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Shayan M, Haddadi NS, Shokrian Zeini M, Shokrian Zeini M, Tashak Golroudbari H, Afrooghe A, Ahmadi E, Rashki A, Dehpour AR. Social interactions and olfactory cues are required for contagious itch in mice. Sci Rep 2024; 14:11334. [PMID: 38760368 PMCID: PMC11101621 DOI: 10.1038/s41598-024-61078-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/30/2024] [Indexed: 05/19/2024] Open
Abstract
The phenomenon of contagious itch, observed in both humans and rodents, remains a topic of ongoing debate concerning its modulators and underlying pathways. This study delves into the relationship between contagious itch and familiar olfactory cues, a non-visual factor contributing to this intriguing behavior. Our findings showed that contagious itch in observer mice occurs during physical interaction with the cagemate itch-demonstrator but not with a stranger demonstrator or in a non-physical encounter condition. Notably, itch-experienced observer mice displayed an increased contagious itch behavior, highlighting the relevance of itch-associated memory in this phenomenon. Furthermore, anosmic observer mice, whether itch-naïve or itch-experienced, displayed no contagious itch behavior. These results demonstrate that the familiar olfactory cues, specifically cagemate body odors, are required for contagious itch behaviors in mice. In line with these behavioral findings, our study reveals increased activity in brain regions associated with olfaction, emotion, and memory during contagious itch, including the olfactory bulb, the amygdala, the hypothalamus, and the hippocampus, with this activity diminished in anosmic mice. In conclusion, our study unveils the critical role of familiar olfactory cues in driving contagious itch in mice, shedding light on the interplay between social factors, sensory perception, and memory in this phenomenon.
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Affiliation(s)
- Maryam Shayan
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, MA, USA
| | - Nazgol-Sadat Haddadi
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Maryam Shokrian Zeini
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mohadese Shokrian Zeini
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Poorsina St., Enghelab Ave., P.O. Box 13145-784, Tehran, Iran
| | - Hasti Tashak Golroudbari
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Poorsina St., Enghelab Ave., P.O. Box 13145-784, Tehran, Iran
| | - Arya Afrooghe
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Poorsina St., Enghelab Ave., P.O. Box 13145-784, Tehran, Iran
| | - Elham Ahmadi
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Poorsina St., Enghelab Ave., P.O. Box 13145-784, Tehran, Iran
| | - Asma Rashki
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Poorsina St., Enghelab Ave., P.O. Box 13145-784, Tehran, Iran
| | - Ahmad-Reza Dehpour
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Poorsina St., Enghelab Ave., P.O. Box 13145-784, Tehran, Iran.
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2
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van de Burgt EWT, van der Mijn R, Fabbri S, Lorist MM. Environmental influences on induction of itching and scratching using immersive virtual reality. Sci Rep 2023; 13:16767. [PMID: 37798390 PMCID: PMC10556052 DOI: 10.1038/s41598-023-42322-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023] Open
Abstract
Chronic itching is a serious and uncomfortable condition. The scratch response might result in a vicious cycle of alternating itching and scratching. To develop psychological interventions for people suffering from chronic itching and to break the vicious itch-scratching-itch cycle, it is important to elucidate which environmental factors trigger itch sensations. Virtual reality (VR) techniques provide a useful tool to examine specific content characteristics in a three-dimensional (3D VR) environment and their influences on itch sensations and scratching behaviour. This article describes two experiments in which we focused on the effects of environmental information on itching and scratching behaviour. Additionally, in the second experiment, we examined the influence of having a chronic skin condition on sensitivity to itch induction. We found evidence for the importance of the content of audio-visual materials for the effectiveness in inducing feelings of itch in the observers. In both experiments, we observed significantly higher levels of perceived itch in the itch-inducing conditions than in the control condition. Moreover, the results showed that elevated levels of perceived itch were associated with an increase in scratching behaviours, which was especially salient in the contagious itch condition, in which perceived itch was accompanied by a significant increase in the number of scratches. Experiment 2 additionally showed increased perceived itch levels in participants who reported having a chronic skin condition, reflecting higher sensitivity to itch-inducing audio-visual stimuli in this group than in participants without a chronic skin condition. Based on the results we concluded that directing attention towards itch- or scratch aspects of related information in the environment and to the consequences for one's own skin are effective tools to induce itch sensations and scratching behaviour. This knowledge provides tools for developing novel strategies in advising and treating people suffering from chronic itching and breaking the vicious itch-scratching-itch cycle.
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Affiliation(s)
- Emmy W T van de Burgt
- Department of Experimental Psychology, University of Groningen, Groningen, The Netherlands.
- Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands.
- University of Applied Sciences, Utrecht, The Netherlands.
| | - Robbert van der Mijn
- Department of Experimental Psychology, University of Groningen, Groningen, The Netherlands
| | - Sara Fabbri
- Department of Experimental Psychology, University of Groningen, Groningen, The Netherlands
| | - Monicque M Lorist
- Department of Experimental Psychology, University of Groningen, Groningen, The Netherlands
- Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
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3
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Valdivieso-Cortadella S, Bernardi-Gómez C, Aureli F, Llorente M, Amici F. Yawning and scratching contagion in wild spider monkeys (Ateles geoffroyi). Sci Rep 2023; 13:8367. [PMID: 37225745 DOI: 10.1038/s41598-023-35693-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/22/2023] [Indexed: 05/26/2023] Open
Abstract
Behavioural contagion is a widespread phenomenon in animal species, which is thought to promote coordination and group cohesion. Among non-human primates, however, there is no evidence of behavioural contagion in Platyrrhines (i.e. primates from South and Central America) yet. Here, we investigated whether behavioural contagion is also present in this taxon, by assessing yawning and scratching contagion in a wild group (N = 49) of Geoffroy's spider monkeys (Ateles geoffroyi). We conducted focal samples to examine whether individuals observing the triggering event (i.e. a naturally occurring yawning or scratching event in the group) would be more likely to yawn or scratch in the following 3 min, as compared to individuals who did not observe the triggering event. We ran generalized linear mixed models using a Bayesian approach, and found that the probability of yawning and scratching was higher for individuals observing others yawning and scratching, respectively, as compared to individuals who did not observe such an event. Behavioural contagion did not vary depending on the observer's sex, kinship or relationship quality with the individual performing the triggering event. These findings provide the first evidence for yawning and scratching contagion in a wild group of spider monkeys, and importantly contribute to the debate about the evolutionary origins of behavioural contagion in primates.
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Affiliation(s)
| | | | - Filippo Aureli
- Instituto de Neuroetologia, Universidad Veracruzana, 91190, Xalapa-Enríquez, Mexico
- Research Centre in Evolutionary Anthropology and Palaeoecology, Liverpool John Moores University, Liverpool, L1 2SF, UK
| | - Miquel Llorente
- Universitat de Girona, Fundació UdG: Innovació i Formació, 17003, Girona, Spain
- Departament de Psicologia, Universitat de Girona, 17004, Girona, Spain
| | - Federica Amici
- Institute of Biology, Human Biology and Primate Cognition Group, University of Leipzig, 04109, Leipzig, Germany.
- Department of Comparative Cultural Psychology, Max-Planck Institute for Evolutionary Anthropology, 04103, Leipzig, Germany.
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4
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Thomaidou MA, Blythe JS, Peerdeman KJ, van Laarhoven AIM, Van Schothorst MME, Veldhuijzen DS, Evers AWM. Learned Nocebo Effects on Cutaneous Sensations of Pain and Itch: A Systematic Review and Meta-analysis of Experimental Behavioral Studies on Healthy Humans. Psychosom Med 2023; 85:308-321. [PMID: 36961347 PMCID: PMC10171297 DOI: 10.1097/psy.0000000000001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 01/24/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE In past decades, the field of nocebo research has focused on studying how sensory perception can be shaped by learning. Nocebo effects refer to aggravated sensory experiences or increased sensitivity to sensations such as pain and itch resulting from treatment-related negative experiences. Behavioral conditioning and verbal suggestions of a negative treatment outcome may aggravate pain and itch perception. Gaining a comprehensive view of the magnitude of nocebo effects and contributing factors will help steer nocebo research toward fruitful directions for understanding complex sensory phenomena. METHODS We conducted a systematic review and meta-analysis of a total of 37 distinct experimental nocebo studies on healthy participants (all published in English between 2008 and 2021), with four separate meta-analyses for nocebo effects on pain or itch. We conducted subgroup analyses and meta-regression on factors such as type and intensity of sensory stimuli, and length of conditioning paradigms. RESULTS This meta-analysis showed that, on average, effect sizes of nocebo effects were moderate to large (Hedges g between 0.26 and 0.71 for the four primary outcomes). The combination of conditioning and verbal suggestions yielded stronger nocebo responses on pain in particular. Subgroup analyses, including factors such as the type of sensory stimulation, did not explain the moderate heterogeneity in nocebo magnitudes between different studies. Risk of bias was generally low and was not related to nocebo magnitudes either. CONCLUSIONS We discuss these results in relation to the role of conditioning and aversive learning, and we recommend more consistency in designing and reporting nocebo experiments.
