Journal of Psychosomatic Research - Articles in Press

Assessing the relationship between rumination and cortisol: A review - Corrected Proof

Peggy M. Zoccola, Sally S. Dickerson — 2012-05-17

Abstract: Objective and methods: For individuals who ruminate, or mentally rehearse past stressful events, the physiological effects of a stressor may be longer lasting. This is well-supported within the cardiovascular domain. In the context of the hypothalamic–pituitary–adrenal (HPA) axis and cortisol, the results are inconsistent. This review summarizes key theoretical and methodological issues that contribute to these mixed findings among the 15 studies to date that have examined the association between rumination and cortisol.Results: State measures of rumination were consistently linked to increased cortisol concentrations. Stress-related rumination questionnaires were often positively associated with cortisol, whereas depression-related rumination scales predicted lower cortisol concentrations or were unrelated to cortisol. Rumination manipulations in the laboratory (e.g., ruminative self-focused writing tasks compared to distraction writing tasks) influenced cortisol concentrations, but often did not increase cortisol relative to baseline values. Studies that utilized social-evaluative stressor tasks to examine the relationship between rumination and cortisol levels generally showed that rumination predicted greater cortisol reactivity or delayed recovery. Results from studies examining rumination and basal cortisol or the cortisol awakening response were inconsistent.Conclusion: The ways in which researchers conceptualize and assess rumination and the associated cortisol response influences the association between rumination and cortisol. Suggestions for future studies in this area of research are provided.

Changes in social support within the early recovery period and outcomes after acute myocardial infarction - Corrected Proof

2012-05-16

Abstract: Objective: To examine changes in social support during early recovery after acute myocardial infarction (AMI) and determine whether these changes influence outcomes within the first year.Methods: Among 1951 AMI patients enrolled in a 19-center prospective study, we examined changes in social support between baseline (index hospitalization) and 1month post-AMI to longitudinally assess their association with health status and depressive symptoms within the first year. We further examined whether 1-month support predicted outcomes independent of baseline support. Hierarchical repeated-measures regression evaluated associations, adjusting for site, baseline outcome level, baseline depressive symptoms, sociodemographic characteristics, and clinical factors.Results: During the first month of recovery, 5.6% of patients had persistently low support, 6.4% had worsened support, 8.1% had improved support, and 80.0% had persistently high support. In risk-adjusted analyses, patients with worsened support (vs. persistently high) had greater risk of angina (relative risk=1.46), lower disease-specific quality of life (β=7.44), lower general mental functioning (β=4.82), and more depressive symptoms (β=1.94) (all p≤.01). Conversely, patients with improved support (vs. persistently low) had better outcomes, including higher disease-specific quality of life (β=6.78), higher general mental functioning (β=4.09), and fewer depressive symptoms (β=1.48) (all p≤.002). In separate analyses, low support at 1month was significantly associated with poorer outcomes, independent of baseline support level (all p≤.002).Conclusion: Changes in social support during early AMI recovery were not uncommon and were important for predicting outcomes. Intervening on low support during early recovery may provide a means of improving outcomes.

When the ringing in the ears gets unbearable: Illness representations, self-instructions and adjustment to tinnitus - Corrected Proof

Manja Vollmann, Natallia Kalkouskaya, Berthold Langguth, Margreet Scharloo — 2012-05-16

Abstract: Objective: Chronic tinnitus can severely impair a person's quality of life. The degree of impairment, however, is not closely related to tinnitus loudness. Applying the common sense model (CSM) of self-regulation of health and illness, this study investigated to what extent psychological factors, i.e. illness representations and positive/negative self-instructions, are associated with the degree of tinnitus-related complaints.Methods: In this cross-sectional study, 118 patients diagnosed with chronic tinnitus filled in questionnaires assessing illness representations (IPQ-R), positive and negative self-instructions (TRSS), and tinnitus-related complaints (TQ).Results: Regression analysis yielded a number of significant associations between illness representations and tinnitus-related complaints, particularly for the IPQ-R dimensions identity, consequences, coherence, and emotional representations. With regard to self-instructions and tinnitus-related complaints, significant effects were found only for negative self-instructions. Moreover, multiple mediation analysis revealed that the effects of consequences and emotional representations on tinnitus-related complaints were (partially) due to the use of negative self-instructions.Conclusion: Psychological factors are strongly related to the extent of tinnitus-related complaints. The findings provide an indication of which aspects should be targeted in psychological and psychotherapeutic tinnitus treatment.

