Journal of Psychosomatic Research

Aims and Scope

2012-02-01

Placebo-controlled comparison of prazosin and cognitive-behavioral treatments for sleep disturbances in US Military Veterans

2011-12-22

Abstract: Objective: Pharmacological and cognitive-behavioral treatments targeting insomnia and nightmares have been shown to be effective in the treatment of military veterans with sleep complaints comorbid with symptoms of stress-related disorders, including Post-Traumatic Stress Disorder (PTSD), but the two approaches have not been directly compared. This randomized controlled trial compared the effects of prazosin vs. a behavioral sleep intervention (BSI), targeting nightmares and insomnia against a placebo pill control condition on sleep and daytime symptoms.Methods: Fifty United States military veterans (mean age 40.9years, SD=13.2years) with chronic sleep disturbances were randomized to prazosin (n=18), BSI (n=17), or placebo (n=15). Each intervention lasted 8weeks. Participants completed self-report measures of insomnia severity, sleep quality, and sleep disturbances. All kept a sleep diary throughout the intervention period. Polysomnographic studies were conducted pre- and post-intervention.Results: Both active treatment groups showed greater reductions in insomnia severity and daytime PTSD symptom severity. Sleep improvements were found in 61.9% of those who completed the active treatments and 25% of those randomized to placebo.Conclusion: BSI and prazosin were both associated with significant sleep improvements and reductions in daytime PTSD symptoms in this sample of military veterans. Sleep-focused treatments may enhance the benefits of first-line PTSD treatments.

Post-inflammatory fatigue in sarcoidosis: Personality profiles, psychological symptoms and stress hormones

2011-11-09

Abstract: Objectives: Chronic fatigue following inflammatory diseases has been well documented. However, little is known about possible risk factors of chronic post-inflammatory fatigue. The aim of this study was to investigate whether chronic post-inflammatory fatigue after clinical remission of the disease sarcoidosis is associated with specific dimensions of personality, psychological symptoms and baseline levels of stress hormones.Methods: Thirty-seven non-fatigued and 33 fatigued patients in clinical remission of sarcoidosis were evaluated with the Temperament and Character Inventory-short form (TCI); the Symptom CheckList-90 (SCL), and the Checklist Individual Strength (CIS). Baseline levels of ACTH and cortisol were measured in plasma. Principal component analysis with orthogonal rotation (varimax) was conducted on all personality, psychological and stress hormone data in order to obtain a smaller set of components. Logistic regression was performed to associate these components with chronic post-inflammatory fatigue.Results: Principal component analyses identified 5 components, of which two components were significantly associated with chronic post-inflammatory fatigue. The first component comprised the personality trait Harm Avoidance and all SCL-subscales except Sleep. The second component consisted of baseline levels ACTH and cortisol, and showed an inverse association with chronic post-inflammatory fatigue. The 3 other components, consisting of respectively SCL-Sleep, TCI-Novelty Seeking-Reward Dependence-Self Transcendence, and TCI-Persistence, were not significantly associated with chronic fatigue.Conclusion: Chronic post-inflammatory fatigue after clinical remission of sarcoidosis is associated with a triad of risk factors: a specific personality profile with profound neurotic characteristics in combination with high levels of psychological distress, and decreased baseline ACTH/cortisol levels.

Psychometric properties of the Pre-Sleep Arousal Scale in a large community sample

Markus Jansson-Fröjmark, Annika Norell-Clarke — 2011-11-28

Abstract: Objective: The purpose was to examine the psychometric properties of the Pre-Sleep Arousal Scale.Methods: From a randomly selected sample of the general population (N=5000), 2327 participants completed a survey on nighttime symptoms, daytime symptoms, health outcomes, and psychological processes. The study sample consisted of 1890 participants who did not fulfill criteria for a sleep disorder other than insomnia.Results: Findings indicated that the PSAS did not produce an adequate factorial solution. When three problematic items were removed, the solution, accounting for 48.5% of the variance, improved (PSAS-13). One subscale, cognitive arousal (α=.88), consisted of five items (37.1%), and one subscale, somatic arousal (α=.72), of eight items (11.4%). The two factors were significantly inter-correlated (ρ=.51) and associated with the PSAS-13 (ρ=.91, ρ=.80). Among those with insomnia, a shortened PSAS (PSAS-14) was established, which consisted of a cognitive and a somatic subscale (48.6% of the variance). The PSAS-13 and the two subscales showed discriminant validity between three sleep groups (normal sleep, poor sleep, and insomnia disorder) (R2=.24–.34). The PSAS-13 and the subscales demonstrated convergent validity with measures on sleep-related worry, sleep-related beliefs, anxiety, and depression. The PSAS-13 and the two subscales were significantly correlated with sleep parameters and daytime impairment.Conclusion: Though acceptable psychometric properties were established for the PSAS, the cognitive subscale's focus upon general pre-sleep arousal and the relatively low variance accounted for calls for further work on and a possible re-conceptualization of the PSAS.

