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Gostoli S, Ferrara F, Quintavalle L, Tommasino S, Gigante G, Montecchiarini M, Urgese A, Guolo F, Subach R, D'Oronzo A, Polifemo A, Buonfiglioli F, Cennamo V, Rafanelli C. Four-year follow-up of psychiatric and psychosomatic profile in patients with Inflammatory Bowel Disease (IBD). BMC Psychol 2024; 12:211. [PMID: 38632660 PMCID: PMC11022322 DOI: 10.1186/s40359-024-01726-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
Psychological characterization of patients affected by Inflammatory Bowel Disease (IBD) focuses on comorbidity with psychiatric disorders, somatization or alexithymia. Whereas IBD patients had higher risk of stable anxiety and depression for many years after the diagnosis of the disease, there is a lack of studies reporting a comprehensive psychosomatic assessment addressing factors of disease vulnerability, also in the long-term. The objective of this investigation is to fill this gap in the current literature. The aims were thus to assess: a) changes between baseline and a 4-year follow-up in psychiatric diagnoses (SCID), psychosomatic syndromes (DCPR), psychological well-being (PWB-I), lifestyle, gastrointestinal symptoms related to IBD and Irritable Bowel Syndrome (IBS)-like symptoms b) stability of psychiatric and psychosomatic syndromes at 4-year follow-up. A total of 111 IBD outpatients were enrolled; 59.5% of them participated at the follow-up. A comprehensive assessment, including both interviews and self-report questionnaires, was provided at baseline and follow-up. Results showed increased psychiatric diagnoses, physical activity, consumption of vegetables and IBS-like symptoms at follow-up. Additionally, whereas psychiatric diagnoses were no longer present and new psychopathological pictures ensued at follow-up, more than half of the sample maintained psychosomatic syndromes (particularly allostatic overload, type A behavior, demoralization) from baseline to follow-up. Long-term presence/persistence of such psychosocial burden indicates the need for integrating a comprehensive psychosomatic evaluation beyond traditional psychiatric nosography in IBD patients. Moreover, since psychosomatic syndromes represent vulnerability factors of diseases, further studies should target subgroups of patients presenting with persistent psychosomatic syndromes and worse course of the disease.
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Affiliation(s)
- Sara Gostoli
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Francesco Ferrara
- Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Bologna, Italy
| | - Ludovica Quintavalle
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Sara Tommasino
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Graziano Gigante
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Maria Montecchiarini
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Alessia Urgese
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Francesco Guolo
- Division of Cardiology, Bellaria Hospital, AUSL Bologna, Bologna, Italy
| | - Regina Subach
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Angelica D'Oronzo
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Annamaria Polifemo
- Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Bologna, Italy
| | | | - Vincenzo Cennamo
- Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Bologna, Italy
| | - Chiara Rafanelli
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy.
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Gostoli S, Subach R, Guolo F, Buzzichelli S, Abbate Daga G, de Figueiredo JM, Rafanelli C. Demoralization in acute coronary syndrome: Treatment and predictive factors associated with its persistence. Int J Clin Health Psychol 2024; 24:100444. [PMID: 38317782 PMCID: PMC10839992 DOI: 10.1016/j.ijchp.2024.100444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
Background/objective Although demoralization is associated with morbidity and mortality in cardiac settings, its treatment has been overlooked. The present randomized controlled trial aimed at 1) evaluating the effectiveness of sequential combination of Cognitive-Behavioral and Well-Being therapies (CBT/WBT), compared to Clinical Management (CM), on demoralization among Acute Coronary Syndromes (ACS) patients, at post-treatment and after 3 months; 2) examining ACS patients' characteristics predicting demoralization persistence at 3-month follow-up. Method 91 demoralized ACS patients were randomized to CBT/WBT (N = 47) or CM (N = 44). Demoralization was assessed with an interview on Diagnostic Criteria for Psychosomatics Research at baseline, post-treatment and 3-month follow-up. Predictors of demoralization maintenance included cardiac parameters, psychological distress and well-being. Results Compared to CM, CBT/WBT significantly reduced demoralization post-treatment. Somatization (odds ratio = 1.11; p = 0.027) and history of depression (odds ratio = 5.16; p = 0.004) were risk factors associated with demoralization persistence at follow-up, whereas positive relationships (odds ratio = 0.94; p = 0.005) represented protective factors. Conclusions The study provides preliminary and promising evidence on the benefits of CBT/WBT in treating demoralization in ACS patients. Moreover, ACS patients with somatization or positive history of depression could be at higher risk for developing persistent demoralization.
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Affiliation(s)
- Sara Gostoli
- Department of Psychology “Renzo Canestrari”, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy
| | - Regina Subach
- Department of Psychology “Renzo Canestrari”, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy
| | - Francesco Guolo
- Division of Cardiology, Bellaria Hospital, AUSL Bologna, Bologna, Italy
| | - Sara Buzzichelli
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giovanni Abbate Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - John M. de Figueiredo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Chiara Rafanelli
- Department of Psychology “Renzo Canestrari”, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy
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Gasparre D, Pepe I, Laera D, Abbatantuono C, De Caro MF, Taurino A, D’Erasmo D, Fanizzi P, Antonucci LA, Pantaleo A, Cavallaro G, Pontillo V, Taurisano P, Quaranta N. Cognitive functioning and psychosomatic syndromes in a subjective tinnitus sample. Front Psychol 2023; 14:1256291. [PMID: 38192387 PMCID: PMC10773809 DOI: 10.3389/fpsyg.2023.1256291] [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: 07/10/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Tinnitus is the perception of a sound in the absence of any corresponding external sound source. Current research suggests a relationship among emotional, cognitive, and psychosomatic symptoms and the occurrence or maintenance of chronic tinnitus. This study aimed to detect the prevalence and role of psychosomatic conditions, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR), and cognitive functioning in a group of patients with tinnitus. Methods Sixty-two patients with subjective tinnitus and 62 non-tinnitus controls were recruited from the Otorhinolaryngology Unit of the University of Bari. Pure-tone audiometry was performed in all tinnitus subjects, and sound level tolerance was evaluated. Additionally, tinnitus handicap (Tinnitus Handicap Inventory [THI]), psychopathological symptoms (Symptom Checklist-90, Revised [SCL-90-R]), anxiety (State-Trait Anxiety Inventory [STAI-Y1/2]), depression (Beck Depression Inventory [BDI]), cognitive impairment (Mini-Mental State Examination [MMSE]), executive functions (Frontal Assessment Battery [FAB]), and psychosomatic syndromes (DCPR) were evaluated. Parametric and non-parametric tests were used to detect cognitive and symptomatological differences between patients and controls. The predictivity of these factors for tinnitus severity was studied using multiple regression (Backward Elimination). All tests were considered significant at p < 0.05 (family wise error corrected for each comparison). Results 69.4% tinnitus patients met multiple DCPR criteria, compared to 32.3% of controls. Tinnitus patients exhibited elevated rates of illness denial (ꭓ2 = 9.02; p < 0.009), demoralization (ꭓ2 = 8.05; p < 0.018), somatization (ꭓ2 = 4.92; p < 0.063) and functional symptoms (ꭓ2 = 5.21; p < 0.06) scoring significantly higher on the BDI, STAI-Y1, and STAI-Y2, and SCL-90-R compared to controls. Patients with tinnitus showed lower MMSE scores, compared to controls (t = -2.282; p < 0.001). No association between tinnitus severity and global cognitive impairment emerged. Conversely, executive function deficits were associated to tinnitus severity. Among the cognitive and psychological factors, only trait anxiety, one or more psychosomatic syndromes, and somatization clusters were strongly correlated with tinnitus severity. Discussion Our findings suggest a relationship between tinnitus severity, psychological, psychosomatic symptoms, and frontal impairment. Additionally, the influence of tinnitus on cognitive functions paves the way for integrated, multidisciplinary diagnostic and treatment options for patients. Although preliminary, our findings highlight the importance of early cognitive and psychological screening to improve patients' quality of life.
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Affiliation(s)
- Daphne Gasparre
- Department of Translational Biomedicine and Neuroscience “DiBraiN”, University of Bari “Aldo Moro”, Bari, Italy
| | - Ilaria Pepe
- Department of Translational Biomedicine and Neuroscience “DiBraiN”, University of Bari “Aldo Moro”, Bari, Italy
| | - Domenico Laera
- Clinical Psychology Service, Mental Health Department, ASL Taranto, Taranto, Italy
| | - Chiara Abbatantuono
- Department of Translational Biomedicine and Neuroscience “DiBraiN”, University of Bari “Aldo Moro”, Bari, Italy
| | - Maria Fara De Caro
- Department of Translational Biomedicine and Neuroscience “DiBraiN”, University of Bari “Aldo Moro”, Bari, Italy
| | - Alessandro Taurino
- Department of Education, Psychology, Communication, University of Bari, Palazzo Chiaia-Napolitano, Bari, Italy
| | - Daniele D’Erasmo
- Department of Translational Biomedicine and Neuroscience “DiBraiN”, University of Bari “Aldo Moro”, Bari, Italy
- Otolaryngology Unit, Department of Biomedical Sciences, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - Piero Fanizzi
- Otolaryngology Unit, Department of Biomedical Sciences, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - Linda A. Antonucci
- Department of Translational Biomedicine and Neuroscience “DiBraiN”, University of Bari “Aldo Moro”, Bari, Italy
| | - Alessandra Pantaleo
- Otolaryngology Unit, Department of Biomedical Sciences, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giada Cavallaro
- Otolaryngology Unit, Department of Biomedical Sciences, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - Vito Pontillo
- Otolaryngology Unit, Department of Biomedical Sciences, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - Paolo Taurisano
- Department of Translational Biomedicine and Neuroscience “DiBraiN”, University of Bari “Aldo Moro”, Bari, Italy
| | - Nicola Quaranta
- Otolaryngology Unit, Department of Biomedical Sciences, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
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Fava M, Sorg E, Jacobs JM, Leadbetter R, Guidi J. Distinguishing and treating demoralization syndrome in cancer: A review. Gen Hosp Psychiatry 2023; 85:185-190. [PMID: 37950966 DOI: 10.1016/j.genhosppsych.2023.10.004] [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: 05/25/2023] [Revised: 08/22/2023] [Accepted: 10/08/2023] [Indexed: 11/13/2023]
Abstract
IMPORTANCE Demoralization, characterized by a persistent inability to cope, as well as helplessness, hopelessness, and despair, is highly prevalent in oncology, with between 36% to 52% of patients exhibiting demoralization syndrome. Given established evidence linking demoralization in patients with cancer to physical symptom burden, quality of life, sleep disturbance, and suicidality, assessment and treatment of demoralization syndrome is critical for optimizing clinical and psychosocial outcomes. OBSERVATIONS The term "demoralization" is highly relevant to the care of patients with cancer facing life-limiting illnesses. Indeed, demoralization can be conceptualized as a feeling state characterized by the perception of being unable to cope with some pressing problems and/or of lack of adequate support from others. Despite a considerable overlap in symptoms, demoralization and depression should be regarded as distinct and independent clinical syndromes. Patients who are demoralized but not clinically depressed often describe a sense of subjective incompetence and do not report anhedonia (i.e., loss of interest and inability to enjoy things). Although the definition of demoralization is now included as a distinct syndrome in the International Classification of Diseases (ICD)-11, it has been neglected by the current U.S. official nosology in psychiatry, such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). As such, demoralization syndrome may be under- or misdiagnosed and treated ineffectively in the oncology setting, potentially prolonging suffering and influencing cancer outcomes. CONCLUSIONS AND RELEVANCE Optimization of methods to diagnose and assess demoralization syndrome is critical to underpin rigorous studies evaluating the efficacy of psychotherapeutic and pharmacological interventions for patients with cancer experiencing demoralization. Our review supports the use of specific diagnostic criteria for demoralization in cancer patients, introduces methodological considerations relevant to treatment studies, and presents a novel measurement approach to the assessment of demoralization severity with the Clinical Interview for Demoralization (CIDE).
