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Somatoform pain poses major challenges in medicine. There is a lack of quantitative instruments that systematically assess psychosocial aspects of somatoform pain. A better knowledge of such aspects could contribute (1) to gaining further insight into the relationship between psychodynamic and psychosocial components of pain, and (2) to facilitating the development and monitoring of improved interventions targeting psychodynamic and psychosocial mechanisms of pain. An item pool on biopsychosocial aspects of pain was developed and completed by 200 patients with somatoform pain disorder. In addition, anxiety (STAI), depression (BDI II), somatization (SOMS-2), and quality of life (SF-36) were assessed. As compared to norm data, patients reported higher scores for anxiety (STAI), depression (BDI-II) somatization (SMOS-2), and lower quality of life (SF-36). Applying item and factor analyses, a new questionnaire (QSP-31) was developed to identify psychodynamic and psychosocial aspects of pain. There was evidence for the construct validity of the six scales through confirmatory factor analysis: Relationships between pain and negative emotions, Negative attitudes towards help-seeking, Negative pain-related childhood experiences, Negative attitudes towards own body, Negative aspects of the doctor-patient relationship, and Perceived pain control. Cronbach's alpha coefficients for these scales lay within the range of .81-.92. Regarding criterion validity, moderate correlations in expected directions were found between all scales and anxiety, depression, somatic symptom severity, and quality of life, except for the scale Perceived pain control. The QSP-31 appears promising for the identification of relevant psychosocial aspects associated with the experience of pain and might be a useful instrument. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

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

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

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