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A sedentary lifestyle is characterized by the development of automation and lack of movement that causes various ailments and diseases and thus negatively affects the health of people. This study aimed to determine the effects of recreational swimming on the psychosomatic status of middle-aged women. The subjective assessment of psychosomatic status (SPPSS) scale was used in the study to assess ailments (disorders) of certain body parts and organic systems before and after the experimental treatment. The results of the research show that there were statistically significant changes in all tested variables, and the largest changes were in the variables: back pain (Z = -5,169, p < 0.001) and leg pain (Z = -4,941, p < 0.001), while the smallest changes were in variables indigestion (Z = -3,983, p < 0.001). [ABSTRACT FROM AUTHOR]

The impact of a temporary or permanent stoma on mental health in Crohn's Disease (CD) is unknown. The aim was to examine the association between intestinal surgery and stoma formation and subsequent antidepressant medication (ADM) use. Using the Clinical Practice Research Datalink, we identified individuals with CD who underwent intestinal surgery between 1998-2018. We excluded individuals with a prescription for an ADM in the 6 months before surgery. Individuals were stratified into three groups: no stoma, temporary stoma, and permanent stoma. We used Kaplan-Meier curves to examine initiation of ADM after intestinal surgery and Cox regression to identify risk factors for ADM use after intestinal surgery. We identified 1,272 cases of CD undergoing their first intestinal surgery. Of these, 871 (68.5%) had no stoma, 191 (15.0%) had a temporary stoma and 210 (16.5%) had a permanent stoma. The 10-year cumulative incidence of ADM use was 26.4%, 33.4% and 37.3% respectively. Individuals with a permanent stoma were 71% more likely to receive an ADM than those with no stoma (HR 1.71, 95% CI 1.20-2.44). Individuals with a temporary stoma reversed within 12 months had a similar likelihood of ADM use to those without stoma formation (HR 0.99, 95% CI 0.64-1.53) whereas temporary stoma formation with late reversal after 12 months was associated with significantly greater likelihood of ADM use (HR 1.85, 95% CI 1.15-2.96). Permanent stomas and temporary stomas with late reversal surgery are associated with increased ADM use after intestinal surgery, likely associated with increased anxiety and depression. [Display omitted] [ABSTRACT FROM AUTHOR]

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Background: Functional urological disorders are highly prevalent, frequently interrelated, and characterized by a chronic course and considerable treatment resistance. From our point of view, poor treatment outcomes are often attributable to underlying but undetected mental disorders. Objective: To investigate the effect of integrated outpatient care by a urologist and a psychiatrist on the symptomatology of patients with functional urological disorders in a tertiary referral Pelvic Care Centre. Setting: Retrospective observational cohort study in functional urological disorders in combination with psychosomatic co‐morbidity. When treatment by a urologist alone was not sufficient, the suitability for a multidisciplinary approach was considered i) if there was a susceptibility for psychiatric comorbidity, ii) if diagnostic procedures did not reveal a treatable somatic cause, or iii) if multiple failed somatic treatments did not relieve complaints. Patients underwent urological treatments before, without reduction of complaints, no treatable somatic cause could be found after diagnostic procedures; or patients suffered from psychiatric comorbidity. Method: Outcome was measured using patient global impression of improvement, hospitality anxiety and depression scale (HADS), global assessment of functioning (GAF), and a health consumption questionnaire. Results: A significant reduction in HADS‐depression score was found (p = 0.001) after multidisciplinary treatment. The GAF score increased from 61 to 80, leading to no more than slight impairment in social, occupational, or school functioning. Patients reported their situation as better in comparison with before multidisciplinary treatment. An association was found between pelvic pain and anxiety (p = 0.032) and panic disorder (p = 0.040). Psychological trauma was found to be associated with depression (p = 0.044), with an odds ratio of 2.93 (1.01–8.50). Psychological trauma coincided in 62.3% of patients with urological pain syndromes and in 83.3% with pelvic pain. Conclusion: Overall results indicate that functional urological patients, previously refractory to urological treatment, benefit from an integrated care approach by urologists and psychiatrists. Explanation about the bladder–brain axis and the alarm falsification model enlightens understanding of urological and psychological contributions to functional syndromes and creates an opportunity for integrated care. [ABSTRACT FROM AUTHOR]

