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Meerwijk EL, Weiss SJ. Does suicidal desire moderate the association between frontal delta power and psychological pain? PeerJ 2016; 4:e1538. [PMID: 26793422 PMCID: PMC4715463 DOI: 10.7717/peerj.1538] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/06/2015] [Indexed: 01/01/2023] Open
Abstract
Psychological pain frequently underlies thoughts of suicide. We investigated if recent suicidal desire moderated the association between potential neurophysiological markers and psychological pain assessed on the Psychache Scale (PS) and the Orbach & Mikulincer Mental Pain Questionnaire (OMMP). The OMMP specifically assesses current psychological pain that may more readily capture emotions present during recent suicidal desire. In contrast, the PS leaves the timeframe undefined. A secondary analysis was conducted of resting-state EEG data and heart rate obtained in adults with a history of depression. In simultaneous multiple regression models, while controlling for depressive symptoms, recent suicidal desire moderated associations with right-frontal EEG delta power (ΔR2 = .07, p < .01) and low-frequency heart rate variability (nonsignificantly) for pain assessed on the PS. No indication for moderation was found for pain on the OMMP. The relationship between the two measures of psychological pain was stronger for individuals with recent suicidal desire (r = .75, p < .01 vs. r = .50, p < .05). The findings suggest that, unless a respondent’s psychological pain is recent and substantial, the PS may not capture the intensity of current psychological pain as effectively as the OMMP.
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Affiliation(s)
- Esther L Meerwijk
- Department of Community Health Systems, University of California, San Francisco , San Francisco, CA , United States
| | - Sandra J Weiss
- Department of Community Health Systems, University of California, San Francisco , San Francisco, CA , United States
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Blasco-Fontecilla H, Fernández-Fernández R, Colino L, Fajardo L, Perteguer-Barrio R, de Leon J. The Addictive Model of Self-Harming (Non-suicidal and Suicidal) Behavior. Front Psychiatry 2016; 7:8. [PMID: 26869941 PMCID: PMC4734209 DOI: 10.3389/fpsyt.2016.00008] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/14/2016] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Behavioral addictions such as gambling, sun-tanning, shopping, Internet use, work, exercise, or even love and sex are frequent, and share many characteristics and common neurobiological and genetic underpinnings with substance addictions (i.e., tolerance, withdrawal, and relapse). Recent literature suggests that both non-suicidal self-injury (NSSI) and suicidal behavior (SB) can also be conceptualized as addictions. The major aim of this mini review is to review the literature and explore the neurobiological and psychological mechanisms underlying the addiction to self-harming behaviors. METHOD This is a narrative review. The authors performed literature searches in PubMed and Google for suicidal behavior, self-harming, addiction, and "major repeaters." Given the scarce literature on the topic, a subset of the most closely related studies was selected. The authors also focused on three empirical studies testing the hypothesis that major repeaters (individuals with ≥5 lifetime suicide attempts) represent a distinctive suicidal phenotype and are the individuals at risk of developing an addiction to SB. RESULTS The authors reviewed the concept of behavioral addictions and major repeaters, current empirical evidence testing concerning whether or not NSSI and SB can be understood as "addictions," and the putative mechanisms underlying them. CONCLUSION Our review suggests that both NSSI and SB can be conceptualized as addictions. This is relevant because if some individual's self-harming behaviors are better conceptualized as an addiction, treatment approaches could be tailored to this addiction.
