Showing papers in "Psychotherapy and Psychosomatics in 1994"
TL;DR: There is evidence to suggest that many of the phenomena of the somatoform disorders are caused by clustering of psychosomatic syndromes or their incomplete or atypical manifestations and a low sensation threshold.
Abstract: A psychosomatic syndrome is defined as a syndrome in which psychological processes play a substantial role in the etiology of the illness in some of the patients. The main conclusions on the extent of the biological and psychosocial contributions to several psychosomatic syndromes are presented and the relationship of these syndromes to somatization and somatoform disorders is discussed. The syndromes summarized include fibromyalgia, chronic fatigue, motility disorders of the esophagus, nonulcer dyspepsia, irritable bowel syndrome, urethral syndrome, behaviors causing disturbances of physiology, and some defined pain syndromes. The findings suggest that the extent of the biological and psychosocial contributions vary among these syndromes as well as among individuals with the same syndrome. In some syndromes the extent and nature of the biological contribution has not been established with certainty. There is evidence to suggest that many of the phenomena of the somatoform disorders are caused by clustering of psychosomatic syndromes or their incomplete or atypical manifestations and a low sensation threshold. The results of the controlled studies of various methods of psychotherapy and drug treatments of the psychosomatic syndromes are listed; these studies have practical implications because the adoption of these methods is likely to enhance the efficacy of the treatment of somatoform disorders.
125 citations
TL;DR: Fluoxetine may be beneficial in the treatment of certain personality disorder traits in patients with major depressive disorder, and the presence of a cluster B diagnosis before treatment predicted positive outcome.
Abstract: The relationship between depression and comorbid personality disorders is still poorly understood. The aims of this study were to examine differences in depression severity between depressed outpatients with and without comorbid personality disorders, to determine the effect of a fixed dose of fluoxetine on personality disorders, and to assess the predictive value of personality disorder diagnoses at baseline with regard to response to fluoxetine. Eighty-three outpatients with major depressive disorder (MDD) were assessed with a self-rating scale, the Personality Diagnostic Questionnaire-Revised (PDQ-R), before and after 8 weeks of treatment with fluoxetine 20 mg/day. The presence of a cluster B diagnosis before treatment predicted positive outcome as measured by the change in score on the modified 17-item Hamilton Rating Scale for Depression (HAM-D-17*). Following treatment, we found significant reductions in the frequency of most individual personality disorder diagnoses and total PDQ-R score. While patients no longer meeting criteria for cluster B personality disorders after treatment had similar reductions in depressive symptoms compared to those maintaining the diagnoses, subjects no longer meeting criteria for cluster A and cluster C diagnoses after treatment exhibited significantly greater decreases in depression severity than those who maintained the diagnoses. Overall, these results suggest that fluoxetine may be beneficial in the treatment of certain personality disorder traits in patients with MDD.
90 citations
67 citations
TL;DR: In the period January 1, 1990 to March 31, 1991, a sample of suicide attempters admitted to the Department of Psychiatry, Odense University Hospital, underwent a structured interview as mentioned in this paper.
Abstract: In the period January 1, 1990 to March 31, 1991 a sample of suicide attempters admitted to the Department of Psychiatry, Odense University Hospital, underwent a structured interview. In the study 52%
51 citations
TL;DR: Alexithymia appears to be independent of negative affect and unrelated to cigarette smoking or nicotine dependence, suggesting that the affect regulation deficits in alexithymian play a negligible role in nicotine addiction.
Abstract: Alexithymia is associated with substance abuse and may interfere with successful psychotherapy. Alexithymia’s relation to smoking, nicotine dependence, and smoking cessation therapy is unknown, and po
49 citations
TL;DR: In analyzing patterns of illness behavior patients with FS showed a high score on IBQ scales of disease conviction, psychological versus somatic focusing and denial, and significant correlations with illness behavior scales.
Abstract: This study reports psychological symptoms assessed in 327 patients with fibromyalgia (FS) in a multicenter investigation. Two self-report scales, in their validated Italian translations, were used for screening: the CES-D (the Center of Epidemiologic Studies-Depression) developed at the NIMH for measuring depression and the Illness Behavior Questionnaire (IBQ) developed by Pilowsky and Spence. The cutoff point of 23 in the CES-D scores revealed about 49% of the fibromyalgic patients as depressed. In analyzing patterns of illness behavior patients with FS showed a high score on IBQ scales of disease conviction, psychological versus somatic focusing and denial. CES-D scores showed significant correlations with illness behavior scales. These results and their implications for the treatment of fibromyalgic patients are discussed.
