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Drane DL, Hewitt KC, Price ME, Rush BK, Blackmon K, Okada N, Shade T, Valentin E, Vinson J, Rosen P, Loring DW. Case study of invalid to valid shift in cognitive performance following successful treatment of psychogenic nonepileptic seizure events. J Clin Exp Neuropsychol 2023; 45:1024-1038. [PMID: 38533868 DOI: 10.1080/13803395.2024.2335600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/06/2024] [Indexed: 03/28/2024]
Abstract
Patients with psychogenic nonepileptic seizure (PNES) who fail performance validity testing (PVT) may appear to produce non-valid cognitive profiles. Consequently, they may not get referred to treatment and events persist, with worsening disability and high resource utilization. As a result, we report pre- and post-treatment neuropsychological evaluation findings in a 59-year-old woman with a confirmed diagnosis of PNES established using video-EEG monitoring. At pre-treatment baseline neuropsychological evaluation, PNES events occurred weekly to daily. Performance was impaired across PVTs and across multiple cognitive domains. After behavioral intervention specific to PNES, these events substantially reduced in frequency to rare stress-induced flares. Post-treatment neuropsychological evaluation revealed marked improvement of most cognitive and behavioral scores from baseline, and valid PVT scores. We review predisposing, precipitating, and perpetuating factors for PNES and cognitive impairment in this case and discuss the patient's outcome from treatment. Effectively managing PNES events and dissociative tendencies while reducing unnecessary pharmacological interventions appears to have allowed this patient to function closer to her optimal state. This case illustrates the complexity of Functional Neurologic Disorder (FND) clinical presentation and challenges the assumption that suboptimal neuropsychological performance predicts poor treatment engagement and outcome. We showcase the reversibility of PNES and cognitive manifestations of FND using targeted psychotherapeutic interventions, which resulted in reduced disability and associated healthcare costs, as well as re-engagement in life.
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Affiliation(s)
- Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Kelsey C Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Michele E Price
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Beth K Rush
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Karen Blackmon
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Noah Okada
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Taylor Shade
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Edward Valentin
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph Vinson
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - Phyllis Rosen
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - David W Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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Zumbaum-Fischer F, Hartmann M, Kotzaeridou U, Mondry A, Resch F, Hoffmann GF, Friederich HC. [The Interdisciplinary Family Consultation in Pediatrics - An Integrative Approach to Complex Burdened Families of Chronically ill Children]. Psychother Psychosom Med Psychol 2023; 73:510-515. [PMID: 37709285 DOI: 10.1055/a-2136-7397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
For families of chronically ill children with a high level of psychosocial stress, it is necessary to involve child and adolescent psychiatric or psychosomatic specialists directly in the pediatric treatment process. For this purpose, a family consultation was set up in the Heidelberg University Pediatrics as part of a model project, which deals with these families in an interdisciplinary and systemic way. It shows that the implementation of the consultation works despite a high organizational effort and is regularly used. The first evaluation results confirm the already described high levels of psychosocial stress in the affected families. They indicate a positive assessment of the consultation and a desire for a permanent offer. First follow-up results indicate a significant decrease in treatment-related concerns, uncertainty and a reduction in treatment-related problems. The lack of a viable funding model poses a challenge for long-term implementation.
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Affiliation(s)
| | - Mechthild Hartmann
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg
| | - Urania Kotzaeridou
- Klinik für Allgemeine Pädiatrie, Neuropädiatrie, Stoffwechsel Erkrankungen, Gastroenterologie und Nephrologie, Universitätsklinikum Heidelberg, Zentrum für Kinder- und Jugendmedizin, UniversitätsKlinikum Heidelberg
| | - Anne Mondry
- Klinik-für Kinder und Jugendpsychiatrie, UniversitätsKlinikum Heidelberg
| | - Franz Resch
- Klinik-für Kinder und Jugendpsychiatrie, UniversitätsKlinikum Heidelberg
| | - Georg Friedrich Hoffmann
- Klinik für Allgemeine Pädiatrie, Neuropädiatrie, Stoffwechsel Erkrankungen, Gastroenterologie und Nephrologie, Universitätsklinikum Heidelberg, Zentrum für Kinder- und Jugendmedizin, UniversitätsKlinikum Heidelberg
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3
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Wong LP, Tan SL, Alias H, Sia TE, Saw A. Longitudinal Follow-Up of Death Anxiety and Psychophysical-Symptom Experience of Participants in the Silent Mentor Program. Omega (Westport) 2023; 88:157-170. [PMID: 34490819 DOI: 10.1177/00302228211043613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study assessed death anxiety (Death Anxiety Questionnaire, DAQ) and psychophysical- (psychological and physical) symptom experience following cadaveric dissection among the Silent Mentor Program (SMP) participants before thawing (T1), after the suturing, dressing and coffining session (T2), and one month post-program (T3). There was a significant decline in the total DAQ score comparing T1 and T2 (t = 7.69, p < 0.001) and T2 and T3 (t = 5.00, p < 0.001) and T1 and T3 (t = 10.80, p < 0.001). There was a significant reduction in total psychological-symptom score comparing T1 and T2 (t = 4.92, p < 0.001) and between T1 and T3 (t = 4.85, p < 0.001). However, for the physical-symptom experience, a significant increase in the physical-symptom score between T1 and T2 (t = -3.25, p = 0.001) was reported but the scores reduced significantly one month after the program (T2-T3; t = 4.12, p < 0.001). The mentoring concept of the SMP program has beneficial effects on improving attitude towards death and psychophysical-symptom experience associated with cadaver dissection.
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Affiliation(s)
- Li Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Unit of Silent Mentor Program, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sik Loo Tan
- Unit of Silent Mentor Program, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Orthopedic Surgery, National Orthopaedic Centre of Excellence for Research & Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Haridah Alias
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Unit of Silent Mentor Program, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Thiam Eng Sia
- Unit of Silent Mentor Program, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Aik Saw
- Unit of Silent Mentor Program, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Orthopedic Surgery, National Orthopaedic Centre of Excellence for Research & Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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4
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Marek A. [Psychosomatic aspects in otorhinolaryngology-historical milestones]. HNO 2023; 71:622-631. [PMID: 37626261 DOI: 10.1007/s00106-023-01349-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND This investigation examined the development of psychosomatics in the field of otolaryngology in Germany using the examples of psychogenic deafness and chronic tinnitus by means of literature research. The focus of the study was on the period 1948-2022. METHODS A literature search was carried out in the PubMed database from 1948 and antiquarian ENT textbooks were evaluated. The search terms used were "ENT and psychosomatics," "tinnitus," "retraining therapy," "analytical psychology," "behavioral therapy," and "sensory systems." RESULTS Psychosomatic phenomena were mentioned in the treatment of nasal diseases and ear ailments in writings of Byzantine and medieval medicine. Even older are references to tinnitus in ancient Egyptian and Indian scripts. From the nineteenth to the mid-twentieth century, psychological abnormalities in ENT symptoms were assigned to the term hysteria. From the middle of the twentieth century, a paradigm shift in the assessment of psychosomatic disorders in otolaryngology became apparent. In the 1950s, a broad psychosomatic discussion was opened in individual lectures and book contributions on mental abnormalities in ENT diseases. With the implementation of the Psychosomatics Working Group of the German Society of Otorhinolaryngology, Head and Neck Surgery, psychosomatics in the field of ENT received the framework for scientific and clinical activity at the turn of the millennium. Psychosomatics is scientifically represented and part of the continuing education regulations for otolaryngology in Germany and at European level. It shows high standards in research, qualification of otolaryngologists, and patient care. CONCLUSION As of 2022, psychosomatics in otolaryngology has been steadily developing for over 70 years. The standards achieved are to be further expanded and research on cognition, affectivity, and sensory analogies intensified.