Copyright of Psychiatrie Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Psychological factors might be involved in some oral mucosal diseases, such as recurrent aphthous stomatitis (RAS) and oral lichen planus (OLP). However, there is little information about the psychosomatic approaches to manage these oral mucosal diseases. This review summarizes the reports on the psychological statuses of patients with oral mucosal diseases, including RAS and OLP and others, and discusses the appropriate psychosomatic approaches for the management of these diseases. The psychosomatic background is probably involved in onset and course of inflammatory oral mucosal diseases, and can be called as "psychosomatic diseases". The field of psychosomatic medicine for oral mucosal diseases may be termed "psychostomatology". [ABSTRACT FROM AUTHOR]

Avoidance behaviors are shaped by associative learning processes in response to fear of impending threats, particularly physical harm. As part of a defensive repertoire, avoidance is highly adaptive in case of acute danger, serving a potent protective function. However, persistent or excessive fear and maladaptive avoidance are considered key factors in the etiology and pathophysiology of anxiety- and stress-related psychosomatic disorders. In these overlapping conditions, avoidance can increase the risk of mental comorbidities and interfere with the efficacy of cognitive behavioral treatment approaches built on fear extinction. Despite resurging interest in avoidance research also in the context of psychosomatic medicine, especially in conditions associated with pain, disturbed interoception, and disorders of the gut-brain axis, current study designs and their translation into the clinical context face significant challenges limiting both, the investigation of mechanisms involved in avoidance and the development of novel targeted treatment options. We herein selectively review the conceptual framework of learning and memory processes, emphasizing how classical and operant conditioning, fear extinction, and return of fear shape avoidance behaviors. We further discuss pathological avoidance and safety behaviors as hallmark features in psychosomatic diseases, with a focus on anxiety- and stress-related disorders. Aiming to emphasize chances of improved translational knowledge across clinical conditions, we further point out limitations in current experimental avoidance research. Based on these considerations, we propose means to improve existing avoidance paradigms to broaden our understanding of underlying mechanisms, moderators and mediators of avoidance, and to inspire tailored treatments for patients suffering from psychosomatic disorders. [ABSTRACT FROM AUTHOR]

Survivors of prolonged hospitalization due to coronavirus disease 2019 (COVID-19) are at risk for psychiatric symptoms that can interfere with rehabilitation and functional outcomes. We developed an inpatient and outpatient behavioral treatment program for COVID-19 patients. We describe the constellation of emotional symptoms we observed, the evolution of symptom presentation from the inpatient to the outpatient setting, and outline the challenges we faced and lessons we learned as we implemented cognitive-behavioral interventions to enhance functioning and decrease symptom burden. We highlight modifications to therapeutic techniques that we made for this population and discuss cultural considerations in our diverse patient population. Initial outcome data indicate that approximately two thirds of patients (66% in the inpatient setting, 65% in the outpatient setting) are discharged from our program without further psychiatric care. As the COVID-19 pandemic continues to intensify and reports of "long-haul" symptoms accumulate among survivors, behavioral interventions to address psychiatric sequelae are paramount. Our approach and experience from the first wave of the pandemic has the potential to inform the development of behavioral treatment programs to mitigate psychiatric symptoms in this vulnerable population, as well as the response of mental health providers to future pandemics and public health emergencies. [ABSTRACT FROM AUTHOR]

Abstract Background Delayed Post Hypoxic Leukoencephalopathy (DPHL) is a syndrome that occurs after hypoxia, and can present with a variety of neuropsychiatric symptoms, including catatonia and paroxysmal sympathetic hyperactivity (PSH). The gold standard for the treatment of catatonia is electroconvulsive therapy (ECT). However, ECT can exacerbate the paroxysms of sympathetic hyperactivity and complicate recovery from DPHL. The treatment of PSH is not well established. Case presentation We present a case of a patient with multiple opiate overdoses who presented with altered mental status. He was diagnosed with catatonia and subsequently treated with ECT. His clinical condition worsened, and a revised diagnosis of PSH was established. The patient’s condition improved with medical management. Conclusion This case highlights the need to distinguish between these two related symptom clusters, as the incidence of DPHL and opioid overdose related neuropsychiatric problems increase. This distinction can greatly influence the course of treatment, and the need to consider alternative treatments.

Abstract Patients with psychocutaneous disorders often refuse psychiatric intervention in their first consultations, leaving initial management to the dermatologist. The use of psychotropic agents in dermatological practice, represented by antidepressants, antipsychotics, anxiolytics, and mood stabilizers, should be indicated so that patients receive the most suitable treatment rapidly. It is important for dermatologists to be familiar with the most commonly used drugs for the best management of psychiatric symptoms associated with dermatoses, as well as to manage dermatologic symptoms triggered by psychiatric disorders.