48 citations
TL;DR: After six months clinically significant hair regrowth occurred in 5 of the 7 patients on imipramine, whereas no response was observed in the placebo group, and an improvement in psychic symptomatology was present in both groups.
Abstract: Alopecia areata (AA) is a dermatologic disease whose onset is significantly associated to life events. Its course may often be characterized by high levels of anxiety and depression. These observations suggested a rationale for using an antidepressant in AA. Thirteen patients were enrolled in a double-blind, placebo-controlled study of efficacy of imipramine in alopecia. After six months clinically significant hair regrowth occurred in 5 of the 7 patients on imipramine, whereas no response was observed in the placebo group. An improvement in psychic symptomatology was present in both groups. Our preliminary results indicate the potential efficacy of imipramine in patients with AA, not acting directly through a reduction of anxiety or depression.
47 citations
TL;DR: When comparing the effects in high and low hypnotizable subjects, it was found that high hypnotizables showed greater decreases in LPR and NKCA than low hypnotizable, and there were several inconsistencies between the results of the limited number of investigations studying the effects of guided imagery and relaxation on immune function.
Abstract: This article presents the results of two investigations, each measuring cellular immune function on 3 investigation days 1 week apart in 15 high and 15 low hypnotizable healthy subjects randomly selected for three groups: (1) a guided imagery group receiving instructions to enhance cellular immune function: (2) a relaxation group which did not receive instructions regarding the immune system, and (3) a control group. Study 1 investigated changes in monocyte chemotaxis (MC) and lymphocyte proliferative response (LPR) to three mitogens, while natural killer cell activity (NKCA) was measured in study 2. The results show similar patterns of brief decreases in LPR and NKCA immediately after intervention on all investigation days in both the imagery and relaxation groups. Increases in MC were found in both intervention groups on day 1. On a follow-up investigation day in study 2, a brief stress task yielded a slight increase in NKCA. In study 2, the control group showed decreases in NKCA similar to those observed in the two intervention groups. In general there were no significant changes in preintervention immune function throughout the investigation period. When comparing the effects in high and low hypnotizable subjects, we found that high hypnotizables showed greater decreases in LPR and NKCA than low hypnotizables. There are several inconsistencies between the results of the limited number of investigations studying the effects of guided imagery and relaxation on immune function. These differences may in part be explained by differences in methodology, time intervals between blood sampling, and subject characteristics such as age, health status and hypnotizability. The inconsistent results make it premature to make inferences about possible benefits of the application of these techniques in the treatment of immune related diseases, and further investigations are needed.
44 citations
TL;DR: Attention and expectancy have been demonstrated to influence symptom reporting and these findings can be relevant for understanding hypochondriasis and it is argued that the effects of expectancy are obtained via increased attention.
Abstract: Attention and expectancy have, in previous research, been demonstrated to influence symptom reporting and these findings can be relevant for understanding hypochondriasis. Earlier attention/expectancy effects on symptom reporting were studied when subjects were physically stimulated by the experimenter. If attention or expectancy produced symptom reporting, which plays a role in hypochondriasis, one expects that attention/expectancy will also produce symptoms in the absence of any deliberate physical stimulation. Eighty healthy volunteers were allocated to one of four groups: attention, expectancy, attention plus expectancy or a control condition. Compared to the control condition there was much higher symptom reporting in the 3 experimental groups. The experimental groups did not differ. It is argued that the effects of expectancy are obtained via increased attention. The relevance of the findings for understanding hypochondriasis is discussed.
42 citations
TL;DR: These preliminary results seem to confirm data reported by other authors who hypothesized that a certain personality trait characterized by emotional inhibition is related to a greater cancer vulnerability.
Abstract: Alexithymia and circulating lymphocyte subsets were studied in 62 women [36 healthy women and 26 women affected by cervical intraepithelial neoplasia (CIN I, II, III) who were not aware of their status] in order to assess a possible relationship between alexithymia, CIN and immunological lymphocytic functions. Alexithymia was estimated by the 20-item Schalling-Sifneos Personality Scale and then correlated with peripheral blood lymphocyte subsets. The results of our study report an association between alexithymia and CIN. Alexithymic women show lower rates of almost all lymphocytic subsets compared to nonalexithymic ones. The difference was also found between alexithymic women affected by CIN and alexithymic women with an unsuspicious Pap smear. On the whole, these preliminary results seem to confirm data reported by other authors who hypothesized that a certain personality trait characterized by emotional inhibition is related to a greater cancer vulnerability. Such relationships might be mediated by certain lymphocytic functions as the result of the alexithymic status. Results reported here need more extensive surveys, in order to control potentially confounding factors related to the personality assessment of the subjects in this study.