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Affiliation(s)
- Hilario Blasco-Fontecilla
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital, Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Consulting Asistencial Sociosanitario (CAS), Madrid, Spain
| | - Roberto Fernández-Fernández
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital , Madrid , Spain
| | - Laura Colino
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital , Madrid , Spain
| | - Lourdes Fajardo
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital , Madrid , Spain
| | - Rosa Perteguer-Barrio
- Department of Psychiatry, Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Puerta de Hierro University Hospital , Madrid , Spain
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital , Lexington, KY , USA
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53
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Verrocchio MC, Carrozzino D, Marchetti D, Andreasson K, Fulcheri M, Bech P. Mental Pain and Suicide: A Systematic Review of the Literature. Front Psychiatry 2016; 7:108. [PMID: 27378956 PMCID: PMC4913233 DOI: 10.3389/fpsyt.2016.00108] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/06/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mental pain, defined as a subjective experience characterized by perception of strong negative feelings and changes in the self and its function, is no less real than other types of grief. Mental pain has been considered to be a distinct entity from depression. We have performed a systematic review analyzing the relationship between mental pain and suicide by providing a qualitative data synthesis of the studies. METHODS We have conducted, in accordance with PRISMA guidelines, a systematic search for the literature in PubMed, Web Of Science, and Scopus. Search terms were "mental pain" "OR" "psychological pain" OR "psychache" combined with the Boolean "AND" operator with "suicid*." In addition, a manual search of the literature, only including the term "psychache," was performed on Google Scholar for further studies not yet identified. RESULTS Initial search identified 1450 citations. A total of 42 research reports met the predefined inclusion criteria and were analyzed. Mental pain was found to be a significant predictive factor of suicide risk, even in the absence of a diagnosed mental disorder. Specifically, mental pain is a stronger factor of vulnerability of suicidal ideation than depression. CONCLUSION Mental pain is a core clinical factor for understanding suicide, both in the context of mood disorders and independently from depression. Health care professionals need to be aware of the higher suicidal risk in patients reporting mental pain. In this regard, psychological assessment should include a clinimetric evaluation of mental pain in order to further detect its contribution to suicidal tendency.
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Affiliation(s)
- Maria Cristina Verrocchio
- Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University , Chieti , Italy
| | - Danilo Carrozzino
- Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University, Chieti, Italy; Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Daniela Marchetti
- Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University , Chieti , Italy
| | - Kate Andreasson
- Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University Hospital , Hillerød , Denmark
| | - Mario Fulcheri
- Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University , Chieti , Italy
| | - Per Bech
- Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University Hospital , Hillerød , Denmark
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Kogler L, Müller VI, Chang A, Eickhoff SB, Fox PT, Gur RC, Derntl B. Psychosocial versus physiological stress - Meta-analyses on deactivations and activations of the neural correlates of stress reactions. Neuroimage 2015; 119:235-51. [PMID: 26123376 PMCID: PMC4564342 DOI: 10.1016/j.neuroimage.2015.06.059] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/09/2015] [Accepted: 06/21/2015] [Indexed: 12/13/2022] Open
Abstract
Stress is present in everyday life in various forms and situations. Two stressors frequently investigated are physiological and psychosocial stress. Besides similar subjective and hormonal responses, it has been suggested that they also share common neural substrates. The current study used activation-likelihood-estimation meta-analysis to test this assumption by integrating results of previous neuroimaging studies on stress processing. Reported results are cluster-level FWE corrected. The inferior frontal gyrus (IFG) and the anterior insula (AI) were the only regions that demonstrated overlapping activation for both stressors. Analysis of physiological stress showed consistent activation of cognitive and affective components of pain processing such as the insula, striatum, or the middle cingulate cortex. Contrarily, analysis across psychosocial stress revealed consistent activation of the right superior temporal gyrus and deactivation of the striatum. Notably, parts of the striatum appeared to be functionally specified: the dorsal striatum was activated in physiological stress, whereas the ventral striatum was deactivated in psychosocial stress. Additional functional connectivity and decoding analyses further characterized this functional heterogeneity and revealed higher associations of the dorsal striatum with motor regions and of the ventral striatum with reward processing. Based on our meta-analytic approach, activation of the IFG and the AI seems to indicate a global neural stress reaction. While physiological stress activates a motoric fight-or-flight reaction, during psychosocial stress attention is shifted towards emotion regulation and goal-directed behavior, and reward processing is reduced. Our results show the significance of differentiating physiological and psychosocial stress in neural engagement. Furthermore, the assessment of deactivations in addition to activations in stress research is highly recommended.
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Affiliation(s)
- Lydia Kogler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; Jülich-Aachen-Research Alliance, Translational Brain Medicine, Germany.
