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Queirolo L, Facco E, Bacci C, Mucignat C, Zanette G. Impairment of Hypnosis by Nocebo Response and Related Neurovegetative Changes: A Case Report in Oral Surgery. Int J Clin Exp Hypn 2024:1-13. [PMID: 38363817 DOI: 10.1080/00207144.2024.2311908] [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] [Received: 08/07/2023] [Accepted: 10/20/2023] [Indexed: 02/18/2024]
Abstract
This article presents the third molar removal in a highly hypnotizable patient, who had been successfully submitted to oral surgery with hypnosis as stand-alone anesthesia in previous sessions. Unexpectedly, hypnosis initially failed, as a result of a nocebo response due to a previous dentist's bad communication; two complaints made by the patient were associated with increased sympathetic activity (as defined by increased heart rate and electrodermal activity and decreased heart rate variability). After deepening of hypnosis, the patient achieved a full hypnotic analgesia allowing for a successful conclusion of the intervention, an event associated with decreased heart rate, electrodermal activity, and increased heart rate variability. Hence, the initial failure was paralleled by a decreased parasympathetic activity and increased sympathetic activity, while hypnotic analgesia was associated with the opposite pattern. The patient's postoperative report indicated that the initial failure of hypnosis depended on a strong nocebo effect because of a previous dentist distrusting hypnosis and persuading her that it was not enough to face a third molar removal.
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Affiliation(s)
- Luca Queirolo
- Department of Neurosciences, Section of Clinical Dentistry, University of Padova, Italy
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Italy
| | - Enrico Facco
- Department of Neurosciences, Section of Clinical Dentistry, University of Padova, Italy
- Institution Franco Granone-Italian Center for Clinical and Experimental Hypnosis, Turin, Italy
| | - Christian Bacci
- Department of Neurosciences, Section of Clinical Dentistry, University of Padova, Italy
| | - Carla Mucignat
- Department of Neurosciences, Section of Clinical Dentistry, University of Padova, Italy
- Department of Molecular Medicine, University of Padova, Italy
| | - Gastone Zanette
- Department of Neurosciences, Section of Clinical Dentistry, University of Padova, Italy
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Estévez-López F, Kim HH, López-Vicente M, Legerstee JS, Hillegers MHJ, Tiemeier H, Muetzel RL. Physical symptoms and brain morphology: a population neuroimaging study in 12,286 pre-adolescents. Transl Psychiatry 2023; 13:254. [PMID: 37438345 DOI: 10.1038/s41398-023-02528-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/14/2023] Open
Abstract
Physical symptoms, also known as somatic symptoms, are those for which medical examinations do not reveal a sufficient underlying root cause (e.g., pain and fatigue). The extant literature of the neurobiological underpinnings of physical symptoms is largely inconsistent and primarily comprises of (clinical) case-control studies with small sample sizes. In this cross-sectional study, we studied the association between dimensionally measured physical symptoms and brain morphology in pre-adolescents from two population-based cohorts; the Generation R Study (n = 2649, 10.1 ± 0.6 years old) and ABCD Study (n = 9637, 9.9 ± 0.6 years old). Physical symptoms were evaluated using continuous scores from the somatic complaints syndrome scale from the parent-reported Child Behavior Checklist (CBCL). High-resolution structural magnetic resonance imaging (MRI) was collected using 3-Tesla MRI systems. Linear regression models were fitted for global brain metrics (cortical and subcortical grey matter and total white matter volume) and surface-based vertex-wise measures (surface area and cortical thickness). Results were meta-analysed. Symptoms of anxiety/depression were studied as a contrasting comorbidity. In the meta-analyses across cohorts, we found negative associations between physical symptoms and surface area in the (i) left hemisphere; in the lateral orbitofrontal cortex and pars triangularis and (ii) right hemisphere; in the pars triangularis, the pars orbitalis, insula, middle temporal gyrus and caudal anterior cingulate cortex. However, only a subset of regions (left lateral orbitofrontal cortex and right pars triangularis) were specifically associated with physical symptoms, while others were also related to symptoms of anxiety/depression. No significant associations were observed for cortical thickness. This study in preadolescents, the most representative and well-powered to date, showed that more physical symptoms are modestly related to less surface area of the prefrontal cortex mostly. While these effects are subtle, future prospective research is warranted to understand the longitudinal relationship of physical symptoms and brain changes over time. Particularly, to elucidate whether physical symptoms are a potential cause or consequence of distinct neurodevelopmental trajectories.
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Affiliation(s)
- Fernando Estévez-López
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
- Department of Education, Faculty of Education Sciences, SPORT Research Group (CTS-1024) and CERNEP Research Center, University of Almería, Almería, Spain.
| | - Hannah H Kim
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Mónica López-Vicente
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ryan L Muetzel
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Björkman L, Musial F, Alræk T, Werner EL, Hamre HJ. Mercury, silver and selenium in serum before and after removal of amalgam restorations: results from a prospective cohort study in Norway. Acta Odontol Scand 2022; 81:298-310. [PMID: 36383213 DOI: 10.1080/00016357.2022.2143422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A prospective cohort study on changes of health complaints after removal of amalgam restorations was carried out at the request of the Norwegian Directorate of Health. The aim was to provide and evaluate experimental treatment to patients with health complaints attributed to dental amalgam fillings. METHODS Patients (n = 32) with medically unexplained physical symptoms (MUPS), which were attributed to dental amalgam restorations had all their amalgam restorations removed and replaced with other dental restorative materials. Samples of blood were collected before and 1 year after removal of the fillings, and concentration of inorganic mercury (I-Hg), methylmercury (MeHg), silver (Ag) and selenium (Se) in serum was determined by inductively coupled plasma-sector field mass spectrometry. The comparison groups (one with MUPS but without attribution to amalgam [n = 28] and one group of healthy individuals [n = 19]) received no treatment. The participants responded to questionnaires at baseline and at follow-up after 1 and 5 years. RESULTS Concentration of I-Hg and Ag in serum decreased significantly after removal of all amalgam restorations. Concentration of MeHg and Se in serum were not changed. Intensity of health complaints was significantly reduced after amalgam removal, but there were no statistically significant correlations between exposure indicators and health complaints. CONCLUSIONS Removal of all amalgam restorations is followed by a decrease of concentration of I-Hg and Ag in serum. The results support the hypothesis that exposure to amalgam fillings causes an increase of the daily dose of both I-Hg and Ag. Even though intensity of health complaints decreased after removal of all amalgam restorations there was no clear evidence of a direct relationship between exposure and health complaints. Trial registration: The project is registered at Clinicaltrials.gov (NCT01682278).
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Affiliation(s)
- Lars Björkman
- Dental Biomaterials Adverse Reaction Unit, NORCE Norwegian Research Centre AS, Bergen, Norway
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Frauke Musial
- Department of Community Medicine, Faculty of Health Sciences, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
| | - Terje Alræk
- Department of Community Medicine, Faculty of Health Sciences, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
| | - Erik L. Werner
- Research Unit for General Practice, NORCE Norwegian Research Centre AS, Bergen, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Harald J. Hamre
- Institute for Applied Epistemology and Medical Methodology, University of Witten/Herdecke, Freiburg, Germany
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Kjeldsberg M, Tschudi-Madsen H, Bruusgaard D, Natvig B. Factors related to self-rated health: a survey among patients and their general practitioners. Scand J Prim Health Care 2022; 40:320-328. [PMID: 35587746 PMCID: PMC9397452 DOI: 10.1080/02813432.2021.2022341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To explore associations between general practice patients' SRH and symptoms, diagnoses, chronic conditions, unexplained conditions, and life stressors. DESIGN A cross-sectional study. Data were collected from GP and patient questionnaires. SETTING General practices in Southeast Norway. SUBJECTS 47 general practitioners (GPs) who included 866 consecutive patients. MAIN OUTCOME MEASURES SRH was measured with a single question from the COOP-WONCA overall health chart and dichotomized into good/poor SRH. Binary logistic regression models were used in the analyses. RESULTS Poor SRH was reported by 48% of the patients in the past week. A higher prevalence of poor SRH was found for women, middle-aged, recipients of social security grants, patients diagnosed with asthenia, lower back pain, and depression/anxiety, and for patients with reported life stressors and unexplained conditions. We found an almost linear association between the number of symptoms and the likelihood of reporting poor SRH. The probability of reporting poor SRH increased along with an increasing number of symptoms for common diagnoses. In a multivariate analysis, the only number of symptoms, being in receipt of social security grants and being retired was associated with poor SRH. CONCLUSION The likelihood of reporting poor SRH increased with an increasing number of symptoms, partly independent of the diagnosis given by GPs. This result coincides with our previous findings of a strong association between the number of symptoms, function, and health. The symptom burden thus appears to be an important factor for SRH among patients in general practice.KEY POINTSThere is a high prevalence of poor SRH in general practice patients.The likelihood of reporting poor SRH is partly independent of the diagnosis given.The number of symptoms was the factor strongest associated with poor SRH.