Validation of the three-factor model of the PSQI in a large sample of chronic fatigue syndrome (CFS) patients

2011-12-26

Abstract: Objective: To evaluate whether a 3-factor model of the Pittsburgh Sleep Quality Index (PSQI) scale would fit the constellation of sleep disturbances in patients with a diagnosis of chronic fatigue syndrome (CFS).Methods: Consecutive CFS patients filled out the PSQI. Scores from this self-report questionnaire were examined with exploratory and confirmatory factor analysis (CFA).Results: 413 CFS patients were included for analysis in this study. CFA showed that the 7 PSQI component scores clustered into the 3 factors reported by Cole et al. (2006), i.e. Sleep Efficiency, Perceived Sleep Quality and Daily Disturbances. In contrast with the single-factor and all 2-factor models, all factor loadings were significant, and all goodness-of-fit values were acceptable.Conclusion: In CFS, the PSQI operates as a 3-factor scoring model as initially seen in healthy and depressed older adults. The separation into 3 discrete factors suggests the limited usefulness of the global PSQI as a single factor for the assessment of subjective sleep quality, as also evidenced by a low Cronbach's alpha (0.64) in this patient sample.

Associations between symptoms and all-cause mortality in individuals with serious mental illness

2011-11-21

Abstract: Objective: To determine if aggression, hallucinations or delusions, and depression contribute to excess mortality risk observed in individuals with serious mental illness (SMI).Methods: We identified SMI cases (schizophrenia, schizoaffective and bipolar disorder) aged≥15years in a large secondary mental healthcare case register linked to national mortality tracing. We modelled the effect of specific symptoms (HoNOS subscales) on all-cause mortality using Cox regression.Results: We identified 6880 SMI cases (242 deaths) occurring 2007–2010. Bipolar disorder was associated with reduced mortality risk compared to schizophrenia (HR 0.7; 95% CI 0.4–0.96; p=0.028). Mortality was not significantly associated with hallucinations and delusions or overactive–aggressive behaviour, but was associated with physical illness/disability. There was a positive association between mortality and subclinical depression among individuals with schizophrenia (HR 1.5; 1.1–2.2; p=0.019) but a negative association with subclinical and more severe depression among those with schizoaffective disorder (HR 0.1; 0.02–0.4; p=0.001 and 0.3; 0.1–0.8; p=0.021, respectively).Conclusions: The recognised increased risk of mortality in SMI did not appear to be influenced by severity of hallucinations, delusions, or overactive–aggressive behaviour. Physical illness and lifestyle may need to be addressed and the relationship between depression and mortality requires further investigation.

Does psychological distress vary between younger and older adults in health and disease?

2011-12-22

Abstract: Objective: The effect of age on psychological distress remains controversial and it is unclear how a chronic medical illness influences this association. We aimed to compare the level of psychological distress between younger and older patients with chronic medical conditions attending hospital specialty clinics and to test whether a different pattern emerges when comparisons with individuals without long-term conditions are made.Methods: In 519 individuals without chronic medical conditions and 949 patients with established severe chronic medical illnesses, we compared psychological distress (GHQ-28 and SCL-90R) between younger (<65, N=1040) and older (≥65, N=428) participants after controlling for gender, marital status, education and primary diagnosis in multiple logistic regression models.Results: Among the healthy participants, a greater proportion of older individuals presented mild/moderate psychological distress (p=.026), predominantly depressive and somatization symptoms. Among the medical patients, both age groups presented elevated levels of psychological distress, but a greater proportion of younger patients had severe psychological distress (p=.016), predominantly depressive, anxiety and hostility symptoms. Younger patients reported similarly high levels of somatization symptoms compared to older patients. The odds of being assessed with severe psychological distress were significantly greater for younger individuals with physical illnesses, independently of gender, marital status, education and primary diagnosis.Conclusions: Medical patients from both age groups had significant psychological distress symptoms scores. Younger patients with chronic medical illnesses were more vulnerable to severe psychological distress, including symptoms of anxiety, depression, hostility and somatization. Therefore, clinicians should direct efforts to recognize these symptoms in order to prevent further functional impairment.