| | - Veronika I Müller
- Institute of Neuroscience und Medicine, INM-1, Research Centre Jülich, 52425 Jülich, Germany; Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Amy Chang
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; Scripps College, Claremont, CA, USA
| | - Simon B Eickhoff
- Institute of Neuroscience und Medicine, INM-1, Research Centre Jülich, 52425 Jülich, Germany; Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Dr, San Antonio, TX 78229, USA; South Texas Veterans Administration Medical Center, San Antonio, TX, USA
| | - Ruben C Gur
- Neuropsychiatry Division, Department of Psychiatry, Medical School, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Birgit Derntl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; Jülich-Aachen-Research Alliance, Translational Brain Medicine, Germany; Institute of Neuroscience und Medicine, INM-1, Research Centre Jülich, 52425 Jülich, Germany
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55
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Linden M. Psychosomatic inpatient rehabilitation: the German model. PSYCHOTHERAPY AND PSYCHOSOMATICS 2015; 83:205-12. [PMID: 24970244 DOI: 10.1159/000358852] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 01/18/2014] [Indexed: 11/19/2022]
Abstract
The term 'psychosomatic' has many connotations, be it in the sense of a general biopsychosocial concept in medicine as outlined in the ICF (International Classification of Functioning, Disability and Health) of the World Health Organization, a holistic and person-centered view of the patient beyond the illness, the treatment of somatoform or somatic disorders, or special psychotherapeutic approaches. In Germany, there are also about 25,000 inpatient beds in 'psychosomatic rehabilitation hospitals', which treat approximately 5/1,000 inhabitants in the working age population per year. These institutions give an example of how to translate the theoretical concepts of psychosomatic medicine and of the ICF into clinical practice. 'Psychosomatic rehabilitation' aims at the prevention, treatment and compensation of chronic illness by a biopsychosocial approach. This includes a multilevel psychosomatic assessment and a multidimensional treatment focus including the reduction of symptoms, the training of capacities, the coping with chronic illness and impairment, the restoration of well-being and normal life, and the occupational reintegration including the search for a workplace, which allows work in spite of impairment. Scientific studies have shown that the psychological status, the motivation to work, the number of days on sickness leave and occupational reintegration can be improved, and that the system pays for the patients themselves, but also pension and health insurance companies.
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Affiliation(s)
- Michael Linden
- Department of Psychosomatic Medicine, Rehabilitation Center Seehof, Federal German Pension Agency, and Research Group Psychosomatic Rehabilitation, Charité University Medicine Berlin, Teltow/Berlin, Germany
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56
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Blasco-Fontecilla H, Baca-García E, Courtet P, García Nieto R, de Leon J. Horror Vacui: Emptiness Might Distinguish between Major Suicide Repeaters and Nonmajor Suicide Repeaters: A Pilot Study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2015; 84:117-119. [PMID: 25720355 DOI: 10.1159/000369937] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 11/05/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Hilario Blasco-Fontecilla
- Department of Psychiatry, Puerta de Hierro University Hospital, IDIPHIM, CIBERSAM, Autonomous University of Madrid, Madrid, Spain
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57
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Trent Haines R, Jackson AD, Thomas EL. Evaluating the Orbach Mikulincer Mental Pain Scale among Late Adolescent and Early Adult African Americans: A Rasch Analysis. Issues Ment Health Nurs 2015; 36:761-72. [PMID: 26514254 DOI: 10.3109/01612840.2015.1028118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although there are only a few psychometric investigations of mental pain measurement in the literature, there are no previous evaluations of mental pain scales among African Americans. The present study examined the Rasch measurement properties of the nine subscales contained in the Orbach-Mikulincer Mental Pain (OMMP) Scale among a sample of older adolescent and young adult African Americans. Results from the analyses suggest that three of the OMMP subscales meet the requirements of the Rasch model and hold promise for use in research and applied settings. Implications for further development and use of the remaining subscales are discussed.
