Journal of Psychosomatic Research - Articles in Press

Validation study of the Chinese version of the Illness Intrusiveness Ratings Scale - Corrected Proof

Wei Li, Kexin Chen, Beth Halfyard, Biyun Qian, Haixin Li, Peizhong Peter Wang — 2010-07-12

Abstract: Objective: The Illness Intrusiveness Ratings Scale (IIRS) measures illness-induced disruptions to 13 different aspects of lifestyles, activities, and interests. A stable three-factor structure has been well documented in studies conducted in Western countries. However, in Asia, the general validity of this scale has not been examined.Methods: This study investigated the factor structure of the Chinese version of the IIRS in 641 inpatients at a Chinese hospital for cancer patients. The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was also administered and compared with the IIRS.Results: Exploratory principal component analysis identified a two-factor structure, “health and living” and “relationships and personal development”, which accounted for 58.65% of the total variance. A “goodness-of-fit” test supported a two-factor solution (P=.070). The IIRS was significantly correlated with scores of every scale in the EORTC QLQ-C30.Conclusion: These findings support the validity of the Chinese version of the IIRS but did not support a cross-cultural equivalence of the factor structure. This study was only performed in hospitalized cancer patients; therefore, further evaluation involving patients with other diseases is warranted.

Attention to the body in nonclinical somatoform dissociation depends on emotional state - Corrected Proof

Richard J. Brown, Adam N. Danquah, Eleanor Miles, Emily Holmes, Ellen Poliakoff — 2010-07-05

Abstract: Objective: Unexplained neurological symptoms (“somatoform dissociation”) are common in health care settings and associated with disproportionately high levels of distress, disability, and resource utilization. Theory suggests that somatoform dissociation is associated with disturbed attentional processing, but there is a paucity of research in this area and the available evidence is contradictory.Methods: We compared undergraduate participants (n=124) with high and low scores on the Somatoform Dissociation Questionnaire (SDQ-20) on a tactile cueing paradigm measuring the time course of attention to touch, following either a neutral film or a film designed to simulate the emotional effects of trauma exposure.Results: Following the neutral film, high SDQ-20 participants exhibited delayed disengagement from tactile cue stimuli compared to the low SDQ-20 group. Following the “trauma” film, however, the high SDQ-20 group showed attentional effects suggesting avoidance of the tactile stimuli in this condition. Early attention to tactile cues following the trauma film predicted film-related intrusive thoughts after the experiment.Conclusion: These findings suggest that both body vigilance and body avoidance may be involved in the expression of somatoform dissociation.

Commentary on “Heart-focused anxiety as a mediating variable in the treatment of non-cardiac chest pain by cognitive-behavioural and psychopharmacological treatment by paroxetine" - Corrected Proof

Olafur S. Palsson — 2010-07-05

Noncardiac chest pain (NCCP) is recurrent pain in the chest resembling heart pain that cannot be attributed to any cardiac cause after a thorough evaluation . It is a common and difficult problem in modern healthcare. Half or more of the millions of patients who are urgently evaluated for chest pain complaints each year in emergency departments and cardiac clinics fit into this diagnostic category . The pain in NCCP is thought to have different causes in different patients, and these may include gastroesophageal acid reflux, esophageal motility abnormalities, visceral hyperalgesia, musculoskeletal problems, or anxiety and panic . Gastroesophageal reflux disease is recognized as the single most common of these causes, and is estimated to have a role in as many as 60% of all NCCP cases . For that reason, a trial of a proton-pump inhibitor medication (PPI) has become a first-line therapy for NCCP, and many patients obtain relief from such treatment . However, for individuals who are unresponsive to proton-pump inhibitors, treatment options are limited and the best course of therapy is often unclear. Their symptom and well-being prognosis is generally relatively poor. Most will continue to suffer from the chest pain for years after their first evaluation , and many will continue to be troubled by anxieties and worries about the possibility that dangerous cardiac problems have gone undetected in spite of test results and reassurance from their doctors . Work absenteeism, disruptions of daily life activities, and emotional symptoms of anxiety and depression are all very common among chronic NCCP patients and as many as 36% of them have substantially impaired quality of life .

The association between obesity, depression, and educational attainment in women: The mediating role of body image dissatisfaction - Corrected Proof

Amelia R. Gavin, Greg E. Simon, Evette J. Ludman — 2010-07-05

Abstract: Objective: We examine the mediating role of body image dissatisfaction (BID) on the association between obesity and depression and the variation of this association as a function of years of education among a population-based sample of women aged 40–65 years.Methods: A series of sample-weighted logistic regression models were used to estimate the associations between obesity, BID, and depression, stratified by educational attainment. Data were obtained from a structured telephone interview of 4543 female health plan enrollees, including self-reported height and weight, the Patient Health Questionnaire assessment of depression, and a single-item measure of BID.Results: Among those with <16 years of education, in both the unadjusted and adjusted models, obesity and BID were significantly associated with depression. Similarly, among those with ≥16 years of education, obesity and BID were significantly associated with depression in the unadjusted models. However, in the adjusted model, only BID was associated with depression. A formal test for mediation suggests that the association between obesity and depression was mediated by BID regardless of level of education.Conclusions: Our data suggest that BID-mediated the obesity-depression association. In addition, obesity and BID may be salient risk factors for depression among middle-aged women as a function of the level of education.

Generalized hypervigilance in fibromyalgia patients: An experimental analysis with the emotional Stroop paradigm - Corrected Proof

2010-07-05

Abstract: Objective: In recent years, a good deal of serious research has been carried out on the hypothesized presence of generalized hypervigilance to sensory stimulation in fibromyalgia (FM). However, there are no studies which, following an operationalization of generalized hypervigilance as a propensity to attend to any task-irrelevant stimuli presented, make use of interference paradigms as the most appropriate experimental models for its analysis. The purpose of this study was to test the hypothesis of generalized hypervigilance in FM using the emotional modification of the Stroop task and to explore the possible mediating role of anxiety.Methods: To this end, 25 women diagnosed with fibromyalgia and 25 matched controls were shown 32 stimulus words equally distributed in four categories: fibromyalgia symptoms, arousing-negative (A−), arousing-positive (A+), and neutral (N). These words had been selected on the basis of the results of an independent study. In addition to the emotional Stroop task, measures of trait and state anxiety were included.Results: The results showed the possible presence of a generalized hypervigilance response in fibromyalgia patients based on significant slowness in the color-naming. This effect was mediated by the degree of perceived unpleasantness of the A−stimuli. However, the expected mediation effect of anxiety was not found.Conclusions: These results suggest the presence of a generalized hypervigilance response in FM patients that is not mediated by anxiety. Implications for the correct functioning of controlled self-regulatory processes in fibromyalgia and similar pathologies are discussed.

Response to Pall, M.L., Multiple chemical sensitivity is a response to chemicals acting as toxicants via excessive NMDA activity - Corrected Proof

2010-07-05

Although we regret the offensive style of Dr. Pall's criticisms to our recent article in this journal (Meulders et al., J. Psychosom. Res., 2010, 68, 47–56) , we appreciate being given the opportunity to respond. His criticisms boil down to the message that we do not know the literature, that we pretend to say something about multiple chemical sensitivity (MCS) based on studies with normals, and that we have not understood an iota of the essential processes involved in MCS. Ever since my high school days (when my chemistry teacher got really angry about my clumsiness in the science lab which had caused an unintended burst of fire), I (OVdB) have not received a message with a similar content and tone. It sounds as if we have done something seriously wrong. In the following, we will provide reasonable arguments to show that our perspective on MCS and our scientific approach are not all that ludicrous.