The relationship between religious coping, psychological distress and quality of life in hemodialysis patients

2012-01-12

Abstract: Objective: No studies have evaluated the relationship among religious coping, psychological distress and health-related quality of life (HRQoL) in patients with End stage renal disease (ESRD). This study assessed whether positive religious coping or religious struggle was independently associated with psychological distress and health-related quality of life (HRQoL) in hemodialysis patients.Methods: This cross-sectional study recruited a random sample of 170 patients who had ESRD from three outpatient hemodialysis units. Socio-demographic and clinical data were collected. Patients completed the Brief RCOPE, the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization Quality of Life instrument—Abbreviated version (WHOQOL-Bref).Results: Positive or negative religious coping strategies were frequently adopted by hemodialysis patients to deal with ESRD. Religious struggle correlated with both depressive (r=0.43; P<.0001) and anxiety (r=0.32; P<.0001) symptoms. These associations remained significant following multivariate adjustment to clinical and socio-demographic data. Positive religious coping was associated with better overall, mental and social relations HRQoL and these associations were independent from psychological distress symptoms, socio-demographic and clinical variables. Religious struggle was an independent correlate of worse overall, physical, mental, social relations and environment HRQoL.Conclusion: In ESRD, religious struggle was independently associated with greater psychological distress and impaired HRQoL, while positive religious coping was associated with improved HRQoL. These data provide a rationale for the design of prospective and/or intervention studies targeting religious coping in hemodialysis populations.

Six year stability of Type-D personality in a German cohort of cardiac patients

Matthias Romppel, Christoph Herrmann-Lingen, Jana-Marie Vesper, Gesine Grande — 2011-12-26

Abstract: Objective: The aim of the study was to systematically analyze the stability of Type-D personality over a time span of several years in a clinical sample.Methods: In a prospective cohort study, cardiac patients from different medical settings in Germany were assessed using the DS14 questionnaire at baseline (n=1240) and at a mean follow-up time of six years (n=679). Different types of stability were examined and compared with the stability of the Hospital Anxiety and Depression Scale (HADS).Results: Rank-order stability was moderate (r=.61 for Negative Affectivity [NA] and r=.60 for Social Inhibition [SI]) and didn't differ from the rank-order stability of the HADS. Whereas the mean level of SI didn't change over time, the mean level of NA increased (d=0.08). On an individual level, approximately one quarter of the participants showed a significant increase or decrease. The factorial structure of the DS14 was stable over time. Finally, the agreement of Type-D classification between the two measurement points was moderate (κ=.42) with 22% of the participants changing their Type-D classification over time.Conclusion: The stability of NA and SI didn't differ from the stability of measures of emotional distress that are generally considered to be less stable. In particular, the only moderate stability of the dichotomous Type-D classification raises some questions.

Psychiatric disorders in burning mouth syndrome

2011-12-08

Abstract: Background: Prevalence of psychiatric disorders in burning mouth syndrome (BMS) is high, but their role in the pathogenesis of BMS remains unclear.Objective: The authors aimed to assess the frequency of psychiatric disorders and the severity of psychopathology in BMS.Methods: Thirty BMS patients and thirty-one controls underwent a psychiatric evaluation which included a structured interview (MINI-Plus) and five psychometric scales. A Visual Analogue Scale (VAS) was used to measure the intensity of burning sensation.Results: Patients with BMS showed a higher frequency of current major depressive disorder, past major depressive disorder, generalized anxiety disorder, hypochondria and cancerophobia (p<0.05). In BMS patients, generalized anxiety disorder was significantly associated with current major depression and social phobia (p<0.05). As expected, cancerophobia was significantly associated with hypochondria (p<0.05). Patients with BMS had higher scores in Hamilton Rating Scale for Depression (HRSD), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Dutch Fatigue Scale (DUFS) (p<0.05).Conclusion: BMS patients may have a particular psychological and/or psychiatric profile. Psychometric scales might be useful in screening psychiatric disorders, as well as for assessment of treatment outcomes. In the presence of clinical relevant psychiatric symptoms, patients must be treated appropriately.