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Affiliation(s)
- Mona Kjeldsberg
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
- CONTACT Mona Kjeldsberg General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, P.O. Box 1130Blindern, N-0318, Oslo, Norway
| | - H. Tschudi-Madsen
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - D. Bruusgaard
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - B. Natvig
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
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Diagnostic difficulty, delayed diagnosis, and increased tendencies of surgical treatment in fibromyalgia syndrome. Clin Rheumatol 2021; 41:831-837. [PMID: 34671855 DOI: 10.1007/s10067-021-05970-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/03/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Aimed to evaluate the time elapsed between the onset of early symptoms and the diagnosis of fibromyalgia syndrome (FMS), the delays in diagnosis and frequent physician visits, increased tendencies of surgical treatment, and the effects of FMS symptoms on the post-surgical result. PATIENTS AND METHODS While there were 101 patients diagnosed with FMS in the 1st group, there were 100 patients in the 2nd group who presented with musculoskeletal complaints but were not diagnosed with FMS. In both groups, information on duration of complaints, time until diagnosis, and number of evaluating physicians were included. They were questioned in terms of whether they had undergone elective surgery before and after FMS diagnosis, and in terms of operation sites. Among these operations, the ones regarding the musculoskeletal system were evaluated, and the preoperative and postoperative, before and after FMS diagnosis. RESULTS It was determined that the diagnosis of FMS was made late; the number of doctor visits increased in the period until the diagnosis, and the rate of surgical treatment was higher than in patients without FMS. It was determined that the patients who were operated on after being diagnosed with FMS gained from the operation while the rate of gaining from surgery was lower in patients with FMS symptoms who were operated on before the diagnosis was made. CONCLUSION The diagnosis of FMS reduces healthcare use, including referrals and examinations. Educating clinicians in the recognition and diagnosis of FMS will provide both patients and healthcare providers with benefits. Key Points • Early detection of FMS reduces healthcare utilization and expenditure, including referrals and examinations. • Educating clinicians in the recognition and diagnosis of FMS will provide both patients and healthcare providers with benefits. Therefore, it is important to understand why the diagnosis of FMS is made in a delayed manner. • Providing pragmatic tools to improve the methodology of primary care providers may help with diagnosing FMS accurately. • Early diagnosis and treatment of FMS may lead to a decrease in the number of operations and an improvement in the results of the operation.
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Björkman L, Musial F, Alraek T, Werner EL, Weidenhammer W, Hamre HJ. Removal of dental amalgam restorations in patients with health complaints attributed to amalgam: A prospective cohort study. J Oral Rehabil 2020; 47:1422-1434. [PMID: 32810306 DOI: 10.1111/joor.13080] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The Norwegian Ministry of Health and Care Services initiated a project including experimental treatment for patients with health complaints attributed to amalgam restorations. OBJECTIVE The aim was to evaluate changes of general health complaints in patients who participated in the project and had all amalgam restorations removed. METHODS The project was designed as a prospective cohort study and organised by the Dental Biomaterials Adverse Reaction Unit in Bergen, Norway. The dental treatment was provided by the patient's local dentist. The main target group consisted of patients with medically unexplained physical symptoms, attributed to dental amalgam restorations (Amalgam cohort). The primary comparison group consisted of patients with medically unexplained physical symptoms without attribution to dental amalgam restorations (MUPS cohort). Primary outcome was self-reported general health complaints (GHC index) at follow-up 12-months after completed amalgam removal. RESULTS In the Amalgam cohort, a significant reduction of GHC index from 43.3 (SD 17.8) at baseline to 30.5 (SD 14.4) at follow-up (mean reduction 12.8, SD 15.9; n = 32; P < .001) was observed. The change scores for GHC index indicated that the reduction of complaints was significantly higher (P = .004) in the Amalgam cohort compared with the MUPS cohort (mean reduction 1.2, SD 12.3, n = 28). After adjustment for age, gender, education and baseline GHC index, the mean adjusted difference was -8.0 (95% confidence interval from -15.4 to -0.5; P = .036). CONCLUSION In a group of patients with medically unexplained physical symptoms, which they attributed to dental amalgam restorations, removal of amalgam restorations was followed by a significant reduction of health complaints.
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Affiliation(s)
- Lars Björkman
- Dental Biomaterials Adverse Reaction Unit, NORCE Norwegian Research Centre AS, Bergen, Norway.,Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Frauke Musial
- Department of Community Medicine, Faculty of Health Sciences, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
| | - Terje Alraek
- Department of Community Medicine, Faculty of Health Sciences, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
| | - Erik L Werner
- Research Unit for General Practice, Uni Research Health Bergen, Bergen, Norway.,Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Harald J Hamre
- Institute for Applied Epistemology and Medical Methodology, University of Witten/Herdecke, Freiburg, Germany
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TAN Y, ŞAHİN EM. The association between somatic symptoms and sociodemographic and clinical characteristics. KONURALP TIP DERGISI 2020. [DOI: 10.18521/ktd.622524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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8
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Rao GR, Ranjan P, Chadda RK, Kaloiya GS, Dwivedi SN, Baitha U, Soneja M, Jadon RS. A descriptive study of disability in patients presenting with medically unexplained physical symptoms in a medical OPD setting. J Family Med Prim Care 2019; 8:1755-1759. [PMID: 31198750 PMCID: PMC6559060 DOI: 10.4103/jfmpc.jfmpc_223_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Medically unexplained physical symptoms (MUPS) are quite common in the primary care setting. These unexplained symptoms lead to physical, psychological, and functional disability increasing patient and caregiver distress. Methodology: Cross-sectional study was conducted on a sample of 100 patients attending medicine outpatient department. The data on sociodemographic profile and detailed clinical history were collected. Disability was assessed using the World Health Organization Disability Assessment Schedule 2.0 instrument. Association between qualitative measures was measured by Chi-square test or Fisher's exact test and for qualitative measure t-test or Wilcoxon test was used. Results: Most of the patients were young, from urban settings and belonging to lower socioeconomic strata. A mean of 6.54 symptoms per patient was presented with headache as the most common symptom. Average gross disability score in each domain was 1.6 with a major impact on the social and lifestyle-related domain. Conclusion: Patients with MUPS have significant disability especially in the domain of mobility and lifestyle-related activities. The disability is more in females, population dwelling in urban settlements, and population belonging to lower socioeconomic status.
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Affiliation(s)
| | | | | | - G S Kaloiya
- Department of Psychiatry, AIIMS, New Delhi, India
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Schéle I, Ask I, Claeson AS. Prototype stories of life with Chemical Intolerance – when the environment becomes a threat to health and well-being. OPEN PSYCHOLOGY 2019. [DOI: 10.1515/psych-2018-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractWe aimed to explore how individuals living with Chemical Intolerance (CI) describe the onset and progression of CI, and how they live and cope with CI. The participants were recruited via Swedish websites hosted by CI support groups. A postal survey, including a Life history calender, was sent to potential participants. Eleven respondents fitted the consensus-based criteria for CI while not reporting comorbidity. A narrative analysis of their written replies resulted in five prototypical stories based on similarities in the onset and course of CI. All five stories contain descriptions of alienation from society and insufficient social support. Differences in participants’ perceptions of the symptom onset – with regard to suddenness, the point in life and the perceived cause of symptoms – partly corresponded to etiological theories of CI related to stress or inflammation. Further differences between the prototype stories mainly concern the possible effects on health and well-being related to social support and coping. Given these differences, we recommend that medical professionals and others apply a holistic, context-sensitive approach before discouraging or promoting a specific coping strategy in relation to CI.
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Affiliation(s)
| | - Ida Ask
- Department of Psychology, Umeå University and Byske Health Center
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10
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Brown JD. A description of 'Australian Lyme disease' epidemiology and impact: an analysis of submissions to an Australian senate inquiry. Intern Med J 2018; 48:422-426. [PMID: 29363839 DOI: 10.1111/imj.13746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 01/09/2018] [Accepted: 01/17/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Many Australian patients are diagnosed and treated for the scientifically and politically controversial diagnosis of an endemic form of 'Australian Lyme Disease'. Patient advocacy led Senator John Madigan to propose an Australian Senate Inquiry into this illness. AIM To describe the symptomology and outcomes of patients diagnosed and treated with Lyme disease in Australia. METHODS All public, first-person submissions (n = 698) to the inquiry were reviewed and responses analysed for epidemiology, symptoms and impact against structured criteria. RESULTS The most common symptoms described were fatigue (62.6%), disordered thinking (51.9%) and sensory disturbance (46.1%). Respondents reported experiencing symptoms for a median of 10 years and spent a median of $30 000 on diagnosis and treatment. Almost 10% of respondents self-diagnosed after being exposed to a media report of Australian Lyme disease. CONCLUSIONS Patients diagnosed with Lyme disease in Australia display a symptomology similar to 'medically unexplained physical symptoms' syndromes, experience social and financial harms, and are at risk of nosocomial harms. Negative medical interactions and the media may contribute to patients seeking alternative and potentially non-evidence-based diagnoses and treatments.