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Affiliation(s)
- Astrid Marek
- Abteilung für Psychosomatik in der HNO-Heilkunde, Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Ruhr-Universität Bochum, St. Elisabeth-Hospital Bochum, Bleichstr. 15, 44787, Bochum, Deutschland.
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Guedes CR, Rangel VM, Camargo KRD. [From psychosomatic medicine to medical psychology: the theoretical and institutional trajectory of Julio de Mello Filho]. Hist Cienc Saude Manguinhos 2023; 29:181-196. [PMID: 36629678 DOI: 10.1590/s0104-59702022000500012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/04/2021] [Indexed: 06/04/2023]
Abstract
Studies on the causality of pathologies and the doctor/patient relationship based on psychoanalytic formulations received two denominations in Brazil: psychosomatic medicine and medical psychology. The physician and psychoanalyst Julio de Mello Filho took a leading role in this movement after the psychiatrist and psychoanalyst Danillo Perestrello was incapacitated by illness. This study investigates how the theoretical concepts of the psychosomatic movement were structured and the institutional strategies used to establish this discipline in Brazil. From an epistemological and historical point of view, the initial notion of transforming the hegemonic medical model was seen to lose force, followed by a shift in medical psychology as a field of health psychology.
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Affiliation(s)
- Carla Ribeiro Guedes
- Professora, Departamento de Saúde e Sociedade / Instituto de Saúde Coletiva / Universidade Federal Fluminense . Niterói - RJ - Brasil
| | - Vanessa Maia Rangel
- Professora, Departamento de Saúde e Sociedade / Instituto de Saúde Coletiva / Universidade Federal Fluminense . Niterói - RJ - Brasil
| | - Kenneth Rochel de Camargo
- Professor, Departamento de Planejamento e Administração em Saúde / Instituto de Medicina Social / Universidade do Estado do Rio de Janeiro . Rio de Janeiro - RJ - Brasil
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Petelin DS, Kondrateva KK, Dzhibladze TA, Volel BA. [Complex therapy of psychosomatic disorders associated with the female reproductive cycle]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:14-21. [PMID: 37994883 DOI: 10.17116/jnevro202312311114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Psychosomatic disorders make a great contribution to the structure of reproductive health disorders in women. The purpose of this review was to analyze the available data on effective methods of therapy for psychosomatic disorders associated with the reproductive cycle of women - psychopharmacological, psychotherapeutic, non-drug biological, hormonal. The review summarizes the evidence in relation to the treatment of disorders such as: stress-related menstrual irregularities; premenstrual dysphoric disorder; perinatal affective disorders (especially depression); psychosomatic disorders of the involutionary period. General recommendations on the complex therapy of psychosomatic disorders associated with the menstrual cycle within the framework of an interdisciplinary team have been formed.
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Affiliation(s)
- D S Petelin
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - K K Kondrateva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - T A Dzhibladze
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - B A Volel
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Mental Health Research Center, Moscow, Russia
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Abstract
PURPOSE OF REVIEW Psychogenic nonepileptic seizures (PNES) are the most common Functional Neurological Disorder/Conversion Disorder subtype. Significant advances have been made related to diagnosis, neurobiology, and treatment. In this review, we summarize updates in diagnosis and management over the past 3 years. RECENT FINDINGS Although evidence is mixed for the treatment of PNES, psychotherapeutic modalities remain a powerful instrument to empower patients and reduce seizures. A multidisciplinary, holistic approach is beneficial. While seizure freedom in all patients may not be the achieved endpoint in this chronic, paroxysmal disorder, quality of life can be improved with treatment. Additional treatment modalities and further research are needed for patients who are refractory to current treatment. Evidence-based therapies exist for PNES, and recent findings represent an increased understanding of the clinical and neurophysiologic aspects of PNES.
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Affiliation(s)
- M Raquel Lopez
- University of Miami, 1120 NW 14th St., Miami, FL, 33136, USA.
- VA Miami Health Care System, Miami, FL, USA.
| | - W Curt LaFrance
- Rhode Island Hospital, Brown University, Providence, RI, USA
- VA Providence Health Care System, Providence, RI, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Myers L, Gray C, Roberts N, Levita L, Reuber M. Shame in the treatment of patients with psychogenic nonepileptic seizures: The elephant in the room. Seizure 2021; 94:176-182. [PMID: 34876339 DOI: 10.1016/j.seizure.2021.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/02/2021] [Accepted: 10/21/2021] [Indexed: 01/19/2023] Open
Abstract
Previous research has established a link between psychogenic nonepileptic seizures (also known as dissociative or functional seizures) and abnormal emotion processing. In a companion article to this multidisciplinary narrative review, we have argued that, in the context of a biopsychosocial understanding of the condition, the emotion of shame is particularly likely to contribute to the aetiology, manifestation, semiology and perpetuation of psychogenic non-epileptic seizures (PNES). Here we demonstrate how unrecognised and unaddressed shame may cause difficulties when clinicians explain the diagnosis, attempt to engage patients in psychological treatment, construct a diagnostic formulation and undertake psychotherapy. Case vignettes are used to bring theoretical considerations to life and to illustrate the complex interactions which may be observed between high shame proneness, chronic and dysregulated shame, stigma and PNES. The particular focus on shame does not mean that recent explanatory models of PNES are obsolete. Rather, we demonstrate how the inclusion of shame helps to embed the emotional, cognitive and behavioural aspects of the Integrative Cognitive Model (ICM) of PNES in a social / interpersonal context. While we describe how a number of different psychotherapeutic approaches can help to address shame-related processes we conclude that specific modalities are less important than the eventual enhancement of emotional literacy and tolerance through a healing relationship with the psychotherapist.
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Affiliation(s)
- Lorna Myers
- Psychogenic Nonepileptic Seizures Program, Northeast Regional Epilepsy Group, New York, United States
| | - Cordelia Gray
- Neurology Psychotherapy Service, Academic Neurology Unit, Sheffield Teaching Hospital, University of Sheffield, Sheffield, United Kingdom
| | - Nicole Roberts
- School of Social and Behavioral Sciences, Arizona State University, Phoenix, AZ, United States
| | - Liat Levita
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Markus Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2JF, United Kingdom.
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Theodorakopoulou A, Tollos I, Christodoulou GN. [Therapeutic approaches in psychosomatic medicine from a biopsychosocial perspective]. Psychiatriki 2021; 32:141-147. [PMID: 34052794 DOI: 10.22365/jpsych.2021.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
| | - Ioannis Tollos
- Second Department of Psychiatry, National and Kapodistrian University of Athens, Athens
| | - Georgios N Christodoulou
- Hellenic Psychiatric Association, Αthens
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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11
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Uhlmann C, Jaeger S, Steinert T, Schmid P. [Clinical courses of depressive and anxiety disorders over 1 year : Direct comparison of four treatment settings in psychiatry and psychosomatic medicine-results of the PfAD study]. Nervenarzt 2021; 92:468-478. [PMID: 32833071 DOI: 10.1007/s00115-020-00980-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inpatient care for patients with depressive and anxiety disorders (ICD-10 F3/F4 diagnoses) is provided in Germany in different settings of psychiatry and psychosomatic medicine. OBJECTIVE Apart from the question of the effectiveness of treatment, it is of interest whether the course of the disease differs between four different settings up to a period of 1 year after discharge. MATERIAL AND METHODS A total of 320 patients with main clinical diagnoses from the ICD-10 F3/F4 spectrum were recruited and interviewed consecutively in four treatment settings (psychiatric depression unit, psychiatric crisis intervention unit, psychiatric day hospital, psychosomatic acute hospital). The interviews were conducted after admission, before discharge and 6 and 12 months after discharge. RESULTS Overall, treatment in all four settings was shown to be highly effective. The slight increase in symptoms in the postinpatient phase described in the literature was observed across all settings. In terms of treatment intensity, those treated in the crisis intervention unit received the most services after index treatment; however, this group was also the one with the most pronounced symptom burden at admission. Patients treated in the psychosomatic department had the lowest symptom burden at admission and overall received the least inpatient services over the observation period; however, outpatient follow-up treatment was apparently used most by those patients. CONCLUSION The treatments proved to be effective in the long-term in both psychiatric and psychosomatic units. The different settings seem to be successful in adapting the treatments to the respective patient groups.