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5
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Is Pain Contagious? Innocuous Stimulation Can be Transformed Into the Pain Experience by Observational Learning. THE JOURNAL OF PAIN 2022; 23:2135-2143. [PMID: 35970444 DOI: 10.1016/j.jpain.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 07/13/2022] [Accepted: 07/31/2022] [Indexed: 01/04/2023]
Abstract
Studies indicate that classical and operant conditioning have potential to play a role in the formation of the allodynic effect. Only a few studies have examined the role of observational learning in pain induction. Due to some methodological challenges, evidence that the allodynic effect can be learned through observation is limited. In the present study, healthy participants (n = 88) received 2 series of innocuous electrocutaneous stimuli: at the beginning of the study and after observation of a model who rated all the stimuli as painful. Participants and the model rated all the stimuli alternately (real-time group), or the participant first observed the model and then rated the stimuli, while the model stayed in (post-hoc+ group) or left (post-hoc- group) the laboratory. There was no model in the control group. The study demonstrated that allodynia can be induced by observational learning. Furthermore, this effect was shown to be similar, regardless of whether stimuli were received during the observation of the model and rated immediately afterwards, or when the observation and stimuli reception were time-separated. The mere presence of the model during the stimuli reception also did not affect the magnitude of this effect. This research may contribute to our understanding of the mechanisms of chronic pain development and assist in the development of suitable treatment for it. PERSPECTIVE: This article presents study results on the role of observational learning in allodynia induction without tissue injury. The results may contribute to our understanding of the mechanisms of chronic pain development and assist in the development of suitable treatment for it.
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6
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Rana AN, Gonzales-Rojas R, Lee HY. Imitative and contagious behaviors in animals and their potential roles in the study of neurodevelopmental disorders. Neurosci Biobehav Rev 2022; 143:104876. [PMID: 36243193 DOI: 10.1016/j.neubiorev.2022.104876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/07/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022]
Abstract
Social learning in the forms of imitative and contagious behaviors are essential for learning abilities and social interaction. However, children with neurodevelopmental disorders and intellectual disabilities show impairments in these behaviors, which profoundly affect their communication skills and cognitive functions. Although these deficits are well studied in humans, pre-clinical animal model assessments of imitative and contagious behavioral deficits are limited. Here, we first define various forms of social learning as well as their developmental and evolutionary significance in humans. We also explore the impact of imitative and contagious behavioral deficits in several neurodevelopmental disorders associated with autistic-like symptoms. Second, we highlight imitative and contagious behaviors observed in nonhuman primates and other social animals commonly used as models for neurodevelopmental disorders. Lastly, we conceptualize these behaviors in the contexts of mirror neuron activity, learning, and empathy, which are highly debated topics. Taken together, this review furthers the understanding of imitative and contagious behaviors. We hope to prompt and guide future behavioral studies in animal models of neurodevelopmental disorders.
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Affiliation(s)
- Amtul-Noor Rana
- The Department of Cellular and Integrative Physiology, the University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Rodrigo Gonzales-Rojas
- The Department of Cellular and Integrative Physiology, the University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Hye Young Lee
- The Department of Cellular and Integrative Physiology, the University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
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7
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Meeuwis SH, Skvortsova A, van Laarhoven AIM, Holle H, Evers AWM. Can contagious itch be affected by positive and negative suggestions? Exp Dermatol 2022; 31:1853-1862. [PMID: 36048562 PMCID: PMC10087404 DOI: 10.1111/exd.14663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/20/2022] [Accepted: 08/10/2022] [Indexed: 12/14/2022]
Abstract
Contagious itch can be evoked by observing people scratching. Verbal suggestions about to-be-received itch can influence itch intensity, as shown by placebo research, but it is unknown whether this extends to contagious itch. The current study aimed to replicate prior findings that listening to scratching and rubbing sounds elicits contagious itch, and to investigate whether suggestions can modulate this process. Healthy participants (n = 140) received positive or negative suggestions about itch in response to the sounds (aimed to decrease or increase expected itch, respectively), or no specific suggestions as a control. Participants listened to a number of audio fragments with scratching and rubbing sounds. The amount of expected itch as well as itch sensation after each audio fragment were measured by self-report. Suggestions had no effect on the expected itch. Both rubbing and scratching sounds significantly elicited itch in all groups. Scratching sounds induced more itch than rubbing sounds exclusively in the control group. These findings indicate that short suggestions might be not effective enough to modify the expectations of people regarding contagious itch. Furthermore, suggestions modulate contagious itch to some degree, but not in the hypothesized direction. Potential similarities and differences in the neurobiological mechanisms of contagious itch and nocebo effects are discussed.
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Affiliation(s)
- Stefanie H Meeuwis
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, the Netherlands.,Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Aleksandrina Skvortsova
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, the Netherlands.,Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Antoinette I M van Laarhoven
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, the Netherlands
| | - Henning Holle
- Department of Psychology, University of Hull, Hull, UK
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, the Netherlands.,Medical Delta Healthy Society, Leiden University, Technical University Delft & Erasmus University Rotterdam, Rotterdam, the Netherlands
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8
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Sutter M, Kamber M, Navarini A, Mueller SM. Contagious Itch, Disgust and Empathy in a Family with Scabies and their Treating Medical Staff: An Exploratory Study. Acta Derm Venereol 2022; 102:adv00816. [PMID: 36281810 PMCID: PMC9811301 DOI: 10.2340/actadv.v102.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Mia Sutter
- Department of Dermatology, University Hospital Basel, Petersgraben 4, CH-4056 Basel, Switzerland
| | - Marise Kamber
- Department of Dermatology, University Hospital Basel, Petersgraben 4, CH-4056 Basel, Switzerland
| | - Alexander Navarini
- Department of Dermatology, University Hospital Basel, Petersgraben 4, CH-4056 Basel, Switzerland
| | - Simon M Mueller
- Department of Dermatology, University Hospital Basel, Petersgraben 4, CH-4056 Basel, Switzerland.
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9
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Saeki H, Ohya Y, Furuta J, Arakawa H, Ichiyama S, Katsunuma T, Katoh N, Tanaka A, Tsunemi Y, Nakahara T, Nagao M, Narita M, Hide M, Fujisawa T, Futamura M, Masuda K, Matsubara T, Murota H, Yamamoto-Hanada K. English Version of Clinical Practice Guidelines for the Management of Atopic Dermatitis 2021. J Dermatol 2022; 49:e315-e375. [PMID: 35996152 DOI: 10.1111/1346-8138.16527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/03/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
This is the English version of the Clinical Practice Guidelines for the Management of Atopic Dermatitis 2021. Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. In Japan, from the perspective of evidence-based medicine, the current strategies for the treatment of AD consist of three primary measures: (i) use of topical corticosteroids, tacrolimus ointment, and delgocitinib ointment as the main treatment of the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling, and advice about daily life. In the present revised guidelines, descriptions of three new drugs, namely, dupilumab, delgocitinib, and baricitinib, have been added. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice.
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Affiliation(s)
- Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Junichi Furuta
- Medical Informatics and Management, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hirokazu Arakawa
- Kitakanto Allergy Research Institute, Kibounoie Hospital, Midori, Japan
| | - Susumu Ichiyama
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Toshio Katsunuma
- Department of Pediatrics, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Akio Tanaka
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuichiro Tsunemi
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Takeshi Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mizuho Nagao
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Masami Narita
- Department of Pediatrics, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - Michihiro Hide
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Department of Dermatology, Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Takao Fujisawa
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Masaki Futamura
- Division of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Koji Masuda
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Tomoyo Matsubara
- Department of Pediatrics, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Hiroyuki Murota
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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10
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Capec S, Petrek M, Capec G, Yaremkevych R, Andrashko Y. Psychologic interventions in patients with the chronic dermatologic itch in atopic dermatitis and psoriasis: A step forward with family constellations seminars. Front Med (Lausanne) 2022; 9:965133. [PMID: 36035402 PMCID: PMC9411859 DOI: 10.3389/fmed.2022.965133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Chronic itch is a complex psychophysiological sensation, which can severely affect the quality of life in patients with atopic dermatitis and psoriasis. Itch depends on the irritation of receptors in the skin and the processing of sensory information in the central nervous system. Severe itch leads to activation and later on to disruption of the stress response, resulting in disorders of skin repair, functional and microstructural changes in the areas of the central nervous system that are responsible for the perception of itch. Psychosocial stress can be an essential factor, activating neurohumoral mechanisms which lead to increased itch and scratch, exacerbating skin damage. Patients with chronic itch often have sleep disorders, increased irritability, and depletion of the nervous system. They are characterized by disrupting social relationships, high incidence of anxiety, depressive disorders, and suicidal tendencies. Psychological methods of intervention can effectively influence various mechanisms in the pathogenesis of itch and scratch and improve social functioning in patients with chronic dermatological itch. In this mini-review, we discuss family constellation seminars as an effective method of psychological intervention that can reduce the intensity of itch, and improve sleep and performance in patients with atopic dermatitis and psoriasis. This method is insufficiently described in previous reviews of psychological interventions in atopic dermatitis and psoriasis patients. The positive impact of family constellations seminars in patients with chronic dermatological itch may be related to reducing stress by improving understanding of the family situation, appropriate management of family secrets, and enhancing interactions with the social environment.