Relations between sleep, fatigue, and health-related quality of life in individuals with insomnia - Corrected Proof

Émilie Fortier-Brochu, Simon Beaulieu-Bonneau, Hans Ivers, Charles M. Morin — 2010-07-01

Abstract: Objective: This study explored the relations between sleep, fatigue, and health-related quality of life in a sample of individuals with chronic insomnia.Methods: A total of 160 adults meeting the diagnostic criteria for chronic insomnia underwent three nights of polysomnography (PSG) and completed sleep diaries and questionnaires assessing daytime functioning including fatigue and health-related quality of life.Results: A cluster analysis was conducted based on PSG-defined sleep disturbances and fatigue severity. A four-cluster solution (R2=0.68) was found, classifying individuals as having either (a) both severe sleep disturbance and severe fatigue (n=15); (b) severe sleep disturbance but milder fatigue (n=15); (c) milder sleep disturbance but severe fatigue (n=68); or (d) both milder sleep disturbance and milder fatigue (n=61). Health-related quality of life was lower in both clusters with severe fatigue compared to those with milder fatigue and was further decreased when severe sleep disturbances were present. Relations between several indicators of fatigue and health-related quality of life were then examined using factor analysis in order to identify different domains of impairment. A three-factor structure was selected, suggesting that daytime symptoms can be classified as relating to fatigue, physical health, or mental health. These different subtypes of daytime impairment were predicted by distinct sets of variables.Conclusion: More severe fatigue is not necessarily related to poorer PSG-defined sleep but appears associated with greater impairment in health-related quality of life. Fatigue and health-related quality of life appear to be distinct but interrelated constructs.

Instruments to measure sexual dysfunction in community and psychiatric populations - Corrected Proof

Sakina J. Rizvi, Niette W. Yeung, Sidney H. Kennedy — 2010-07-01

Abstract: Sexual dysfunction is a significant issue for many individuals. This can be the result of existing disorders, side effects of medications, or both. In order to effectively assess and, if appropriate, manage sexual dysfunction in various populations, it is important to consider the use of validated instruments that can provide a baseline to detect dysfunction and measure change over time. This review will assess the psychometric properties of scales (self-report and interview-based) that have been used in community, psychiatric, and gender-specific populations, with a particular emphasis on depressed patients before and during antidepressant therapy. Key considerations for scale selection and development are also discussed.

Daily mood, shortness of breath, and lung function in asthma: Concurrent and prospective associations - Corrected Proof

Thomas Ritz, David Rosenfield, Steve DeWilde, Andrew Steptoe — 2010-06-24

Abstract: Objective: Previous asthma diary studies have yielded equivocal findings on concurrent associations between lung function and mood, and prospective associations have rarely been explored. We therefore examined concurrent and prospective associations between daily mood, shortness of breath, and lung function, and studied between-individual variability and stability of concurrent associations across different times of the day.Method: Twenty asthma patients and 20 healthy controls recorded their positive and negative mood, shortness of breath, physical activity, peak expiratory flow (PEF) and forced expiratory volume in the first second (FEV1) using an electronic pocket spirometer with diary functions three times per day for about 21 days.Results: For both groups, PEF showed positive concurrent associations with ratings of various mood states, whereas FEV1 was only associated with positive mood. Both indices correlated negatively with shortness of breath. Within-individual concurrent associations varied significantly in both groups and their stability varied across time of the day, with overall higher stability for associations with shortness of breath in asthma and PEF for both groups. Prospectively, higher shortness of breath consistently predicted lower lung function later during the day and on the subsequent day.Conclusion: The relationship between normal mood variations and lung function is highly variable across individuals and times of the day, limiting the predictive value of average group associations. Shortness of breath is predictive of future lung function decline in asthma. Future longitudinal research should focus on extreme emotional states, effort-independent measures of lung function, and additional indicators of asthma control.

A randomized controlled trial of quetiapine versus placebo in the treatment of delirium - Corrected Proof

2010-06-24

Abstract: Background: Delirium is a commonly occurring complex neuropsychiatric disorder. Evidence for its treatment based on randomized controlled trials (RCTs) is poor.Aims: To determine the efficacy and acceptability of quetiapine in the treatment of delirium.Method: A double-blind, RCT was conducted. A total of 42 patients were randomized to quetiapine or a placebo group. The primary outcome measure was the Delirium Rating Scale Revised 98. Other scales used were the Brief Psychiatric Rating Scale, Mini-Mental State Examination and Clinical Global Improvement. In order to account for missing data, a nonlinear mixed-effects model was used to estimate the difference between the two groups.Results: The quetiapine group improved more rapidly than the placebo group. Specifically, the quetiapine group recovered 82.7% faster (S.E. 37.1%, P=.026) than the placebo group in terms of DRS-R-98 severity score. In terms of the DRS-R-98 noncognitive subscale, the quetiapine group improved 57.7% faster (S.E. 29.2%, P=.048) than the placebo group.Conclusions: Quetiapine has the potential to more quickly reduce the severity of noncognitive aspects of delirium. This study was underpowered for treatment comparisons at specific points in time but nonetheless detected significant differences when analyzing the whole study period. While it is not possible to draw definitive conclusions, further larger studies exploring the use of quetiapine in other delirium populations seem justified. Larger increments in the dose of quetiapine may yield even stronger results.

Multiple chemical sensitivity is a response to chemicals acting as toxicants via excessive NMDA activity - Corrected Proof

Martin L. Pall — 2010-06-24

Meulders et al. claim to have presented evidence for symptom learning in multiple chemical sensitivity (MCS). They make this claim even though they studied only normal people and they studied the responses of such normals to chemicals not implicated in MCS. They present not one iota of evidence that can be clearly linked to MCS.

Qigong for the treatment of tinnitus: A prospectiverandomized controlled study - Corrected Proof

Eberhard Biesinger, Ulrike Kipman, Susanne Schätz, Berthold Langguth — 2010-06-14

Abstract: Objective: Tinnitus is a frequent disorder which is very difficult to treat. Qigong is a mindful exercise and an important constituent of traditional Chinese medical practice. Here we performed a randomized controlled trial to evaluate the effect of a Qigong intervention on patients with tinnitus. We hypothesized that especially tinnitus patients with somatosensoric components may benefit from the mind–body technique of Qigong.Methods: Eighty patients with tinnitus of at least 3 months duration were randomly assigned to an intervention group (n=40) consisting of 10 Qigong training sessions in 5 weeks or a waiting-list control group (n=40). Tinnitus severity was assessed with a visual analogue scale (VAS) and with a tinnitus questionnaire (TBF-12) before treatment, immediately after treatment, and 1 and 3 months after treatment.Results: Qigong did not cause any side effects and was completed by 80% of the assigned patients. Compared with the control group, Qigong participants experienced improvement in tinnitus severity, as reflected by a significant reduction in both the VAS and the TBF-12. In the subgroup of patients with somatosensoric tinnitus, Qigong effects were more pronounced, resulting in a highly significant improvement in both scales compared to the waiting-list group.Conclusion: These findings suggest that Qigong interventions could be a useful complement to the therapeutic management of patients with tinnitus and especially for those with somatosensoric components. Satisfaction with the intervention, a high degree of completion, and stability of the effects for at least 3 months after the intervention further underscore the potential of Qigong in the treatment of tinnitus.