Alexithymia in adolescents with borderline personality disorder

2011-12-06

Abstract: Objective: The aim of this study was to explore the relationship between alexithymia and borderline personality disorder (BPD) in adolescents.Methods: The study investigated a sample of 59 consulting or inpatient adolescents with a well-established diagnosis of BPD (SIDP-IV) and a control sample of healthy adolescents individually matched by gender, age and socio-economic status. Alexithymia, depression and trait-anxiety were rated using the Twenty-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory (BDI-II) and the trait-anxiety subscale from the State-Trait Anxiety Inventory (STAI-T), respectively. A confirmatory factorial analysis (CFA) was performed to test the fit of the three-factor structure of the TAS-20 in the adolescent sample (N=140). BPD and control groups were compared on alexithymic scores using ANCOVA analyses controlling for the potential confounding effects of depression and anxiety.Results: The ratio of the chi-square to its degrees of freedom, the goodness-of-fit index, the adjusted goodness-of-fit index and Steiger's root-mean-square error of approximation had satisfactory values of 1.54; 0.87; 0.83 and 0.058, respectively. The two ANCOVA demonstrated no significant difference for TAS-20 scores. BPD subjects were more alexithymic than healthy subjects but this difference was mainly explained by the levels of depression or anxiety.Limitations: Since BPD subjects have high comorbidity with depression or anxiety, longitudinal studies examining the absolute and relative stability of TAS-20 scores are necessary to determine whether alexithymia constitutes a state or a trait in BPD.Conclusions: BPD adolescents are characterized by alexithymia, probably of a secondary or state-dependent nature.

Blushing in rosacea sufferers

Peter D. Drummond, Daphne Su — 2011-10-03

Abstract: Objective: Rosacea is characterized by extremely sensitive skin and persistent facial flushing, perhaps initiated or exacerbated by frequent or intense blushing. To investigate this, blushing was assessed in rosacea sufferers and controls during embarrassing laboratory tasks.Methods: Changes in forehead blood flow were monitored with laser Doppler fluxmetry in 31 rosacea sufferers (12 with severe symptoms and 19 with mild symptoms) and 86 controls while singing, giving an impromptu speech, and listening to recordings of these activities.Results: Changes in forehead blood flow were similar in rosacea sufferers and controls, and were similar in subgroups with mild and severe rosacea. Even so, rosacea sufferers thought that that they blushed more intensely and were more embarrassed than controls during most of the tasks. Likewise, changes in forehead blood flow were similar in participants with mild and severe rosacea. Nevertheless, ratings of embarrassment and blushing were greater in those with severe than mild symptoms. Within the rosacea group, increases in blood flow while singing were greatest in participants with the highest blushing ratings, whereas increases in blood flow while listening to the speech were greatest in the most embarrassed participants.Conclusions: These findings do not support the hypothesis that blushing is abnormal in rosacea but, nevertheless, suggest that rosacea sufferers are more aware of and embarrassed by blushing than controls. This might contribute to social anxiety in rosacea sufferers.

Leisure activities and cognitive function in elderly community-dwelling individuals in Japan: A 5-year prospective cohort study

2011-11-10

Abstract: Objective: This study aimed to clarify the longitudinal relationship between leisure activities and cognitive decline among Japanese community-dwelling older adults, using a 5-year prospective cohort study design.Methods: A total of 567 men and women, aged 70years and over, participated in the study. The Mini-Mental State Examination was used in baseline and follow-up surveys to assess cognitive function. The change in cognitive function from baseline to follow-up was determined, and cognitive decline over 5years was used as the outcome variable. Leisure activities (hobby, social activity, and physical activity) were assessed at baseline and used as independent variables. Age, gender, number of years of education, presence of chronic diseases, instrumental activities of daily living, depressive symptoms, smoking, hearing deficits, and level of cognitive function at baseline were used as covariates.Results: Multivariate logistic regression analysis, adjusted for potential confounders, showed that non-participation in a hobby was significantly and independently associated with cognitive decline (odds ratio: 1.87, 95% confidence interval: 1.16–3.02, p<0.01). There were no significant relationships between social activity, physical activity and cognitive decline.Conclusions: Our study found a longitudinal inverse relationship between hobby participation and cognitive decline among elderly Japanese community-dwelling individuals, suggesting that engaging in a hobby in later life can contribute to preserving cognitive function.

