Search

This article attempts to look at an area we have yet to explore, the enormous impact that disease and treatment can have on people‘s lives. In recent decades, medical thinking has gradually changed, and today we are increasingly talking about psychosomatic medicine. The appearance of the disease creates a new life situation to which the patient must adapt. This new adaptation takes much of his energy—much more than is needed for physiological defense processes. This adaptation is a complex, multidirectional process. The article attempts to present the importance of psychological support provided in a hospital environment. The role of the personality, with its complexity and dynamics in relation to the patient‘s perception of the disease, is examined by presenting a case of a patient who experienced a complex cardiac surgery. [ABSTRACT FROM AUTHOR]

Purpose: Radiation encephalopathy (REP) is one of the most common complications of radiotherapy for malignant tumors of the head and neck. Symptoms usually appear months to years following radiotherapy, with headache, insomnia, and memory loss as the main clinical features. We report a patient who was admitted to the hospital with anxiety and depressive disorder and was eventually diagnosed with REP. Patients and methods: A 48-year-old patient who had undergone over 2 years of radiotherapy for nasopharyngeal carcinoma was admitted to the Department of Psychosomatic Medicine of our hospital because of recurrent fear, low mood, and waking up from dreams. Magnetic resonance imaging (MRI) revealed a mass in the left temporal lobe with a large peripheral edema. After multidisciplinary consultation, the possibility of tumor recurrence could not be excluded. Results: Resection of the lesioned brain tissue to obtain pathological tissue showed glial cell proliferation and small focal areas of degeneration and necrosis, which indicated that the lesions were inflammatory. Postoperative MRI showed no abnormal signal, and the patient's condition improved. Conclusion: Nasopharyngeal carcinoma patients with a history of radiotherapy and symptoms of increased intracranial pressure and neurological damage should be examined for REP. Furthermore, patients may experience anxiety and depressive disorders as a result of temporal lobe damage caused by REP. [ABSTRACT FROM AUTHOR]

Patients who survive critical COVID-19 frequently report post-acute sequelae of COVID-19 (PASC) such as psychosomatic and neurocognitive health problems. The goal of this study was to identify clinical risk factors and other predictors for such long-term consequences in severely ill COVID-19 patients. Adult COVID-19 intensive care unit (ICU) survivors from August 2020 to May 2021 were enrolled. A broad range of clinical, laboratory and chest computed tomography (CT) data was collected during their ICU stays. The association between ICU predictors and psychosomatic, respiratory, and neurocognitive assessments 12 months after ICU discharge was analyzed using univariate regression analysis. In 17 patients (mean age 58.9 ± 11.4 years), laboratory markers (CRP, lymphocytes, hemoglobin), ICU severity (SOFA, SAPS II, need for mechanical ventilation), complications (ARDS), and lung CT data (ground-glass opacity) were promising predictors of depressive and anxiety symptoms, fatigue, and sleep problems. Recovery of psychosomatic health such as fatigue, depression, and anxiety correlated with lower levels of inflammation and high hemoglobin levels. ARDS, mechanical ventilation, and worse SOFA and SAPS II scores were further risk factors for depressive and anxiety symptoms. Our study identified novel associations such as pulmonary ground-glass opacity being positively associated with depression, anxiety, fatigue, and insomnia levels. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Chongqing University of Posts & Telecommunications (Natural Science Edition) is the property of Chongqing University of Posts & Telecommunications and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Agora (0211-6642) is the property of Universidad de Santiago de Compostela, Servicio de Publicaciones and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

General practice in China has developed rapidly in recent years with remarkable progress, but the gap with developed countries in Europe and the United States is still large, and the training system of general practitioners still remains impefect. In Germany, the construction of the primary health care system and the training system of general practitioners have been well developed. Under the system of universal health insurance coverage and hierarchical diagnosis and treatment, a high level of health and patient satisfaction with primary healthcare services among residents have been achieved in Germany. Therefore, this study compares post-graduate education and continuing education of general practice in China and Germany, analyzes the challenges of general practice education reform in China, drawing on the conceptual framework of general practice education in Germany, and proposes targeted ideas and recommendations for solutions as follows: for the standardized residency training of general practice, increase the rotation flexibility as appropriate to facilitate the optimization of trainees' individualized competencies, incorporate the standardized curriculum of psychosomatic medicine and Balint group training to improve trainees' competence in psychosomatic medicine, establish standardized selection criteria and promote standardized training program for faculty of community hospital, and revisit the duration of general practice (including community) rotation after improving the qualifications of general practice faculty of community hospital; for the continuing education, incorporate the special interest and small specialties into the general practice continuing education system to strengthen the functional medical characteristics of general practice and promote the professional diversification of general practitioners, and establish a national unified platform for continuing education in general practice. More practical research and resources are needed to improve the training system of general practitioners in China in the future.

Abstract Background Functional somatic symptoms (FFS) and bodily distress disorders are highly prevalent across all medical settings. Services for these patients are dispersed across the health care system with minimal conceptual and operational integration, and patients do not currently access therapeutic offers in significant numbers due to a mismatch between their and professionals’ understanding of the nature of the symptoms. New service models are urgently needed to address patients’ needs and to align with advances in aetiological evidence and diagnostic classification systems to overcome the body–mind dichotomy. Method A panel of clinical experts from different clinical services involved in providing aspects of health care for patients with functional symptoms reviewed the current care provision. This review and the results from a focus group exploration of patients with lived experience of functional symptoms were explored by the multidisciplinary expert group, and the conclusions are summarised as recommendations for best practice. Results The mapping exercise and multidisciplinary expert consultation revealed five themes for service improvement and pathway development: time/access, communication, barrier-free care, choice and governance. Service users identified four meta-themes for best practice recommendations: focus on healthcare professional communication and listening skills as well as professional attributes and knowledge base to help patients being both believed and understood in order to accept their condition; systemic and care pathway issues such as stronger emphasis on primary care as the first point of contact for patients, resources to reduce the length of the patient journey from initial assessment to diagnosis and treatment. Conclusion We propose a novel, integrated care pathway for patients with ‘functional somatic disorder’, which delivers care according to and working with patients’ explanatory beliefs. The therapeutic model should operate based upon an understanding of the embodied nature of patient’s complaints and provide flexible access points to the care pathway.