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Affiliation(s)
- Carmen Uhlmann
- Versorgungsforschung Weissenau, ZfP Südwürttemberg, Klinik I für Psychiatrie und Psychotherapie, Universität Ulm, Weingartshofer Str. 2, 88214, Ravensburg-Weissenau, Deutschland.
| | - Susanne Jaeger
- Versorgungsforschung Weissenau, ZfP Südwürttemberg, Klinik I für Psychiatrie und Psychotherapie, Universität Ulm, Weingartshofer Str. 2, 88214, Ravensburg-Weissenau, Deutschland
| | - Tilman Steinert
- Versorgungsforschung Weissenau, ZfP Südwürttemberg, Klinik I für Psychiatrie und Psychotherapie, Universität Ulm, Weingartshofer Str. 2, 88214, Ravensburg-Weissenau, Deutschland
| | - Petra Schmid
- Versorgungsforschung Weissenau, ZfP Südwürttemberg, Klinik I für Psychiatrie und Psychotherapie, Universität Ulm, Weingartshofer Str. 2, 88214, Ravensburg-Weissenau, Deutschland
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Kishk N, Raafat O, Abdou H, Nawito A, Shamloul RM, Belal M, El-Makawi S. Psychogenic Nonepileptic Seizures in Patients With Epilepsy: A Comparative Study With Patients With Pure Epilepsy. J Nerv Ment Dis 2021; 209:196-202. [PMID: 33315796 DOI: 10.1097/nmd.0000000000001281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ABSTRACT Psychogenic nonepileptic seizures (PNES) represent management challenges, especially if associated with epilepsy. We aimed to evaluate patients with mixed epilepsy (true and PNES) and compare them with pure epilepsy to identify predictors of psychogenic seizures. This study included 40 patients with pure epilepsy and 40 patients with mixed epilepsy matched in age and sex. Patients underwent neurological assessment, semistructured psychiatric clinical interview, and video electroencephalogram monitoring. We found that unemployment, divorce, and seizure frequency were higher in mixed epilepsy, as well as history of family dysfunction, child adversity, and depressive and dissociative disorders. Both groups were similar regarding family history for seizures and personality dysfunction scores. Family dysfunction, child adversity, and depressive disorders were predictors of PNES. We recommend early evaluation for social instability, family dysfunction, child adversity, and depressive disorders in epileptic patients with higher seizure frequency to avoid misdiagnosis of false drug-resistant epilepsy and enhance proper management.
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Affiliation(s)
| | | | | | - Amani Nawito
- Clinical Neurophysiology Unit, Department of Neurology, Cairo University, Cairo, Egypt
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Stajić D, Hasanović M. EMDR Treatment of Psychosomatic Difficulties Caused by a Specific Style of Familial Interactions - Case Report. Psychiatr Danub 2021; 33:42-45. [PMID: 33638956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Dajana Stajić
- Association "Amica Educa", Klosterska 13, 75000 Tuzla, Bosnia and Herzegovina,
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Wuling Capsule Clinical Application Expert Consensus Group, Division of Psychosomatic Medicine, Chinese Medical Association. [Recommendations on clinical application of Wuling Capsule in psychosomatic related disorders: an expert consensus]. Zhonghua Nei Ke Za Zhi 2020; 59:427-32. [PMID: 32486582 DOI: 10.3760/cma.j.cn112138-20191223-00838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Psychosomatic related disorders are diseases closely related to psychosocial factors. Patients are often treated in the non-psychiatric department of general hospitals due to somatic symptoms, and physicians often fail to recognize psychological symptoms, and could not make a proper diagnosis. Therefore, the status of diagnosis and treatment of psychosomatic disorders needs to be improved urgently. Wuling Capsule is a kind of national first class new traditional Chinese medicine with a single ingredient. It is widely used in the field of psychosomatic disorders. As an effective therapeutic drug for patients with depressive, anxious and insomnic symptoms in various departments of general hospitals, Wuling Capsule can be used alone or combined with other medications. It has fewer side effects and with higher safety. It can reduce patients' stigma and, thus, increase compliance. All these make Wuling Capsule a valuable drug in clinical application. The aim of the consensus was to summarize the clinical application situation of Wuling Capsule in psychosomatic related disorders, standardize its application in clinical practice, and provide evidence-based expert consensus recommendations for the clinical diagnosis and treatment of psychosomatic related disorders for physicians in both general and primary hospitals.
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15
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Dikann A. [Land art therapy, a return to the essence of the creative process]. Soins Psychiatr 2020; 41:27-30. [PMID: 32718458 DOI: 10.1016/s0241-6972(20)30040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Nature and humans are inseparable creators. Since time immemorial, humans have created in nature to express themselves, unburden themselves, heal themselves and transform themselves. By providing the conditions for rediscovering this form of authentic creative expression, land art therapy enables anyone whatever their problem (psychosomatic disorders, psychological pathologies, addictive behaviour, etc.) to liberate their stifled body, to rediscover their vital force, to reconstruct a real link between the body and the mind and to become a subject again.
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Affiliation(s)
- Alain Dikann
- Art-thérapeute certifié (arts plastiques, dramathérapie, land art et écriture), enseignant en art-thérapie et coresponsable pédagogique formation continue art-thérapie à l'université de Strasbourg, artiste plasticien et auteur documentaire c/o Soins Psychiatrie, 65 rue Camille-Desmoulins, 92442 Issy-les-Moulineaux cedex, France.
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Kaushik M, Jain A, Agarwal P, Joshi SD, Parvez S. Role of Yoga and Meditation as Complimentary Therapeutic Regime for Stress-Related Neuropsychiatric Disorders: Utilization of Brain Waves Activity as Novel Tool. J Evid Based Integr Med 2020; 25:2515690X20949451. [PMID: 32985243 PMCID: PMC7545749 DOI: 10.1177/2515690x20949451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 12/17/2022] Open
Abstract
During recent decades, stress-related neuropsychiatric disorders such as anxiety, depression, chronic tension headache, and migraine have established their stronghold in the lives of a vast number of people worldwide. In order to address this global phenomenon, intensive studies have been carried out leading to the advancement of drugs like anti-depressants, anxiolytics, and analgesics which although help in combating the symptoms of such disorders but also create long-term side effects. Thus, as an alternative to such clinical practices, various complementary therapies such as yoga and meditation have been proved to be effective in alleviating the causes and symptoms of different neuropsychiatric disorders. The role of altered brain waves in this context has been recognized and needs to be pursued at the highest level. Thus, the current study provides a review focused on describing the effects of yoga and meditation on anxiety and depression as well as exploring brain waves as a tool for assessing the potential of these complementary therapies for such disorders.