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Affiliation(s)
- Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, Bulfinch 351 - 55 Fruit Street, Boston, MA 02114, United States of America.
| | - Emily Sorg
- Center for Psychiatric Oncology & Behavioral Sciences, Department of Psychiatry & Mass General Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States of America
| | - Jamie M Jacobs
- Center for Psychiatric Oncology & Behavioral Sciences, Department of Psychiatry & Mass General Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States of America
| | - Robert Leadbetter
- Reset Pharmaceuticals, Massachusetts General Hospital MA United States of America
| | - Jenny Guidi
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy
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Sancassiani F, Montisci R, Meloni L, Nardi AE, Carta MG. Why is it Important to Assess and Treat Alexithymia in the Cardiologic Field? An Overview of the Literature. Clin Pract Epidemiol Ment Health 2023; 19:e174501792307140. [PMID: 37916203 PMCID: PMC10507214 DOI: 10.2174/17450179-v19-230810-2022-ht15-4764-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/23/2023] [Accepted: 07/01/2023] [Indexed: 11/03/2023]
Abstract
Background Alexithymia has been found to be associated with several somatic illnesses, such as cardiovascular, indicating that it might be a risk factor for early death in the long-term course of post-myocardial infarction. From the cardiology perspective, the aim was to collect current evidence about the relationship between alexithymia and somatic illness. Methods The literature was synthesized and summarized in a narrative format. The literature search was carried out in PubMed. Pertinent studies published in the last 50 years written in English were included and organized by three main topics ("The relation between alexithymia and somatic illness from the cardiology perspective"; "How do assess alexithymia?"; "Treating alexithymia") to be discussed. Results High alexithymia is a dimensional trait that affects around 10% of the general population and up to 55% of people with essential hypertension. Also, the link between alexithymia and cardiovascular activity has been pointed out. There are several validated tools to assess alexithymia, as well as treatment options. Conclusion Knowledge about the main features of alexithymia, as well as its assessment and treatment, can promote a multifactorial approach to the primary, secondary, and tertiary prevention of cardiac diseases.
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Affiliation(s)
- Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E, SS 554 bivio Sestu 09042 Monserrato (CA), Italy
| | - Roberta Montisci
- Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E, SS 554 bivio Sestu 09042 Monserrato (CA), Italy
| | - Luigi Meloni
- Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E, SS 554 bivio Sestu 09042 Monserrato (CA), Italy
| | - Antonio Egidio Nardi
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E, SS 554 bivio Sestu 09042 Monserrato (CA), Italy
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Gostoli S, Piolanti A, Buzzichelli S, Benasi G, Roncuzzi R, Abbate Daga G, de Figueiredo JM, Rafanelli C. Negative health outcomes in depressed cardiac patients are associated with both low and high psychological well-being dimensions. PSYCHOL HEALTH MED 2023; 28:555-563. [PMID: 34505821 DOI: 10.1080/13548506.2021.1975781] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Literature supports the positive effects of psychological well-being (P.W.B.) on health. However, most studies focused on the unitary construct of P.W.B., neglecting the different role played by distinct P.W.B. dimensions on health-related outcomes. The aim of this study was to determine whether unbalanced (i.e. low or high) levels of P.W.B. dimensions could differentially affect cardiac course after acute coronary syndrome (A.C.S.), in terms of participation in secondary prevention (S.P.) and/or survival. The sample included 136 depressed and/or demoralized A.C.S. patients referred for a S.P. program on lifestyle modification, in addition to routine cardiac visits provided by the hospital where they were admitted. Psychological assessment included validated interviews on depression and demoralization, Symptom Questionnaire and Psychological Well-Being scales. 100 patients joined the S.P. program, 36 did not. Logistic regression revealed that older age (B = 0.051; p < 0.05), higher autonomy (B = 0.070; p < 0.05) and lower personal growth (B = -0.073; p < 0.05) levels were associated with non-participation in S.P. Moreover, only among patients who did not join the program, those presenting with an impaired level of P.W.B. 'positive relations' dimension (i.e. below the 25th percentile) showed a worse cardiac prognosis (Log Rank: χ2(1) = 4.654; p = 0.031). Negative health outcomes in depressed cardiac patients, such as non-participation in S.P. and worse cardiac course, are associated with both high and low levels of certain P.W.B. dimensions. Psychotherapeutic approaches geared to a balance in P.W.B. dimensions could represent promising new additions to S.P. programs.
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Affiliation(s)
- Sara Gostoli
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Sara Buzzichelli
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giada Benasi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Renzo Roncuzzi
- Department of Cardiology, Bellaria Hospital, Ausl Bologna, Bologna Italy
| | - Giovanni Abbate Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - John M de Figueiredo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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Woźniewicz A, Cosci F. Clinical utility of demoralization: A systematic review of the literature. Clin Psychol Rev 2023; 99:102227. [PMID: 36462221 DOI: 10.1016/j.cpr.2022.102227] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/28/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
Demoralization is a complex clinical phenomenon which has raised a growing interest in clinical and research realms. The present systematic review of the literature aimed at (1) updating on demoralization prevalence in different populations, (2) identifying the instruments more largely used to assess demoralization, and (3) verifying whether new tools of assessment have been proposed. PubMed and Web of Science were searched from inception to April 2022. Search terms were: demoralization/demoralized/demoralizing/demoralised/demoralising. PRISMA guidelines were followed. GRADE rating system was used. A total of 188 papers were included. Demoralization appeared to be a distinctive psychological state common in medical, psychiatric, and non-clinical settings, thus not limited to life-threatening diseases. Diagnostic Criteria for Psychosomatic Research (DCPR) and Demoralization Scale (DS) are the most commonly used tools to assess it. DCPR allow to diagnose demoralization as a manifestation of dealing with chronic stress. DS captures dimensionally a psychological distress related to end of life. Demoralization is associated with clinical features encompassing allostatic overload, quality of life, wellbeing/euthymia. Implications on health outcomes and treatment are discussed. Demoralization warrants careful consideration in clinical contexts through valid assessment procedures. DCPR are recommended to diagnose it, DS can be helpful to capture clinical details.
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Affiliation(s)
- Agnieszka Woźniewicz
- Department of Geriatrics, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Jurija Gagarina 11, 87-100 Toruń, Poland
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, via di San salvi n. 12, Florence, Italy; Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616 6200, MD, Maastricht, The Netherlands.
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Romaniello C, Romanazzo S, Cosci F. Clinimetric properties of the diagnostic criteria for psychosomatic research among the elderly. Clin Psychol Psychother 2023. [PMID: 36607260 DOI: 10.1002/cpp.2822] [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: 11/15/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Among the elderly, the availability of tool assessing psychosomatic syndromes is limited. The present study aims at testing inter-rater reliability and concurrent validity of the semi-structured interview for the Diagnostic Criteria for Psychosomatic Research (DCPR-R-SSI) in the elderly of the general population. METHOD One hundred eight subjects were recruited. Participants received a clinical assessment which included the DCPR-R-SSI, the Illness Attitude Scale (IAS), the Geriatric Depression Scale (GDS), the Psychosocial Index (PSI), the Toronto Alexithymia Scale-20 (TAS-20). Analyses of inter-rater reliability of DCPR-R-SSI and concurrent validity between DCPR-R-SSI and self-administered questionnaires were conducted. RESULTS DCPR-R-SSI showed excellent inter-rater reliability with a percent of agreement of 90.7% (K Cohen: 0.856 [SE = 0.043], 95% CI: 0.77-0.94). DCPR-R demoralization showed fair concurrent validity with GDS; concurrent validity was also fair between DCPR-R Alexithymia and TAS-20, and between DCPR-R allostatic overload and PSI allostatic load, while the concurrent validity between DCPR-R Disease Phobia and IAS was moderate. CONCLUSION DCPR-R-SSI represents a reliable and valid tool to assess psychosomatic syndromes in the elderly. DCPR-R is in need of being implemented in the elderly clinical evaluation.
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Affiliation(s)
- Caterina Romaniello
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sara Romanazzo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,International Lab of Clinical Measurements, University of Florence, Florence, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
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Mansueto G, Romanazzo S, Cosci F. Clinical utility of the Diagnostic Criteria for Psychosomatic Research for a comprehensive assessment of the elderly. Clin Psychol Psychother 2022; 29:1963-1971. [PMID: 35776097 DOI: 10.1002/cpp.2766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION According to the revised version of the Diagnostic Criteria for Psychosomatic Research (DCPR-R), this study explored the prevalence and clinical correlates of DCPR-R psychosomatic syndromes in the elderly and tested whether DCPR-R provide an incremental contribution to the prediction of psychosocial functioning over and above DSM-5. METHOD One hundred seven elderly subjects were recruited. Participants received a clinical assessment, which included the DCPR-Revised Semi-Structured Interview (DCPR-R SSI), the Structured Clinical Interview for DSM-5-Clinician Version (SCID-5-CV), the Psychological Well-Being (PWB) Scales, the Geriatric Anxiety Scale (GAS) and the Geriatric Depression Scale (GDS). Analyses of covariance (ANCOVA) and hierarchical regression analyses were run. RESULTS Twenty-two (20.6%) subjects had at least one DSM-5 diagnosis, and 62 (57.9%) reported at least one DCPR-R diagnosis. Subjects with at least one DCPR-R diagnosis showed lower PWB Personal Growth and PWB Purpose in Life than those without DCPR-R diagnoses. When the incremental validity of the DCPR-R was tested using PWB Personal Growth, PWB Purpose in Life, PWB Self-acceptance, GAS Cognitive symptoms and GAS affective symptoms subscales as criterion variable, the DCPR-R increased up to 0.135-0.263 the explained variance. CONCLUSION The DCPR-R might be implemented together with the DSM-5 to have a comprehensive assessment of elderly subjects.