Background Psychosomatic disorders present high prevalence and disease burden in the community. Currently, different disciplines of medical institutions possess unclear functions and inadequate process strategies for the diagnosis and treatment of psychosomatic disorders, resulting in differences in the perceptions of disease and behavioral characteristics of doctors and patients, which affects the management of disease in the community. Objective To understand and analyze the cognitive and behavioral characteristics as well as the influencing factors of psychosomatic disorders from multiple perspectives of doctors and patients, and then provide strategic directions to improve the diagnosis and management of psychosomatic patients in the community. Methods During the period from 2022-02-01 to 06-31, 5 internists from a general hospital (H1) in Yangpu District, 12 general practitioners from 2 community health centers (H2, H3) in Yangpu District, and 2 community health centers (H4, H5) in Jiading and Pudong New Districts, 2 healthcare professionals from a mental health center hospital in Yangpu District, and 10 patients and with psychosomatic disorders who had been treated in the above hospitals or their relatives. The interview was performed by WeChat, face-to-face as well as telephone and other methods, with the content including perceptions of psychosomatic disorders, healthcare seeking behaviors, disease attitudes, problems and suggestions, and lasted 15-30 min. The interview content was recorded and transcribed into text, coded, summarized to generate themes, and finally quoted from representative interviewees. Results (1) There was a high level of disease awareness among general practitioners and psychiatrists, a low level of awareness among internists, and a general lack of awareness among patients. (2) General practitioners and psychiatrists possessed more experience in the diagnosis and treatment of psychosomatic disorders, but lacking sufficient work and effective treatment results. (3) The attitudes of multiple doctors and patients were varied with an overall lack of positivity. General practitioners had the most positive attitudes toward the diagnosis and treatment of psychosomatic disorders. (4) Doctors of different disciplines faced difficulties, including large patient bases, insufficient mental health resources, lack of solid psychological perceptions, lack of standardized guidelines for diagnosis and treatment, and busy practices, etc. (5) Most patients had not received psychotherapy, but they didn't exclude it either, while there were problems such as distrust of general practitioners, fear of treatment side effects, and health seeking behavior affected by many factors. (6) Both doctors and patients offered constructive suggestions, which included strengthening publicity and policy guidance to the public, promoting the continuous development of psychosomatic medicine, improving doctors' identification of psychological disorders, opening joint clinic for chronic disease and psychology, improving the experience of medical treatment, setting up a comfortable treatment environment, and coordinating referrals, etc. Conclusion Barriers such as differences in perceptions and attitudes between doctors and patients, unequal medical resources, and irregularities in behavior exist between doctors and patients. In the community, it is necessary to strengthen the advantages and functions of general practitioners on the management of psychosomatic disorders; fully implement and utilize relevant resources; and improve the negative attitudes of both doctors and patients, so that patients can seek proper medical treatment and improve their mental health.

Interpersonal touch represents the primal sensory experience between humans, fostering social bonding from the cradle to the death bed. In recent decades “affective touch” has been intensely studied, stimulated by the discovery of a population of mechanosensitive unmyelinated C-tactile afferents in mammalian skin. A lack of touch in childhood is associated with negative consequences for psychosocial and physical health and the benefits of professional touch techniques in the prevention and treatment of various diseases have been shown over and over again in clinical studies. However, its application in mainstream clinical applications remains limited. To bridge the gap between recent discoveries in touch research and clinical medicine, we propose the establishment of a new discipline: ‘Touch Medicine’. Here, we unfold the potential of Touch Medicine by focusing on the treatment of depression, which in our view is primarily a disorder of the lived body. Controlled studies and systematic reviews have demonstrated the antidepressant, anxiolytic and analgesic effects of specific massage techniques. Underlying mechanisms of action are currently under investigation, ranging from interoceptive, endocrinological, to stress-related or psychological underpinnings. Touch Medicine represents a novel interdisciplinary field connected to various medical specialities such as neonatology, pediatrics, pain medicine, neurology, psychiatry, and geriatrics – but also clinical psychology and psychosomatic medicine might benefit from the integration of these findings into their daily practice. [ABSTRACT FROM AUTHOR]

Background: Functional somatic symptoms (FFS) and bodily distress disorders are highly prevalent across all medical settings. Services for these patients are dispersed across the health care system with minimal conceptual and operational integration, and patients do not currently access therapeutic offers in significant numbers due to a mismatch between their and professionals’ understanding of the nature of the symptoms. New service models are urgently needed to address patients’ needs and to align with advances in aetiological evidence and diagnostic classification systems to overcome the body–mind dichotomy. Method: A panel of clinical experts from different clinical services involved in providing aspects of health care for patients with functional symptoms reviewed the current care provision. This review and the results from a focus group exploration of patients with lived experience of functional symptoms were explored by the multidisciplinary expert group, and the conclusions are summarised as recommendations for best practice. Results: The mapping exercise and multidisciplinary expert consultation revealed five themes for service improvement and pathway development: time/access, communication, barrier-free care, choice and governance. Service users identified four meta-themes for best practice recommendations: focus on healthcare professional communication and listening skills as well as professional attributes and knowledge base to help patients being both believed and understood in order to accept their condition; systemic and care pathway issues such as stronger emphasis on primary care as the first point of contact for patients, resources to reduce the length of the patient journey from initial assessment to diagnosis and treatment. Conclusion: We propose a novel, integrated care pathway for patients with ‘functional somatic disorder’, which delivers care according to and working with patients’ explanatory beliefs. The therapeutic model should operate based upon an understanding of the embodied nature of patient’s complaints and provide flexible access points to the care pathway. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Psychosomatische Medizin und Psychotherapie is the property of Vandenhoeck & Ruprecht GmbH & Co. KG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: International evidence strongly suggests that medical students are at high risk of mental health problems. This distress, which can be mediated by a variety of individual, interpersonal and contextual factors within the curriculum, can be mitigated by effective coping strategies and interventions. Central to this discourse is the recognition that the challenges of professional identity formation can contribute significantly to medical students' distress. The focus of our study is therefore to examine discrepancies in professional identities and role models in undergraduate medical education in relation to affective burden. Methods: Medical students at different stages of university education and high school graduates intending to study medicine were surveyed in a cross-sectional study. The study employed Osgood and Hofstätter's polarity profile to evaluate the self-image of participants, the image of an ideal and real physician, and their correlation with depression (PHQ-9) and anxiety (GAD-7). Results: Out of the 1535 students recruited, 1169 (76.2%) participated in the study. Students rated their self-image as somewhere between amore critical real image of physicians and a more positive ideal image. Medical students at all training levels consistently rated the ideal image as remaining constant. Significant correlations were found between the professional role models of medical students and affective symptoms, particularly for the discrepancy between the ideal image of a physician and their self-image. Furthermore, 17% and nearly 15% reported significant symptoms of depression and anxiety, respectively. Discussion: Our study adds to the growing body of knowledge on professional identity formation in medicine and socialisation in the medical environment. The study highlights the importance of discrepancies between self-image and ideal image in the experience of depressive and anxiety symptoms. Primary prevention-oriented approaches should incorporate these findings to promote reflective competence in relation to professional role models and strengthen the resilience of upcoming physicians in medical training. [ABSTRACT FROM AUTHOR]