Abstract Background The change in the benzodiazepine (BZD) use of patients with medically unexplained symptoms (MUS) following the application of relaxation therapy were examined. Methods Of the 221 outpatients with MUS using BZD, 42 received relaxation therapy. Change in BZD use was compared using a relaxation group (n = 42) and a control group that had 84 MUS patients whose baseline was matched by optimal matching algorithms. Logistic regression analysis was done to evaluate the effect of BZD-dependent factors on the BZD dose of the relaxation group. Results Compared with the control group, the number of patients who decreased the amount of BZD and the number of patients whose subjective symptoms of MUS improved were significantly higher in the relaxation group (p

ABSTRACT BACKGROUND: The brief psychotherapeutic intervention “relaxation, mental images and spirituality” (relaxamento, imagens mentais e espiritualidade, RIME) is a form of complementary and alternative health-related therapy. It is a pioneer in the matter of relating the elements of spirituality to relaxation and to visualization of mental images. OBJECTIVE: To ascertain the history, use and benefits of RIME that have been reported in the scientific literature, within different health/disease contexts. The questions that guided this study were: In what contexts has the brief RIME psychotherapeutic intervention been used? What were its benefits? DESIGN AND SETTING: Systematic review, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, in a public university. METHODS: The BVSPsi, CINAHL, MEDLINE, SciELO, SCOPUS and Web of Science databases were searched in September and October 2018. RESULTS: The findings showed that RIME promoted resignification of the symbolic pain of the death of patients without the possibility of cure; improved quality of life within the process of dying; contributed to the quality of life of breast cancer patients with cure possibilities; contributed to the emotional wellbeing of ostomized patients; brought quality-of-life benefits for patients with head-and-neck cancer; promoted empowerment for women with breast cancer and strengthened their libido; and promoted resignification of the spiritual pain of bereaved youths, offering a satisfactory return from mourning preparation. CONCLUSIONS: It was found that RIME has a construct history based on rigorous scientific methodology, covering quality of life and spiritual, emotional and subjective wellbeing. RIME has not been used internationally and new studies within this field, with different cases, should be encouraged. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ID 164211.

Abstract Background Functional somatic symptoms and disorders are common and complex phenomena involving both bodily and brain processes. They pose major challenges across medical specialties. These disorders are common and have significant impacts on patients’ quality of life and healthcare costs. Main body We outline five problems pointing to the need for a new classification: (1) developments in understanding aetiological mechanisms; (2) the current division of disorders according to the treating specialist; (3) failure of current classifications to cover the variety of disorders and their severity (for example, patients with symptoms from multiple organs systems); (4) the need to find acceptable categories and labels for patients that promote therapeutic partnership; and (5) the need to develop clinical services and research for people with severe disorders. We propose ‘functional somatic disorders’ (FSD) as an umbrella term for various conditions characterised by persistent and troublesome physical symptoms. FSDs are diagnosed clinically, on the basis of characteristic symptom patterns. As with all diagnoses, a diagnosis of FSD should be made after considering other possible somatic and mental differential diagnoses. We propose that FSD should occupy a neutral space within disease classifications, favouring neither somatic disease aetiology, nor mental disorder. FSD should be subclassified as (a) multisystem, (b) single system, or (c) single symptom. While additional specifiers may be added to take account of psychological features or co-occurring diseases, neither of these is sufficient or necessary to make the diagnosis. We recommend that FSD criteria are written so as to harmonise with existing syndrome diagnoses. Where currently defined syndromes fall within the FSD spectrum – and also within organ system-specific chapters of a classification – they should be afforded dual parentage (for example, irritable bowel syndrome can belong to both gastrointestinal disorders and FSD). Conclusion We propose a new classification, ‘functional somatic disorder’, which is neither purely somatic nor purely mental, but occupies a neutral space between these two historical poles. This classification reflects both emerging aetiological evidence of the complex interactions between brain and body and the need to resolve the historical split between somatic and mental disorders.