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Affiliation(s)
- Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Sara Romanazzo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
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Cui X, Cao J, Rafanelli C, Zhu B, Gostoli S. Efficacy of group biofeedback treatment on hyperemesis gravidarum with psychosomatic symptoms diagnosed with the revised version of Diagnostic Criteria for Psychosomatic Research (DCPR-R): study protocol for a randomised controlled trial. BMJ Open 2022; 12:e051295. [PMID: 35361636 PMCID: PMC8971773 DOI: 10.1136/bmjopen-2021-051295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Hyperemesis gravidarum (HG) is a condition characterised by dehydration, electrolyte imbalance, lack of nutrition and at least 5% loss in body weight, occurring in the first half of pregnancy. The aim of this trial is to examine the efficacy of group biofeedback treatment on patients with HG with psychosomatic symptoms, which will be evaluated through the revised version of Diagnostic Criteria for Psychosomatic Research (DCPR-R). METHODS AND ANALYSIS In this single-blinded randomised controlled clinical trial, 68 patients with HG diagnosed with at least one psychosomatic syndrome according to DCPR-R and aged 18-40 years, will be recruited in a Chinese Maternal and Child Health Hospital. The sample will be randomised (1:1) into two arms: experimental group, which will undergo group biofeedback treatment, psycho-education and treatment as usual (TAU); and control group, which will undergo psycho-education and TAU only. The primary outcomes will be reduction of the frequency of psychosomatic syndromes, severity of nausea/vomiting, quality of life and heart rate variability. The secondary outcomes will include days of hospitalisation, repeated hospitalisation and laboratory investigations. ETHICS AND DISSEMINATION This study has received ethical approval from the Nanjing Medical University (No. 2019/491, granted 22 February 2019). All participants will be required to provide written informed consent. Study outcomes will be disseminated through peer-reviewed publications and academic conferences, and used to confirm a tailored biofeedback intervention for patients with HG with psychosomatic symptoms. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR2000028754).
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Affiliation(s)
- Xuelian Cui
- Department of Healthcare, Changzhou Maternity and Child Healthcare Hospital, Changzhou, China
| | - Jianxin Cao
- Department of Gastroenterology, Third Affiliated Hospital of Soochow University, Changzhou, China
- Soochow University Psychosomatic Gastroenterology Institute, Changzhou, People's Republic of China
| | - Chiara Rafanelli
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Boheng Zhu
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sara Gostoli
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
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Roohafza H, Goli F, Khani A, Afshar H. Validation of Self-Assessed Form of Diagnostic Criteria for Psychosomatic Research Adapted from Diagnostic Criteria for Psychosomatic Research - Structured Interview. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2022; 27:11. [PMID: 35342447 PMCID: PMC8943649 DOI: 10.4103/jrms.jrms_938_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 05/02/2021] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
Background: As the diagnostic criteria for psychosomatic research-structured interview (DCPR-SI) is a rater-assessed questionnaire, it has not been used vastly in community-based studies and clinics. Describing and investigating self-assessed form of DCPR are an attempt to apply it easier and more worthwhile for medical settings. The aim of this study was to describe and present self-assessed form of DCPR self-assessed (DCPR-SA) and test its validity and reliability. Materials and Methods: The DCPR-SI was translated to Persian according to the best practice methodology and the guideline for adaptation of self-report measures. In this cross-sectional study, 540 patients and healthy individuals were recruited and answered DCPR-SA and some related questionnaires. Inter-rater (test–interview) and test–retest reliability were determined. Construct, concurrent, discriminant, and known-group validity were tested. Results: The kappa coefficients were expressed substantial and almost perfect agreement (0.617–0.784, P ≤ 0.05). In addition, phi correlation coefficients were indicated adequate test–retest reliability for each cluster (0.548–0.754, P ≤ 0.05). Three domains (anxiety-related symptoms, functional symptoms, and dysfunctional traits and emotional patterns) were confirmed by factor analysis. The results of the discriminate validity analysis were promising. Conclusion: The findings show that the DCPR-SA is valid and reliable and can be used by medical professionals as a psychosomatic screening tool and can be used properly in Persian-speaking population.
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Rafanelli C, Gostoli S, Buzzichelli S, Guidi J, Sirri L, Gallo P, Marzola E, Bergerone S, De Ferrari GM, Roncuzzi R, Di Pasquale G, Abbate-Daga G, Fava GA. Sequential Combination of Cognitive-Behavioral Treatment and Well-Being Therapy in Depressed Patients with Acute Coronary Syndromes: A Randomized Controlled Trial (TREATED-ACS Study). PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:345-356. [PMID: 32791501 DOI: 10.1159/000510006] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/06/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Randomized controlled trials (RCT) of psychotherapeutic interventions have addressed depression and demoralization associated with acute coronary syndromes (ACS). The present trial introduces psychological well-being, an increasingly recognized factor in cardiovascular health, as a therapeutic target. OBJECTIVE This study was designed to determine whether the sequential combination of cognitive-behavioral therapy (CBT) and well-being therapy (WBT) may yield more favorable outcomes than an active control group (clinical management; CM) and to identify subgroups of patients at greater risk for cardiac negative outcomes. METHODS This multicenter RCT comparedCBT/WBT sequential combination versus CM, with up to 30 months of follow-up. One hundred consecutive depressed and/or demoralized patients (out of 740 initially screened by cardiologists after a first episode of ACS) were randomized to CBT/WBT associated with lifestyle suggestions (n = 50) and CM (n = 50). The main outcome measures included: severity of depressive symptoms according to the Clinical Interview for Depression, changes in subclinical psychological distress, well-being, and biomarkers, and medical complications and events. RESULTS CBT/WBT sequential combination was associated with a significant improvement in depressive symptoms compared to CM. In both groups, the benefits persisted at follow-up, even though the differences faded. Treatment was also related to a significant amelioration of biomarkers (platelet count, HDL, and D-dimer), whereas the 2 groups showed similar frequencies of adverse cardiac events. CONCLUSIONS Addressing psychological well-being in the psychotherapeutic approach to ACS patients with depressive symptoms was found to entail important clinical benefits. It is argued that lifestyle changes geared toward cardiovascular health may be facilitated by a personalized approach that targets well-being.
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Affiliation(s)
- Chiara Rafanelli
- Department of Psychology, University of Bologna, Bologna, Italy,
| | - Sara Gostoli
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Sara Buzzichelli
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Laura Sirri
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Pamela Gallo
- Division of Cardiology, Maggiore Hospital, Bologna, Italy
| | - Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Serena Bergerone
- Division of Cardiology, Internal Medicine Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Internal Medicine Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Renzo Roncuzzi
- Division of Cardiology, Bellaria Hospital, Bologna, Italy
| | | | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, Buffalo, New York, USA
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13
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Gostoli S, Montecchiarini M, Urgese A, Ferrara F, Polifemo AM, Ceroni L, Gasparri A, Rafanelli C, Cennamo V. The clinical utility of a comprehensive psychosomatic assessment in the program for colorectal cancer prevention: a cross-sectional study. Sci Rep 2021; 11:15575. [PMID: 34341444 PMCID: PMC8329196 DOI: 10.1038/s41598-021-95171-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023] Open
Abstract
Few studies have investigated psychosocial characteristics and lifestyle behaviors of participants at programs for secondary prevention of colorectal cancer (CRC). This study aimed, through a comprehensive psychosomatic assessment based on clinimetric principles, to evaluate psychosocial characteristics and lifestyle behaviors in participants at CRC secondary prevention program, and to investigate the associations between these variables and endoscopic outcomes. In this cross-sectional study, the first 150 consecutive asymptomatic participants at the CRC prevention program who resulted positive to fecal occult blood test (FOBT) and were thus referred to colonoscopy, underwent a psychosomatic assessment including psychiatric diagnoses (DSM-5), psychosomatic syndromes (DCPR-R), psychological distress, psychological well-being and lifestyle behaviors. Whereas only 5.3% of the sample showed at least one DSM-5 diagnosis, 51.3% showed at least one DCPR syndrome, such as allostatic overload, alexithymia, Type A behavior, and demoralization. Patients affected by psychosomatic syndromes presented with significantly higher psychological distress, lower psychological well-being and unhealthy lifestyle behaviors, such as tobacco smoking and unhealthy diet, in comparison with patients without DCPR syndromes. Among endoscopic outcomes, the presence of adenomas was significantly associated with DCPR irritable mood. In a clinical context of secondary prevention addressing asymptomatic patients with positive FOBT, a comprehensive psychosomatic assessment may provide relevant clinical information for those patients who present certain psychosomatic syndromes associated with high psychological distress, impaired psychological well-being, unhealthy lifestyle behaviors and colorectal precancerous lesions. The results of the present study indicate a road to the practice of "preventive" medicine at CRC screening program.
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Affiliation(s)
- Sara Gostoli
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Maria Montecchiarini
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Alessia Urgese
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Francesco Ferrara
- Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Bologna, Italy
| | - Anna Maria Polifemo
- Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Bologna, Italy
| | - Liza Ceroni
- Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Bologna, Italy
| | - Asia Gasparri
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Chiara Rafanelli
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy.
| | - Vincenzo Cennamo
- Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Bologna, Italy
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Guidi J, Piolanti A, Berrocal C, Gostoli S, Carrozzino D. Incremental Validity Of The Diagnostic Criteria For Psychosomatic Research - Revised (DCPR-R) To Clinical Assessment In Primary Care. Psychiatry Res 2020; 291:113233. [PMID: 32563748 DOI: 10.1016/j.psychres.2020.113233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 01/26/2023]
Abstract
Psychosocial problems are highly prevalent among primary care (PC) patients, but they often remain undetected using traditional classification systems. The aim of the present study was to test the incremental validity of the revised version of the Diagnostic Criteria for Psychosomatic Research (DCPR-R), in addition to standard psychiatric assessment based on DSM-5, with regard to the prediction of psychosocial functioning of PC patients. Two-hundred PC patients were consecutively recruited. A comprehensive assessment was performed using two clinical interviews and three self-rating questionnaires (the PsychoSocial Index [PSI], the Short-Form Health Survey [SF-12] and the Illness Attitude Scales [IAS]) for the assessment of psychopathology and psychosocial functioning. Adding the DCPR-R to DSM-5, the amount of explained variance significantly increased by 9% to 16% in the PSI subscales, by 13% in the SF-12 mental component summary, and by 2% to 6% in the IAS scales. The joint use of DCPR-R and DSM-5 thus significantly increased the prediction of psychosocial functioning of primary care patients. These findings further support the use of the DCPR-R in PC settings, particularly in patients who do not satisfy DSM-5 criteria and yet present with high psychological distress, maladaptive illness behavior, impaired psychological well-being and quality of life.