Purpose: Generalized anxiety disorder (GAD) is a suboptimally managed chronic recurring psychiatric condition with a lifetime prevalence of 2.6% in Japan. We assessed the current status of GAD management in Japan. Patients and Methods: This was an observational, cross-sectional study conducted through an anonymous web-based survey in Japan from December 12– 16, 2022. Psychiatrists and psychosomatic medicine physicians who agreed to participate and saw ≥ 10 outpatients in the previous month were eligible. Survey questionnaire comprised 37 single/multiple choice, numerical entry, or open-ended questions in Japanese. Results: Among 509 participants (493 psychiatrists and 16 psychosomatic medicine physicians), 96.9% were aware of GAD. On average, 12.4 outpatients and 1.0 inpatient were diagnosed with GAD per physician per month. Of 433 physicians having patients diagnosed with GAD, 46.9% used operational diagnostic tools; among these, DSM-5 diagnostic criteria were used by 81.5% physicians. The majority (54.7%) of participants did not use a self-administered rating scale; depression scales were used more than anxiety scales. Among these 433 physicians, 96.8% used selective serotonin reuptake inhibitors for GAD management, and 79.2% used it as the first choice; of 431 physicians who prescribed drug therapy, 54.3% gave antidepressant monotherapy as first choice. The most frequent symptom in patients diagnosed with GAD was excessive anxiety/worry (96.5%); depression was the most commonly reported comorbidity (84.3%) as per physicians aware of GAD (N=508). Conclusion: This study illustrates that although GAD awareness is high among Japanese psychiatric specialists, GAD is not frequently diagnosed using operational diagnostic approaches. Due to a lack of Japanese guidelines for GAD diagnosis and treatment, diverse international guidelines are followed, with similar treatment paradigms as that of depression. This may not be an optimal approach given cultural/geographical differences. These findings highlight the need for uniform diagnosis and treatment recommendations for GAD management in Japan. Clinical Trial Registration: UMIN-CTR: UMIN000049572. [ABSTRACT FROM AUTHOR]

Background and Objectives: Defined by chronic pain, rheumatic diseases are often co-occurring with anxiety and depression. Among the available psychological interventions, cognitive-behavioral therapies have an already-proven efficiency in these cases. However, the need to adjust their structure became ubiquitous during the post-pandemic period. Hence, the objective of this study was to investigate the impact of a single-session, process-based cognitive-behavioral intervention for patients with rheumatic conditions within an in-patient setting. Materials and Methods: A total of 31 participants (mean age 58.9 years) completed the single-session intervention. Assessments were conducted prior to the intervention, post-intervention and after one month. Results: Pearson's correlations, paired samples T tests and a covariance analysis based on the Linear Mixed Model were performed for exploring the relations between baseline variables and evaluating the impact of the SSI intervention. Immediately after the intervention, a significant reduction in cognitive fusion (p = 0.001, d = 1.78), experiential avoidance (p = 0.001, d = 1.4) and dysfunctional behavioral processes was observed. At the one-month evaluation, participants reported decreased pain (p = 0.001, d = 1.11), anxiety (p = 0.004, d = 0.55) and depression (p = 0.001, d = 0.72). Conclusions: The single-session, process-based approach represents a promising intervention in healthcare contexts, as an integrative part of a multimodal rehabilitation treatment in patients with rheumatic conditions. [ABSTRACT FROM AUTHOR]

Background: Career stress is one of the most important and challenging risk factors among employees because of its vast effect on mental and physical health. This research was conducted with the aim to compare the effectiveness of mindfulness-based stress reduction (MBSR) and bioenergy economy-based health improvement (BEHI) program on occupational stress and psychosomatic symptoms of distressed employees. Methods: This quasi-experimental study was conducted using a pretest-posttest design. The targeted population of the study comprised all employees of the customer service management department of Telecommunications Company in Isfahan, Iran, in the year 2018. Purposeful sampling was employed, and 60 candidates exhibiting distress symptoms were randomly assigned to 3 groups (MBSR, BEHI, and control groups), each consisting of 20 individuals. Data collection was performed using the Kessler Psychological Distress Scale (K6; Kessler et al., 2003), Stressful Life Event (SLE) Questionnaire (Roohafza et al., 2011), Occupational Stress Questionnaire (Cousins et al., 2004), and Screening for Somatoform Symptoms-7 (SOMS-7) questionnaire (Ebrahimi et al., 2018). The experimental groups participated in the MBSR (Kabat-Zinn, 1990) and BEHI (Goli, 2022) program training sessions. The control group received no intervention. The data were assessed in SPSS software. Results: Both the BEHI program and MBSR therapy significantly decreased the occupational stress (F = 2.78) and psychosomatic symptoms (F = 3.63) of distressed employees (P < 0.05). However, there was no significant difference between the mean scores of the experimental groups in the posttest (P > 0.05). Conclusion: Both programs could reduce the employees' distress on worksites and could be beneficial for healers to mitigate the psychosomatic manifestations of occupational stressors. [ABSTRACT FROM AUTHOR]

Sixty years ago, on March 8, 1964, Franz Alexander, the founder of “psychosomatic medicine”, ended his life. Alexander was a psychoanalytic physician who worked to improve the technique of psychoanalytic treatment and who had the ability, based on his vast interdisciplinary culture, to go beyond the Freudian revolution by envisaging an epochal breakthrough in the ability to take care of the human being. The novelty and originality of the paradigm proposed by Alexander, considered to be highly relevant in both scientific and clinical terms, are reconstructed. The criticisms and misrepresentations of Alexander’s elaboration are also reviewed; they have come over time in both the psychoanalytic and psychosomatic fields, leading to his expulsion from contemporary reflection. The dismissal of Alexander’s perspective also explains the progressive decline of psychosomatics in recent decades. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Psychosomatische Medizin und Psychotherapie is the property of Vandenhoeck & Ruprecht GmbH & Co. KG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background At an individual level, physician resilience protects against burnout and against its known negative effects on individual physicians, patient safety, and quality of care. However, it remains uncertain whether physician resilience also correlates with maintaining a high level of healthcare quality during crises such as a pandemic. This study aimed to investigate whether higher resilience among physicians, who had received training in resilience-related competences in the past, would be associated with higher quality of care delivered during the COVID-19 pandemic. Methods This study enrolled physicians working in family medicine, psychiatry, internal medicine, and other medical specialties, who had obtained at least one of three consecutive diplomas in psychosomatic medicine in the past. Participants completed a quantitative and qualitative anonymous online survey. Resilience was measured using the Connor-Davidson Resilience Scale, and healthcare quality was assessed through single-item quality indicators, including perceived quality of care, professional autonomy, adequate time for patient care, and job satisfaction. Results The study included 229 physicians (70 males/159 females) with additional training in psychosomatic medicine, working in family medicine (42.5%), psychiatry (28.1%), internal medicine (7.0%), or other medical specialties (22.4%). Participants represented four intensity levels of training background (level 1 to level 4: 9.2%, 32.3%, 46.3%, and 12.2% of participants). Training background in psychosomatic medicine was positively associated with resilience (B = 0.08, SE = 0.04, p

The incidence of psychiatric dizziness is high. If clinicians do not have enough knowledge about it, they are prone to misdiagnose psychiatric dizziness as posterior circulation ischemic attack, cervical dizziness, vestibular peripheral vertigo or other diseases, thus leading to inappropriate examinations and treatments. With the increasing emphasis on psychosomatic diseases, the Holistic Health Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association formulated the Chinese Expert Consensus on Diagnosis and Treatment of Psychiatric Dizziness in combination with the latest evidence in relevant fields at home and abroad, as well as the opinions of experts in psychosomatic health, mental disorders, vertigo and other fields. This consensus elaborated the concept, etiology and pathogenesis, clinical characteristics, diagnosis and evaluation, and various treatment approaches of psychiatric dizziness, and formulated the final expert consensus after multidisciplinary expert communication, aiming to provide a reference basis for standardized diagnosis and treatment of psychiatric dizziness.