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Affiliation(s)
- Jeremy D Brown
- Institute for Clinical Pathology and Medical Research, Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Sydney, New South Wales, Australia.,Nepean Hospital, Nepean Blue Mountains Health District, Sydney, New South Wales, Australia.,Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
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11
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Misery L, Dutray S, Chastaing M, Schollhammer M, Consoli SG, Consoli SM. Psychogenic itch. Transl Psychiatry 2018; 8:52. [PMID: 29491364 PMCID: PMC5830411 DOI: 10.1038/s41398-018-0097-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/06/2017] [Accepted: 11/01/2017] [Indexed: 11/09/2022] Open
Abstract
Psychogenic itch can be defined as "an itch disorder where itch is at the center of the symptomatology and where psychological factors play an evident role in the triggering, intensity, aggravation, or persistence of the pruritus." The disorder is poorly known by both psychiatrists and dermatologists and this review summarizes data on psychogenic itch. Because differential diagnosis is difficult, the frequency is poorly known. The burden is huge for people suffering from this disorder but a management associating psychological and pharmacological approach could be very helpful. Classification, psychopathology, and physiopathology are still debating. New data from brain imaging could be very helpful. Psychological factors are known to modulate itch in all patients, but there is a specific diagnosis of psychogenic itch that must be proposed cautiously. Neurophysiological and psychological theories are not mutually exclusive and can be used to better understand this disorder. Itch can be mentally induced. Opioids and other neurotransmitters, such as acetylcholine and dopamine, are probably involved in this phenomenon.
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Affiliation(s)
- Laurent Misery
- French Psychodermatology Group, French Society of Dermatology, Paris, France. .,Department of Dermatology, University Hospital of Brest, Brest, France. .,Laboratory of Neurosciences of Brest, University of Western Brittany, Brest, France.
| | - Sabine Dutray
- French Psychodermatology Group, French Society of Dermatology, Paris, France ,0000 0004 0472 3249grid.411766.3Department of Dermatology, University Hospital of Brest, Brest, France
| | - Myriam Chastaing
- French Psychodermatology Group, French Society of Dermatology, Paris, France ,0000 0001 2188 0893grid.6289.5Laboratory of Neurosciences of Brest, University of Western Brittany, Brest, France ,Department of Psychiatry and Medical Psychology, Unit of Liaison Psychiatry, Brest, France
| | - Martine Schollhammer
- French Psychodermatology Group, French Society of Dermatology, Paris, France ,0000 0004 0472 3249grid.411766.3Department of Dermatology, University Hospital of Brest, Brest, France
| | - Sylvie G. Consoli
- French Psychodermatology Group, French Society of Dermatology, Paris, France
| | - Silla M. Consoli
- French Psychodermatology Group, French Society of Dermatology, Paris, France ,0000 0004 1788 6194grid.469994.fDepartment of Consultation Liaison Psychiatry, Paris-Descartes University, Sorbonne Paris Cité, Paris, France
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12
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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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Rainham D, Brown P, Sampalli T. Spatial variation in risk for physician diagnosed environmental sensitivity. Spat Spatiotemporal Epidemiol 2017; 23:35-45. [PMID: 29108689 DOI: 10.1016/j.sste.2017.07.002] [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] [Received: 02/21/2017] [Revised: 07/20/2017] [Accepted: 07/29/2017] [Indexed: 10/19/2022]
Abstract
Multiple chemical sensitivity (MCS) is a chronic condition characterized by recurring and severe symptoms triggered by exposures to low levels of toxicants or anthropogenic pollution. This study investigated the spatial structure of MCS incidence and estimated the contribution of socio-economic deprivation to variations in rates of MCS at the community level in Nova Scotia, Canada. Patient data were used to calculate cumulative incidence rate ratios for treated multiple chemical sensitivities. Poisson regression with a spatially autoregressive random effect was employed to assess spatial variation in MCS. Odds of MSC incidence are greatest among patients from the highest socioeconomic category using the most socioeconomically deprived category as reference (OR: 1.94, CI [2.5-95%] 1.45-2.56). No discernable spatial pattern for MCS risk was evident after controlling for known risk factors. This is the first study to investigate spatial variations in cumulative incidence of multiple chemical sensitivities. The socioeconomic status of the community in which patients live has a significant influence on the geographic patterns of MCS. Future research will include a smartphone application to assess positional and temporal information on environmental exposures to further explain MCS prevalence.
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Affiliation(s)
- Daniel Rainham
- Healthy Populations Institute, Dalhousie University, 1318 Robie Street, Halifax, Nova Scotia B3H 3E2, Canada.
| | - Patrick Brown
- Department of Statistical Sciences, University of Toronto, 100 St. George St., Toronto, Ontario M5S 3G3, Canada.
| | - Tara Sampalli
- Primary Health Care, Nova Scotia Health Authority, 6960 Mumford Road, Suite 265, Halifax, Nova Scotia B3L 4P1, Canada.
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Facco E, Lucangeli D, Tressoldi P. On the Science of Consciousness: Epistemological Reflections and Clinical Implications. Explore (NY) 2017; 13:163-180. [PMID: 28359768 DOI: 10.1016/j.explore.2017.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Indexed: 12/18/2022]
Abstract
Consciousness has been one of the most important and tantalizing issues ever since the origin of philosophy and medicine. The concept of consciousness and the so-called "hard problem" (i.e., the mind-brain relationship) are highly complex topics that have yet to be elucidated, involving the realms of both science and philosophy with profound epistemological implications. In the lively debate on the foundations of the science of consciousness there are several potential biases of an essentially philosophical nature, such as those related to the paradigm and axioms adopted, and the ostensible logical contradiction between monism and dualism. Their origin dates back largely to Descartes' thinking and the birth of the new sciences as a compromise with the Inquisition, but they have been handed down through the Enlightenment and Positivism. A proper investigation of consciousness and the world of subjectivity demands a careful reflection on the paradigm of scientific medicine to identify possible flaws and overcome the limits of the mechanistic-reductionist approach.
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Affiliation(s)
- Enrico Facco
- Studium Patavinum, University of Padua, Italy; Institute Franco Granone-Italian Center of Clinical & Experimental Hypnosis (CIICS), Turin, Italy.
| | - Daniela Lucangeli
- Department of Developmental Psychology and Socialization, University of Padua, Italy; Human Potential Network Research Foundation, Padua, Italy
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Brownell AKW, Atkins C, Whiteley A, Woollard RF, Kornelsen J. Clinical practitioners' views on the management of patients with medically unexplained physical symptoms (MUPS): a qualitative study. BMJ Open 2016; 6:e012379. [PMID: 28003283 PMCID: PMC5223638 DOI: 10.1136/bmjopen-2016-012379] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES By identifying strategies that practicing physicians use in managing patients with medically unexplained physical symptoms (MUPS), we present an interim practical management guide (IPMG) that clinical practitioners may find useful in their clinical practices and that may help guide future research. DESIGN A qualitative research study based on interview data from practicing physicians with experience in dealing with MUPS and known to the physician members of the research team. A parallel exploration of patient experiences was carried out simultaneously and is reported elsewhere. SETTING 2 urban centres in 2 different Canadian provinces in a healthcare system where family physicians provide the majority of primary care and self-referral to specialists rarely occurs. PARTICIPANTS The physician members of the research team invited practicing family and specialty physicians to participate in the study. RESULTS We characterise the care of patients with MUPS in terms of a 4-part framework: (1) the challenge of diagnosis; (2) the challenge of management/treatment; (3) the importance of communication and (4) the importance of the therapeutic relationship. CONCLUSIONS On the basis of the details in the different parts of the framework, we propose an IPMG that practitioners may find useful to facilitate the clinical care of patients with MUPS. The guide can be readily implemented into the practice of any physician who cares for patients with MUPS.
