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Objective Most individuals experiencing whiplash accidents recover rapidly. A considerable proportion, however, develop chronic symptoms. Psychological factors may slow recovery, possibly by increasing the likelihood of other symptoms being misattributed to, and amplified by the whiplash injury. We aimed to investigate how pre-injury mental and somatic symptoms, self-rated health, use of health-services and medications, health-behavior and socio-demographics predict the development of chronic whiplash. Methods Data from two waves of a large, population based study (HUNT2 (baseline) and HUNT3) were used. Individuals reporting no whiplash at baseline were identified in HUNT3. Characteristics reported at baseline were compared between those who had developed chronic whiplash in HUNT3 (n = 199) and those who had not (n = 20,600), using Pearson's chi-squared tests, independent sample t-tests and logistic regression analyses. Results Individuals developing chronic whiplash reported worse baseline health than those reporting no chronic whiplash. Poor self-rated health was a strong risk factor for subsequent chronic whiplash (OR = 2.26, 95%CI: 1.68–3.04). Musculoskeletal pain also increased the risk (OR = 1.21, 95%CI: 1.15–1.26), as did diffuse somatic symptoms (OR = 2.09, 95%CI: 1.47–2.96), use of different health services (OR = 1.31, 95%CI: 1.19–1.45), high use of medications (OR = 1.28, 95%CI: 1.14–1.43) and symptoms of anxiety (OR = 1.93, 95%CI: 1.39–2.68). Physical activity was protective (OR = 0.67, 95%CI: 0.49–0.91). Most socio-demographic variables were not significantly associated with chronic whiplash. Conclusion Poor somatic and mental pre-injury health increased the risk of subsequent chronic whiplash. This suggests that chronic whiplash is not merely an organic disorder, and highlights the importance of individual expectations, symptom reattribution and amplification in development of chronic whiplash.

The aim of the research described here is to provide knowledge of adolescents and their coping strategies through the construct of mindful coping. Little is known about the contributions of mindfulness to the enhancement of mental health in adolescents. Inspired by dialectical behaviour therapy (Linehan, 1993a, b), we discuss the mindful coping process and investigate how different aspects of this process are related to mental health in a non-clinical adolescent sample. The empirical approach consisted of a cross-sectional study of 652 high-school students from two high schools, covering all streams. The relations between the four proposed mindful coping aspectsawareness, distraction, preventing negative emotions and constructive self-assertionwith psychological symptoms (PS), as well as how these four aspects moderated the relationship of perceived life strains (LS) with PS, were studied. The results show that coping by preventing negative emotions and constructive self-assertion were associated with few...

OBJECTIVE: To assess the role of personality as a predictor of Short form-36 (SF-36) in distressed patients (perceived stress questionnaire, PSQ) with ulcerative colitis (UC) and Crohn's disease (CD). MATERIAL AND METHODS: Fifty-four patients with CD and 55 with UC (age 18-60 years) who had relapsed in the previous 18 months, i.e. with an activity index (AI) for UC or CD> or =4, PSQ> or =60, and without severe mental or other major medical conditions, completed the Buss-Perry Aggression Questionnaire (BPA), the Neuroticism and Lie scales of the Eysenck Personality Questionnaire (EPQ-N and -L), the Multidimensional Health Locus of Control Scale (LOC) (Internal (I), Powerful Other (PO), Chance (C)), the Toronto Alexithymia Scale (TAS) and the SF-36. RESULTS: Multiple linear regression analyses controlling for gender, age and clinical disease activity (AI) in separate analyses for UC and CD showed that the mental and vitality subscales were predicted by neuroticism in both UC and CD. The highest explained variance was 43.8% on the "mental" subscale in UC. The social function subscale was related to alexithymia only in UC, while the role limitation and pain subscales were related to personality in CD only. The physical function subscale related differently to personality in UC and CD. CONCLUSIONS: While mental and vitality subscales were predicted by neuroticism in both UC and CD, other subscales had different relationships to personality, suggesting different psychobiological interactions in UC and CD.