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Affiliation(s)
- Szergej Capec
- Department of Pathological Physiology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia
- *Correspondence: Szergej Capec,
| | - Martin Petrek
- Department of Pathological Physiology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia
| | - Gabriella Capec
- Department of Pathological Physiology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia
| | - Roman Yaremkevych
- Department of Skin and Venereal Diseases, Faculty of Medicine, Uzhhorod National University, Uzhhorod, Ukraine
| | - Yuriy Andrashko
- Department of Skin and Venereal Diseases, Faculty of Medicine, Uzhhorod National University, Uzhhorod, Ukraine
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11
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Shelomi M. Thiamine (vitamin B1) as an insect repellent: a scoping review. BULLETIN OF ENTOMOLOGICAL RESEARCH 2022; 112:431-440. [PMID: 35199632 DOI: 10.1017/s0007485321001176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
While the desire for systemic repellents is high, ineffective repellents put one at risk of insect-vectored pathogens. Vitamin B1, or thiamine, has been touted as a systemic insect repellent since 1943, and denounced as an ineffective placebo for just as long. This paper presents a scoping review of 104 relevant case reports, research studies, and review articles to trace the evolution of this idea and identify an evidence-based, scientific consensus. Reports of thiamine's systemic repellency are primarily anecdotal and based on uncontrolled trials and/or used bite symptoms as a proxy for reduced biting. Controlled experiments on insect landing and feeding found no evidence of repellency. Of the 49 relevant review papers, 16 insect bite prevention guidelines, and 4 government documents, none after the 1990s claimed thiamine is a repellent. The findings of this review are that thiamine cannot repel arthropods in any dosage or route of administration. Due to limited available evidence, the possibility that thiamine reduces the subjective symptoms of insect bites cannot currently be ruled out. Unfortunately, many medical professionals and travelers today still believe thiamine may be effective despite the evidence stating otherwise. Continued promotion of debunked repellents on the commercial market poses a serious risk in countries with the endemic, mosquito-vectored disease.
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Affiliation(s)
- Matan Shelomi
- Department of Entomology, National Taiwan University, Taipei, Taiwan
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12
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Novak N. Dem Juckreiz auf den Fersen. J Dtsch Dermatol Ges 2022; 20:133-135. [PMID: 35146886 DOI: 10.1111/ddg.14735_g] [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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13
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Fortugno AP, Bakke JR, Babajani-Feremi A, Newman J, Patel TS. Functional Magnetic Resonance Imaging and Applications in Dermatology. JID INNOVATIONS 2022; 1:100015. [PMID: 35024683 PMCID: PMC8669514 DOI: 10.1016/j.xjidi.2021.100015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 12/05/2022] Open
Abstract
As a noninvasive imaging modality able to show the dynamic changes in neurologic activity, functional magnetic resonance imaging has revolutionized the ability to both map and further understand the functional regions of the brain. Current applications range from neurosurgical planning to an enormous variety of investigational applications across many diverse specialties. The main purpose of this article is to provide a foundational understanding of how functional magnetic resonance imaging is being used in research by outlining the underlying basic science, specific methods, and direct investigational and clinical applications. In addition, the use of functional magnetic resonance imaging in current dermatological research, especially in relation to studies concerning the skin‒brain axis, is explicitly addressed. This article also touches on the advantages and limitations concerning functional magnetic resonance imaging in comparison with other similar techniques.
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Affiliation(s)
- Andrew P Fortugno
- Department of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Joshua R Bakke
- Kaplan-Amonette Department of Dermatology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Abbas Babajani-Feremi
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Magnetoencephalography Laboratory, Dell Children's Medical Center, Austin, Texas, USA
| | - Justin Newman
- Memphis Radiological Professional Corporation, Germantown, Tennessee, USA
| | - Tejesh S Patel
- Kaplan-Amonette Department of Dermatology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
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14
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Hölsken S, Krefting F, Schedlowski M, Sondermann W. Expectation-induced enhancement of pain, itch and quality of life in psoriasis patients: study protocol of a randomised controlled trial. BMJ Open 2021; 11:e047099. [PMID: 34475155 PMCID: PMC8413966 DOI: 10.1136/bmjopen-2020-047099] [Citation(s) in RCA: 1] [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: 12/24/2022] Open
Abstract
INTRODUCTION Experimental and clinical data demonstrate that skin diseases like psoriasis are affected by psychological factors and can be modulated by interventions other than conventional drug therapy. The expectation of patients towards the benefit of a forthcoming treatment as well as treatment pre-experiences have been demonstrated as crucial factors mediating placebo responses in inflammatory skin diseases. However, it is unknown whether and to what extent treatment outcomes of psoriasis patients under therapy with monoclonal antibodies like secukinumab can be experimentally modulated at subjective and physiological levels by modifying the expectation of patients via verbal instruction or prior experience. METHODS AND ANALYSIS Treatment expectations will be modulated in patients with moderate-to-severe psoriasis undergoing treatment with the anti-interleukin-17A monoclonal antibody secukinumab. Patients with a Psoriasis Area and Severity Index (PASI) >12 will be randomly allocated to one of three groups (N=40 each). As a standard schedule, patients in the pharmacological control group (group 1) will be treated weekly with 300 mg secukinumab, while patients in groups 2 and 3 will receive only 75 mg secukinumab (75% dose reduction) during all treatment weeks. In addition to the injections, patients in group 3 will ingest a novel tasting drink, with a cover story explaining that previous studies showed additional beneficial effects of this combination (drug and drink). Patients will be assessed and treated at nine visits over a 16-week period, during which the severity of pain and itch symptoms, skin lesions and quality of life will be analysed with standardised questionnaires and the PASI. ETHICS AND DISSEMINATION This study was approved by the Ethics committee of the Medical Faculty of the University Duisburg-Essen. Study outcomes will be published in peer-reviewed scientific journals.
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Affiliation(s)
- Stefanie Hölsken
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Frederik Krefting
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institute, Stockholm, Sweden
| | - Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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15
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Lee IS, Kim K, Park HJ, Lee H, Jung WM, Kim DW, Chae Y. Neural Oscillation Associated with Contagious Itch in Patients with Atopic Dermatitis. Brain Sci 2021; 11:brainsci11040438. [PMID: 33805350 PMCID: PMC8067125 DOI: 10.3390/brainsci11040438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Itch is an unpleasant sensation associated with an urge to scratch and is a major health care issue associated with atopic dermatitis (AD). Contagious itch, i.e., subjective feelings of itchiness induced by watching others’ scratching behavior, is common in patients with AD. Using electroencephalography, we examined alpha (8–13 Hz) oscillations in sensorimotor areas associated with the desire to scratch in patients with AD. Methods: Thirty-six patients with AD and 34 healthy controls (HCs) participated in this study. They evaluated their itch levels after watching short videos of a model scratching or tapping parts of his body. Neural oscillations were recorded from nine electrodes, including those placed over sensorimotor areas. Time–frequency analysis was used to compare mu rhythm suppression over the sensorimotor areas in response to these videos between patients with AD and HCs. Results: The behavioral test showed that the visual stimuli induced increased feelings of itchiness in patients with AD relative to HCs under the tapping and scratching conditions. The time–frequency analysis revealed that mu rhythm suppression in response to scratching images was significantly prominent in patients with AD, but not in HCs. Conclusion: Patients with AD exhibited increased susceptibility to contagious itch. This phenomenon might be related to enhanced mu rhythm suppression in sensorimotor areas of the brain in these patients. Our findings provide new insight into the neurophysiological basis of itch sensations in patients with AD.
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Affiliation(s)
- In-Seon Lee
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul 02447, Korea; (I.-S.L.); (H.-J.P.); (H.L.); (W.-M.J.)
| | - Kyuseok Kim
- Department of Ophthalmology, Otorhinolaryngology and Dermatology of Korean Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea;
| | - Hi-Joon Park
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul 02447, Korea; (I.-S.L.); (H.-J.P.); (H.L.); (W.-M.J.)
| | - Hyangsook Lee
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul 02447, Korea; (I.-S.L.); (H.-J.P.); (H.L.); (W.-M.J.)
| | - Won-Mo Jung
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul 02447, Korea; (I.-S.L.); (H.-J.P.); (H.L.); (W.-M.J.)
| | - Do-Won Kim
- Department of Biomedical Engineering, Chonnam National University, Yeosu 59626, Korea
- Correspondence: (D.-W.K.); (Y.C.)
| | - Younbyoung Chae
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul 02447, Korea; (I.-S.L.); (H.-J.P.); (H.L.); (W.-M.J.)