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Affiliation(s)
- Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy.
| | | | - Carmen Berrocal
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Sara Gostoli
- Department of Psychology, University of Bologna, Bologna, Italy
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15
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Criterion-related validity in a sample of migraine outpatients: the diagnostic criteria for psychosomatic research. CNS Spectr 2020; 25:545-551. [PMID: 31656206 DOI: 10.1017/s1092852919001536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Diagnostic Criteria for Psychosomatic Research (DCPR) are those of psychosomatic syndromes that did not find room in the classical taxonomy. More recently, the DCPR were updated, called DCPR-revised (DCPR-R). The present study was conducted to test the criterion-related validity of the DCPR-R. METHODS Two hundred consecutive subjects were enrolled at the Headache Center of Careggi University Hospital (Italy): 100 subjects had a diagnosis of chronic migraine (CM) and 100 had a diagnosis of episodic migraine (EM). Participants received a clinical assessment, which included the DCPR-revised Semi-Structured Interview (DCPR-R SSI), the Structured Clinical Interview for DSM-5 (SCID-5), and the psychosocial index (PSI). RESULTS Forty-seven subjects (23.5%) had at least one DSM-5 diagnosis: major depressive disorder (8.5%; n = 17) and agoraphobia (7.5%; n = 15) were the most frequent. One hundred and ten subjects (55%) reported a DCPR-R diagnosis: allostatic overload (29%; n = 58) and type A behavior (10.5%; n = 21) were the most frequent. When the incremental validity of the DCPR system over the DSM system was tested using PSI subscales as the criterion variable, the DCPR-R increased up to 0.11-0.24 the amount of explained variance. Subjects with at least one DCPR-R diagnosis showed lower PSI well-being scores (p = .001), higher PSI stress scores (p < .001), and higher PSI psychological distress scores (p = .008) than subjects without a DCPR-R diagnosis. CONCLUSION The DCPR-R showed a good criterion-related validity in migraine outpatients. Thus, they might be implemented, together with the DSM-5, in the assessment of migraine subjects.
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16
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Alexithymia and self-harm: A review of nonsuicidal self-injury, suicidal ideation, and suicide attempts. Psychiatry Res 2020; 288:112920. [PMID: 32279008 DOI: 10.1016/j.psychres.2020.112920] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Suicide attempts are a significant global public health concern. Research into non-traditional factors, such as the presence of alexithymia, may shed light on the prediction of suicidal behaviours, which can aid intervention and prevention strategies. To ascertain whether alexithymia is a unique risk factor for suicide attempts, this article reviews the evidence on alexithymia related to suicidal ideation, attempts, and non-suicidal self-injury (NSSI). METHODS A literature search was conducted for original articles examining the general and psychiatric populations. RESULTS There is consistent evidence linking alexithymia with suicidal ideation and NSSI, but inconsistent evidence linking it to suicide attempts. CONCLUSION The relationship between alexithymia and suicidality seems to differ based on whether the research focuses on suicidal ideation, suicide attempts, or NSSI. The relationship between alexithymia and suicidality can be understood within the context of multiple code theory and childhood trauma. Future research should explore the whether alexithymia can reliably distinguish between those with a single attempt and those with multiple suicide attempts as well as alexithymia levels pre- and post-intervention with suicide-related behavior as outcomes in treatment studies.
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Rosenblat JD, Kurdyak P, Cosci F, Berk M, Maes M, Brunoni AR, Li M, Rodin G, McIntyre RS, Carvalho AF. Depression in the medically ill. Aust N Z J Psychiatry 2020; 54:346-366. [PMID: 31749372 DOI: 10.1177/0004867419888576] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Depressive disorders are significantly more common in the medically ill compared to the general population. Depression is associated with worsening of physical symptoms, greater healthcare utilization and poorer treatment adherence. The present paper provides a critical review on the assessment and management of depression in the medically ill. METHODS Relevant articles pertaining to depression in the medically ill were identified, reviewed and synthesized qualitatively. A systematic review was not performed due to the large breadth of this topic, making a meaningful summary of all published and unpublished studies not feasible. Notable studies were reviewed and synthesized by a diverse set of experts to provide a balanced summary. RESULTS Depression is frequently under-recognized in medical settings. Differential diagnoses include delirium, personality disorders and depressive disorders secondary to substances, medications or another medical condition. Depressive symptoms in the context of an adjustment disorder should be initially managed by supportive psychological approaches. Once a mild to moderate major depressive episode is identified, a stepped care approach should be implemented, starting with general psychoeducation, psychosocial interventions and ongoing monitoring. For moderate to severe symptoms, or mild symptoms that are not responding to low-intensity interventions, the use of antidepressants or higher intensity psychotherapeutic interventions should be considered. Psychotherapeutic interventions have demonstrated benefits with small to moderate effect sizes. Antidepressant medications have also demonstrated benefits with moderate effect sizes; however, special caution is needed in evaluating side effects, drug-drug interactions as well as dose adjustments due to impairment in hepatic metabolism and/or renal clearance. Novel interventions for the treatment of depression and other illness-related psychological symptoms (e.g. death anxiety, loss of dignity) are under investigation. LIMITATIONS Non-systematic review of the literature. CONCLUSION Replicated evidence has demonstrated a bidirectional interaction between depression and medical illness. Screening and stepped care using pharmacological and non-pharmacological interventions is merited.
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Affiliation(s)
- Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, VIC, Australia.,The University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia.,Centre of Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Michael Maes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, VIC, Australia.,Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Madeline Li
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Gary Rodin
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
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Guidi J, Lucente M, Piolanti A, Roncuzzi R, Rafanelli C, Sonino N. Allostatic overload in patients with essential hypertension. Psychoneuroendocrinology 2020; 113:104545. [PMID: 31862612 DOI: 10.1016/j.psyneuen.2019.104545] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 02/06/2023]
Abstract
The role of psychosocial stress in the development of essential hypertension has attracted increasing attention in the last decades, even though research findings have been often inconclusive. We specifically investigated allostatic overload (AO) in hypertensive patients using a clinimetric approach. Allostatic overload was assessed by a semi-structured research interview based on clinimetric criteria in 80 consecutive outpatients with essential hypertension (46.3 % females; mean age 62.18 ± 8.59 years; age range 47-74 years) and 80 normotensive matched controls. Three clinical interviews and two self-rating questionnaires for assessing psychological distress and well-being were also administered. Cardiac variables were collected. AO was present in 26 (32.5 %) of the hypertensive patients based on clinical interviewing, and in only 6 normotensive controls (p < .001). Hypertensive patients with AO had significantly higher levels of psychological distress than those without. Further, patients with AO displayed significantly lower levels of well-being and quality of life (p < .001). A significantly greater prevalence of psychosomatic syndromes was found to be associated with the presence of AO (p < .05), whereas no significant association was detected as to psychiatric diagnoses. Significantly greater cardiovascular risk was found among hypertensive patients reporting AO compared to those without (p < .05). The results of this study support the clinical relevance of a psychological assessment of hypertensive patients, with important implications for the non-pharmacological management of hypertension.
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Affiliation(s)
- Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy.
| | | | | | - Renzo Roncuzzi
- Division of Cardiology, Bellaria Hospital, Bologna, Italy
| | | | - Nicoletta Sonino
- Department of Statistical Sciences, University of Padova, Padova, Italy; Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
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Abstract
OBJECTIVE Assessment of mood in eating disorders (EDs) has important clinical implications, but the current standard psychiatric classification (DSM-5) has limitations. The aim of the current study is to broaden the evaluation of depressive symptomatology by providing a comprehensive and innovative assessment approach in EDs through instruments that capture clinical phenomena of demoralization, subclinical distress, and psychological well-being. METHODS Seventy-nine patients who met diagnostic criteria for EDs of the Diagnostic and Statistical Manual of Mental Disorders - Fifth edition (DSM-5) were evaluated for depressive symptoms through Paykel's Clinical Interview for Depression, the Structured Clinical Interview for DSM-5 for major depressive episode and persistent depressive disorder, and the Diagnostic Criteria for Psychosomatic Research (DCPR) interview for demoralization. Further, self-report inventories encompassing psychological well-being and distress were used. RESULTS Guilt, abnormal reactivity to social environment, and depressed mood were the most common depressive symptoms in the sample. DSM-defined depressive disorders were found in 55.7% of patients. The DCPR-demoralization criteria identified an additional 20.3% of the sample that would have been undetected with DSM criteria. Both DSM and DCPR diagnostic categories were associated with compromised psychological well-being and distress. Demoralization, unlike depression, was not associated with the severity of ED symptomatology. CONCLUSION The findings indicate that a standard psychiatric approach, DSM-5-based, captures only a narrow part of the spectrum of mood disturbances affecting patients with EDs. A broadened clinimetric assessment unravels the presence of demoralization and yields clinical distinctions that may entail prognostic and therapeutic differences among patients who would be otherwise simply labeled as depressed.
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Settineri S, Frisone F, Alibrandi A, Merlo EM. Emotional Suppression and Oneiric Expression in Psychosomatic Disorders: Early Manifestations in Emerging Adulthood and Young Patients. Front Psychol 2019; 10:1897. [PMID: 31481915 PMCID: PMC6710394 DOI: 10.3389/fpsyg.2019.01897] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/01/2019] [Indexed: 01/08/2023] Open
Abstract
Background The function of emotions, beginning from the proto-emotions, is the adaptation to the environment. This is based on the Homeorhesis, the equilibrium due to the adaptive operation of excitement and the dissipation of emotions. The object relations of the participants foresee the practice of defense mechanisms in a continuum that goes from the consciousness to the oneiric activities. The predominant and maladaptive use of defense mechanisms in the psychosomatic phenomenology, can be identified with deficits in emotional awareness, with the impossibility to manage excitement and dissipation of emotions foreseen by the oneiric phenomena. Methods The observation group is composed by 140 participants, 56 males (43%) and 84 females (57%),with pathological-functional disorders of psychosomatic domain. The study had been conducted with the use of measures related to the conscious defense of suppression (Suppression Mental Questionnaire), to the emotional awareness linked to the psychosomatic phenomena (Diagnostic Criteria for Psychosomatic Research Structured Interview-DCPR-SI) and to the states of perturbation and conservation of oneiric activities (The Manheim Dream Questionnaire-MADRE). Results Significant inverse correlations emerged among rationalization, repressive function and illness Denial, as for the suppression mental questionnaire factors and irritable mood, but for Regression in the service of the Ego; inverse and significant correlations emerged among suppression, repressive function, rationalization and gastrointestinal psychosomatic outcomes and among suppression, repression and cardiological psychosomatic outcomes. Regarding alexithymia, a positive correlation emerged with rationalization and inverse with Regression in the service of the Ego. Positive correlations emerged between illness denial and overall emotional tone, for disease phobia and meaningfulness and for cardiological psychosomatic outcomes and nightmare distress and recurring nightmares. Conclusion The study of such outcomes due to a prevalent defensive style based on suppression, suggest the identification of a key phenomenon, which translates into maladjustment that goes from functional disorders to parasomnia. The bridge established by the obfuscation of conscious contents until the manifestations of disturbance of ancient activities such as oneiric ones, expresses the need to transform an emotional maladaptive style, in line with classic literature and the current state of art.