Background: Female physicians are in some cases preferred by patients due to their sex-related characteristics such as softness and empathy. Psychosomatic medicine presents a compelling working environment due to its holistic approach. Methods: This brief review synthesizes the challenges encountered by female physicians in psychosomatic medicine and outlines potential strategies for overcoming these barriers. Results: The presence of female role models may constitute a crucial advancement in this process. There exists a pressing demand for specialized clinical and scientific programs in psychosomatic medicine at both national and international levels. Such programs, offered by universities and ministries, as well as comprehensive training initiatives, are indispensable in fostering the next generation of females in psychosomatics. Leading journals can lend their support by publishing special issues dedicated to female physicians. Conclusion: Strengthening female physicians throughout all positions in psychosomatic medicine can contribute ultimately to the improvement of patient care.

This document provides an overview of the use of Rasch analysis in the development and evaluation of measurement scales in psychosomatic medicine. Rasch analysis is a statistical method that allows for the measurement of structural validity in clinimetric measures. It considers the contributions of individual items to measuring the underlying trait and supports the differentiation of symptoms based on severity. The document explains the Rasch model and its application in psychological and psychiatric assessments, as well as the key outputs of Rasch analysis and reasons for inadequate fit to the model. It emphasizes the importance of using Rasch analysis appropriately in measure development. [Extracted from the article]

Background At an individual level, physician resilience protects against burnout and against its known negative effects on individual physicians, patient safety, and quality of care. However, it remains uncertain whether physician resilience also correlates with maintaining a high level of healthcare quality during crises such as a pandemic. This study aimed to investigate whether higher resilience among physicians, who had received training in resilience-related competences in the past, would be associated with higher quality of care delivered during the COVID-19 pandemic. Methods This study enrolled physicians working in family medicine, psychiatry, internal medicine, and other medical specialties, who had obtained at least one of three consecutive diplomas in psychosomatic medicine in the past. Participants completed a quantitative and qualitative anonymous online survey. Resilience was measured using the Connor-Davidson Resilience Scale, and healthcare quality was assessed through single-item quality indicators, including perceived quality of care, professional autonomy, adequate time for patient care, and job satisfaction. Results The study included 229 physicians (70 males/159 females) with additional training in psychosomatic medicine, working in family medicine (42.5%), psychiatry (28.1%), internal medicine (7.0%), or other medical specialties (22.4%). Participants represented four intensity levels of training background (level 1 to level 4: 9.2%, 32.3%, 46.3%, and 12.2% of participants). Training background in psychosomatic medicine was positively associated with resilience (B = 0.08, SE = 0.04, p <.05). Resilience and training background independently predicted perceived quality of care, even after controlling for variables such as own health concerns, involvement in the treatment of COVID-19 patients, financial strain, percentage of working hours spent on patient care, age, and gender (resilience: B = 0.33, SE = 0.12, p <.01; training background: B = 0.17, SE = 0.07, p <.05). Both resilience and training background predicted job satisfaction (resilience: B = 0.42, SE = 0.12, p <.001; training background: B = 0.18, SE = 0.07, p <.05), while resilience alone predicted professional autonomy (B = 0.27, SE = 0.12, p <.05). In response to an open question about their resources, resilient physicians more frequently reported applying conscious resilient skills/emotion regulation (p <.05) and personal coping strategies (p <.01) compared to less resilient medical doctors. Conclusion Physician resilience appears to play a significant role in the perceived quality of patient care, professional autonomy, and job satisfaction during healthcare crises. [ABSTRACT FROM AUTHOR]

Nowadays, Henry Head is best known for his Head zones. The concept was understood very differently by Head in comparison to what current medical books falsely describe them to be. In reality, there is no direct relationship between one particular skin zone and one single organ. It is certain that the drawings considered depictions of the Head zones in today's medical textbooks were actually not created by Head. From a neurological point of view, Head is important for two reasons: his self-experiment in 1909 to damage one of his own peripheral nerves followed by regeneration was heroic. It has helped generations of neurologists to have a better understanding of the pathophysiology of peripheral nerve damage and thus make a better assessment of the prognosis of such injuries. Head's second contribution pertains to the radicular organization at the level of the spinal cord. The pathophysiology of herpes zoster radiculitis enabled him to develop the concept of the dermatomes on the basis of preliminary work around 1900. Henry Head's contribution was the systematic compilation of the existing publications of the time and amendment of his own cases. As he was the most important neurologist at that time, at least in the English speaking world, and was well connected with people in the German neurology community, it was probably easy for him to make his dermatome maps well known. In retrospect, Head was less successful in neuropsychology with holistic concepts for higher cognitive functions which were in vogue during his lifetime. His late work on aphasia is now considered refuted. Head's criticism of the strict localization was well in syncronization with the zeitgeist of the early twentieth century. Establishing the fact that Broca's aphasia and Wernicke's aphasia are not easily diagnostically distinguishable from each other was more an achievement of subsequent generations of neurologists and neuropsychologists as well as technical advances. [ABSTRACT FROM AUTHOR]

The shared trauma and slow violence caused by industrial disasters alter the collective environmental memory of the surviving population. The survivors and victims of mercury poisoning are a case in point that exist as memorial remains of eco-sickness. Industrial disaster comics galvanise such discussions as concerns of environmental, social, and biological damage. The Minamata Story: An Eco Tragedy, written by Sean Michael Wilson and Akiko Shimojima, visualises the chaotic memories of the mercury poisoning disaster that ravaged the Japanese village of Minamata in 1956. Mediated through witness accounts and the research expeditions of the protagonist Tomi, the comic portrays the spatial landscape of Minamata as a container of memories. The Minamata Story illustrates the psychosomatic damage of the eco-crime on human body, and the resultant social vulnerability of victims in their post-disaster lives. It exposes the typical portrayal of the victims as toxic embodiments and assumes an empathetic perspective which is pitted against the medicalisation of the identities of survivors. The long-lasting nature of the biological damage qualifies the text as a case for intergenerational trauma and postmemory. Taking these cues, the present article analyses the representation of environmental memory, and reviews the visualisation of eco-sickness in industrial disaster comics. [ABSTRACT FROM AUTHOR]

• Work addresses methodological considerations relevant for psychoneuroimmunology. • Different forms of reductionism and notions of mechanism and system are discussed. • Several positions in medicine and science regarding the mind–body problem are covered. • Recommendations for more robust and interdisciplinary science are provided. In medicine and science, one is typically taught the main theories in a discipline or field along with standard models before receiving more instructions on how to apply certain methods. The aim of this work is not to address one method, but rather methodology, the study and evaluation of methods, by taking a philosophy of science detour. In this, a critique of biomedicine will be used as a starting point to address some positions regarding reductionism, specifying notions such as systems and mechanisms, as well as regarding the mind–body problem discussing psychosomatic medicine and psychoneuroimmunology. Some recommendations to make science more pluralistic, robust and translationally-relevant will then be made as a way to foster constructive debates on reductionism and the mind–body problem and, in turn, favor more interdisciplinary research. [ABSTRACT FROM AUTHOR]