Avoidance behaviors are shaped by associative learning processes in response to fear of impending threats, particularly physical harm. As part of a defensive repertoire, avoidance is highly adaptive in case of acute danger, serving a potent protective function. However, persistent or excessive fear and maladaptive avoidance are considered key factors in the etiology and pathophysiology of anxiety- and stress-related psychosomatic disorders. In these overlapping conditions, avoidance can increase the risk of mental comorbidities and interfere with the efficacy of cognitive behavioral treatment approaches built on fear extinction. Despite resurging interest in avoidance research also in the context of psychosomatic medicine, especially in conditions associated with pain, disturbed interoception, and disorders of the gut-brain axis, current study designs and their translation into the clinical context face significant challenges limiting both, the investigation of mechanisms involved in avoidance and the development of novel targeted treatment options. We herein selectively review the conceptual framework of learning and memory processes, emphasizing how classical and operant conditioning, fear extinction, and return of fear shape avoidance behaviors. We further discuss pathological avoidance and safety behaviors as hallmark features in psychosomatic diseases, with a focus on anxiety- and stress-related disorders. Aiming to emphasize chances of improved translational knowledge across clinical conditions, we further point out limitations in current experimental avoidance research. Based on these considerations, we propose means to improve existing avoidance paradigms to broaden our understanding of underlying mechanisms, moderators and mediators of avoidance, and to inspire tailored treatments for patients suffering from psychosomatic disorders.

Background and objectives: Delirium is the most prevalent psychiatric disorder in inpatient older people. Its presence is associated with higher rates of institutionalization, functional disability and mortality. This study aims to evaluate delirium in a hospitalized psychogeriatric population, focusing on which factors predict the appearance of delirium, the impact it generates and the diagnostic concordance between non-psychiatric physicians and psychiatrists. Material and methods: This is an observational, cross-sectional, retrospective, and comparative study. We obtained data from a sample of 1017 patients (≥65 years) admitted to general hospital and referred from different services to the consultation-liaison psychiatry (CLP) unit. Logistic regression was performed using delirium as the dependent variable. To estimate the concordance of the diagnoses, the Kappa coefficient was used. To assess the impact of delirium, an ordinal regression, Wilcoxon median test and Fisher’s test were performed. Results: Delirium is associated with a higher number of visits, OR 3.04 (95% CI 2.38–3.88), longer length of stay and mortality, OR 2.07 (95% CI, 1.05 to 4.10). The model to predict delirium shows that being >75 years old has an OR of 2.1 (95% CI, 1.59–2.79), physical disability has an OR of 1.66 (95% CI, 1.25–2.20), history of delirium has an OR of 10.56 (95% CI, 5.26–21.18) and no use of benzodiazepines has an OR of 4.24 (95% CI, 2.92–6.14). The concordance between the referring physician’s psychiatric diagnosis and the psychiatrist CLP unit showed a kappa of 0.30. When analysing depression and delirium, the concordance showed Kappa = 0.46. Conclusions: Delirium is a highly prevalent psychiatric disorder, but it is still underdiagnosed, with low diagnostic concordance between non-psychiatric doctors and psychiatrists from CLP units. There are multiple risk factors associated with the appearance of delirium, which must be managed to reduce its appearance.

Competing Interests: Die Autorinnen und Autoren geben an, dass kein Interessenskonflikt besteht.

This systematic review primarily aims to provide a summary of the game mechanics implemented in eHealth tools supporting young people's self-management of their chronic diseases. This review secondarily investigates the rationale for implementing game mechanics and the effects of these tools. A systematic search was conducted in Embase, Medline, PsycINFO, and Web of Science, from inception until August 30, 2022. Studies were eligible if focus was on the utilization of gamification in eHealth self-management interventions for young people (age = 10-25 years) with chronic diseases. Primary quantitative, qualitative, and mixed-method studies written in English were included. We identified 34 eHealth tools, of which 20 (59%) were gamified tools and 14 (41%) were serious games. We found that 55 unique game mechanics were implemented. The most commonly used were rewards (50%), score (44%), creative control (41%), and social interaction (32%). In comparison with gamified tools, the number and diversity of game mechanics applied were higher in serious games. For most tools (85%), a general rationale was provided for utilizing gamification, which often was to promote engaging experiences. A rationale for using specific game mechanics was less commonly provided (only for 45% of the game mechanics). The limited availability of experimental research precludes to test the effectiveness of using gamification in eHealth to support self-management in young people with chronic diseases. In this study, we highlight the importance of reporting the rationale for utilizing specific game mechanics in eHealth tools to ensure a proper alignment with evidence-based practice and the need of conducting experimental research. PROSPERO: CRD42021293037.