Zu den chronisch entzundlichen Darmerkrankungen (CED) gehoren die Colitis ulcerosa (UC) und der Morbus Crohn (CD). Kennzeichen dieser entzundlichen Erkrankungen des Intestinaltraktes bisher unbekannter Ursache ist ein chronischer, meist rezidivierender Verlauf. Zu den Symptomen gehoren Bauchschmerzen und -krampfe, Durchfalle, Gewichtsabnahme und Blutverlust aus dem Darm. Beim Morbus Crohn, der alle Abschnitte des Gastrointestinaltraktes befallen kann, finden sich haufig Ulzera am Ubergang zwischen Dunn- und Dickdarm. Bei einigen Patienten entstehen Fisteln zwischen Darmabschnitten, zu nahe liegenden Organen oder zur Haut. Bei der Colitis ulcerosa, die meist im Rektum beginnt und sich variierend nach proximal ausbreitet, entstehen diffuse und kontinuierliche Schleimhautulzerationen. Die somatische Behandlung ist abhangig von der Krankheitsaktivitat und beinhaltet 5-Aminosalicylate (5-ASA), Kortikosteroide und Immunsuppressiva (Azathioprin, Methotrexat, Ciclosporin, Infliximab). Sowohl die Glukokortikoide als auch Tumornekrosefaktor-Alpha-Antikorper (Infliximab) konnen zu psychischen und psychiatrischen Nebenwirkungen fuhren, am haufigsten Angst und Depressionen bzw. Manie. Auser der Erhohung der Lithiumkonzentration durch Methotrexat sind ernsthafte Interaktionen mit Psychopharmaka selten. Es gibt Anhaltspunkte fur eine negative Auswirkung auf den Krankheitsverlauf durch subjektiv erlebten Stress und fur ein etwas haufigeres Vorkommen psychischer Storungen als in der Normalbevolkerung. Gesicherte Nachweise fur die Zuordnung der chronisch entzundlichen Darmerkrankungen zu psychosomatischen Erkrankungen im traditionellen Verstandnis sind nicht gegeben. Unter Experten besteht Konsens, Patienten mit diesen Erkrankungen bei Vorhandensein chronischer Stressbelastungen oder eventuellen psychischen Storungen eine Behandlung anzubieten. Die Therapie erfolgt nach den ublichen Behandlungsleitlinien. Alle Psychopharmaka konnen eingesetzt werden. Eine Lithiumbehandlung ist schwer zu kontrollieren. Demgegenuber gibt es keine ausreichenden Hinweise, routinemasig den betroffenen Patienten eine psychodynamische oder andere Form von Psychotherapie anzubieten.

Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications

The aim of this study was to elucidate the relationship between duodenal ulcer (DU) disease and psychological symptoms.Sixty-four Helicobacter pylori-positive patients with frequently relapsing DUs (patient group 1) were compared with 78 control subjects without dyspepsia, starting 2 years before and ending 10 years after eradication of H. pylori. Seven non-relapsing and untreated patients (patient group 2) were also followed-up.The relapse rate was reduced from 100% per year in the two years before anti-H. pylori treatment to 0.3% per year after treatment in patient group 1. The reinfection rate was 0.7% per year. Anxiety and neuroticism were high at inclusion, but had normalized at the 10-year follow-up in relapse-free patients. There was no increase of gastro-oesophageal reflux symptoms during the 10 years after H. pylori eradication.Normalization of anxiety and neuroticism following cure of DU disease supports the view that the increased anxiety and neuroticism are consequences, and not causes, of the disease.

Functional dysepsia (FD) is defined as persistent or recurrent pain or discomfort centered in the upper abdomen without evidence of organic disease likely to explain the symptoms. Visceral hypersensitivity, motor dysfunction, and impaired gastric accommodation are found in some patients with FD, and psychological factors like chronic stress, attention and perception bias are also likely to play a part in the symptom formation. There is considerable overlap of non-specific symptoms like fatigue, headache, abdominal discomfort, muscle pain, and sleep disturbance in patients with different functional disorders, in this article exemplified by FD, fibromyalgia, and chronic fatigue syndrome. This overlap of symptoms indicates a common underlying sensitization process, leading to somatization.