Objective: Multimorbidity is a growing challenge in the care for older people with mental illness. To address both physical and mental illnesses, integrated care management is required. The purpose of this scoping review is to identify core components of integrated care models for older adults with depression and physical comorbidity, and map reported outcomes and implementation strategies. Methods: PubMed, EMBASE, CINAHL and Cochrane Library were searched independently by two reviewers for studies concerning integrated care interventions for older adults with depression and physical comorbidity. We used the SELFIE framework to map core components of integrated care models. Clinical and organisational outcomes were mapped. Results: Thirty-eight studies describing thirteen care models were included. In all care models, a multidisciplinary team was involved. The following core components were mainly described: continuity, person-centredness, tailored holistic assessment, pro-activeness, treatment interaction, individualized care planning, and coordination tailored to complexity of care needs. Twenty-seven different outcomes were evaluated, with more attention given to clinical than to organisational outcomes. Conclusion: The core components that comprise integrated care models are diverse. Future studies should focus more on implementation aspects of the intervention and describe financial parts, e.g., the cost of the intervention for the healthcare user, more transparently. [ABSTRACT FROM AUTHOR]

Copyright of Praxis der Kinderpsychologie und Kinderpsychiatrie is the property of Vandenhoeck & Ruprecht GmbH & Co. KG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

IntroductionInternational evidence strongly suggests that medical students are at high risk of mental health problems. This distress, which can be mediated by a variety of individual, interpersonal and contextual factors within the curriculum, can be mitigated by effective coping strategies and interventions. Central to this discourse is the recognition that the challenges of professional identity formation can contribute significantly to medical students' distress. The focus of our study is therefore to examine discrepancies in professional identities and role models in undergraduate medical education in relation to affective burden.MethodsMedical students at different stages of university education and high school graduates intending to study medicine were surveyed in a cross-sectional study. The study employed Osgood and Hofstätter's polarity profile to evaluate the self-image of participants, the image of an ideal and real physician, and their correlation with depression (PHQ-9) and anxiety (GAD-7).ResultsOut of the 1535 students recruited, 1169 (76.2%) participated in the study. Students rated their self-image as somewhere between a more critical real image of physicians and a more positive ideal image. Medical students at all training levels consistently rated the ideal image as remaining constant. Significant correlations were found between the professional role models of medical students and affective symptoms, particularly for the discrepancy between the ideal image of a physician and their self-image. Furthermore, 17% and nearly 15% reported significant symptoms of depression and anxiety, respectively.DiscussionOur study adds to the growing body of knowledge on professional identity formation in medicine and socialisation in the medical environment. The study highlights the importance of discrepancies between self-image and ideal image in the experience of depressive and anxiety symptoms. Primary prevention-oriented approaches should incorporate these findings to promote reflective competence in relation to professional role models and strengthen the resilience of upcoming physicians in medical training.

The article summarizes the book "Medicine in Romanticism and Idealism. Health in Body and Soul, Nature and Culture" written by Dietrich von Engelhardt. The book consists of four volumes that include a scholarly introduction, an anthology of historical texts, a presentation of the most relevant medical personalities of the period, and a comprehensive bibliography for researchers. The author highlights the connection between the personal biography of the authors and their scientific and literary works during Romanticism, as well as the relationship between medicine and philosophy in that period. The concern for one's own health and the relationship between biography and illness in that era are also mentioned. The text discusses the medical systems that emerged during the Romantic period and their relationship with nature and spirit. The importance of sociocultural and environmental factors in the development of medical disciplines is also emphasized, as well as the relevance of psychosomatic medicine. [Extracted from the article]

Objective: Anorexia nervosa (AN) and atypical anorexia nervosa (AAN) are severe and complex eating disorders that can be prevalent among individuals with type 1 diabetes mellitus (T1DM). Insulin purging, characterized by the intentional underuse / omission of insulin to control weight, is under-recognized in medicine and is a purging strategy of patients with AN or AAN and comorbid T1DM. Often, this can lead to renal failure, necessitating a (pancreas-) kidney transplantation. This article presents a comprehensive overview of the interplay between AN/AAN and T1DM and summarizes the evidence in literature. Methods: A narrative review is presented on basis of a detailed case study of a 32-year-old female with end-stage renal failure seeking (pancreas-) kidney transplantation displaying etiology, diagnosis, comorbidities, complications, and treatment of AN and AAN with emphasis on those patients with T1DM. Results: Insulin purging in patients with AN/AAN and coexisting T1DM can exacerbate T1DM complications, including accelerating the onset of end-stage renal failure. A multidisciplinary approach including nutrition treatment and psychotherapeutic techniques was considered necessary for treatment, focusing on psychosomatic in-patient care before and after organ transplantation. Conclusion: Insulin purging in patients with AAN and T1DM poses severe health risks, including accelerated renal complications. For those considering transplantation, insulin purging has explicitly to be diagnosed and a holistic treatment addressing both the renal condition and psychosomatic symptoms/ disorders is crucial for successful post-transplant outcomes. [ABSTRACT FROM AUTHOR]

This study evaluated whether psychological stress increases the incidence of ovarian cancer. A literature search of the electronic databases PubMed and Web of Science from the date of inception to August 2022 was undertaken. Studies with data on psychosocial factors associated with ovarian cancer incidence were included in this study. A random-effect model meta-analysis was undertaken to estimate these data. We used subgroup analysis to adjust for heterogeneity. A total of 4 articles, 10 sets of data, 8 cohort studies, and 2 case–control studies from 682 records were included in this review. Meta-analyses of the included cohort study subgroups suggested that psychological factors increase the risk of ovarian cancer (effect size = 1.37, 95% CI: 1.20–1.53); the subgroup of case–control studies suggested that psychological factors did not increase ovarian cancer risk (effect size = 0.84, 95% CI: 0.70–0.98). These findings indicate that psychological stress is a possible new risk factor for ovarian cancer. Prospero registration number: CRD42022357983 What is already known on this subject? Psychological stress has been shown to increase the risk of many diseases. The relationship between psychological stress and the incidence of ovarian cancer has not been confirmed. What do the results of this study add? The effect of psychological stress on the risk of ovarian cancer was estimated using meta-analysis as an overall ratio. What are the implications of these findings for clinical practice and/or further research? Relaxing psychological stress and appropriate psychotherapy in clinical settings can help reduce the risk of ovarian cancer. [ABSTRACT FROM AUTHOR]

