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Purpose: The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis II for psychosocial assessment was adopted to grade chronic pain severity and to correlate that severity with levels of depression and somatization in a population of chronic TMD patients. Materials and Methods: A series of 111 consecutive patients who sought treatment for TMD symptoms lasting longer than 6 months were recruited and underwent assessment using the RDC/TMD axis II instrument. The frequencies of the different scores from the Graded Chronic Pain Scale (GCPS) and the Symptoms Checklist-90R Depression (SCL-DEP) and Somatization (SCL-SOM) scales in the study population were recorded. Correlation between categories of patients identified by the GCPS items and the SCL-DEP and SCL-SOM scales was assessed by means of the Spearman rank correlation test. Results: Severe or moderate somatization was shown by 47.7% and 26.1% of patients, and severe or moderate depression scores were recorded by 39.6% and 1.8% of the sample, respectively. GCPS scores showed that the vast majority of patients had a low disability or no disability at all, with only 5.4% of patients showing a severely limiting high disability. A significant correlation was found between SCL-SOM and GCPS scores, but not between SCL-DEP and GCPS, even if raw depression scores of patients with a high disability were greater than those of subjects with a low disability. Conclusions: Within the limitations of the present investigation, the external validity of which is far from optimal and should be improved in future studies on more representative samples, the RDC/TMD axis II for psychosocial assessment has provided interesting data regarding the prevalence of the different degrees of chronic pain severity and their relation with levels of depression and somatization. [ABSTRACT FROM AUTHOR]

The article focuses on the significance of skydiving on human anxiety and death based on the views of philosopher Martin Heideggeria. It notes that in a phenomenological focus, skydiving shows the radical disruption of instrumentality and that the loss of earthly concerns is an associated to anxiety. It mentions that disruption of the world and the experience of anxiety have a connection and that it is supported through the illustration of skydiving. Moreover, it states that the said unpleasant emotion opens the way for an experience of being-toward-death. It further notes that skydiving makes the possibility of directing one's own death.

Aims: To test whether extraction of the 2 subscales in the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) affected the subscale score reliability and whether scores from the RDC/TMD subscales are comparable to the same scales when the whole Symptom Check List-90 (SCL-90R) is administered. Methods: The full SCL90-R and a modified version containing only the depression and somatization scales were administered in counterbalanced order to 103 subjects. As another test of context, a subset of participants completed the modified and full versions as part of a larger battery of instruments relevant to facial pain. Statistical analyses included internal reliability for item analysis and intraclass correlation (ICC) and Lin's concordance correlation coefficient (CCC) for total scale score reliability. Results: Internal reliability was approximately 0.95 for depression and 0.87 for somatization, independent of test form. Total scale scores were reliable across test versions, with both ICC and CCC approximately 0.95 for depression and 0.91 for somatization. Permutation tests using the CCC indicated a mild influence on the somatization score but not the depression score due to order effects, but these effects were not significant when considering the 95% CIs based on resampling methods. Conclusion: Whether items from other subscales are present or not does not affect the internal reliability or parallel forms reliability of the total scores from either depression or somatization. Context of administration, via order of forms completion, does not alter total score or reliability of depressive items but may alter total scores for somatization. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES Somatization of depressive symptoms among Chinese American older adults remains understudied. This study aimed to identify whether the relationship between depressive symptoms and use of health services (ie, doctor visits, hospital, and emergency department) could be due to pain and whether acculturation played a role in the relations among depressive symptoms, pain, and health service use. DESIGN AND PARTICIPANTS Secondary data came from the Population Study of Chinese Elderly in Chicago that surveyed 3159 Chinese community‐dwelling older adults in the greater Chicago area. The average age was 76.3 years (standard deviation = 8.4); 57.95% were female). Negative binominal models were used to identify the effects of depression and pain on each type of health service use, controlling for sociodemographics and health‐related factors (eg, chronic illness). MEASUREMENTS Depressive symptoms were assessed using the Patient Health Questionnaire‐9; pain was assessed by self‐reported pain severity. Participants were classified into low, moderate, and high acculturation groups based on acculturation scores. RESULTS: Depressive symptoms and pain were positively related to health service use on the bivariate level. For groups with both low and high acculturation levels, depression and pain each independently predicted more health service use, whereas for the group with a moderate acculturation level, the effect of somatization was substantialized. CONCLUSION: Depression largely influenced health service use independently and partially through pain for older Chinese Americans. The somatization tended to be only salient for the moderate acculturation group, calling for more research attention to the complicated effect of acculturation. J Am Geriatr Soc 67:S584–S589, 2019. [ABSTRACT FROM AUTHOR]

