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Jongsma K, Darboh BS, Davis S, MacKillop E. A cognitive behavioural group treatment for somatic symptom disorder: a pilot study. BMC Psychiatry 2023; 23:896. [PMID: 38037036 PMCID: PMC10690984 DOI: 10.1186/s12888-023-05141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/26/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Somatic symptom disorder (SSD) presents challenges to the healthcare system, including frequent medical visits, lack of symptom relief experienced by individuals with this condition, high associated medical costs, and patient dissatisfaction. This study examined the utility of a novel, low-barrier, brief cognitive behavioural therapy (CBT) group intervention for individuals with SSD. METHODS Participants were referred by their mental health providers or self-referral. Each participant underwent a telephone screen and in-person psychological and neuropsychological screen. Two cycles of the CBT-based group (n = 30), each consisting of six weekly two-hour sessions, were facilitated at a large outpatient mental healthcare facility in Ontario, Canada. The final sample consisted of 13 individuals of whom 11 completed the treatment. Clinical outcome measures were administered pre-, mid- and post-group, including the Generalized Anxiety Disorder-7, Perceived Stress Scale-4, Pain Self-Efficacy Questionnaire, Pain Disability Index, Revised Illness Perception Questionnaire, and sections of the Patient Health Questionnaire. Six healthcare utilization metrics were collected from electronic medical records at six months pre- and post-group. Paired samples t-tests were used to examine pre- to post-group differences in participants' somatic symptoms, psychological functioning, health, and degree of healthcare utilization. RESULTS When comparing pre- and post- group, we observed reductions in the mean scores for somatic symptom severity, depressive symptomatology, anxiety, perceived stress, and perceived disability related to pain. The change in depressive symptomatology yielded a small effect size (d = 0.30). Further, we observed downward trends across participants' pre- to post-group healthcare utilization, with small effect sizes observed for hospital admission (d = 0.36), days admitted to hospital (d = 0.47), and inpatient consults (d = 0.42). Differences between pre- and post-group measures of somatic symptom severity, psychological functioning, health, or healthcare utilization did not reach significance. CONCLUSIONS Current findings provide support for the potential effectiveness of an abbreviated CBT group for individuals with SSD in reducing psychiatric symptomatology. Further research is recommended, including randomized control trials, cost-benefit analyses, and comparisons between abbreviated versus longer-duration treatment programs for SSD. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Katherine Jongsma
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
- Clinical Neuropsychology Service, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
| | - Bri Susanna Darboh
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Clinical Neuropsychology Service, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | - Sasha Davis
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Clinical Neuropsychology Service, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Emily MacKillop
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Clinical Neuropsychology Service, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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Kondapura MB, Manjunatha N, Nagaraj AKM, Praharaj SK, Kumar CN, Math SB, Rao GN. Cost of Illness Analysis of Common Mental Disorders: A Study from an Indian Academic Tertiary Care Hospital. Indian J Psychol Med 2023; 45:519-525. [PMID: 37772137 PMCID: PMC10523518 DOI: 10.1177/02537176221108867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Background The cost of illness (COI) for common mental disorders (CMDs) that include depression, anxiety, and somatoform disorder is less studied in India. Hence, we studied the COI and disability of CMDs and their relationship in patients with depression, anxiety, and somatoform disorders. Methods In this cross-sectional study, we recruited 220 patients (110 with depression, 58 with anxiety disorders, and 52 with somatoform disorders) and evaluated disability using the Sheehan Disability Scale (SDS). The schedule for the cost of illness (S-COI) was used for evaluating COI for the last year. Results The annual COI of CMDs from the patient perspective was ₹21,620 (interquartile range [IQR], ₹47,761; ≈US$290). The median annual direct COI was ₹4,907 (IQR ₹7,502), and indirect COI was ₹12,900 (IQR ₹37744). The direct COI was 18%, whereas the indirect COI was 82%. The direct and indirect COI in the three groups were similar. In all three groups with ongoing treatment, the mean scores indicated a mild level of disability. Total and indirect COI, but not the direct COI, correlated positively with the severity of illness and disability. Conclusion All the CMDs with ongoing treatment are associated with a mild level of disability and are a significant financial burden, with higher indirect costs.
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Affiliation(s)
- Manjunatha B. Kondapura
- Dept. of Psychiatry, National
Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Dept. of Psychiatry, National
Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anil Kumar Mysore Nagaraj
- Dept. of Psychiatry, Kasturba Medical
College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka,
India
| | - Samir Kumar Praharaj
- Dept. of Psychiatry, Kasturba Medical
College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka,
India
| | | | - Suresh Bada Math
- Dept. of Psychiatry, National
Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Dept. of Epidemiology, Centre for
Public Health, National Institute of Mental Health and Neurosciences, Bengaluru,
Karnataka, India
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3
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Chinneimawi E, Nagarajan P, Menon V. Caregiver Burden and Disability in Somatoform Disorder: An Exploratory Study. Indian J Psychol Med 2021; 43:500-507. [PMID: 35210678 PMCID: PMC8826199 DOI: 10.1177/0253717620957563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Very few Indian studies have explored disability among patients with somatoform disorder and the burden experienced by their caregivers. We aimed to assess the levels of disability among patients with somatoform disorder and the levels of burden among their caregivers and compare these parameters against patients with schizophrenia. METHODS Participants included adults with a diagnosis of somatoform disorders (F45.0-F 45.9) (n = 28) or schizophrenia (F20.0-F20.9) (n = 28) diagnosed as per the International Classification of Diseases, Tenth Revision (ICD-10), clinical descriptions, and diagnostic guidelines, as well as their caregivers. The WHO Disability Assessment Schedule 2.0 and Family Burden Interview Schedule were used to assess patient disability and caregiver burden, respectively. Independent Student's t-test or chi-square test was used to compare relevant sociodemographic and clinical parameters. RESULTS Out of 56 patients, the mean (±SD) age of the sample was 38.6 (±10.5) years. Females constituted a slender majority of the sample (n = 29, 51.8%). The mean disability score of patients with somatoform disorders was slightly higher (83.6 ±20.9) than that of patients with schizophrenia (82.3 ±16.7). Similarly, the mean burden score of caregivers of patients with somatoform disorders was nominally higher (18.96 ±9.9) than that of caregivers of patients with schizophrenia (15.7 ±9.7). Neither of these differences approached statistical significance (P > 0.05). CONCLUSION Patients with somatoform disorders experience considerable levels of disability, and their caregivers go through various levels of burden in their daily life that is comparable to schizophrenia.