42 citations
TL;DR: The psychometric properties of the Hamilton rating scales for depression and anxiety and the Melancholia Scale proved useful, indicating that the symptomatic structure of depression in cancer patients is rather identical to that seen in primary depression.
Abstract: Depressive psychopathology was measured in a prospective follow-up study of 36 cancer patients. The psychometric properties of the Hamilton rating scales for depression and anxiety and the Melancholia Scale were examined. The scales proved useful, indicating that the symptomatic structure of depression in cancer patients is rather identical to that seen in primary depression. Depressive states were found in about 40% of patients before the start of chemotherapy. The frequency of intermediate and high scores on the depression scales showed a low to moderate decrease after 6 months. Aspects of depression in the medically ill are discussed, and screening routines suggested.
TL;DR: A quantitative taxonomy for the identification of patients with narcissistic pathology and with borderline personality disorders based on test results is presented and becomes clear that different high levels of disorder in self-regulation correspond to varying degrees of prognostic significance.
Abstract: A quantitative taxonomy for the identification of patients with narcissistic pathology and with borderline personality disorders based on test results is presented. The quantitative identification of these subgroups was produced using a Q-factor analysis. Based on the correlation of the subjects by means of the 241 questions from the narcissistic inventory of Deneke and Muller [27], three subgroups could be defined. Two of these groups exhibited a pathology of the self-system which corresponded to the pathology described by Kernberg [24] for narcissistic and borderline personality disorders. The third group is characterized by reduced observable self-pathology traits from the narcissistic inventory. By means of the reclassification of these three taxonomical groups with the discriminant analysis, two discriminant functions could be calculated, using the weighting of the single test scales for a classification of new patients. These classification functions were used to examine 18 patients suffering from factitious disorders. The evaluation of test profiles with the reduced narcissistic inventory of Deneke and Muller [11] in order to identify the three taxonomical groups showed that 9 patients (50%) had a borderline personality disorder and 6 patients (33%) a narcissistic personality disorder, while 3 patients (17%) could be assigned to the subgroup without self-pathology. In summary, 83% of the examined patients with factitious disorders exhibited a disorder in self-regulation. The previous clinical observations of self-regulation for patients with factitious disorders could thus be confirmed. It becomes clear that different high levels of disorder in self-regulation (position in the sphere of the discriminant function) correspond to varying degrees of prognostic significance.
TL;DR: A model integrating antidepressant treatment with Beck's cognitive therapy, a form of psychotherapy with established efficacy in the acute treatment of depression, is proposed, to prevent relapses and recurrences of depressive episodes and to impact positively on the overall quality of life in recovered depressed patients.
Abstract: Psychiatric clinicians frequently prescribe biologic treatments such as antidepressant medication in combination with psychologic treatments such as psychotherapy. In the present article we propose a model integrating antidepressant treatment with Beck’s cognitive therapy, a form of psychotherapy with established efficacy in the acute treatment of depression. We argue for adding cognitive therapy following successful pharmacological treatment, i.e., for spending cognitive therapy resources in the continuation phase of treatment, where they are most likely to make a unique and separate contribution to patient well-being, particularly in the areas of relapse prevention and treating residual symptoms. We encourage researchers to compare this treatment strategy to other approaches in terms of its ability to (1) prevent relapses and recurrences of depressive episodes, and (2) to impact positively on the overall quality of life in recovered depressed patients.
TL;DR: This patient calls attention to a potentially life-threatening complication of laxative abuse and indicates that volume depletion can exacerbate laxative-associated renal failure.
Abstract: Eating disorder patients often abuse laxatives in an attempt to purge excess food. Laxative abuse can cause hypokalemia and volume depletion. Hypokalemia, in turn, can lead to rhabdomyolysis. Laxative-induced hypokalemia and volume depletion have been previously reported to cause renal insufficiency, but not severe enough to require hemodialysis. A 27-year-old woman with a long history of laxative abuse presented with severe renal failure associated with hypokalemia and volume depletion. She required acute hemodialysis for worsening acidosis (pH 7.05) despite assisted ventilation. A prior episode of hypokalemic rhabdomyolysis at age 23 had resulted in only mild renal insufficiency. Her later episode of severe renal failure was linked to profound volume depletion (blood urea nitrogen 135 mg/dl). This patient calls attention to a potentially life-threatening complication of laxative abuse and indicates that volume depletion can exacerbate laxative-associated renal failure.