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Affiliation(s)
- Salvatore Settineri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Fabio Frisone
- Department of Cognitive Sciences, Psychology, Educational and Cultural Studies (COSPECS), University of Messina, Messina, Italy.,CRISCAT (International Research Center for Theoretical and Applied Cognitive Sciences) University of Messina and Universitary Consortium of Eastern Mediterranean, Noto (CUMO), University of Messina, Messina, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Messina, Italy
| | - Emanuele Maria Merlo
- Department of Cognitive Sciences, Psychology, Educational and Cultural Studies (COSPECS), University of Messina, Messina, Italy.,CRISCAT (International Research Center for Theoretical and Applied Cognitive Sciences) University of Messina and Universitary Consortium of Eastern Mediterranean, Noto (CUMO), University of Messina, Messina, Italy
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Abstract
Illness anxiety disorder is a primary disorder of anxiety about having or developing a serious illness. The core feature is the cycle of worry and reassurance seeking regarding health, as opposed to a focus on relief of distress caused by somatic symptoms (as in Somatic Symptom Disorder). Clinically significant health anxiety is common, with estimates ranging up to 13% in the general adult population. There are evidence-based treatments, including psychopharmacology and cognitive behavioral therapy, that can significantly alleviate symptoms. An understanding of the core psychopathology and clinical features of illness anxiety disorder is essential to fostering a working alliance with patients with health anxiety, as is the maintenance of an empathic, curious, and nonjudgmental stance toward their anxiety. Collaboration between medical providers is essential to avoid the pitfalls of excess testing and medical treatment.
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Abstract
The aim of the study was to test whether acquired hearing loss (AHL)-related perceived disability mediates the association between AHL and psychological outcomes, including anger. Two-hundred ninety-seven consecutive outpatients with AHL assessed by pure tone average (PTA) loss completed the following: Hearing Handicap Inventory for Adults (HHIA), State-Trait Anger Expression Inventory-2 (STAXI-2), Brief Symptom Inventory (BSI), Diagnostic Criteria for Use in Psychosomatic Research (DCPR), and Social Functioning Questionnaire. In the sample, composed of 44.5% males with a mean age of 53.8 and a mean PTA of 30.7, AHL was associated to perceived hearing handicap, also correlating to all psychological measures except DCPR demoralization. Associations were stronger between the HHIA-Emotional Subscale, STAXI-2 State Anger and Feeling Angry, and BSI-Somatization, Interpersonal Sensitivity, Depression, and Psychoticism. Perceived disability predicted the presence of almost all psychosocial outcomes and confirms to be the most significant target of clinical action.
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Relationship of Suicidal Ideation With Demoralization, Depression, and Anxiety: A Study of Cancer Patients in Mainland China. J Nerv Ment Dis 2019; 207:326-332. [PMID: 30958419 DOI: 10.1097/nmd.0000000000000974] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Demoralization is a form of psychological distress that may cause suicidal ideation. Demoralization syndrome is common among cancer patients, but there has been little empirical study on the association of suicidal ideation with demoralization, depression, and anxiety in this population. This study aims to investigate the prevalence of high demoralization among cancer patients in mainland China and the contribution of high demoralization to suicidal ideation beyond the impact of self-report depression and anxiety. In this cross-sectional study, 303 patients with cancer were invited to complete questionnaires. In total, 14.5% participants reported suicidal ideation and 49.50% high demoralization. Logistic regression analysis identified high demoralization as an independent risk factor for suicidal ideation. Only depression (odds ratio [OR], 6.68) had a stronger influence on suicidal ideation than demoralization (OR, 5.85), and patients with both depression and high demoralization were most likely to experience suicidal ideation. These findings suggest that measures of demoralization can help identify cancer patients at high suicide risk and that such patients require further attention and measures targeting demoralization for suicide prevention.
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Piolanti A, Gostoli S, Gervasi J, Sonino N, Guidi J. A Trial Integrating Different Methods to Assess Psychosocial Problems in Primary Care. PSYCHOTHERAPY AND PSYCHOSOMATICS 2019; 88:30-36. [PMID: 30783072 DOI: 10.1159/000496477] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/28/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND A number of studies have documented psychosocial problems, psychiatric morbidity and impaired quality of life in primary care patients. OBJECTIVE The aim of this trial was to test the usefulness of the joint use of different diagnostic interviews and self-rated questionnaires. METHODS Two hundred consecutive patients in a primary care practice in Italy underwent the Structured Clinical Interview for DSM-5 and the Semi-Structured Interview for the Diagnostic Criteria for Psychosomatic Research (DCPR) in its recently revised form. As self-rated evaluations, the PsychoSocial Index, the Short-Form Health Survey and the Illness Attitude Scales were administered. RESULTS There were 46 patients (23%) with at least 1 DSM-5 diagnosis. Eighty-eight patients (44%) had at least 1 DCPR diagnosis, mainly maladaptive illness behavior (26.5%), allostatic overload (15.5%) and demoralization (15%). There were 47 (23.5%) patients who had a DCPR diagnosis only; 5 subjects (2.5%) had a DSM diagnosis only. Patients with DCPR syndromes displayed significantly higher self-rated levels of stress, psychological distress and maladaptive illness behavior and significantly lower levels of quality of life and well-being than patients with no diagnoses. CONCLUSIONS In a busy clinical setting, a simple self-rated questionnaire such as the PsychoSocial Index may afford a useful tool to unveil patient current distress. The DCPR can provide clinical information for a substantial number of patients who do not satisfy DSM-5 classification criteria and yet present with psychosocial problems, as measured by self-rated scales. The DCPR may improve the assessment and treatment plan of primary care psychologists or consulting psychiatrists.
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Affiliation(s)
| | - Sara Gostoli
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Jessica Gervasi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Nicoletta Sonino
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA.,Department of Statistical Sciences, University of Padua, Padua, Italy
| | - Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy,
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Huang WL, Liao SC. Psychometric Properties of the Chinese Version of the Diagnostic Criteria for Psychosomatic Research. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 86:119-120. [PMID: 28183094 DOI: 10.1159/000450714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/06/2016] [Indexed: 01/23/2023]
Affiliation(s)
- Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
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Grassi L, Mezzich JE, Nanni MG, Riba MB, Sabato S, Caruso R. A person-centred approach in medicine to reduce the psychosocial and existential burden of chronic and life-threatening medical illness. Int Rev Psychiatry 2017; 29:377-388. [PMID: 28783462 DOI: 10.1080/09540261.2017.1294558] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The psychiatric, psychosocial, and existential/spiritual pain determined by chronic medical disorders, especially if in advanced stages, have been repeatedly underlined. The right to approach patients as persons, rather than symptoms of organs to be repaired, has also been reported, from Paul Tournier to Karl Jaspers, in opposition and contrast with the technically-enhanced evidence-based domain of sciences that have reduced the patients to 'objects' and weakened the physician's identity deprived of its ethical value of meeting, listening, and treating subjects. The paper will discuss the main psychosocial and existential burden related to chronic and advanced medical illnesses, and the diagnostic and therapeutic implications for a dignity preserving care within a person-centred approach in medicine, examined in terms of care of the person (of the person's whole health), for the person (for the fulfilment of the person's health aspirations), by the person (with physicians extending themselves as total human beings), and with the person (working respectfully with the medically ill person).
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Affiliation(s)
- Luigi Grassi
- a Department of Biomedical and Specialty Surgical Sciences, School of Medicine , Institute of Psychiatry, University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care Integrated Department of Mental Health and Addictive Behavior , University Hospital and Health Authorities , Ferrara , Italy
| | - Juan E Mezzich
- c Icahn School of Medicine at Mount Sinai, International College of Person-Centered Medicine , New York City , NY , USA
| | - Maria Giulia Nanni
- a Department of Biomedical and Specialty Surgical Sciences, School of Medicine , Institute of Psychiatry, University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care Integrated Department of Mental Health and Addictive Behavior , University Hospital and Health Authorities , Ferrara , Italy
| | - Michelle B Riba
- d Integrated Medical and Psychiatric Services Department of Psychiatry , University of Michigan Comprehensive Depression Center , Ann Arbor , MI , USA.,e PsychOncology Program, University of Michigan Comprehensive Cancer Center , Ann Arbor , MI , USA
| | - Silvana Sabato
- a Department of Biomedical and Specialty Surgical Sciences, School of Medicine , Institute of Psychiatry, University of Ferrara , Ferrara , Italy
| | - Rosangela Caruso
- a Department of Biomedical and Specialty Surgical Sciences, School of Medicine , Institute of Psychiatry, University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care Integrated Department of Mental Health and Addictive Behavior , University Hospital and Health Authorities , Ferrara , Italy
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Abstract
BACKGROUND Demoralization frequently occurs in hospice, cancer, and critically ill patients. Severe demoralization can lead to suicidal ideation, making this issue of great import to healthcare providers. OBJECTIVE The aim of this study is to inform nursing professionals of the risk factors of demoralization in cancer patients via investigating its relationship with cancer patients' demographic data and disease characteristics. METHODS This is a cross-sectional descriptive study using a structured questionnaire including assessments of demographic data and disease characteristics, as well as the Demoralization Scale Mandarin version. Univariate logistic regression was used to explore the relations between demoralization and these other variables. RESULTS The mean (SD) Demoralization Scale Mandarin version score was 30.08 (13.68) (range, 0-73). Demoralization was significantly related to age (r = 0.1, P = .050), marital status (r = 0.11, P = .034), education (r = 0.17, P < .001), monthly income (r = 0.22, P < .001), disease status (r = 0.10, P = .050), and treatment type (r = 0.12, P = .014). CONCLUSIONS This study demonstrates the factors influencing demoralization among cancer patients. Future studies might expand to include patients with other chronic or critical illnesses or disadvantaged groups to better understand the prevalence of demoralization. This would help draw more attention from clinical healthcare providers, healthcare institutions, and other healthcare authorities to demoralization. IMPLICATIONS OR PRACTICE The results provide reference data for nursing professionals about the care of cancer patients.
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Affiliation(s)
- Yu-Chi Li
- Author Affiliations: Department of Nursing (Mrs Li) and Department of Medical Research (Dr Ho), Chi-Mei Medical Center, Tainan; and College of Nursing, Kaohsiung Medical University, Taiwan (Mrs Li and Dr Wang)
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Fava GA, Cosci F, Sonino N. Current Psychosomatic Practice. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 86:13-30. [PMID: 27884006 DOI: 10.1159/000448856] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/03/2016] [Indexed: 11/19/2022]
Abstract
Psychosomatic research has advanced over the past decades in dealing with complex biopsychosocial phenomena and may provide new effective modalities of patient care. Among psychosocial variables affecting individual vulnerability, course, and outcome of any medical disease, the role of chronic stress (allostatic load/overload) has emerged as a crucial factor. Assessment strategies include the Diagnostic Criteria for Psychosomatic Research. They are presented here in an updated version based on insights derived from studies carried out so far and encompass allostatic overload, type A behavior, alexithymia, the spectrum of maladaptive illness behavior, demoralization, irritable mood, and somatic symptoms secondary to a psychiatric disorder. Macroanalysis is a helpful tool for identifying the relationships between biological and psychosocial variables and the individual targets for medical intervention. The personalized and holistic approach to the patient includes integration of medical and psychological therapies in all phases of illness. In this respect, the development of a new psychotherapeutic modality, Well-Being Therapy, seems to be promising. The growth of subspecialties, such as psychooncology and psychodermatology, drives towards the multidisciplinary organization of health care to overcome artificial boundaries. There have been major transformations in health care needs in the past decades. From psychosomatic medicine, a land of innovative hypotheses and trends, many indications for changes in the current practice of medicine are now at hand. The aim of this critical review is to outline current and potential clinical applications of psychosomatic methods.
