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Metzen E, Nayyeri MD, Schäfer R, Dinger U, Franz M, Seitz R, Rademacher J. Emotion processing of facial affect expression in patients with somatic symptom disorder with predominant pain-An EEG-study. Neuroimage 2025; 307:121036. [PMID: 39826776 DOI: 10.1016/j.neuroimage.2025.121036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/16/2025] [Accepted: 01/16/2025] [Indexed: 01/22/2025] Open
Abstract
Despite their high prevalence, somatoform pain disorders are often not recognized early enough, not diagnosed reliably enough and not treated appropriately. Patients often experience a high level of suffering and the feeling of not being understood. For the medical care system, the symptoms represent a diagnostic and therapeutic challenge. Having the aim to get a better understanding of the disease, this study investigated the patients' emotion processing. In addition, the influence of surgical masks on facial affect processing was investigated, which has become more important since the onset of the Covid-19. The study involved an electroencephalogram (EEG) experimental paradigm extracting visual event-related potentials (vERP) evoked by emotional faces with and without surgical masks. Overall, the results of the face-related vERP indicate that the healthy control participants process the different emotional faces in a differentiated way. This can be seen from the fact that in this group the amplitudes of the vERP differ according to the different affects. In contrast, the patient group does not show any affect-specific potential differences in the vERP components. Besides, in healthy control participants, masks appear to limit the brain's ability to process emotions by hiding important facial information. Patients do not show any differences in the way they process images with and without masks, which suggests that patients generally process this content more rudimentary.
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Affiliation(s)
- Eva Metzen
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine University Duesseldorf, Bergische Landstraße 2, 40629 Duesseldorf, Germany.
| | - Mahboobeh Dehghan Nayyeri
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine University Duesseldorf, Bergische Landstraße 2, 40629 Duesseldorf, Germany.
| | - Ralf Schäfer
- Centre for Neurology and Neuropsychiatry (ZNN), LVR Clinic, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Ulrike Dinger
- Centre for Neurology and Neuropsychiatry (ZNN), LVR Clinic, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Matthias Franz
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine University Duesseldorf, Bergische Landstraße 2, 40629 Duesseldorf, Germany
| | - Rüdiger Seitz
- Centre for Neurology and Neuropsychiatry (ZNN), LVR Clinic, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Jörg Rademacher
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine University Duesseldorf, Bergische Landstraße 2, 40629 Duesseldorf, Germany
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Habib S, Mozumder MK. Validation of the somatic symptom disorder-B Criteria Scale (SSD-12) in Bangladesh. PLoS One 2025; 20:e0318062. [PMID: 39854595 PMCID: PMC11760037 DOI: 10.1371/journal.pone.0318062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 01/10/2025] [Indexed: 01/26/2025] Open
Abstract
BACKGROUND The absence of a reliable and valid Bangla instrument for measuring somatic symptom disorder hinders research and clinical activities in Bangladesh. The present study aimed at translating and validating the Somatic Symptom Disorder-B criteria (SSD-12). METHOD A cross-sectional design was used with purposively selected clinical (n = 100) and non-clinical (n = 100) samples. The clinical sample was collected from psychiatric departments at three hospitals, while the non-clinical sample was drawn from the local community. Exploratory (EFA) and confirmatory factor analysis (CFA) were conducted on the SSD-12, along with reliability and validity assessments. RESULTS Results indicated satisfactory internal consistency reliability (Cronbach's alpha = .94, split-half r = .93); criterion-related validity (r = .86, with Morey's Somatic Complaints Scale); and construct validity (r = .64 with anxiety subscale and r = .57 with depression subscale of the Hospital Anxiety and Depression Scale) of the translated scale. In contrast to the three-factor structure of the original SSD-12, the Bangla version indicated a single-factor structure (accounting for 61.29% of the total variance). This scale also demonstrates its ability to distinguish between clinical and non-clinical participants (t198 = 16.74, p < .01). CONCLUSION The Bangla translated SSD-12 has demonstrated strong psychometric properties, indicating its suitability for use in Bangladesh. This tool is expected to aid mental health practitioners in their clinical work by providing them with a quick assessment of their patients having somatic complaints.
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Affiliation(s)
- Sumaiya Habib
- Department of Clinical Psychology, University of Dhaka, Bangladesh
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Tallman PS, Seligman RA, Madimenos FC, Liebert MA, Cepon-Robins TJ, Snodgrass JJ, McDade TW, Sugiyama LS. Somatic Symptoms Are Associated With Elevated Blood Pressure and Epstein-Barr Virus Antibodies Among Shuar of the Ecuadorian Amazon. Am J Hum Biol 2025; 37:e24191. [PMID: 39613339 DOI: 10.1002/ajhb.24191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 11/05/2024] [Accepted: 11/06/2024] [Indexed: 12/01/2024] Open
Abstract
INTRODUCTION This study tests the hypothesis that self-reported somatic symptoms are associated with biomarkers of stress, including elevated blood pressure and suppressed immune function, among Shuar adults living in the Ecuadorian Amazon. METHODS Research was conducted in three Shuar communities in the Upano Valley of the Ecuadorian Amazon and included the collection of biomarkers and a structured morbidity interview. Participants self-reported somatic symptoms such as headaches, body pain, fatigue, and other bodily symptoms. We examined whether the number of somatic symptoms reported was associated with measures of immune (Epstein-Barr virus [EBV] antibodies) and cardiovascular (blood pressure) functioning in 97 Shuar adults (37 women, 60 men; ages 18-65 years). Multivariate linear regression analyses were used to examine the relationships among somatic symptoms and stress biomarkers, controlling for age, sex, body mass index (BMI), active infection, level of education, and income. RESULTS Controlling for relevant covariates, Shuar adults reporting the highest level of somatic symptoms (three symptoms) were more likely to exhibit elevated systolic (β = 0.20, p = 0.04) and diastolic blood pressure (β = 0.23, p = 0.03), in comparison to adults reporting no symptoms. Shuar adults reporting two symptoms, compared to no symptoms, were more likely to exhibit elevated EBV antibody concentrations (β = 0.34, p = < 0.01). CONCLUSIONS These preliminary findings demonstrate that somatic symptoms reported by Shuar men and women are associated with physiological measures widely associated with chronic psychosocial stress. These findings complement the cross-cultural literature in medical anthropology documenting the close connection between the expression of somatic symptoms and stressful life circumstances and highlight the important role that human biologists can play in exploring biocultural phenomena.
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Affiliation(s)
- Paula S Tallman
- Department of Anthropology, Loyola University Chicago, Chicago, Illinois, USA
- The Keller Science Action Center, Field Museum of Natural History, Chicago, Illinois, USA
- Social Welfare Graduate Program, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Rebecca A Seligman
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
| | - Felicia C Madimenos
- Queens College, City University of New York, New York, New York, USA
- New York Consortium in Evolutionary Primatology (NYCEP), New York, New York, USA
| | - Melissa A Liebert
- Department of Anthropology, Northern Arizona University, Flagstaff, Arizona, USA
| | | | - J Josh Snodgrass
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
| | - Thomas W McDade
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
| | - Lawrence S Sugiyama
- Department of Anthropology, Northern Arizona University, Flagstaff, Arizona, USA
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Reme SE. Medically unexplained symptoms explained. Lancet 2024; 403:2568-2569. [PMID: 38879241 DOI: 10.1016/s0140-6736(24)01138-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024]
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Komasi S, Hemmati A, Rahmani K, Rezaei F. Construct and criterion validity of the HiTOP spectra to predict dimensional and categorical somatization in a large non-western sample. Sci Rep 2023; 13:13197. [PMID: 37580386 PMCID: PMC10425466 DOI: 10.1038/s41598-023-40545-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 08/12/2023] [Indexed: 08/16/2023] Open
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) is a phenotypic data-driven framework for the classification of psychopathology. We tested the construct and criterion validity of the HiTOP spectra measured by the Personality Inventory for DSM-5 (PID-5) using exploratory structural equation modeling (ESEM) and hierarchical regressions both to predict somatic symptom and related disorders (SSRD) and a somatization factor. The case-control study used hierarchical logistic regressions to distinguish 257 cases with SSRD from 1007 healthy controls by both the maladaptive and the temperament factors. The extracted factors were also used in hierarchical linear regressions to predict the dimensional somatization factor. The seven temperament factors explained more variance above and beyond the five maladaptive factors when predicting SSRD (pseudo R2 = 0.169 to 0.266 versus 0.125 to 0.196; change in pseudo R2 = 0.055 to 0.087 versus 0.011 to 0.017). The temperament factors also explained more variance above and beyond the maladaptive factors when predicting the somatization factor (R2 = 0.392 versus 0.269; change in R2 = 0.146 versus 0.023). Although the HiTOP spectra measured by PID-5 are significant structures related to the categorical and dimensional measurements of somatoform, our findings highlight potential problems with both the construct and criterion validity of the HiTOP spectra.
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Affiliation(s)
- Saeid Komasi
- Neurosciences Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran.
| | - Azad Hemmati
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Khaled Rahmani
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Farzin Rezaei
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Affiliation(s)
- Heike Künzel
- Psychosomatische Beratungsstelle / Ambulanz, Klinikum Innenstadt d. LMU München, Pettenkoferstraße 8 a, 80336, München, Deutschland.