Background : In patients with low-grade reflux oesophagitis adequate symptom control is the aim of treatment. Effervescent tablets alleviate heartburn more rapidly than ordinary tablets. Aim : To investigate symptom control, patient satisfaction, health-related quality of life and disease progress when ranitidine 150 mg effervescent tablets were offered as on demand treatment. We also wanted to investigate whether any biological or psycho-social factor could predict patient satisfaction. Method : Consecutive patients with endoscopically verified reflux oesophagitis grade I–II were followed up for 12 months. 24 h pH-metry, disease history, symptoms and several psycho-social factors were registered at baseline and 12 months follow-up. Results : Eighty-one patients were included. Mean age was 50.7 years (range 21–82), 63% were men. Mean tablet consumption was 1.21 per day (range 7–1016 tablets/year). At the 1-year follow-up discomfort resulting from reflux symptoms was significantly reduced (P

Participation in screening programs for malignant disease may have negative psychologic health effects that could outweigh the beneficial effects of the screening itself. The present study was designed to investigate the psychologic effect of attending a screening program for detection and removal of colorectal adenomas, which are precursors to colorectal cancer.In 1983 a prospective. controlled screening study using flexible sigmoidoscopy to detect adenomas was started in Telemark County, Norway. Four hundred individuals were enrolled as a screening group and 399 as a control group. In 1996 survivors in both groups were invited to have a colonoscopic screening examination for detection and removal of polyps. Four hundred and fifty-one individuals (71%) attended; their mean age was 67.2 years (range, 63-72 years), and 48% were women. Fourteen days and 3 and 17 months after the examination the attendees received by mail a questionnaire composed of Goldberg's General Health Questionnaire (GHQ-28) and the Hospital Anxiety and Depression Scale (HADS). The questionnaire was also mailed to an age- and sex-matched group not enrolled in the endoscopic screening study. Four hundred and nine (95%), 395 (92%), and 389 (91%), respectively, returned the questionnaire. Of the controls 314 (70%) returned filled-in questionnaires.The scores for both GHQ-28 and HADS were lower, indicating a lower level of psychiatric morbidity among those attending the examination in 1996 than among the controls. There was a trend towards higher scores with increasing time after the examination in the screened group.During the first 17 months after screening the attendees, as a group, did not appear to have developed untoward psychologic effects as judged by HADS and GHQ questionnaires.

Measures of disability pensions, sickness certification and long-term health related benefits are often self-reported in epidemiological studies. Few studies have examined these measures, and the validity is yet to be established. We aimed to estimate the validity of self-reported disability pension, rehabilitation benefit and retirement pension and to explore the benefit status and basic characteristics of those not responding to these items. A large health survey (HUNT2) containing self-reported questionnaire data on sickness benefits and pensions was linked to a national registry of pensions and benefits, used as “gold standard” for the analysis. We investigated two main sources of bias in self-reported data; misclassification - due to participants answering questions incorrectly, and systematic missing/selection bias - when participants do not respond to the questions. Sensitivity, specificity, positive (PPV) and negative (NPV) predicative value, agreement and Cohen’s Kappa were calculated for each benefit. Co-variables were compared between non-responders and responders. Results: In the study-population of 40,633, 9.2% reported receiving disability pension, 1.4% rehabilitation benefits and 6.1% retirement pension. According to the registry, the corresponding numbers were 9.0%, 1.7% and 5.4%. Excluding non-responders, specificity, NPV and agreement were above 98% for all benefits. Sensitivity and PPV were lower. When including non-responders as non-receivers, specificity got higher, sensitivity dropped while the other measures changed less. Between 17.7% and 24.1% did not answer the questions on benefits. Non-responders were older and more likely to be female. They reported more anxiety, more depression, a higher number of somatic diagnoses, less physical activity and lower consumption of alcohol (p < 0.001 for all variables). For disability pension and retirement pension, non-responders were less likely to receive benefits than responders (p < 0.001). For each benefit 2.1% or less of non-responders were receivers. False positive responses were more prevalent than false negative responses. Conclusions: The validity of self-reported data on disability pension, rehabilitation benefits and retirement pension is high – it seems that participants’ responses can be trusted. Compared to responders, non-responders are less likely to be receivers. If necessary, power and validity can be kept high by imputing non-responders as non-receivers. © Myrtveit et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background Gastrointestinal complaints are very common in the general population and very often co-occur with common mental disorders. We aimed to study the prospective impact of gastrointestinal complaints on long term sickness absence, and address the contribution from co-occurring common mental disorders and other somatic symptoms. Method Health data on 13 880 40-45 year olds from the Hordaland Health Study (1997-99) were linked to national registries on sickness absence. As part of a wider health screening, gastrointestinal complaints were ascertained. Participant's anxiety and depression, and the presence of other somatic symptoms were evaluated. In Cox regression models, we predicted sickness absences over an average 5.4 years follow-up, with adjustment for confounders, anxiety and depression and other somatic symptoms. Results After adjusting for gender, level of education and smoking, those reporting GI complaints had higher risk for later sickness absence (HR = 1.42, 95% CI 1.34-1.51). GI complaints were associated with both anxiety (OR = 3.66, 95% CI 3.31-4.04) and depression (OR = 3.28, 95% CI 2.89-3.72), and a high level of other somatic symptoms (OR = 8.50, 95% CI 7.69-9.40). The association of GI complaints was still independently associated with future sickness absence (HR = 1.17, 95% CI 1.10-1.16) adjusting for mental illness and other somatic symptoms. Discussion Sickness absence is a complex behavioural outcome, but our results suggest GI complaints contribute by increasing the risk of long term sickness absence independently of comorbid mental illness and presence of other somatic symptoms. Occupational consequences of illness are important, and should also be addressed clinically with patients presenting with GI complaints.