- Correspondence: (D.-W.K.); (Y.C.)
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16
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Lefgren LJ, Stoddard OB, Stovall JE. Rationalizing self-defeating behaviors: Theory and evidence. JOURNAL OF HEALTH ECONOMICS 2021; 76:102407. [PMID: 33383261 DOI: 10.1016/j.jhealeco.2020.102407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 09/10/2020] [Accepted: 10/12/2020] [Indexed: 06/12/2023]
Abstract
Why do individuals engage in self-defeating behaviors like self-harm, addiction, and risky sexual behaviors? Why do they experience the apathy of depression or inaction when trapped by multiple competing problems? We propose a framework for explaining these and other related behaviors based on the insight that individuals can only experience a limited number of latent stimuli to which they are exposed. We conduct an experiment to test this model and find that more than two thirds of the subjects behave consistent with our theoretical framework.
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Affiliation(s)
- Lars J Lefgren
- Department of Economics, Brigham Young University and National Bureau of Economic Research, United States.
| | - Olga B Stoddard
- Department of Economics, Brigham Young University, United States.
| | - John E Stovall
- Department of Economics, Brigham Young University, United States.
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17
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Visual triggers of skin picking episodes: An experimental study in self-reported skin picking disorder and atopic dermatitis. CLINICAL PSYCHOLOGY IN EUROPE 2020; 2:e2931. [DOI: 10.32872/cpe.v2i4.2931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background
Skin Picking Disorder (SPD) is a new diagnosis with limited information available about triggers of picking episodes. Itch can be induced via audio-visual stimuli and the effect of contagious itch is stronger for those affected by atopic dermatitis. We examined if picking-related visual stimuli can trigger the urge to pick skin in self-reported SPD. We compared itch and the urge to pick in a sample of AD and/or SPD-affected to controls without either.
Method
Urge to pick skin and/or scratch when viewing 24 itch-related, picking-related or neutral online pictures was assessed in adult females, who self-report skin-picking (SPD-only, n = 147) and/or atopic dermatitis (AD-only, n = 47; AD+SPD, n = 46) as well as in skin healthy controls (HC, n = 361).
Results
All participants reported a stronger urge to pick for picking-related pictures compared to neutral content (F[1, 597] = 533.96, p < .001, ηp2 = .472) and more itch for itch-related pictures compared to neutral stimuli (F[1, 597] = 518.73, p < .001, ηp2 = .465). SPD-all (SPD-only & AD+SPD) reported stronger urges to pick for picking-related vs. other stimuli compared to the AD-only and HC group (p < .001, ηp2 = .047). Likewise, AD-all (AD-only & AD+SPD) reported significantly stronger itching for itch-related vs. other stimuli compared to SPD-only and HC (p = .001, ηp2 = .019).
Conclusions
Analog to visual provocation of itch, the urge to pick can be triggered by visual stimuli. Treatments for SPD and AD may profit from addressing visual stimuli.
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18
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Gieler U, Gieler T, Peters EMJ, Linder D. Haut und Psychosomatik – Psychodermatologie heute. J Dtsch Dermatol Ges 2020; 18:1280-1300. [PMID: 33251743 DOI: 10.1111/ddg.14328_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Uwe Gieler
- Universitäts-Hautklinik, Universitätsklinikum Gießen
| | - Tanja Gieler
- Kinder- und Jugendpsychosomatik, Universitäts-Kinderklinik, Universitätsklinikum Gießen
| | - Eva Milena Johanne Peters
- Psychoneuroimmunologie Labor, Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Gießen, Gießen in Kooperation mit der Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin - Charité, Berlin
| | - Dennis Linder
- Universitäts-Hautklinik, Universität Padua, Italien, Institut für Medizinische Psychologie und Psychotherapie, Medizinische Universität Graz, Österreich
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19
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Kamber MS, Sutter M, Navarini A, Mueller SM. Contagious itch and disgust during a lecture on ectoparasitic infestations: Two co‐activated complementary parasite defense systems? Dermatol Ther 2020; 33:e14456. [DOI: 10.1111/dth.14456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/10/2020] [Accepted: 10/15/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Marise S. Kamber
- Department of Dermatology University Hospital Basel Basel Switzerland
| | - Mia Sutter
- Department of Dermatology University Hospital Basel Basel Switzerland
| | | | - Simon M. Mueller
- Department of Dermatology University Hospital Basel Basel Switzerland
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20
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Gieler U, Gieler T, Peters EMJ, Linder D. Skin and Psychosomatics - Psychodermatology today. J Dtsch Dermatol Ges 2020; 18:1280-1298. [PMID: 33251751 PMCID: PMC7756276 DOI: 10.1111/ddg.14328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023]
Abstract
Modern psychodermatology relies on the bio-psycho-social disease model in psychosomatics, according to which biological, psychological and social factors (on various levels, from molecules to the biosphere) play a major role in the disease pathogenesis through complex, non-linear interactions over the entire disease course. It is nowadays experimentally proven that "emotions get into the skin". Recent research shows close anatomical, physiological and functional connections between skin and nervous system, already known to be ontogenetically related. These connections are reflected in many skin diseases where psychological and somatic etiological factors are closely intertwined. A holistic approach by the physician should do justice to this interdependence; biological, psychological and social factors should be adequately taken into account when taking anamnesis, making a diagnosis and choosing a therapy. The "visibility" of the skin organ bestows dermatology a special position among the various other clinical subjects, and renders a holistic, psychosomatic approach to the patient that is particularly important. The life course belongs also to modern psychodermatological approaches. Based on the modern psychodermatology concept, other corresponding sub-areas such as psychogastroenterology, psychocardiology etc. have emerged. After the theoretical part of this article, some selected skin diseases are discussed in more detail from the psychosomatic point of view.
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Affiliation(s)
- Uwe Gieler
- Department of DermatologyUniversity Hospital Gießen
| | - Tanja Gieler
- Psychosomatic Medicine for Children and AdolescentsDepartment of PediatricsUniversity Hospital Gießen
| | - Eva Milena Johanne Peters
- Laboratory for PsychoneuroimmunologyDepartment of Psychosomatic Medicine and PsychotherapyUniversity Hospital Gießen in cooperation with the Department of Psychosomatic Medicine and PsychotherapyUniversity Hospital – CharitéBerlin
| | - Dennis Linder
- Department of DermatologyUniversity of PaduaItalyInstitute for Medical Psychology and PsychotherapyMedical University GrazAustria
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21
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Helt MS, de Marchena AB, Schineller ME, Kirk AI, Scheub RJ, Sorensen TM. Contagious itching is heightened in children with autism spectrum disorders. Dev Sci 2020; 24:e13024. [PMID: 33617103 DOI: 10.1111/desc.13024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 06/23/2020] [Accepted: 07/06/2020] [Indexed: 11/27/2022]
Abstract
The authors tested susceptibility to contagious itching, laughter, and yawning in 55 children with autism spectrum disorder (ASD), ages 8-14, and 106 typically developing (TD) children, ages 5-14. Children with ASD were less likely to yawn or laugh contagiously compared with TD peers, but showed increased susceptibility to contagious itching, under naturalistic conditions. Contagious yawning and laughter were positively correlated with emotional empathy in the TD group. In contrast, contagious itching showed no relationship to empathy, and was positively correlated with autism symptom severity in the ASD group. The authors explore the implications of these findings in terms of psychological theories about ASD.