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Altamura M, D’Andrea G, Angelini E, Tortorelli FMP, Balzotti A, Porcelli P, Margaglione M, Brunetti ND, Cassano T, Bellomo A. Psychosomatic syndromes are associated with IL-6 pro-inflammatory cytokine in heart failure patients. PLoS One 2022; 17:e0265282. [PMID: 35271674 PMCID: PMC8912235 DOI: 10.1371/journal.pone.0265282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
Psychosomatic syndromes have emerged as an important source of comorbidity in cardiac patients and have been associated with increased risk for adverse outcomes in patients with heart failure (HF). Understanding of the mechanisms underlying this connection is limited, however immune activity represents a possible pathway. While there have been numerous studies connecting immune activity to psychosomatic psychopathology, there is a lack of research on patients with HF. We examined forty-one consecutive outpatients affected by HF. We assessed psychosomatic psychopathology using the Diagnostic Criteria for Psychosomatic Research (DCPR) and the Patient Health Questionnaire-15 (PHQ-15). The Psychosocial Index (PSI) was used for assessing stress and psychosocial dimensions. Depression was evaluated with Beck Depression Inventory-II (BDI-II). Circulating levels of proinflammatory cytokines IL-6 and TNF-alpha were ascertained. Univariate and multivariable regression models were used to test for associations between inflammatory cytokines and psychosomatic psychopathology (i.e., DCPR syndromes, PHQ-15) and psychological dimensions (i.e., BDI-II, PSI). A significant positive correlation was found between IL-6 levels and psychosomatic psychopathology even when controlling for any confounding variables (i.e., Body-mass index (BMI), New York Heart Association (NYHA) class, smoking habits, alcohol consumption, statin use, aspirin use, beta blockers use, age, and gender). In contrast, the associations between TNF-alpha levels were non-significant. These findings can contribute to research in support of a psychoneuroimmune connection between psychosomatic psychopathology and HF. Findings also suggest the possibility that elevated IL-6 levels are more relevant for the pathogenesis of psychosomatic syndromes than for depression in patients with HF.
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Affiliation(s)
- Mario Altamura
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
- * E-mail:
| | - Giovanna D’Andrea
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Eleonora Angelini
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | - Angela Balzotti
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Piero Porcelli
- Department of Psychological, Health and Territorial Sciences, D’Annunzio University of Chieti–Pescara, Chieti, Italy
| | - Maurizio Margaglione
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Natale D. Brunetti
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Tommaso Cassano
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Li W, Zhao N, Yan X, Xu X, Zou S, Wang H, Li Y, Du X, Zhang L, Zhang Q, Cheung T, Ungvari GS, Ng CH, Xiang YT. Network Analysis of Depression, Anxiety, Posttraumatic Stress Symptoms, Insomnia, Pain, and Fatigue in Clinically Stable Older Patients With Psychiatric Disorders During the COVID-19 Outbreak. J Geriatr Psychiatry Neurol 2022; 35:196-205. [PMID: 35245998 PMCID: PMC8899828 DOI: 10.1177/08919887221078559] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The Coronavirus Disease 2019 (COVID-19) pandemic has profound negative effects on the mental health of clinically stable older patients with psychiatric disorders. This study examined the influential nodes of psychiatric problems and their associations in this population using network analysis. METHODS Clinically stable older patients with psychiatric disorders were consecutively recruited from four major psychiatric hospitals in China from May 22 to July 15, 2020. Depressive and anxiety syndromes (depression and anxiety hereafter), insomnia, posttraumatic stress symptoms (PTSS), pain, and fatigue were measured using the Patient Health Questionnaire, General Anxiety Disorder, Insomnia Severity Index, Posttraumatic Stress Disorder Checklist - Civilian Version, and Numeric Rating Scales for pain and fatigue, respectively. RESULTS A total of 1063 participants were included. The network analysis revealed that depression was the most influential node followed by anxiety as indicated by the centrality index of strength. In contrast, the edge connecting depression and anxiety was the strongest edge, followed by the edge connecting depression and insomnia, and the edge connecting depression and fatigue as indicated by edge-weights. The network structure was invariant by gender based on the network structure invariance test (M = .14, P = .20) and global strength invariance tests (S = .08, P = .30). CONCLUSIONS Attention should be paid to depression and its associations with anxiety, insomnia, and fatigue in the screening and treatment of mental health problems in clinically stable older psychiatric patients affected by the COVID-19 pandemic.
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Affiliation(s)
- Wen Li
- Unit of Psychiatry, Department of Public
Health and Medicinal Administration, & Institute of Translational
Medicine, Faculty of Health Sciences, University of
Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities
and Social Sciences,
University
of Macau, Macao SAR, China
| | - Na Zhao
- Unit of Psychiatry, Department of Public
Health and Medicinal Administration, & Institute of Translational
Medicine, Faculty of Health Sciences, University of
Macau, Macao SAR, China
- Center for Cognition and Brain
Disorders,
Institutes of
Psychological Sciences,
Hangzhou Normal
University, Hangzhou, China
| | - Xiaona Yan
- Department of Psychiatry,
Xiamen
Xianyue Hospital, Xiamen, China
| | - Xiuying Xu
- Department of Psychiatry,
Xiamen
Xianyue Hospital, Xiamen, China
| | - Siyun Zou
- Guangji Hospital Affiliated to Soochow
University, Soochow, China
| | - Huan Wang
- Department of Psychiatry,
Lanzhou
University Second Hospital, Lanzhou,
China
| | - Yulong Li
- Department of Psychiatry,
Lanzhou
University Second Hospital, Lanzhou,
China
| | - Xiangdong Du
- Guangji Hospital Affiliated to Soochow
University, Soochow, China
| | - Lan Zhang
- Department of Psychiatry,
Lanzhou
University Second Hospital, Lanzhou,
China
| | - Qinge Zhang
- The National Clinical Research
Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders,
Beijing Anding Hospital & the Advanced Innovation Center for Human Brain
Protection, Capital Medical University, Beijing, China
| | - Teris Cheung
- School of
Nursing, Hong Kong Polytechnic
University, Hong Kong SAR, China
| | - Gabor S. Ungvari
- Division of Psychiatry, School of
Medicine, University of
Western Australia, Perth, WA,
Australia
- University of Notre Dame
Australia, Fremantle, WA,
Australia
| | - Chee H. Ng
- Department of Psychiatry,
The Melbourne
Clinic and St Vincent’s Hospital,
University of
Melbourne, Richmond, VIC,
Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public
Health and Medicinal Administration, & Institute of Translational
Medicine, Faculty of Health Sciences, University of
Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities
and Social Sciences,
University
of Macau, Macao SAR, China
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Varela AJ, Melvin A. The theatre of depression: a role for physical therapy. Physiother Theory Pract 2022:1-17. [DOI: 10.1080/09593985.2022.2041136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Antonio J Varela
- School of Physical Therapy, Arkansas College of Health Education, Fort Smith, AR, USA
| | - Ann Melvin
- School of Social and Behavioral Sciences, Capella University, Minneapolis, MN, USA
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Löffler-Stastka H, Dietrich D, Sauter T, Fittner M, Steinmair D. Simulating the mind and applications – a theory-based chance for understanding psychic transformations in somatic symptom disorders. World J Meta-Anal 2021; 9:474-487. [DOI: 10.13105/wjma.v9.i6.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/15/2021] [Accepted: 12/24/2021] [Indexed: 02/06/2023] Open
Abstract
With the new category of somatic symptom disorder/bodily distress disorder in ICD-11, research into pathogenetic and therapeutic pathways is stimulated. By turning away from the definition of somatoform disorders as “the lack of something physical explaining everything”, this new classification might offer a way to put the focus on the individual patient’s psychodynamic balance and conflicts and their condensation in the symptom. Modelling and simulation have a long history in science to gain insight also into complex phenomena. Considering the evolution of precision medicine many different parameters are meanwhile operationalised and ready for consequent process research. Calculation models have to fit to the complexity of this disorder category. In an interdisciplinary discourse between computer and medical/psychoanalytic scientists a multilayer, fine grained calculation model is elaborated. Starting from a clinical case history, within iterative discussion, by acknowledging the demand for interdisciplinary synergy and cooperation in science, psychoanalytic theory served as the basis for computer-scientific information technique. A parallelisation with the Mealy model helped to establish a meaningful calculation possibility for further process research. How psychic transformations can be understood properly in order to provide meaningful treatments, the respective training, and to conduct appropriate process- and outcome-research is established in simulating the mind and applications.
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Affiliation(s)
| | | | - Thilo Sauter
- Institute of Computer Technology, TU Wien, Vienna 1040, Austria
- Center for Integrated Sensor Systems, Danube University Krems, Wiener Neustadt 2700, Austria
| | - Martin Fittner
- Institute of Computer Technology, TU Wien, Vienna 1040, Austria
| | - Dagmar Steinmair
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna 1090, Austria
- University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten 3100, Austria
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11
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Lucini D, Pagani M. Exercise Prescription to Foster Health and Well-Being: A Behavioral Approach to Transform Barriers into Opportunities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:968. [PMID: 33499284 PMCID: PMC7908585 DOI: 10.3390/ijerph18030968] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 12/12/2022]
Abstract
The current literature contains multiple examples of exercise interventions to foster health and to prevent/treat many chronic non-communicable diseases; stress and functional syndromes. On the other hand, sedentariness is increasing and to transform a sedentary subject into a regular exerciser is not only very difficult but considered by some unrealistic in current clinical practice. Ideally a physical activity intervention may be considered actually efficacious when it outgrows the research setting and becomes embedded in a system, ensuring maintenance and sustainability of its health benefits. Physicians need specific skills to improve patients' exercise habits. These range from traditional clinical competencies, to technical competencies to correctly prescribe exercise, to competencies in behavioral medicine to motivate the subject. From a behavioral and medical point of view, an exercise prescription may be considered correct only if the subject actually performs the prescribed exercise and this results in an improvement of physiological mechanisms such as endocrine, immunological and autonomic controls. Here we describe a model of intervention intended to nurture exercise prescription in everyday clinical setting. It aims to a tailored prescription, starts from the subject's assessment, continues defining clinical goals/possible limitations and ends when the subject is performing exercise obtaining results.