Background: Apart from changes in mood and cognition, depressive disorders are also characterized by changes in body experience, changes that largely influence daily functioning and aggravate distress. In order to gain more insight into this important issue, three domains of body experience - body attitude, body satisfaction and body awareness - and their associations with symptom severity of depression were studied pre- and post-treatment in a clinical sample of depressed patients in a multidisciplinary setting.Methods: Body attitude (Dresden Body Image Questionnaire), body satisfaction (Body Cathexis Scale), body awareness (Somatic Awareness Questionnaire) and severity of depressive symptoms (Inventory of Depressive Symptomatology) were measured. Differences between pre-treatment and post-treatment scores were studied with paired t-tests. Associations between body experience and depression were analysed with Pearson correlations and partial correlations.Results: At the start of treatment, patients scored significantly lower than a healthy comparison sample on body attitude and body satisfaction, but not on body awareness. After treatment, depression scores decreased with large effect sizes, scores for body attitude and body satisfaction increased with medium effect sizes and body awareness scores increased slightly. Medium pre-treatment and strong post-treatment associations were found between depression severity and body attitude and between depression severity and body satisfaction.Limitations: The design does not allow to draw causal conclusions. Because of the multidisciplinary treatment no information is available on the specific contribution of interventions targeting body experience.Conclusions: The study provides evidence for medium to strong associations in clinically depressed patients between body attitude, body satisfaction and depression. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to investigate how doctors working in primary health care in Latin American address patients with common mental disorders and to investigate how stigma can affect their clinical decisions. Methods: Using a cross-sectional design, we applied an online self-administered questionnaire to a sample of 550 Primary Care Physicians (PCPs) from Bolivia, Brazil, Cuba and Chile. The questionnaire collected information about sociodemographic variables, training and experience with mental health care. Clinicians’ stigmatizing attitudes towards mental health were measured using the Mental Illness Clinicians' Attitudes Scale (MICA v4). The clinical decisions of PCPs were assessed through three clinical vignettes representing typical cases of depression, anxiety and somatization. Results: A total of 387 professionals completed the questionnaires (70.3% response rate). The 63.7% of the PCPs felt qualified to diagnose and treat people with common mental disorders. More than 90% of the PCPs from Bolivia, Cuba and Chile agreed to treat the patients presented in the three vignettes. We did not find significant differences between the four countries in the scores of the MICA v4 stigma levels, with a mean = 36.3 and SD = 8.3 for all four countries. Gender (p = .672), age (p = .171), training (p = .673) and years of experience (p = .28) were unrelated to stigma. In the two multivariate regression models, PCPs with high levels of stigma were more likely to refer them to a psychiatrist the patients with depression (OR = 1.03, 95% CI, 0.99 to 1.07 p<0.05) and somatoform symptoms somatoform (OR = 1.03, 95% CI, 1.00 to 1.07, p<0.05) to a psychiatrist. Discussion: The majority of PCPs in the four countries were inclined to treat patients with depression, anxiety and somatoform symptoms. PCPs with more levels of stigma were more likely to refer the patients with depression and somatoform symptoms to a psychiatrist. Stigmatizing attitudes towards mental disorders by PCPs might be important barriers for people with mental health problems to receive the treatment they need in primary care. [ABSTRACT FROM AUTHOR]

Despite predominance of positive findings on associations of morning-evening preference with seasonality and depression, it remains to be clarified whether morning and evening components of this preference equally contribute to these associations and whether these associations persist after accounting for confounding variables. Data on retrospectively reported seasonal changes in well-being, mood, and behaviors were collected from 2398 residents of West Siberia, South and North Yakutia, Chukotka, Alaska, and Turkmenistan. Other self-reports included mental and physical health, sleep duration, and adaptabilities of the sleep-wake cycle. Depression was found to be linked to morning rather than evening component of morning-evening preference, i.e., morning lateness. Morning lateness was also linked to retrospectively reported degree of seasonal changes rather than to severity of problems associated with such changes. Variation in morning-evening preference explained not more than 2% and 4% of the total variation in depression and seasonality, respectively. The associations became even weaker but remained significant after accounting for other differences between respondents, such as their gender, age, physical health, and adaptability of their sleep-wake cycle. These results have practical relevance for understanding of the roles playing by morning earliness and insensitivity to seasonal changes in the environment to protection against different mood disorders. [ABSTRACT FROM AUTHOR]

Background: Research on emotion regulation (ER) in medically unexplained physical symptoms (MUS) is rare.Purpose: The goal of this study was to compare ER skills between MUS-patients without comorbid depression, MUS-patients with comorbid depression (MUS+MDD), patients with major depressive disorder (MDD), and healthy controls. Additionally, we examined the mediating effect of depression and anxiety on the relationship between ER and somatization.Methods: The Emotion-Regulation Skills Questionnaire (ERSQ) and other self-report measures were completed by 138 MUS-patients, 114 MUS+MDD-patients, 106 MDD-patients, and 100 healthy controls. Multiple mediation analyses were applied to investigate the role of depression and anxiety as potential mediators.Results: A MANCOVA and post-hoc test with age, sex and education as covariates indicated that ER skills of the MUS-group were lower than the controls (p<0.001-p=0.047), but higher than the MDD- and MUS+MDD-group (p<0.001-p=0.042). ER skills of the MDD-group and MUS+MDD-group did not differ (p=0.78-p=0.99), but were lower than controls (p<0.001-p=0.011). In the MUS-groups depression and anxiety had a mediating effect on the relationship between ER and somatization (b=-0.23, 95% bias-corrected CI: -0.30, -0.17). The direct effect of ER on somatization was no longer significant when controlling for the mediating variables (b=0.07, p=0.083).Conclusions: Our study reveals that patients with MUS+MDD have higher deficits in ER skills than MUS patients without MDD. Additionally, deficits in ER in MUS-patients are influenced by depression and anxiety. This indicates that MUS-patients with comorbid mental disorders might benefit from an emotion regulation training. [ABSTRACT FROM AUTHOR]