The connection between psychologic factors and somatic diseases is still unknown. The activation theory, a fairly new theory for psychosomatic diseases, is presented. Duodenal ulcer is traditionally known as a psychosomatic disease, and psychotherapy can influence the symptoms. Duodenal ulcer is effectively treated with H2 blockers, but the relapse rate is high: 50-80% have a relapse within the first year after healing. In this project patients with duodenal ulcer are treated with cognitive therapy to influence the relapse rate. There is a strong relationship between non-ulcer dyspepsia and psychosocial factors. In this project patients with non-ulcer dyspepsia are treated with cognitive therapy to influence the symptoms. The design of the project and some preliminary results are presented.

Background: It has convincingly been shown that relapses of duodenal ulcers are significantly reduced after eradication of Helicobacter pylori. The aim of this study was to examine the long-term effect of bacteria eradication on Quality of Life (QOL) and subjective somatic symptoms. Methods: Seventy-four Helicobacter pylori-positive patients with recurrent duodenal ulcer disease were treated with triple treatment. Relapses, H. pylori status, QOL and subjective somatic symptoms were registered at yearly intervals for 4 years. Results: Preliminary results show that the patients were more satisfied with the healthcare system, had better sexual relationships and less psychological distress up to 3 years after eradication of the bacteria. They also had fewer symptoms of exhaustion and less stomach discomfort than before triple treatment. Conclusion: Long-term follow-up of patients after eradication of H. pylori shows that QOL is improved and feeling of exhaustion and stomach discomfort reduced.

The aim of the study was to compare relapse rates and quality of life before and after eradication of Helicobacter pylori in a group of patients with documented recurrent duodenal ulcer disease.Seventy-four patients with three endoscopically verified duodenal ulcers during the past 2 years received triple treatment consisting of bismuth subnitrate, oxytetracycline, and metronidazole for 14 days. Quality of life was measured with the Psychosocial Adjustment to Illness Scale (PAIS-SR) and H. pylori status with the 14C-urea breath test.After triple treatment H. pylori was eradicated in 96%, and the ulcer was healed in all. Ulcer relapse was reduced from 100% before to 1.4% during a mean observation time of 111 weeks. The H. pylori reinfection rate was 2.4% during the 1st year. The patients were more satisfied with the health care system and had better sexual relationship and less psychologic distress 1 year after eradication of H. pylori than before.For patients with recurrent duodenal ulcer, eradication of H. pylori with triple treatment leads to a significantly reduced ulcer relapse rate and improved quality of life.