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Affiliation(s)
- Molly S Helt
- Departments of Psychology and Neuroscience, Trinity College, Hartford, CT, USA
| | - Ashley B de Marchena
- Department of Behavioral and Social Sciences, University of the Sciences, Philadelphia, PA, USA
| | - Molly E Schineller
- Departments of Psychology and Neuroscience, Trinity College, Hartford, CT, USA
| | - Anna I Kirk
- Departments of Psychology and Neuroscience, Trinity College, Hartford, CT, USA
| | - Rachel J Scheub
- Departments of Psychology and Neuroscience, Trinity College, Hartford, CT, USA
| | - Taylor M Sorensen
- Departments of Psychology and Neuroscience, Trinity College, Hartford, CT, USA
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22
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Najafi P, Ben Salem D, Carré JL, Misery L, Dufor O. Functional and anatomical brain connectivity in psoriasis patients and healthy controls: a pilot brain imaging study after exposure to mentally induced itch. J Eur Acad Dermatol Venereol 2020; 34:2557-2565. [PMID: 32267024 DOI: 10.1111/jdv.16441] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 03/10/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Despite the prevalence of psoriasis, the processing of itch in psoriasis and its impact on the central nervous system (CNS) remain unclear. OBJECTIVE We studied the influence of psoriasis on the CNS using magnetic resonance imaging techniques (fMRI and DTI, respectively) to investigate whether mentally induced itch can modify the functional connectivity or the white matter microstructure of the brain. METHODS Fourteen patients with chronic psoriasis and 15 healthy controls were recruited. Itch was mentally induced in subjects by videos showing others scratching themselves. RESULTS The observation of functional connectivity during the viewing the video revealed an interconnected network of brain regions that are more strongly coupled in psoriasis patients than in healthy controls. This network links the cerebellum, the thalami, the anteroposterior cingulum, the inferior parietal lobules, the middle temporal poles and the parahippocampal, hippocampal, lingual and supramarginal gyri. We also found connections with the right precuneus and both left insula and superior temporal gyrus. The DTI analysis showed that chronic itch affects the microstructure of white matter, including the anterior thalamic radiations, the superior and inferior longitudinal fasciculi, the corticospinal tracts, the cingulum, the external capsules, the inferior frontal-occipital fasciculi and both minor and major forceps. CONCLUSION Our results indicate that there could exist a network which is more interconnected in psoriasis patients. Among two building blocks of this network, the subnetwork encoding the perception and control of itch sensation is more affected than the subnetwork representing mentalizing and empathy. With an approach consisting of measuring microstructural changes at a local level in the brain, we also contradict the findings obtained with global measures which stated that chronic psoriasis cannot alter the anatomy of the brain. This confirms that itchy pathophysiological conditions have similar effects on functional and structural connectivity as those observed in chronic pain.
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Affiliation(s)
| | - D Ben Salem
- Univ Brest, LATIM, Brest, France.,University Hospital of Brest, Brest, France
| | - J-L Carré
- Univ Brest, LIEN, Brest, France.,University Hospital of Brest, Brest, France
| | - L Misery
- Univ Brest, LIEN, Brest, France.,University Hospital of Brest, Brest, France
| | - O Dufor
- Univ Brest, LIEN, Brest, France
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23
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Mueller SM, Carruthers HR, Navarini AA, Goldust M, Gysin S, Itin PH. Pruritic and antipruritic colors: An exploratory pilot study. Dermatol Ther 2020; 33:e13447. [DOI: 10.1111/dth.13447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/20/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Simon M. Mueller
- Department of Dermatology University Hospital Basel Basel Switzerland
| | | | | | - Mohamad Goldust
- Department of Dermatology University Hospital Basel Basel Switzerland
- University of Rome G. Marconi Rome Italy
- Department of Dermatology University Medical Center Mainz Mainz Germany
| | - Stefan Gysin
- Department of Dermatology University Hospital Basel Basel Switzerland
- Institute of Primary and Community Care Lucerne Switzerland
- Department of Health Sciences and Health Policy University of Lucerne Lucerne Switzerland
| | - Peter H. Itin
- Department of Dermatology University Hospital Basel Basel Switzerland
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24
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Meeuwis SH, van Middendorp H, van Laarhoven AIM, van Leijenhorst C, Pacheco-Lopez G, Lavrijsen APM, Veldhuijzen DS, Evers AWM. Placebo and nocebo effects for itch and itch-related immune outcomes: A systematic review of animal and human studies. Neurosci Biobehav Rev 2020; 113:325-337. [PMID: 32240668 DOI: 10.1016/j.neubiorev.2020.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/24/2020] [Indexed: 12/19/2022]
Abstract
Placebo and nocebo effects can influence somatic symptoms such as pain. For itch and other dermatological symptoms these effects have been far less investigated. This review systematically integrates evidence from both animal (mainly rodents) and human trials on placebo and nocebo effects in itch, itch-related symptoms and conditions of the skin and mucous membranes, and related immune outcomes (e.g., histamine). Thirty-one animal studies, and fifty-five human studies (k = 21 healthy participants, k = 34 patients) were included. Overall, studies consistently show that placebo and nocebo effects can be induced by various methods (e.g., suggestions, conditioning and social cues), despite high heterogeneity across studies. Effects of suggestions were found consistently across subjective and behavioral parameters (e.g., itch and scratching in humans), whereas conditioning was likely to impact physiological parameters under certain conditions (e.g., conditioning of histamine levels in stressed rodents). Brain areas responsible for itch processing were associated with nocebo effects. Future research may investigate how variations in methods impact placebo and nocebo effects, and whether all symptoms and conditions can be influenced equally.
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Affiliation(s)
- Stefanie H Meeuwis
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, P.O. Box 9555, 2300RB, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, P.O. Box 9600, 2300RC, Leiden University Medical Center, Leiden, the Netherlands.
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, P.O. Box 9555, 2300RB, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, P.O. Box 9600, 2300RC, Leiden University Medical Center, Leiden, the Netherlands
| | - Antoinette I M van Laarhoven
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, P.O. Box 9555, 2300RB, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, P.O. Box 9600, 2300RC, Leiden University Medical Center, Leiden, the Netherlands; Department of Psychiatry, Leiden University Medical Center, P.O. Box 9600, 2300RC, Leiden, the Netherlands
| | - Cora van Leijenhorst
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, P.O. Box 9555, 2300RB, Leiden, the Netherlands
| | - Gustavo Pacheco-Lopez
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, P.O. Box 9555, 2300RB, Leiden, the Netherlands; Metropolitan Autonomous University (UAM), Campus Lerma, Health Sciences Department, Lerma, 52005, Edo Mex, Mexico
| | - Adriana P M Lavrijsen
- Department of Dermatology, Leiden University Medical Center, P.O. Box 9600, 2300RC, Leiden, the Netherlands
| | - Dieuwke S Veldhuijzen
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, P.O. Box 9555, 2300RB, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, P.O. Box 9600, 2300RC, Leiden University Medical Center, Leiden, the Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, P.O. Box 9555, 2300RB, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, P.O. Box 9600, 2300RC, Leiden University Medical Center, Leiden, the Netherlands; Department of Psychiatry, Leiden University Medical Center, P.O. Box 9600, 2300RC, Leiden, the Netherlands
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25
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Lerner EA. Why do we itch? Exp Dermatol 2019; 28:1474-1475. [DOI: 10.1111/exd.14004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/02/2019] [Accepted: 04/29/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Ethan A. Lerner
- Department of Dermatology Massachusetts General Hospital / Harvard Medical School Charlestown MA USA
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26
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27
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Marzell R, Reichwein G, Gieler U, Kupfer J, Schut C. Itch induction by audiovisual stimuli and histamine iontophoresis: a randomized, controlled noninferiority study. Br J Dermatol 2019; 182:1253-1261. [PMID: 31344257 DOI: 10.1111/bjd.18368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous research has mainly used skin-manipulating methods to induce itch. In comparison, itch induced by audiovisual stimuli lacks direct skin manipulation. OBJECTIVES The aim of this double blind, noninferiority study was to test the experimental hypothesis that itch induced by audiovisual stimuli is noninferior to itch induced by histamine iontophoresis in case of priming and without priming. METHODS In 80 of 160 healthy volunteers itch was induced by histamine iontophoresis, while in the other 80 itch was induced by audiovisual stimulation. Forty people in each group experienced either an initial resting phase or dermal priming. Itch intensity was measured by visual analogue scales, while scratch duration and frequency were video-recorded and evaluated by two independent raters. In addition, itch quality and location were measured by self-report. RESULTS Itch induced by audiovisual stimuli was inferior to itch induced by histamine iontophoresis in the absence of dermal priming. However, in the case of priming, maximal itch induced by audiovisual stimuli was not inferior to maximal itch induced by histamine iontophoresis. Additionally, differences in itch quality and location were observed. CONCLUSIONS The finding that maximal audiovisually-induced itch was comparable with maximal histamine itch only after priming emphasizes that attention plays a dominant role in mentally-induced itch. The comparability of maximal histamine and audiovisually-induced itch in the case of priming opens up new research opportunities. What's already known about this topic? Itch is a multidimensional sensation that is altered by, among other things, attention. To induce itch in basic research, different methods are used, which are partially invasive or cause skin manipulation. Noninvasive audiovisual stimuli can be used to induce itch. What does this study add? This study investigated whether itch induced by audiovisual stimuli is noninferior to itch induced by histamine iontophoresis. Itch induced by audiovisual stimuli is noninferior with regard to maximal intensity in the case of priming. Noninferiority was not shown in the case of no priming, emphasizing the role of attention in itch induction. Histamine and audiovisually-induced itch differ in terms of quality and location, but not in affective reaction.