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Affiliation(s)
- A Keith W Brownell
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chloe Atkins
- Department of Sociology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Whiteley
- Graduate Program in Communication and Media, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Robert F Woollard
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jude Kornelsen
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Söderholm A, Öhman A, Stenberg B, Nordin S. Experience of living with nonspecific building-related symptoms. Scand J Psychol 2016; 57:406-12. [PMID: 27532686 DOI: 10.1111/sjop.12319] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/28/2016] [Indexed: 11/27/2022]
Abstract
Nonspecific building-related symptoms (NBRS) is a combination of general, skin and mucosal symptoms related to certain buildings. Despite high prevalence in the general population and severe symptomatology in certain cases there is no scientific documentation of quality of life in NBRS. The purpose of this study was to illuminate how individuals with NBRS experience daily life. Data were collected through descriptive, written texts and through telephone interviews with 11 individuals diagnosed with NBRS, and qualitative content analysis was conducted. Three main content areas were identified: (1) attitudes from the surrounding (categories: being questioned and lack of understanding from others; from zero to full support); (2) consequences (difficulties with daily activities; financial difficulties; affecting family and friends; emotional consequences); and (3) coping (learning to accept and finding solutions; avoiding; struggling; finding the positive; making one's home a sanctuary). As a conclusion, NBRS may affect several aspects of daily life, resulting in considerable alterations, limitations and emotional impact for the afflicted person and his/her family. Both environmental factors and attitudes from the surrounding can contribute to this impact on daily life. Strategies needed to cope with this impact may include both problem-focused and emotion-focused strategies, such as struggling, avoiding trigger factors and finding positive aspects.
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Affiliation(s)
| | - Ann Öhman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Umeå Centre for Gender Studies, Umeå University, Umeå, Sweden
| | - Berndt Stenberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
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Daniilidou P, Carding P, Wilson J, Drinnan M, Deary V. Cognitive Behavioral Therapy for Functional Dysphonia: A Pilot Study. Ann Otol Rhinol Laryngol 2016; 116:717-22. [DOI: 10.1177/000348940711601002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: We sought to investigate whether a brief period of training in cognitive behavioral therapy (CBT) can improve the treatment of functional dysphonia by a speech and language therapist and ameliorate the psychological distress associated with this condition. Methods: In a consecutive cohort design, a speech and language therapist treated a small cohort (n = 15) of dysphonic patients with voice therapy alone. After a brief period of CBT training, she treated the next cohort of dysphonic patients (n = 13) with CBT-enhanced voice therapy. Pretreatment and posttreatment measures were taken of voice quality and voice-related quality of life. The General Health Questionnaire 28 and the Hospital Anxiety and Depression Scale were used to assess psychological distress and general well-being. Results: All voice measures improved significantly in both cohorts. Both groups improved significantly on the General Health Questionnaire 28, with the CBT group improving significantly more than the control group. Only the CBT group improved significantly on the Hospital Anxiety and Depression Scale (depression subscale). Conclusions: Despite limitations of size, design, and between-group baseline differences, the results support the hypothesis that the addition of CBT skills to existing voice therapy is both feasible and clinically effective in the treatment of functional dysphonia.
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18
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Facco E, Agrillo C, Greyson B. Epistemological implications of near-death experiences and other non-ordinary mental expressions: Moving beyond the concept of altered state of consciousness. Med Hypotheses 2015; 85:85-93. [PMID: 25892488 DOI: 10.1016/j.mehy.2015.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 03/31/2015] [Accepted: 04/06/2015] [Indexed: 11/19/2022]
Abstract
During the last decades an increasing interest has developed in the so-called altered state of consciousness (ASCs); among these, near-death experiences (NDEs) are one of the most intriguing and debated examples. NDEs are deep and universal experiences with a clear phenomenology and incidence, while some of their features challenge the current views of human consciousness (focused on neural circuits and based on the concept of mind as a byproduct of brain circuitry) with relevant epistemological and historical implications. The origin of the ruling mechanist-reductionist paradigm can be traced back to Descartes' radical separation of res cogitans and res extensa and the conflict between the nascent science and the Inquisition; this led to removing the subjective properties of mind from the field of scientific interest, relegating them to philosophy and theology in order to enable the development of modern science. However, the physics of the 20th century has eventually moved beyond the classical paradigm, permitting a profound renewal of scientific interest in the mind. Modern research on NDEs has contributed to reopening the debate surrounding the Cartesian separation, the mind-brain relationship and the nature of consciousness. It is now time to reappraise the relevance, strengths, and weaknesses of the available scientific interpretations of NDEs, their relationship with other ASCs, as well as the very concept of ASC; the latter looks to be ill-founded, suggesting the need for: (a) a revision of the conventional approach to subjective phenomena, including both the third- and first-person perspective; and (b) a deep reflection on the possible links between different non-ordinary mental expression, as regards both their phenomenology and mechanisms from a non-pathological perspective.
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Affiliation(s)
- Enrico Facco
- Department of Neurosciences, University of Padua, Italy; Inst. F. Granone - Italian Center of Clinical and Experimental Hypnosis (CIICS), Turin, Italy.
| | - Christian Agrillo
- Department of General Psychology, University of Padua, Italy; Cognitive Neuroscience Center, University of Padua, Italy
| | - Bruce Greyson
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, United States
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19
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Management of a patient with slow recovery from a mild traumatic brain injury. PM R 2014; 5:890-9. [PMID: 24160302 DOI: 10.1016/j.pmrj.2013.08.599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 08/22/2013] [Indexed: 11/23/2022]
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20
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Hennings A, Schwarz MJ, Riemer S, Stapf TM, Selberdinger VB, Rief W. Exercise affects symptom severity but not biological measures in depression and somatization - results on IL-6, neopterin, tryptophan, kynurenine and 5-HIAA. Psychiatry Res 2013; 210:925-33. [PMID: 24140252 DOI: 10.1016/j.psychres.2013.09.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 09/11/2013] [Accepted: 09/15/2013] [Indexed: 01/15/2023]
Abstract
Exercise leads to symptom reduction in affective disorders and functional somatic syndromes. Biological hypotheses of underlying mechanisms include serotonergic and immunological pathways. We aimed to investigate biological features in persons with major depression and somatoform syndromes, and to analyze effects of short-term graded exercise on these parameters. Baseline values for depressive and somatoform symptoms, tryptophan, kynurenine, 5-hydroxyindoleacetic acid, neopterin and interleukin-6 were compared with those after one week of increased and one week of reduced physical activity. Thirty-eight persons with major depression, 27 persons with a minimum of 6-8 somatoform symptoms, and 48 healthy controls participated in the study. Depressive and somatoform symptoms were reduced after the active week, and an interaction pointed towards group-specific reduction of psychopathology. Participants with major depression had lower levels of kynurenine compared to controls, with intermediate concentrations in somatoform patients. There were no systematic associations of symptom improvement with biological changes. A possible limitation of the design is that a control condition with low physical activity, but no placebo condition was included. People with multiple somatoform symptoms and major depression benefit from a short and low-graded exercise intervention. These effects do not seem to be mediated by changes in serotonergic and inflammatory parameters.
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Affiliation(s)
- Anika Hennings
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstrasse 18, 35032 Marburg, Germany.
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21
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Andersson L, Claeson AS, Ledin L, Wisting F, Nordin S. The influence of health-risk perception and distress on reactions to low-level chemical exposure. Front Psychol 2013; 4:816. [PMID: 24204356 PMCID: PMC3817372 DOI: 10.3389/fpsyg.2013.00816] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/14/2013] [Indexed: 11/13/2022] Open
Abstract
The general aim of the current study was to investigate how perceived health risk of a chemical exposure and self-reported distress are related to perceived odor intensity and odor valence, symptoms, cognitive performance over time as well as reactions to blank exposure. Based on ratings of general distress, 20 participants constituted a relatively low distress group, and 20 other participants a relatively high distress group. Health risk perception was manipulated by providing positively and negatively biased information regarding n-butanol. Participants made repeated ratings of intensity, valence and symptoms and performed cognitive tasks while exposed to 4.7 ppm n-butanol for 60 min (first 10 min were blank exposure) inside an exposure chamber. Ratings by the positive and negative bias groups suggest that the manipulation influenced perceived health risk of the exposure. The high distress group did not habituate to the exposure in terms of intensity when receiving negative information, but did so when receiving positive information. The high distress group, compared with the low distress group, rated the exposure as significantly more unpleasant, reported greater symptoms and performed worse on a cognitively demanding task over time. The positive bias group and high distress group rated blank exposure as more intense. The main findings suggest that relatively distressed individuals are negatively affected by exposures to a greater degree than non-distressed.