Exposure to negative acts at work, psychological stress reactions and physiological stress response - Corrected Proof

Annie Hogh, Åse M. Hansen, Eva G. Mikkelsen, Roger Persson — 2012-05-09

Abstract: Objectives: The overall aim of the study was to test the association between exposure to negative acts at work, psychological stress-reactions and cortisol secretion and whether some negative acts are more detrimental to health than others.Methods: A questionnaire study included 1010 respondents from 55 workplaces. Three saliva samples collected from the participants at awakening, 30min later and at 20:00 during a workday were analysed for cortisol concentrations. Negative acts were measured using a modified version of the revised Negative Acts Questionnaire (to measure bullying behaviour). Factor analyses identified four subscales: social isolation, direct harassment, intimidating behaviour and work related acts. Psychological stress-reactions were measured by the Impact of Event Scale (IES) measuring traumatic stress-reactions.Results: Having controlled for gender, age, other traumatic incidents and physical violence, multiple regression analyses showed significant linear associations between social isolation and the three IES scales: hyper-arousal, intrusive thoughts, and avoidance behaviour. Work-related negative acts were significantly associated with all three outcome scales though to a lesser degree, whereas direct harassment was only associated with avoidance behaviour. Intimidating acts were significantly associated with hyper-arousal. We found significantly reduced levels of cortisol concentration for exposure to direct harassment and intimidating behaviour.Conclusion: The results show that some negative acts such as direct harassment and intimidating behaviour are associated with psychological stress-reactions and a negative physiological stress response. Extending previous research this indicates that some negative acts are more detrimental than others in so far as exposure to these acts affects both psychological and physiological health.

Improvement of EEG slowing in OSAS after CPAP treatment - Corrected Proof

Sang Don Lee, Gawon Ju, Jeong-Whun Kim, In-Young Yoon — 2012-05-09

Abstract: Objectives: This study was done to investigate change of electroencephalography (EEG) slowing and its relationship to daytime sleepiness and cognitive functions by continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea syndrome (OSAS).Methods: We enrolled thirteen male subjects with severe OSAS, and all the subjects were treated with CPAP for 3months. Quantitative EEG (QEEG) and neuropsychological tests were performed before and after CPAP treatment.Results: After CPAP treatment, delta absolute power decreased in the frontal, central, parietal and temporal regions and the slowing ratio was reduced in the frontal region. The Epworth Sleepiness Scale (ESS) score was reduced after CPAP treatment. Reduction in the ESS score was correlated with a decrease in delta absolute power in the frontal region (r=0.559) and a decrease in slowing ratio in frontal, central, parietal, and temporal regions (frontal, r=0.650; other regions, r=0.603). Results of neuropsychological tests assessing memory and attention were improved after CPAP treatment.Conclusions: EEG slowing was decreased across all cerebral regions in patients with severe OSAS after CPAP treatment accompanied by improvement of cognitive functions involving several brain areas. These findings suggest that CPAP can induce improvement of cerebral function in OSAS without regional specificity.

Further research needed: A comment on Coyne and van Sonderen's call to abandon the Hospital Anxiety and Depression Scale - Corrected Proof

Sam Norton, Amanda Sacker, John Done — 2012-05-07

Coyne and van Sonderen provide a commentary to Cosco et al.'s systematic review of the Hospital Anxiety and Depression Scale (HADS) that calls for the abandonment of this widely used assessment of psychological distress. This judgement is based mainly on their perception of inconsistent findings with regard to its factor structure. We argue that the inconsistency is due to the hierarchical structure of anxiety and depression and that interpretation of literature from this perspective resolves the issue.