Man of unconscious sorrow - Corrected Proof

Keith J. Petrie, Kavita Vedhara — 2010-06-14

Brosschot et al. in this issue make a cogent and compelling argument for researchers to pay more attention to the role of unconscious processes. They argue that the prolonged physiological activity of the type that that produces wear and tear on the body and eventual stress-related illness may be more due to unconscious worry and distress than researchers have previously recognized. This unconscious worry or rumination by individuals may be in anticipation of a stressful event or continue long after the episode has passed. They propose that a focus on the nature of stressor itself may be less important than rumination and worry about the stressor, much of which occurs unconsciously. Currently, the majority of physiological evidence for prolonged activation seems to apply to cardiovascular indices rather than HPA activity. This may reflect the limited work in this area so far, but may also indicate the type of disease processes affected by perseverative cognition.

A moderator–mediator analysis of coronary heart disease mortality - Corrected Proof

Robert D. Keeley, Margaret Driscoll — 2010-06-14

Abstract: Objective: The purpose of this study is to better understand how risk factors for coronary heart disease (CHD) mortality may interact.Methods: We conducted a moderator–mediator analysis of a representative national sample of 5027 and 2902 community-dwelling women and men in the first National Health and Nutrition Examination Survey free of CHD in 1982. The outcome was 10-year CHD mortality.Results: Two hundred sixty-seven subjects experienced CHD mortality. In the complete sample, gender moderated the effect of depressive symptoms, and among women, race–ethnicity moderated the effect of nonleisure activity on CHD mortality, defining three subgroups for further analysis: men, white women, and black/other women. Among men, baseline differences from median age (55 to 64 years), systolic blood pressure (129 to 158 mmHg), or self-rated general health (“good” to “poor”) were associated with equivalent increases in 10-year CHD mortality from 2.3% to 5.3% [area-under-the-curve effect size (ES)=0.53]. These factors appeared to mediate the effect of education on CHD mortality. Severe depression in men was associated with higher 10-year CHD mortality than less or no depression, 10.0% vs. 2.5% (ES=0.55). Among white women, baseline differences from median age (51 to 65 years) was also associated with 10-year mortality (1.2 to 13.4%, ES=0.56), as was higher blood pressure (125 to 151 mmHg) or worse self-rated health (“very good” to “fair”) to a lesser extent (1.2% to 3.5%, ES=0.51).Conclusion: Moderators (gender, race–ethnicity) defined possible pathways to CHD mortality characterized by varying factors and interactions between factors, highlighting potential utility for targeted interventions among community-dwelling persons.

Diagnosing somatisation disorder (P75) in routine general practice using the International Classification of Primary Care - Corrected Proof

2010-06-14

Abstract: Objective: (i) To analyze general practitioners' diagnosis of somatisation disorder (P75) using the International Classification of Primary Care (ICPC)-2-E in routine general practice. (ii) To validate the distinctiveness of the ICD-10 to ICPC-2 conversion rule which maps ICD-10 dissociative/conversion disorder (F44) as well as half of the somatoform categories (F45.0-2) to P75 and codes the other half of these disorders (F45.3-9), including autonomic organ dysfunctions and pain syndromes, as symptom diagnoses plus a psychosocial code in a multiaxial manner.Methods: Cross-sectional analysis of routine data from a German research database comprising the electronic patient records of 32 general practitioners from 22 practices. For each P75 patient, control subjects matched for age, gender, and practice were selected from the 2007 yearly contact group (YCG) without a P75 diagnosis using a propensity-score algorithm that resulted in eight controls per P75 patient.Results: Of the 49,423 patients in the YCG, P75 was diagnosed in 0.6% (302) and F45.3-9 in 1.8% (883) of cases; overall, somatisation syndromes were diagnosed in 2.4% of patients. The P75 coding pattern coincided with typical characteristics of severe, persistent medically unexplained symptoms (MUS). F45.3-9 was found to indicate moderate MUS that otherwise showed little clinical difference from P75. Pain syndromes exhibited an unspecific coding pattern. Mild and moderate MUS were predominantly recorded as symptom diagnoses. Psychosocial codes were rarely documented.Conclusions: ICPC-2 P75 was mainly diagnosed in cases of severe MUS. Multiaxial coding appears to be too complicated for routine primary care. Instead of splitting P75 and F45.3-9 diagnoses, it is proposed that the whole MUS spectrum should be conceptualized as a continuum model comprising categorizations of uncomplicated (mild) and complicated (moderate and severe) courses. Psychosocial factors require more attention.

Social determinants of self-reported sleep problems in South Korea and Taiwan - Corrected Proof

Kyoko Nomura, Kazue Yamaoka, Mutsuhiro Nakao, Eiji Yano — 2010-06-11

Abstract: Objective: To clarify the social determinants of insomnia in South Korea and Taiwan.Methods: Cross-sectional surveys were conducted in South Korea (n=1007) and Taiwan (n=785) in 2003. Nationwide samples of people completed a structured questionnaire, based on face-to-face interviews. Outcome measures were self-reported sleep problems, defined by at least one of three sleep symptoms on a nightly basis for more than 2 weeks: difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning waking (EMW). Explanatory variables investigated were demographic characteristics (gender, age), socioeconomic factors (income, education), and social capital, including norms of reciprocity, interpersonal trust, civic association, and social support (i.e., the availability of persons to consult regarding personal problems and important matters).Results: The prevalence of sleep problems was 8.2% in South Korea and 9.3% in Taiwan. Stepwise logistic regression showed that, in South Korea, sleep problems were significantly associated with increasing age (P<.05), low income (P<.01), and having few persons with whom to consult compared to having a spouse/partner (P<.05); in Taiwan, sleep problems were significantly associated with being female (P<.05), increasing age (P<.001), and having family members vs. a spouse/partner to consult (P<.05).Conclusion: Self-reported sleep problems in two northeast Asian countries were associated with certain demographic characteristics and socioeconomic factors, which is consistent with previous results in Western countries. In addition, the results of this study suggested that sleep problems may also be associated with social support.