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Affiliation(s)
- Daniela Lucini
- BIOMETRA Department, University of Milan, Milano 20122, Italy
- Exercise Medicine Unit, Humanitas Clinical and Research Center; Rozzano 20089, Italy
| | - Massimo Pagani
- BIOMETRA Department, University of Milan, Milano 20122, Italy
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12
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[Psychiatric aspects in treatment of HIV]. MMW Fortschr Med 2020; 162:34-37. [PMID: 32583251 DOI: 10.1007/s15006-020-0643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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SAHIN SENGULKOCAMER, YAŞAMALI CELAL, ÖZYÜREK MUHAMMETBERKAY, ELBOĞA GÜLÇIN, ALTINDAĞ ABDURRAHMAN, ŞAHIN AHMETZIYA. Neutrophil-lymphocyte ratio in catatonia. ARCH CLIN PSYCHIAT 2020. [DOI: 10.1590/0101-60830000000232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Tibubos AN, Ernst M, Brähler E, Fischbeck S, Hinz A, Blettner M, Zeissig SR, Weyer V, Imruck BH, Binder H, Beutel ME. Fatigue in survivors of malignant melanoma and its determinants: a register-based cohort study. Support Care Cancer 2019; 27:2809-2818. [PMID: 30539313 DOI: 10.1007/s00520-018-4587-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Fatigue has found increasing attention as a debilitating and lasting condition of cancer patients. However, it has remained unclear to what degree long-term survivors of malignant melanoma suffer from fatigue. Therefore, this study aimed to determine fatigue and its link with quality of life, aftercare behavior, and mental and physical symptoms among melanoma survivors. METHODS A register-based sample of 684 long-term survivors an average of 8.4 (SD = 1.72; range 5.67-12.17) years after diagnosis was compared to 2049 participants from a representative survey by the Multidimensional Fatigue Inventory. In a hierarchical linear regression, statistical predictors for fatigue were ascertained. RESULTS Overall fatigue was not increased in melanoma survivors except for younger melanoma survivors under 40 years. As in the general population, fatigue increased with age, and it was higher in women compared to men. Fatigue was associated with decreased quality of life, reduced functioning, and increased physical and mental symptoms. Substantial predictors (30% explained variance) were higher age, additional chronic illness, self-blame, detrimental interactions and lack of social support, and also fear of recurrence. There was neither an effect of medical parameters (clinical stage, time since diagnosis) nor of participation in follow-up care. CONCLUSIONS Fatigue needs to be taken seriously in the aftercare of melanoma survivors as it is associated with multiple functional and quality of life impairments and heightened distress. Reduction of fatigue in melanoma patients should address younger survivors (under 40 years) and older survivors (over 60 years) with additional chronic illness and focus on illness coping and social support.
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Affiliation(s)
- Ana Nanette Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany.
| | - Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Sabine Fischbeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Maria Blettner
- Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University, Institute for Medical Biostatistics, Mainz, Germany
- Cancer Registry of Rhineland Palatinate, Mainz, Germany
| | - Sylke R Zeissig
- Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University, Institute for Medical Biostatistics, Mainz, Germany
- Cancer Registry of Rhineland Palatinate, Mainz, Germany
| | - Veronika Weyer
- Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University, Institute for Medical Biostatistics, Mainz, Germany
| | - Barbara H Imruck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Harald Binder
- Faculty of Medicine and Medical Center - University of Freiburg, Institute of Medical Biometry and Statistics (IMBI), Freiburg im Breisgau, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
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Restrepo M, Restrepo D. From Conversion Disorders to Functional Neurological Disorders. Overcoming the Rule-out Diagnosis? REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2019; 48:174-181. [PMID: 31426920 DOI: 10.1016/j.rcp.2017.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 07/23/2017] [Accepted: 10/22/2017] [Indexed: 06/10/2023]
Abstract
Functional neurological disorders, formerly referred to as conversion disorders, are a frequent clinical problem in neurology, psychiatry and primary care departments. In the new diagnostic categories, emphasis is placed on the positive characteristics necessary to diagnose this disorder. A narrative review of the scientific medical literature related to the subject was performed in order to determine the differences and advantages that the new classification of functional neurological disorders gives to doctors and patients. Historical, diagnostic, clinical and treatment concepts related to functional neurological disorders are reviewed. The conceptual differences between conversion disorders and functional neurological disorders and the implications of these changes in the clinical approach are identified. The new proposed diagnosis for functional neurological disorders provides the opportunity to transform a diagnosis made by ruling out other pathologies to a diagnosis where the presence of neurological signs suggestive of the disorder are verified and can be taught to the patient, and based on them, treatment strategies posed.
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16
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Wang Y, Murray AM, Toussaint AK, Chen L, Guo WJ, He N, Luo SX, Yu JY, Liu Y, Huang MJ, Dong ZQ, Zhang L. Why is the recognition rate of psychological distress under-estimated in general hospitals? A cross-sectional observational study in China. Medicine (Baltimore) 2019; 98:e16274. [PMID: 31277153 PMCID: PMC6635296 DOI: 10.1097/md.0000000000016274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This study aimed to investigate the recognition rate of psychological distress in general hospitals in China and to examine the main associated factors.Using a cross-sectional study design, the questionnaires were administered to a total of 1329 inpatients from a tertiary hospital. The Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire (PHQ-15) and the Whiteley-7 (WI-7) were used to assess patients' mental health status. Two subjective questions were used to identify the awareness of psychological distress in patients and doctors.The frequency of psychological distress measured by the questionnaires was high in our sample (53.4%). However, the recognition rates of both patients (34.9%) and by doctors (39.1%) was low. The concordance rate between patients and doctors of whether the patient had psychological distress or not was extremely poor (Kappa = 0.089, P = .001). Factors associated with the poor concordance rate included patients' annual household income and clinically significant self-reported symptoms of anxiety and hypochondriasis.The recognition rate of psychological distress was underestimated and this may be related to a lack of awareness of mental disturbances and patients' low annual household income.
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Affiliation(s)
- Yu Wang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Alexandra M. Murray
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Anne-Kristin Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Liang Chen
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Wan-Jun Guo
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ning He
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Shan-Xia Luo
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jian-Ying Yu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yang Liu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ming-Jin Huang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zai-Quan Dong
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Lan Zhang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
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Peng W, Meng J, Lou Y, Li X, Lei Y, Yan D. Reduced empathic pain processing in patients with somatoform pain disorder: Evidence from behavioral and neurophysiological measures. Int J Psychophysiol 2019; 139:40-47. [DOI: 10.1016/j.ijpsycho.2019.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 01/09/2023]
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Kop WJ, Toussaint A, Mols F, Löwe B. Somatic symptom disorder in the general population: Associations with medical status and health care utilization using the SSD-12. Gen Hosp Psychiatry 2019; 56:36-41. [PMID: 30578985 DOI: 10.1016/j.genhosppsych.2018.10.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Somatic Symptom Disorder (SSD) is characterized by excessive thoughts, feelings, and behaviors associated with physical symptoms. DSM-5 criteria for SSD focus on these psychological features (criterion B) rather than the presence or absence of an identifiable medical disorder. This study examines the role of medical disorder in the assessment of SSD and associations of SSD with health care utilization. METHOD Participants (N = 448, mean age 46.7 ± 16.9 years, 53.8% women) were recruited from the general community and completed the SSD-12 to quantify DSM-5 Criterion B for SSD. Participants also provided demographic and medical background information. RESULTS The SSD-12 total score was elevated in individuals with a major medical disorder (N = 97: cardiovascular disease, cancer, pulmonary disease or other: SSD-12 = 11.6 ± 8.8), and also among those with medical conditions commonly treated in primary care (N = 46: e.g., migraine, asthma: SSD-12 = 8.3 ± 7.1), compared to those free of these disorders (SSD-12 = 5.8 ± 7.0), which remained significant in age- and sex-adjusted models. Normative values are reported. High SSD-12 scores (≥15) were associated with more health care utilization (adjusted OR primary care visits = 3.35, 95%CI = 1.64-6.87). CONCLUSIONS The SSD-12 is a useful tool for the assessment of SSD. Medical comorbidity is associated with higher SSD-12 scores. Future studies are needed to determine whether SSD is more common in medical patients or whether correction of normative values is needed for screening purposes.
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Affiliation(s)
- Willem J Kop
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, the Netherlands.
| | - Anne Toussaint
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Hamburg, Germany
| | - Floortje Mols
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, the Netherlands
| | - Bernd Löwe
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Hamburg, Germany
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Krause D, Stapf TM, Kirnich VB, Hennings A, Riemer S, Chrobok A, Fries DR, Pedrosa Gil F, Rief W, Schwarz MJ, Schmidmaier R. Stability of Cellular Immune Parameters over 12 Weeks in Patients with Major Depression or Somatoform Disorder and in Healthy Controls. Neuroimmunomodulation 2018; 25:7-17. [PMID: 29895009 DOI: 10.1159/000488353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 03/01/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Cellular immune status in major depression (MD) patients differs from that in somatoform disorder (SFD) patients and healthy controls (HC). It is still questionable whether the patterns of immune parameters remain stable over time. Therefore, we studied lymphocyte and monocyte cell counts and neopterin levels in peripheral blood of MD and SFD patients and HC over 12 weeks and tested for correlations between biochemical and psychometric parameters. METHODS Thirty-nine patients with MD, 27 with SFD, and 51 HC were recruited. Peripheral blood was drawn at four visits, at 4-week intervals. We assessed the total cell count of B lymphocytes, natural killer (NK) cells, T lymphocyte subpopu-lations, and monocytes by flow cytometry, and neopterin serum levels by ELISA. Psychometric parameters were measured with questionnaires. RESULTS Counts of lymphocytes, monocytes, and neopterin were stable in the SFD and HC groups. In the MD group, total CD3+, CD3+CD8+, NK cells, and CD3+CD25+ T cells showed inhomogeneous variances in Friedman tests, particularly in females. Neopterin correlated with depressed mood in MD patients, and with body mass index in HC. CONCLUSIONS Cellular immune parameters are stable in HC and SFD. Our results may indicate influences of MD and gender on some cellular immune parameters. This may need to be considered in future immunological studies.