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22
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Facco E, Pasquali S, Zanette G, Casiglia E. Hypnosis as sole anaesthesia for skin tumour removal in a patient with multiple chemical sensitivity. Anaesthesia 2013; 68:961-5. [DOI: 10.1111/anae.12251] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2013] [Indexed: 11/26/2022]
Affiliation(s)
- E. Facco
- Department of Neurosciences University of Padua, and the Italian Center for Clinical and Experimental Hypnosis Turin Italy
| | - S. Pasquali
- Department of Oncological and Surgical Sciences University of Padua Padua Italy
| | - G. Zanette
- Department of Neurosciences University of Padua, and the Italian Center for Clinical and Experimental Hypnosis Turin Italy
| | - E. Casiglia
- Department of Medicine University of Padua, and the Italian Center for Clinical and Experimental Hypnosis Turin Italy
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23
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Yoon BI, Han DS, Ha US, Lee SJ, Sohn DW, Kim HW, Han CH, Cho YH. Clinical courses following acute bacterial prostatitis. Prostate Int 2013; 1:89-93. [PMID: 24223408 PMCID: PMC3814117 DOI: 10.12954/pi.12013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 05/15/2013] [Indexed: 11/13/2022] Open
Abstract
Purpose: There are few studies about clinical courses following acute bacterial prostatitis (ABP). We evaluated the progression rates of chronic bacterial prostatitis (CBP) and inflammatory chronic pelvic pain syndrome (CPPS) after ABP treatment. Also evaluated the characteristics of the patients who developed CBP and inflammatory CPPS after ABP treatment. Methods: Total 437 patients compatible with a confirmed diagnosis of ABP from 5 urological centers between 2001 and 2010 were enrolled to study. We defined chronic infection (CI) as a progression to CBP and inflammatory CPPS after treatment of ABP in admission periods when followed up at 3 months or more. Results were analyzed between two groups: recovered without CI (group A, n=385) and developed to CI (group B, n=52). Results: Of the 437 ABP patients, 1.3% (6/437) progressed to CBP and 10.5% (46/437) progressed to inflammatory CPPS. The progression rate of CI was 11.8% (52/437). The patients who developed to CI were higher in alcohol consumption rate, diabetes, voiding symptoms, prior manipulation rate, enlarged prostate volume, catheterization history rate and short duration of antibiotic treatment (P<0.05). Conclusions: The identification and characterization of these factors may accelerate the development of preventive, diagnostic and therapeutic strategies for the treatment of CI from ABP.
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Affiliation(s)
- Byung Il Yoon
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
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24
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Abstract
Pruritus and psyche are intricately and reciprocally related, with psychophysiological evidence and psychopathological explanations helping us to understand their complex association. Their interaction may be conceptualized and classified into 3 groups: pruritic diseases with psychiatric sequelae, pruritic diseases aggravated by psychosocial factors, and psychiatric disorders causing pruritus. Management of chronic pruritus is directed at treating the underlying causes and adopting a multidisciplinary approach to address the dermatologic, somatosensory, cognitive, and emotional aspects. Pharmcotherapeutic agents that are useful for chronic pruritus with comorbid depression and/or anxiety comprise selective serotonin reuptake inhibitors, mirtazapine, tricyclic antidepressants (amitriptyline and doxepin), and anticonvulsants (gabapentin, pregabalin); the role of neurokinin receptor-1 antagonists awaits verification. Antipsychotics are required for treating itch and formication associated with schizophrenia and delusion of parasitosis (including Morgellons disease).
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Affiliation(s)
- Hong Liang Tey
- Department of Dermatology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA
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Dupas D, Dagorne MA. Syndrome d’intolérance aux odeurs chimiques (SIOC) : un diagnostic à ne pas manquer. Épidémiologie, diagnostic, traitement. ARCH MAL PROF ENVIRO 2013. [DOI: 10.1016/j.admp.2013.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Barnig C, de Blay F. [Pathophysiology of multiple chemical sensitivity]. Rev Mal Respir 2013; 30:446-50. [PMID: 23835316 DOI: 10.1016/j.rmr.2013.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 02/11/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND BACKGROUND Multiple chemical sensitivity (MCS) is a complex clinical entity that includes a large number of non-specific symptoms, associated in a univocal manner in each patient and triggered by exposure to various chemicals at low concentrations, well below those known to cause toxic effects. However, no objective test exists currently to diagnose this syndrome. One of the main reasons is that the pathophysiology is poorly understood. However, many explanatory hypotheses have been proposed. VIEWPOINTS AND CONCLUSIONS Patients with symptoms of MCS are often encountered by pulmonologists. Their suffering is undeniable but, unfortunately, the lack of understanding of the pathophysiological mechanisms makes treatment difficult and empirical.
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Affiliation(s)
- C Barnig
- Service de pneumologie, d'allergologie et de pathologie respiratoire de l'environnement, pôle de pathologie thoracique, hôpitaux universitaires de Strasbourg, BP 426, 67091 Strasbourg cedex, France.
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27
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[Multiple chemical sensitivity: a diagnosis not to be missed]. Rev Mal Respir 2012; 30:99-104. [PMID: 23419440 DOI: 10.1016/j.rmr.2012.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 06/26/2012] [Indexed: 11/23/2022]
Abstract
Multiple chemical sensitivity (MCS) is a chronic condition, which belongs to the group of medically unexplained syndromes. Patients (men as well as women) complain of many subjective symptoms such as nose and mouth irritation, sore throat, dyspnea, tiredness, dizziness, headache and concentration difficulties. Patient typically report at least four or five symptoms occurring when they are exposed to particular substances, at a very low concentration that usually does not cause symptoms or harm in normal individuals. The common feature of products that appear to be responsible (either occupational or domestic) is that they have a strong smell and include: solvent, paint, glue, tar, oil, pesticides, perfume, cosmetics and spray products. MCS is nowadays considered to be one aspect of idiopathic environmental intolerance (IEI) whose other main aspect is hypersensitivity to electromagnetic fields. If the diagnosis is suspected clinically it can be confirmed using the Quick Environmental Exposure and Sensitivity Inventory (QEESI(©)) self-questionnaire. MCS is often misdiagnosed as asthma or an allergic conditions which means that patients are frequently referred to respiratory and allergy specialists. Misdiagnosis can lead to many futile medical investigations. Psychotherapy can improve quality of life in some cases. Preventive measures are often ineffective and do not stop the condition worsening: hypersensitivity can spread to common environmental odors so that a few people become severely disabled and limited in their workplace as well as in private life. In France, 435 cases were registered in the university hospital occupational disease departments network (RNV3P) during the period 2007-2010. It is therefore important that every clinician be able to recognize the condition and ensure that their patients could get compensation when unable to go on working.
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Schaefert R, Hausteiner-Wiehle C, Häuser W, Ronel J, Herrmann M, Henningsen P. Non-specific, functional, and somatoform bodily complaints. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:803-13. [PMID: 23248710 PMCID: PMC3521192 DOI: 10.3238/arztebl.2012.0803] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 09/19/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND 4-10% of the general population and 20% of primary care patients have what are called "non-specific, functional, and somatoform bodily complaints." These often take a chronic course, markedly impair the sufferers' quality of life, and give rise to high costs. They can be made worse by inappropriate behavior on the physician's part. METHODS The new S3 guideline was formulated by representatives of 29 medical and psychological specialty societies and one patient representative. They analyzed more than 4000 publications retrieved by a systematic literature search and held two online Delphi rounds and three consensus conferences. RESULTS Because of the breadth of the topic, the available evidence varied in quality depending on the particular subject addressed and was often only of moderate quality. A strong consensus was reached on most subjects. In the new guideline, it is recommended that physicians should establish a therapeutic alliance with the patient, adopt a symptom/coping-oriented attitude, and avoid stigmatizing comments. A biopsychosocial diagnostic evaluation, combined with sensitive discussion of signs of psychosocial stress, enables the early recognition of problems of this type, as well as of comorbid conditions, while lowering the risk of iatrogenic somatization. For mild, uncomplicated courses, the establishment of a biopsychosocial explanatory model and physical/social activation are recommended. More severe, complicated courses call for collaborative, coordinated management, including regular appointments (as opposed to ad-hoc appointments whenever the patient feels worse), graded activation, and psychotherapy; the latter may involve cognitive behavioral therapy or a psychodynamic-interpersonal or hypnotherapeutic/imaginative approach. The comprehensive treatment plan may be multimodal, potentially including body-oriented/non-verbal therapies, relaxation training, and time-limited pharmacotherapy. CONCLUSION A thorough, simultaneous biopsychosocial diagnostic assessment enables the early recognition of non-specific, functional, and somatoform bodily complaints. The appropriate treatment depends on the severity of the condition. Effective treatment requires the patient's active cooperation and the collaboration of all treating health professionals under the overall management of the patient's primary-care physician.
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Affiliation(s)
- Rainer Schaefert
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Thibautstrasse 2, Heidelberg, Germany.