The Hospital Anxiety and Depression Scale (HADS) is dead, but like Elvis, there will still be citings - Corrected Proof

James C. Coyne, Eric van Sonderen — 2012-05-04

We apologize to readers if we were unclear about our reasons for calling for the abandonment of the HADS and we thank Sam Norton and colleagues for providing an occasion for us to clarify. Our jumping off point was indeed a review by Cosco and colleagues demonstrating considerable inconsistency in the latent structure of the HADS. However, for us, the Cosco et al. analyses served as an impetus for considering the numerous structural, conceptual, and psychometric problems of this instrument that have led to wildly inconsistent findings and recommendations for cutpoints in what has now become a thoroughly confused literature.

Frequency and natural history of fatigue after stroke: A systematic review of longitudinal studies - Corrected Proof

Fiona Duncan, Simiao Wu, Gillian E. Mead — 2012-05-01

Abstract: Background: Fatigue is a common and distressing symptom after stroke. Stroke survivors and health professionals need to know whether fatigue is likely to improve, or get worse over time; and whether there is a temporal association with depression or anxiety, which might provide a target for treatment,Aims and objectives: To systematically review all longitudinal observational studies which have assessed fatigue on at least two separate time points after stroke onset to determine its frequency, natural history and temporal relationship with anxiety and/or depression.Method: We systematically searched MEDLINE, EMBASE, CINAHL and PsychInfo using the keywords “fatigue” and “stroke” and their associated terms or synonyms. Data were extracted regarding time points after stroke where fatigue was assessed, frequency of fatigue at each time point and any reported associations with anxiety and/or depression.Results: 101 full texts were retrieved after scrutinising the titles and abstracts. Nine fulfilled our inclusion criteria. Fatigue was assessed at a variety of time points after stroke (from admission—to 36months). The frequency of fatigue ranged from 35%–92% at the first time point. Frequency of fatigue declined across time points in seven of the studies (n=764) and increased in two studies (n=195). Three papers found significant associations between fatigue and mood at the same time point. The single study investigating temporal associations between fatigue and mood disorders reported that depression predicted subsequent fatigue.Conclusions: Fatigue is present soon after stroke onset and remains common in the longer term. There is little evidence regarding the temporal relationship between fatigue and mood: this is an area where further research is needed.

Smoking, childhood IQ, and cognitive function in old age - Corrected Proof

Janie Corley, Alan J. Gow, John M. Starr, Ian J. Deary — 2012-04-30

Abstract: Objectives: To examine the association between smoking history and cognitive function in old age, and whether it remains after controlling for childhood cognitive ability (IQ) and adult socioeconomic status (SES).Methods: In the Lothian Birth Cohort 1936 Study, 1080 men and women, who previously participated in a nationwide IQ-type test in childhood, were followed up at age 70. The associations between smoking history and age 70 IQ, general cognitive ability (g), processing speed, memory, and verbal ability were assessed.Results: Lower childhood IQ was associated with a higher risk of becoming a smoker and continuing to smoke in late life, and with reduced lung function (FEV1) in late life. Current smokers scored significantly lower than ex-smokers and never smokers on tests of age 70 IQ, general cognitive ability, and processing speed, but not memory or verbal ability. After controlling for childhood IQ and SES, current smoking at age 70 (but not pack years of smoking) was associated with impairments in general cognitive ability and processing speed.Conclusion: Smoking in old age makes a small, independent contribution to cognitive performance in old age.