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Affiliation(s)
- Giovanni A Fava
- Department of Psychology, University of Bologna, Bologna, Italy
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Subsyndromal psychosomatic concepts and personality traits in community adults. Compr Psychiatry 2017; 75:110-116. [PMID: 28347882 DOI: 10.1016/j.comppsych.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 01/26/2017] [Accepted: 03/05/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of features of the Diagnostic Criteria for Psychosomatic Research (DCPR) in the Taiwanese community and to explore their relationships with psychological states and personality traits. METHOD The participants were 153 individuals without a DSM-5 psychiatric diagnosis who were grouped according to whether they had a DCPR diagnosis (at least one DCPR diagnosis, DCPR(+): n=66; no DCPR diagnosis, DCPR(-): n=87). The groups were compared with respect to psychological states (measured with Patient Health Questionnaire-15 [PHQ-15], Health Anxiety Questionnaire [HAQ], Beck Depression Inventory-II [BDI-II], Beck Anxiety Inventory [BAI)]) and personality (measured with Tridimensional Personality Questionnaire). Multiple logistic and linear regressions were used to examine associations among demographic, personality, DCPR, and psychological states. RESULTS The DCPR(+) group had higher BDI-II, BAI, PHQ-15 and HAQ scores than the DCPR(-) group and also had a higher anticipatory worry. The most common DCPR diagnoses were health anxiety (42.42%) and alexithymia (37.88%). Anticipatory worry was the variable most closely associated with all the DCPR diagnoses. Health anxiety was related to anticipatory worry and age, whereas alexithymia was associated with dependence and fatiguability. PHQ-15, HAQ, and BDI-II scores were related to health anxiety but not alexithymia. CONCLUSION DCPR has clinical utility in the community samples without DSM-5 diagnoses. DCPR may be a valid mediator between psychological trait and state.
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Gostoli S, Roncuzzi R, Urbinati S, Morisky DE, Rafanelli C. Unhealthy behaviour modification, psychological distress, and 1-year survival in cardiac rehabilitation. Br J Health Psychol 2017; 21:894-916. [PMID: 27316556 DOI: 10.1111/bjhp.12204] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 05/16/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Cardiac rehabilitation (CR) is considered the recommended secondary prevention treatment for cardiovascular diseases (CVD), in terms of health behaviours and, secondarily, better cardiac outcomes promotion. However, the role of psychiatric and psychosomatic distress on the efficacy of CR is unclear. This research aimed to evaluate the impact of CR on unhealthy behaviour modification and cardiac course, considering the moderating role of depression, anxiety, and psychosomatic syndromes. DESIGN A longitudinal design between and within groups was employed. The assessment was repeated four times: at admission to CR (T1), at discharge (T2), 6 (T3) and 12 months following CR completion (T4). METHOD One hundred and eight patients undergoing CR versus 85 patients with CVD not referred to CR, underwent psychiatric, psychosomatic, and health behaviour assessment. The assessment included the Structured Clinical Interview for DSM-IV (depression and anxiety), the interview based on Diagnostic Criteria for Psychosomatic Research, GOSPEL Study questionnaire (health behaviours), Pittsburgh Sleep Quality Index, and 8-item Morisky Medication Adherence Scale. RESULTS Cardiac rehabilitation was associated with maintenance of physical activity, improvement of behavioural aspects related to food consumption, stress management, and sleep quality. On the contrary, CR was not associated with weight loss, healthy diet, and medication adherence. Depression and psychosomatic syndromes seem to moderate the modification of specific health-related behaviours (physical activity, behavioural aspects of food consumption, stress management, and pharmacological adherence). CONCLUSION In CR settings, an integrated assessment including both psychiatric and psychosomatic syndromes is needed to address psychological factors associated with unhealthy behaviour modification. Statement of contribution What is already known on this subject? Cardiac rehabilitation (CR) is considered a class 1A treatment recommendation and the most cost-effective model of secondary prevention to reduce cardiovascular events. There is evidence about the association between psychological distress and both unhealthy behaviour and cardiac course. Depression and psychosomatic distress, such as type A behaviour and demoralization, are frequently associated with CVD course. However, the role of psychiatric and psychosomatic distress in CR is not well known. What does this study add? CR exerted a protective effect on physical activity and a positive effect on eating behaviour, stress management, and quality of sleep. CR did not show any particular effect on smoking, overweight/obesity, dietary habits, medication adherence, and patients' 1-year survival. Findings from this study suggest the importance to consider specific psychological and psychosomatic aspects in affecting lifestyle.
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Affiliation(s)
- Sara Gostoli
- Department of Psychology, University of Bologna, Italy.
| | - Renzo Roncuzzi
- Division of Cardiology, Bellaria Hospital, Bologna, Italy
| | | | - Donald E Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USA
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Gostoli S, Bonomo M, Roncuzzi R, Biffi M, Boriani G, Rafanelli C. Psychological correlates, allostatic overload and clinical course in patients with implantable cardioverter defibrillator (ICD). Int J Cardiol 2016; 220:360-4. [DOI: 10.1016/j.ijcard.2016.06.246] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 06/26/2016] [Indexed: 01/01/2023]
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The clinical inadequacy of the DSM-5 classification of somatic symptom and related disorders: an alternative trans-diagnostic model. CNS Spectr 2016; 21:310-7. [PMID: 26707822 DOI: 10.1017/s1092852915000760] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The Diagnostic and Statistical of Mental Disorders, Fifth Edition (DSM-5) somatic symptom and related disorders chapter has a limited clinical utility. In addition to the problems that the single diagnostic rubrics and the deletion of the diagnosis of hypochondriasis entail, there are 2 major ambiguities: (1) the use of the term "somatic symptoms" reflects an ill-defined concept of somatization and (2) abnormal illness behavior is included in all diagnostic rubrics, but it is never conceptually defined. In the present review of the literature, we will attempt to approach the clinical issue from a different angle, by introducing the trans-diagnostic viewpoint of illness behavior and propose an alternative clinimetric classification system, based on the Diagnostic Criteria for Psychosomatic Research.
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Rafanelli C, Gostoli S, Tully PJ, Roncuzzi R. Hostility and the clinical course of outpatients with congestive heart failure. Psychol Health 2015; 31:228-38. [PMID: 26387801 DOI: 10.1080/08870446.2015.1095299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The role of depression and quality of life on clinical outcomes of congestive heart failure (CHF) is well recognised. However, there are fewer studies investigating the prognostic role of subclinical psychological distress and well-being impairments. The aims of this study were to evaluate clinical/subclinical psychological distress and well-being in CHF outpatients, and the influence of these psychological factors on adverse cardiac events (re-hospitalisation, cardiac death), at 4-year follow-up. DESIGN Sixty-eight CHF outpatients underwent psychological assessment at baseline and, after 4 years, information about cardiac events was collected in 60 patients by means of clinical records. MAIN OUTCOME MEASURES Psychological assessment included structured clinical interview for DSM (major/minor depression), Interview for diagnostic criteria for psychosomatic research (demoralisation), symptom questionnaire, psychological well-being scales. RESULTS At follow-up, 39.7% of the baseline sample reported cardiovascular events (14 CHF-related re-hospitalisations and 13 cardiac deaths) and 5.9% other causes for death. Among the variables examined as potential risk factors for adverse cardiovascular outcomes, only hostility was significant, even after controlling for disease severity (hazard ratio = 2.38, 95%confidence interval: 1.04-5.45, p = .040). CONCLUSION In outpatients with CHF, psychological assessment should include both clinical and subclinical distress such as hostility, in order to better address psychological risk factors for cardiac outcomes.
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Affiliation(s)
- Chiara Rafanelli
- a Department of Psychology , University of Bologna , Bologna , Italy
| | - Sara Gostoli
- a Department of Psychology , University of Bologna , Bologna , Italy
| | - Phillip J Tully
- b Discipline of Medicine , University of Adelaide , Adelaide , Australia
| | - Renzo Roncuzzi
- c Division of Cardiology , Bellaria Hospital , Bologna , Italy
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Abstract
BACKGROUND Demoralization has been described as a psychological state characterized by helplessness, hopelessness, a sense of failure and the inability to cope. METHODS We conducted a systematic review with qualitative data analysis following PRISMA criteria with the following aims: to review validated assessment instruments of the demoralization syndrome, report main findings regarding demoralization as measured by validated instruments that emerge in the literature, compare and report evidence for the clinical utility of the identified instruments. Utilizing the key word 'demoralization' in PubMed and PsycINFO databases, an electronic search was performed, supplemented by Web of Science and manual searches. Study selection criteria included the assessment of medical patients and use of instruments validated to assess demoralization. Seventy-four studies were selected. RESULTS Four instruments emerged in the literature. Main findings concern prevalence rates of demoralization, evidence of discriminant validity from major depression, factors associated with demoralization and evidence of clinical utility. The instruments vary in their definition, the populations they aim to assess, prevalence rates they estimate and their ability to discriminate between different conditions. Nonetheless, demoralization appears to be a distinctive psychological state characterized by helplessness, hopelessness, giving up and subjective incompetence. It is not limited to life-threatening diseases such as cancer, but may occur in any type of clinical situation. It is associated with stress and adverse health outcomes. CONCLUSIONS Studies addressing the incremental value of demoralization in psychiatry and psychology are needed. However, demoralization appears to entail specific clinical features and may be a distinct condition from major depression.
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Affiliation(s)
- L Tecuta
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology,University of Bologna,Bologna,Italy
| | - E Tomba
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology,University of Bologna,Bologna,Italy
| | - S Grandi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology,University of Bologna,Bologna,Italy
| | - G A Fava
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology,University of Bologna,Bologna,Italy
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Abstract
AbstractObjectives:Focused management strategies, including effective distribution of available resources is dependent on ongoing analysis of referral type in any liaison psychiatry consultation service. This survey sought to measure rate of diagnoses in an Irish liaison psychiatry consultation service, and compare the results with other similar services.Method:A survey of referral reasons and diagnoses was performed on all patients presenting to a Dublin based inpatient liaison psychiatry consultation service over two six month periods. The results were subsequently compared with other similar international studies.Results:Commonest referral reasons were for depressive disorders, while commonest diagnoses included alcohol related disorders, depressive disorders, and delirium, with notably higher rates of alcohol related disorders than in other similar international studies.Conclusions:This study provides valuable information for referral reasons and diagnoses present in an Irish liaison psychiatry consultation service. The differences noted between diagnoses in our study and other international studies, as well as some of the difficulties in establishing these diagnoses, are discussed.