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Affiliation(s)
- Medha Kaushik
- Department of Toxicology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
- School of Computer Science and Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Akarshi Jain
- Department of Computer Science, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Puneet Agarwal
- School of Computer Science and Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Shiv Dutt Joshi
- Department of Electrical Engineering, Indian Institute of Technology, Hauz Khas, New Delhi, India
| | - Suhel Parvez
- Department of Toxicology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
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Röhrig G, Lindner R. [Survey on psychosomatic treatment options in geriatric clinical routine: state of the art]. Z Gerontol Geriatr 2019; 53:430-436. [PMID: 31720831 DOI: 10.1007/s00391-019-01658-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/28/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mental and physical disorders form a common body of experience and suffering in old age that can negatively influence aging. Experience and handling of age-associated functional impairments are challenging for multimorbid patients, their relatives and the healthcare providers involved. Among patients aged 70 years or older more than 50% suffer from psychopathological symptoms and 30-40% of geriatric inpatients have a psychosomatic or psychiatric comorbidity; however, despite this high prevalence of mental problems in older patients they are hardly ever treated and if treatment is offered it is carried out by specialists for somatic medicine. The aim of the present study of the working group on gerontopsychosomatics of the German Geriatric Society (DGG) was the evaluation of interdisciplinary co-management opportunities for geriatricians who treat inpatients with gerontopsychosomatic needs. METHOD Online survey among members of the DGG regarding experiences with interdisciplinary co-management of inpatients with gerontopsychosomatic needs. RESULTS The majority of the respondents were senior physicians in a department for geriatrics. While every second institution had access to a psychiatric consultation service, psychosomatic cooperation was only offered in every fifth department. Psychosomatic co-management was particularly required in connection with neurogeriatric problems. CONCLUSION There is need of gerontopsychosomatic co-management among geriatric inpatients; however, in comparison to gerontopsychiatric co-management the options are deficient and need to be strengthened.
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Affiliation(s)
- Gabriele Röhrig
- Zentrum für spezialisierte geriatrische Diagnostik, MVZ Medicum Köln-Ost, Johann Classen Straße 68, 51103, Köln, Deutschland.
| | - Reinhard Lindner
- Institut für Sozialwesen, Fachbereich Humanwissenschaften, FG Theorie, Empirie und Methoden der Sozialen Therapie, Universität Kassel, Kassel, Deutschland
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Masik O, Podolian V, Masik N. [APPLICATION OF CLIENT-CENTERED PSYCHOTHERAPY IN THE COMPLEX TREATMENT OF ADOLESCENTS WITH PSYCHOSOMATIC DISORDERS]. Georgian Med News 2019:55-61. [PMID: 31889705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Treatment of psychosomatic disorders does not allow to do without medication intervention, although psychotherapy is important, aimed at correcting psychopathological symptoms. That's why, the definition of a method of therapy, which is better and more likely to cause positive results. The aim - determining which the better method of treatment and more effective of the causes a positive shift in the dynamics of clinical syndromes. The group of 90 adolescents (34 boys and 56 girls) with psychosomatic disorders divided into 2 groups, were inspected using received comprehensive clinical psychopathological examination. The average age of adolescents was 14.4 ± 0.06 years old. The 1-st group (57 persons) consisted of adolescents, who received treatment with Lamotrigine and Sertraline 25 mg / day for persons from 12 to 16 years old and 50 mg / day - over 16 years old. The duration of treatment was 1.5-2 months. Adolescents of the 2-nd group (33 persons) were prescribed Lamotrigine and Sertraline therapy in combination with psychotherapy. Control of therapeutic effectiveness was evaluated by clinical and Spielberger anxiety questionnaire (STPI - State Trait Personal Inventory), Phillips' school anxiety test and CDI scale (Children Depression's Inventory) by M. Kovacs. Statistical processing was carried out on the basis of the computer program "Statistica 6.1." (Stat Soft Inc., USA). The anxiety level moved to an average level after medication, except situational negative experiences, which remained at a high level. In adolescents of the 1-st and 2-nd groups the fear of self-expression decreased significantly by comparison with it before treatment. The anxiety test scores decreased to an average level after complex treatment. At the same time the level of personal cognitive activity remained high, which confirmed the positive effect of combined treatment of psychosomatic disorders due to increased interest, curiosity, interest, which activates cognitive activity of adolescents. The level of depression in the 1-st group of adolescents after the treatment was 2.16 ± 0.16, which corresponded to the level of subdepression or masked depression with high scores on scale B. On the background of combined treatment in adolescents the level of depression decreased to 1.71 ± 0.12, which corresponded to slight decrease of mood with high scores on scale B. Adolescents with psychosomatic disorders who responded positively to psychotherapy were characterized by low level of somatization, but higher specific weight of psychological problems and difficulties in interpersonal relationships in the internal picture of the illness with peaks at subclasses of interpersonal sensitivity and hostility. The obtained results of treatment of psychosomatic disorders in adolescents show positive influence of both methods of therapy. However, adolescents with psychosomatic disorders were most susceptible to complex treatment, which accelerates the regression of clinical manifestations and increases the effectiveness of treatment 2.85 times.
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Affiliation(s)
- O Masik
- National Pirogov Memorial Medical University, Vinnytsa, Ukraine
| | - V Podolian
- National Pirogov Memorial Medical University, Vinnytsa, Ukraine
| | - N Masik
- National Pirogov Memorial Medical University, Vinnytsa, Ukraine
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Mohapatra B, Shisler Marshall R. Psychosomatic and Physical Well-Being Factors After Mind-Body Interventions in a Hospital Setting. Adv Mind Body Med 2019; 33:4-11. [PMID: 31605600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CONTEXT Mind-body interventions encompass a variety of treatments that directly affect health. Researchers have found that yoga can decrease symptoms of depression and anxiety as well as improve dietary patterns, enhance physical function and capacity, and enrich sleep. Research has shown that mindfulness can have psychological and physiological benefits and treat symptoms of anxiety and depression. OBJECTIVE This study intended to compare the benefits of 2 mind-body interventions-yoga and mindfulness-in a hospital setting. DESIGN The research team performed a retrospective analysis of outcome data obtained from a hospital's programs. SETTING The study took place at a mind-body center at a hospital in Athens, GA (USA). PARTICIPANTS Participants were 46 individuals enrolled either in a yoga (n = 24) or a mindfulness (n = 22) intervention program at the hospital. INTERVENTION Participants self-selected a mind-body-intervention program offered at the hospital: yoga or mindfulness. They received guided training in their chosen intervention at weekly 2-h sessions for 6 to 9 wk. OUTCOME MEASURES Participants completed measures of anxiety, depression, mindfulness, and quality of life at 2 points during the mind-body programs, at baseline and postintervention. The programs used the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Freiburg-Mindfulness Inventory (FMI), Automatic Thought Questionnaire (ATQ), and RAND 36-Item Short Form Health Survey (SF-36). RESULTS The results showed significant decreases between baseline and postintervention in depression (on BDI-II) and anxiety (on BAI) levels for participants in both groups; however, only participants in the mindfulness group showed significant increases in mindfulness (on FMI) and quality of life and decreases in the frequency of negative thoughts (on ATQ) and significant improvements in some health-related measures (on SF-36; all P < .05). However, a significant difference between the groups existed at postintervention only for limitations due to physical health on the SF-36. CONCLUSIONS The overall findings suggest that both the programs are effective. Although significant differences existed between the groups only for limitations due to physical health, the significant increases in categories other than anxiety and depression for the mindfulness group suggest that mindfulness can offer a more encompassing intervention for improving psychosomatic well-being, although further research is needed.