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Kendall EA, Zaman RU, Naved RT, Rahman MW, Kadir MA, Arman S, Azziz-Baumgartner E, Gurley ES. Medically unexplained illness and the diagnosis of hysterical conversion reaction (HCR) in women's medicine wards of Bangladeshi hospitals: a record review and qualitative study. BMC WOMENS HEALTH 2012; 12:38. [PMID: 23088583 PMCID: PMC3534409 DOI: 10.1186/1472-6874-12-38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 10/18/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Frequent reporting of cases of hysterical conversion reaction (HCR) among hospitalized female medical patients in Bangladesh's public hospital system led us to explore the prevalence of "HCR" diagnoses within hospitals and the manner in which physicians identify, manage, and perceive patients whom they diagnose with HCR. METHODS We reviewed admission records from women's general medicine wards in two public hospitals to determine how often and at what point during hospitalization patients received diagnoses of HCR. We also interviewed 13 physicians about their practices and perceptions related to HCR. RESULTS Of 2520 women admitted to the selected wards in 2008, 6% received diagnoses of HCR. HCR patients had wide-ranging symptoms including respiratory distress, headaches, chest pain, convulsions, and abdominal complaints. Most doctors diagnosed HCR in patients who had any medically-unexplained physical symptom. According to physician reports, women admitted to medical wards for HCR received brief diagnostic evaluations and initial treatment with short-acting tranquilizers or placebo agents. Some were referred to outpatient psychiatric treatment. Physicians reported that repeated admissions for HCR were common. Physicians noted various social factors associated with HCR, and they described failures of the current system to meet psychosocial needs of HCR patients. CONCLUSIONS In these hospital settings, physicians assign HCR diagnoses frequently and based on vague criteria. We recommend providing education to increase general physicians' awareness, skill, and comfort level when encountering somatization and other common psychiatric issues. Given limited diagnostic capacity for all patients, we raise concern that when HCR is used as a "wastebasket" diagnosis for unexplained symptoms, patients with treatable medical conditions may go unrecognized. We also advocate introducing non-physician hospital personnel to address psychosocial needs of HCR patients, assist with triage in a system where both medical inpatient beds and psychiatric services are scarce commodities, and help ensure appropriate follow up.
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Affiliation(s)
- Emily A Kendall
- Massachusetts General Hospital, Department of Medicine, Bigelow 740, 55 Fruit St, Boston, MA 02114, USA.
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Prevalence of environmental and other military exposure concerns in Operation Enduring Freedom and Operation Iraqi Freedom veterans. J Occup Environ Med 2012; 54:659-64. [PMID: 22588478 DOI: 10.1097/jom.0b013e3182570506] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study examined the prevalence of self-reported exposures in returning Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans and the relationship of exposure reports to current physical symptoms. METHODS Using self-reports obtained immediately after return from deployment in a cohort of 760 enlisted Army reserve component military personnel, we assessed prevalence rates of environmental and other exposures and the association of these exposures to severity of physical symptoms. RESULTS Reporting of environmental exposures was relatively low in veterans of OEF/OIF, but reporting more environmental and other exposures, in particular screening positive for a traumatic brain injury, was related to greater physical symptom severity immediately after deployment. CONCLUSIONS Non-treatment-seeking, enlisted Army reserve component personnel reported relatively few exposures immediately after return from deployment; however, more exposures was modestly associated with greater severity of physical symptoms when controlling for predeployment symptoms, gender, and other deployment-related exposures.
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31
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Acute bacterial prostatitis: how to prevent and manage chronic infection? J Infect Chemother 2012; 18:444-50. [DOI: 10.1007/s10156-011-0350-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 11/16/2011] [Indexed: 11/25/2022]
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Soltis-Jarrett VM. His-story or her-story: deconstruction of the concepts of somatization towards a new approach in advanced nursing practice care. Perspect Psychiatr Care 2011; 47:183-93. [PMID: 21950365 DOI: 10.1111/j.1744-6163.2010.00288.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This article will endeavor to present an alternative view of somatoform disorders, assist in understanding the possible underlying comorbid psychiatric symptoms, and identify psychopharmacological options for treatment. CONCLUSIONS Recognizing symptom clusters is a useful strategy when considering psychotropic options for treatment and management. PRACTICE IMPLICATIONS The alternative strategies presented and discussed in this article can contribute to a useful and positive experience for both the clinician and the individual suffering from medically unexplained physical symptoms as they promote the care, health, and well-being of the individual rather than a cure, illness, and/or disease state that needs rendering, mending, and/or surgery.
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Sampalli T, Shepherd M, Duffy J. Clinical vocabulary as a boundary object in multidisciplinary care management of multiple chemical sensitivity, a complex and chronic condition. J Multidiscip Healthc 2011; 4:91-102. [PMID: 21594060 PMCID: PMC3093953 DOI: 10.2147/jmdh.s17564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Research has shown that accurate and timely communication between multidisciplinary clinicians involved in the care of complex and chronic health conditions is often challenging. The domain knowledge for these conditions is heterogeneous, with poorly categorized, unstructured, and inconsistent clinical vocabulary. The potential of boundary object as a technique to bridge communication gaps is explored in this study. METHODS A standardized and controlled clinical vocabulary was developed as a boundary object in the domain of a complex and chronic health condition, namely, multiple chemical sensitivity, to improve communication among multidisciplinary clinicians. A convenience sample of 100 patients with a diagnosis of multiple chemical sensitivity, nine multidisciplinary clinicians involved in the care of patients with multiple chemical sensitivity, and 36 clinicians in the community participated in the study. RESULTS Eighty-two percent of the multidisciplinary and inconsistent vocabulary was standardized using the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED(®) CT as a reference terminology. Over 80% of the multidisciplinary clinicians agreed on the overall usefulness of having a controlled vocabulary as a boundary object. Over 65% of clinicians in the community agreed on the overall usefulness of the vocabulary. CONCLUSION The results from this study are promising and will be further evaluated in the domain of another complex chronic condition, ie, chronic pain. The study was conducted as a preliminary analysis for developing a boundary object in a heterogeneous domain of knowledge.
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Fibromyalgia and the therapeutic relationship: where uncertainty meets attitude. Pain Res Manag 2011; 15:385-91. [PMID: 21165373 DOI: 10.1155/2010/354868] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Fibromyalgia remains underdiagnosed and suboptimally treated even though it affects an estimated 3.3% of Canadians. The present study examines knowledge and attitudinal challenges affecting optimal care. METHODS A mixed-methods approach was employed. Discussion groups, semistructured interviews and a quantitative online survey (five-point scale) were conducted (June 2007 to January 2008). Participants included 189 general practitioners (GPs) and 139 specialists (anesthesiologists, neurologists, physiatrists, psychiatrists and rheumatologists) distributed across Canada. Participants included 18 patients to enrich the scope of the findings. RESULTS GPs reported insufficient knowledge and skill in diagnosing fibromyalgia, with not all believing it to be a diagnosable condition (mean 3.74/5). Twenty-three per cent of GPs and 12% of specialists characterized fibromyalgia patients as malingerers. They further reported a lack of knowledge and skill in treating fibromyalgia (mean 2.73/5), including the pain, sleep disorders and mood disorders related to the condition (mean 3.32/5). Specialists shared these challenges, although to a lesser degree - "We are not trained to treat distress and suffering" (Specialist). Attitudinal issues centred around frustration (mean 3.91⁄5) and negative profiling of fibromyalgia patients (mean 3.06/5 and 1.99/5). CONCLUSIONS Findings revealed the presence of GP attitudinal and confidence challenges in caring for fibromyalgia patients. As care of fibromyalgia patients moves to general practices, these fundamental competencies must be addressed to assure that all patients receive the quality of care necessary to manage their disease and to empower physicians to be more professionally effective. As stated by one patient, "Why are we being penalized for having this disability?"
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Moyal-Barracco M, Labat JJ. [Vulvodynia and chronic pelvic and perineal pain]. Prog Urol 2010; 20:1019-26. [PMID: 21056380 DOI: 10.1016/j.purol.2010.08.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To define vulvodynia and to describe the main approaches to treatment. MATERIAL AND METHODS Review of the literature concerning vulvodynia. RESULTS Vulvodynia is defined as chronic vulvar discomfort, usually with a burning nature, with no relevant clinical lesions and no clinically identifiable neurological lesion. Localized provoked vulvodynia essentially affects young women and is responsible for major sexual and psychological repercussions. Treatment consists of local anaesthetics, drugs used to treat neuropathic pain, physiotherapy and psychotherapy. Vestibulectomy is only very rarely indicated. CONCLUSION Many unknowns persist especially concerning the aetiology of vulvodynia. Evaluation of symptoms and treatment have not been clearly defined. However, symptomatic management provide satisfactory long-term results.