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Vertigo “In the Pink”: The Impact of Female Gender on Psychiatric-Psychosomatic Comorbidity in Benign Paroxysmal Positional Vertigo Patients. PSYCHOSOMATICS 2014; 55:280-8. [DOI: 10.1016/j.psym.2013.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 02/06/2013] [Accepted: 02/07/2013] [Indexed: 11/20/2022]
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Beyond psychiatric classification in oncology: Psychosocial dimensions in cancer and implications for care. PSYCHO-ONCOLOGIE 2013. [DOI: 10.1007/s11839-013-0436-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Porcelli P, Guidi J, Sirri L, Grandi S, Grassi L, Ottolini F, Pasquini P, Picardi A, Rafanelli C, Rigatelli M, Sonino N, Fava GA. Alexithymia in the medically ill. Analysis of 1190 patients in gastroenterology, cardiology, oncology and dermatology. Gen Hosp Psychiatry 2013; 35:521-7. [PMID: 23664571 DOI: 10.1016/j.genhosppsych.2013.04.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 04/04/2013] [Accepted: 04/08/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To use the Diagnostic Criteria for Psychosomatic Research (DCPR) for characterizing alexithymia in a large and heterogeneous medical population, in conjunction with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and other DCPR criteria. METHOD Of 1305 patients recruited from 4 medical centers in the Italian Health System, 1190 agreed to participate. They all underwent an assessment with DSM-IV and DCPR structured interviews. A total of 188 patients (15.8%) were defined as alexithymic by using the DCPR criteria. Data were submitted to cluster analysis. RESULTS Five clusters of patients with alexithymia were identified: (1) alexithymia with no psychiatric comorbidity (29.3% of cases); (2) depressed somatization with alexithymic features (23.4%); (3) alexithymic illness behavior (17.6%); (4) alexithymic somatization (17%) and (5) alexithymic anxiety (12.8%). CONCLUSIONS The results indicate that DCPR alexithymia is associated with a comorbid mood or anxiety disorder in about one third of cases; it is related to various forms of somatization and abnormal illness behavior in another third and may occur without psychiatric comorbidity in another subgroup. Identification of alexithymic features may entail major prognostic and therapeutic differences among medical patients who otherwise seem to be deceptively similar since they share the same psychiatric and/or medical diagnosis.
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Affiliation(s)
- Piero Porcelli
- Psychosomatic Unit, IRCCS De Bellis Hospital, Castellana Grotte, Italy.
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Rafanelli C, Gostoli S, Roncuzzi R, Sassone B. Psychological correlates of vasovagal versus medically unexplained syncope. Gen Hosp Psychiatry 2013; 35:246-52. [PMID: 23415579 DOI: 10.1016/j.genhosppsych.2013.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 01/09/2013] [Accepted: 01/10/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Psychiatric morbidity is quite common in vasovagal syncope (VVS), but findings are sometimes contradictory. Among patients with suspected VVS, up to 40% has a negative response to Head-Up Tilt test (HUT), the cause of syncope remaining unexplained (US). The authors evaluated and compared the psychological and psychosomatic profile in patients with positive (VVS) and negative HUT (US). METHOD A consecutive series of 67 patients with suspected VVS underwent HUT: 45 patients had a positive HUT, 22 negative. They were evaluated by means of observer- and self-rated measures. RESULTS Of the total sample, 95.5% had at least one Diagnostic and Statistical Manual of Mental Disorders diagnosis or one psychosomatic syndrome, such as specific and social phobias, illness denial and demoralization. Comparing VVS and US patients, no statistical differences on diagnoses' frequencies were found. However, the US group had significantly poorer health habits, lower levels of well-being and higher psychological distress. They also reported to be more anxious, depressed and hostile. VVS patients were significantly more blood and social phobic than US patients. CONCLUSION Despite similar and remarkable observer-rated psychopathology, US patients reported higher self-perceived psychological distress than VVS patients. Psychological evaluation of patients undergoing HUT should incorporate both clinical and subclinical methods to better address syncope management.
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Affiliation(s)
- Chiara Rafanelli
- Department of Psychology, University of Bologna, 40127 Bologna, Italy.
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Guidi J, Rafanelli C, Roncuzzi R, Sirri L, Fava GA. Assessing psychological factors affecting medical conditions: comparison between different proposals. Gen Hosp Psychiatry 2013; 35:141-6. [PMID: 23122485 DOI: 10.1016/j.genhosppsych.2012.09.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/25/2012] [Accepted: 09/25/2012] [Indexed: 01/10/2023]
Abstract
OBJECTIVE We compared the provisional Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for Somatic Symptom Disorders (SSD) and an alternative classification based on the Diagnostic Criteria for Psychosomatic Research (DCPR) as to prevalence and associations with dimensional measures of psychological distress and functioning in a population of medical patients. METHOD Seventy consecutive outpatients with congestive heart failure were administered an ad hoc structured clinical interview for the identification of DSM-5 SSD, the section concerning hypochondriasis of the Structured Clinical Interview for DSM-IV, the Structured Interview for DCPR and Paykel's Clinical Interview for Depression. Subjects also completed the Symptom Questionnaire and the Psychosocial Index. Global assessment of functioning was performed with the DSM-IV Axis V. RESULTS A diagnosis within DSM-5 SSD was found in 13 patients (18.5%): 61.5% of them were diagnosed with the Psychological Factors Affecting Medical Condition category. Twenty-nine patients (41.4%) were classified according to the DCPR-based proposal: illness denial, demoralization and irritable mood were the most frequent specifiers. The DCPR-based classification showed a greater number of significant associations with dimensional measures of psychological distress, global functioning and stress. CONCLUSION Compared to DSM-5 SSD, the DCPR-based proposal was more sensitive in detecting psychological factors relevant to illness course and provided a better characterization of such factors. The DCPR-based proposal was also superior in identifying patients with increased psychological distress and poor psychosocial functioning.
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Affiliation(s)
- Jenny Guidi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Italy.
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Abstract
The Diagnostic Criteria for Psychosomatic Research (DCPR) were introduced in 1995 by an international group of investigators to expand the traditional domains of the disease model. The DCPR are a set of 12 'psychosomatic syndromes' which provide operational tools for psychosocial variables with prognostic and therapeutic implications in clinical settings. Eight syndromes concern the main manifestations of abnormal illness behaviour: somatization, hypochondriacal fears and beliefs, and illness denial. The other four syndromes (alexithymia, type A behaviour, demoralization and irritable mood) refer to the domain of psychological factors affecting medical conditions. This review describes the conceptual bases of the DCPR and the main findings concerning their application, with particular reference to the incremental information they added to the customary psychiatric classification. The DCPR were also compared with the provisional DSM-5 somatic symptom disorders. The DCPR were found to be more sensitive than DSM-IV in identifying subthreshold psychological distress and characterizing patients' psychological response to medical illness. DSM-5 somatic symptom disorders seem to neglect important clinical phenomena, such as illness denial, resulting in a narrow view of patients' functioning. The additional information provided by the DCPR may enhance the decision-making process.
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Affiliation(s)
- Laura Sirri
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
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Abbate-Daga G, Delsedime N, Nicotra B, Giovannone C, Marzola E, Amianto F, Fassino S. Psychosomatic syndromes and anorexia nervosa. BMC Psychiatry 2013; 13:14. [PMID: 23302180 PMCID: PMC3556145 DOI: 10.1186/1471-244x-13-14] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 01/03/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In spite of the role of some psychosomatic factors as alexithymia, mood intolerance, and somatization in both pathogenesis and maintenance of anorexia nervosa (AN), few studies have investigated the prevalence of psychosomatic syndromes in AN. The aim of this study was to use the Diagnostic Criteria for Psychosomatic Research (DCPR) to assess psychosomatic syndromes in AN and to evaluate if psychosomatic syndromes could identify subgroups of AN patients. METHODS 108 AN inpatients (76 AN restricting subtype, AN-R, and 32 AN binge-purging subtype, AN-BP) were consecutively recruited and psychosomatic syndromes were diagnosed with the Structured Interview for DCPR. Participants were asked to complete psychometric tests: Body Shape Questionnaire, Beck Depression Inventory, Eating Disorder Inventory-2, and Temperament and Character Inventory. Data were submitted to cluster analysis. RESULTS Illness denial (63%) and alexithymia (54.6%) resulted to be the most common syndromes in our sample. Cluster analysis identified three groups: moderate psychosomatic group (49%), somatization group (26%), and severe psychosomatic group (25%). The first group was mainly represented by AN-R patients reporting often only illness denial and alexithymia as DCPR syndromes. The second group showed more severe eating and depressive symptomatology and frequently DCPR syndromes of the somatization cluster. Thanatophobia DCPR syndrome was also represented in this group. The third group reported longer duration of illness and DCPR syndromes were highly represented; in particular, all patients were found to show the alexithymia DCPR syndrome. CONCLUSIONS These results highlight the need of a deep assessment of psychosomatic syndromes in AN. Psychosomatic syndromes correlated differently with both severity of eating symptomatology and duration of illness: therefore, DCPR could be effective to achieve tailored treatments.
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Affiliation(s)
- Giovanni Abbate-Daga
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin, Italy.
| | - Nadia Delsedime
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin, Italy
| | - Barbara Nicotra
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin, Italy
| | - Cristina Giovannone
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin, Italy
| | - Enrica Marzola
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin, Italy
| | - Federico Amianto
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin, Italy
| | - Secondo Fassino
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin, Italy
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Chaturvedi SK, Goswami K. Feasibility of diagnostic criteria for psychosomatic research in India: a pilot qualitative evaluation. PSYCHOTHERAPY AND PSYCHOSOMATICS 2013; 81:320-1. [PMID: 22854842 DOI: 10.1159/000337361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 02/22/2012] [Indexed: 11/19/2022]
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Sirri L, Fava GA, Guidi J, Porcelli P, Rafanelli C, Bellomo A, Grandi S, Grassi L, Pasquini P, Picardi A, Quartesan R, Rigatelli M, Sonino N. Type A behaviour: a reappraisal of its characteristics in cardiovascular disease. Int J Clin Pract 2012; 66:854-61. [PMID: 22897462 DOI: 10.1111/j.1742-1241.2012.02993.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS The role of type A behaviour in cardiovascular disease is controversial and most of the research is based on self-rating scales. The aim of this study was to assess the prevalence of type A behaviour in cardiology and in other medical settings using reliable interview methods that reflect its original description. METHODS A sample of 1398 consecutive medical patients (198 with heart transplantation, 153 with a myocardial infarction, 190 with functional gastrointestinal disorders, 104 with cancer, 545 with skin disorders and 208 referred for psychiatric consultation) was administered the Structured Clinical Interview for the DSM-IV and the Structured Interview for the Diagnostic Criteria for Psychosomatic Research (DCPR) which identifies 12 clusters, including type A behaviour. RESULTS A cardiac condition was present in 366 patients. There was a significant difference in the prevalence of type A behaviour in cardiovascular disease (36.1%) compared with other medical disorders (10.8%). Type A behaviour frequently occurred together with psychiatric and psychosomatic disturbances, particularly irritable mood, even though in the majority of cases it was not associated with DSM-IV diagnoses. Among cardiac patients, those with type A behaviour were less depressed, demoralised and worried about their illness. CONCLUSIONS Type A behaviour was found to occur in about a third of cases of patients with cardiovascular disease. Only in a limited number of cases was it associated with depression. It has a lifestyle connotation that may have important clinical consequences as to stress vulnerability and illness behaviour.