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Affiliation(s)
- R Marzell
- Institute of Medical Psychology, University of Gießen, Gießen, Germany
| | - G Reichwein
- Institute of Medical Psychology, University of Gießen, Gießen, Germany
| | - U Gieler
- Clinics for Dermatology and Allergology, University of Gießen, Gießen, Germany
| | - J Kupfer
- Institute of Medical Psychology, University of Gießen, Gießen, Germany
| | - C Schut
- Institute of Medical Psychology, University of Gießen, Gießen, Germany
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28
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Dong X, Dong X. Peripheral and Central Mechanisms of Itch. Neuron 2019; 98:482-494. [PMID: 29723501 DOI: 10.1016/j.neuron.2018.03.023] [Citation(s) in RCA: 221] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/12/2018] [Accepted: 03/15/2018] [Indexed: 12/15/2022]
Abstract
Itch is a unique sensory experience that is encoded by genetically distinguishable neurons both in the peripheral nervous system (PNS) and central nervous system (CNS) to elicit a characteristic behavioral response (scratching). Itch interacts with the other sensory modalities at multiple locations, from its initiation in a particular dermatome to its transmission to the brain where it is finally perceived. In this review, we summarize the current understanding of the molecular and neural mechanisms of itch by starting in the periphery, where itch is initiated, and discussing the circuits involved in itch processing in the CNS.
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Affiliation(s)
- Xintong Dong
- The Solomon H. Snyder Department of Neuroscience and the Center for Sensory Biology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | - Xinzhong Dong
- The Solomon H. Snyder Department of Neuroscience and the Center for Sensory Biology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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Sanders KM, Fast K, Yosipovitch G. Why we scratch: Function and dysfunction. Exp Dermatol 2019; 28:1482-1484. [DOI: 10.1111/exd.13977] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Kristen M. Sanders
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, Miller School of Medicine University of Miami Miami Florida
| | - Katharine Fast
- Department of Allergy and Immunology California Pacific Medical Center San Francisco California
| | - Gil Yosipovitch
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, Miller School of Medicine University of Miami Miami Florida
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Reszke R, Szepietowski JC. Can we use psychoactive drugs to treat pruritus? Exp Dermatol 2019; 28:1422-1431. [PMID: 31087719 DOI: 10.1111/exd.13959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/09/2019] [Indexed: 12/21/2022]
Abstract
Pruritus is a frequent complaint both in dermatology and general medicine. This burdensome symptom has a complex and multifactorial pathogenesis, with the key involvement of central nervous system in its development. Psychoactive drugs (psychopharmaceuticals) encompass several therapeutic groups utilized mainly in psychiatry. However, these drugs are occasionally used in dermatological practice and may contribute to alleviation of pruritus in a variety of cutaneous and extracutaneous disorders. This review article summarizes the role of H1-antihistamines, antidepressants, antipsychotics and antiepileptics in managing pruritus.
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Affiliation(s)
- Radomir Reszke
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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Kupfer TR, Fessler DMT. Ectoparasite defence in humans: relationships to pathogen avoidance and clinical implications. Philos Trans R Soc Lond B Biol Sci 2019; 373:rstb.2017.0207. [PMID: 29866920 DOI: 10.1098/rstb.2017.0207] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2018] [Indexed: 11/12/2022] Open
Abstract
Currently, disgust is regarded as the main adaptation for defence against pathogens and parasites in humans. Disgust's motivational and behavioural features, including withdrawal, nausea, appetite suppression and the urge to vomit, defend effectively against ingesting or touching sources of pathogens. However, ectoparasites do not attack their hosts via ingestion, but rather actively attach themselves to the body surface. Accordingly, by itself, disgust offers limited defence against ectoparasites. We propose that, like non-human animals, humans have a distinct ectoparasite defence system that includes cutaneous sensory mechanisms, itch-generation mechanisms and grooming behaviours. The existence of adaptations for ectoparasite defence is supported by abundant evidence from non-human animals, as well as more recent evidence concerning human responses to ectoparasite cues. Several clinical disorders may be dysfunctions of the ectoparasite defence system, including some that are pathologies of grooming, such as skin picking and trichotillomania, and others, such as delusory parasitosis and trypophobia, which are pathologies of ectoparasite detection. We conclude that future research should explore both distinctions between, and overlap across, ectoparasite defence systems and pathogen avoidance systems, as doing so will not only illuminate proximate motivational systems, including disgust, but may also reveal important clinical and social consequences.This article is part of the Theo Murphy meeting issue 'Evolution of pathogen and parasite avoidance behaviours'.
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Affiliation(s)
- Tom R Kupfer
- School of Psychology, Keynes College, University of Kent, Canterbury, Kent CT2 7NP, UK
| | - Daniel M T Fessler
- Department of Anthropology and Center for Behavior, Evolution and Culture, University of California, Los Angeles, Los Angeles, CA 90095-1553, USA
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Lu JS, Chen QY, Zhou SB, Wu FY, Liu RH, Zhou ZX, Zhang H, Zhuo M. Contagious itch can be induced in humans but not in rodents. Mol Brain 2019; 12:38. [PMID: 31014383 PMCID: PMC6480616 DOI: 10.1186/s13041-019-0455-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/27/2019] [Indexed: 11/29/2022] Open
Abstract
Itch contagion has been reported in human when people watch someone scratching in a video. The basic mechanism of contagious itch induced by scratching video is still being investigated. A recent study has reported that adult mice showed itch like responses after watching itch-like video or mice showing itching responses. However, such contagious itch behaviors failed to be reproduced by another study by repeating the same experiments of viewing itching mice. It is unclear if contagious itch induced by seeing itching video may be reproducible. In the present study, we used a four-iPad paradigm to repeat these experiments, and found that mice showed no significant itch-like responses after watching itching video of mice. To test if mice actually can see the video, we placed mirrors at the same location. Interestingly, mice showed altered activities in the open field with the mirrors. Finally, in healthy subjects, we found that viewing human itch video did cause itch sensation or responses. Our results indicate that the mouse model may not appropriate for studying contagious itch in humans.
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Affiliation(s)
- Jing-Shan Lu
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Qi-Yu Chen
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Si-Bo Zhou
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Feng-Yi Wu
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Ren-Hao Liu
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Zhao-Xiang Zhou
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Hua Zhang
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Min Zhuo
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China. .,Department of Physiology, Faculty of Medicine, University of Toronto, Medical Science Building, Room #3342, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada.
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Abstract
OBJECTIVE Allergic rhinitis symptoms can be reduced by behaviorally conditioning antihistamine. It is unclear whether these findings extend to histamine-induced itch or work when participants are informed about the conditioning procedure (open-label conditioning). The current study aims to investigate the efficacy of (open-label) antipruritic behavioral conditioning for histamine-induced itch. METHODS Healthy participants (n = 92; 84% female) were randomized to I) an open-label conditioned, II) closed-label conditioned, III) conditioned-not-evoked control, or IV) nonconditioned control group. A two-phase conditioning paradigm was used. During acquisition, a conditioned stimulus (CS; distinctively tasting beverage) was repeatedly paired with the H1-antihistamine levocetirizine (groups I-III). During evocation, the CS was paired with placebo (I, II), or instead of the CS, water was paired with placebo (III). The nonconditioned control group (IV) received CS with placebo in both phases. Itch after histamine iontophoresis and physiological data (i.e., spirometry, heart rate, skin conductance) were assessed. Combined conditioned and combined control groups were first compared, and analyses were repeated for separate groups. RESULTS Marginally lower itch was reported in the combined conditioned compared with the control groups (F(1,88) = 2.10, p = .076, ηpartial = 0.02); no differences between separate groups were found. No effects on physiological data were found, except for heart rate, which reduced significantly and consistently for control groups, and less consistently for conditioned groups (group by time interaction: F(7,80) = 2.35, p = .031, ηpartial = 0.17). CONCLUSION Limited support was found for the efficacy of antipruritic behavioral conditioning, regardless of whether participants were informed about the conditioning procedure. The application of open-label conditioning in patient populations should be further researched. TRIAL REGISTRATION www.trialregister.nl; ID NTR5544.
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Pouillon L, Socha M, Demore B, Thilly N, Abitbol V, Danese S, Peyrin-Biroulet L. The nocebo effect: a clinical challenge in the era of biosimilars. Expert Rev Clin Immunol 2018; 14:739-749. [PMID: 30118338 DOI: 10.1080/1744666x.2018.1512406] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The nocebo effect is defined as a negative effect of a pharmacological or non-pharmacological medical treatment that is induced by patients' expectations, and that is unrelated to the physiological action of the treatment. The nocebo effect is an important clinical challenge in the current era of biosimilars. Areas covered: This review aims to answer five key questions about the nocebo effect, namely to reveal its definition, pathophysiology, clinical relevance, contributing factors, and management. Expert commentary: The nocebo effect lowers patients' quality of life and negatively affects treatment adherence rates in biosimilar-treated patients. It may negatively impact on the cost-savings of biosimilars. Health-care providers in charge of biosimilar-treated patients need to be aware of the nocebo effect and adopt strategies to minimize it. They have to be well-informed and confident about the existing evidence about biosimilars. A good patient-physician relationship will improve patients' acceptance of biosimilars, and limits the risk of inappropriate negative bias and the nocebo effect.