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Affiliation(s)
- Daniela Krause
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Theresa M Stapf
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Verena B Kirnich
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Anika Hennings
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Sabine Riemer
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Agnieszka Chrobok
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Daniel R Fries
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | | | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Markus J Schwarz
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ralf Schmidmaier
- Department of Hematology and Oncology, Medizinische Klinik Innenstadt, Klinikum der LMU, Munich, Germany
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20
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Suzuki S, Ohira Y, Noda K, Ikusaka M. A-MUPS score to differentiate patients with somatic symptom disorder from those with medical disease for complaints of non-acute pain. J Pain Res 2017; 10:1411-1423. [PMID: 28652807 PMCID: PMC5476605 DOI: 10.2147/jpr.s137482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Purpose To develop a clinical score to discriminate patients with somatic symptom disorder (SSD) from those with medical disease (MD) for complaints of non-acute pain. Methods We retrospectively examined the clinical records of consecutive patients with pain for a duration of ≥1 month in our department from April 2003 to March 2015. We divided the subjects according to the diagnoses of definite SSD (as diagnosed and tracked by psychiatrists in our hospital), probable SSD (without evaluation by psychiatrists in our hospital), matched MD (randomly matched two patients by age, sex, and pain location for each definite SSD patient), unmatched MD, other mental disease, or functional somatic syndrome (FSS). We investigated eight clinical factors for definite SSD and matched MD, and developed a diagnostic score to identify SSD. We subsequently validated the model with cases of probable SSD and unmatched MD. Results The number of patients with definite SSD, probable SSD, matched MD, unmatched MD, other mental disease, and FSS was 104 (3.5%), 214 (7.3%), 197 (6.7%), 742 (25%), 708 (24%), and 978 (33%), respectively. In a conditional logistic regression analysis, the following five factors were included as independent predictors of SSD: Analgesics ineffective, Mental disorder history, Unclear provocative/palliative factors, Persistence without cessation, and Stress feelings/episodes (A-MUPS). The area under the receiver operating characteristic curve (AUC) of the model was 0.900 (95% CI: 0.864–0.937, p<0.001), and the McFadden’s pseudo-R-squared was 0.709. For internal validation, the AUC between probable SSD and unmatched MD was 0.930 (95% CI: 0.910–0.950, p<0.001). The prevalence and the likelihood ratio of SSD increased as the score increased. Conclusion The A-MUPS score was useful for discriminating patients with SSD from those with MD for complaints of non-acute pain, although external validation and refinement should be needed.
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Affiliation(s)
- Shingo Suzuki
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Yoshiyuki Ohira
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Kazutaka Noda
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
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Luo Y, Yan C, Huang T, Fan M, Liu L, Zhao Z, Ni K, Jiang H, Huang X, Lu Z, Wu W, Zhang M, Fan X. Altered Neural Correlates of Emotion Associated Pain Processing in Persistent Somatoform Pain Disorder: An fMRI Study. Pain Pract 2016; 16:969-979. [PMID: 27641732 DOI: 10.1111/papr.12358] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 07/11/2015] [Indexed: 12/11/2022]
Abstract
Patients with persistent somatoform pain disorder (PSPD) suffer from long-term pain and emotional conflicts. Recently, accumulating evidence indicated that emotion has a significant role in pain perception of somatoform pain disorder. To further understand the association between emotion and pain-related brain activities, functional activities of patients with PSPD fulfilling ICD-10 criteria and healthy controls were assessed using functional magnetic resonance imaging technology, while participants viewed a series of positive, neutral, or negative pictures with or without pinprick pain stimulation. Results showed that patients with PSPD had altered brain activities in the parietal gyrus, temporal gyrus, posterior cingulate cortex, prefrontal cortex, and parahippocampus in response to pinprick pain stimuli during different emotions compared with the healthy control group. Moreover, patients with PSPD consistently showed hyperactivities in the prefrontal, the fusiform gyrus and the insula in response to negative stimuli under pinprick pain vs. non-pain condition. The current findings provide some insights into the underlying relationship between emotion and pain-related brain activity in patients with PSPD, which is of both theoretical and clinical importance.
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Affiliation(s)
- Yanli Luo
- Department of Psychiatry, Tongji Hospital of Tongji University, Shanghai, China
| | - Chao Yan
- Key Laboratory of Brain Functional Genomics, Ministry of Education, Shanghai Key Laboratory of Brain Functional Genomics (MOE & STCSM), East China Normal University, Shanghai, China
| | - Tianming Huang
- Mental Health Center of Changning District, Shanghai, China
| | - Mingxia Fan
- Department of Physics, East China Normal University, Shanghai, China
| | - Liang Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyong Zhao
- Department of Physics, East China Normal University, Shanghai, China
| | - Kaiji Ni
- Department of Psychiatry, Tongji Hospital of Tongji University, Shanghai, China
| | - Hong Jiang
- Department of Medical Imaging, Tongji Hospital of Tongji University, Shanghai, China
| | - Xiao Huang
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zheng Lu
- Department of Psychiatry, Tongji Hospital of Tongji University, Shanghai, China
| | - Wenyuan Wu
- Department of Psychiatry, Tongji Hospital of Tongji University, Shanghai, China
| | - Mingyuan Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoduo Fan
- Department of Psychiatry, University of Massachusetts Medical School, Massachusetts, USA
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22
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Budtz-Lilly A, Schröder A, Rask MT, Fink P, Vestergaard M, Rosendal M. Bodily distress syndrome: A new diagnosis for functional disorders in primary care? BMC FAMILY PRACTICE 2015; 16:180. [PMID: 26669977 PMCID: PMC4681035 DOI: 10.1186/s12875-015-0393-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 12/03/2015] [Indexed: 12/14/2022]
Abstract
Background Conceptualisation and classification of functional disorders appear highly inconsistent in the health-care system, particularly in primary care. Numerous terms and overlapping diagnostic criteria are prevalent of which many are considered stigmatising by general practitioners and patients. The lack of a clear concept challenges the general practitioner’s decision-making when a diagnosis or a treatment approach must be selected for a patient with a functional disorder. This calls for improvements of the diagnostic categories. Intense debate has risen in connection with the release of the fifth version of the ‘Diagnostic and Statistical Manual of Mental Disorders’ and the current revision of the ‘International Statistical Classification of Diseases and Related Health Problems’. We aim to discuss a new evidence based diagnostic proposal, bodily distress syndrome, which holds the potential to change our current approach to functional disorders in primary care. A special focus will be directed towards the validity and utility criteria recommended for diagnostic categorisation. Discussion A growing body of evidence suggests that the numerous diagnoses for functional disorders listed in the current classifications belong to one family of closely related disorders. We name the underlying phenomenon ‘bodily distress’; it manifests as patterns of multiple and disturbing bodily sensations. Bodily distress syndrome is a diagnostic category with specific criteria covering this illness phenomenon. The category has been explored through empirical studies, which in combination provide a sound basis for determining a symptom profile, the diagnostic stability and the boundaries of the condition. However, as bodily distress syndrome embraces only the most common symptom patterns, patients with few but impairing symptoms are not captured. Furthermore, the current lack of treatment options may also influence the acceptance of the proposed diagnosis. Summary Bodily distress syndrome is a diagnostic category with notable validity according to empirical studies. Nevertheless, knowledge is sparse on the utility in primary care. Future intervention studies should investigate the translation of bodily distress syndrome into clinical practice. A particular focus should be directed towards the acceptability among general practitioners and patients. Most importantly, it should be investigated whether the new category may provide the basis for better treatment and improved clinical outcome.
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Affiliation(s)
- Anna Budtz-Lilly
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
| | - Mette Trøllund Rask
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
| | - Mogens Vestergaard
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Marianne Rosendal
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
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Basch MC, Chow ET, Logan DE, Schechter NL, Simons LE. Perspectives on the clinical significance of functional pain syndromes in children. J Pain Res 2015; 8:675-86. [PMID: 26504406 PMCID: PMC4605245 DOI: 10.2147/jpr.s55586] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Functional pain syndromes (FPS) characterize a subset of individuals who experience pain and related symptoms and disability without clear structural or disease etiology. In the pediatric population, FPS hold high clinical importance due to significant prevalence rates and potential to persist into adulthood. Although extensive research has been executed to disambiguate FPS, the syndromes that fall within its spectrum remain conceptually complex and sometimes ill-defined. This paper provides an overview of available research on the classification and multifaceted etiology of FPS in youth and their effects on interpersonal, psychological, and familial function. Vital aspects of a successful multidisciplinary approach to treating this population are described; however, it is evident that future research requires more longitudinal studies.