Pregnancy complications in women with childhood sexual abuse experiences - Corrected Proof

Brigitte Leeners, Ruth Stiller, Emina Block, Gisela Görres, Werner Rath — 2010-06-11

Abstract: Objective: Childhood sexual abuse (CSA) has an estimated prevalence of 20% and has a constantly growing list of known long-term consequences on physical as well as psychological health which may also influence obstetrical care attributed to it. However, scientific data on the association of CSA and pregnancy are sparse. Therefore, the study investigated pregnancy complications in women exposed to CSA.Methods: The study was designed as a cohort study comparing 85 women exposed to CSA with 170 matched unexposed women. CSA was identified by interview using modified questions from Wyatt [Child Abuse Negl 9 (1985) 507–519]. Data on pregnancy complications were collected by questionnaire and based on entries in a booklet (Mutterpass) in which all relevant data on pregnancy are documented at each prenatal consultation for any women attending prenatal care in Germany. Statistical analysis was performed with chi square, Fisher's Exact Test, and multiple logistic regression analysis to control the association between CSA and pregnancy complications for confounders significant in univariate analysis, i.e., physical abuse, other adverse experiences during childhood, abuse during pregnancy, substance abuse, and occupation.Results: Women exposed to CSA were significantly more often hospitalized during pregnancy (41.2%/19.4%; OR 2.91, CI 1.64–5.17). They presented more often complications such as premature contractions (38.8%/20%; OR 2.54 CI 1.43–4.51), cervical insufficiency (25.9%/9.4%; OR 3.36, CI 1.65–6.82), and premature birth (18.8%/8.2%; OR 2.58, CI 1.19–5.59).Conclusion: Therefore, health care providers should adapt prenatal care to the specific needs of women exposed to CSA.

An evaluation of illness, treatment perceptions, and depression in hospital- vs. home-based dialysis modalities - Corrected Proof

Konstadina Griva, Andrew Davenport, Michael Harrison, Stanton Newman — 2010-06-09

Abstract: Objectives: Depressive symptoms are common among patients with end-stage renal disease (ESRD). In order to better understand what factors influence these symptoms, we examined the impact of illness and treatment cognitions on emotional adjustment and the influence of dialysis modality (hospital- vs. home-based dialysis) on this relationship.Methods: A cross-sectional sample of 145 ESRD patients on four different dialysis modalities [hospital hemodialysis (HD), n=52; home HD, n=25; continuous ambulatory peritoneal dialysis (CAPD), n=45; automated PD (APD), n=23] completed the Illness Perceptions Questionnaire, the Illness Effects Questionnaire, the Treatment Effects Questionnaire, and the Beck Depression Inventory. Measures of ESRD severity/comorbidity and biochemistry were also collected.Results: Perceptions of treatment disruptiveness and attributions to poor medical care were significantly greater in CAPD. Home-based treatments were not found to confer an emotional adjustment advantage compared to hospital HD. There were marked differences across home-based modalities, with n=22 (44.4%) CAPD meeting the clinical cutoff of depression (≧16) vs. n=6 (26.1%) in APD and n=2 (8%) in home HD. After adjusting for case-mix differences, the mean levels of depressed mood remained significantly higher in CAPD patients compared to APD and home HD (P<.01). On multiple regression analysis, 42.5% of the variance in depression was explained by the End-Stage Renal Severity Index, dialysis modality, perceived treatment disruptiveness, and beliefs about illness consequences and the extent to which the illness could be controlled.Conclusion: The findings suggest that the benefits of self-care are not uniformly manifested across dialysis modalities and that patients' cognitions are important determinants of depressed mood with implications for future research and clinical practice.

Cognitive and behavioural correlates of different domains of psychological adjustment in early-stage multiple sclerosis - Corrected Proof

Laura Dennison, Rona Moss-Morris, Eli Silber, Ian Galea, Trudie Chalder — 2010-06-09

Abstract: Objective: This study investigated a cognitive–behavioural model of adjustment to multiple sclerosis (MS). It aimed to determine the contribution of cognitions and behaviours to the explanation of two distinct adjustment outcomes above and beyond measures of MS severity. Illness-related functional impairment was anticipated to be most strongly related to unhelpful thoughts and behaviours that were specific for MS and the experience of symptoms. Psychological distress was hypothesised to be most strongly related to more general unhelpful cognitions about the self and emotions.Methods: Ninety-four people with MS completed questionnaires. Correlations and hierarchical multiple regressions determined the relative contribution of illness severity, cognitions, and behaviours to the prediction of psychological distress and functional impairment.Results: Illness-related functional impairment was related to disease severity, progressive versus relapsing–remitting disease, and unhelpful illness perceptions and cognitive and behavioural responses to symptoms. Illness severity factors accounted for a significant 23.7% of the variance in functional impairment (P .05), while cognitive and behavioural variables accounted for 37.1% (P<.001). Unhelpful beliefs about the self were the strongest predictor.Conclusion: Longitudinal and experimental research is required to investigate potential causal relationships. However, the cognitions and behaviours identified as important for adjustment are potentially modifiable and thus may be useful to address within interventions for adjustment to MS.

A cognitive model of menopausal hot flushes and night sweats - Corrected Proof

Myra S. Hunter, Eleanor Mann — 2010-06-02

Abstract: Hot flushes and night sweats (HF/NS) are commonly experienced by mid-aged women during the menopause transition. They affect approximately 70% of women but are regarded as problematic for 15–20% largely due to physical discomfort, distress, social embarrassment, and sleep disturbance. There is a need for effective and acceptable nonmedical treatments for menopausal symptoms due to the declining use of hormone therapy (HT) following publication of the Women's Health Initiative and other prospective studies which associated HT use with increased risk of stroke and breast cancer. HF/NS are an example of a physiological process embedded within, and moderated by, psychological processes, as evidenced by discrepancies between subjective experiences and physiologically measured symptoms. We describe a cognitive model of menopausal hot flushes that can explain symptom perception, cognitive appraisal, and behavioral reactions to symptoms. Theoretically, the model draws on symptom perception theory, self-regulation theory, and cognitive behavioral theories. The model can be used to identify the variables to target in psychological interventions for HF/NS and to aid understanding of possible mediating factors. As part of Phase II intervention development, we describe a cognitive behavioral treatment which links the bio-psycho-social processes specified in the model to components of the intervention.

The Hospital Anxiety and Depression Scale: A diagnostic meta-analysis of case-finding ability - Corrected Proof

Cathy Brennan, Anne Worrall-Davies, Dean McMillan, Simon Gilbody, Allan House — 2010-06-02

Abstract: Objective: To quantify the accuracy of the Hospital Anxiety and Depression Scale (HADS) as a case-finding instrument for anxiety and depressive disorders.Method: MEDLINE, PSYCHINFO, EMBASE, CINAHL, BNI, and AMED were searched from January 1983 to June 2006. Studies were included that administered the HADS, used a standardized psychiatric interview to establish a diagnosis of anxiety or depression, and provided sufficient data on sensitivity and specificity (N=41). Summary sensitivity, specificity, likelihood ratios, and diagnostic odds ratios were calculated for each study. Random effects meta-analytic pooling across studies at the recommended clinical (7/8) and research (10/11) cutoff points was undertaken and summary receiver operating characteristic curves constructed.Results: For major depressive disorders, a cut point of ≥8 gave a sensitivity of 0.82 (95% CI, 0.73–0.89) and a specificity of 0.74 (95% CI, 0.60–0.84) and a cut point ≥11 gave a sensitivity of 0.56 (95% CI, 0.40–0.71) and a specificity of 0.92 (95% CI, 0.79–0.97).Conclusions: Many studies have shown that the HADS is a useful screening tool to identify emotional distress in nonpsychiatric patients. However, it does not appear to be superior to other screening instruments in terms of identifying specific mental disorders in physical health settings.