Background: Non-cardiac chest pain is common and associated with increased anxiety and reduced health-related quality of life. Randomized controlled trials on psychological interventions for patients with non-cardiac chest pain have reported mixed results. Patients with non-cardiac chest pain are a heterogeneous group. Identifying sub-groups that could potentially benefit more (or less) from an intervention would be valuable knowledge. We have conducted a randomized controlled trial where internet-based cognitive behavioural therapy (iCBT) had effect on reducing cardiac anxiety and increasing health-related quality of life at 12-month follow-up. The aim of the present study was to explore potential effect modifiers of iCBT in patients with non-cardiac chest pain on cardiac anxiety and/or health related quality of life at 12-month follow-up. Methods: We analysed data from our randomized, controlled trial where 161 patients with non-cardiac chest pain were included and randomized to either iCBT or a treatment as usual (control). Cardiac anxiety measured by the Cardiac Anxiety Questionnaire and health-related quality of life measured by the EuroQol Visual Analog Scale at 12 month follow-up were the primary outcomes. Four potential baseline characteristics where identified as potential effect modifiers by a theory-based approach: (1) depression measured by the Patient Health Questionnaire; (2) anxiety measured by the Body Sensations Questionnaire; (3) prior healthcare contacts measured by a self-developed question; and (4) chest pain frequency measured by a self-developed question. Each potential effect modifier was analysed in a linear regression model where cardiac anxiety and EQ-VAS scores at 12-month follow-up, separately, were used as dependent variables. The potential differential treatment effect for each effect modifier was assessed by the interaction term: effect modifier x treatment group. Results: Depression symptoms at baseline predicted a differential treatment effect at 12-month follow-up on health-related quality of life in favor of the iCBT group (regression coefficient of the interaction term: -1.85 (CI -3.28 to -0.41), p = 0.01), but not on cardiac anxiety at 12-month follow-up. Fear of bodily symptoms, chest pain frequency and prior health care contacts at baseline did not predict a treatment effect on either health-related quality of life or cardiac anxiety. Conclusions: Depression symptoms at baseline predicted a positive treatment effect of iCBT on health-related quality of life in patients suffering from non-cardiac chest pain. This indicates that it is important to identify patients with non-cardiac chest pain and co-occurring depression symptoms given that they are particularly likely to benefit from iCBT. Trial registration: ClinicalTrials.gov NCT03096925. [ABSTRACT FROM AUTHOR]

Purpose: To calibrate the item parameters of the German PROMIS® Pain interference (PROMIS PI) items using an item-response theory (IRT) model and investigate psychometric properties of the item bank. Methods: Forty items of the PROMIS PI item bank were collected in a convenience sample of 660 patients, which were recruited during inpatient rheumatological treatment or outpatient psychosomatic medicine visits in Germany. Unidimensionality, monotonicity, and local independence were tested as required for IRT analyses. Unidimensionality was examined using confirmatory factor analyses (CFA) and exploratory factor analysis (EFA). Unidimensional and bifactor graded-response IRT models were fitted to the data. Bifactor indices were used to investigate whether multidimensionality would lead to biased scores. To evaluate convergent and discriminant validity, the item bank was correlated with legacy pain instruments. Potential differential item functioning (DIF) was examined for gender, age, and subsample. To investigate whether U.S. item parameters may be used to derive T-scores in German patients, T-scores based on previously published U.S. and newly estimated German item parameters were compared with each other after adjusting for sample specific differences. Results: All items were sufficiently unidimensional, locally independent, and monotonic. Whereas the fit of the unidimensional IRT model was not acceptable, a bifactor IRT model demonstrated acceptable fit. Explained common variance and Omega hierarchical suggested that using the unidimensional model would not lead to biased scores. One item demonstrated DIF between subsamples. High correlations with legacy pain instruments supported construct validity of the item bank. T-scores based on U.S. and German item parameters were similar suggesting that U.S. parameters could be used in German samples. Conclusion: The German PROMIS PI item bank proved to be a clinically valid and precise instrument for assessing pain interference in patients with chronic conditions. [ABSTRACT FROM AUTHOR]

The implementation status of clinical guidelines is, despite their important role in connecting research with practice, frequently not satisfactory. This study aims to investigate the implementation status of the current German guideline for schizophrenia. Moreover, the attitude toward a living guideline has been explored for the first time by presenting screenshots of the German schizophrenia guideline transferred to a digital living guideline format called MAGICapp. A cross-sectional online survey was performed under the participation of 17 hospitals for psychiatry and psychosomatic medicine in Southern Germany and one professional association for German neurologists and psychiatrists. 439 participants supplied sufficient data for analysis. 309 provided complete data sets. Regarding the current guideline for schizophrenia and key recommendations, a large awareness-to-adherence gap was found. Group comparisons between different professions (caregivers, medical doctors, psychologists/psychotherapists, psychosocial therapists) detected differences in the implementation status showing higher awareness and agreement with the schizophrenia guideline and its key recommendations among medical doctors compared to psychosocial therapists and caregivers. Moreover, we detected differences in the implementation status of the guideline as a whole and its key recommendations between specialist and assistant doctors. The attitude toward an upcoming living guideline was mostly positive, especially among younger healthcare professionals. Our findings confirm an awareness-to-adherence gap, not only for the current schizophrenia guideline in general but also for its key recommendations with apparent differences between professions. Overall, our results show promising positive attitudes toward the living guideline for schizophrenia among healthcare providers, suggesting that a living guideline may be a supportive tool in everyday clinical practice. [ABSTRACT FROM AUTHOR]

A brief history is given of early manipulation in the form of bone-setting, deriving from Britain, to demonstrate the sophistication of DD Palmer's methods of spinal manipulation which he named Chiropractic. Palmer not only introduced the use of the spinous process as a lever for his spinal corrections but identified and reported a range of effects gathered as neuroimmunity and neuroimmunology to form his Chiropractic brand of neurobiology. It is shown that Palmer's ideas mirrored those of Cannon, credited with the discovery of the stress response around 1915 and heralded as the father of psychosomatic medicine, and of Koch, one of the founders of bacteriology. The distinction of Chiropractic from Osteopathy is given, along with a discussion on the opprobrium of medicine as represented by the American Medical Association, described as the 4th arm of American government with its plan to 'contain and eliminate' Chiropractic. [ABSTRACT FROM AUTHOR]

Abstract Aims Co-occurring somatic diseases exhibit complex clinical profiles, which can differentially impact the development of late-life depression. Within a community-based cohort, we aimed to explore the association between somatic disease burden, both in terms of the number of diseases and their patterns, and the incidence of depression in older people. Methods We analysed longitudinal data of depression- and dementia-free individuals aged 60+ years from the population-based Swedish National Study on Aging and Care in Kungsholmen. Depression diagnoses were clinically ascertained following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision over a 15-year follow-up. Somatic disease burden was assessed at baseline through a comprehensive list of chronic diseases obtained by combining information from clinical examinations, medication reviews and national registers and operationalized as (i) disease count and (ii) patterns of co-occurring diseases from latent class analysis. The association of somatic disease burden with depression incidence was investigated using Cox models, accounting for sociodemographic, lifestyle and clinical factors. Results The analytical sample comprised 2904 people (mean age, 73.2 [standard deviation (SD), 10.5]; female, 63.1%). Over the follow-up (mean length, 9.6 years [SD, 4 years]), 225 depression cases were detected. Each additional disease was associated with the occurrence of any depression in a dose–response manner (hazard ratio [HR], 1.16; 95% confidence interval [CI]: 1.08, 1.24). As for disease patterns, individuals presenting with sensory/anaemia (HR, 1.91; 95% CI: 1.03, 3.53), thyroid/musculoskeletal (HR, 1.90; 95% CI: 1.06, 3.39) and cardiometabolic (HR, 2.77; 95% CI: 1.40, 5.46) patterns exhibited with higher depression hazards, compared to those without 2+ diseases (multimorbidity). In the subsample of multimorbid individuals (85%), only the cardiometabolic pattern remained associated with a higher depression hazard compared to the unspecific pattern (HR, 1.71; 95% CI: 1.02, 2.84). Conclusions Both number and patterns of co-occurring somatic diseases are associated with an increased risk of late-life depression. Mental health should be closely monitored among older adults with high somatic burden, especially if affected by cardiometabolic multimorbidity.