Background This study aimed to (1) provide a comprehensive characterization of depressive symptoms profiles, and (2) examine the cross-sectional association between depressive symptom profiles and cardio-metabolic outcomes, including metabolic syndrome and obesity, while controlling for sociodemographic variables, health behaviors and inflammation. Methods Our sample was comprised of 1085 participants (55.80% female) enrolled in the MIDUS-II biomarker study. Latent profile analysis (LPA) was used to derive depressive symptom profiles using subscales of the Mood and Anxiety Symptom Questionnaire (MASQ) and the Center for Epidemiologic Studies Depression Scale (CES-D) subscales as well as Pittsburgh Sleep Quality Index (PSQI) global score. Metabolic syndrome was defined according to the Interim Joint Statement definition. CRP was used as a marker of inflammation. Results Four depressive symptom profiles were identified. The “No Symptoms” subgroup (60.65% of the sample) had the lowest overall scores across subscales. The “Mild Symptoms” subgroup (26.73%) was characterized by lower scores across indicators, with subscales measuring somatic symptoms being the highest within group. The “Moderate Symptoms” subgroup (10.32%) had higher scores across subscales (1 SD above the mean), with subscales measuring negative affect/loss of interest being the highest within group. Finally, the “Acute symptoms” subgroup (2.30%) was characterized by the highest overall scores (1.5–3 SD above the mean) on all indicators. After controlling for sociodemographic characteristics and health behaviors, the “Moderate Symptoms” subgroup was significantly associated with metabolic syndrome (OR = 1.595, p = 0.035) and obesity (OR = 1.555, p = 0.046). Further, there was a trend between the “Mild Symptoms” subgroup and the presence of obesity (OR = 1.345, p = 0.050). Inflammation attenuated these associations. Conclusions Four depressive symptom profiles were identified among healthy mid-life individuals in the US. These profiles are differentially associated with cardio-metabolic outcomes. Future work should examine whether distinct symptom profiles may reflect differential pathways to increased risk, and whether tailored management of symptoms is needed. [ABSTRACT FROM AUTHOR]

This article discusses the ways in which the dominated collaborate with their own domination, and it does it based on the ethnographic work of an investigation about the discursivity and the practice of the correctional pedagogy in an educational centre of Spanish juvenile justice. Establishing a dialogue between the concepts of symbolic violence by Bourdieu and that of moral career by Goffman, the article presents a double analytical approach that, first, elucidates the behaviours and staging of the inmates from a situated point of view and, secondly, inquires about how they somaticize the dynamics of subjugation of the prison regime. In this way, the paper explores the ways in which young people interpenetrate, or pretend to do so, with the perspective of themselves that confers the institution, in this case, one that expects to attend dangerous and violent individuals. That one labelling as a «young delinquent? seems to adopt the identity attributed to him and (re)presenting himself from that stigma. But other forms of obedience or participation are also discussed. Those forms that remain within the margins of control and the will of the inmates, and which respond to the coercive system of the total institutions. And others that insinuate a kind of subjection that attends to more subtle, continuous and inadvertent coercion: those unconscious dispositions that compel the dominated to unconsciously participate with their subjugation as an incorporated effect of the dynamics of domination itself. [ABSTRACT FROM AUTHOR]

Psychogenic non-epileptic seizures (PNES) are common in neurological settings and often associated with considerable distress and disability. The psychological mechanisms underlying PNES are poorly understood and there is a lack of well-established, evidence-based treatments. This paper advances our understanding of PNES by providing a comprehensive systematic review of the evidence pertaining to the main theoretical models of this phenomenon. Methodological quality appraisal and effect size calculation were conducted on one hundred forty empirical studies on the following aspects of PNES: life adversity, dissociation, anxiety, suggestibility, attentional dysfunction, family/relationship problems, insecure attachment, defence mechanisms, somatization/conversion, coping, emotion regulation, alexithymia, emotional processing, symptom modelling, learning and expectancy. Although most of the studies were only of low to moderate quality, some findings are sufficiently consistent to warrant tentative conclusions: (i) physical symptom reporting is elevated in patients with PNES; (ii) trait dissociation and exposure to traumatic events are common but not inevitable correlates of PNES; (iii) there is a mismatch between subjective reports of anxiety and physical arousal during PNES; and (iv) inconsistent findings in this area are likely to be attributable to the heterogeneity of patients with PNES. Empirical, theoretical and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Previous research has documented that Asians tend to somatize negative experiences to a greater degree than Westerners. It is posited that somatization may be a more functional communication strategy in Korean than American context. We examined the effects of somatization in communications of distress among participants from the US and Korea. We predicted that the communicative benefits of somatic words used in distress narratives would depend on the cultural contexts. In Study 1, we found that Korean participants used more somatic words to communicate distress than US participants. Among Korean participants, but not US participants, use of somatic words predicted perceived effectiveness of the communication and expectations of positive reactions (e.g., empathy) from others. In Study 2, we found that when presented with distress narratives of others, Koreans (but not Americans) showed more sympathy in response to narratives using somatic words than narratives using emotional words. These findings suggest that cultural differences in use of somatization may reflect differential effectiveness of somatization in communicating distress across cultural contexts. [ABSTRACT FROM AUTHOR]

Background: There are differences across ethno-cultural groups in the degree of somatization among patients with major depressive disorder (MDD). Studies showed that the attribution style of somatic symptoms is an important predictor of health outcome in depressed patients. Aims: The aims of this study were to investigate associations of psychologizing, normalizing and somatizing attribution styles as measured by the Symptom Interpretation Questionnaire (SIQ) in Turkish patients with MDD. Methods: Ninety patients who were diagnosed with a major depressive episode using a semi-structured interview were administered the SIQ to assess attribution styles, each of which was regressed on age, gender, educational level, depressive symptom severity, tendency for somatosensory amplification, current somatic symptoms and alexithymia. Results: Scores on somatizing, psychologizing and normalizing attribution subscales of the SIQ were strongly correlated with each other. Somatosensory amplification and alexithymia were independent correlates of somatizing attributions. Higher levels of psychologizing and normalizing attributions were both related to more severe symptoms of depression and to somatosensory amplification. Conclusions: These results suggested that patients with higher levels of depressive symptoms were more likely to engage in a greater diversity of attribution styles as measured by the SIQ in our sample. Independent correlates of somatic symptom attribution in patients with MDD were found to be different from Western countries, suggestive of disparate cultural characteristics and help-seeking pathways and behaviour in Turkey. [ABSTRACT FROM AUTHOR]