Does social support differentially affect sleep in older adults with versus without insomnia? - Corrected Proof

Wendy M. Troxel, Daniel J. Buysse, Timothy H. Monk, Amy Begley, Martica Hall — 2010-05-21

Abstract: Objective: Insomnia is a significant public health problem, particularly among older adults. We examined social support as a potential protective factor for sleep among older adults (60 years and older) with insomnia (n=79) and age- and sex-matched controls without insomnia (n=40).Methods: Perceived social support, sleep quality, daytime sleepiness, and napping behavior were assessed via questionnaires or daily diaries. In addition, wrist actigraphy provided a behavioral measure of sleep continuity parameters, including sleep latency (SL), wakefulness after sleep onset (WASO), and total sleep time (TST). Analysis of covariance for continuous outcomes or ordinal logistic regression for categorical outcomes were used to examine the relationship between social support and sleep-wake characteristics and the degree to which observed relationships differed among older adults with insomnia versus non-insomnia controls. Covariates included demographic characteristics, depressive symptoms, and the number of medical comorbidities.Results: The insomnia group had poorer subjective sleep quality, longer diary-assessed SL and shorter TST as compared to the control group. Higher social support was associated with lesser actigraphy-assessed WASO in both individuals with insomnia and controls. There was a significant patient group by social support interaction for diary-assessed SL, such that higher levels of social support were most associated with shorter sleep latencies in those with insomnia. There were no significant main effects of social support or social support by patient group interactions for subjective sleep quality, daytime sleepiness, napping behavior, or TST (diary or actigraphy assessed).Conclusion: These findings extend the literature documenting the health benefits of social support, and suggest that social support may similarly influence sleep in individuals with insomnia as well as non-insomnia controls.

What every adolescent needs to know: Cannabis can cause psychosis - Corrected Proof

Gilla K. Shapiro, Leslie Buckley-Hunter — 2010-05-20

Abstract: Objective: Cannabis is a widely used substance that may be becoming more socially accepted, legally tolerated, and utilized by younger individuals. This review explores the relationship between cannabis and the onset of psychosis as well as the policy ramifications of current research.Method: This article synthesizes published work that was considered by the author to be relevant to the discussion of cannabis and the onset of psychosis.Results: The evidence suggests that, along with other harms, cannabis is a significant risk factor in the etiology of psychosis. Adolescents are more vulnerable to using cannabis, and because of their stage of mental development, the cognitive effects are more pronounced. The mechanism for this change is thought to be neuro-chemical with a stronger effect in those with a diathesis for psychosis.Conclusion: The risk that cannabis poses to adolescent health should not be neglected. Policy measures should use a multifaceted and strategic perspective in order to prevent adolescents from using this drug.

Nocturnal awakenings and difficulty resuming sleep: Their burden in the European general population - Corrected Proof

Maurice M. Ohayon — 2010-04-30

Abstract: Objectives: To (1) define the prevalence and importance of nocturnal awakenings (NA) in the general population, and (2) investigate its associations with daytime impairment, physical diseases, and psychiatric disorders.Methods: This is a cross-sectional telephone study conducted in the general population of France, United Kingdom, Germany, Italy, and Spain. A representative sample consisting of 22,740 non-institutionalized individuals aged 15 or over was interviewed regarding sleeping habits, health, sleep and mental disorders. Nocturnal awakenings were evaluated according to their frequency per week and per night and their duration.Results: At the time of the interview, 31.2% (95% confidence interval: 30.6–31.8%) of the sample reported waking up at least 3 nights per week and 7.7% (7.4% to 8.0%) of the sample had difficulty resuming sleep (DRS) after they woke up. Duration of the symptom was longer than one year in 78.8% of the cases. DRS had greater impacts on daytime functioning than any other kind of NA or other insomnia symptoms with odds ratios five to seven times higher than individuals waking up once or twice within the same night. Individuals with painful physical condition or with a psychiatric disorder were more than four times more likely to have DRS. Other significant factors associated with NA were hypertension, cardio-vascular disease, upper airway disease, diabetes, and heavy caffeine consumption.Conclusions: Nocturnal awakenings are highly prevalent in the general population and strongly associated with various physical diseases and psychiatric disorders. There is also a dose response effect in the associations: odds ratios increased with the number of awakenings during the same night and the difficulty resuming sleep once awakened. The study shows that nocturnal awakenings are complex and should be assessed systematically.

A study of concordance between adolescent self-report and parent-proxy report of health-related quality of life in school-going adolescents - Corrected Proof

Kasturi Agnihotri, Shally Awasthi, Uttam Singh, Hem Chandra, Savitri Thakur — 2010-04-30

Abstract: Objectives: The purpose of the study was to determine the degree of concordance between the self-report and the parent's proxy report of health-related quality of life (HRQoL) in school-going adolescents using the World Health Organization Quality of Life (WHOQOL)-BREF instrument in India.Methods: Twenty schools were purposively selected out of the 1900 schools in Lucknow, India. About 5% adolescents (between 10–19 years) per school were randomly selected by lottery system. Subjects, whose parents consented for child's participation, completed the WHOQOL-BREF self-report and their parents filled the WHOQOL-BREF proxy-report for adolescent's HRQoL. Degree of concordance and association were assessed using Cohen's κ and Spearman's correlation, respectively.Results: Five hundred fifteen adolescents (mean age=14 years with a standard deviation of ±2 years; 48.2% females) were included. κ Statistic values ranged from fair to moderate for all facets and dimensions of HRQoL between adolescent and parent report (κ=0.31–0.58, P<.01). There were moderate to very strong correlations between adolescent self and parent proxy report (r=0.62–0.81, P<.01) which declined with age of adolescent. The mother's scores correlated best in psychological dimension (r=0.81–0.88, P<.01) while that of father correlated best in environment dimension (r=0.81–0.79, P<.01), irrespective of child's gender.Conclusion: Our study illustrated that fair to moderate agreement existed between parent proxy and subject's self-report for adolescent's HRQoL. That may be an indicator for suitability of parent's proxy report in certain dimensions, if a child is unavailable or unable to respond. However, further research may provide new insights into the determinants of concordance between subject self and parent proxy report of adolescent HRQoL.

The association between tinnitus and mental health in a general population sample: Results from the HUNT Study - Corrected Proof

Norun Hjertager Krog, Bo Engdahl, Kristian Tambs — 2010-04-22

Abstract: Objectives: Clinical studies indicate a strong association between tinnitus and mental health, but results from general population data are missing. The purpose of the study was to examine the association between tinnitus, mental health, and well-being in the general adult population and to identify factors that might mediate and moderate this association.Methods: Data from 51,574 adults participating in the Nord-Trøndelag Hearing Loss Study (1995–1997), part of the Nord-Trøndelag Health Study (HUNT-2), were analyzed. The association between tinnitus symptom intensity and symptoms of depression, anxiety, self-esteem, and subjective well-being was examined by multivariate ANOVA, stratified by age group and sex. Explanatory variables were age, marital status, education, hearing, dizziness, vision, physical disability, and somatic illness. In a subsample of participants with tinnitus, the effects of “time since onset,” “predictability of tinnitus episodes,” and “noise sensitivity” were tested.Results: Participants with tinnitus scored significantly higher on anxiety and depression and lower on self-esteem and well-being than people without tinnitus. The effect sizes were small and quite similar across levels of tinnitus symptom intensity. No significant effect of time since onset was found. A significant effect of predictability of tinnitus episodes and noise sensitivity was found in some groups.Conclusion: A weak association between tinnitus and mental health was found in this general population study.