Abstract Background Few studies have examined the economic costs of outpatient care for eating disorders in Japan. This study aimed to clarify the reimbursement for outpatient treatment of eating disorders and compare the costs between the departments of Psychosomatic Medicine and Psychiatry in Japan. Method A multicenter, prospective, observational study of patients with an eating disorder was conducted in the Psychosomatic Medicine departments of three centers and the Psychiatry departments of another three centers in Japan. We analyzed medical reimbursement for an outpatient revisit, time of clinical interviews, and the treatment outcome measured by the Eating Disorder Examination Questionnaire (EDE-Q) global scores and body mass index (BMI) at 3 months. Multivariate linear regression models were performed to adjust for covariates. Results This study included 188 patients in the Psychosomatic Medicine departments and 68 in the Psychiatry departments. The average reimbursement cost for an outpatient revisit was 4670 yen. Even after controlling for covariates, the Psychosomatic Medicine departments had lower reimbursement points per minute of interviews than the Psychiatry departments (coefficient = − 23.86; 95% confidence interval = − 32.09 to − 15.63; P

Background. Many patients affected by FM present different comorbidities, but to date no case of FM in patients with CRMO has been reported in literature. Several studies show the importance of psychosomatic assessment in FM, but only one reported the presence of allostatic overload. Case presentation. In April 2022, a 21-year-old female patient, a third-year medical student, came to our clinic to be assessed and treated for FM. She presents with a diagnosis of CRMO made in 2014 and a diagnosis of FM made in 2019. Results. At the psychiatric evaluation she presented symptoms of anxiety, depression, insomnia and reported widespread pain with the presence of almost daily headaches. From the psychosomatic point of view using DCPR-revised she presented diagnostic criteria for allostatic overload, related to study and periodic flare-ups of painful symptoms due to CRMO, persistent somatization, with musculoskeletal and gastroenterological symptoms, demoralization and type A behaviour. Conclusion. This case shows how useful a psychosomatic assessment of the patient can be for offering insights into what stressors at the origin of allostatic overload may be present in different FM patients. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Psychosomatische Medizin und Psychotherapie is the property of Vandenhoeck & Ruprecht GmbH & Co. KG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The healing response is a complex and multiform procedure that involves many physical and symbolic interactions and synchronizations. In the clinical research model, certain factors are abstracted during which contextual elements, such as placebo responses and communicative factors, are excluded to reveal the pieces of evidence that are necessary for the mass production of clinical materials and methods. On the other side, clinical practice is a singular and chaotic communicative action in which we should include contextual and discursive factors for prompting proper biological as well as behavioral responses. Placebo responses, personal history and attitudes, and clinical relationships and communication are some of the contextual and individual factors that can be changed effectively if we can communicate with the symbolic and reflective matrices of clinical practice. In this article, the author introduces a biosemiotic formula for healing responses that include symbolic and reflective factors of healing response aligned with the related biological procedures. Not only are psychological interventions beneficial in mental health problems and symptom control but they could also be used as co-treatments to reinforce placebo responses and improve illness behavior and treatment narratives.

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has affected the treatment system of medical institutions across the world. Studies of the populations and patients have reported mental health problems caused by the pandemic. However, there are few large-scale studies that have examined the effects of the COVID-19 on diseases from the perspective of psychosomatic medicine. The purpose of this study was to examine changes made to the psychosomatic treatment system of Japan during the COVID-19 pandemic and the impact of the pandemic on patients with diseases treated in psychosomatic medicine. Methods We conducted a nationwide questionnaire survey of members of the Japanese Society of Psychosomatic Medicine and the Japanese Society of Psychosomatic Internal Medicine from December 24, 2021 to January 31, 2022. Results Of the 325 respondents, 23% reported restrictions in initial outpatient admissions, 66% implemented telemedicine, 46% reported a decrease in outpatient admissions, and 31% working in facilities with inpatient units reported decreased inpatient admissions. To reduce in-person visits, 56% of the respondents decreased the frequency of patient visits and 66% introduced telemedicine. Seventy-eight percent of the respondents reported that the COVID-19 pandemic affected the onset or exacerbation of diseases treated in psychosomatic medicine, including psychosomatic disorders, anxiety disorders, mood disorders, adjustment disorders, and eating disorders. Conclusions This study revealed that the COVID-19 pandemic might have affected the practice of psychosomatic treatment in Japan and that various alternative measures were taken to prevent infection. In addition, although the items in this study were not compared to pre-pandemic data, the COVID-19 pandemic, it could have significant psychosocial effects on Japanese patients requiring psychosomatic care. Furthermore, respondents believed that numerous psychosocial factors were behind the impact of the COVID-19 pandemic on patients with diseases treated in psychosomatic medicine.

ObjectiveAnorexia nervosa (AN) and atypical anorexia nervosa (AAN) are severe and complex eating disorders that can be prevalent among individuals with type 1 diabetes mellitus (T1DM). Insulin purging, characterized by the intentional underuse / omission of insulin to control weight, is under-recognized in medicine and is a purging strategy of patients with AN or AAN and comorbid T1DM. Often, this can lead to renal failure, necessitating a (pancreas-) kidney transplantation. This article presents a comprehensive overview of the interplay between AN/AAN and T1DM and summarizes the evidence in literature.MethodsA narrative review is presented on basis of a detailed case study of a 32-year-old female with end-stage renal failure seeking (pancreas-) kidney transplantation displaying etiology, diagnosis, comorbidities, complications, and treatment of AN and AAN with emphasis on those patients with T1DM.ResultsInsulin purging in patients with AN/AAN and coexisting T1DM can exacerbate T1DM complications, including accelerating the onset of end-stage renal failure. A multidisciplinary approach including nutrition treatment and psychotherapeutic techniques was considered necessary for treatment, focusing on psychosomatic in-patient care before and after organ transplantation.ConclusionInsulin purging in patients with AAN and T1DM poses severe health risks, including accelerated renal complications. For those considering transplantation, insulin purging has explicitly to be diagnosed and a holistic treatment addressing both the renal condition and psychosomatic symptoms/disorders is crucial for successful post-transplant outcomes.