The role of antidepressants in the management of inflammatory bowel disease (IBD): A short report on a clinical case-note audit

2011-08-01

Abstract: Objective: This study sought to determine the frequency of use and types of antidepressants used in IBD patients and to collect data with respect to any effect of antidepressants on the course of IBD in a usual care setting.Method: A case-note audit was conducted at an IBD Service in a public tertiary hospital. Included patients were those diagnosed with IBD by a gastroenterologist; and have had contact with the IBD Service in the last 6months. Descriptive statistics were used to summarise the data.Results: Overall, 313 patients were eligible and 287 had complete data. Overall, 51 (17.8%) patients were currently taking antidepressants and 71 (24.7%) previously received antidepressants. Eighty-three (28.9%) patients had used an antidepressant at some time. In terms of disease activity while on antidepressants, the majority of patients had inactive disease but presented with what were thought by their clinicians to be functional symptoms.Conclusion: Antidepressants are commonly prescribed in IBD patients. In our cohort, they appear to be mostly used for functional symptoms. The current data do not allow us to judge whether they improve IBD disease activity. Targeted studies are needed to answer this question and to improve practice and patient outcomes.

Presentation of the Multidisciplinary Guideline Medically Unexplained Physical Symptoms (MUPS) and Somatoform Disorder in the Netherlands: Disease management according to risk profiles

2011-12-12

Abstract: Objective: January 2011, the Dutch Multidisciplinary Guideline for Medically Unexplained Symptoms (MUPS) and Somatoform Disorder (SD) was published. The aim was to set a standard for multidisciplinary prevention, diagnosis and treatment of MUPS and SD.Methods: First, the Multidisciplinary Guideline group defined a conceptual approach for the guideline. After this, a systematic literature review, followed by consensus meetings in the Multidisciplinary working group, aimed to answer the following questions: 1) What evidence exists for preventive interventions, including the patient-doctor communication in MUPS and SD? 2) How can the diagnosis of MUPS be established? 3) What effective treatments of MUPS are available? 4) Which types of treatment are most effective for which patients?Results: As conceptual approach for the guideline, based on existing literature, in this guideline MUPS are considered a category of symptoms that have many common aspects and are best approached by one, generic approach. 1) Research for preventive interventions and the patient-doctor relationship in MUPS and SD is scanty. 2) To establish the diagnosis of MUPS or SD, the GP should follow a parallel somatic-psychosocial diagnostic step plan. 3) A Systematic Review identified Cognitive Behavioral Treatment (CBT), treatment of comorbid depressive and anxiety disorder, psychiatric consultation with a Consultation Letter to General Practitioners (GPs) and stepped care as evidence based interventions for MUPS and SD. 4) In order to apply the best fitting treatment to patients, patient risk profiles were formulated to guide stepped-care treatment that should start at an appropriate level and treatment setting. Three levels are discerned: Low risk patients need reassurement by the GP. Moderate risk patients suffer from comorbidity. They need case-management and generally can be treated by the GP as well, who can be supported by psychiatric consultation. High risk patients often have long term SD and a perturbed patient-doctor relationship with their GP. For this group, specialist mental health treatment is needed.Conclusion: Disease-managament based on risk profiles, providing stepped care and case management by the GP, supported by psychiatric consultation with a consultation letter, and mental health in-patient multidisciplinary treatment for severe cases, is the recommended strategy of the Dutch Multidisciplinary Guideline for MUPS and SD.

Corrigendum to ‘Heterogeneity in the response to Rheumatoid Arthritis (RA): The challenge of accounting for individual variability in the face of chronic disease’ [Journal of Psychosomatic Research 71 (2011)288-289]

Perry M. Nicassio — 2012-02-01

The author regrets that Dr. Norton's name was consistently misspelled throughout the above commentary as “Morton et al.” instead of “Norton et al.”. The author would like to apologise for the inconvenience caused.

Corrigendum to “Disease-specific quality-of-life measures as predictors of mortality in individuals living with type 2 diabetes”☆☆☆ [Journal of Psychosomatic Research 70 (2011) 155–160]

2012-02-01

The authors regret that an error occurred in the listing of some affiliation addresses in their original paper. The correct listings appear above. The authors would like to apologise for any inconvenience caused.

Contents of this Issue

2012-02-01

Title Page

2012-02-01

Copyright Page

2012-02-01