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De Souza B, McMichael A. A new somatic-type delusional disorder subtype: delusion inversus. Dermatol Online J 2019; 25:13030/qt20s9f78r. [PMID: 31735003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023] Open
Abstract
The interplay between psychiatric and dermatologic conditions has been recognized for decades as evidenced by the widely accepted classification system of psychocutaneous disorders: (1) primary dermatologic disorder with psychiatric sequelae, (2) primary dermatologic disorder exacerbated by stress, (3) primary psychiatric disorder with dermatologic sequelae, and (4) miscellaneous. However, there is minimal literature regarding dermatologic patients who demonstrate a preoccupation with a more severe cutaneous disorder despite evidence confirming a diagnosis of a minor, treatable skin condition. These patients are a hybrid of the first and fourth categories and should be classified under a new entity known as delusion inversus. These patients have a primary dermatologic condition; however, they believe their condition to be more severe and malignant than it is, despite evidence to the contrary. Their beliefs are pathological and analogous to delusion disorder somatic type. Given the scarcity of data concerning delusion inversus, the epidemiology, diagnosis, and management of the disorder as described in this review is extrapolated from reported cases of delusion disorder and delusion disorder somatic-type. Often these patients will present to a non-psychiatric, outpatient clinic for medical care. Thus, it is imperative that dermatologists are able to identify the condition and manage the patient appropriately.
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Affiliation(s)
| | - Amy McMichael
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC.
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Affiliation(s)
- Benjamin Tolchin
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
- Epilepsy Center of Excellence, Neurology Service, VA Connecticut Healthcare System, Connecticut
| | - Steve Martino
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Psychology Service, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Lawrence J Hirsch
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
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Bonet J. [A short review of four key physiopathological mechanisms for psychosomatic medicine]. Vertex 2019; XXX:185-194. [PMID: 31968037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The notion that "psychological factors " and the psychosocial environment influence the body function and the health maintenance or disease onset has been maintained over the years, and from different approaches to science, medicine, and psychology. Psychosomatic Medicine traditionally deals with this issue, but the "psychosomatic" name is now being criticized because of some implicit ambiguity, probably derived from the identification with the different theoretical frameworks and/or specific research methods that have been used in its evolution. This has given rise to misunderstandings about its definition, objectives, and a delay in the search for pathways of mediatizing these effects. Since then, there has been an increasing interest in the research of mechanisms, or mediatizing pathways through which the mind, the brain, and the environment could produce an impact on the somatic functioning. This brief review focuses on early stress, epigenetics and polymorphisms, such as the mechanism of penetration of the psychosocial environment; alostasis and alostatic load such as the accumulated wear and tear produced by the continuous adaptation to a variable psicosocial context; activation of the neuroimmune pathways as the physiological basis of somatizations; and interoception as a the pathway that the body introduces into the brain, mind and consciousness.
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Affiliation(s)
- José Bonet
- Centro de Estrés, Fundación Favaloro. Universidad Favaloro, Argentina.
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Grinnell D. How I Thought Myself into Illness, Then Thought My Way Out. Perspect Biol Med 2019; 62:758-764. [PMID: 31761805 DOI: 10.1353/pbm.2019.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
When doctors couldn't find an explanation for my mysterious symptoms, including back pain, aching joints, and tingling limbs, I went on a quest to uncover the root causes. My journey took me from the West Coast to the East Coast, from physical therapists to psychiatrists, from the body to the mind, chronic pain to repressed emotions, existential crisis to posttraumatic growth.
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Nigg C. [Not Available]. Praxis (Bern 1994) 2019; 108:1045. [PMID: 31822233 DOI: 10.1024/1661-8157/a003344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Stötter A, Harrer ME, Mosgoeller W, Endler PC, Haring C. [Achtsame Massage und Achtsamkeitsschulung (Insightouch®) bei Depressionen, psychosomatischen und Bindungsstörungen]. Complement Med Res 2018; 26:4-12. [PMID: 30261502 DOI: 10.1159/000492060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hintergrund: Bindungsstörungen können das Auftreten von Angst und Depression begünstigen, lassen sich aber durch korrigierende emotionale Erfahrungen verändern. Eine Massage - insbesondere wenn beide, Masseur (m/w) und Klient, sich in einem Zustand der Achtsamkeit befinden - kann eine solche korrigierende Erfahrung vermitteln. In der vorliegenden Interventionsstudie wurden die Auswirkungen von Insightouch® - einer Kombination von achtsamkeitsbasierter Massage mit Achtsamkeitsschulung - untersucht. Teilnehmer und Methoden: Wir rekrutierten 36 Personen mit psychischen Beschwerden, geringer Bindungsfähigkeit und geringer Achtsamkeit. In Intervallen von 8 Wochen wurden mittels validierter Fragebögen Parameter wie psychosomatische Symptome (Brief Symptom Inventory), Bindungsqualitäten (Adult Attachment Scale) und Achtsamkeit (Freiburger Achtsamkeitsfragebogen) erhoben. Die Hälfte der Teilnehmer (Gruppe A) startete mit der 8-wöchigen Behandlungsphase; nach weiteren 8 Wochen ohne Behandlung wurde die Nachhaltigkeit der Behandlungswirkung dokumentiert. Die Teilnehmer der Gruppe B starteten mit einer 8-wöchigen Wartephase (Kontrollphase ohne Behandlung), gefolgt von der Behandlungsphase. Ergebnisse: Während sich nach der Kontrollphase keine signifikanten Änderungen zeigten, bewirkte die aktive Behandlung statistisch signifikante Besserungen der 1) Symptomatik, 2) Bindungsdefizite und 3) Achtsamkeit. Nach der 8-wöchigen Nachbeobachtungsphase waren die psychischen und die bindungsbezogenen Symptome weiter verbessert; die behandlungsbedingt erhöhte Fähigkeit zur Achtsamkeit blieb hoch. Schlussfolgerung: Insightouch als primär nonverbale Intervention erhöht die Bindungsfähigkeit, verbessert psychosomatische Symptome und erhöht nachhaltig die Fähigkeit zur Achtsamkeit.
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Kirsten A, Linder S, Olbrich S. [Perspectives for the Electroencephalogram in Psychiatry]. Praxis (Bern 1994) 2018; 107:837-843. [PMID: 30043707 DOI: 10.1024/1661-8157/a003028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Perspectives for the Electroencephalogram in Psychiatry Abstract. The electroencephalogram (EEG) is a non-invasive and cost-effective method to monitor spontaneous neuronal activity over time. Pathologies in EEG recordings indicate with high sensitivity but low specificity abnormal functional brain states. The main psychiatric indications for EEG recordings include atypical clinical symptoms of a neuropsychiatric syndrome or atypical reactions to medication as well as a baseline diagnostic before starting treatment with specific drugs or stimulation modalities. In recent research the EEG continues to be a valuable tool not only in diagnostics but also for the prediction of treatment success. The following paper focuses on basic electrophysiological understanding of EEG recordings, the diagnostic value of EEG recordings in different clinical entities, and new research attempts in diagnostic and treatment prediction.