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Affiliation(s)
| | - Padmavathi Nagarajan
- Dept. of Psychiatric Nursing, College of Nursing, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pudhucherry, India
| | - Vikas Menon
- Dept. of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pudhucherry, India
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Goel A, Ranjan P, Klanidhi KB, Deb KS, Sarkar S, Kaur T, Sahu A, Baitha U, Chakrawarty A, Kumar A. Comprehensive Treatment Module for Medically Unexplained Physical Symptoms - A Guide for General Practitioners. Cureus 2021; 13:e16263. [PMID: 34414039 PMCID: PMC8364782 DOI: 10.7759/cureus.16263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose: This study was aimed to develop a comprehensive treatment module that the general physician can use to manage patients with Medically Unexplained Physical Symptoms (MUPS) at a primary care level. Methods: This comprehensive module was developed after a literature review followed by its validation by a two-step Delphi technique with experts from internal medicine, psychiatry, and clinical psychology. Results: The developed module for the patients with MUPS includes case diagnosis, initial evaluation, strategy for referral, and a comprehensive treatment module. The comprehensive treatment module includes symptom discussion, rapport establishment, physical health counselling, stress management, cognitive strategies for symptom control, comorbidities treatment, and medical management. Conclusion: The developed module has unique features, such as intensive sessions with these patients, a patient-specific treatment strategy, and a holistic approach incorporating pharmacological and non-pharmacological interventions. General Practitioners across the world can use this comprehensive treatment module for the management of patients with MUPS.
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Affiliation(s)
- Aastha Goel
- Internal Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Piyush Ranjan
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Kamal B Klanidhi
- Internal Medicine: Geriatrics, All India Institute of Medical Sciences, New Delhi, IND
| | | | - Siddharth Sarkar
- Psychiatry, All India Institute of Medical Sciences, New Delhi, IND
| | - Tanveer Kaur
- Psychology, All India Institute of Medical Sciences, New Delhi, IND
| | - Anamika Sahu
- Psychiatry, All India Institute of Medical Sciences, New Delhi, IND
| | - Upendra Baitha
- Internal Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Avinash Chakrawarty
- Internal Medicine • Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Arvind Kumar
- Internal Medicine, All India Institute of Medical Sciences, New Delhi, IND
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5
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Su Q, Yu M, Liu F, Zhang Z, Lei M, Jiang Y, Luo T, Guo W. Frequency-specific alterations of the frontal-cerebellar circuit in first-episode, drug-naive somatization disorder. J Affect Disord 2021; 280:319-325. [PMID: 33221718 DOI: 10.1016/j.jad.2020.11.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 09/28/2020] [Accepted: 11/08/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND With the development of imaging techniques, evidence of abnormal neural activity has been implicated in patients with somatization disorder (SD). It remains unclear whether abnormal spontaneous neural activities are related to specific frequency bands. In this study, resting-state functional magnetic resonance imaging (fMRI) using the frequency-specific amplitude of low frequency fluctuation (ALFF) approach was applied to investigate changes in spontaneous neural activity in different frequency bands in patients with SD. METHODS Twenty-five first-episode, medication-naive patients with SD and 28 age-, sex-, education-matched healthy controls (HCs) underwent resting-state fMRI. The ALFF method with the classical low-frequency (0.01 - 0.08 Hz), slow-5 (0.01 - 0.027 Hz) and slow-4 (0.027 - 0.08 Hz) bands was employed to analyze the data. RESULTS With the classical low-frequency and slow-5 bands, patients with SD showed significantly increased ALFF in the left orbitofrontal cortex (OFC) and reduced ALFF in the right cerebellum compared with HCs. With the slow-4 band, patients with SD exhibited significantly reduced ALFF in the right cerebellum compared with HCs. However, no significant correlation was observed between the ALFF value in the left OFC or right cerebellum and clinical/cognitive variables. CONCLUSIONS Our findings indicate that there are abnormal regional activities of the left OFC and right cerebellum in first-episode, treatment-naive patients with SD, suggesting that these alterations occur early in the course of the disease and are independent of medication status. Our study provides novel evidence that different regional activities of the frontal-cerebellar circuit may be involved in the pathophysiology of SD.