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Affiliation(s)
- Molly C Basch
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston University, Boston, MA, USA
- Boston Children’s Hospital, Center for Pain and the Brain, PAIN Research Group, Boston University, Boston, MA, USA
| | - Erika T Chow
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston University, Boston, MA, USA
- Boston University School of Medicine, Boston University, Boston, MA, USA
| | - Deirdre E Logan
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston University, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Neil L Schechter
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Laura E Simons
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston University, Boston, MA, USA
- Boston Children’s Hospital, Center for Pain and the Brain, PAIN Research Group, Boston University, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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In vivo β-adrenergic receptor responsiveness: ethnic differences in the relationship with symptoms of depression and fatigue. Int J Behav Med 2015; 21:843-50. [PMID: 24114717 DOI: 10.1007/s12529-013-9359-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Depressive symptoms and fatigue frequently overlap in clinical samples and the general population. The link of depressive symptoms and fatigue with increased risk of cardiovascular disease has been partly explained by shared biological mechanisms including sympathetic overactivity. Prolonged sympathetic overactivity downregulates the responsiveness of the β-adrenergic receptor (β-AR), a receptor that mediates several end-organ sympathetic responses. PURPOSE The authors studied whether depression and fatigue are related to reduced β-AR responsiveness within the human body (in vivo) in an ethnically diverse sample of African and Caucasian Americans. METHODS The chronotropic25 dose (CD25) was used to determine in vivo β-AR responsiveness in 93 healthy participants. Psychometric measures included the Center of Epidemiological Studies-Depression Scale and the Multidimensional Fatigue Symptom Inventory. RESULTS Hierarchical regression analyses (adjusted for age, gender, body mass index, blood pressure, smoking, and ethnicity) revealed that mental fatigue was significantly related to reduced β-AR responsiveness (i.e., higher CD25 values) in the whole sample. Moderation analyses indicated significant ethnicity × depression/fatigue interactions. Depressive symptoms, total fatigue, emotional fatigue, mental fatigue, and physical fatigue were related to reduced β-AR responsiveness in Caucasian American but not in African Americans. CONCLUSIONS Our findings suggest that symptoms of depression and fatigue are related to decreased in vivo β-AR responsiveness in Caucasian Americans. The lack of this association in African Americans highlights the importance for considering ethnicity as a potential moderator in research focusing on associations between psychological variables and cardiovascular function.
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25
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Shanahan L, Zucker N, Copeland WE, Bondy CL, Egger HL, Costello EJ. Childhood somatic complaints predict generalized anxiety and depressive disorders during young adulthood in a community sample. Psychol Med 2015; 45:1721-1730. [PMID: 25518872 PMCID: PMC4691537 DOI: 10.1017/s0033291714002840] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children with somatic complaints are at increased risk for emotional disorders during childhood. Whether this elevated risk extends into young adulthood - and to which specific disorders - has rarely been tested with long-term prospective-longitudinal community samples. Here we test whether frequent and recurring stomach aches, headaches, and muscle aches during childhood predict emotional disorders in adulthood after accounting for childhood psychiatric and physical health status and psychosocial adversity. METHOD The Great Smoky Mountains Study is a community representative sample with 1420 participants. Children/adolescents were assessed 4-7 times between ages 9-16 years. They were assessed again up to three times between ages 19-26 years. Childhood somatic complaints were coded when subjects or their parents reported frequent and recurrent headaches, stomach aches, or muscular/joint aches at some point when children were aged 9-16 years. Psychiatric disorders were assessed with the Child and Adolescent Psychiatric Assessment and the Young Adult Psychiatric Assessment. RESULTS Frequent and recurrent somatic complaints in childhood predicted adulthood emotional disorders. After controlling for potential confounders, predictions from childhood somatic complaints were specific to later depression and generalized anxiety disorder. Long-term predictions did not differ by sex. Somatic complaints that persisted across developmental periods were associated with the highest risk for young adult emotional distress disorders. CONCLUSIONS Children from the community with frequent and recurrent physical distress are at substantially increased risk for emotional distress disorders during young adulthood. Preventions and interventions for somatic complaints could help alleviate this risk.
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Affiliation(s)
- L Shanahan
- Department of Psychology,University of North Carolina at Chapel Hill,Chapel Hill,NC,USA
| | - N Zucker
- Department of Psychiatry and Behavioral Sciences,Duke University Medical Center,Durham,NC,USA
| | - W E Copeland
- Department of Psychiatry and Behavioral Sciences,Duke University Medical Center,Durham,NC,USA
| | - C L Bondy
- Department of Psychology,University of North Carolina at Chapel Hill,Chapel Hill,NC,USA
| | - H L Egger
- Department of Psychiatry and Behavioral Sciences,Duke University Medical Center,Durham,NC,USA
| | - E J Costello
- Department of Psychiatry and Behavioral Sciences,Duke University Medical Center,Durham,NC,USA
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Leong K, Tham JC, Scamvougeras A, Vila-Rodriguez F. Electroconvulsive therapy treatment in patients with somatic symptom and related disorders. Neuropsychiatr Dis Treat 2015; 11:2565-72. [PMID: 26504388 PMCID: PMC4605246 DOI: 10.2147/ndt.s90969] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Medically unexplained somatic complaints are highly prevalent, and lead to significant impairment and disability. The number of effective treatment modalities for somatic symptom and related disorders (SSDs) or somatoform disorders (SDs) remains limited. To date, there is no formal indication for electroconvulsive therapy (ECT) in SSD or SD. We report on the largest case series to date regarding the effectiveness of ECT in patients with SSD and SD. METHODS A retrospective chart review of all patients treated with an index course of ECT at the Neuropsychiatric Program at the University of British Columbia Hospital from 2000 to 2010 was conducted. The primary outcomes consisted of changes in pseudoneurologic symptoms, pain symptoms, cardiopulmonary symptoms, and gastrointestinal symptoms. Complaints were examined pre- and post-ECT. RESULTS Twenty-eight participants were included in this study. Twenty-one participants received right unilateral ECT. Six received bifrontal ECT. One received bitemporal ECT. Eighteen of 21 participants reported improvement in pseudoneurologic symptoms; eleven of 14 participants reported improvement in pain symptoms; one participant reported improvement in cardiopulmonary symptoms; and one of two participants reported improvement in gastrointestinal symptoms. This paper discusses the putative mechanism of action of ECT in the treatment of SD/SSD. CONCLUSION This retrospective study suggests that ECT could be included as part of the existing treatment for refractory SSD and SD, particularly in refractory cases with comorbid mood disorders.
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Affiliation(s)
- KaWai Leong
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Joseph Cw Tham
- BC Neuropsychiatry Program, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Anton Scamvougeras
- BC Neuropsychiatry Program, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory at UBC, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Srinath A, Young E, Szigethy E. Pain management in patients with inflammatory bowel disease: translational approaches from bench to bedside. Inflamm Bowel Dis 2014; 20:2433-49. [PMID: 25208108 DOI: 10.1097/mib.0000000000000170] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) that negatively affects quality of life and can lead to increased health-seeking behavior. Although abdominal pain has been traditionally attributed to inflammation, there is growing literature demonstrating the existence of functional abdominal pain in patients with IBD, of which there are a variety of potential causes. Thus, when approaching a patient with IBD who has abdominal pain, in addition to IBD-related complications (e.g., inflammation/stricture), it is important to screen for related contributors, including peripheral factors (visceral hypersensitivity, bacterial overgrowth, and bowel dysmotility) and centrally mediated neurobiological and psychosocial underpinnings. These central factors include psychological symptoms/diagnoses, sleep disturbance, and stress. Opioid-induced hyperalgesia (e.g., narcotic bowel syndrome) is also growing in recognition as a potential central source of abdominal pain. This review draws from clinical studies and animal models of colitis and abdominal pain to consider how knowledge of these potential etiologies can be used to individualize treatment of abdominal pain in patients with IBD, including consideration of potential novel treatment modalities for the future. Accurate assessment of the source(s) of pain in patients with IBD can help guide appropriate diagnostic workup and use of disease-modifying therapy.
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Affiliation(s)
- Arvind Srinath
- *Department of Pediatric Gastroenterology, Children's Hospital of UPMC, Pittsburgh, Pennsylvania; †Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and ‡Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Zech N, Seemann M, Hansen E. Noceboeffekte und Negativsuggestionen in der Anästhesie. Anaesthesist 2014; 63:816-24. [DOI: 10.1007/s00101-014-2386-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Elevated concentration of C-reactive protein is associated with pregnancy-related co-morbidities but not with relapse activity in multiple sclerosis. Neurol Sci 2014; 36:441-7. [PMID: 25308726 DOI: 10.1007/s10072-014-1980-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/06/2014] [Indexed: 01/29/2023]
Abstract
During pregnancy, alterations take place in mother's immune system with the goal of maintaining a successful pregnancy, and delivering healthy offspring. Immune alterations include activation of the innate immune system and dampening of cell-mediated adaptive immunity. Due to these alterations, cell-mediated autoimmune diseases typically ameliorate during pregnancy. The objectives of this study were to evaluate whether C-reactive protein (CRP) concentration, a sensitive marker of systemic inflammation (1) is increased during MS pregnancy (2) predicts pregnancy-related co-morbidities associated with MS (3) predicts MS disease activity after delivery. CRP concentration was measured using a high sensitivity assay from seven prospectively collected serum samples of 41 MS patients and 19 controls during pregnancy and 6 months after delivery. Annualized relapse rates, EDSS, fatigue scores and obstetric details of the patients were recorded. Delivery-related CRP levels were significantly elevated both among MS patients and in controls. CRP levels were higher during pregnancy than during the postpartum period in both study groups. Delivery-related elevated CRP levels did not correlate with postpartum disease activity. MS patients with eventual gestational diabetes had a significantly higher median CRP in the beginning of pregnancy compared to non-diabetic MS patients (9.28 vs. 2.98 mg/l, p = 0.0025). MS patients reporting fatigue had a significantly higher CRP throughout pregnancy compared to patients without fatigue. Higher CRP values were associated with pregnancy-related co-morbidities but not with MS disease activity.