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Affiliation(s)
- M Moyal-Barracco
- Service de dermatologie, hôpital Tarnier, 89, rue d'Assas, 75006 Paris, France
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Outil de dépistage de l’intolérance environnementale idiopathique ou hypersensibilité chimique multiple. À propos de la traduction française du Quick Environmental Exposure Sensitivity Inventory (QEESI©). ARCH MAL PROF ENVIRO 2010. [DOI: 10.1016/j.admp.2010.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Illness trajectories in the chronic fatigue syndrome: a longitudinal study of improvers versus non-improvers. J Nerv Ment Dis 2010; 198:486-93. [PMID: 20611051 DOI: 10.1097/nmd.0b013e3181e4ce0b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The natural progression of chronic fatigue syndrome (CFS) in adults is not well established. The aims of this longitudinal study were to (a) compare CFS Improvers and Non-Improvers; (b) determine whether an initial diagnosis of fibromyalgia (FM) was associated with CFS nonimprovement; and (c) determine whether this effect could be explained by the presence of nonspecific physical symptoms. Consecutive referrals to a tertiary clinic that satisfied case criteria for CFS were invited to enroll in a longitudinal study. After an initial on-site physical examination and psychiatric interview, a total of 94 female care-seekers completed biannual telephone surveys, including the Short Form-36 physical functioning (PF) scale, over a period of 2(1/2) years. There were very few differences between Improvers and Non-Improvers at baseline but at final assessment Improvers had less disability, less fatigue, lower levels of pain, fewer symptoms of depressed mood, and fewer nonspecific physical complaints. Participants with FM at baseline were 3.23 times (p < 0.05) more likely to become Non-Improvers than those without FM. Participants identified initially as Somatizers were 3.33 times (p < 0.05) more likely to become Non-Improvers. Patients with CFS who bear the added burden of FM are at greater risk of a negative outcome than patients with CFS alone. This effect could not be explained by the presence of multiple, nonspecific symptoms.
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An evaluation of SNOMED CT in the domain of complex chronic conditions. Int J Integr Care 2010; 10:e038. [PMID: 20422022 PMCID: PMC2858517 DOI: 10.5334/ijic.514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 01/15/2010] [Accepted: 01/29/2010] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To determine the content coverage in SNOMED CT to represent the multidisciplinary terms and concepts in the domain for complex chronic conditions. METHODS An evaluation of the coverage of multidisciplinary health factors in SNOMED CT for the complex and chronic condition, multiple chemical sensitivity (MCS) is conducted in the study. The methodology included a retrospective audit of patient charts and feedback from multidisciplinary clinicians in the creation of a controlled vocabulary used in the generation of patient profiles for MCS. Clinicians and experts in the field reviewed and tested the vocabulary for its usefulness (scope, specificity and structure) by re-coding three patient profiles using the vocabulary. Cohen's kappa analysis was conducted to determine inter-rater reliability. Cronbach's alpha analysis was conducted to determine the internal reliability of the survey questionnaire. RESULTS One hundred patient charts and nine clinicians from varying health disciplines participated in the study. SNOMED CT was shown to capture nearly 82% of the concepts spanning multidisciplinary areas of health focus. The nutrition area of health focus had the highest level of exact matches. Furthermore, post-coordination was applied in an attempt to improve coverage of concepts to 75% (of 45 terms) of the missing terms in SNOMED CT. Seventy-five percent (n=9) of the clinicians agreed on the overall usefulness of the vocabulary. CONCLUSIONS SNOMED CT had a reasonable coverage of the multidisciplinary health concepts required to describe a complex and chronic condition. Standardizing the multidisciplinary vocabulary with reference tag to a widely used reference terminology, such as SNOMED CT to discuss the terms and concepts used may improve the understanding across disciplines and communities of practice. Overall, based on the availability of concepts in SNOMED CT and the feedback from clinicians, the approach looks promising and should be further explored.
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Avellaneda Fernández A, Pérez Martín Á, Izquierdo Martínez M. Síndrome de fatiga crónica. Documento de consenso. Aten Primaria 2009; 41:529-31. [DOI: 10.1016/j.aprim.2009.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 06/23/2009] [Indexed: 11/15/2022] Open
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Arruti Bustillo M, Avellaneda Fernández A, Barbado Hernández F, de la Cruz Labrado J, Díaz-Delgado Peñas R, Gutiérrez Rivas E, Izquierdo Martínez M, Palacín Delgado C, Pérez Martín Á, Ramón Giménez J, Rivera Redondo J. Síndrome de fatiga crónica. Semergen 2009. [DOI: 10.1016/s1138-3593(09)72676-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Buffington CAT. Developmental influences on medically unexplained symptoms. PSYCHOTHERAPY AND PSYCHOSOMATICS 2009; 78:139-44. [PMID: 19270468 PMCID: PMC2790791 DOI: 10.1159/000206866] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 04/13/2008] [Indexed: 12/30/2022]
Abstract
BACKGROUND Medically unexplained (or 'functional') symptoms (MUS) are physical symptoms that prompt the sufferer to seek healthcare but remain unexplained after an appropriate medical evaluation. Examples of MUS also occur in veterinary medicine. For example, domestic cats suffer a syndrome comparable to interstitial cystitis, a chronic pelvic pain syndrome of humans. METHOD Review of current evidence suggests the hypothesis that developmental factors may play a role in some cases of MUS. Maternal perception of a threatening environment may be transmitted to the fetus when hormones cross the placenta and affect fetal physiology, effectively 'programming' the fetal stress response system and associated behaviors toward enhanced vigilance. After birth, intense stress responses in the individual may result in similar vulnerability, which may be unmasked by subsequent stressors. RESULTS Epigenetic modulation of gene expression (EMGEX) appears to play a central role in creation of this 'survival phenotype'. The recent development of techniques to identify the presence of EMGEX provides new tools to investigate these questions, and drugs and other interventions that may reverse EMGEX are also under active investigation. CONCLUSION Viewing MUS from the perspective of underlying developmental influences involving EMGEX that affect function of a variety of organs based on familial (genetic and environmental) predispositions rather than from the traditional viewpoint of isolated organ-originating diseases has at least two important implications: it provides a parsimonious explanation for findings heretofore difficult to reconcile, and it opens whole new areas of investigation into causes and treatments for this class of disorders.
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Health care utilisation and attitudes towards health care in subjects reporting environmental annoyance from electricity and chemicals. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2009; 2009:106389. [PMID: 19936124 PMCID: PMC2778839 DOI: 10.1155/2009/106389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 02/16/2009] [Accepted: 02/24/2009] [Indexed: 11/20/2022]
Abstract
Environmentally intolerant persons report decreased self-rated health and daily functioning. However, it remains unclear whether this condition also results in increased health care costs. The aim of this study was to describe the health care consumption and attitudes towards health care in subjects presenting subjective environmental annoyance in relation to the general population, as well as to a group with a well-known disorder as treated hypertension (HT). Methods. Postal questionnaire
(n = 13 604) and record linkage with population-based register on health care costs. Results. Despite significantly lower subjective well being and health than both the general population and HT group, the environmentally annoyed subjects had lower health care costs than the hypertension group. In contrast to the hypertension group, the environmentally annoyed subjects expressed more negative attitudes toward the health care than the general population. Conclusions. Despite their impaired subjective health and functional capacity, health care utilisation costs were not much increased for the environmentally annoyed group. This may partly depend on negative attitudes towards the health care in this group.
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Sampalli T, Berlasso E, Fox R, Petter M. A controlled study of the effect of a mindfulness-based stress reduction technique in women with multiple chemical sensitivity, chronic fatigue syndrome, and fibromyalgia. J Multidiscip Healthc 2009; 2:53-9. [PMID: 21197347 PMCID: PMC3004557 DOI: 10.2147/jmdh.s5220] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The objective of this study was to examine the effect of a mindfulness-based stress reduction (MBSR) program on women diagnosed with conditions such as multiple chemical sensitivity (MCS), chronic fatigue syndrome (CFS), and fibromyalgia (FM). METHODS The intervention group underwent a 10-week MBSR program. Symptoms Checklist Inventory (SCL-90R) was used as outcome measure and was administered before the start of the program (pre-), immediately upon completion (post-) and at three-month follow-up. Women on the wait list to receive treatment at the Nova Scotia Environmental Health Centre were used as control subjects for the study. RESULTS A total of 50 participants in the intervention group and 26 in the wait-list controls group were recruited for this study. Global scores in the intervention group reached statistical significance pre-post (<0.0001) and at pre-follow-up (<0.0001) while the global scores in the control group remained the same. Five of nine and eight of nine subscales of the SCL-90R showed improvement of statistical significance in MBSR group following treatment and at three-month follow-up. CONCLUSIONS The study showed the importance of complementary interventions such as MBSR techniques in the reduction of psychological distress in women with chronic conditions.