Characteristics of oligosymptomatic versus polysymptomatic presentations of somatoform disorders in patients with suspected allergies - Corrected Proof

2010-04-20

Abstract: Objective: Psychobehavioral characteristics of patients with somatoform disorders (SFDs), are increasingly discussed as possible positive criteria for this diagnostic group. However, little is known about psychobehavioral differences, or similarities, between the different SFD presentations, i.e., polysymptomatic [multisomatoform/somatization disorders (MSD)] versus mono- or oligosymptomatic courses [pain disorder (PD), undifferentiated somatoform disorder (USD)].Methods: This is a cross-sectional study including 268 consecutive allergology inpatients. After an Structured Clinical Interview for DSM-IV, patients completed several self-rating questionnaires. Results were compared within the different SFD presentations as well as between patients with versus without SFDs.Results: We identified 72 patients with an SFD. There were fewer and smaller psychobehavioral differences within patients with the different SFD presentations (MSD, USDs, PDs) than between patients with undifferentiated versus no SFD. Patients with one of the three different SFD subdiagnoses scored similarly on many measures referring to psychosocial distress (e.g., psychological distress, mental health-related quality of life, dissatisfaction with care). The number of reported symptoms, somatic symptom severity, a self-concept of bodily weakness, the degree of disease conviction, and physical health-related quality of life discriminated the different SFD presentations not only from patients without SFDs but also from each other.Conclusions: Patients diagnosed with one of the different SFD subtypes share many psychobehavioral characteristics, mostly regarding the reporting of psychosocial distress. Perceived somatic symptom severity and physical impairment as indicators of bodily distress could either further define categorical subdivisions of SFD or dimensionally graduate one general SFD category defined by bothering bodily symptoms and disproportionate psychosocial distress.

Physiological reactivity to phobic stimuli in people with fear of flying - Corrected Proof

Bert Busscher, Lucas J. van Gerwen, Philip Spinhoven, Eco J.C. de Geus — 2010-04-09

Abstract: Objective: The nature of the relationship between physiological and subjective responses in phobic subjects remains unclear. Phobics have been thought to be characterized by a heightened physiological response (physiological perspective) or by a heightened perception of a normal physiological response (psychological perspective).Method: In this study, we examined subjective measures of anxiety, heart rate (HR), and cardiac autonomic responses to flight-related stimuli in 127 people who applied for fear-of-flying therapy at a specialized treatment center and in 36 controls without aviophobia.Results: In keeping with the psychological perspective, we found a large increase in subjective distress (η2=.43) during exposure to flight-related stimuli in the phobics and no change in subjective distress in the controls, whereas the physiological responses of both groups were indiscriminate. However, in keeping with the physiological perspective, we found that, within the group of phobics, increases in subjective fear during exposure were moderately strong coupled to HR (r=.208, P=.022) and cardiac vagal (r=.199, P=.028) reactivity. In contrast to predictions by the psychological perspective, anxiety sensitivity did not modulate this coupling.Conclusion: We conclude that subjective fear responses and autonomic responses are only loosely coupled during mildly threatening exposure to flight-related stimuli. More ecologically valid exposure to phobic stimuli may be needed to test the predictions from the physiological and psychological perspectives.

Conscious and unconscious perseverative cognition: Is a large part of prolonged physiological activity due to unconscious stress? - Corrected Proof

Jos F. Brosschot, Bart Verkuil, Julian F. Thayer — 2010-04-09

Abstract: Prolonged physiological activity is believed to be a key factor mediating between stress and later disease outcomes. Few studies, however, have investigated the crucial psychological factors that cause prolonged activity. This article proposes that conscious as well as unconscious perseverative cognition are the critical factors. Perseverative cognition indicates repetitive or sustained activation of cognitive representations of past stressful events or feared events in the future. In daily life, most prolonged physiological activity is not due to stressful events but to perseverative cognition about them. We and others have already found evidence that conscious perseverative cognition, i.e., worry, has physiological effects, in both laboratory and real life settings, and that perseverative cognition mediates prolonged responses to stressful events. Yet, there are convincing reasons to expect that unconscious perseverative cognition has an even larger role in stress-related prolonged activity. Firstly, since the greater part of cognitive processing operates without awareness, a considerable part of perseverative cognition is likely to be unconscious too. People may not be aware of most of their stress-related cognitive processes. Secondly, our recent studies have shown that increased activity of the autonomic nervous system continues after conscious perseverative cognition has stopped: It goes on for several hours and even during sleep. This and several other findings suggest that a considerable part of increased physiological activity may be due to unconscious perseverative cognition. The article closes with suggesting methods to test unconscious perseverative cognition and ways to change it, and concludes with stating that the notion of unconscious perseverative cognition potentially opens an entirely new area within stress research.

Severe asthma and adherence to peak flow monitoring: Longitudinal assessment of psychological aspects - Corrected Proof

2010-04-09

Abstract: Background: Adherence in severe asthma is a difficult health problem. Although psychosocial factors may be responsible for non-adherence, few longitudinal studies have investigated their link with adherence, with most studies having focused on pharmacology.Methods: Sixty patients with severe asthma were recruited. Adherence was electronically monitored using peak flow measurements at entry and after 1 year of follow-up. Eysenck's Personality Inventory, Rotter's Locus of Control (LOC), and health control beliefs were all studied. Multiple logistic regression (MLR) was used for risk calculations.Results: Initially, subjects with poor adherence had an external LOC (P=.001) and a high extraversion score (P=.003) compared to those with good adherence. The lie score was high in all patients. Nocturnal awakenings were highly significantly correlated with poor adherence (P=.006). After 1 year, patient adherence, extraversion, and neuroticism remained unchanged. The LOC changed in subjects with poor adherence, showing a less “external” orientation (P=.007). The health parameters were better at the end of the study. By MLR analysis, externality, extraversion, and low social desirability were associated with poor adherence. Patients with poor adherence had a greater probability of nocturnal symptoms.Conclusion: No specific personality type was associated with lack of adherence in the present study, but a high extraversion score, a low social desirability score, and a high level of externality were all predictors of poor adherence.

Corrected Proof

Hans J. Grabe — 2010-04-08

This Casebook of Psychosomatic Medicine provides an illustrative collection of compelling cases. These cases provide a unique opportunity for students, residents, psychiatrists, and specialists to learn from the patients' characteristic responses to the challenges of illness. All cases are presented in a concise way, the individual psychosocial and psychodynamic background and complex medical conditions are described, followed by the DSM-IV-TR diagnosis. Then, each case is discussed from an etiological and therapeutic perspective. Psychological interventions, psychopharmacological treatment strategies appropriate to the individual case and the interplay with the underlying medical condition are outlined followed by a statement on the real outcome of the individual patient. The authors accomplish the challenge to present each case and the focused discussion on just 2–4 pages.