Pain and the relationship with mood and anxiety disorders and psychological symptoms - Corrected Proof

Lana J. Williams, Julie A. Pasco, Felice N. Jacka, Seetal Dodd, Michael Berk — 2012-04-23

Abstract: Objective: The objective of this study was to investigate the association between pain and mood and anxiety disorders, as well as psychological symptoms, in a population-based sample of women.Methods: This study examined the data collected from 1067 women aged 20–93years (median 51years) participating in the Geelong Osteoporosis Study. Mood and anxiety disorders were diagnosed using a clinical interview (SCID-I/NP) and psychological symptomatology was assessed using the General Health Questionnaire. Pain was determined using a Visual Analogue Scale (0–100mm) and deemed present if score≥40mm.Results: Current mood disorders were associated with an increased likelihood of overall (OR=3.2, 95% CI 2.0–5.1), headache (OR=2.8, 95% CI 1.6–4.8), back (OR=4.0, 95% CI 2.5–6.5) and shoulder pain (OR=2.2, 95% CI 1.2–4.2). In those with current mood disorders, the pain interfered with daily activities (OR=3.2, 95% CI 1.9–5.5) and was present most of their time awake (OR=2.5, 95% CI 1.5–4.1). This pattern was similarly observed for those with past mood disorders. Current anxiety disorders were associated with an increased likelihood for overall (OR=2.2, 95% CI 1.4–3.6), headache (OR=2.2, 95% CI 1.3–4.0), back (OR=1.8, 95% CI 1.1–3.0) and shoulder pain (OR=1.9, 95% CI 1.0–3.5, p=.05). In those with current anxiety disorders, the pain interfered with daily activities (OR=2.4, 95% CI 1.4–4.1) and was present most of their time awake (OR=1.9, 95% CI 1.2–3.2). There was no association between pain and past anxiety. Psychological symptomatology was associated with pain at each site (all p<.001).Conclusions: This study is consistent with studies utilising clinical samples in reporting that mood and anxiety disorders, as well as psychological symptoms, are associated with higher levels of perceived pain.

Sexual functioning among testicular cancer survivors: A case–control study in the U.S. - Corrected Proof

2012-04-23

Abstract: Objective: Sexual function among testicular cancer survivors is a concern because affected men are of reproductive age when diagnosed. We conducted a case–control study among United States military men to examine whether testicular cancer survivors experienced impaired sexual function.Methods: A total of 246 testicular cancer cases and 236 ethnicity and age matched controls were enrolled in the study in 2008–2009. The Brief Male Sexual Function Inventory (BMSFI) was used to assess sexual function.Results: Compared to controls, cases scored significantly lower on sex drive (5.77 vs. 5.18), erection (9.40 vs. 8.63), ejaculation (10.83 vs. 9.90), and problem assessment (10.55 vs. 9.54). Cases were significantly more likely to have impaired erection (OR 1.72; 95% CI 1.11–2.64), ejaculation (OR 2.27; 95% CI 1.32–3.91), and problem assessment (OR 2.36; 95% CI 1.43–3.90). In histology and treatment analysis, nonseminoma, chemotherapy and radiation treated cases risk of erectile dysfunction, delayed ejaculation, and/or problem assessment were greater when compared to controls.Conclusion: This study provides evidence that testicular cancer survivors are more likely to have impaired sexual functioning compared to demographically matched controls. The observed impaired sexual functioning appeared to vary by treatment regimen and histologic subtype.

Frequent attendance in family practice and common mental disorders in an open access health care system - Corrected Proof

2012-04-16

Abstract: Frequent attenders in family practice are known to have higher rates of mental disorder. However little is known about specific psychiatric disorders and whether this behavior extends to specialist services, in an open access fee-for-service health care system.Methods: 1060 patients from 46 family practices completed the Patient Health Questionnaire and the Client Service Receipt Inventory. During the consultation, family practitioners blind to the questionnaire responses rated the severity of mental health and physical disorders. The 10% of patients with the highest number of 6-month consultations in six age and sex stratified groups were defined as frequent attenders.Results: After adjustments for sociodemographic variables, physical health and other psychiatric diagnoses, patients with a somatoform disorder were more likely to be frequent attenders, with an odds ratio of 2.3 (95% CI: 1.3–3.8, p=.002).Conclusion: When adjusting for confounders, among the four psychiatric diagnoses investigated only somatoform disorders remain significantly associated with frequent attendance. Physical health and chronic disease were no longer associated with frequent attendance which does not support the hypothesis that in an open access fee-for-service system, patients will consult for a wider range of health problems. Greater investigation into unexplained somatic symptoms could help reduce the frequency of attendance in both primary and secondary care, as this behaviour appears to be a general health-seeking drive than extends beyond family practice.