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Affiliation(s)
- Qinji Su
- Mental Health Center, The Second Affiliated Hospital, Guangxi Medical University; Nanning, Guangxi 530021, China
| | - Miaoyu Yu
- Mental Health Center, The Second Affiliated Hospital, Guangxi Medical University; Nanning, Guangxi 530021, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhikun Zhang
- Mental Health Center, The Second Affiliated Hospital, Guangxi Medical University; Nanning, Guangxi 530021, China
| | - Meiying Lei
- Mental Health Center, The Second Affiliated Hospital, Guangxi Medical University; Nanning, Guangxi 530021, China
| | - Yongmei Jiang
- Mental Health Center, The Second Affiliated Hospital, Guangxi Medical University; Nanning, Guangxi 530021, China
| | - Tiantian Luo
- Mental Health Center, The Second Affiliated Hospital, Guangxi Medical University; Nanning, Guangxi 530021, China
| | - Wenbin Guo
- Mental Health Center, The Second Affiliated Hospital, Guangxi Medical University; Nanning, Guangxi 530021, China; Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China.
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Naskar C, Grover S, Sharma A, Padhy SK. A comparison of patients with somatic symptom disorder attending psychiatric services and those unwilling to attend psychiatric services. Asian J Psychiatr 2020; 53:102163. [PMID: 32474346 DOI: 10.1016/j.ajp.2020.102163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 11/30/2022]
Abstract
The present study aimed to compare the symptom profile, psychological correlates, public stigma, quality of life and disability of patients with somatic symptom disorder attending the psychiatric outpatient services and those who refuse to attend the psychiatry outpatient services. For this, patients were recruited from both Psychiatry outpatient services (N = 62) and Rheumatology outpatient services (N = 41). Participants were assessed on Screening for Somatoform Disorders Instrument, Beck's Depression Inventory, Somatosensory Amplification Scale, Whitley Index, Twenty-item Toronto Alexithymia Scale-Hindi version, Community Attitudes toward the Mentally Ill Scale, World Health Organization-Quality of Life Scale-BREF version (Hindi) and Indian Disability Evaluation and Assessment Scale. Both the groups were comparable on socio-demography and symptom profile. Compared to the patients attending the psychiatry outpatient services, patients attending the rheumatology outpatient services had higher level of somatosensory amplification, hypochondriasis, alexithymia (in the subscales of difficulty in identifying and describing feelings), higher stigmatizing attitude towards mental illness, poorer quality of life and higher disability. To conclude, present study suggests that, patients of somatic symptom disorder, who refuse to attend the psychiatry outpatient services differ from those attending the psychiatry outpatient services in terms of somatosensory amplification, alexithymia, hypochondriasis, public stigma held towards mental illnesses, disability and quality of life. There is a need to develop a treatment model to address these issues in the medical setting to improve the outcome of patients with somatic symptom disorders attending the medical outpatient setting.
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Affiliation(s)
- Chandrima Naskar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Aman Sharma
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Susanta Kumar Padhy
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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7
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Teagarden DL, Morton ML, Janocko NJ, Groover O, Villarreal HK, Evans L, Drane DL, Karakis I. Socioeconomic disparities in patients with psychogenic nonepileptic seizures and their caregivers. Epilepsy Behav 2020; 110:107160. [PMID: 32493610 DOI: 10.1016/j.yebeh.2020.107160] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE There is no information on disparities of patients with psychogenic nonepileptic seizures (PNES) and their caregivers. The objective of this exploratory study is to compare patients with PNES and caregivers with low socioeconomic status (SES) with those of high SES for disparities in healthcare use, seizures, medication adverse effects, psychosocial impact, and knowledge about epilepsy. METHODS Patients with PNES and caregivers completed surveys about the aforementioned outcomes during their Epilepsy Monitoring Unit (EMU) admission. Associations were evaluated using SES as a binary independent variable and the patient- and caregiver-related outcomes as dependent variables. RESULTS Forty-three patients and 28 caregivers were recruited. The majority of patients were on average 36 years old, single women, unemployed, with some college education. The majority had PNES for 8 years averaging 20 seizures per month and were maintained on ≥2 antiepileptic drugs (AEDs) prior to their EMU admission. Most caregivers were first-degree relatives with a mean age of 43 years, married employed women of higher educational attainment, typically cohabitating with the patients. Low SES patients showed poorer knowledge about epilepsy (p < 0.0001) and higher anxiety levels (p = 0.03). Conversely, high SES patients demonstrated poorer social functioning (p = 0.04). High SES caregivers showed higher caregiving burden (p = 0.01). CONCLUSION There are noteworthy disparities in patients with PNES of different SES and their caregivers. Identification of those disparities is a critical step in the creation of appropriate interventions to address them.
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Affiliation(s)
- Diane L Teagarden
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew L Morton
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Nicholas J Janocko
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Olivia Groover
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Hannah K Villarreal
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Latasha Evans
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington, Seattle, WA, USA
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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Zhang T, Bai T, Xie W, Wei Q, Lv H, Wang A, Guan J, Tian Y, Wang K. Abnormal connectivity of anterior-insular subdivisions and relationship with somatic symptom in depressive patients. Brain Imaging Behav 2020; 15:1760-1768. [PMID: 32748317 DOI: 10.1007/s11682-020-00371-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Depressive patients frequently present with somatic complaints such as pain and fatigue. The anterior insula (AI) is a crucial region for somatic processing, but reported contributions of AI dysfunction to somatic symptoms have varied across studies. We speculated that functional heterogeneity among AI subdivisions may contribute to this inconsistency. To reveal the correlation between each subdivision and somatic symptoms, we investigated resting-state functional connectivity (RSFC) based on seeds within distinct AI subdivisions in 45 depressive patients and 35 matched healthy controls (HCs). Depressive and somatic symptoms were assessed using the Hamilton Depression Rating Scale (HDRS) and the 15-item somatic symptom severity scale of the Patient Health Questionnaire (PHQ-15), respectively. The contributions of AI subregion-specific pathways to depression were further validated by examining changes in symptom severity and RSFC following electroconvulsive therapy (ECT). At baseline, depressive patients exhibited weaker RSFC between ventral AI (vAI) and right orbitofrontal cortex (rOFC) than HCs. Moreover, vAI-rOFC RSFC strength was negatively correlated with PHQ-15 and HDRS scores, indicating that weaker RSFC predicted greater symptom severity. ECT reduced depressive and somatic symptoms, and symptom mitigation was correlated with enhanced vAI-rOFC RSFC. The findings suggest that reduced vAI-rOFC RSFC underlies the somatic symptoms of depression and that enhancing vAI-rOFC RSFC can contribute to amelioration of somatic symptoms.