TL;DR: A favorable therapeutic course is achieved by the combination of an initial clinical psychotherapy and a subsequent analytical long-term treatment implemented as an outpatient therapy or an interval therapy, which was offered to all of the patients and was accepted by half of the patient collective.
Abstract: A favorable therapeutic course is achieved by the combination of an initial clinical psychotherapy and a subsequent analytical long-term treatment implemented as an outpatient therapy or an interval therapy. This form of therapy was offered to all of the patients and was accepted by half of the patient collective, i.e., by 12 out of 24. Only in 1 of these 12 cases, was it possible to dispense with the initial clinical therapy in favor of a primary outpatient therapy. Of these 12 therapies, 2 were terminated by the patients. We were able to continue the other 10 for longer periods, extending up to 4 years. In this setting, a transition from the working phase to the separation phase is possible around the fourth year of therapy. Termination of therapy is almost always based on a negative therapeutic reaction. The patients were generally capable of development, but were not able to take advantage of this opportunity because of the dominance of malignant introjects. In several cases, this pattern has become consolidated on a social as well as an endopsychic level. The therapy is then terminated in favor of a structured mother-child relationship or a similarly structured marriage. In those cases where the therapy was broken off prematurely, the establishment of a sufficiently stable working relationship was prevented by the predominantly negative transference. As a result, it was not possible to conduct a follow-up therapy after the normal end of the clinical psychotherapy, for example. The question remains whether a significant lengthening of the clinical psychotherapy could have changed anything here; in my opinion, this is not the case. In these cases, the inpatient therapy was always terminated by the patients, either by a directly expressed wish or by a symptomatic development making referral or discharge imperative. The 10 cases undergoing long-term therapy all progressed favorably, with a significant, or at least marked, improvement of the symptomatology and the relationship capability. In this context, the results are, in each case, a function of the severity of the illness, the individual capability for growth, and the length of treatment. Even though 6 of the 10 long-term therapies are now in the separation phase, none of them has been finally ended yet. As a result, we have only a small amount of information so far on the possibilities for reaching a final conclusion of the therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
TL;DR: It is suggested that psychosocial factors may have a role in determining whether the pregnant woman experiences a transient spell of mild vomiting or progresses towards the much rarer but more significant pernicious vomiting.
Abstract: Hyperemesis gravidarum is a potentially dangerous disorder of pregnancy characterized by severe and protracted vomiting. It is suggested that psychosocial factors may have a role in determining whether the pregnant woman experiences a transient spell of mild vomiting or progresses towards the much rarer but more significant pernicious vomiting. Psychotherapy, hypnotherapy and behavior therapy have been reported to contribute to the treatment of patients with hyperemesis gravidarum. A review of the etiological factors as well as of the therapeutic approaches is presented.
TL;DR: A specific relationship between GAD and hypochondriasis was not found because worries about illness, which characterize some GAD patients, were largely independent from disease fears/phobias and Hypochondriacal beliefs, which are a hallmark of hypochondRIasis.
Abstract: In order to compare hypochondriacal phenomena in patients with generalized anxiety disorder (GAD) and panic disorder (PD), and in order to examine the relationship between worries about illness on one hand, and disease fears/phobias and hypochondriacal beliefs on the other, the authors administered the Illness Attitudes Scales to patients with both GAD and PD, and determined the spheres of worry in patients with GAD. Patients with GAD were significantly less hypochondriacal than PD patients. A specific relationship between GAD and hypochondriasis was not found because worries about illness, which characterize some GAD patients, were largely independent from disease fears/phobias and hypochondriacal beliefs, which are a hallmark of hypochondriasis.
TL;DR: 3 case examples of patients with choking phobia who were given a brief, cognitive-behavioral treatment that combined the interventions of psychoeducation, cognitive restructuring, interoceptive and in vivo exposure to address fears of anxiety and choking sensations.
Abstract: The present study describes 3 case examples of patients with choking phobia who were given a brief, cognitive-behavioral treatment that combined the interventions of psychoeducation, cognitive restructuring, interoceptive and in vivo exposure. This program was designed to address fears of anxiety and choking sensations as well as fears of swallowing. The patients were treated for 11-13 sessions. All 3 patients responded to the program as measured by their progression on their food hierarchy and by weight gain. Issues in the treatment of these patients are discussed.
TL;DR: The conclusion is that the Coping Wheel, applied as in the present examination, may be of help in prognosis and in identifying psychosocial needs in patients with HIV infection.