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Peterson KT, Kosior R, Meek BP, Ng M, Perez DL, Modirrousta M. Right Temporoparietal Junction Transcranial Magnetic Stimulation in the Treatment of Psychogenic Nonepileptic Seizures: A Case Series. Psychosomatics 2018; 59:601-606. [PMID: 29628295 DOI: 10.1016/j.psym.2018.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/02/2018] [Accepted: 03/04/2018] [Indexed: 11/19/2022]
Affiliation(s)
| | - Robert Kosior
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Benjamin P Meek
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Marcus Ng
- Department of Internal Medicine (Neurology), University of Manitoba, Winnipeg, Canada
| | - David L Perez
- Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry, Neuropsychiatry Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Tong X, An D, Reuber M, Zhang Q, Zhou D. Diagnostic and treatment services for patients with Psychogenic Nonepileptic Seizures (PNES): A survey of health professionals in urban China. Seizure 2018; 56:78-87. [PMID: 29454194 DOI: 10.1016/j.seizure.2018.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 02/05/2023] Open
Abstract
PURPOSE This study is intended to provide an overview of diagnostic and treatment services for patients with psychogenic nonepileptic seizures (PNES) across China. METHODS Using a questionnaire devised by the PNES Task Force of Neuropsychiatry Commission of the International League Against Epilepsy (ILAE), we conducted a survey among Chinese health professionals at the Sixth Advanced International Course: Clinical Epileptology. Descriptive analyses were performed. RESULTS Responses from 102 eligible clinicians were analysed. Responses were received from urban areas in 20 provinces/municipalities around China. Most respondents were neurologists. The results showed that hospitals in urban China were mostly well-equipped, and that health professionals' understanding of PNES largely reflected current international expert opinion. However, many of the participants would not actually make the diagnosis, and most provided neither follow-up nor treatment (especially psychotherapy) for patients with PNES. Only about one third of the patients diagnosed with PNES were estimated to receive at least one appointment for psychological treatment. In the opinion of the respondents, tacit trauma (neglect and stress) play an important role in the development of PNES. The main obstacles to patients with PNES accessing health services for their condition were thought to be lack of knowledge or awareness among health professionals, patients and society. CONCLUSION Despite good access to equipment, diagnostic and treatment services for patients with PNES in China are currently deficient. Education programs about PNES with different target groups, and more effective referral and social security systems emerge as particular development needs from this survey.
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Affiliation(s)
- Xin Tong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Dongmei An
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom
| | - Qin Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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Abstract
Depending on whether or not psyche/soma is seen as singular or dual, one may construct different systems explaining man and the world, life and death. In the author's view, the discoveries of psychoanalysis offer a perfectly cogent and unique solution to the famous mind/body problem. In transferring the duality psyche/soma on to the duality of drives, psychoanalysis places the origin of the thought process in the body. In Beyond the pleasure principle, Freud discusses the drastic effect of a painful somatic illness on the distribution and modalities of the libido. He provides a starting point for the Paris Psychosomatic School's psychoanalytical approach to patients afflicted with somatic illnesses. To illustrate the technical implications of this theory the author relates two clinical cases.
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Söllner W, Wunner C, Wentzlaff E, Reichhart C, Stein B. [Psychosomatic medicine in old age]. Z Gerontol Geriatr 2017; 50:713-725. [PMID: 29170825 DOI: 10.1007/s00391-017-1337-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/22/2017] [Accepted: 10/11/2017] [Indexed: 11/26/2022]
Abstract
Approximately 25% of people over 65 years old suffer from psychiatric disorders but in cases of simultaneously occurring somatic diseases the prevalence is increased. Sickness, loss of important reference persons and life crises in older age often reactivate traumatic experiences from earlier life stages. It can be difficult to differentiate between psychological disorders and the psychological symptoms accompanying somatic illness. The biographic medical history and estimation of cognitive skills within a geriatric basis assessment should be standard in geriatric diagnostics. Psychological disorders are often overlooked or inadequately treated in older people. In the case of psychopharmacological treatment, effects on somatic sickness as well as drug-drug interactions have to be kept in mind. Psychotherapeutic approaches focusing on resources and social support particularly in group therapy seem to be very helpful.
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Affiliation(s)
- Wolfgang Söllner
- Univ.-Klinik für Psychosomatische Medizin und Psychotherapie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
| | - Christina Wunner
- Univ.-Klinik für Psychosomatische Medizin und Psychotherapie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| | - Elisabeth Wentzlaff
- Univ.-Klinik für Psychosomatische Medizin und Psychotherapie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| | - Corinne Reichhart
- Univ.-Klinik für Psychosomatische Medizin und Psychotherapie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| | - Barbara Stein
- Univ.-Klinik für Psychosomatische Medizin und Psychotherapie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
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Affiliation(s)
- Christopher C Butler
- Department of General Practice, University of Wales College of Medicine, Llanedeyrn Health Centre, Cardiff CF23 9PN, Wales, UK.
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Affiliation(s)
- Najat Khalifa
- Leicestershire Partnership NHS Trust, Leicester LE5 0LE, UK
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Abstract
This paper discusses psychosomatic illness as a disorder of the individual's subjectivity in relation, or a surrender of mind and mindfulness to the other. Illustrative clinical material highlights the usefulness of Harry Stack Sullivan's (I954) detailed inquiry in locating the psychosomatic patient's own voice in the consulting room. Particular attention is paid to the form and use of language to impede or foster private experience and personal agency.
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Abstract
INTRODUCTION The present study examined seizure clusters as a primary outcome in patients receiving treatment for PNES. Cluster reduction is examined longitudinally using frequency threshold and statistical definitions of seizure cluster for patients. Possible risk factors for clustering will be examined along with clustering as a risk factor for poorer secondary outcomes. METHODS Participants were from a pilot randomized treatment trial for PNES where they received cognitive behavioral therapy-informed psychotherapy (CBT-ip), sertraline, combination therapy, or treatment as usual. Seizure data are from patients' seizure dairies. RESULTS Cluster reduction was observed for those receiving CBT-ip or combination treatment using all definitions of daily clusters and weekly clusters. No risk factors of clustering were observed. Those who were identified as having clusters during the trial had poorer secondary outcomes on several measures at baseline relative to those who were not identified as having clusters. DISCUSSION This is the first study known to the authors to not only examined seizure clusters as a primary outcome for those with PNES, but also the first study to suggest that CBT-ip and combination therapy may be effective in reducing the frequency of clusters.
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Affiliation(s)
- Grayson L Baird
- Lifespan Biostatistics Core, Rhode Island Hospital, United States; Diagnostic Imaging, The Warren Alpert Medical School of Brown University, United States; University of Rhode Island, Department of Psychology, United States.
| | - Lisa L Harlow
- Lifespan Biostatistics Core, Rhode Island Hospital, United States
| | - Jason T Machan
- Lifespan Biostatistics Core, Rhode Island Hospital, United States; University of Rhode Island, Department of Psychology, United States
| | - W C LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital and Brown University, United States
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36
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Widmer D, Allaz AF. [Not Available]. Rev Med Suisse 2017; 13:189. [PMID: 28703969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Daniel Widmer
- Médecine interne générale FMH, Médecine psychosomatique et psychosociale ASMPP, Chargé de cours IUMF PMU UNIL, Rédacteur francophone Primary and Hospital Care, Vice-président Union européenne de médecine générale / de famille (UEMO), 2, avenue Juste-Olivier, 1006 Lausanne
| | - Anne-Françoise Allaz
- Médecine psychosomatique et psychosociale ASMPP, Médecin-chef de service, Service de médecine interne de réhabilitation Beau-Séjour (SMIR-BS), Cheffe du Département de médecine interne réhabilitation et gériatrie, HUG, 1211 Genève 14
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Abstract
The mind-skin connection has been studied since the nineteenth century. The last 40 years have set the development of new research areas which allowed the clarifying of how these two dimensions interact. The diseases that involve skin and mind constitute the field of psychodermatology and require that specialists in dermatology, psychiatry and psychology together and integrated take part in it, since skin, nervous system and mind are simultaneously affected. This paper aims to expose how psychodermatoses are currently conceptualized and the need of integration of these three specialties for conveniently treating the patients.