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Marouf F, Giallourakis CC, Baer L, Hanau MS, Holbert BC. Case records of the Massachusetts General Hospital. Case 33-2013. A 40-year-old woman with abdominal pain, weight loss, and anxiety about cancer. N Engl J Med 2013; 369:1639-47. [PMID: 24152264 DOI: 10.1056/nejmcpc1215968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Cho HJ, Kivimäki M, Bower JE, Irwin MR. Association of C-reactive protein and interleukin-6 with new-onset fatigue in the Whitehall II prospective cohort study. Psychol Med 2013; 43:1773-1783. [PMID: 23151405 PMCID: PMC3819455 DOI: 10.1017/s0033291712002437] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although basic research on neuroimmune interactions suggests that inflammatory processes may play a role in the development of fatigue, population-based evidence on this association is limited. This study examined whether plasma C-reactive protein (CRP) and interleukin-6 (IL-6), biomarkers of systemic inflammation, predict fatigue onset. METHOD The Whitehall II study is a large-scale cohort study conducted in 20 civil service departments in London. Plasma CRP and IL-6 were measured in 4847 non-fatigued participants at phase 3 (1991-1993, aged 39-63 years). Fatigue was assessed using the Vitality subscale of the 36-item Short Form Health Survey (SF-36) at phase 3 and phase 4 (1995-1996). RESULTS During a mean follow-up of 3.1 years, 957 new fatigue cases (19.7%) were identified using the pre-established cut-off score of ≤ 50 on the Vitality subscale. CRP values were dichotomized as low (<1.0 mg/l ) or high (≥ 1.0 mg/l) using the Centers for Disease Control/American Heart Association recommendations. Similarly, IL-6 values were also dichotomized as low (<1.5 pg/ml) or high (≥ 1.5 pg/ml). After full adjustment for sociodemographic and biobehavioral covariates, the odds ratios for new-onset fatigue were 1.28 [95% confidence interval (CI) 1.09-1.49, p = 0.003] for high CRP and 1.24 (95% CI 1.06-1.45, p = 0.008) for high IL-6. Similar results were found when CRP and IL-6 were treated as continuous variables. CONCLUSIONS Plasma CRP and IL-6 were prospectively associated with new-onset fatigue, supporting the hypothesis that low-grade inflammation has a role in the development of fatigue.
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Affiliation(s)
- H J Cho
- Cousins Center for Psychoneuroimmmunology, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
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Baldwin DV. Primitive mechanisms of trauma response: an evolutionary perspective on trauma-related disorders. Neurosci Biobehav Rev 2013; 37:1549-66. [PMID: 23792048 DOI: 10.1016/j.neubiorev.2013.06.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 05/23/2013] [Accepted: 06/03/2013] [Indexed: 01/09/2023]
Abstract
The symptoms we identify and the behaviors we recognize as defenses define which symptoms we see as trauma-related. Early conceptions of trauma-related disorders focused on physical signs of distress while current ones emphasize mental symptoms, but traumatizing experiences evoke psychobiological reactions. An evolutionary perspective presumes that psychophysical reactions to traumatizing events evolved to ensure survival. This theoretical review examines several primitive mechanisms (e.g., sensitization and dissolution) associated with responses to diverse stressors, from danger to life-threat. Some rapidly acquired symptoms form without conscious awareness because severe stresses can dysregulate mental and physical components within systems ensuring survival. Varied defensive options engage specialized and enduring psychophysical reactions; this allows for more adaptive responses to diverse threats. Thus, parasympathetically mediated defense states such as freeze or collapse increase trauma-related symptom variability. Comorbidity and symptom variability confuse those expecting mental rather than psychophysical responses to trauma, and active (sympathetically mediated flight and fight) rather than immobility defenses. Healthcare implications for stress research, clinical practice and diagnostic nosology stem from the broader evolutionary view.
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Yoshino A, Okamoto Y, Yoshimura S, Shishida K, Toki S, Doi M, Machino A, Fukumoto T, Yamashita H, Yamawaki S. Distinctive neural responses to pain stimuli during induced sadness in patients with somatoform pain disorder: An fMRI study. NEUROIMAGE-CLINICAL 2013; 2:782-9. [PMID: 24179828 PMCID: PMC3777689 DOI: 10.1016/j.nicl.2013.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/25/2013] [Accepted: 06/03/2013] [Indexed: 12/13/2022]
Abstract
Pain is a multidimensional phenomenon. Patients with somatoform pain disorder suffer from long-lasting pain, with the pathology being closely associated with cognitive–emotional components. Differences between these patients and controls in cerebral responses to pain stimuli have been reported. However, to our knowledge, no studies of somatoform pain disorder have evaluated altered pain-related brain activation as modulated by emotional dysregulation. We examined the distinct neural mechanism that is engaged in response to two different pain intensities in a sad emotional condition, performing functional magnetic resonance imaging (fMRI) on a group of 11 somatoform pain patients and an age-matched control group. Our results showed that the ratio for low-pain intensity ratings between the sad and neutral conditions in patients was higher than in controls. They also showed significant increased activation in the anterior/posterior insula in the low pain sadness condition. Furthermore, there was specific functional connectivity between the anterior insula and the parahippocampus in patients during presentation of low-pain stimuli in the sad context. These findings suggest that a negative emotional context such as sadness contributes to dysfunctional pain processing in somatoform pain disorder. Greater sensitivity to low levels of pain in an emotional context of sadness might be an important aspect of the psychopathology of somatoform pain disorder.
Patients show higher pain sensitivities for low pain under sadness. The insula to low-pain stimuli are particularly changeable in patients. There was strong connectivity between the insula and the parahippocampus in patients. We suggest potential importance of emotional context in somatoform pain disorder.
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Affiliation(s)
- Atsuo Yoshino
- Department of Psychiatry and Neurosciences, Division of Frontier Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Nunes J, Ventura T, Encarnação R, Pinto PR, Santos I. What do patients with medically unexplained physical symptoms (MUPS) think? A qualitative study. MENTAL HEALTH IN FAMILY MEDICINE 2013; 10:67-79. [PMID: 24427173 PMCID: PMC3822638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 06/01/2013] [Indexed: 06/03/2023]
Abstract
Context Medically unexplained physical symptoms (MUPS) are frequently encountered in family medicine, and lead to disability, discomfort, medicalisation, iatrogenesis and economic costs. They cause professionals to feel insecure and frustrated and patients to feel dissatisfied and misunderstood. Doctors seek answers for rather than with the patient. Objectives This study aimed to explore patients' explanations of the medically unexplained physical symptoms that they were experiencing by eliciting their own explanations for their complaints, their associated fears, their expectations of the consultation, changes in their ideas of causality, and the therapeutic approach that they considered would be useful. Methodology A qualitative analysis was under-taken of interviews with 15 patients with MUPS in a family medicine unit, 6 months after diagnosis. Results Experience is crucial in construction of the meaning of symptoms and illness behaviour. Many patients identify psychosocial causes under-lying their suffering. These patients received more medication and fewer requests for diagnostic examinations than they had expected. Normalisation is a common behaviour in the clinical approach. Normalisation without explanation can be effective if an effective therapeutic relationship exists that may dispense with the need for words. Listening is the procedure most valued by patients. Diagnostic tests may denote interest in patients' problems. The clinician's flexibility should allow adaptation to the patient's phases of acceptance of the significance of their physical, emotional and social problems. Conclusion Patients with MUPS have explanations and fears associated with their complaints. The patient comes to the consultation not because of the symptom, but because of what he or she thinks about the symptom. The therapeutic relationship, therapeutic listening, and flexibility should be the basis for approaching patients with MUPS. Patients do not always expect medication, although it is what they most often receive. Diagnostic tests, although used sparingly, can be a way to maintain and build a relationship. Drugs and tests can be a ritual statement of clinical interest in the patient and their symptoms.
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Affiliation(s)
- José Nunes
- Department of Family Medicine, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal
| | - Teresa Ventura
- Department of Family Medicine, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal
| | - Ricardo Encarnação
- Department of Mental Health, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal
| | - Patrícia Rosado Pinto
- Head of Medical Education Department, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal
| | - Isabel Santos
- Department of Family Medicine, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal
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Lemche E, Giampietro VP, Brammer MJ, Surguladze SA, Williams SCR, Phillips ML. Somatization severity associated with postero-medial complex structures. Sci Rep 2013; 3:1032. [PMID: 23301153 PMCID: PMC3538283 DOI: 10.1038/srep01032] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 11/13/2012] [Indexed: 01/29/2023] Open
Abstract
Somatisation is a frequent problem in various psychiatric disorders, yet the cerebral mechanisms of somatisation remain unexamined. To test if somatisation is susceptible to emotional states, we investigated relationships between somatisation severity, neural effective connectivity, and autonomic responses to emotional facial expressions. Volunteering participants (N = 20) were presented with facial expressions of happy and sad emotion at three intensity levels (0%–50%–100%) in a fast implicit ER-fMRI design with concurrent derivation of skin conductance levels (SCL). Self-reported somatisation severity as assessed with Rief's SOMS-2 index was correlated with neural response controlling for other clinical traits to ascertain brain bases of somatisation. Regression analyses estimated effective connectivity of main clusters so determined with peripheral autonomic responses. Regions in which magnitude of activity correlated with somatisation severity consisted in both happy and sad conditions of the anterior ventral precuneus (BA7), along with posterior cingulate gyrus (PCC, BA23, sad condition) and anteromedial thalamus (happy condition).