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Affiliation(s)
- L Sirri
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
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Tomba E, Rafanelli C, Grandi S, Guidi J, Fava GA. Clinical configuration of cyclothymic disturbances. J Affect Disord 2012; 139:244-9. [PMID: 22551912 DOI: 10.1016/j.jad.2012.01.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 01/11/2012] [Accepted: 01/12/2012] [Indexed: 01/04/2023]
Abstract
OBJECTIVE While there is an increasing recognition of the role of subthreshold symptomatology in bipolar disorder, little attention has been dedicated to its only formally acknowledged subtype, cyclothymic disorder. The aim of this investigation was to provide a controlled evaluation of DSM-IV cyclothymic disorder by using a broad assessment strategy geared to subclinical signs. METHODS Sixty-two patients who met the DSM-IV criteria for cyclothymic disorder and did not present comorbidity with other mood disorders, alcohol and drug abuse, and borderline personality disorder and 62 control subjects matched for sociodemographic variables were administered the Structured Interview for Diagnostic Criteria for Psychosomatic Research (DCPR), the Clinical Interview for Depression (CID) and the Mania Scale (MAS). RESULTS In DSM-IV terms, there was an overlap with anxiety disorders in more than half of the cases. About 3 patients out of 4 were found to present with at least one DCPR syndrome (particularly demoralization and irritable mood). Cyclothymic patients displayed significantly higher levels of depressive and anxiety disturbances on the CID, with particular reference to reactivity to social environment. They also had significantly higher scores on the MAS. LIMITATIONS The study was cross-sectional and the sample, because of the exclusion criteria, may not be representative of the clinical populations in psychiatric settings. CONCLUSION In our patients with cyclothymia, without comorbidity with major mood disorders, DSM-IV anxiety disorders, psychosomatic clinical syndromes (irritable mood, demoralization) and subclinical symptoms such as reactivity to social environment resulted to be more frequent than in controls. The use of a broad assessment strategy aimed at subclinical symptomatology may help identifying clinical phenomena that cut across the current definition of subthreshold forms of bipolar disorder.
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Affiliation(s)
- Elena Tomba
- Affective Disorders Program, Department of Psychology, University of Bologna, Italy.
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Rafanelli C, Offidani E, Gostoli S, Roncuzzi R. Psychological correlates in patients with different levels of hypertension. Psychiatry Res 2012; 198:154-60. [PMID: 22386218 DOI: 10.1016/j.psychres.2011.09.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 06/20/2011] [Accepted: 09/17/2011] [Indexed: 11/18/2022]
Abstract
The evidence linking essential systemic arterial hypertension (SAH) with psychological characteristics remains equivocal. The aims of this study were to assess clinical and subclinical distress, psychosocial aspects and psychological well-being in treated hypertensive patients and to evaluate the psychosocial variables associated with higher levels of blood pressure according to guidelines for hypertension management. A consecutive series of 125 hypertensive patients were evaluated using both self- and observer-rated reliable measures. Generalized anxiety disorder, minor depression, demoralization and alexithymia were the most frequent diagnoses. Cluster analysis revealed an association of three distinct symptomatological groups such as the Anxiety-Depression, the Alexithymia and the Somatization groups, with different levels of hypertension. In particular, patients with moderate to severe hypertension were more frequently in the Anxiety-Depression and the Alexithymia groups, whereas the Somatization cluster has been shown to be associated with isolated systolic hypertension. The results provide new insight into the psychosocial characteristics among patients with different levels of SAH according to recent guidelines of the management of hypertension. They also outline the need to monitor the clinical course of hypertensive patients characterized by these specific clinical and subclinical psychological conditions.
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Affiliation(s)
- Chiara Rafanelli
- Department of Psychology, University of Bologna, Bologna, Italy.
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Grandi S, Sirri L, Wise TN, Tossani E, Fava GA. Kellner's emotional inhibition scale: a clinimetric approach to alexithymia research. PSYCHOTHERAPY AND PSYCHOSOMATICS 2012; 80:335-44. [PMID: 21829045 DOI: 10.1159/000328576] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 04/15/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Emotional inhibition has been an enduring concept in the psychosomatic literature explaining the onset and course of medical disorders. Currently the personality style of alexithymia is a focus of this dimension in psychosomatic theory, while actual conscious emotional inhibition, which may overlap with alexithymia, has received less attention. In the early 80s Robert Kellner developed the Emotional Inhibition Scale (EIS), a self-rating scale for emotional inhibition based on clinimetric principles. In this study we explored whether the EIS differentiated a sample of cardiac recipients from normal controls, as well as the associations between the EIS and 2 measures of alexithymia, i.e. the Toronto Alexithymia Scale-20 (TAS-20) and the Diagnostic Criteria for Psychosomatic Research (DCPR). We also examined whether the EIS and the TAS-20 were differently related to depressive symptoms measured by the Symptom Questionnaire (SQ). METHODS Ninety-five heart-transplanted patients and a sample of normal controls, matched for sociodemographic variables, were administered the EIS (total score and 4 subscales concerning 'verbal inhibition', 'timidity', 'disguise of feelings', and 'self-control'), the TAS-20, the SQ, and the Structured Interview according to the DCPR for alexithymia. RESULTS Cardiac recipients did not display significant differences compared to normal controls in observer (DCPR) and self-rated (TAS-20) measures of alexithymia. There were, however, significant differences in EIS with regard to 'disguise of feelings'. In both groups the EIS 'verbal inhibition' and 'timidity' subscales were positively associated with the TAS-20, while the EIS 'disguise of feelings' and 'self-control' subscales were independent of alexithymia. Depressive symptoms were more related to TAS-20 than EIS total scores. CONCLUSIONS Our results suggest that emotional inhibition and alexithymia are distinct phenomena even though they may share certain features. The EIS appears to be relatively independent of depressed mood and will be useful in assessing the individual's conscious management of affect in future psychosomatic research.
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Affiliation(s)
- Silvana Grandi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
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Fava GA, Guidi J, Porcelli P, Rafanelli C, Bellomo A, Grandi S, Grassi L, Mangelli L, Pasquini P, Picardi A, Quartesan R, Rigatelli M, Sonino N. A cluster analysis-derived classification of psychological distress and illness behavior in the medically ill. Psychol Med 2012; 42:401-407. [PMID: 24438853 DOI: 10.1017/s0033291711001231] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The classification of psychological distress and illness behavior in the setting of medical disease is still controversial. Current psychiatric nosology does not seem to cover the spectrum of disturbances. The aim of this investigation was to assess whether the joint use of DSM-IV categories and the Diagnostic Criteria for Psychosomatic Research (DCPR), that provide identification of syndromes related to somatization, abnormal illness behavior, irritable mood, type A behavior, demoralization and alexithymia, could yield subtyping of psychosocial variables in the medically ill. METHOD A cross-sectional assessment using both DSM-IV and the DCPR was conducted in eight medical centers in the Italian Health System. Data were submitted to cluster analysis. Participants were consecutive medical out-patients and in-patients for whom a psychiatric consultation was requested. A total of 1700 subjects met eligibility criteria and 1560 agreed to participate. RESULTS Three clusters were identified: non-specific psychological distress, irritability and affective disturbances with somatization. CONCLUSIONS Two-step cluster analysis revealed clusters that were found to occur across clinical settings. The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of somatization, illness behavior and subclinical distress encompassed by the DCPR.
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Affiliation(s)
- G A Fava
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - J Guidi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - P Porcelli
- Psychosomatic Unit, IRCCS De Bellis Hospital, Castellana Grotte, Bari, Italy
| | - C Rafanelli
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - A Bellomo
- Section of Psychiatry and Clinical Psychology, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - S Grandi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - L Grassi
- Section of Psychiatry, Department of Medical Sciences of Communication and Behavior, University of Ferrara, Ferrara, Italy
| | - L Mangelli
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - P Pasquini
- Clinical Epidemiology Unit, Istituto Dermapatico dell'Immacolata (IDI-IRCCS), Roma, Italy
| | - A Picardi
- Mental Health Unit, Italian National Institute of Health Center of Epidemiology, Surveillance and Health Promotion, Roma, Italy
| | - R Quartesan
- Section of Psychiatry, Clinical Psychology and Psychiatric Rehabilitation, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy
| | - M Rigatelli
- Department of Neuroscience, University of Modena and Reggio Emilia, Modena, Italy
| | - N Sonino
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
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Gori A, Giannini M, Palmieri G, Salvini R, Schuldberg D. Assessment of Alexithymia: Psychometric Properties of the Psychological Treatment Inventory-Alexithymia Scale (PTI-AS). ACTA ACUST UNITED AC 2012. [DOI: 10.4236/psych.2012.33032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Guidi J, Fava GA, Picardi A, Porcelli P, Bellomo A, Grandi S, Grassi L, Pasquini P, Quartesan R, Rafanelli C, Rigatelli M, Sonino N. Subtyping depression in the medically ill by cluster analysis. J Affect Disord 2011; 132:383-8. [PMID: 21458076 DOI: 10.1016/j.jad.2011.03.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 02/28/2011] [Accepted: 03/01/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is increasing awareness of the need of subtyping major depressive disorder, particularly in the setting of medical disease. The aim of this investigation was to use both DSM-IV comorbidity and the Diagnostic Criteria for Psychosomatic Research (DCPR) for characterizing depression in the medically ill. METHODS 1700 patients were recruited from 8 medical centers in the Italian Health System and 1560 agreed to participate. They all underwent a cross-sectional assessment with DSM-IV and DCPR structured interviews. 198 patients (12.7%) received a diagnosis of major depressive disorder. Data were submitted to cluster analysis. RESULTS Two clusters were identified: depressed somatizers and irritable/anxious depression. The somatizer cluster included 58.6% of the cases and was characterized by DCPR somatization syndromes (persistent somatization, functional somatic symptoms secondary to a psychiatric disorder, conversion symptoms, and anniversary reactions) and DCPR alexithymia. The anxious/irritable cluster had 41.4% of the total sample and included DCPR irritable mood and type A behavior and DSM-IV anxiety disorders. LIMITATIONS The study has limitations due to its cross-sectional nature. Further, these findings require additional validation in another sample. CONCLUSIONS The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of somatization, irritable mood, type A behavior and alexithymia, as encompassed by the DCPR. Subtyping major depressive disorder may yield improved targets for psychosomatic research and treatment trials.
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Affiliation(s)
- Jenny Guidi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy.
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