The present study investigates the somatization symptoms among grammar school students. High school students (N=218) from a convenience sample school were asked to complete The Somatization Scale. Data analysis showed that girls reported somatization symptoms more frequently than boys. The analysis showed that 1.4% of students felt some of the somatic symptoms on a daily basis, while 6.9% of students had such symptoms 2-3 times a week. Other students reported physical symptoms less frequently. 41.3% of students reported having somatic symptoms once a week and 46.8% of the students complained of somatic symptoms once or twice a month. Only 3.2% of students said that they had never experienced such symptoms. The most common somatic symptoms in adolescence are headaches and fatigue, while the rarest physical symptom is abdominal pain. Contemporary authors associated somatization tendencies with stressful situations in school. Therefore, it is important that parents, teachers and school counselors are familiar with the frequency and potential causes of somatic symptoms in adolescence. [ABSTRACT FROM AUTHOR]

Introduction While previous literatures have provided substantial evidence on the burden of somatic symptoms and the prognostic value of resilience in the treatment course of depression, little is speculated on the relationship between resilience and somatic symptoms in depressed patients. We aimed to clarify the relationship between resilience and somatic symptoms in depressed patients retrospectively. Methods Two hundred and fifty-four outpatients with depressive disorders participated in the study and completed self-administered questionnaires regarding demographic, clinical and psychological factors. We divided the patients into four groups based on their scores of Connor- Davidson Resilience Scale and Beck Depression Inventory. The partial correlation analysis was implemented to show the relationship between somatic symptoms and resilience after controlling for depression, and one-way analysis of variance was conducted to demonstrate the differences in somatization scores of Symptoms Checklist-90- Revised in the aforementioned four groups. Results After the correlation analysis, somatization was significantly correlated with resilience even after controlling for depressive symptoms. The one-way analysis of vairance and post-hoc analysis revealed statistically significant differences in somatization scores between the four groups, with the high Beck Depression Inventory, high Connor- Davidson Resilience Scale group having the highest somatization scores. Discussion Striving to be resilient during the peak of depression, cultural factors and positive illusions of depressed patients can result in high resilience scores and high somatization scores in depressed patients, and such clinical implications would help clinicians evaluate resilience and somatization in depressed patients with multidimensional aspects. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder's (PTSD) four-factor dysphoria model has substantial empirical support (reviewed in Elhai & Palmieri, Journal of Anxiety Disorders, 25, 849-854, ; Yufik & Simms, Journal of Abnormal Psychology, 119, 764-776, ). However, debatable is whether the model's dysphoria factor adequately captures all of PTSD's emotional distress (e.g., Marshall et al., Journal of Abnormal Psychology, 119(1), 126-135, ), which is relevant to understanding the assessment and psychopathology of PTSD. Thus, the present study assessed the factor-level relationship between PTSD and emotional distress in 818 children/adolescents attending school in the vicinity of the 2008 Mumbai terrorist attacks. The effective sample had a mean age of 12.85 years ( SD = 1.33), with the majority being male ( n = 435, 53.8 %). PTSD and emotional distress were measured by the UCLA PTSD Reaction Index (PTSD-RI) and Brief Symptom Inventory-18 (BSI-18) respectively. Confirmatory factor analyses (CFA) assessed the PTSD and BSI-18 model fit; Wald tests assessed hypothesized PTSD-distress latent-level relations; and invariance testing examined PTSD-distress parameter differences using age, gender and direct exposure as moderators. There were no moderating effects for the PTSD-distress structural parameters. BSI-18's depression and somatization factors related more to PTSD's dysphoria than PTSD's avoidance factor. The results emphasize assessing for specificity and distress variance of PTSD factors on a continuum, rather than assuming dysphoria factor's complete accountability for PTSD's inherent distress. Additionally, PTSD's dysphoria factor related more to BSI-18's depression than BSI-18's anxiety/somatization factors; this may explain PTSD's comorbidity mechanism with depressive disorders. [ABSTRACT FROM AUTHOR]

The number of immigrants in Italy has doubled every 10 years from 1972 and Genoa hosts two large communities of immigrants from South America and Africa. We investigated differences in the somatic perception between immigrants and Italians and between South Americans and Africans living in the city of Genoa. During a 7 month period, an anonymous questionnaire asking for sociodemographic information and the Modified Somatic Perception Questionnaire (MSPQ) were administered to all immigrants accessing an outpatient clinic or the general practitioners offices. MSPQ mean scores were significantly higher in immigrant patients than in Italian patients, after adjusting for sex and age differences. We found no differences between South Americans and Africans in MSPQ score. The tendency to express discomfort through physical symptoms appears to be related to being a foreigner who arrived in Italy through a migratory trip and also to being a person who comes from a cultural context that is very different from the one of developed countries. [ABSTRACT FROM AUTHOR]

Background: Valuations of depression are useful to evaluate depression interventions offered to patients with chronic somatic conditions. The only classification system to describe depression developed specifically for valuation purposes is the McSad, but it has not been used among somatic patients. The aim of this study was to test the construct validity of the McSad among diabetes and cancer patients and then to compare the McSad to the commonly used EuroQol - 5 Dimensions (EQ-5D™) classification system. The comparison was expected to shed light on their capacity to reflect the range of depression states experienced by somatic patients. Methods: Cross-sectional data were collected online from 114 diabetes and 195 cancer patients; additionally, 241 cancer patients completed part of the survey on paper. Correlational analyses were performed to test the construct validity. Specifically, we hypothesized high correlations of the McSad domains with depression (Center for Epidemiological Studies Depression Scale (CES-D) and the Patient Health Questionnaire (PHQ-9)). We also expected low/moderate correlations with self-esteem (Rosenberg Self-Esteem scale - RSE) and extraversion (Eysenck Personality Questionnaire Extraversion scale - EPQ-e). Multiple linear regression analyses were run so that the proportion of variance in depression scores (CES-D, PHQ-9) explained by the McSad could be compared to the proportion explained by the EQ-5D classification system. Results: As expected, among all patients groups, we found moderate to high correlations for the McSad domains with the CES-D (.41 to .70) and the PHQ-9 (.52 to .76); we also found low to moderate correlations with the RSE (-.21 to .-48) and the EPQ-e (.18 to .31). Linear regression analyses showed that the McSad explained a greater proportion of variance in depression (CES-D, PHQ-9) (Diabetes: 73%, 82%; Cancer: 72%, 72%) than the EQ-5D classification system (Diabetes: 47%, 59%; Cancer: 51%, 47%). Conclusions: Findings support the construct validity of the McSad among patients with somatic conditions and demonstrate that it performs better than the EQ-5D classification system to reflect the range of depression states. For future valuation purposes, the McSad classification system could therefore be recommended to describe depression as experienced by patients with a chronic medical condition. [ABSTRACT FROM AUTHOR]