Is co-morbid depression adequately treated in patients repeatedly referred to specialist medical services with symptoms of a medical condition? - Corrected Proof

Michael Sharpe, Christopher Burton, Aarti Sawhney, Kelly McGorm, David Weller — 2012-04-13

Abstract: Objective: Patients with a medical condition and co-morbid depression have more symptoms and use more medical services. We aimed to determine the prevalence of depression and the adequacy of its treatment in patients who had been repeatedly referred from primary to specialist medical care for the assessment of a medical condition.Methods: All patients who had at least three referrals to medical and surgical specialists for an assessment of symptoms attributed to a medical condition, over a five year period from five primary care practices in Edinburgh, UK were identified using a referral database and review of records. Participants were sent a questionnaire which included the PHQ-9 depression scale and additional questions about depression during the preceding 5years. Details of treatment for depression were obtained from primary care records.Results: Questionnaires were sent to 230 patients and returned by 162 (70.4%). Forty-one (25.3%) had a PHQ-9 score of 10 or more and hence probable current depressive disorder. An additional 36 (22.2%) reported depression in the previous 5years. Only eight (19.5%) of those reporting current depression and 20 (26%) of the 77 patients reporting previous depression had received minimally adequate treatment for it.Conclusion: Whilst we know that patients with medical conditions are often depressed and that such co-morbid depression is often undertreated, we have found that it is undertreated even in patients repeatedly referred to medical specialists. Better assessment and management of depression in such patients could both improve patients' quality of life and reduce the cost of care.

Dynamic risk factors in the misuse of opioid analgesics - Corrected Proof

2012-04-09

Abstract: Objective: Identify the risk factors for prescription opioid misuse among patients taking prescription opioids to deal with chronic pain.Methods: We examined the literature for a variety of dynamic risk factors associated with opioid misuse among the chronic pain population in order to present a narrative review. Considered were: taking single or multiple opioids, pain intensity, mental health disorders, including a history of preadolescent sexual abuse, personal and familial history of substance abuse, a history of legal problems, being a crime victim, drug-seeking behaviors, drug craving, and age.Results: A variety of risk factors have been studied in the literature. Risk factors in chronic opioid therapy patients are dynamic in that they can change with disease progression, tolerance, changes in pain quality, mental health, comorbidities, other drug therapies or drug interactions, and changes in the patient's lifestyle.Conclusion: Opioid analgesic therapy must be tailored to carefully monitor all patients in order to minimize misuse and abuse, since the risk is constant and dynamic and therefore every patient is at some degree of risk for opioid misuse.

A nurse-led mental health service for people with multiple sclerosis - Corrected Proof

Sally Askey-Jones, Eli Silber, Pauline Shaw, Richard Gray, Anthony S. David — 2012-04-05

Abstract: Background: Mental health problems are under recognised and under treated in people with multiple sclerosis (MS).Method: A nurse-led project linking MS and mental health services was evaluated. Data on all referrals and management from 2006 to 2008 were collected prospectively.Results: 127 referrals were received. 82% had depression, 53% had anxiety (45% both). 42% were offered case management; 52% received Cognitive Behaviour Therapy (CBT), 55% required initiation or alteration of psychiatric medications and 19% were referred to secondary care; 16% had made suicidal plans. Significant improvements in depression at 6months occurred, but not anxiety or fatigue.Clinical implications: This service provides a model of mental health provision for patients with long term neurological conditions, in particular MS.