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Affiliation(s)
- Roberto Doglia Azambuja
- Service of Dermatology of the Hospital
Universitário de Brasília - Universidade de Brasília (UnB)
- Brasília (DF), Brazil
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Biondi M, Valentini M. [Relaxation treatments and biofeedback for anxiety and somatic stress-related disorders]. Riv Psichiatr 2016; 49:217-26. [PMID: 25424335 DOI: 10.1708/1668.18262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Relaxation techniques (TR) and biofeedback (BFB) are widely used in psychiatric and psychological practice for the treatment for anxiety and stress-related disorders. METHODS An examination of studies focusing on the correlates of psychophysiology of relaxation and biofeedback has been done, in addiction to controlled therapeutic studies that describes clinical aspects, efficacy and limits. RESULTS There are different TR and BFB procedures, but they have the same goal and same physiological modifications, resulting in stress and anxiety reduction. There is a proven action to musculoskeletal, neuroendocrine and autonomic nervous system, showing similar results. Very few data on immune changes are available. Meta-Analysis show superior efficacy to no treatment or placebo in anxiety disorders, tension headache, bruxism, temporomandibular pain syndrome, rehabilitation and prevention of ischemic heart disease. Moderate efficacy is shown for chronic low back pain, cancer-related pain, rheumatoid arthritis and gastrointestinal disorders; data for essential hypertension are controversial. Variability of techniques, procedures, sampling problems, non-systematic make definitive conclusions difficult. TR and BFB are often used in combination with cognitive-behavioral and educational techniques. The association of the active relaxation technique facilitates generalization and self-control during stress situation and outside the training session. CONCLUSIONS TR and BFB are effective for anxiety and somatic stress-related disorders, associated with coping and quality of life improvement and affordable costs; they are minimally invasive but needing an active participation in the treatment process. Some limits are responders' prediction, continuity of practice and limited effectiveness for depression disorders. Finally, it is shown that they are real psychosomatic therapies that are able to produce somatic peripheral changes (neuroendocrine, neurovegetative and muscular systems) generated by the mind and secondary to the involvement of central neurotransmitter circuits.
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Abstract
Medically unexplained symptoms and chronic functional syndromes are common but few health care professionals have had formal training about their connection to psychosocial issues. A systematic approach to diagnosis and treatment is described that is based on published evidence and detailed interviews with more than 7,000 of these patients. This approach is designed to meet the needs of primary care teams using techniques for assessing and treating current life stresses, the prolonged impact of adversity in childhood and somatic presentations of depression, posttraumatic stress, and anxiety disorders. (PsycINFO Database Record
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Evans J, Dummer V, Kinzl J. [Psychiatric and psychosomatic day hospitals in Austria]. Neuropsychiatr 2016; 30:216-222. [PMID: 27854010 DOI: 10.1007/s40211-016-0207-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/24/2016] [Indexed: 06/06/2023]
Abstract
This paper on psychiatric and psychosomatic day hospitals in Austria first looks at the overall situation of Austrian day clinics then, in a second step, compares psychiatric and psychosomatic day hospitals. For this purpose, a questionnaire was developed and sent to all psychiatric and psychosomatic day hospitals in Austria. The first part consisted of closed questions and was used to gather and evaluate the categories: general conditions for treatment in day hospitals, tasks of day hospitals, therapeutic paradigms, indication and contraindication, diagnostics, day hospital organisation, interdisciplinary cooperation and the offering in day hospitals. The second section consisted of open questions which were used to gather and evaluate active factors, difficulties, specifics and requests for future treatment in day hospitals. The results show that there is a trend towards more day hospitals. Psychosomatic day hospitals are a rather new phenomenon. Furthermore, the distinction between psychiatric and psychosomatic day hospitals is important in order to offer patients distinguishable treatment options in future. The results show that psychiatric and psychosomatic day hospitals both have a strong focus on psychotherapy and both fulfill the active factors for psychotherapy by Grawe.
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Affiliation(s)
- Janet Evans
- Leopold-Franzens Universität Innsbruck, Innsbruck, Österreich.
| | - Verena Dummer
- Universitätsklinik für Psychiatrie II, Department für Psychiatrie, Psychotherapie und Psychosomatik, Innsbruck, Österreich
| | - Johann Kinzl
- Universitätsklinik für Psychiatrie II, Department für Psychiatrie, Psychotherapie und Psychosomatik, Innsbruck, Österreich
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Hilmarsdóttir D, Birk S, Rask CU. [Psychotherapeutic treatment of psychogenic non-epileptic seizures]. Ugeskr Laeger 2016; 178:V04160303. [PMID: 27908324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Psychogenic non-epileptic seizures (PNES) are seizures which clinically resemble epileptic seizures but are without concurrent abnormal electrical charges. Though PNES can be just as serious and disabling as epileptic seizures, specific treatment guidelines are lacking, and different types of treatments are used. In this article we address the current research on psychotherapeutic treatment for PNES by discussing recent reviews and six randomized controlled trials (RCTs) on the subject. In conclusion, larger well-designed RCTs are needed in order to support the evidence for psychological interventions for this patient group.
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Abstract
PURPOSE OF REVIEW This article details the evaluation process involved in the diagnosis of psychogenic nonepileptic seizures (PNES). The psychological underpinnings, prognostic factors, and recent treatment advances of PNES are also reviewed. RECENT FINDINGS The diagnosis of PNES is determined based on concordance of the composite evidence available, including historical and physical examination findings, seizure symptoms and signs, and ictal/interictal EEG. No single clinical data point is definitively diagnostic of PNES. The diagnosis of PNES can be challenging at times, such as when seizure documentation on video-EEG cannot be readily obtained. Yet, delayed diagnosis of PNES portends poor outcome. A multicomponent approach to the diagnosis of PNES, with use of an aggregate of available evidence, may facilitate diagnosis and then care of patients with PNES. Emerging evidence supports the effectiveness of cognitive-behavioral-based therapy in the treatment of these patients. SUMMARY The diagnosis of PNES can be made reliably, and evidence-based treatment now exists. Continued efforts remain necessary to enhance prompt recognition and interdisciplinary management for patients with PNES.
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Abstract
Psychodermatology is a relatively new field of medicine. It encompasses the interaction of mind and skin. The role of psychoneuroimmunology in the causation of psychocutaneous disorders and psychosocial aspects of skin disease have gained momentum lately. The treatment of psychodermatological disorders focus on improving function, reducing physical distress, diagnosing and treating depression and anxiety associated with skin disease, managing social isolation and improving self esteem of the patient. Both pharmacological and psychological interventions are used in treating psychocutaneous disorders. The interest in Psychodermatology around the world is increasing and there are several organizations holding their regular meetings.
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Affiliation(s)
- Mohammad Jafferany
- Department of Psychiatry and Behavioural Sciences, Central Michigan University, MI 48603 Saginaw, USA.
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Abstract
Psychodermatology is a newer and emerging subspecialty of dermatology, which bridges psychiatry, psychology, paediatrics and dermatology. It has become increasingly recognised that the best outcomes for patients with psychodermatological disease is via a multidisciplinary psychodermatology team. The exact configuration of the multidisciplinary team is, to some extent, determined by local expertise. In addition there is a growing body of evidence that it is much more cost effective to manage patients with psychodermatological disease in dedicated psychodermatology clinics. Even so, despite this evidence, and the demand from patients (and patient advocacy groups), the delivery and establishment of psychodermatology services is very sporadic globally. Clinical and academic expertise in psychodermatology is emerging in dermatology and other (often peer-reviewed) literature. Organisations such as the European Society for Dermatology and Psychiatry champion clinical and academic advances in psychodermatology, whist also enabling training of health care professionals in psychodermatology. Emiliano Panconesi, to whom this supplement is dedicated, was at the forefront of psychodermatology research and was a founding member of ESDaP.