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Affiliation(s)
- R Trent Haines
- a Morgan State University, Department of Psychology, Graduate Program in Psychometrics , Baltimore , Maryland , USA
| | - Avis D Jackson
- a Morgan State University, Department of Psychology, Graduate Program in Psychometrics , Baltimore , Maryland , USA
| | - Erika L Thomas
- a Morgan State University, Department of Psychology, Graduate Program in Psychometrics , Baltimore , Maryland , USA
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58
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Evers AWM, Gieler U, Hasenbring MI, van Middendorp H. Incorporating biopsychosocial characteristics into personalized healthcare: a clinical approach. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 83:148-57. [PMID: 24732828 DOI: 10.1159/000358309] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 01/02/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
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59
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de Heer EW, Gerrits MMJG, Beekman ATF, Dekker J, van Marwijk HWJ, de Waal MWM, Spinhoven P, Penninx BWJH, van der Feltz-Cornelis CM. The association of depression and anxiety with pain: a study from NESDA. PLoS One 2014; 9:e106907. [PMID: 25330004 PMCID: PMC4198088 DOI: 10.1371/journal.pone.0106907] [Citation(s) in RCA: 218] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/05/2014] [Indexed: 11/20/2022] Open
Abstract
Chronic pain is commonly co-morbid with a depressive or anxiety disorder. Objective of this study is to examine the influence of depression, along with anxiety, on pain-related disability, pain intensity, and pain location in a large sample of adults with and without a depressive and/or anxiety disorder. The study population consisted of 2981 participants with a depressive, anxiety, co-morbid depressive and anxiety disorder, remitted disorder or no current disorder (controls). Severity of depressive and anxiety symptoms was also assessed. In separate multinomial regression analyses, the association of presence of depressive or anxiety disorders and symptom severity with the Chronic Pain Grade and location of pain was explored. Presence of a depressive (OR = 6.67; P<.001), anxiety (OR = 4.84; P<.001), or co-morbid depressive and anxiety disorder (OR = 30.26; P<.001) was associated with the Chronic Pain Grade. Moreover, symptom severity was associated with more disabling and severely limiting pain. Also, a remitted depressive or anxiety disorder showed more disabling and severely limiting pain (OR = 3.53; P<.001) as compared to controls. A current anxiety disorder (OR = 2.96; p<.001) and a co-morbid depressive and anxiety disorder (OR = 5.15; P<.001) were more strongly associated with cardio-respiratory pain, than gastro-intestinal or musculoskeletal pain. These findings remain after adjustment for chronic cardio respiratory illness. Patients with a current and remitted depressive and/or anxiety disorder and those with more severe symptoms have more disabling pain and pain of cardio-respiratory nature, than persons without a depressive or anxiety disorder. This warrants further research.
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Affiliation(s)
- Eric W. de Heer
- TopClinical Center for Body, Mind, and Health, GGz Breburg Tilburg, Tilburg, The Netherlands
- Tilburg School of Behavioral and Social Sciences, Tranzo Department, University of Tilburg, Tilburg, The Netherlands
- * E-mail:
| | - Marloes M. J. G. Gerrits
- Department of Psychiatry, EMGO Institute for Health and Care research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Aartjan T. F. Beekman
- Department of Psychiatry, EMGO Institute for Health and Care research, VU University Medical Centre, Amsterdam, The Netherlands
- GGZ inGeest, Mental Health Institute, Amsterdam, The Netherlands
| | - Jack Dekker
- Arkin, Mental Health Institute, Amsterdam, The Netherlands
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Harm W. J. van Marwijk
- Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Margot W. M. de Waal
- Department of Public Health and Primary Care, Leiden university Medical Centre, Leiden, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Brenda W. J. H. Penninx
- Department of Psychiatry, EMGO Institute for Health and Care research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Christina M. van der Feltz-Cornelis
- TopClinical Center for Body, Mind, and Health, GGz Breburg Tilburg, Tilburg, The Netherlands
- Tilburg School of Behavioral and Social Sciences, Tranzo Department, University of Tilburg, Tilburg, The Netherlands
- Trimbos Institute, Utrecht, the Netherlands
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60
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Meerwijk EL, Weiss SJ. Toward a unifying definition: response to 'The concept of mental pain'. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 83:62-3. [PMID: 24281693 DOI: 10.1159/000348869] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 02/10/2013] [Indexed: 11/19/2022]
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Meerwijk EL, Chesla CA, Weiss SJ. Psychological pain and reduced resting-state heart rate variability in adults with a history of depression. Psychophysiology 2014; 51:247-56. [DOI: 10.1111/psyp.12175] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 10/05/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Esther L. Meerwijk
- Department of Community Health Systems; University of California; San Francisco San Francisco California USA
| | - Catherine A. Chesla
- Department of Family Health Care Nursing; University of California; San Francisco San Francisco California USA
| | - Sandra J. Weiss
- Department of Community Health Systems; University of California; San Francisco San Francisco California USA
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62
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Michel K. Will new insights into neural networks help us improve our models of suicidal behavior? CRISIS 2014; 35:215-8. [PMID: 25113887 DOI: 10.1027/0227-5910/a000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Konrad Michel
- University Hospital of Psychiatry, Bern, Switzerland
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63
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Fava GA, Tossani E, Bech P, Berrocal C, Chouinard G, Csillag C, Wittchen HU, Rief W. Emerging clinical trends and perspectives on comorbid patterns of mental disorders in research. Int J Methods Psychiatr Res 2014; 23 Suppl 1:92-101. [PMID: 24375537 PMCID: PMC6878355 DOI: 10.1002/mpr.1412] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Comorbidity is a well-established and documented phenomenon in mental disorders and medicine with heuristic value. The concept of comorbidity remains however poorly defined and lacks a comprehensive and coherent theoretical framework. There is a need to develop coherent methodological strategies in order to promote a fuller understanding of the implications of comorbidity and to exploit its potential value with regard to etiopathogenic and therapeutic issues. This position paper makes recommendations of improved methodological standards and procedures and discusses a range of options that can provide incremental information that is likely to improve therapeutic outcomes.