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Affiliation(s)
- Erwin Lemche
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, King's College Medical School, London SE5 8AF, United Kingdom.
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Abstract
The etiopathology of somatoform disorders can only be understood against the background of an integrated biopsychosocial model. Cultural and historical influences must be taken into account as well as contemporary settings of scientific or medical priorities. In this context the emphasis on neurobiological findings can be interpreted as the non-accidental struggle for legitimacy of both patients and physicians. Altogether the available data on factors influencing the formation and maintenance of somatoform symptoms has to be described as both diverse and unspecific and thus points to a challenging research program in the coming years.
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Hansell NK, Wright MJ, Medland SE, Davenport TA, Wray NR, Martin NG, Hickie IB. Genetic co-morbidity between neuroticism, anxiety/depression and somatic distress in a population sample of adolescent and young adult twins. Psychol Med 2012; 42:1249-1260. [PMID: 22051348 DOI: 10.1017/s0033291711002431] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Genetic studies in adults indicate that genes influencing the personality trait of neuroticism account for substantial genetic variance in anxiety and depression and in somatic health. Here, we examine for the first time the factors underlying the relationship between neuroticism and anxiety/depressive and somatic symptoms during adolescence. METHOD The Somatic and Psychological Health Report (SPHERE) assessed symptoms of anxiety/depression (PSYCH-14) and somatic distress (SOMA-10) in 2459 adolescent and young adult twins [1168 complete pairs (35.4% monozygotic, 53% female)] aged 12-25 years (mean=15.5 ± 2.9). Differences between boys and girls across adolescence were explored for neuroticism, SPHERE-34, and the subscales PSYCH-14 and SOMA-10. Trivariate analyses partitioned sources of covariance in neuroticism, PSYCH-14 and SOMA-10. RESULTS Girls scored higher than boys on both neuroticism and SPHERE, with SPHERE scores for girls increasing slightly over time, whereas scores for boys decreased or were unchanged. Neuroticism and SPHERE scores were strongly influenced by genetic factors [heritability (h(2)) = 40-52%]. A common genetic source influenced neuroticism, PSYCH-14 and SOMA-10 (impacting PSYCH-14 more than SOMA-10). A further genetic source, independent of neuroticism, accounted for covariation specific to PSYCH-14 and SOMA-10. Environmental influences were largely specific to each measure. CONCLUSIONS In adolescence, genetic risk factors indexed by neuroticism contribute substantially to anxiety/depression and, to a lesser extent, perceived somatic health. Additional genetic covariation between anxiety/depressive and somatic symptoms, independent of neuroticism, had greatest influence on somatic distress, where it was equal in influence to the factor shared with neuroticism.
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Affiliation(s)
- N K Hansell
- Genetic Epidemiology, Queensland Institute of Medical Research, Brisbane, Australia
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38
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Lucini D, Pagani M. From stress to functional syndromes: an internist's point of view. Eur J Intern Med 2012; 23:295-301. [PMID: 22560374 DOI: 10.1016/j.ejim.2011.11.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 11/21/2011] [Accepted: 11/23/2011] [Indexed: 01/01/2023]
Abstract
In this brief review we address schematically the relationship between two emerging issues in clinical medicine: stress and functional syndromes. It is becoming increasingly clear that they demand a multidimensional approach, considering simultaneously elements of behavioral therapy with traditional pharmacological treatment, guided by a better physiopathological understanding including autonomic assessment. New techniques, based on innovative analysis of continuous segments of electrocardiogram and non invasive arterial pressure recordings capable to extract hidden oscillations, provide quantitative indices of sympathetic and vagal modulation of the cardiovascular system. This more complete diagnostic process facilitates explanation of symptoms and reassurance of patients, based on functional evidence. The described clinical approach implies in addition an active collaboration of patients requiring the implementation of a creative alliance. Physical exercise, eating habits and muscular-mental relaxation are combined with pharmacological tools as needed.
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Affiliation(s)
- Daniela Lucini
- Centro di Ricerca Terapia Neurovegetativa e Medicina dell'Esercizio, Dipartimento Scienze Cliniche, Università degli Studi di Milano, Italy.
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Noll-Hussong M, Autenrieth M, Pokorny D, Herberger S, Huber D. The subject, its biology, and the chronic recurrent cystitis. Case Rep Psychiatry 2012; 2012:601705. [PMID: 22934220 PMCID: PMC3420663 DOI: 10.1155/2012/601705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 02/02/2012] [Indexed: 01/29/2023] Open
Abstract
Functional disorders in urology are troubling for both patients and physicians. Moreover, advances in recent research promise to provide biological insights into psycho-neuro-endocrino-immunological pathways that are one important facet of chronic urogenital inflammations. We present a case of a middle-aged woman with long-lasting recurrent cystitis for which especially a psychosomatic approach helped to understand and cure the disorder. Altogether, as practitioners treat subjects, not illnesses, a biopsychosocial understanding of human disease should be taken into account in cases of chronic recurrent cystitis.
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Affiliation(s)
- Michael Noll-Hussong
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Ulm, Am Hochstraess 8, 89081 Ulm, Germany
- Klinik und Poliklinik fuer Psychosomatische Medizin und Psychotherapie, Technische Universitaet Muenchen, Langerstrasse 3, 81675 Muenchen, Germany
| | - Michael Autenrieth
- Urologische Klinik und Poliklinik des Klinikums rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Muenchen, Germany
| | - Dan Pokorny
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Ulm, Am Hochstraess 8, 89081 Ulm, Germany
| | - Simone Herberger
- Klinik fuer Psychosomatische Medizin und Psychotherapie, Klinikum Harlaching, Staedtisches Klinikum Muenchen, Sanatoriumsplatz 2, 81545 Muenchen, Germany
| | - Dorothea Huber
- Klinik fuer Psychosomatische Medizin und Psychotherapie, Klinikum Harlaching, Staedtisches Klinikum Muenchen, Sanatoriumsplatz 2, 81545 Muenchen, Germany
- International Psychoanalytic University Berlin, Stromstrasse 3, 10555 Berlin, Germany
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Euteneuer F, Schwarz MJ, Hennings A, Riemer S, Stapf T, Selberdinger V, Rief W. Psychobiological aspects of somatization syndromes: contributions of inflammatory cytokines and neopterin. Psychiatry Res 2012; 195:60-5. [PMID: 21864915 DOI: 10.1016/j.psychres.2011.07.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 06/30/2011] [Accepted: 07/21/2011] [Indexed: 02/09/2023]
Abstract
Previous research suggests a dysregulation of immune-to-brain communication in the pathophysiology of somatization syndromes (multiple somatoform symptoms). We compared blood levels of the inflammatory markers tumor necrosis factor-alpha (TNF-α), interleukin-1 receptor antagonist (IL-1ra), interleukin-6 (IL-6) and neopterin between 23 patients with somatization syndromes (Somatoform Symptom Index-8, SSI-8), 23 age- and sex-matched healthy controls and 23 patients with major depression. No group differences were found for IL-1ra and IL-6. While TNF-α was increased in both clinical groups, neopterin was only increased in somatization syndromes. Correlational analyses revealed that neopterin tended to be related to somatoform pain complaints in patients with somatization syndromes. This study is the first to demonstrate increased levels of TNF-α and neopterin in patients with somatization syndromes without a diagnosis of depression, which may support a role of immune alterations in somatization syndromes. Neopterin is a reliable indicator for interferon-γ (IFN-γ) which was identified as the only cytokine that induces significant production of neopterin. Considering recent research indicating that IFN-γ can lead to increased neuronal responsiveness and body perceptions by reducing inhibitory tone in the dorsal horn, the observed association between somatization syndromes and neopterin might support the idea of central sensitization in the pathogenesis of somatoform symptoms.
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Affiliation(s)
- Frank Euteneuer
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Germany.
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Prevalence and psychiatric comorbidity of self-reported electromagnetic field sensitivity in Taiwan: A population-based study. J Formos Med Assoc 2011; 110:634-41. [DOI: 10.1016/j.jfma.2011.08.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 05/13/2010] [Accepted: 06/30/2010] [Indexed: 11/23/2022] Open
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Affiliation(s)
- Michael R. Irwin
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience, 300 UCLA Medical Plaza, Room 3130, Los Angeles, CA 90095-7076, USA
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Depression, cytokines and experimental pain: evidence for sex-related association patterns. J Affect Disord 2011; 131:143-9. [PMID: 21167607 DOI: 10.1016/j.jad.2010.11.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 11/12/2010] [Accepted: 11/12/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is robust evidence that altered neural-immune interactions including increased levels of proinflammatory cytokines are involved in both the pathogenesis of depression and altered pain processing. Proinflammatory cytokines induce sickness behavior, a constellation of symptoms that bears a strong similarity to those of depression. A feature of sickness behavior is enhanced pain sensitivity and it has been suggested that proinflammatory cytokines interact with pain processing directly and via several neurobiological pathways. Previous research indicates that depression and pain are closely related. We investigated the association between proinflammatory cytokines and experimental pain in major depression. METHODS Psychopathological variables, pressure pain thresholds (PPT) and concentrations of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) were measured in 37 outpatients with major depression and 48 healthy controls. RESULTS Compared with controls, depressed patients exhibited significantly higher levels of TNF-α and significantly decreased PPT indicating enhanced pain sensitivity. The group differences were robust when adjusting for sex and body mass index, although sex was significantly related to PPT. No group difference was observed in IL-6. PPT correlated significantly with TNF-α in women but not in men. LIMITATIONS Because of the cross-sectional design, causality of the relation between TNF-α and pain cannot be determined. Results should be considered preliminary given the small sample size. CONCLUSION The present findings suggest that increased pain sensitivity in depression may be linked to increased TNF-α concentration. The absence of this association in men is discussed in terms of pain-related psychobiological sex differences.