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Affiliation(s)
- Claire Marshall
- Department of Dermatology, Barts NHS Trust, Whipps Cross University Hospital, E11 1NR London, United Kingdom
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Shaw RJ, Pao M, Holland JE, DeMaso DR. Practice Patterns Revisited in Pediatric Psychosomatic Medicine. Psychosomatics 2016; 57:576-585. [PMID: 27393387 DOI: 10.1016/j.psym.2016.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/18/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Given the heightened focus on the implementation of integrated care and population health management strategies, there is a critical need for an analysis of pediatric psychosomatic medicine (PPM) programs. OBJECTIVE The goal was to survey current practice patterns in academic PPM programs in North America regarding their service composition, clinical consultation services, changes in service demand, funding, and major challenges so as to inform and support advocacy efforts on behalf of children in their need for responsive and effective PPM services. RESULTS With a 52.5% survey response rate from 122 child and adolescent psychiatry programs in North America, the demand for PPM services was reported to have significantly increased over the past decade as seen in the described expansion in clinical consultation services and the reported higher patient acuity, as well as new responsibilities in the care of youth with psychiatric illnesses who require boarding on medical inpatient services. Although an increased willingness by hospital administrators to fund PPM services was apparent, adequate funding remained a core issue. Although the value of research is well recognized, few programs are engaged in systematic PPM investigation. CONCLUSION This survey provides evidence that the current field of PPM appears to be in an increasingly stronger position within academic medical centers. It is just as apparent today, as it has been in the past, that there is a need to communicate at local, regional, and national levels that PPM is an essential behavioral health service.
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Affiliation(s)
- Richard J Shaw
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Maryland Pao
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | | | - David R DeMaso
- Department of Psychiatry, Boston Children's Hospital, Boston, MA.
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Weber K, Leardini L. [Personality and psychophysiologic disorders: risk or opportunity?]. Rev Med Suisse 2016; 12:306-308. [PMID: 27039443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
Suggestion in hypnosis has been applied to the treatment of functional neurologic symptoms since the earliest descriptions of hypnosis in the 19th century. Suggestion in this sense refers to an intentional communication of beliefs or ideas, whether verbally or nonverbally, to produce subjectively convincing changes in experience and behavior. The recognition of suggestion as a psychologic process with therapeutic applications was closely linked to the derivation of hypnosis from earlier healing practices. Animal magnetism, the immediate precursor of hypnosis, arrived at a psychologic concept of suggestion along with other ideas and practices which were then incorporated into hypnosis. Before then, other forms of magnetism and ritual healing practices such as exorcism involved unintentionally suggestive verbal and nonverbal stimuli. We consider the derivation of hypnosis from these practices not only to illustrate the range of suggestive processes, but also the consistency with which suggestion has been applied to the production and removal of dissociative and functional neurologic symptoms over many centuries. Nineteenth-century practitioners treated functional symptoms with induction of hypnosis per se; imperative suggestions, or commands for specific effects; "medical clairvoyance" in hypnotic trance, in which patients diagnosed their own condition and predicted the time and manner of their recovery; and suggestion without prior hypnosis, known as "fascination" or "psychotherapeutics." Modern treatments largely involve different types of imperative suggestion with or without hypnosis. However, the therapeutic application of suggestion in hypnosis to functional and other symptoms waned in the first half of the 20th century under the separate pressures of behaviorism and psychoanalysis. In recent decades suggestion in hypnosis has been more widely applied to treating functional neurologic symptoms. Suggestion is typically applied within the context of other treatment approaches, such as cognitive-behavioral, rehabilitative, or psychodynamic therapy. Suggestions are generally symptom-focused (designed to resolve a symptom) or exploratory (using methods such as revivification or age regression to explore experiences associated with symptom onset). The evidence base is dominated by case studies and series, with a paucity of randomized controlled trials. Future evaluation studies should allow for the fact that suggestion with or without hypnosis is a component of broader treatment interventions adapted to a wide range of symptoms and presentations. An important role of the concept of suggestion in the management of functional neurologic symptoms is to raise awareness of how interactions with clinicians and wider clinical contexts can alter expectancies and beliefs of patients in ways that influence the onset, course, and remission of symptoms.
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Affiliation(s)
- Q Deeley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Kings College, London, UK.
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Abstract
Patients with functional neurologic disorders present to clinicians with a variety of symptomatic manifestations, with various levels of severity, chronicity, and comorbidity, as well as with various degrees of past adversity, intrinsic resilience, and available external support. Clearly, treatment must be individualized. For those patients who have been severely or chronically impaired, especially if adequate prior outpatient treatments have failed, inpatient treatment that integrates the various modalities outlined here provides a rational route of rescue from a course otherwise potentially characterized by protracted dependence and disability. Based on the data currently available, we believe this treatment approach is worthy of further study to refine the component treatment strategies and enhance the potentially most effective ingredients. For patients with severe levels of disability, who could be managed in a multimodal day-treatment program, that approach also warrants further consideration.
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Affiliation(s)
- D T Williams
- Movement Disorders Division, Columbia University Medical Center and Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, NY, USA.
| | - K Lafaver
- Movement Disorders Clinic, University of Louisville, Louisville, KY, USA
| | - A Carson
- Departments of Clinical Neurosciences and of Rehabilitation Medicine, NHS Lothian and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - S Fahn
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
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49
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Abstract
Functional neurologic disorder (FND), also known as conversion disorder, is common and often associated with a poor prognosis. It has been relatively neglected by research and as such there is a conspicuous lack of evidence-based treatments. Physical and psychologic therapies are the main treatment modalities, over and above reassurance and sensitive explanation of the diagnosis. However there are two other historic treatments that have seen a recent resurgence of interest and use. The first is electric stimulation, which was initially pioneered with direct stimulation of nerves but now used indirectly (and therefore noninvasively) in the form of transcranial magnetic stimulation (TMS). The second is (therapeutic) sedation, previously known as "abreaction," where it was mostly used in the context of psychologic investigation and treatment, but now increasingly advocated during rehabilitation as a way to therapeutically demonstrate reversibility of symptoms. This chapter introduces the background of these treatment modalities, their evolution into their current applications before critically evaluating their current evidence base and exploring possible mechanisms of action. It also tentatively suggests when they should be considered in current practice and briefly considers their future potential. In summary there is encouraging preliminary evidence to suggest that both TMS and sedation may be effective treatments for FNDs.
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Affiliation(s)
- T R J Nicholson
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - V Voon
- Department of Psychiatry, Behavioural and Clinical Neurosciences Institute, University of Cambridge, Cambridge, UK
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50
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Abstract
The field of psychosomatics has gained increasing significance; it has been struggling to establish its position as either an independent discipline or a subdomain of specific areas such as internal medicine or psychiatry. However, the rise of psychosomatic syndromes and disease patterns as well as an increase of specific integrated psychosomatic wards is a clear indication for the growing importance of interdisciplinary approaches to psychosomatic disorders. The study presents data from an 8-week inpatient treatment at a psychosomatic facility and investigates whether patients improved in their subjective symptom experience. A complex treatment approach, ranging from pharmacological treatment and group and individual psychotherapy to physiotherapy and ergotherapy was integrated into this intervention. In essence, containment of intrapsychic aggression derivatives played a central role in the treatment of psychosomatic symptoms. A significant factor contributing to a successful treatment is the doctor-patient relationship. All these factors were investigated in the present study.
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Affiliation(s)
- Karoline Parth
- Department of Psychoanalysis and Psychotherapy at the Medical University of Vienna, Vienna, Austria
| | - Ania Rosar
- Department of Psychoanalysis and Psychotherapy at the Medical University of Vienna, Vienna, Austria
- General Psychiatric Hospital, Vienna, Vienna, Austria
| | - Kurt Stastka
- Department of Psychiatry, SMZ Süd Hospital of Vienna, Vienna, Austria
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