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Affiliation(s)
- Ting Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Tongjian Bai
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Wen Xie
- Anhui Mental Health Center, Hefei, Anhui Province, China
| | - Qiang Wei
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Huaming Lv
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Anzhen Wang
- Anhui Mental Health Center, Hefei, Anhui Province, China
| | - Jianjun Guan
- Anhui Mental Health Center, Hefei, Anhui Province, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, Hefei, China. .,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China. .,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China. .,National Clinical Research Center for Mental Disorders, Hefei, China. .,Department of Medical Psychology, Anhui Medical University, Anhui Province, Hefei, China.
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, Hefei, China. .,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China. .,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China. .,Department of Medical Psychology, Anhui Medical University, Anhui Province, Hefei, China.
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Voxel-based global-brain functional connectivity alterations in first-episode drug-naive patients with somatization disorder. J Affect Disord 2019; 254:82-89. [PMID: 31121532 DOI: 10.1016/j.jad.2019.04.099] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/27/2019] [Accepted: 04/30/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Altered functional connectivity (FC) is associated with the pathophysiology of patients with somatization disorder (SD). However, inconsistent results were obtained due to different selections of regions of interest (ROIs) in previous researches. This study aims to examine voxel-wise brain-wide FC alterations in patients with first-episode, drug-naive SD in an unbiased way. METHODS A total of 25 patients with SD and 28 age-, sex-, and education-matched healthy controls underwent resting-state functional magnetic resonance imaging. Global-brain FC (GFC) was applied to analyze the images. Receiver operating characteristic curves and support vector machine were used to differentiate the patients from the controls. RESULTS Compared with healthy controls, patients with SD exhibited increased GFC in the right inferior temporal gyrus (t-value = 4.0663, p < 0.001) and left superior occipital gyrus (t-value = 3.8197, p < 0.001). Decreased GFC in the right insula (t-value = ‒4.1667, p < 0.001) was observed in the patients relative to the controls. The GFC values in the right insula of the patients were positively correlated to their scores of the sleep subscale of the Hamilton Depression Scale (r = 0.455, p = 0.022) and the lie subscale of the Eysenck Personality Questionnaire (r = 0.436, p = 0.029). A combination of GFC values in the right insula and left superior occipital gyrus can be applied to discriminate the patients from the controls with optimal sensitivity, specificity, and accuracy of 88.00%, 85.71%, and 86.79%, respectively. CONCLUSIONS Our study indicates that patients with SD show abnormal GFC in the brain areas of insula-centered sensorimotor network, and thus providing a new perspective for understanding the pathological changes of FC in SD. Furthermore, a combination of the GFC values in the right insula and left superior occipital gyrus may be used as a potential biomarker to identify the patients from the controls.
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Kim SM, Hong JS, Min KJ, Han DH. Brain Functional Connectivity in Patients With Somatic Symptom Disorder. Psychosom Med 2019; 81:313-318. [PMID: 30932990 DOI: 10.1097/psy.0000000000000681] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate whether individuals with somatic symptom disorder (SSD) display increased resting-state functional connectivity (FC) within and between the sensorimotor network (SMN), default mode network (DMN), salience network, and dorsal attention network (DAN). METHODS Eighteen patients with SSD and 20 age- and sex-matched healthy control participants underwent resting-state functional magnetic resonance imaging. We used a seed-based correlation approach for the four brain networks. RESULTS Patients with SSD had higher scores on the Somato-Sensory Amplification Scale (z = 5.22, p < .001) and Symptom Checklist-90-Revised-Somatization (z = 4.94, p < .001) and greater FC within the SMN, DMN, and salience network than healthy control participants. Patients with SSD also had increased FC between the SMN and DMN, SMN and salience network, SMN and DAN, and salience network and DAN (t = 5.10-7.47, all false discovery rate q < .05). The Somato-Sensory Amplification Scale scores correlated with FC between the SMN and salience network and between the SMN and DAN (r = .61-.82, all p < .003). CONCLUSIONS Based on the results of the FC analysis between the SMN and salience network, we suggest that SSD may be associated with alterations of sensory-discriminative processing of pain and other somatic symptoms, which is influenced by affective processing. Based on the results of the FC analysis of the SMN and DAN, we suggest that patients with SSD have a deficit in attention, leading to misperception of external stimuli and failure to regulate bodily functions aimed at interactions with external stimuli.