Sleepiness and sleep quality in patients with HIV infection - Corrected Proof

Tanja Wibbeler, Doris Reichelt, Ingo-W. Husstedt, Stefan Evers — 2012-04-05

Abstract: Objectives: Patients with HIV infection frequently complain of sleep disturbances and daytime sleepiness. Only few data on these problems evaluated by standardized measures is available.Methods: A sample of 180 consecutive patients with HIV infection referred to the internal and to the neurological HIV clinics at the University of Münster was enrolled in this study. The data were compared to a sample of 120 age- and sex-matched control subjects. We used the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the Beck's Depression Inventory (BDI). In addition, the clinical and immunological data of the patients were registered.Results: All scores of the ESS, the PSQI, and the BDI were significantly increased in the HIV infected patients as compared to the control group. There were no significant correlations between any of the immune parameters and the scores. Only a higher BDI score was correlated with both the ESS score and the PSQI score.Conclusions: Patients with HIV infection and not using evavirenz show an increased daytime sleepiness and a decreased quality of sleep. These findings could not be related to the immunological state of the patients. The only specific factor influencing daytime sleepiness in HIV infected patients is probably treatment with HAART. The most important factor determining sleepiness and sleep quality in HIV infected patients is depression which was found to be independent from the immunological state and HAART of the patients.

Profiling illness perceptions to identify patients at-risk for decline in health status after heart valve replacement - Corrected Proof

Sebastian Kohlmann, Helen Rimington, John Weinman — 2012-04-04

Abstract: Objective: Identification of risk factors for decline in health status by profiling illness perceptions before and one year after heart valve replacement surgery.Methods: Prospective data from N=225 consecutively admitted first time valve replacement patients was assessed before and one year after surgery. Patients were asked about their illness perceptions (Illness Perception Questionnaire-Revised) and mood state (Hospital Anxiety and Depression Scale). Health status was defined by quality of life (Short-Form 36) and New York Heart Association (NYHA) class. Cluster analyses were conducted to identify illness perception profiles over time. Predictors of health status after surgery were analyzed with multivariate methods.Results: Patients were grouped according to the stability and nature (positive, negative) of their illness perception profile over one year. One year after surgery patients holding a negative illness perception profile showed a lower physical quality of life and were diagnosed in a higher New York Heart Association class than patients changing to positive and patients with stable positive illness perceptions (P<.001). Over and above biological determinants, post-surgery physical quality of life and NYHA class were both predicted by pre-surgery illness perception profiles (P<.05).Conclusion: Patients going for heart valve replacement surgery can be easily categorized into illness perception profiles that predict health status one year after surgery. These patients could benefit from early screening as negative illness perceptions are modifiable risk factors.

Post-traumatic stress disorder (PTSD) in cardiology and oncology — which diagnostic tools should be used? - Corrected Proof

Franziska Einsle, Dagmar Kraft, Volker Köllner — 2012-03-29

Abstract: Objectives: PTSD prevalence rates in cardiac and cancer patients greatly vary probably due to diverging samples, designs and assessments. Aim of this study was therefore to compare prevalence rates of PTSD as well as instruments assessing PTSD in different cardiac and cancer patient groups.Methods: A total of 274 cardiac and cancer patients were examined with the Post-Traumatic Stress Scale 10 (PTSS-10) and the Impact of Event Scale — revised (IES-R). Presence of PTSD was validated by Structured Clinical Interview for DSM-IV (SCID).Results: Diagnostic criteria for the existence of PTSD were met by 29.2% of all patients via PTSS-10, by 7.6% in IES-R and by 4.8% in SCID, indicating substantial discrepancy among assessments. This is further underlined by the moderate correlation between self-reports and poor agreement with the standardised interview.Conclusion: A structured interview is the “gold standard” for diagnosing PTSD in cardiac and cancer patients. Questionnaires can be used as screening instruments when they reliably assess trauma-related diagnostic criteria. Further studies are necessary to clarify the specifics of trauma criteria in medical setting.