Objective To provide basis for effects of an early psychological intervention on parents of children with cleft lip/palate, and investigate the effects of an early psychological intervention to them. Methods One self-administered questionnaire (SCL-90) was applied in 102 parents of children with cleft lip/palate, compared to 126 parents of healthy individuals on the day of admission. They were given the psychological intervention during hospitalization and 3 months after discharge. The questionnaire (SCL-90) was again applied to them on the day of discharge and 3 months after discharge. Results Using the questionnaire (SCL-90), the answer scores of somatization, obsessive-compulsive, depression and anxiety etc. were significantly higher than those of the control group (P<0.05). There were no statistical differences during 3 subgroups in the case group (P>0.05). There were no statistical differences on the day of admission and on the day of discharge (P>0.05), but there were statistical difference on the day of admission and 3 months after discharge (P<0.05). Conclusion In this study, the psychosomatic states of parents of children with cleft lip/palate is poor. It's important and greatly significant that we conduct early psychological intervention to parents of children with cleft lip/palate and to the children's psychosomatic health. [ABSTRACT FROM AUTHOR]

Background: Inattention to symptoms of mental disorders and substance abuse in patients with HIV/AIDS and other at-risk groups, may lead to irreversible damages. The purpose of this study was to compare the psychopathological dimensions in substance abusers with and without HIV/AIDS and healthy matched groups. Methods: In a cross-sectional and analytical study, selected samples (by available, consecutive, and objective methods) were 43 HIV-positive substance abusers, 49 HIV negative substance abusers under methadone maintenance therapy (MMT) in the counseling clinic of Behavioral Diseases and Addiction Abandonment, and 45 ordinary individuals. All of them were evaluated by matched confounding variables via Symptom Checklist-90-Revised (SCL-90-R). Findings: Results indicated a significant difference between these groups in the Global Severity Index (GSI), Positive Symptom Distress Index (PSDI), and Positive Symptom Total (PST) (P < 0.001). Two by two the comparison of the three groups from psychopathological dimensions revealed that substance abusers with HIV/AIDS persistently suffer more mental problems in all dimensions compared with healthy individuals (P < 0.05). In addition, in comparison with HIV negative substance abusers, they also suffer more mental problems in other dimensions, including somatization, interpersonal sensitivity, depression, anxiety, phobia, and psychoticism (P < 0.05). Yet, the difference in paranoid ideation, hostility, and obsessive-compulsive cases was insignificant. Two by two, the comparison between healthy individuals and substance abusers without HIV/AIDS showed higher levels of depression and psychoticism in substance abusers (P < 0.05), but no difference in other dimensions. Conclusion: Comorbidity of substance abuse and HIV diagnosis intensify mental disorder symptoms. Moreover, lack of prevention and implementation of appropriate psychological and psychiatric interventions after substance abuse and HIV lead to extended establishment of mental disorder symptoms. [ABSTRACT FROM AUTHOR]

Abstract: No treatment, to date, has been developed to improve both posttraumatic stress disorder (PTSD) and medically unexplained physical symptoms (MUPS), despite mounting evidence of high comorbidity between PTSD and MUPS. This study assessed the feasibility, acceptability, and treatment outcomes of an adapted cognitive behavioral therapy for PTSD and abridged somatization in a sample of eight participants. Fifteen percent of completers did not meet PTSD criteria after treatment completion and 62.5% improved their somatic symptoms. There was a significant difference between pre- and post-treatment depression symptoms, as well as in psychological and physical functioning measures. Results indicated a small to moderate effect size (d = 0.27–0.78) in PTSD severity scores, and moderate to large effect size in depression symptoms and psychosocial and physical functioning variables (d = 0.39–1.12). Preliminary evidence of acceptability indicates that the current CBT intervention may be suitable for Latinos individuals with PTSD and MUPS. [Copyright &y& Elsevier]

Résumé: Objectifs: Tenter d’analyser le vécu de couples ayant vécu des fausses couches à répétition, en répondant aux questions suivantes : que nous apprennent ces hommes et ces femmes vivant des fausses couches à répétition ? Que pouvons-nous mieux appréhender sur le couple lui-même ? Patients et méthodes: Un questionnaire de personnalité approfondi, le MMPI-2, a été proposé à 50 couples ayant vécu des fausses couches répétées. Résultats: Grâce à une classification hiérarchique, des profils différents apparaissent tant dans le groupe des femmes que dans la groupe des hommes, mettant en évidence une somatisation de la souffrance psychologique ; elle montre aussi l’existence de profils de personnalité particulièrement défensifs témoignant d’une restriction des affects chez beaucoup d’hommes de ces couples vivant des échecs répétés de procréation. Cette restriction émotionnelle peut être facteur de souffrance supplémentaire pour leurs compagnes et pour eux-mêmes. Discussion et conclusion: On peut conclure que dans ces conditions, la prise en charge médicale et/ou psychologique devra inclure les deux membres du couple pour favoriser un meilleur ajustement marital et permettre au couple d’aborder la prochaine grossesse, toujours vécue dans l’angoisse d’un nouvel échec, avec une plus grande sérénité. Quelques hypothèses étiologiques pourront être évoquées. [ABSTRACT FROM AUTHOR]