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Affiliation(s)
- Giovanni A Fava
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
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Xie W, Li H, Luo X, Fu R, Ying X, Wang N, Yin Q, Zou Y, Cui Y, Wang X, Shi C. Anhedonia and pain avoidance in the suicidal mind: behavioral evidence for motivational manifestations of suicidal ideation in patients with major depressive disorder. J Clin Psychol 2013; 70:681-92. [PMID: 24307489 DOI: 10.1002/jclp.22055] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Psychological pain may be helpful in conceptualizing suicidal behavior, in that high motivation to avoid pain combined with painful feelings may contribute to an increased risk of suicide. However, no experimental study has tested this hypothesis. The aim of the present study is to provide empirical evidence for the relationship between anhedonia, pain avoidance motivation, and suicidal ideation. METHOD The sample comprised 40 depressed outpatients and 20 healthy control subjects. All participants completed the Beck Scale for Suicide Ideation (BSS), Beck Depression Inventory, Psychache Scale, Three-Dimensional Psychological Pain Scale, the monetary incentive delay (MID), and affective incentive delay (AID) tasks. Based on BSS scores, clinical participants were divided into high suicidal ideation (HSI) and low suicidal ideation (LSI) groups. RESULTS In the AID task, the HSI group had longer response times (RTs) under the reward condition than those under the punishment condition (p = .002). The LSI and control groups had shorter RTs under the reward condition compared with those under the neural condition (p <.001 and p = .008, respectively). The LSI group also had shorter RTs under the reward condition than under the punishment condition (p = .003). Pain arousal (r = -.33, p <.01) and BSS scores were significantly negatively correlated with differences in RTs between neutral and reward conditions. Pain avoidance (r = .35, p <.01) and BSS scores were positively correlated with differences in RTs between neutral and punishment conditions. CONCLUSIONS The AID task was more sensitive than the MID task for the detection of participants' motivation in approaching hedonic experiences and avoiding pain. A suicidal mindset is manifested as decreased motivation to experience hedonia and increased motivation to avoid pain, which could be strong predictors of suicidal behavior.
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65
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Fava GA, Tomba E, Tossani E. Innovative trends in the design of therapeutic trials in psychopharmacology and psychotherapy. Prog Neuropsychopharmacol Biol Psychiatry 2013; 40:306-11. [PMID: 23123361 DOI: 10.1016/j.pnpbp.2012.10.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 10/15/2012] [Accepted: 10/23/2012] [Indexed: 02/08/2023]
Abstract
The standard randomized controlled trial design is still based on the acute disease model. This is in sharp contrast with the fact that the patient is likely to have experienced other treatments before, that may actually modify clinical course and responsiveness. The current standard of therapeutic trial in psychiatry is represented by the large, multi-center, controlled randomized trial with broad inclusion criteria, and little attention to other factors such as the clinical history of patients and comorbidity. The heterogeneous features of these patients would then affect the outcome of the trial. Conflicting results among randomized controlled trials can represent a spectrum of outcomes, based on different patient groups, more than bias or random variability. If a treatment is tested by a series of small trials with inclusion criteria for specific characteristics (including treatment history, subgroups and comorbidity), we may have a better knowledge of its indications and contraindications. Further, there is increasing need of expanding the content of customary clinical information, by including evaluation of variables such as stress, lifestyle, well-being, illness behavior and psychological symptoms. These joint strategies would actually constitute a paradigm shift in psychopharmacology and psychotherapy research.
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Affiliation(s)
- Giovanni A Fava
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Italy.
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