Abstract: HIV-infected hemophiliacs participated in a psychosocial prognosis study. The Coping Wheel was filled out 1–2 years after the subjects had been told that they were HIV-infected and between 1 and 7 yea
TL;DR: Some personality and endocrine measures correlate with immune function, and a positive correlation was found between prolactin and T4 lymphocyte percentage.
Abstract: The impact of stress and its neuroendocrine correlates on immune function are well established and individual variations could be attributed to modulation by personality characteristics. To assess the influence of everyday life stress and personality on neuroendocrine and immune function, we administered, to 18 healthy adults, the Minnesota Multiphasic Personality Inventory (MMPI) to assess their personality, the State-Trait Anxiety Inventory to measure anxiety, the Reaction Scheme Test to assess their coping reaction style, the Life Events Survey to assess the impact of stressful life events, and the Subjective Stress Questionnaire to assess perceived stress. The endocrine evaluation comprised prolactin, cortisol, and growth hormone plasma levels, while the immunological evaluation assessed T4, T8, and T11 lymphocyte percentages, as well as natural killer cell count and activity. All evaluations were made at baseline and after 8 months. We found a reduction of the T11 lymphocyte percentage to be accompanied by a reduction in the scores of the MMPI scale of Subtle Defensiveness and by an increase in the scores of the Social Introversion Scale. A positive correlation was found between prolactin and T4 lymphocyte percentage. These preliminary data show that some personality and endocrine measures correlate with immune function.
TL;DR: Depression in the coronary unit and nonuse of problem-solving strategies were the most sensitive variables to correctly classify psychiatric and nonpsychiatric cases and severity of psychopathology was directly related to early depressive reaction and use of avoidant strategies.
Abstract: A sample of 97 males suffering from myocardial infarction was studied in order to determine the influence of psychological variables and emotional states on psychopathology displayed by patients in th
TL;DR: Quality of life was assessed in patients with limited small-cell carcinoma of the lung utilizing psychological scales that measured mood, functional status, and cognitive impairment and support the importance of utilizing quality of life measures in addition to measures of physical toxicity so that patients can make an informed choice regarding treatment options.
Abstract: Quality of life was assessed in 57 patients with limited small-cell carcinoma of the lung utilizing psychological scales that measured mood, functional status, and cognitive impairment. These patients received chemotherapy with or without radiotherapy to the primary tumor. All patients received prophylactic cranial radiation. Patients who received the combination of chemotherapy and radiotherapy to both the primary tumor and CNS had an increase in overall survival. However, because of the increased toxicity experienced by these patients, a decrease in quality of life was documented by measures of psychological distress when compared to patients receiving chemotherapy alone. The findings support the importance of utilizing quality of life measures in addition to measures of physical toxicity so that patients can make an informed choice regarding treatment options.
TL;DR: It is shown that neuroticism is secondary to the clinical symptoms of duodenal ulcer (a psychological adjustment to illness) and not an etiological factor.
Abstract: A psychometric analysis on patients with duodenal ulcer using latent structure coefficients (Loevinger and Mokken) showed that the MMPI subscales of depression, psychasthenia, hypochondriasis, hysteri
TL;DR: Tension-type headache (TTH) is an ill-defined nosographic entity and the treatment of this disorder requires a thorough diagnostic framing, which should take into account its psychosomatic aspects, focusing on the individual patient and his history.
Abstract: Tension-type headache (TTH) is an ill-defined nosographic entity. The classification of headaches according to the Headache Classification Committee of the International Headache Society is closer to clinical reality with respect to the past classification. From an aetiopathological standpoint, hypotheses trying to explain primary headache disorders in a unified way are interesting. The treatment of this disorder requires a thorough diagnostic framing, which should take into account its psychosomatic aspects, focusing on the individual patient and his history. In fact, the many studies which aimed at characterising the disorder from a psychological viewpoint are not able to provide generalisable indications. In the same way, as it appears that none of the currently available treatments (drugs, biofeedback and psychotherapy) demonstrates clear superiority over the others, the choice should involve an intervention targeted on those factors which are held to be most important in an individual patient. Finally, as for acupuncture and other physical therapies, although interesting results are reported, these treatments are difficult to assess and should be reserved to particular cases.
TL;DR: Within a subsample of 22 patients treated with intensive psychoanalytic technique, patients with whom a highly circumscribed conflict could be identified had the most favourable dynamic change 4 years after therapy.
Abstract: The clinical proposition that an ideal focus for intensive brief dynamic psychotherapy is an intra-psychic conflict rooted in oedipal pathology with circumscribed effects on personality functioning ha