of surveyed hospital CL services; 52 responses originated from Germany, 20 from Austria, and 26 from Switzerland. A total of 77 (79%) of the 98 responding CL services reported that "COVID-19-related psychosocial care" (COVID-psyCare) was provided in their hospital. Among these, 47 CL services (61%) indicated that specific cooperation structures for COVIDpsyCare had been established within the hospital. A total of 26 CL services (34%) reported providing specific COVID-psyCare for patients, 19 (25%) for relatives, and 46 (60%) for staff, with 61, 12, and 27% of time resources invested for these target groups, respectively. Regarding emerging needs, 37 (48%) CL services expressed wishes for mutual exchange and support regarding COVID-psyCare, and 39 (51%) suggested future changes or improvements that they considered essential. Conclusion: More than three-quarters of the participating CL services provided COVID-psyCare for patients, their relatives, or staff. The high prevalence of COVIDpsyCare services targeting hospital staff emphasizes the liaison function of CL services and indicates the increased psychosocial strain on health care personnel during the COVID-19 pandemic. Future development of COVID-psyCare warrants intensified intraand interinstitutional exchange and support. [ABSTRACT FROM AUTHOR]

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Backgrounds. Alexithymia is a relevant phenomenon, occurring transversally to healthy subjects and individuals affected by several conditions. Its role is considerable, according to current state of the art several conditions emerged as influenced, maintained and worsened by alexithymic structures and figures. The present study was aimed at highlighting the existing relations, the differences and the directions assumed by alexithymic factors and health status in patients affected by psychosomatic conditions. Methods. The sample consisted of 150 participants, 42 males (28.0%) and 108 females (72.0%), aged 26 to 78 years old with a mean of 42.24 years old (SD = 12.39). Subjects were previously assessed through DCPR-SI, in order to identify psychosomatic issues. The study evaluated measures related to alexithymia (Tas-20) and health status (SF-36), and considered demographic characteristics such as age, gender, and education. Results and Conclusions. The analyses demonstrated a number of significant relationships between alexithymia, psychological outcomes, and physical outcomes, including psychosomatic disorders. In addition, sex differences were found in gastrointestinal outcomes, as well as outcomes related to energy/fatigue and physical functioning. The study of alexithymia may provide a fruitful approach in understanding various issues related to pathology and general health. Further studies are needed to expand the understanding of alexithymia to other groups and health-related outcomes.

Music-imaginative Pain Treatment (MIPT) is a form of music therapy addressing pain experience and affective attitudes toward pain. It includes two self-composed music pieces: one dedicated to the pain experience (pain music, PM) and the other to healing imagination (healing music, HM). Our non-experimental study addresses patients with chronic somatoform pain disorders participating in MIPT. The goal is to gain insight into the direct effect mechanisms of MIPT by combining outcome measures on both the objective physiological and subjective perception levels. The research questions are directed toward changes in pain experience and heart rate variability and their correlations. Thirty-seven hospitalized patients with chronic or somatoform pain disorders receiving MIPT participated in this study. Demographic data and psychometric measures (Symptom Check List SCL90, Childhood Trauma Questionnaire CTQ) were collected to characterize the sample. Subjective pain experience was measured by McGill Pain Questionnaire (SF-MPQ), and Heart Rate Variability by 24 h-ECG. Data analysis shows a reduction of reported pain from MT1 = 19.1 (SD = 7.3) to MT2 = 10.6 (SD = 8.0) in all dimensions of the SF-MPQ. HRV analyses shows a reduced absolute power during PM and HM, while a relative shift in the autonomic system toward higher vagal activity appears during HM. Significant correlations between HRV and MPQ could not be calculated. Findings are interpreted as a physiological correlate to the psychological processes of the patients. Future studies with more participants, a control-group design, and the integration of medium- and long-term effects are recommended.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic was accompanied by new challenges for psychosocial health care to enable the support of affected patients, their families, and staff in general hospitals. In this study, we aimed to describe the structures and procedures put in place by psychosomatic, psychiatric, and psychological consultation and liaison (CL) services in German, Austrian, and Swiss general hospitals, and to elucidate the emerging needs for cooperation, networking, and improvement.MethodsWe conducted a cross-sectional online survey between December 2020 and May 2021, using a 25-item questionnaire derived from relevant literature, professional experience, and consultation with the participating professional societies. The survey was disseminated via national professional societies, relevant working and interest groups, and heads of the above-mentioned CL services.ResultsWe included responses from 98 CL services in the analyses, with a total response rate of 55% of surveyed hospital CL services; 52 responses originated from Germany, 20 from Austria, and 26 from Switzerland. A total of 77 (79%) of the 98 responding CL services reported that “COVID-19-related psychosocial care” (COVID-psyCare) was provided in their hospital. Among these, 47 CL services (61%) indicated that specific cooperation structures for COVID-psyCare had been established within the hospital. A total of 26 CL services (34%) reported providing specific COVID-psyCare for patients, 19 (25%) for relatives, and 46 (60%) for staff, with 61, 12, and 27% of time resources invested for these target groups, respectively. Regarding emerging needs, 37 (48%) CL services expressed wishes for mutual exchange and support regarding COVID-psyCare, and 39 (51%) suggested future changes or improvements that they considered essential.ConclusionMore than three-quarters of the participating CL services provided COVID-psyCare for patients, their relatives, or staff. The high prevalence of COVID-psyCare services targeting hospital staff emphasizes the liaison function of CL services and indicates the increased psychosocial strain on health care personnel during the COVID-19 pandemic. Future development of COVID-psyCare warrants intensified intra- and interinstitutional exchange and support.Trial RegistrationClinicalTrials.gov NCT04753242, version 11 February 2021.

