Cardiovascular reactivity of mitral valve prolapse patients during experimental stress exposure: evidence for a functional nature of cardiovascular symptoms

Clinical application of somatosensory amplification in psychosomatic medicine

Many patients with somatoform disorders are frequently encountered in psychosomatic clinics as well as in primary care clinics. To assess such patients objectively, the concept of somatosensory amplification may be useful. Somatosensory amplification refers to the tendency to experience a somatic sensation as intense, noxious, and disturbing. It may have a role in a variety of medical conditions characterized by somatic symptoms that are disproportionate to demonstrable organ pathology. It may also explain some of the variability in somatic symptomatology found among different patients with the same serious medical disorder. It has been assessed with a self-report questionnaire, the Somatosensory Amplification Scale. This instrument was developed in a clinical setting in the U.S., and the reliability and validity of the Japanese and Turkish versions have been confirmed as well.

Many studies have attempted to clarify the specific role of somatosensory amplification as a pathogenic mechanism in somatization. It has been reported that somatosensory amplification does not correlate with heightened sensitivity to bodily sensations and that emotional reactivity exerts its influence on somatization via a negatively biased reporting style. According to our recent electroencephalographic study, somatosensory amplification appears to reflect some aspects of long-latency cognitive processing rather than short-latency interoceptive sensitivity.

The concept of somatosensory amplification can be useful as an indicator of somatization in the therapy of a broad range of disorders, from impaired self-awareness to various psychiatric disorders. It also provides useful information for choosing appropriate pharmacological or psychological therapy. While somatosensory amplification has a role in the presentation of somatic symptoms, it is closely associated with other factors, namely, anxiety, depression, and alexithymia that may also influence the same. The specific role of somatosensory amplification with regard to both neurological and psychological function should be clarified in future studies. In this paper, we will explain the concept of amplification and describe its role in psychosomatic illness.

Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research

This meta-analysis reviews 208 laboratory studies of acute psychological stressors and tests a theoretical model delineating conditions capable of eliciting cortisol responses. Psychological stressors increased cortisol levels; however, effects varied widely across tasks. Consistent with the theoretical model, motivated performance tasks elicited cortisol responses if they were uncontrollable or characterized by social-evaluative threat (task performance could be negatively judged by others), when methodological factors and other stressor characteristics were controlled for. Tasks containing both uncontrollable and social-evaluative elements were associated with the largest cortisol and adrenocorticotropin hormone changes and the longest times to recovery. These findings are consistent with the animal literature on the physiological effects of uncontrollable social threat and contradict the belief that cortisol is responsive to all types of stressors.

Psychiatric and medical co-morbidity in mitral valve prolapse

OBJECTIVE

Significant controversy continues to exist in the empirical literature regarding the diagnosis and treatment of mitral valve prolapse (MVP). In addition, there is also inconsistency in the correlation of anxiety disorders as co-existing with MVP, as well as cause and effect issues in terms of the role of the autonomic nervous system, MVP and panic attacks. Recent studies suggest that the co-morbidity of an anxiety disorder and clinical depression appears to increase the likelihood of MVP in predisposed patients. The objective of this review was to examine, clarify, and further define the medical and psychiatric aspects of MVP.

METHODS

A literature review was conducted on empirical studies and reviews examining MVP.

RESULTS

It was found that although MVP is highly correlated with psychiatric disorders, the lack of adequate control groups and clear criteria for a diagnosis of MVP in most empirical studies examining these associations make it difficult to determine the relationship between MVP and psychiatric disorders.

CONCLUSIONS

Suggestions for further research in the areas of depression and personality characteristics are offered. It is also suggested that the use of control groups from populations with cardiac disorders and a better definition of MVP will clarify many of the problems in empirical studies aiming to determine the relationship between MVP and psychiatric disorders.

Alexithymia following myocardial infarction: psychometric properties and correlates of the Toronto Alexithymia Scale

OBJECTIVE

The purpose was to explore the psychometrics and correlates of the Toronto Alexithymia Scale (TAS-20) after myocardial infarction (MI).

METHODS

The TAS-20 and other self-report measures were administered 3-6 months after discharge to 1443 patients.

RESULTS

Good internal reliability was confirmed for the total TAS-20 and two subscales (F1 and F2). The F3 showed low internal consistency linked to negatively keyed items. The prevalence of alexithymia was 30.2% at the first interview. Alexithymics were older, less educated, more likely to have previous MIs and had higher scores on all measures of negative emotions. Six-month test-retest reliability was.47 (n=167). Residual change score analysis showed patients with more education and a first MI had greater decreases in alexithymia than expected.

CONCLUSIONS

The TAS-20 has adequate internal consistency in post-MI patients, and its correlates are similar to other reports. Low temporal stability suggests that secondary alexithymia is important after MI.

ECG Changes, Emotional Arousal, and Subjective State

Abstract Laboratory studies with CHD patients suggest an adverse influence of emotional/mental arousal on myocardial ischaemia or ventricular premature contractions (VPCs). However, it is controversial whether such studies can be generalized to everyday life. In addition, existing ambulatory monitoring studies have shortcomings because emotional arousal is entirely based on subjective reports. The hypothesis of the present study is that during ischaemic episodes or VPCs “objective emotional/mental arousal” will be more pronounced than during comparable episodes without these events. Objective emotional/mental arousal was indicated by a special ambulatory monitoring method which was based on the online analysis of heart rate and physical activity, resulting in the so-called emotional or non-metabolic heart rate. Moreover, the method allowed for ratings of anginal pain. In 223 CHD patients the associations between ischaemia, VPCs, objective emotional/mental arousal, and anginal pain were investigated. Forty-nine patients revealed ischaemic episodes and 115 patients VPCs. Emotional/mental arousal was higher during ischaemic episodes as compared to control minutes whereas minutes with VPCs showed no difference. No differences between ischaemic episodes or VPCs and the respective control minutes were observed for anginal pain. Objective emotional/mental arousal was associated in this study with ischaemia but not with arrhythmia, thus partly confirming the hypothesis stated. Because anginal pain was not related to objective cardiac events, detection of CHD has to rely on medical examinations.