In this study, we aimed to investigate the relationship between the sociodemographic features and symptom distribution in GAD. A total of 63 patients were included in the study. All participants were asked to complete SCL-90, Beck Depression Inventory, Beck Anxiety Inventory and sociodemographic data form. Significant differences were found between male and female patients with GAD at subscales of SCL-90 (GSI) (phobic (p <.01), paranoid (p <.05), anger (p <.01), depression (p <.01), anxiety (p <.05), and somatization (p <.01)) and the Beck depression scale scores (p <.05). Age and level of education shows a significant difference between married singles. The average age of the patients who were married was higher. In contrast, the average education level of the singles was higher than married people. The married and single patients showed no significant difference in terms of GSI. Anger subscale of the SCL-90 was found to be higher in married patients than single patients. Severity of symptoms of GAD may be different between the genders as well as different sets of symptoms can vary according to the gender. In addition, the distribution of symptoms varies among different age groups (i.e. anger). Gender, age, and marital status should be considered as a factor that can affect the prognosis of GAD. This cross-sectional study has shown that symptoms in women may be more severe than men. [ABSTRACT FROM AUTHOR]

Background Previous work indicated that psychosocial factors (depression and somatization) are more strongly associated with symptom severity and weight loss in functional dyspepsia (FD) than gastric sensorimotor function. However, there is conflicting evidence regarding the association of these etiopathogenetic factors with Rome III symptom-based subgroups in FD [epigastric pain syndrome (EPS), postprandial distress syndrome (PDS)]. We aimed to test whether gastric sensitivity and emptying, depression, and somatization are differentially associated with empirically derived functional gastroduodenal disorders (FGD) symptom factors in one comprehensive model. Methods In 259 tertiary care FD patients, we studied gastric sensorimotor function with barostat and gastric emptying breath test. Depression, somatization, and FGD symptoms were measured using self-report questionnaires. Confirmatory factor analysis (CFA) on 7 FGD symptoms was used to determine the fit of a latent variable structure based on Rome III symptom-based subgroups. Structural equation modeling (SEM) was used to test the putative relationships of the symptom factors with gastric sensorimotor function, depression, and somatization. Key Results The results of the CFA show a good fit [ Cmin/DF = 1.54, CFI(comparative fit index) = 0.97] for the three-factor solution based on Rome III subgroups. The SEM also fitted the data well ( Cmin/DF = 1.24, CFI = 0.98) and demonstrated that gastric sensitivity and depression are associated with PDS and nausea and vomiting. Gastric emptying is uniquely associated with EPS and somatization is strongly associated with all three symptom factors. Conclusions & Inferences Confirmatory factor analysis confirms the existence of three FGD symptom factors, corresponding to Rome III symptom-based subgroups. The SEM results suggest that different psychobiological mechanisms may play a role in these subgroups. [ABSTRACT FROM AUTHOR]

The object of this paper is to provide a metapsychological definition of alexithymia as described in 1967 in terms of operational thinking and negative hallucination. This is a familiar and established concept in the fields of psychopathology, psychology, and of clinical and psychosomatic medicine. From a psychoanalytic and psychosomatic point of view, the term is conceptually close to P. Marty's 'operative thinking', as described in 1963, even though we know they do not belong to the same epistemological field: on one hand Neuroscience, Psychiatry and the objectalization of the symptom at different levels, and on the other, as regards mechanical functioning, a psychoanalytic clinical approach within the dynamics of the relationship between transference and counter-transference. The present authors consider that Freudian metapsychology, as now complexified by Andrè Green, allows for a metapsychological approach to alexithymia insofar as it relates to Marty's operative thinking. Thus does Green's conceptualization of the mother's negative hallucination, of negative introjection, of a psychically 'dead (and insecure) mother', now provide us with the opportunity to describe, in metapsychological terms, the genesis of this particular mode of psychical functioning. Given the mother's negative hallucination produces a host structure as a background to negativity that will fit future object representations, we will assume that in the case of ... future operational or alexithymic ...?, this negative hallucination will pathologically and defensively involve the endo-psychic perception of affect. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Temporomandibular disorders (TMD) have often been related to sleep bruxism and elevated nocturnal masseter muscle activity (NMMA). However, previous studies have revealed controversial results, and the role of somatization, depression and anxiety has not been studied in this context. The aim of this study was to investigate the association between NMMA and pain intensity, TMD related symptoms, somatoform symptoms, depression, and anxiety in chronic TMD. Methods: Thirty-six subjects with chronic painful TMD, 34 subjects with pain free bruxism, and 36 healthy controls recorded their nocturnal masseter muscle activity during three consecutive nights with portable devices. In addition, participants completed pain diaries and questionnaires. Diagnoses were established using the research diagnostic criteria for TMD. Results: Subjects with chronic TMD reported a reduced general health state (p <.001), higher levels of somatoform symptoms (p <.001), depression (p <.05), and anxiety (p <.001) compared to control subjects with or without sleep bruxism. The amount of NMMA did not differ significantly between the groups. In subjects with TMD, pain intensity was not related to NMMA. However, higher NMMA was related to higher intensity of jaw related symptoms such as headache or tinnitus, and higher somatization in general. Conclusion: Chronic TMD is associated with elevated levels of psychopathology. These findings suggest a common link between NMMA, somatization, and symptom intensity in chronic TMD. [Copyright &y& Elsevier]