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Lee TW, Yu YWY, Chen MC, Chen TJ. Cortical mechanisms of the symptomatology in major depressive disorder: a resting EEG study. J Affect Disord 2011; 131:243-50. [PMID: 21256600 DOI: 10.1016/j.jad.2010.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Revised: 12/15/2010] [Accepted: 12/15/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Diagnosis and treatment rely on symptom criteria in modern psychiatry. However, the cortical mechanisms of symptomatology in major depressive disorder (MDD) are still not clear. This study examined neural correlates of symptom clusters of MDD by electroencephalography (EEG). METHODS Resting state eye-closed EEG signals were recorded in 196 depressive patients. Quantitative EEG (qEEG) of regional power, coherence and power series correlation across delta, theta, alpha and beta frequencies were used to correlate with overall depression severity evaluated by the Hamilton Depression Rating Scale (HDRS). Further, statistical comparisons between patients with high vs. low qEEG indices (median-split) were undertaken regarding symptom severity of core depression, sleep, activity, psychic anxiety, somatic anxiety, and delusion. RESULTS None of the qEEG indices significantly correlated with overall depression severity or differentiated symptom severity of core depression, sleep, activity and psychic anxiety. A higher symptom severity of somatic anxiety was associated with higher regional power over widespread cortical regions and lower strengths at bi-temporal, temporo-parietal and fronto-parietal connections. A higher symptom severity of delusion was associated with higher regional power in the frontal and temporal regions, and lower strengths at inter-hemispheric (frontal, temporal and parietal) and fronto-temporo-parietal connections. LIMITATIONS Our EEG recording with sampling rate of 128Hz and 20 electrodes may provide restricted spatial and temporal precision. CONCLUSIONS Our results suggest that cortical mechanisms play important roles in the symptom manifestation of cognitive distortion (sub-score of delusion) and somatic anxiety in MDD. Our findings further imply that psychic anxiety and somatic anxiety are distinct entities.
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Affiliation(s)
- Tien-Wen Lee
- Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan County, Taiwan
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van Ravenzwaaij J, Olde Hartman T, van Ravesteijn H, Eveleigh R, van Rijswijk E, Lucassen P. Explanatory models of medically unexplained symptoms: a qualitative analysis of the literature. MENTAL HEALTH IN FAMILY MEDICINE 2010; 7:223-231. [PMID: 22477946 PMCID: PMC3083258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Background Medically unexplained symptoms (MUS) are common in primary health care. Both patients and doctors are burdened with the symptoms that negatively affect patients' quality of life. General practitioners (GPs) often face difficulties when giving patients legitimate and convincing explanations for their symptoms. This explanation is important for reassuring patients and for maintaining a good doctor-patient communication and relationship.Objective To provide an overview of explanatory models for MUS.Study design We performed a systematic search of reviews in PsycINFO and PubMed about explanatory models of MUS. We performed a qualitative analysis of the data according to the principles of constant comparative analysis to identify specific explanatory models.Results We distinguished nine specific explanatory models of MUS in the literature: somatosensory amplification, sensitisation, sensitivity, immune system sensitisation, endocrine dysregulation, signal filter model, illness behaviour model, autonomous nervous system dysfunction and abnormal proprioception. The nine different explanatory models focus on different domains, including somatic causes, perception, illness behaviour and predisposition. We also found one meta-model, which incorporates these four domains: the cognitive behavioural therapy model.Conclusion Although GPs often face difficulties when providing explanations to patients with MUS, there are multiple explanatory models in the scientific literature that may be of use in daily medical practice.
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[Determinants of quality of life in patients with somatoform disorders with pain as main symptom - the case for differentiating subgroups]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2010; 56:3-22. [PMID: 20229488 DOI: 10.13109/zptm.2010.56.1.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES What impact do the degree of somatization and the presence of a comorbid psychological disorder have on health-related quality of life in patients with pain-dominated somatoform disorders? METHODS 282 consecutive patients (57.6 %) from a total population of N=490 patients fulfilling the criteria of somatoform pain disorders were included in the study following a thorough interdisciplinary diagnostic process at a German university hospital. Structured interviews (SKIDI and SKID-II) to assess comorbid psychological disorders as well as a structured biographical interview to assess chronification factors were conducted. We employed the Screening for Somatoform Disorders form (SOMS) to discover the extent and distribution of somatic symptoms and the SF-36 to determine the health-related quality of life. RESULTS The patients exhibited a multiplicity of further somatic complaints apart from pain. 69 % had a comorbid psychological disorder. The health-related physical and psychological quality of life was clearly impaired in patients with "small", "substantial" and "pronounced" somatization. Regression analysis explained 48 % of the variance of the body-related and 35 % of the variance of the psychological quality of life: Besides the extent of somatization, older age, duration of pain-associated hospitalizations and the subjective amount of occupational impairment proved to be important. With regard to the psychological (but not the somatic) health-related quality of life, the presence of a current comorbid psychological disorder was also relevant. CONCLUSION Patients with pain-dominated somatoform disorders are substantially impaired in their quality of life. Because 31 % of the patients with such disorders have no additional comorbid psychic disorder and the existence of a comorbid psychic disorder impacts only the psychological domain of their health-related quality of life, the results appear to strongly support maintaining the diagnostic category of somatoform disorders in ICD-11 and DSM-V. They also support the grading of the severity of the somatization similar to the grading of depressive disorders.
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Van Houdenhove B, Luyten P. Central Sensitivity Syndromes: Stress System Failure May Explain the Whole Picture. Semin Arthritis Rheum 2009; 39:218-9; author reply 220-1. [DOI: 10.1016/j.semarthrit.2008.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 08/25/2008] [Indexed: 11/16/2022]
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Dysfunction of the hypothalamic-pituitary-adrenal axis and functional somatic symptoms: a longitudinal cohort study in the general population. Psychoneuroendocrinology 2009; 34:869-77. [PMID: 19181451 DOI: 10.1016/j.psyneuen.2008.12.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Revised: 12/24/2008] [Accepted: 12/26/2008] [Indexed: 11/23/2022]
Abstract
In persons with functional somatic symptoms (FSS), no conventionally defined organic pathology is apparent. It has been suggested that complex interactions of psychological, physiological, and social factors are involved in the etiology of FSS. One of the physiological mechanisms that may contribute to FSS is the function of the hypothalamic-pituitary-adrenal (HPA)-axis. This study investigates the association of HPA-axis function with cross-sectional presence and prospective development of FSS in the general population. This study was performed in a population-based cohort of 741 male and female adults (mean age 53.1, S.D. 10.9). Participants completed the somatization section of the Composite International Diagnostic Interview (CIDI) in which the presence of 43 FSS is surveyed. In addition to the total number of FSS, bodily system FSS clusters with musculoskeletal, gastrointestinal, cardiorespiratory, and general symptoms were constructed. HPA-axis function was assessed by measuring 24-h urinary free cortisol (24-h UFC) excretion. Follow-up measurements were performed approximately 2 years later. All analyses were adjusted for age, gender, body mass index, smoking, alcohol use, depression, exercise frequency, and urinary volume. Regression analysis detected no cross-sectional association between 24-h UFC excretion and the number of FSS (beta=-0.021, t=-0.521, p=0.603). In addition, 24-h UFC excretion was not associated with any of the bodily system FSS clusters (all p>0.050). Furthermore, 24-h UFC excretion did not predict new-onset FSS in the 2-year follow-up period (beta=0.021, t=0.566, p=0.572). We conclude that this study does not provide evidence for an association between altered HPA-axis function, as indexed by 24-h UFC, and FSS in the general population. We conclude that this study does not provide evidence for an association between altered HPA-axis function, as indexed by 24-h UFC, and FSS in the general population.
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Affiliation(s)
- R Nickel
- Klinik für Psychosomatische Medizin und Psychotherapie , Dr. Horst Schmidt Klinik Wiesbaden, Rheingauer Strasse 35, 65388, Schlangenbad, Deutschland.
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Does hypothalamic-pituitary-adrenal axis hypofunction in chronic fatigue syndrome reflect a 'crash' in the stress system? Med Hypotheses 2009; 72:701-5. [PMID: 19237251 DOI: 10.1016/j.mehy.2008.11.044] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 11/18/2008] [Accepted: 11/21/2008] [Indexed: 11/22/2022]
Abstract
The etiopathogenesis of chronic fatigue syndrome (CFS) remains poorly understood. Although neuroendocrine disturbances - and hypothalamic-pituitary-adrenal (HPA) axis hypofunction in particular - have been found in a large proportion of CFS patients, it is not clear whether these disturbances are cause or consequence of the illness. After a review of the available evidence we hypothesize that that HPA axis hypofunction in CFS, conceptualized within a system-biological perspective, primarily reflects a fundamental and persistent dysregulation of the neurobiological stress system. As a result, a disturbed balance between glucocorticoid and inflammatory signaling pathways may give rise to a pathological cytokine-induced sickness response that may be the final common pathway underlying central CFS symptoms, i.e. effort/stress intolerance and pain hypersensitivity. This comprehensive hypothesis on HPA axis hypofunction in CFS may stimulate diagnostic refinement of the illness, inform treatment approaches and suggest directions for future research, particularly focusing on the neuroendocrine-immune interface and possible links between CFS, early and recent life stress, and depression.
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