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García-Blanco A, González-Valls P, Iranzo-Tatay C, Rojo-Moreno L, Sierra P, Livianos L. Hypoesthesia in generalised anxiety disorder and major depression disorder. Int J Psychiatry Clin Pract 2018; 22:310-313. [PMID: 29320917 DOI: 10.1080/13651501.2017.1417441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: The determination of soft signs can be a conducive practice to understand the differential etiology between depression and anxiety. This study aims at examining malleolar hypoesthesia role in distinguishing between patients with generalised anxiety disorder (GAD) and major depression disorder (MDD). Methods: This study examines the presence of malleolar hypoesthesia in patients with GAD (n = 47) compared to patients with MDD (n = 48) and healthy individuals (controls; n = 99). The Wartenberg wheel, a medical device for neurological use, was employed to determine the presence of hypoesthesia on both sides of the ankles. Results: The data revealed: i) MDD patients showed higher hypoesthesia than GAD patients (p = .008), ii) participants with hypoesthesia had higher anxiety and depression scores than participants without hypoesthesia (all p < .001) and iii) logistic regression model indicated that hypoesthesia can be a predictor of MDD relative to GAD diagnosis (Odds Ratio: 17.43 (1.40-217.09; p = .026)). Conclusions: Malleolar hypoesthesia was higher in MDD than GAD. The detection of hypoesthesia may help to investigate the differential etiology between MDD and GAD diagnosis.
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Affiliation(s)
- Ana García-Blanco
- a Health Research Institute La Fe , Valencia , Spain.,b Department of Personality , University of Valencia , Valencia , Spain
| | | | | | - Luis Rojo-Moreno
- a Health Research Institute La Fe , Valencia , Spain.,c Department of Medicine , University of Valencia , Valencia , Spain.,d CIBERESP , Valencia , Spain
| | - Pilar Sierra
- a Health Research Institute La Fe , Valencia , Spain.,c Department of Medicine , University of Valencia , Valencia , Spain
| | - Lorenzo Livianos
- a Health Research Institute La Fe , Valencia , Spain.,c Department of Medicine , University of Valencia , Valencia , Spain.,d CIBERESP , Valencia , Spain
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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: 1.6] [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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Stevenson E, Cole J. Associations between chronic non‐cancer pain and medication assisted treatment outcomes for opiate addiction. Am J Addict 2015; 24:138-143. [DOI: 10.1111/ajad.12151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/25/2014] [Accepted: 06/16/2014] [Indexed: 12/28/2022] Open
Affiliation(s)
| | - Jennifer Cole
- Center on Drug and Alcohol ResearchUniversity of KentuckyLexingtonKY
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Livianos L, González-Valls PI, García-Blanco AC, Tobella H, Díaz-Alonso I, Alberola N, García-Aznar S, Bellot R, Saiz V, Ros L. Hypoesthesia of the malleolus as a soft sign in depression. J Affect Disord 2015; 171:128-31. [PMID: 25305426 DOI: 10.1016/j.jad.2014.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 09/15/2014] [Accepted: 09/20/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Physical signs often are present in many psychiatric conditions, making up a fundamental part of them and accompanying the psychiatric manifestations themselves. Identifying minor neurological signs is especially of interest due to they are easily accessible through simple neurological examination and could be a useful if underused tool for the diagnostic process and patient therapy. METHOD A group of depressed patients (n=85) and group of healthy individuals (n=101) that served as control were examined using the Wartenberg wheel, a medical device for neurological use, in order to determine the presence of hypoesthesia on both sides of their ankles. RESULTS The data revealed: (i) patients with depression are generally more likely to present malleolar hypoesthesia than healthy participants; and (ii) participants who presented malleolar hypoesthesia presented greater depressive symptomatology as well as greater anxiety symptomatology at the time of assessment. LIMITATIONS Although all patients in this study were taking psychotropic medication, anxiolytics and antidepressants are not associated with skin sensitivity. As is usual, the categorization of hypoesthesia is based on participant subjectivity. However, this subjectivity cannot explain the differences between depressed patients and healthy individuals. CONCLUSIONS The present findings corroborate that localized tactile sensitivity is altered in depression and correlates with anxiety-depressive symptomatology, even on a subclinical level. The observation of neurological soft signs such as the detection of malleolar hypoesthesia in patients with depressive symptomatology is easily accessible using a simple neurological examination, and it could became a powerful tool that could provide objective information on affective disorders.
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Affiliation(s)
- Lorenzo Livianos
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain; University of Valencia, Department of Medicine, Valencia, Spain; CIBERESP, Spain
| | - Pablo I González-Valls
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain
| | - Ana C García-Blanco
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain.
| | - Helena Tobella
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain
| | - Ignacio Díaz-Alonso
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain
| | - Núria Alberola
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain
| | - Susana García-Aznar
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain
| | - Ramón Bellot
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain
| | - Vanessa Saiz
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain
| | - Lourdes Ros
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain
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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: 20] [Impact Index Per Article: 1.8] [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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Mak ADP, Wu JCY, Chan Y, Chan FKL, Sung JJY, Lee S. Dyspepsia is strongly associated with major depression and generalised anxiety disorder - a community study. Aliment Pharmacol Ther 2012; 36:800-10. [PMID: 22957985 DOI: 10.1111/apt.12036] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 03/23/2012] [Accepted: 08/14/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND The relationship between dyspepsia and psychiatric comorbidity such as anxiety and depression is poorly defined. Previous studies have been limited by lack of standardised diagnostic criteria. AIM To examine the prevalence and comorbidity of dyspepsia as defined by Rome III (6-month duration) with DSM-IV-TR generalised anxiety disorder (GAD) and major depressive episodes (MDE) in the general population. METHODS A random population-based telephone survey was done using a questionnaire on symptoms of Rome III Dyspepsia, DSM-IV-TR GAD and MDE and their chronological relationship. RESULTS Of the 2011 respondents 8.0% currently had Rome III Dyspepsia, 3.8% reported GAD and 12.4% reported MDE respectively. Dyspeptic subjects had a twofold increased risk of GAD (OR = 2.03, 95% CI: 1.06-3.89, P < 0.001) and a threefold increased risk of MDE (OR = 3.56, 95% CI: 2.33-5.43, P < 0.001). MDE and GAD most often coincided with dyspepsia in onset. Dyspepsia (OR = 2.48, 95% CI: 1.65-3.72 P < 0.001), MDE (OR = 2.39, 95% CI: 1.64-3.46, P < 0.001) and female sex (OR = 1.65, 95% CI: 1.21-2.23, P < 0.001) independently predicted frequent medical consultations. GAD independently predicted high investigation expenditure (OR = 4.65, 95% CI: 1.15-18.70, P = 0.03). CONCLUSIONS With stringently adopted Rome III and DSM-IV-TR criteria, dyspepsia was strongly associated and often coincident in onset with generalised anxiety disorder and major depressive episodes in the community. Excessive healthcare utilisation should alert clinicians to risk of psychiatric comorbidity.
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Affiliation(s)
- A D P Mak
- Department of Psychiatry, Shatin Hospital, Hong Kong, China
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