Copyright of Zeitschrift für Psychosomatische Medizin und Psychotherapie is the property of Vandenhoeck & Ruprecht GmbH & Co. KG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Zeitschrift für Psychosomatische Medizin und Psychotherapie is the property of Vandenhoeck & Ruprecht GmbH & Co. KG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Creativity does not specific only the history of the disciplines of spirit. It also defines normality itself to the extent to which normality is given to man who, at best, to use a term coined by the creator of psychosomatic medicine, Viktor von Wiezsäcker, is stricken by normopathie. After a defining meeting with Freud, he published a research in Die Kreatur magazine demonstrating that, as long as it is to be found "exiled on earth", in its minor and pathological meaning, the "creature" is synonym with suffering. For psychoanalysis, in its major opposite meaning, the therapeutic one, the following is implied: how much creativity so much normality. Given this context, the major theoretical and practical plus that Lacan brings in addition to Freud is represented by the possibility of treatment for psychosis using what he coined as the "substitute". His seminar titled Le Sinthome is entirely focused on the manner in which James Joyce could "substitute" his psychosis through the recursive act of his own creativity. The recursion to creation can substitute the recurrence of psychosis. In this paper we argue the importance and function of the substitute in Samuel Becket's case - he was, for a while, Joyce's personal secretary. After a schizophrenic episode followed by an analysis with Wilfred Bion, Beckett managed not only to find substitution in and through his work, but also to provide some important indications for the therapy of this serious condition. [ABSTRACT FROM AUTHOR]

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Although previous cross-sectional studies suggested significantly dysregulated immune response in alexithymia, there is a lack of longitudinal studies. We sought to determine the reliability of the reported relationship between alexithymia and decreased immune response in a longitudinal study. Thirty-eight healthy women who had participated in a cross-sectional study were recontacted 1-year later. Of this sample, 26 were finally included: 13 females who had been found to be alexithymic, and 13 females who were classified as non-alexithymic under the 20-item Toronto Alexithymia Scale during the first phase of the study. A year later, they were still healthy women without any psychiatric disorders, their ages now ranging from 19 to 28 years old. Lymphocyte subset counts (CD4, CD8), in vitro production of interleukin 1β (IL-1β), IL-2, IL-4, and IL-10 by phytohemagglutinin stimulated peripheral blood lymphocytes, as well as serum cortisol levels, were compared between women with and without alexithymia. One-year later, alexithymic women still had significantly lowered in vitro production of IL-2 and IL-4, with lowered IL-2/IL-10 ratio and a reduced percentage of CD4. This is the first ever published study assessing cytokine production during a follow-up of alexithymics. Although our results should be interpreted with caution due the small sample size, they suggest a sustained reduction in both major type 1 and type 2 cytokines while the former seems to be more affected. The potential long-term health impact, if any, is still to be determined. [ABSTRACT FROM AUTHOR]

Although pain services have been established in many hospitals, there is considerable heterogeneity among them with respect to organization of service, staff and qualifications of staff, and treatment approaches. With this recommendation, the German Society for Anesthesiology and Intensive Care Medicine defines requirements for pain services in hospitals with respect to organizational standards and staff qualifications. The therapy offered by pain services supplements the treatment provided by the other departments involved, ensuring the high quality of specialized pain management in all areas of the hospital. Pain services shall oversee treatment with specialized analgesia techniques as well as the involvement of consultants, bringing together in-hospital pain medicine expertise in one service with availability 24 h and 7 days per week via a single contact. The medical head of the pain service shall be a qualified provider of pain medicine as defined by the German Medical Association and as a minimum should also have undergone additional training in basic psychosomatic medicine. Further members of the medical staff should possess the credentials of a medical specialist: non-medical staff should have completed continuing education in the treatment of pain. Minimal guidelines for personnel resources were defined: these included a specific time frame for first contacts (20 min) and follow-up (10 min) for specific analgesic techniques and for the involvement of consultants (first contact 45 min, follow-up 20 min), with additional time for travel, set-up, training and quality management. In addition to definition of the space and equipment needed, each service should draft its own budget, and this should be adequate and plannable. Written agreements between the disciplines and transparent documentation, including patient-reported outcomes, are recommended to ensure quality. The provision of specialized pain therapy should have high priority over all disciplines or departments. [ABSTRACT FROM AUTHOR]