Introduction Severe mental disorders experience premature mortality mostly from physical causes. When a patient with a history of bipolar disorder is admitted to the emergency room (ER) for psychiatric symptoms, these are routinely interpreted as a psychiatric disturbance. However, a careful history should be performed to correctly interpret key clinical information to rule out somatic etiology and establish adequate diagnosis. Objectives To describe a patient whose presenting symptoms were misdiagnosed as psychiatric relapse, rather than serious somatic comorbidity debut. Methods A 70-year-old man, with a history of type I bipolar disorder and multiple cardiovascular conditions, was admitted to the ER for self-referred nervousness, depressed mood, insomnia, and suicidal thoughts. Symptoms had greatly worsened the previous week to his consultation with paroxysmal episodes of severe anxiety, feelings of strangeness, and sensations of unpleasant odors. Results During observation, the patient was found lying down with loss of consciousness, urinary incontinence, and amnesia of the event. Generalized tonic-clonic seizures were observed by neurologists while mental status examination was being performed. After symptoms were oriented as having a neurological etiology, the patient suffered cardiac arrest and defibrillation was required. After admittance to the intensive care unit and inpatient cardiology care, the patient was discharged from the hospital with the diagnosis of ventricular fibrillation due to drug-induced QT prolongation. There was no evidence of mixed depression or seizures once the cardiac dysfunction was identified and treated. Conclusions The psychiatric symptoms were the clinical manifestation of a generalized seizure-like activities that were attributed to transient cerebral hypoperfusion secondary to ventricular fibrillation. Disclosure No significant relationships.

Introduction The Naimigen questionnaire (Van Dixhoorn, Duivenvoordent, 1985) was developed in the 1980s to assess the severity of hyperventilation syndrome, which causes respiratory alkalosis and, as a result, polysystemic functional symptoms. Later, this questionnaire was recommended for use in the diagnosis of dysfunctional breathing. The COVID-19 pandemic provokes anxiety as a stressful event and objectifies the respiratory function, which becomes a favorable ground for the growth of the prevalence of dysfunctional breathing in society. Objectives To validate the Naimigen questionnaire in the context of the COVID-19 pandemic among the Russian-speaking population. Methods The author’s socio-demographic questionnaire and the Naimigen Questionnaire (NQ) were used (Van Dixhoorn, Duivenvoordent, 1985). The study was conducted online from April 27 to December 28, 2020. It was attended by 1,362 people from all regions of Russia, including 1,153 women and 209 men aged 15 to 88 years (38.3 ±11.4). Results The stable reliability of the Alpha-Kronbach coefficients (> 0.877) was revealed for all NQ points. To check the factor structure of the Naimigen questionnaire, we conducted an exploratory factor analysis using the direct Oblimin criterion, which, when explaining 57.3% of the total variance, allowed us to identify 4 factors: respiratory symptoms, paresthesia and gastrointestinal symptoms, tension, derealization. Conclusions Checking the reliability and factor structure of the Naimigen questionnaire allows us to reasonably use this questionnaire on a Russian-language sample in the conditions of the COVID-19 pandemic. Disclosure: Research is supported by the Russian Science Foundation, project No. 21-18-00624. Disclosure Research is supported by the Russian Science Foundation, project No. 21-18-00624.

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The COVID-19 coronavirus pandemic has added additional difficulties to the differential diagnostic evaluation of the status of patients with disorders of affective and neurotic registers. In such conditions, the works describing and analyzing specific clinical cases are of considerable interest. The paper describes three clinical cases of somatization mental disorders manifesting themselves during the COVID-19 pandemic, with an account of their history, somatic and mental status, psychopathological classification of the condition, and a rationale for the therapy regimen. Itching, dysuria, and hyperventilation without a somatic basis come to the fore in the clinical picture. These somatic symptoms developing in the pattern of mental disorders of the affective and neurotic registers substantially make the diagnosis, specialized care provision, and medical routing of patients difficult. An integrated psychosomatic approach to clinically evaluating psychopathological disorders that are partially realized in dermatological, urological, and pulmonological spheres, contributes to their adequate diagnosis and effective therapy.