Type D personality and three-month psychosocial outcomes among patients post-myocardial infarction - Corrected Proof

Lynn Williams, Rory C. O'Connor, Neil R. Grubb, Ronan E. O'Carroll — 2012-03-26

Abstract: Objective: Type D personality has been proposed as a risk factor for poor prognosis in cardiac patients. Recent studies which have adopted a dimensional approach to Type D (negative affectivity×social inhibition) found no effect of Type D on mortality, after controlling for its constituent elements. To-date, no study has determined if Type D is associated with psychosocial outcomes in post-myocardial infarction (MI) patients when conceptualised as a dimensional variable.Methods: Participants were 192 MI patients (138 males, 54 females, mean age 66.0years) who provided demographic and clinical information, and completed measures of Type D one-week post-MI. Three months later, 131 of these MI patients completed measures of disability and quality of life.Results: Using regression analyses, adjusted for demographic and clinical data, Type D emerged as a significant predictor of disability and quality of life in MI patients, when analysed using the traditional categorical approach. However, Type D did not predict disability and quality of life when it was analysed using the interaction of negative affectivity and social inhibition. Negative affect emerged as a significant predictor of both disability (β=.433, t(130)=3.53, p<.01), and quality of life (β=−.624, t(130)=−5.68, p<.001).Conclusions: The results suggest that Type D is not associated with short-term psychosocial outcome in MI patients, after controlling for its constituent elements. However, negative affect was significantly associated with both disability and quality of life. Future research should conceptualise Type D as the interaction between negative affectivity and social inhibition, rather than as a typology.

Training in consultation–liaison psychiatry in Eastern Europe - Corrected Proof

Joanna Rymaszewska, Wolfgang Söllner — 2012-03-22

Interest in a subject of consultation–liaison psychiatry reached Europe rather late, and included mainly Western European countries. Beginning with the 1960s–1970s, liaison psychiatry acquired credit in Europe, particularly in France, Germany, Italy, the Netherlands, Spain, Switzerland and the United Kingdom. Starting with the 1990s, the term liaison psychiatry has become widely used in the literature . The European activity of liaison psychiatry and psychosomatics was first evaluated in a study commissioned in 1987 by the European Community. The study included 11 countries: Finland, Norway, the United Kingdom, Germany, the Netherlands, Belgium, Greece, Italy, France, Spain and Portugal. The absence of well-developed liaison psychiatry and psychosomatic services in general hospitals led to the conclusion that the patients' mental health needs were not met . In 2002 the European C–L Workgroup Collaborative Study attempted to investigate the organisation of C–LP in Western European countries. A large variation has been found in all aspects of service delivery and size of staffing . Today, liaison psychiatry is striving to become a clinical subspecialty in an increasing number of European countries. In 1997, the European Board of Psychiatry approved the report Consultation–Liaison Psychiatry and Psychosomatic Medicine in the European Union. None of Eastern countries has been included . In 2002, the UEMS Section and Board of Psychiatry approved the Requirements for the Speciality of Psychiatry and defined consultation–liaison psychiatry as “a model or component of the psychiatrist's work that involves attending general hospital wards or outpatients, or alternatively primary care settings to see and/or discuss patients, so as to provide advice on the diagnosis and management of psychiatric disorder in such settings”.

The teaching of liaison psychiatry - Corrected Proof

2012-02-20

Abstract: Objective: To document performance and satisfaction of medical students in a short course on liaison psychiatry.Methods: The emphasis in this optional course is placed on the discussion of clinical cases, bed-side clinical teaching, and a research-oriented part. The "Innovative Teaching Plan" (ITP) is intended to train student-leaders to guide small groups (SG) of students. Trainee performance was assessed by the marks in the final examination, and a reliable and valid tool, the Medical Teaching Quality Questionnaire (MTQQ) was used to document trainee satisfaction. The results of four academic courses are presented in this report.Results: External experts consulted assured that the content of the course was adequate. It has been completed by more than 200 medical students, and high marks have been obtained by most. Above average scores (AA, “high” or “very high”) were given by substantial proportions of students in most items, related to the “relevance” of the subject, the “usefulness of the clinical cases” or the "enhancement of student-teacher interaction". Compared to the first academic course, students’ satisfaction has improved. "Enhancement of a researcher's mind" was rated AA by 61.1% of students in the last academic course, and "global satisfaction" by 88.8%.Conclusions: Good performance and high satisfaction of medical students was documented in a course on liaison psychiatry. Lessons may be drawn to inform about efficient and effective ways of teaching and learning this subject.