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Affiliation(s)
- Lieven Pouillon
- a Department of Gastroenterology , Nancy University Hospital , Vandœuvre-lès-Nancy , France.,b Imelda GI Clinical Research Centre , Imeldaziekenhuis Bonheiden , Bonheiden , Belgium
| | - Marie Socha
- c Université de Lorraine, Labo CITHEFOR , Nancy , France.,d Pôle Pharmacie , Nancy University Hospital , Vandœuvre-lès-Nancy , France
| | - Beatrice Demore
- d Pôle Pharmacie , Nancy University Hospital , Vandœuvre-lès-Nancy , France.,e Université de Lorraine, Labo APEMAC , Nancy , France
| | - Nathalie Thilly
- e Université de Lorraine, Labo APEMAC , Nancy , France.,f Plateforme d'Aide à la Recherche Clinique , Nancy University Hospital , Vandœuvre-lès-Nancy , France
| | - Vered Abitbol
- g Department of Hepato-Gastroenterology , Cochin Hospital , Paris , France
| | - Silvio Danese
- h Department of Biomedical Sciences , Humanitas University , Rozzano, Milan , Italy
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Jafferany M, Davari ME. Itch and psyche: psychiatric aspects of pruritus. Int J Dermatol 2018; 58:3-23. [PMID: 29917231 DOI: 10.1111/ijd.14081] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/07/2018] [Accepted: 05/16/2018] [Indexed: 01/02/2023]
Abstract
Itch, also referred to as pruritus, is an unpleasant cutaneous sensation provoking the desire to scratch. It is often an uncomfortable, subjective sensation responsible for decreased quality of life in a variety of psychodermatological conditions. Comorbid psychiatric conditions, including depression and anxiety, are frequently associated with itch and scratch cycle. The reciprocal and intricate relationship between the psyche and itch has been widely studied. The neurobiology of itch involves the complexity of specific mediators, itch-related neuronal pathways, and central processing of itch. The connection between itch and the psyche can be grouped under three headings: pruritic diseases with psychosocial sequelae, pruritic diseases aggravated by psychosocial factors, and psychiatric disorders causing pruritus. Itch and pain modulation go together in most circumstances and involve various substances including histamine, interleukins, protease-activated receptors, transient receptor potential receptors, opioids, and cannabinoids. The close interaction between keratinocytes and nerve endings modulating pain and itch also play a major role. Management of itch associated with its psychosomatic components is directed at an underlying cause and adopting a holistic approach to address not only dermatologic and somatosensory aspects, but also the cognitive, emotional, and psychosocial components. An integrated multidisciplinary team consisting of a dermatologist, psychiatrist, psychologist, and social worker is vital in addressing the multifaceted aspects of pruritus.
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The vicious cycle of itch and anxiety. Neurosci Biobehav Rev 2018; 87:17-26. [PMID: 29374516 DOI: 10.1016/j.neubiorev.2018.01.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/28/2017] [Accepted: 01/21/2018] [Indexed: 12/21/2022]
Abstract
Chronic itch is associated with increased stress, anxiety, and other mood disorders. In turn, stress and anxiety exacerbate itch, leading to a vicious cycle that affects patient behavior (scratching) and worsens disease prognosis and quality of life. This cycle persists across chronic itch conditions of different etiologies and even to some extent in healthy individuals, suggesting that the final common pathway for itch processing (the central nervous system) plays a major role in the relationship between itch and anxiety. Pharmacological and nonpharmacological treatments that reduce anxiety have shown promising anti-itch effects. Further research is needed to establish specific central mechanisms of the itch-anxiety cycle and provide new targets for treatment.
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Nocebo-induced modulation of cerebral itch processing - An fMRI study. Neuroimage 2017; 166:209-218. [PMID: 29107770 DOI: 10.1016/j.neuroimage.2017.10.056] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/12/2017] [Accepted: 10/25/2017] [Indexed: 12/29/2022] Open
Abstract
It has been shown repeatedly that perceiving itch-related pictures or listening to a lecture on itch can enhance itch sensation and scratching behaviour (Niemeier and Gieler, 2000; Holle et al., 2012; Lloyd et al., 2013), indicating that itch is strongly influenced by expectations. Using fMRI, we investigated the neural correlates of the itch-related nocebo effect in healthy male and female human subjects. Itch sensation on the left forearm was induced by cutaneous histamine application and thermally modulated, with cooling leading to higher itch. Nocebo-induced aggravation of histaminergic itch was achieved by ostensibly treating volunteers with "transcutaneous electrical nerve stimulation (TENS)" about which subjects were instructed that it would increase itch. During a conditioning phase subjects indeed experienced stronger itch due to slightly altered cooling and histamine concentrations, but attributed it to the alleged "TENS stimulation". Importantly, in the subsequent test phase where no "TENS" or electrical stimulation was applied, volunteers significantly reported stronger itch during the nocebo as compared to the control condition. Comparing BOLD responses during nocebo in contrast to control, we observed increased activity in contralateral (right) rolandic operculum. Opercular involvement was repeatedly reported in studies related to the expectation of stimulus intensification and might thus represent an early area integrating expectation information with somatosensory information. Finally, functional coupling between the insula and the periaqueductal gray (PAG) was enhanced specifically in the nocebo condition. This cortex-PAG interaction indicates that context-dependent top-down modulation during itch might represent a shared mechanism with other modalities such as pain.
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Liljencrantz J, Pitcher MH, Low LA, Bauer L, Bushnell MC. Comment on "Molecular and neural basis of contagious itch behavior in mice". Science 2017; 357:357/6347/eaan4749. [PMID: 28706013 DOI: 10.1126/science.aan4749] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/16/2017] [Indexed: 11/02/2022]
Abstract
Yu et al (Reports, 10 March 2017, p. 1072) state that contagious itch occurs in mice based on imitative scratching in normal mice observing excessive scratching in genetically modified demonstrator mice. However, despite employing multiple behavioral analysis approaches, we were unable to extend these findings to normal mice observing the well-established histamine model of acute itch in demonstrator mice.
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Affiliation(s)
- Jaquette Liljencrantz
- Pain and Integrative Neuroscience Laboratory, National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mark H Pitcher
- Pain and Integrative Neuroscience Laboratory, National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Lucie A Low
- Pain and Integrative Neuroscience Laboratory, National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lucy Bauer
- Pain and Integrative Neuroscience Laboratory, National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - M Catherine Bushnell
- Pain and Integrative Neuroscience Laboratory, National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD 20892, USA
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Bartels DJP, van Laarhoven AIM, Stroo M, Hijne K, Peerdeman KJ, Donders ART, van de Kerkhof PCM, Evers AWM. Minimizing nocebo effects by conditioning with verbal suggestion: A randomized clinical trial in healthy humans. PLoS One 2017; 12:e0182959. [PMID: 28910291 PMCID: PMC5598922 DOI: 10.1371/journal.pone.0182959] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 07/25/2017] [Indexed: 11/19/2022] Open
Abstract
Nocebo effects, i.e., adverse treatment effects which are induced by patients' expectations, are known to contribute to the experience of physical symptoms such as pain and itch. A better understanding of how to minimize nocebo responses might eventually contribute to enhanced treatment effects. However, little is known about how to reduce nocebo effects. In the current randomized controlled study, we tested whether nocebo effects can be minimized by positive expectation induction with respect to electrical and histaminic itch stimuli. First, negative expectations about electrical itch stimuli were induced by verbal suggestion and conditioning (part 1: induction of nocebo effect). Second, participants were randomized to either the experimental group or one of the control groups (part 2: reversing nocebo effect). In the experimental group, positive expectations were induced by conditioning with verbal suggestion. In the control groups either the negative expectation induction was continued or an extinction procedure was applied. Afterwards, a histamine application test was conducted. Positive expectation induction resulted in a significantly smaller nocebo effect in comparison with both control groups. Mean change itch NRS scores showed that the nocebo effect was even reversed, indicating a placebo effect. Comparable effects were also found for histamine application. This study is the first to demonstrate that nocebo effects can be minimized and even reversed by conditioning with verbal suggestion. The results of the current study indicate that learning via counterconditioning and verbal suggestion represents a promising strategy for diminishing nocebo responses.