Corrected Proof

Philip W.B Watson — 2010-04-08

In acknowledgement of the limited number of therapists trained in cognitive behavioral therapy for psychosis in the UK, and given the National Institute for Health and Clinical Excellence's (2002) guidelines recommending that individuals presenting with schizophrenia should have access to this form of clinical input, this text is a successful attempt to construct a practical self-help/management guide to bridge the current gap in provision.

Corrected Proof

Daniel Pratt — 2010-04-08

Following the pioneering studies conducted over twenty years ago, we have seen enormous growth and investment in the development of clinical and research initiatives focused upon the early identification and intervention of psychosis. The editors of “The Recognition and Management of Early Psychosis” have accurately captured this explosion of research and interest. The wide variety of topics reviewed by authors from a range of professional backgrounds reflects the realizable need for a multidisciplinary approach in the treatment and management of individuals experiencing early psychosis.

Factors associated with suicidal ideation: Role of emotional and instrumental support - Corrected Proof

Sang-Mi Park, Sung-il Cho, Sang-Sik Moon — 2010-04-08

Abstract: Objectives: Suicidal ideation is an important phase in the suicidal process, preceding suicide attempts and completed suicide. Weak social ties and low support from friends or relatives have been significantly associated with suicidal ideation. This study investigated the relationship between social support and suicidal ideation among young and middle-aged adults in Korea.Methods: The Seoul Citizens Health and Social Indicators Survey conducted face-to-face interviews with 10,922 self-reporting adults. Questions were asked to assess suicidal ideation, and several questions focused on social support, social networks, health behaviors, and health status.Results: The strongest association in middle-aged adults was that between suicidal ideation and lack of social support. Poor emotional support significantly influenced suicidal ideation in middle-aged men, whereas lack of instrumental support significantly affected suicidal thoughts in middle-aged women, after controlling for sociodemographic factors, health behaviors, and health status. High alcohol use, functional limitations, and stress were related to suicidal thoughts in young adults, whereas depressive feelings had the strongest association with suicidal ideation in middle-aged women.Conclusions: Social support is a crucial independent correlate of suicidal ideation, especially in middle-aged adults in an urban community setting. This study shows that it is essential to provide gender-specific social support to prevent suicide.

Are the available apathy measures reliable and valid? A review of the psychometric evidence - Corrected Proof

2010-04-01

Abstract: Objective: Apathy is highly prevalent among neuropsychiatric populations and is associated with greater morbidity and worse functional outcomes. Despite this, it remains understudied and poorly understood, primarily due to lack of consensus definition and clear diagnostic criteria for apathy. Without a gold standard for defining and measuring apathy, the availability of empirically sound measures is imperative. This paper provides a psychometric review of the most commonly used apathy measures and provides recommendations for use and further research.Methods: Pertinent literature databases were searched to identify all available assessment tools for apathy in adults aged 18 and older. Evidence of the reliability and validity of the scales were examined. Alternate variations of scales (e.g., non-English versions) were also evaluated if the validating articles were written in English.Results: Fifteen apathy scales or subscales were examined. The most psychometrically robust measures for assessing apathy across any disease population appear to be the Apathy Evaluation Scale and the apathy subscale of the Neuropsychiatric Inventory based on the criteria set in this review. For assessment in specific populations, the Dementia Apathy Interview and Rating for patients with Alzheimer's dementia, the Positive and Negative Symptom Scale for schizophrenia populations, and the Frontal System Behavior Scale for patients with frontotemporal deficits are reliable and valid measures.Conclusion: Clinicians and researchers have numerous apathy scales for use in broad and disease-specific neuropsychiatric populations. Our understanding of apathy would be advanced by research that helps build a consensus as to the definition and diagnosis of apathy and further refine the psychometric properties of all apathy assessment tools.

Heart-focused anxiety as a mediating variable in the treatment of noncardiac chest pain by cognitive-behavioral therapy and paroxetine - Corrected Proof

Philip Spinhoven, A.J. Willem Van der Does, Eduard Van Dijk, Yanda R. Van Rood — 2010-03-31

Abstract: Objective: We compared the efficacy of cognitive behavior therapy (CBT), paroxetine and placebo in the treatment of noncardiac chest pain (NCCP). We also investigated whether pre- to mid-treatment reduction of (heart-focused) anxiety mediated mid- to post-treatment pain reduction.Methods: Sixty-nine adults with NCCP were randomly assigned to 16 weeks of outpatient treatment with CBT, paroxetine or placebo. The comparison between placebo and paroxetine was carried out in a double-blind fashion. The main outcome measure was a chest pain index (duration*intensity) as derived from daily pain diaries. Putative mediator measures were general anxiety (HADS:A) and heart-focused anxiety (Cardiac Anxiety Questionnaire).Results: Eleven patients treated with paroxetine or placebo dropped out prematurely. Intent-to-treat analysis showed that CBT was significantly superior to placebo and to paroxetine in reducing NCCP at posttreatment. Only CBT significantly reduced heart-focused anxiety compared to placebo at mid- and post-treatment. Pre- to mid-treatment reduction of heart-focused anxiety predicted mid- to post-treatment NCCP reduction. The indirect effect of CBT on pain reduction by reducing heart-focused anxiety was significant compared to placebo but not to paroxetine.Conclusion: CBT is an effective treatment option for patients with NCCP. Paroxetine is not more effective than placebo on the short term. Reduction of heart-focused anxiety by CBT seems to mediate subsequent reduction of NCCP compared to placebo. The results provide further support for cognitive–behavioral models of NCCP and point to the potential benefits of, in particular, cognitive-behavioral interventions to modify heart-focused anxiety.

The INTERMED Japanese version: Inter-rater reliability and internal consistency - Corrected Proof

2010-03-31

Abstract: Objective: The intent of this study was to establish the inter-rater reliability and the internal consistency of the Japanese version of the INTERMED.Methods: The study included a series of patients referred to psychiatric consultation service or palliative care service. The study participants were independently scored using the INTERMED by the raters.Results: The INTERMED-Japanese version had high inter-rater reliability (intraclass correlation coefficient=0.98) and high internal consistency (alpha=.89). All four domains (biological, psychological, social, and health care domains) were positively correlated. Based on a cutoff score of 20/21, a κ of 0.79 was found.Conclusions: The INTERMED is an easy and useful proactive biopsychosocial screening tool, which could be a reasonable utility under the current Japanese health care situations. Future studies focusing on the INTERMED utility in improving health care delivery for patients with complex biopsychosocial care needs has to be demonstrated in various medical settings in Japan.

The development of the irritable bowel syndrome-behavioral responses questionnaire - Corrected Proof

Silje E. Reme, Simon Darnley, Tom Kennedy, Trudie Chalder — 2010-03-17

Abstract: Objective: Unhelpful behavior related to irritable bowel syndrome (IBS) is often targeted and expected to change in treatments such as cognitive behavioral therapies. However, no scale has previously been produced to assess these dimensions. The aim of this study was to develop and validate an IBS-specific behavioral responses questionnaire.Methods: A total of 153 patients with IBS as diagnosed by a general practitioner completed the 28-item Irritable Bowel Syndrome-Behavioral Responses Questionnaire (IBS-BRQ). A total of 117 persons without IBS also completed the IBS-BRQ and were used as a control group. Tests of internal consistency and principal components analyses (PCAs) were performed on both sets of data.Results: The scale was found to be both reliable and valid with a high degree of internal consistency for both IBS patients (Cronbach's α=.86) and controls (Cronbach's α=.89). The scale differentiated significantly between IBS patients and controls (F=221, P<.01). The PCA supported a two-factor solution in both sets of data. Two items were removed from the scale due to low discriminative ability. The criterion validity was high as evidenced by a strong correlation with the Cognitive Scale for Functional Bowel Disorders (CS-FBD) (r=.67, P<.001).Conclusion: The IBS-BRQ is a valid and reliable scale that can be used for clinical as well as empirical purposes.