Somatization disorder (SD) was included as a new syndrome in the DSM-III (APA, 1980), but its removal from the DSM-V as a diagnostic category is more than probable. This work examines the main studies that SD has generated in the last 30 years as regards epidemiology, comorbidity, and associated psychological variables: illness concern, somatosensory amplification, somatic attribution, alexithymia, and neuroticism. The several nosological proposals in the past decade are also revised, as well as the debate that developed until the current DSM-V classification proposals. The radical changes proposed by the DSM-V work group are considered necessary and positive, although two risks of the proposal are also exposed: clustering under the same diagnostic category the current SD and hypochondriasis, and including non-explained and factitious symptoms in the same category. [ABSTRACT FROM AUTHOR]

Background: Second-generation antidepressants dominate the management of major depressive disorder (MDD), but evidence on the comparative benefits and harms of these agents is contradictory. Purpose: To compare the benefits and harms of second-generation antidepressants for treating MDD in adults. Data Sources: English-language studies from PubMed, Embase, the Cochrane Library, PsycINFO, and International Pharmaceutical Abstracts from 1980 to August 2011 and reference lists of pertinent review articles and gray literature. Study Selection: 2 independent reviewers identified randomized trials of at least 6 weeks' duration to evaluate efficacy and observational studies with at least 1000 participants to assess harm. Data Extraction: Reviewers abstracted data about study design and conduct, participants, and interventions and outcomes and rated study quality. A senior reviewer checked and confirmed extracted data and quality ratings. Data Synthesis: Meta-analyses and mixed-treatment comparisons of response to treatment and weighted mean differences were conducted on specific scales to rate depression. On the basis of 234 studies, no clinically relevant differences in efficacy or effectiveness were detected for the treatment of acute, continuation, and maintenance phases of MDD. No differences in efficacy were seen in patients with accompanying symptoms or in subgroups based on age, sex, ethnicity, or comorbid conditions. Individual drugs differed in onset of action, adverse events, and some measures of healthrelated quality of life. Limitations: Most trials were conducted in highly selected populations. Publication bias might affect the estimates of some comparisons. Mixed-treatment comparisons cannot conclusively exclude differences in efficacy. Evidence within subgroups was limited. Conclusion: Current evidence does not warrant recommending a particular second-generation antidepressant on the basis of differences in efficacy. Differences in onset of action and adverse events may be considered when choosing a medication. [ABSTRACT FROM AUTHOR]

Abstract: Background: Untreated depression during pregnancy may have adverse outcomes for the mother and her child. Screening for depression in the general pregnant population is thus recommended. The Edinburgh Depression Scale (EDS) is widely used for postpartum depression screening. There is no consensus on which EDS cutoff values to use during pregnancy. The aim of the current study was to examine the predictive validity and concurrent validity of the EDS for all three trimesters of pregnancy. Methods: In a large unselected sample of 845 pregnant women, the sensitivity, specificity, and validity of the EDS were evaluated. The Composite International Diagnostic Interview (depression module) was used to examine the predictive validity of the EDS. The anxiety and somatization subscales of the Symptom Checklist 90 (SCL-90) were used to examine its concurrent validity. Only women with a major depressive episode were considered as cases. Results: The prevalence of depression decreased toward end term: 5.6%, 5.4%, and 3.4%. The EDS scores also decreased toward end term, while the SCL-90 subscale anxiety scores increased. The EDS showed high test–retest reliability and high concurrent validity with the SCL-90 anxiety and somatization subscales. The area under the receiver operating characteristic curve was high and varied between 0.93 and 0.97. A cutoff value of 11 in the first trimester and that of 10 in the second and third trimesters gave the most adequate combination of sensitivity, specificity, and positive predictive value. Conclusions: The EDS is a reliable instrument for screening depression during pregnancy. A lower cutoff than commonly applied in the postpartum period is recommended. [Copyright &y& Elsevier]

Primary dystonia is a movement disorder attributed mainly to basal ganglia dysfunction. Besides motor control, striatopallidal structures are known to implement also non-motor functions including processing of cognitive and emotional information. Previous research has already demonstrated deficient recognition of emotional faces in patients with primary focal dystonia. However, it remains elusive if emotional prosody processing in dystonia is also affected. In this study, 30 patients with primary cervical dystonia (CD) and 30 healthy control subjects (HC) had to classify auditory presented words according to their emotional prosody (angry, happy, relaxed, sad). Analysis of hit rates and reaction times revealed a significantly poorer performance of patients with CD in judging angrily intonated words. Additional psychological assessment (SCL-90 R) demonstrated a higher level of psychological distress in patients with CD who displayed symptoms of somatization, anxiety and depression. Together these findings bring further insight into the basal ganglia involvement in processing of emotional prosody and emphasize the importance to identify the psychopathological symptoms in patients with CD as complementary to the motor deficit. [ABSTRACT FROM AUTHOR]

Aim: This study aims to investigate the prevalence of somatic symptoms in depressed adolescents and in their healthy peers. A second aim is to investigate the correlation, in the depressed adolescents, between the number of somatic symptoms and severe concurrent symptoms, signs and life events. Methods: The total population of 16-17 year olds - in the city of Uppsala - was screened for depression and then interviewed using a structured interview questionnaire. Depressed subjects and matched controls were identified. A total of 177 pairs were used for pair-wise analyses of somatic symptoms. Severe symptoms, signs and life events were selected for analysing their relation to depression with somatic symptoms. Results: The adolescents with depressive disorders experienced considerably more somatic symptoms than their healthy controls. The duration and depth of the depression correlated with the number of somatic symptoms. There was a strong correlation between depression with many somatic symptoms and suicidal plans/thoughts, suicidal attempts, disruptive behaviour, as well as multiple stressful relationships. Conclusion: This study demonstrates that somatic symptoms are common in adolescent depression. Multiple somatic symptoms within depression imply a higher severity in terms of duration, depth and psychiatric comorbidity. The strong correlation with suicidal plans, suicidal attempts and disruptive behaviour is concerning. [ABSTRACT FROM AUTHOR]