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Affiliation(s)
- Tara Sampalli
- Nova Scotia Environmental Health Centre, Fall River, Nova Scotia, Canada
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Fox R, Sampalli T, Fox J. Measuring health outcomes of a multidisciplinary care approach in individuals with chronic environmental conditions using an abbreviated symptoms questionnaire. J Multidiscip Healthc 2008; 1:97-104. [PMID: 21197341 PMCID: PMC3004547 DOI: 10.2147/jmdh.s4147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Nova Scotia Environmental Health Centre is a treatment facility for individuals with chronic environmental conditions such as multiple chemical sensitivity, chronic fatigue syndrome, fibromyalgia, chronic respiratory conditions and in some cases chronic pain. The premise of care is to provide a patient-centred multidisciplinary care approach leading to self-management strategies. In order to measure the outcome of the treatment in these complex problems, with overlapping diagnoses, symptoms in many body systems and suspected environmental triggers, a detailed symptoms questionnaire was developed specifically for this patient population and validated. Results from a pilot study in which an abbreviated symptoms questionnaire based on the top reported symptoms captured in previous research was used to measure the efficacy of a multidisciplinary care approach in individuals with multiple chemical sensitivity are presented in this paper. The purpose of this study was to examine the extent, type and patterns of changes over time in the top reported symptoms with treatment measured using the abbreviated symptoms questionnaire. A total of 183 active and 109 discharged patients participated in the study where the health status was measured at different time periods of follow up since the commencement of treatment at the Centre. The findings from this study were successful in generating an initial picture of the nature and type of changes in these symptoms. For instance, symptoms such as difficulty concentrating, sinus conditions and tiredness showed early improvement, within the first 6 months of being in treatment, while others, such as fatigue, hoarseness or loss of voice, took longer while others showed inconsistent changes warranting further enquiry. A controlled longitudinal study is planned to confirm the findings of the pilot study.
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Affiliation(s)
- Roy Fox
- Nova Scotia Environmental Health Centre, Fall River, NS, Canada
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Abbass A, Lovas D, Purdy A. Direct diagnosis and management of emotional factors in chronic headache patients. Cephalalgia 2008; 28:1305-14. [PMID: 18771494 DOI: 10.1111/j.1468-2982.2008.01680.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Somatization, anxiety, depression and personality disorders are common features of many patients with chronic headaches. Intensive short-term dynamic psychotherapy (ISTDP) is a brief therapy method developed specifically to treat patients with this cluster of somatic problems, symptoms and maladaptive behaviours through focusing on how the patient handles emotional experiences. It also contains a direct method of assessing the somatic discharge pathways of both emotions and anxiety, thus allowing direct observation of somatization in the case of many chronic headache sufferers. In this review, we summarize the extant literature on emotional factors in headache, review the evidence for short-term dynamic therapies in somatic problems and describe the assessment and treatment method of ISTDP we use routinely with chronic headache sufferers.
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Affiliation(s)
- A Abbass
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
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Clemens JQ, Meenan RT, O'Keeffe Rosetti MC, Kimes TA, Calhoun EA. Case-Control Study of Medical Comorbidities in Women With Interstitial Cystitis. J Urol 2008; 179:2222-5. [DOI: 10.1016/j.juro.2008.01.172] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Indexed: 11/25/2022]
Affiliation(s)
- J. Quentin Clemens
- Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Richard T. Meenan
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Teresa A. Kimes
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Elizabeth A. Calhoun
- Department of Health Policy Administration, School of Public Health, University of Illinois, Chicago, Illinois
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Marter A, Agruss JC. Solving the Riddle of Fibromyalgia: An Evidence-Based Practice Protocol for the Advanced Practice Nurse. J Nurse Pract 2008. [DOI: 10.1016/j.nurpra.2008.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hong ZR, Hong SY, Han MJ, Lee HS, Gil HO, Yang JO, Lee EY, Hong SY. Clinical observation of 12 farmers who believe themselves to have suffered from chronic pesticide intoxication. Korean J Intern Med 2008; 23:1-4. [PMID: 18363272 PMCID: PMC2686957 DOI: 10.3904/kjim.2008.23.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM We assessed twelve cases of suspected chronic pesticide intoxication, with medically unexplained physical symptoms. METHODS Complete blood cell count (CBC), blood chemistry, routine urinalysis, chest X-ray, ECG, gastrofiberscopy, abdominal ultrasonography, neuroselective sensory nerve conduction threshold, and psychological assessment were performed on 12 farmers who believe themselves to have suffered from chronic pesticide intoxication. RESULTS No specific abnormalities were observed on CBC, routine urinalysis, chest X-ray, ECG, gastroscopy, abdominal ultrasonography, or peripheral nerve conduction velocity test. They persistently manifested helplessness, depression, and anxiety. The results of both psychological assessment and general physical examination revealed the following clinical features: depression (8 cases), multiple chemical hypersensitivity syndrome (2 cases), alcoholism (1 case), and religious preoccupation (1 case). CONCLUSION In those living in the western rural area of South Korea, depression is a prominent ongoing presentation in pesticide-exposed farmers, in addition to unexplainable physical symptoms.
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Affiliation(s)
- Zoong-Rock Hong
- Department of Internal Medicine, Soonchunhyang University Chunan Hospital, Chunan, Korea
| | - So-Young Hong
- Department of Psychology, Korea University College of Medicine, Seoul, Korea
| | - Mi-Jung Han
- Department of Psychology, Soonchunhyang University Chunan Hospital, Chunan, Korea
| | - Hae-seung Lee
- Department of Internal Medicine, Soonchunhyang University Chunan Hospital, Chunan, Korea
| | - Hyo-Ook Gil
- Department of Internal Medicine, Soonchunhyang University Chunan Hospital, Chunan, Korea
| | - Jong-O Yang
- Department of Internal Medicine, Soonchunhyang University Chunan Hospital, Chunan, Korea
| | - En-Yung Lee
- Department of Internal Medicine, Soonchunhyang University Chunan Hospital, Chunan, Korea
| | - Sae-Yong Hong
- Department of Internal Medicine, Soonchunhyang University Chunan Hospital, Chunan, Korea
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Friedberg F, Sohl SJ, Halperin PJ. Teaching medical students about medically unexplained illnesses: a preliminary study. MEDICAL TEACHER 2008; 30:618-621. [PMID: 18608944 DOI: 10.1080/01421590801946970] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND This study examined how an interactive seminar focusing on two medically unexplained illnesses, chronic fatigue syndrome (CFS) and fibromyalgia, influenced medical student attitudes toward CFS, a more strongly stigmatized illness. METHODS Forty-five fourth year medical students attended a 90 minute interactive seminar on the management of medically unexplained illnesses that was exemplified with CFS and fibromyalgia. A modified version of the CFS attitudes test was administered immediately before and after the seminar. RESULTS Pre-seminar assessment revealed neutral to slightly favorable toward CFS. At the end of the seminar, significantly more favorable attitudes were found toward CFS in general (t (42) = 2.77; P < 0.01) and for specific items that focused on (1) supporting more CFS research funding (t (42) = 4.32; P < 0.001; (2) employers providing flexible hours for people with CFS (t (42) = 3.52, P < 0.01); and (3) viewing CFS as not primarily a psychological disorder (t (42) = 2.87, P < 0.01). Thus, a relatively brief exposure to factual information on specific medically unexplained illnesses was associated with more favorable attitudes toward CFS in fourth year medical students. CONCLUSION This type of instruction may lead to potentially more receptive professional attitudes toward providing care to these underserved patients.
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Affiliation(s)
- Fred Friedberg
- Department of Psychiatry and Behavioral Science, Stony Brook University, New York 11794-8790, USA.
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Feder HM, Johnson BJB, O'Connell S, Shapiro ED, Steere AC, Wormser GP, Agger WA, Artsob H, Auwaerter P, Dumler JS, Bakken JS, Bockenstedt LK, Green J, Dattwyler RJ, Munoz J, Nadelman RB, Schwartz I, Draper T, McSweegan E, Halperin JJ, Klempner MS, Krause PJ, Mead P, Morshed M, Porwancher R, Radolf JD, Smith RP, Sood S, Weinstein A, Wong SJ, Zemel L. A critical appraisal of "chronic Lyme disease". N Engl J Med 2007; 357:1422-30. [PMID: 17914043 DOI: 10.1056/nejmra072023] [Citation(s) in RCA: 300] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Henry M Feder
- Department of Family Medicine and Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA.
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