The most common negative consequences of trauma exposure are depression and posttraumatic stress disorder (PTSD) symptoms, both of which are promoted by personality type-D in the form of negative affectivity and social inhibition (Denollet et al. Psychosomatic Medicine, 8(12), 749-756, 2008; Vibhakar et al. Journal of Affective Disorders, 255, 77-89, 2019). The aim of the study was to determine the links between the dimensions of type-D personality, depression and PTSD in a group of adolescents exposed to trauma. The sample comprised 99 high school students from Poland, aged from 17 to 18 (M = 17.4, SD = 0.49) who reported experiencing at least one traumatic event in their life. The participants were surveyed with the Life Events Checklist (LEC-5), PTSD Checklist for DSM-5 (PCL-5), Children's Depression Inventory 2 (CDI 2) and DS14 to measure of two type-D personality dimensions. The most frequently-experienced traumatic events were road accident (79.8%), fire or explosion (62.6%) and physical assault (62.6%). Both type-D personality dimensions were positively associated with depression and PTSD symptoms. Mediation analysis showed that depression played a mediating role between type-D personality and PTSD, and that PTSD mediated the relationship between type-D personality and depression. Decreasing the tendency to experience negative emotions and social inhibition may contribute to reducing the symptoms of depression and PTSD after exposure to trauma. [ABSTRACT FROM AUTHOR]

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Copyright of NTM Zeitschrift für Geschichte der Wissenschaften, Technik und Medizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Submission ID: 28; Submission Group: Other An evidence-based review of cognition in MS from the MSBEST project U Eman Abdulhadi u SP 1 sp , Magdalena Mirkowski SP 2 sp , Sarah A Morrow SP 3 sp , Whitney Duff SP 1 sp , Julia Rybkina SP 4 sp , Yen Le SP 1 sp , Sarah J Donkers SP 1 sp , Tania Bruno SP 4 sp , Mark Bayley SP 5 sp , Katherine B Knox SP 1 sp SP 1 sp I University of Saskatchewan, Saskatoon, Canada i , SP 2 sp I Parkwood Institute Research, Lawson Health Research Institute, London, Canada i , SP 3 sp I Western University, London, Canada i , SP 4 sp I University of Toronto, Toronto, Canada i , SP 5 sp I University Health Network-Toronto Rehabilitation Institute, Toronto, Canada i B Background and Purpose: b MSBEST (Multiple Sclerosis Best Evidence-Based Strategies and Treatment/Therapies for Rehabilitation) is a team of researchers and clinicians across North America with expertise in MS rehabilitation. Submission ID: 15; Submission Group: Other Gender differences in the Quality of life of elderly patients with multiple sclerosis U Matej Koprivnik u SP 1 sp , Zorica Knezevi'c SP 2 sp SP 1 sp I Institute for Physical and Rehabilitation medicine, University Medical Centre Maribor, Maribor, Slovenia i , SP 2 sp I Faculty of Theology, University of Ljubljana Maribor Unit, Maribor, Slovenia i B Background: b In elderly multiple sclerosis (MS) patients gender differences are also present in the field of quality of life. Submission ID: 19; Submission Group: Other Robotic rehabilitation to enhance motor function in patients with multiple sclerosis: prelimi... U Frank Houlmont u , Aurore Thibaut, Benoît Maertens de Noordhout, Jordan Roncin, Emilie Lemaire, Alice de Magnée, Daniel Guillaume, Charlotte Beaudart, Jean-François Kaux B Introduction b : Most multiple sclerosis (MS) patients suffer from balance and gait impairments, which severely impact their quality of life. [Extracted from the article]

Keywords: paraphilic disorders; psychosomatic medicine; sexual and gender minorities; sexual behavior; social determinants of health EN paraphilic disorders psychosomatic medicine sexual and gender minorities sexual behavior social determinants of health 431 437 7 11/15/21 20211101 NES 211101 CASE HISTORY History of Present Illness Mr. Z is a middle-aged, cisgender-identifying gay man with a history of major depressive disorder (MDD), posttraumatic stress disorder (PTSD), one prior suicide attempt, HIV (undetectable viral load, on antiretroviral therapy), chronic lower back pain, and history of rectal foreign body perforation in 2014, transported from home to the Emergency Department by ambulance in the setting of acute onset hematochezia. One of the patient's friends, a physician himself, contacted the team with the concern that one of the patient's current providers was the same practitioner who made the above-mentioned homophobic comment during the patient's previous hospitalization. Even for those therapists who identify openly as a sexual or gender minority, patients may incorrectly assume that the experiences of the therapist and the patient are similar or that the therapist is comfortable talking about specific sexual behaviors or gender role variation. It would be important to inquire about the frequency and nature of the patient's paraphilic experiences, bearing in mind that patients may suffer from multiple paraphilias (paraphilic disorders) and comorbid mental health issues.[[8]] Finally, the psychiatrist should inquire about the patient's exposure to sexual and nonsexual violence, as well as its relationship to his or her sexual behaviors or current sexual functioning. [Extracted from the article]