This study evaluated whether psychological stress increases the incidence of ovarian cancer. A literature search of the electronic databases PubMed and Web of Science from the date of inception to August 2022 was undertaken. Studies with data on psychosocial factors associated with ovarian cancer incidence were included in this study. A random-effect model meta-analysis was undertaken to estimate these data. We used subgroup analysis to adjust for heterogeneity. A total of 4 articles, 10 sets of data, 8 cohort studies, and 2 case–control studies from 682 records were included in this review. Meta-analyses of the included cohort study subgroups suggested that psychological factors increase the risk of ovarian cancer (effect size = 1.37, 95% CI: 1.20–1.53); the subgroup of case–control studies suggested that psychological factors did not increase ovarian cancer risk (effect size = 0.84, 95% CI: 0.70–0.98). These findings indicate that psychological stress is a possible new risk factor for ovarian cancer. Prospero registration number: CRD42022357983IMPACT STATEMENT What is already known on this subject? Psychological stress has been shown to increase the risk of many diseases. The relationship between psychological stress and the incidence of ovarian cancer has not been confirmed. What do the results of this study add? The effect of psychological stress on the risk of ovarian cancer was estimated using meta-analysis as an overall ratio. What are the implications of these findings for clinical practice and/or further research? Relaxing psychological stress and appropriate psychotherapy in clinical settings can help reduce the risk of ovarian cancer.

Purpose: to substantiate the algorithm for predicting the state of psychological adaptation - maladaptation of patients with dermatological pathology with different levels of vital threat, on the basis of which to develop personalized psychocorrection programs for this contingent, and to evaluate the effectiveness of their implementation. . Contingent and research methods. Based on the principles of biomedical ethics and deontology, we comprehensively examined 120 dermatological patients who were treated in three branches of the clinic "Dr. Zapolska Clinic" during 2020-2022, namely: 60 patients with non-vital dermatological diseases (seborrheic keratosis L82, condylomas A63.0, angiomas D18.0, pigmentation disorders L80), and 60 patients with dermatological diseases posing a vital threat ( melanoma C43, basal cell carcinoma C44, skin carcinoma in situ D04). Results. Among patients with dermatological diseases, there are both psychologically adapted and maladapted individuals, regardless of the vitality/non-vitality of the pathological process. The process of formation of psychological maladaptation in patients with dermatological diseases with different levels of vital threat does not have nosospecificity, but depends on the initial state of the adaptive resource base of the individual, first of all, its psychosocial and individual-psychological components. Summarizing the obtained results made it possible to identify three main blocks of characteristics that cover a wide range of biological, individual-psychological, social-environmental and psychosocial factors, which we defined as factors/markers of psychological adaptation-maladaptation in patients with dermatological diseases with different levels of vital threat: psychoemotional , psychosocial and personal. Based on the analysis of determined markers of psychological adaptation-maladaptation using mathematical methods, an algorithm for assessing and predicting psychological maladaptation in this contingent of patients is proposed. This algorithm determines the criteria of personification, the structure and scope of developed psychocorrective measures at different degrees of risk of psychological maladaptation in patients with dermatological diseases with different levels of vital threat. A three-stage system of psychocorrective interventions (assessment-diagnostic, clinical-therapeutic, and correction-adaptation stages) has been developed, united by the complexity and continuity of correction, psychotherapeutic, and adaptation measures. At the assessment-diagnostic stage, the prognosis of the development and progression of maladaptation is assessed, which ensures the personification of psychocorrective interventions, which are carried out mainly at the clinical-therapeutic stage, the positive effect of which is fixed at the last, corrective-adaptation stage. The evaluation of the effectiveness of these measures proved their effectiveness in eliminating psychopathological manifestations (depression and anxiety), improving the quality of life and social functioning, and increasing vitality and resilience. Conclusion. Personalized psychocorrection of patients of dermatological practice with different levels of psychological maladaptation may be recommended for the introduction into health care practice.

Background Avoidant paruresis is a common clinical condition in urology and psychosomatic medicine. However, it has limited treatment options that are safe and effective with few side effects. Aims Our study aimed to investigate the effectiveness and safety of the Chinese herbal Yangxin Tongquan decoction combined with cognitive-behavioural therapy (CBT) for avoidant paruresis. Methods Sixty-eight patients with avoidant paruresis were divided into a treatment group (33 patients) and a control group (35 patients). The control group was assigned 10 weeks of CBT and systematic desensitisation. In addition to CBT and systematic desensitisation, the treatment group was given the Chinese herbal Yangxin Tongquan decoction during the 10-week study. The Shy Bladder Syndrome Scale (SBS) and the Self-rating Anxiety Scale (SAS) were administered before and after treatment to measure any change. Results The overall efficacy in the treatment group (n=30) was 80.0% vs 62.5% in the control group (n=33). Comparing pretreatment and post-treatment measures, both groups showed improvement in SBS scores and SAS scores (treatment group: t(SBS)=8.397, p(SBS)<0.001, t(SAS)=8.216, p(SAS)<0.001; control group: t(SBS)=6.802, p(SBS)<0.001, t(SAS)=5.171, p(SAS)<0.001). Moreover, both groups' SBS and SAS scores changed significantly over time (SBS scores: Ftime=118.299, p<0.001; SAS scores: Ftime=92.114, p<0.001). However, the treatment group performed better than the control group (SBS scores: Ftime*group=5.709, p=0.020; SAS scores: Ftime*group=7.235, p=0.009). Conclusions The Chinese herbal Yangxin Tongquan decoction combined with cognitive-behavioural psychotherapy positively affects the treatment of avoidant paruresis without significant adverse effects. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies that focused on socioeconomic differences did not comprehensively explain existing inequalities in psychosomatic rehabilitation in Germany. We applied a social milieu approach, which additionally includes sociocultural factors such as lifestyles, attitudes and values, to investigate differences among patients in symptom severity, psychosocial impairment and improvement over the course of the intervention. Methods: As a model for social milieus, the empirical Sinus milieus were used. 2,000 patients of two psychosomatic rehabilitation clinics in Germany were included and their milieu was assessed with the Sinus milieu indicator for Germany 10/2018 questionnaire. BDI-II (N  =  1,832) and HEALTH-49 (N  =  1,829) questionnaires were used to measure depressiveness and psychosocial impairment at admission (T0) and discharge after 5  weeks of treatment (T1). Milieu differences in severity and improvement were analyzed by mixed-model ANOVAs. Results: Milieu distribution was not representative of the overall population of Germany. We found significant differences between patients from different milieus in both BDI-II and HEALTH-49 (p  <  0.001). Patients from the Precarious Milieu had the highest burden of depressive symptoms in BDI-II and the highest impairment on all HEALTH-49 scales at T0 and T1. Over the course of rehabilitation, patients from all milieus improved significantly in all domains (p  <  0.001). Significant interaction effects showed milieu-dependent differences in improvement for depressiveness on the BDI-II [F(9, 1822)  =  2.50, p  =  0.008] and for three HEALTH-49 scales, namely Psychological well-being [F(9, 1819)  =  3.30, padj  =  0.005], Interactional difficulties [F(9, 1819)  =  2.74, padj  =  0.036] and Activity and Participation [F(9, 1819)  =  4.94, padj  <  0.001], while post-hoc tests only revealed two significant group differences for the last scale. In all domains, patients from the Precarious Milieu retained higher symptoms and impairment at T1 than patients from better-off milieus had at T0. Discussion: Social milieu was associated with symptom severity, treatment access and outcome of psychosomatic rehabilitation patients. Milieuspecific sociocultural habits, psychosocial needs and therapeutic demands may help describe differences and should be considered in therapy planning and implementation, to improve equal access, quality and effectiveness of rehabilitation. Therefore, further research on milieu-specific differences and needs is necessary. [ABSTRACT FROM AUTHOR]