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Affiliation(s)
- Sun Mi Kim
- From the Department of Psychiatry, Chung-Ang University Medical Center, Seoul, Republic of Korea
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11
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Ou Y, Su Q, Liu F, Ding Y, Chen J, Zhang Z, Zhao J, Guo W. Increased Nucleus Accumbens Connectivity in Resting-State Patients With Drug-Naive, First-Episode Somatization Disorder. Front Psychiatry 2019; 10:585. [PMID: 31474890 PMCID: PMC6706814 DOI: 10.3389/fpsyt.2019.00585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/25/2019] [Indexed: 11/13/2022] Open
Abstract
The nucleus accumbens (NAc) plays an important role in the reward circuit, and abnormal regional activities of the reward circuit have been reported in various psychiatric disorders including somatization disorder (SD). However, few researches are designed to analyze the NAc connectivity in SD. This study was designed to explore the NAc connectivity in first-episode, drug-naive patients with SD using the bilateral NAc as seeds. Twenty-five first-episode, drug-naive patients with SD and 28 healthy controls were recruited. Functional connectivity (FC) was designed to analyze the images. LIBSVM (a library for support vector machines) was used to identify whether abnormal FC could be utilized to discriminate the patients from the controls. The patients showed significantly increased FC between the left NAc and the right gyrus rectus and left medial prefrontal cortex/anterior cingulate cortex (MPFC/ACC), and between the right NAc and the left gyrus rectus and left MPFC/ACC compared with the controls. The patients could be separated from the controls through increased FC between the left NAc and the right gyrus rectus with a sensitivity of 88.00% and a specificity of 82.14%. The findings reveal that patients with SD have increased NAc connectivity with the frontal regions of the reward circuit. Increased left NAc-right gyrus rectus connectivity can be used as a potential marker to discriminate patients with SD from healthy controls. The study thus highlights the importance of the reward circuit in the neuropathology of SD.
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Affiliation(s)
- Yangpan Ou
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Qinji Su
- Mental Health Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yudan Ding
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Jindong Chen
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Zhikun Zhang
- Mental Health Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jingping Zhao
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Wenbin Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
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Ou Y, Liu F, Chen J, Pan P, Wu R, Su Q, Zhang Z, Zhao J, Guo W. Increased coherence-based regional homogeneity in resting-state patients with first-episode, drug-naive somatization disorder. J Affect Disord 2018; 235:150-154. [PMID: 29656259 DOI: 10.1016/j.jad.2018.04.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/08/2018] [Accepted: 04/04/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Abnormal neural activity has been observed in patients with somatization disorder (SD), especially in brain regions of the default-mode network (DMN). In this study, a coherence-based regional homogeneity (Cohe-ReHo) approach was used to detect abnormal regional synchronization in patients with SD, which might be used to differentiate the patients from the controls. METHODS We recruited 25 patients with SD and 28 healthy controls. The imaging data of the participants were analyzed using the Cohe-ReHo approach. LIBSVM (a library for support vector machines) was utilized to verify whether abnormal Cohe-ReHo values could be applied to separate patients with SD from healthy controls. RESULTS Compared with healthy controls, patients with SD showed an increased Cohe-ReHo in the left medial prefrontal cortex/anterior cingulate cortex (MPFC/ACC) (t = 5.5017, p < 0.001). No correlations were detected between the increased Cohe-ReHo values and clinical variables of the patients. The Cohe-ReHo values in the left MPFC/ACC could be applied to distinguish patients from controls with a sensitivity and a specificity of 84.00% and 85.71%, respectively. CONCLUSIONS An increased Cohe-ReHo was observed in the anterior DMN of the patients and could be applied as a marker to distinguish patients from healthy controls. These results highlighted the importance of the DMN in the pathophysiology of SD.
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Affiliation(s)
- Yangpan Ou
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300000, China
| | - Jindong Chen
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Pan Pan
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Renrong Wu
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Qinji Su
- Mental Health Center of the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530007, China
| | - Zhikun Zhang
- Mental Health Center of the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530007, China
| | - Jingping Zhao
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Wenbin Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China.
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Abstract
SummaryPatients with severe and enduring somatoform disorders (SESD) characteristically present with multiple, recurrent and frequently changing physical symptoms that have usually been present for several years before referral to a psychiatrist/psychologist. Many patients report long histories of contact with both primary and tertiary care services, have undergone repeated fruitless investigations and have high levels of disability. SESD are responsible for disproportionately high healthcare costs and are the third most common cause of workplace absence. Identification of patients with SESD by psychiatrists requires particular skills: collaboration with colleagues is vital and there are risks of iatrogenic harm. We describe the obstacles encountered in identifying these patients as well as methods of assessment and management. Treatment pathways best suited to managing this large and as yet untended group of patients are described.
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Sharma M, Singh SM, Avasthi A, Varma SC, Sharma A, Suri V. Medically unexplained physical symptoms in patients attending a medical outpatient clinic in a tertiary hospital in North India. Asian J Psychiatr 2018; 32:99-104. [PMID: 29222988 DOI: 10.1016/j.ajp.2017.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/31/2017] [Accepted: 11/27/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Medically unexplained physical symptoms (MUPS) are commonly seen across health care settings. Earlier studies have focussed on prevalence, cost-utilization and burden. Data from India is scarce. Patients with persistent MUPS have more impairment and psychological distress. This study was designed to assess psychological morbidity, health anxiety (HA), somatic symptom load, disability, quality of life (QOL) in patients with persistent MUPS presenting to a general medical outpatient service and compare it with patients with medically explained physical symptoms (MEPS). METHODS The study was conducted in the outpatient service of the Department of Internal Medicine in a tertiary hospital in North India. Persistent MUPS was defined as physical symptoms of at least 3 months duration leading to dysfunction and with no identifiable medical cause. 70 patients with persistent MUPS and MEPS each were recruited. Psychiatric morbidity was assessed using the Mini International Neuropsychiatric interview, somatic symptom load with Patient Health Questionniare-15 (PHQ-15), HA with Whiteley Index, disability with WHODAS 2.0 and QOL with WHOQOL-Bref. RESULTS Both the groups were comparable on socio-demography and length of symptoms. Prevalence of psychiatric disorders and HA was significantly greater in MUPS. Patients with persistent MUPS had significantly more health care utilization, number and burden of somatic symptoms, greater disability and worse QOL. CONCLUSIONS Patients with persistent MUPS have a different profile when compared to MEPS. There is a need to screen and identify patients with MUPS and manage them keeping in mind the psychological factors and chronic nature and number of symptoms.