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Affiliation(s)
- Danielle J. P. Bartels
- Unit Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, the Netherlands
- * E-mail:
| | - Antoinette I. M. van Laarhoven
- Unit Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, the Netherlands
| | - Michiel Stroo
- Unit Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Kim Hijne
- Unit Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Kaya J. Peerdeman
- Unit Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, the Netherlands
| | - A. Rogier T. Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Andrea W. M. Evers
- Unit Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, the Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
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Schut C, Mochizuki H, Grossman SK, Lin AC, Conklin CJ, Mohamed FB, Gieler U, Kupfer J, Yosipovitch G. Brain Processing of Contagious Itch in Patients with Atopic Dermatitis. Front Psychol 2017; 8:1267. [PMID: 28790959 PMCID: PMC5524890 DOI: 10.3389/fpsyg.2017.01267] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/11/2017] [Indexed: 11/13/2022] Open
Abstract
Several studies show that itch and scratching cannot only be induced by pruritogens like histamine or cowhage, but also by the presentation of certain (audio-) visual stimuli like pictures on crawling insects or videos showing other people scratching. This phenomenon is coined "Contagious itch" (CI). Due to the fact that CI is more profound in patients with the chronic itchy skin disease atopic dermatitis (AD), we believe that it is highly relevant to study brain processing of CI in this group. Knowledge on brain areas involved in CI in AD-patients can provide us with useful hints regarding non-invasive treatments that AD-patients could profit from when they are confronted with itch-inducing situations in daily life. Therefore, this study investigated the brain processing of CI in AD-patients. 11 AD-patients underwent fMRI scans during the presentation of an itch inducing experimental video (EV) and a non-itch inducing control video (CV). Perfusion based brain activity was measured using arterial spin labeling functional MRI. As expected, the EV compared to the CV led to an increase in itch and scratching (p < 0.05). CI led to a significant increase in brain activity in the supplementary motor area, left ventral striatum and right orbitofrontal cortex (threshold: p < 0.001; cluster size k > 50). Moreover, itch induced by watching the EV was by trend correlated with activity in memory-related regions including the temporal cortex and the (pre-) cuneus as well as the posterior operculum, a brain region involved in itch processing (threshold: p < 0.005; cluster size k > 50). These findings suggest that the fronto-striatal circuit, which is associated with the desire to scratch, might be a target region for non-invasive treatments in AD patients.
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Affiliation(s)
- Christina Schut
- Institute of Medical Psychology, Justus-Liebig-UniversityGiessen, Germany
| | - Hideki Mochizuki
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, PhiladelphiaPA, United States
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center, Miller School of Medicine, University of Miami, MiamiFL, United States
| | - Shoshana K. Grossman
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, PhiladelphiaPA, United States
| | - Andrew C. Lin
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, PhiladelphiaPA, United States
| | - Christopher J. Conklin
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, PhiladelphiaPA, United States
| | - Feroze B. Mohamed
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, PhiladelphiaPA, United States
| | - Uwe Gieler
- Department of Dermatology, University Hospital of Giessen and MarburgGiessen, Germany
| | - Joerg Kupfer
- Institute of Medical Psychology, Justus-Liebig-UniversityGiessen, Germany
| | - Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center, Miller School of Medicine, University of Miami, MiamiFL, United States
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Mochizuki H, Schut C, Nattkemper LA, Yosipovitch G. Brain mechanism of itch in atopic dermatitis and its possible alteration through non-invasive treatments. Allergol Int 2017; 66:14-21. [PMID: 27688121 DOI: 10.1016/j.alit.2016.08.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 01/19/2023] Open
Abstract
Atopic dermatitis (AD) is a common chronic skin disease that is characterized by intense pruritus and has high impairment of quality of life. AD is often described as "the itch that rashes, rather than the rash that itches". Several studies suggest that mechanisms of central modulation play an important role in the development and maintenance of chronic itch. Therefore, treating the neurosensory aspects of itch is an important part in the management of chronic itch. However, little attention has been paid to the role of the central nervous system in the processing of itch in AD. Targeting itch-related anatomical structures in the brain with non-invasive treatments such as psychological interventions and transcranial Direct Current Stimulation (tDCS) could have an antipruritic effect in AD. Therefore, in this review article, we discuss the current progress in brain imaging research of itch, as well as the efficacy of non-invasive interventions for itch relief in this patient group.
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Affiliation(s)
- Hideki Mochizuki
- Department of Dermatology, Lewis Katz School of Medicine, Philadelphia, PA, USA; Temple Itch Center, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Christina Schut
- Institute of Medical Psychology, Justus-Liebig-University, Giessen, Germany
| | - Leigh A Nattkemper
- Department of Dermatology, Lewis Katz School of Medicine, Philadelphia, PA, USA; Temple Itch Center, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, USA.
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Murota H, Katayama I. Exacerbating factors of itch in atopic dermatitis. Allergol Int 2017; 66:8-13. [PMID: 27863904 DOI: 10.1016/j.alit.2016.10.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/11/2016] [Accepted: 10/12/2016] [Indexed: 01/01/2023] Open
Abstract
Atopic dermatitis (AD) displays different clinical symptoms, progress, and response to treatment during early infancy and after childhood. After the childhood period, itch appears first, followed by formation of well-circumscribed plaque or polymorphous dermatoses at the same site. When accompanied with dermatitis and dry skin, treatment of skin lesions should be prioritized. When itch appears first, disease history, such as causes and time of appearance of itch should be obtained by history taking. In many cases, itch increases in the evening when the sympathetic nerve activity decreased. Treatment is provided considering that hypersensitivity to various external stimulations can cause itch. Heat and sweating are thought to especially exacerbate itch. Factors causing itch, such as cytokines and chemical messengers, also induce itch mainly by stimulating the nerve. Scratching further aggravates dermatitis. Skin hypersensibility, where other non-itch senses, such as pain and heat, are felt as itch, sometimes occurs in AD. Abnormal elongation of the sensory nerve into the epidermis, as well as sensitizing of the peripheral/central nerve, are possible causes of hypersensitivity, leading to itch. To control itch induced by environmental factors such as heat, treatment for dermatitis is given priority. In the background of itch exacerbated by sweating, attention should be given to the negative impact of sweat on skin homeostasis due to 1) leaving excess sweat on the skin, and 2) heat retention due to insufficient sweating. Excess sweat on the skin should be properly wiped off, and dermatitis should be controlled so that appropriate amount of sweat can be produced. Not only stimulation from the skin surface, but also visual and auditory stimulation can induce new itch. This "contagious itch" can be notably observed in patients with AD. This article reviews and introduces causes of aggravation of itch and information regarding how to cope with such causes.
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Abstract
The social context in which people take medicines can strongly influence the drug response in both positive and negative ways. We first examine the role of social modeling in influencing treatment outcomes through modifying placebo and nocebo responses, and then explore possible mechanisms for these effects. Viewing another person show improvement after taking a drug can increase the placebo component of the medicine and thus the overall potency of the treatment. Likewise, seeing another person who has taken the same medicine report side effects can substantially increase adverse effects. Such effects can also occur on a wider scale following changes in medicine formulations or from vaccinations programs, when the media transmit adverse effects from these treatments to a wider audience. Females seem to be more susceptible than males to the social modeling of adverse effects of treatments. A greater awareness of the effects of social modeling has potential to improve the effectiveness of medical treatments, minimize side-effect burden, and also lead to more effective management of health scares.
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Affiliation(s)
- Kate Faasse
- School of Psychology, University of New South Wales
| | - Keith J. Petrie
- Department of Psychological Medicine, University of Auckland
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Abstract
This chapter summarizes recent findings regarding the central transmission of acute and chronic itch. Itch is transduced by cutaneous pruriceptors that transmit signals to neurons in the superficial spinal cord. Spinal itch-signaling circuits utilize several neuropeptides whose receptors represent novel targets to block itch transmission. Itch is relieved by scratching, which activates spinal interneurons to inhibit itch-transmitting neurons. Spinal itch transmission is also thought to be modulated by descending pathways. Itch is transmitted rostrally via ascending pathways to activate a variety of brain regions involved in sensory discrimination of affective and motor responses to itch. The pathophysiological mechanisms of chronic itch are poorly understood but likely involve sensitization of itch-signaling pathways and/or dysfunction of itch-inhibitory circuits. Improved understanding of central itch mechanisms has identified a number of novel targets for the development of antipruritic treatment strategies.
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[Psychological aspects of pruritus and therapy options]. Hautarzt 2016; 67:622-6. [PMID: 27341824 DOI: 10.1007/s00105-016-3825-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Besides biological factors, which cause or influence chronic pruritus, more and more attention has recently also been paid to psychological and psychoneuroimmunological factors which uphold the symptom. OBJECTIVES This review article gives an overview of the state of research regarding psychological and psychoneuroimmunological factors and the resulting therapeutic options. MATERIALS AND METHODS The article is based on a literature search in the PubMed database. RESULTS Under experimental conditions, pruritus can be induced by verbal instructions and modulated by placebo and nocebo effects. Stressful life events can also induce pruritus or its exacerbation. This can also be demonstrated on a cellular level. CONCLUSION The knowledge that pruritus intensity is modulated by cognitions, behavioral factors, and stress is important for the development and application of psychological interventions. More research should be done regarding psychological interventions in the treatment of chronic itch and they should be applied clinically more often.
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In the presence of others: Self-location, balance control and vestibular processing. Neurophysiol Clin 2015; 45:241-54. [DOI: 10.1016/j.neucli.2015.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/10/2015] [Accepted: 09/11/2015] [Indexed: 11/23/2022] Open
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