Illusory touch and tactile perception in somatoform dissociators - Corrected Proof

Richard J. Brown, Natalie Brunt, Ellen Poliakoff, Donna M. Lloyd — 2010-01-22

Abstract: Objective: The psychological mechanisms of somatoform dissociation (i.e., pseudoneurological symptoms) are poorly understood. This study evaluated recent theoretical predictions regarding the role of tactile perception in the development of somatoform dissociative symptoms.Methods: Eighty nonclinical participants scoring either high or low on the Somatoform Dissociation Questionnaire (SDQ-20) completed the Somatic Signal Detection Task (SSDT), a novel perceptual paradigm designed to simulate the occurrence of somatoform symptoms in the laboratory. Prior to the SSDT, participants completed a memory task designed to produce either minimal or maximal activation of tactile representations in memory.Results: The high SDQ-20 group exhibited a more liberal response criterion (c) on the SSDT than the low SDQ-20 group after controlling for negative affectivity, somatosensory amplification and depression. This effect was mainly attributable to an increased number of false alarms (i.e., illusory experiences of touch) in the high SDQ-20 group rather than an increased hit rate. General perceptual ability (i.e., tactile sensitivity) was comparable between the two groups. The memory manipulation had no effect on SSDT performance.Conclusions: Somatoform dissociators appear more likely to experience illusory perceptual events under conditions of sensory ambiguity than nondissociators, despite comparable perceptual abilities more generally. These findings support theories that identify distorted perceptual processing as a feature of somatoform dissociation. The SSDT has potential as a tool for further research in this area.

Adult attachment measures: A 25-year review - Corrected Proof

Paula Ravitz, Robert Maunder, Jon Hunter, Bhadra Sthankiya, William Lancee — 2009-12-07

Abstract: Objective: Over the past 25 years, attachment research has extended beyond infant–parent bonds to examine dyadic relationships in children, adolescents, and adults. Attachment has been shown to influence a wide array of biopsychosocial phenomena, including social functioning, coping, stress response, psychological well-being, health behavior, and morbidity, and has thus emerged as an important focus of psychosomatic research. This article reviews the measurement of adult attachment, highlighting instruments of relevance to—or with potential use in—psychosomatic research.Methods: Following a literature search of articles that were related to the scales and measurement methods of attachment in adult populations, 29 instruments were examined with respect to their utility for psychosomatic researchers.Results: Validity, reliability, and feasibility were tabulated on 29 instruments. Eleven of the instruments with strong psychometric properties, wide use, or use in psychosomatic research are described. These include the following: Adult Attachment Interview (George, Kaplan, and Main); Adult Attachment Projective (George and West); Adult Attachment Questionnaire (Simpson, Rholes, and Phillips); Adult Attachment Scale (and Revised Adult Attachment Scale) (Collins and Read); Attachment Style Questionnaire (Feeney); Current Relationship Interview (Crowell and Owens); Experiences in Close Relationships (Brennan, Clark, and Shaver) and Revised Experiences in Close Relationships (Fraley, Waller, and Brennan); Parental Bonding Instrument (Parker, Tupling, and Brown); Reciprocal Attachment Questionnaire (West and Sheldon-Keller); Relationship Questionnaire (Bartholomew and Horowitz); and Relationship Scales Questionnaire (Grifiin and Bartholomew).Conclusion: In addition to reliability and validity, investigators need to consider relationship focus, attachment constructs, dimensions or categories of interest, and the time required for training, administration, and scoring. Further considerations regarding attachment measurement in the context of psychosomatic research are discussed.

Social support concepts and measures - Corrected Proof

Benjamin H. Gottlieb, Anne E. Bergen — 2009-12-07

Abstract: Distinctions among concepts and approaches to assessing social support are made, and published generic and specialized measures of social support are reviewed. Depending on study aims, investigators may be interested in assessing perceived or received support from the perspective of the provider, the recipient, or both. Whereas some measures inquire about the availability or mobilization of several kinds of supportive resources, others seek supplemental information about the membership and structural properties of the social network as well. Observational and self-reported measures of support are presented, along with brief and extensive measures. A final set of three support measures is highlighted, including their psychometric properties.

Assessment methods for eating disorders and body image disorders - Corrected Proof

Ferenc Túry, Hayriye Güleç, Elisabeth Kohls — 2009-09-24

Abstract: The growing interest in the treatment and research of eating disorders has stimulated the development of assessment methods, and there are now many questionnaires for evaluating behavioral and attitudinal characteristics of eating pathology. The present article sets out to review the assessment tools that are widely used in clinical practice and research. In particular, it covers self-report measures with summaries of their psychometric properties. It also presents diagnostic questionnaires based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria. The instruments described include screening questionnaires, measurement tools for specific eating disorder symptoms, measurement of quality of life in eating disorders, and some tools for the measurement of body image disorder, a common feature of eating disorders. There is also a discussion of distorting factors that decrease the authenticity of assessment tools. These problems arise from the definition of some constructs and from the phenomena of denial and concealment, which are frequent among eating-disordered individuals. The frequent co-occurrence of other psychopathological features (e.g., multiimpulsive symptoms) shows that other psychological phenomena should also be evaluated in line with the assessment of eating disorders.

Measurement of psychiatric treatment adherence - Corrected Proof

2009-07-27

Abstract: Objective: Nonadherence to medications for mental disorders substantially limits treatment effectiveness and results in higher rates of relapse, hospitalization, and disability. Accurate measurement of medication adherence is important not only in adherence research but also in clinical trials in which medications are being evaluated and in clinical practice where failure to detect nonadherence results in premature medication changes, unnecessary polypharmacy, and greater likelihoods of functional deteriorations and hospitalizations. This is a review of psychiatric treatment adherence methods and measures arising from a meeting on “Methodological Challenges in Psychiatric Treatment Adherence Research” held on September 27–28, 2007, in Bethesda, MD, and organized by the National Institute of Mental Health (NIMH).Methods: This paper reviews the range of modalities currently available for assessing adherence behavior including pill counts, pharmacy records, technology-assisted monitoring, biological assays, and a range of self-report and interviewer-rated scales. Measures of adherence attitudes are also reviewed.Results: Each of the adherence measures described are imperfect estimates of actual medication ingestion, but each provides informative estimates of adherence or the attitudinal factors associated with adherence. Measure selection depends on a range of factors including the patient sample, the context in which the measure is being used, and the clinical outcomes expected from various levels of nonadherence. The use of multiple measures of adherence is encouraged to balance the limitations of individual measures.Conclusion: While adherence assessment has become increasingly sophisticated in recent years, there remains a need for refinement and expansion on currently available methods and measures.