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Affiliation(s)
- Mohit Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Shubh Mohan Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Subhash C Varma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Aman Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh 16012, India.
| | - Vikas Suri
- Postgraduate Institute of Medical Education and Research, Chandigarh 16012, India.
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Assessment of functioning and disability in patients with schizophrenia using the WHO Disability Assessment Schedule 2.0 in a large-scale database. Eur Arch Psychiatry Clin Neurosci 2018; 268:65-75. [PMID: 28801847 DOI: 10.1007/s00406-017-0834-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/06/2017] [Indexed: 12/28/2022]
Abstract
Schizophrenia is a common mental disorder characterized by deficits in multiple domains of functioning. This study is arguably the first of its kind in Taiwan to examine, in a multifaceted and objective manner, the disability of patients with schizophrenia and the factors affecting it. A cross-sectional design was adopted to gather data from 24,299 patients with schizophrenia who were listed in the Taiwan Databank of Persons with Disabilities. The level of disability in these patients was measured using the World Health Organization Disability Assessment Schedule 2.0. Statistical analyses were conducted through the χ 2 statistic and Poisson regression. The highest level of disability was in participation and the lowest was in self-care. An analysis of disability in all six domains of functioning on the basis of sex, age, type of residence, and socioeconomic status (SES) showed significant differences (P < 0.05). Significant factors (P < 0.05) affecting disability in these domains were female gender, age, educational attainment, SES, type of residence, and employment status. The overall degree of disability in schizophrenia patients was moderate. Six domains were measured in this study. The degrees of disability in mobility and self-care were mild while cognition, getting along, life activities, and participation were moderate. Moreover, female gender, an age of 45 or older, low educational attainment, middle to low SES, staying at healthcare institutions, and unemployment were crucial factors affecting disability of the participants. Preventive and rehabilitation programs should be developed to delay disability and functional degeneration in schizophrenic patients with these characteristics.
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Guo W, Liu F, Chen J, Wu R, Li L, Zhang Z, Chen H, Zhao J. Anatomical distance affects cortical-subcortical connectivity in first-episode, drug-naive somatization disorder. J Affect Disord 2017; 217:153-158. [PMID: 28411503 DOI: 10.1016/j.jad.2017.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/30/2017] [Accepted: 04/07/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Brain structural and functional alterations in the cortical-subcortical circuits have been observed in somatization disorder (SD). However, whether and how anatomical distance affects the cortical-subcortical connectivity in SD remain unclear. This study aims to examine whether anatomical distance affects the cortical-subcortical in first-episode, drug-naive SD. METHODS Twenty-five first-episode, drug-naive patients with SD and twenty-eight healthy controls were recruited for a resting-state scan. Regional functional connectivity strength (FCS) was calculated for each voxel in the brain, which was further divided into short- and long-range FCSs. Correlation analyses were conducted between abnormal FCS and clinical/cognitive variables in the patients. RESULTS Compared with the controls, the patients showed increased short-range positive FCS (spFCS) in the right superior frontal gyrus (SFG) and decreased spFCS in the left pallidum, and increased long-range positive FCS (lpFCS) in the left middle frontal gyrus and right inferior temporal gyrus (ITG). Positive correlations were observed between the spFCS values in the right SFG and Eysenck Personality Questionnaire psychoticism scores (r=0.441, p=0.027, uncorrected) and between the lpFCS values in the right ITG and scores of digit symbol-coding of Wechsler Adult Intelligence Scale (r=0.416, p=0.039, uncorrected) in the patients CONCLUSIONS: The patients exhibited increased spFCS/lpFCS in the cortical regions and decreased spFCS in the subcortical regions. The left pallidum is first reported here to show decreased spFCS in SD. The present results suggest that abnormal cortical-subcortical circuits may play an important role in SD neurobiology.
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Affiliation(s)
- Wenbin Guo
- Department of Psychiatry of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China; National Technology Institute on Mental Disorders, Changsha, Hunan 410011, China; Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China.
| | - Feng Liu
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jindong Chen
- Department of Psychiatry of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China; National Technology Institute on Mental Disorders, Changsha, Hunan 410011, China; Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Renrong Wu
- Department of Psychiatry of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China; National Technology Institute on Mental Disorders, Changsha, Hunan 410011, China; Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Lehua Li
- Department of Psychiatry of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China; National Technology Institute on Mental Disorders, Changsha, Hunan 410011, China; Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Zhikun Zhang
- Mental Health Center of the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Huafu Chen
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jingping Zhao
- Department of Psychiatry of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China; National Technology Institute on Mental Disorders, Changsha, Hunan 410011, China; Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China.
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Subramanian K, Manohar H, Menon V. Family accommodation in somatoform disorders-its effects on diagnosis and management: A case report. Asian J Psychiatr 2017; 27:147-148. [PMID: 28558890 DOI: 10.1016/j.ajp.2017.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 03/01/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Karthick Subramanian
- Senior Resident, Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Dhanvanthri Nagar, Puducherry, India.
| | - Harshini Manohar
- Senior Resident, Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Dhanvanthri Nagar, Puducherry, India.
| | - Vikas Menon
- Senior Resident, Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Dhanvanthri Nagar, Puducherry, India.
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Federici S, Bracalenti M, Meloni F, Luciano JV. World Health Organization disability assessment schedule 2.0: An international systematic review. Disabil Rehabil 2016; 39:2347-2380. [PMID: 27820966 DOI: 10.1080/09638288.2016.1223177] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument. METHOD Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases. RESULTS We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry). CONCLUSIONS The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.
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Affiliation(s)
- Stefano Federici
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Marco Bracalenti
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Fabio Meloni
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Juan V Luciano
- b Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu , St. Boi De Llobregat , Spain.,c Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Madrid , Spain
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Wang H, Guo W, Liu F, Chen J, Wu R, Zhang Z, Yu M, Li L, Zhao J. Clinical significance of increased cerebellar default-mode network connectivity in resting-state patients with drug-naive somatization disorder. Medicine (Baltimore) 2016; 95:e4043. [PMID: 27428190 PMCID: PMC4956784 DOI: 10.1097/md.0000000000004043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The cerebellum has been proven to be connected to the brain network, as in the default-mode network (DMN), among healthy subjects and patients with psychiatric disorders. However, whether or not abnormal cerebellar DMN connectivity exists and what its clinical significance is among drug-naive patients with somatization disorder (SD) at rest remain unclear.A total of 25 drug-naive patients with SD and 28 healthy controls were enrolled for a resting-state scan. The imaging data were analyzed using the seed-based functional connectivity (FC) method.Compared with the controls, patients with SD showed increased left/right Crus I-left/right angular gyrus (AG) connectivity and Lobule IX-left superior medial prefrontal cortex (MPFC) connectivity. The FC values of the left/right Crus I-right AG connectivity of the patients were positively correlated with their scores in the somatization subscale of the symptom checklist-90 (Scl-90). A trend level of correlations was observed between the FC values of the left Crus I-left AG connectivity of the patients and their scores for the somatization subscale of Scl-90, as well as between the FC values of their Lobule IX-left superior MPFC connectivity and their scores for the Eysenck personality questionnaire (EPQ) extraversion.Our findings show the increased cerebellar DMN connectivity in patients with SD and therefore highlight the importance of the DMN in the neurobiology of SD. Increased cerebellar DMN connectivities are also correlated with their somatization severity and personality, both of which bear clinical significance.
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Affiliation(s)
- Houliang Wang
- Department of Psychiatry, Mental Health Institute of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health. Changsha, Hunan 410011, China
| | - Wenbin Guo
- Department of Psychiatry, Mental Health Institute of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health. Changsha, Hunan 410011, China
- Correspondence: Wenbin Guo, Department of Psychiatry, Mental Health Institute of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health. Changsha, Hunan 410011, China (e-mail: )
| | - Feng Liu
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan
| | - Jindong Chen
- Department of Psychiatry, Mental Health Institute of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health. Changsha, Hunan 410011, China
| | - Renrong Wu
- Department of Psychiatry, Mental Health Institute of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health. Changsha, Hunan 410011, China
| | - Zhikun Zhang
- Mental Health Center, the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Miaoyu Yu
- Mental Health Center, the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Lehua Li
- Department of Psychiatry, Mental Health Institute of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health. Changsha, Hunan 410011, China
| | - Jingping Zhao
- Department of Psychiatry, Mental Health Institute of the Second Xiangya Hospital, Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health. Changsha, Hunan 410011, China
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20
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Wei S, Su Q, Jiang M, Liu F, Yao D, Dai Y, Long L, Song Y, Yu M, Zhang Z, Zhao J, Guo W. Abnormal default-mode network homogeneity and its correlations with personality in drug-naive somatization disorder at rest. J Affect Disord 2016; 193:81-8. [PMID: 26771948 DOI: 10.1016/j.jad.2015.12.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/23/2015] [Accepted: 12/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND While the default-mode network (DMN) appears to play a crucial role in patients suffering from somatization disorder (SD), the abnormalities of the network homogeneity (NH) of the DMN in SD patients have been poorly explored. The aim of this study is to examine DMN NH using an NH approach in patients suffering from SD at rest and determine its correlations with personality as measured by the Eysenck Personality Questionnaire (EPQ). METHODS A total of 25 drug-naive patients with SD and 28 sex-, age-, and education-matched healthy controls underwent functional magnetic resonance imaging scans at rest. The data were analyzed by an automated NH method. RESULTS Patients showed increased NH in the left superior frontal gyrus and decreased NH in the bilateral precuneus. Moreover, a significantly negative correlation was observed between the NH values in the bilateral precuneus and the EPQ--Neuroticism scores. LIMITATIONS The present study should be considered preliminary due to a lenient, uncorrected threshold of p<0.01. CONCLUSIONS The results suggest that abnormal DMN NH exists in drug-naive SD and further highlight the importance of the DMN in the pathophysiology of SD.
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Affiliation(s)
- Shubao Wei
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Qinji Su
- Mental Health Institute, The 303rd Hospital of Chinese People's Liberation Army, Nanning, Guangxi 530021, China
| | - Muliang Jiang
- Department of Radiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Feng Liu
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, China
| | - Dapeng Yao
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Yi Dai
- Department of Radiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Yan Song
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Miaoyu Yu
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Zhikun Zhang
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Jingping Zhao
- Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan 410011, China
| | - Wenbin Guo
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, China.
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Su Q, Yao D, Jiang M, Liu F, Long L, Dai Y, Yu M, Zhang Z, Zhang J, Liu J, Xiao C, Zhao J, Guo W. Decreased interhemispheric functional connectivity in insula and angular gyrus/supramarginal gyrus: Significant findings in first-episode, drug-naive somatization disorder. Psychiatry Res Neuroimaging 2016; 248:48-54. [PMID: 26826895 DOI: 10.1016/j.pscychresns.2016.01.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 11/01/2015] [Accepted: 01/03/2016] [Indexed: 01/14/2023]
Abstract
Neuroimaging data have demonstrated brain functional alterations in patients with somatization disorder (SD). However, there is little information on interhemispheric resting-state functional connectivity (FC) in SD. In this study, resting-state functional magnetic resonance imaging (fMRI) and voxel-mirrored homotopic connectivity (VMHC) were applied to examine the changes of interhemispheric FC of the whole brain in patients with SD. A total of 25 first-episode, medication-naive SD patients and 28 age-, sex-, education-matched healthy controls (HC) underwent resting-state fMRI, and the data were analyzed by VMHC. Compared with HC, patients had lower VMHC in the angular gyrus/supramarginal gyrus (AG/SG) and insula. The reproducibility of the results was validated using the split-half and leave-one-out validations. No significant correlation was found between the VMHC in AG/SG or insula and clinical variables. Our findings indicate that the interhemispheric FC in the AG/SG and insula is decreased in first-episode, treatment-naive patients with SD, and thus provide new insight for disruption of interhemispheric FC in the pathophysiological mechanism of SD.
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Affiliation(s)
- Qinji Su
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Dapeng Yao
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Muliang Jiang
- Department of Radiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Feng Liu
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, PR China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Yi Dai
- Department of Radiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Miaoyu Yu
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Zhikun Zhang
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Jian Zhang
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Jianrong Liu
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Changqing Xiao
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Jingping Zhao
- Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan 410011, PR China
| | - Wenbin Guo
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, PR China.
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22
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Alterations in white matter integrity in first-episode, treatment-naive patients with somatization disorder. Neurosci Lett 2015; 599:102-8. [DOI: 10.1016/j.neulet.2015.05.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 04/13/2015] [Accepted: 05/19/2015] [Indexed: 11/19/2022]
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23
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Su Q, Yao D, Jiang M, Liu F, Jiang J, Xu C, Dai Y, Yu M, Long L, Li H, Liu J, Zhang Z, Zhang J, Xiao C, Guo W. Increased functional connectivity strength of right inferior temporal gyrus in first-episode, drug-naive somatization disorder. Aust N Z J Psychiatry 2015; 49:74-81. [PMID: 25313257 DOI: 10.1177/0004867414553949] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evidence of brain structural and functional alterations have been implicated in patients with somatization disorder (SD). However, little is known about brain functional connectivity in SD. In the present study, resting-state functional magnetic resonance imaging (fMRI) and graph theory were used to obtain a comprehensive view of whole-brain functional connectivity and to investigate the changes of voxel-wise functional networks in patients with SD. METHODS Twenty-five first-episode, medication-naive patients with SD and 28 age-, sex- and education-matched healthy controls (HCs) underwent resting-state fMRI. The graph theory approach was employed to analyze the data. RESULTS Compared to the HCs, patients with SD showed significantly increased functional connectivity strength in the right inferior temporal gyrus (ITG). There is a significant positive correlation between the z-values of the cluster in the right ITG and Hamilton Anxiety Scale scores. CONCLUSIONS Our findings indicate that there is a disruption of the functional connectivity pattern in the right ITG in first-episode, treatment-naive patients with SD, which bears clinical significance.
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Affiliation(s)
- Qinji Su
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Dapeng Yao
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Muliang Jiang
- Department of Radiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Feng Liu
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jiajing Jiang
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Chunxing Xu
- Mental Health Institute, The 303rd Hospital of Chinese People's Liberation Army, Nanning, Guangxi, China
| | - Yi Dai
- Department of Radiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Miaoyu Yu
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Hongzheng Li
- Mental Health Institute, The 303rd Hospital of Chinese People's Liberation Army, Nanning, Guangxi, China
| | - Jianrong Liu
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Zhikun Zhang
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Jian Zhang
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Changqing Xiao
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Wenbin Guo
- Mental Health Center, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
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24
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Affiliation(s)
- Rakesh K. Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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25
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Kushwaha V, Sinha Deb K, Chadda RK, Mehta M. A study of disability and its correlates in somatization disorder. Asian J Psychiatr 2014; 8:56-8. [PMID: 24655628 DOI: 10.1016/j.ajp.2013.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 10/15/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The present study was conducted to assess disability, and its demographic and clinical correlates in patients suffering from somatization disorder. METHOD Sixty-six patients, diagnosed as somatization disorder according to ICD 10 Diagnostic Criteria for Research (ICD 10-DCR), were assessed for disability using the Indian Disability Evaluation and Assessment Scale (IDEAS). Patients were also assessed for associated anxiety, depression, neuroticism and subjective distress using the Hamilton Rating Scale for Anxiety (HAM-A), Hamilton Rating Scale for Depression (HAM-D), PGI Health Questionnaire N2 (PGIN2), and Visual Analog Scale, respectively. RESULTS Mean age of the sample was 34.5±5.8 years. Females constituted about 60% of the sample. Mean duration of illness was 9.14±4.13 years. More than 70% of the subjects suffered moderate to severe disability. Age, number of symptoms, duration of illness, and scores on HAM-A and HAM-D showed a positive correlation with disability. CONCLUSION Somatization disorder is associated with significant disability which increases with the number of somatic symptoms, duration of illness, associated depressive and anxiety symptoms.
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Affiliation(s)
- Vijeta Kushwaha
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Koushik Sinha Deb
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh K Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Manju Mehta
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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