Abstract: Background: Few studies have simultaneously compared the ability of depression, anxiety, and somatic symptoms to predict the outcome of major depressive disorder (MDD). This study aimed to compare the MDD outcome predictive ability of depression, anxiety, and somatic severity at 6-month and 2-year follow-ups. Methods: One-hundred and thirty-five outpatients (men/women=34/101) with MDD were enrolled. Depression and anxiety were evaluated by the Hamilton Depression Rating Scale, Hospital Anxiety and Depression Scale, and depression subscale of the Depression and Somatic Symptoms Scale (DSSS). Somatic severity was evaluated by the somatic subscale of the DSSS. Subjects undergoing pharmacotherapy in the follow-up month were categorized into the treatment group; the others were categorized into the no-treatment group. Multiple linear regressions were used to identify the scales most powerful in predicting MDD outcome. Results: Among the 135 subjects, 119 and 106 completed the 6-month and 2-year follow-ups, respectively. Somatic severity at baseline was correlated with the outcomes of the three scales at the two follow-ups. After controlling for demographic variables, somatic severity independently predicted most outcomes of the three scales at the two follow-ups in the no-treatment group and the cost of pharmacotherapy and DSSS score at the 6-month follow-up in the treatment group. Limitations: Division of the subjects into treatment and no-treatment groups was not based on randomization and bias might have been introduced. Conclusions: Somatic severity was the most powerful index in predicting MDD outcome. Psychometric scales with appropriate somatic symptom items may be more accurate in predicting MDD outcome. [ABSTRACT FROM AUTHOR]

To analyze the distribution of depressive, anxiety, and somatization symptoms across different occupational positions in a random sample of Danish residents. The study sample consisted of 591 Danish residents (50% women), aged 20–65, drawn from an age- and gender-stratified random sample of the Danish population. Participants filled out a survey that included the 92 item version of the Hopkins Symptom Checklist (SCL-92). We categorized occupational position into seven groups: high- and low-grade non-manual workers, skilled and unskilled manual workers, high- and low-grade self-employed, and unemployed. Compared to the reference group of high-grade non-manual workers, the depressive symptom score was statistically significantly elevated among unskilled manual workers ( P = 0.043) and the unemployed ( P < 0.001), after adjustment for age, gender, cohabitation, life events, and low household income. The anxiety symptom score was elevated only among the unemployed ( P = 0.004). The somatization symptom score was elevated among unskilled manual workers ( P = 0.002), the low-grade self-employed ( P = 0.023), and the unemployed ( P = 0.001). When we analyzed caseness of severe symptoms, we found that unskilled manual workers (OR = 3.27, 95% CI = 1.06–10.04) and the unemployed (OR = 6.20, 95% CI = 1.98–19.42) had a higher prevalence of severe depressive symptoms, compared to the reference group of high-grade non-manual workers. The unemployed also had a higher prevalence of severe somatization symptoms (OR = 6.28, 95% CI = 1.39–28.46). Unskilled manual workers, the unemployed, and, to a lesser extent, the low-grade self-employed showed an increased level of mental distress. Activities to promote mental health in the Danish population should be directed toward these groups. [ABSTRACT FROM AUTHOR]

Background Meta-analyses on psychological treatment for depression in individuals with a somatic disease are limited to specific underlying somatic diseases, thereby neglecting the generalisability of the interventions. Aims To examine the effectiveness of cognitive-behavioural therapy (CBT) for depression in people with a diversity of somatic diseases. Method Meta-analysis of randomised controlled trials evaluating CBT for depression in people with a somatic disease. Severity of depressive symptoms was pooled using the standardised mean difference (SMD). Results Twenty-nine papers met inclusion criteria. Cognitive-behavioural therapy was superior to control conditions with larger effects in studies restricted to participants with depressive disorder (SMD= -0.83, 95% CI -1.36 to -031, P<0.001) than in studies of participants with depressive symptoms (SMD= -0.16, 95% CI -0.27 to -0.06, P = 0.001). Subgroup analyses showed that CBT was not superior to other psychotherapies. Conclusions Cognitive-behavioural therapy significantly reduces depressive symptoms in people with a somatic disease, especially in those who meet the criteria for a depressive disorder. [ABSTRACT FROM AUTHOR]

This case study reports on a 52-year-old man suffering from depression which was largely precipitated by loss of fatherhood after divorce when his ex-wife took their son and migrated to Canada. In the presentation of his distress to the therapist, he mainly complained of "heart ache," which could not be confirmed by a number of physicians as having any kind of physical disorder. The sense of psychological pain due to the loss of the love relationship with his son was hidden and was expressed in physical form. His self-identify as a strong man and as a manager of a pharmacy company were main barriers for him to reveal his psychological pain. His feelings of anger toward his ex-wife and grief from the separation from his son began to occur during an 8-week body-mind-spirit group therapy. Biological, psychological, and social aspects of pain were integrated into the healing process. [ABSTRACT FROM AUTHOR]

Somatization is a clinical and public health problem as it can lead to social dysfunction, occupational difficulties and increased healthcare use. Hence understanding somatoform disorders is of paramount importance, especially so in developing countries like India. This paper discusses the history and evolution of the concept of somatization and somatoform disorders, etiological considerations, classification, assessment, diagnosis and clinical management. Research from India, controversies and criticisms and future perspectives are mentioned. A new model to understand functional somatic symptoms, in Indian setting is also proposed. [ABSTRACT FROM AUTHOR]

Background: To investigate the validity and stability of a Portuguese version for the Screening for Somatoform Symptoms-2 (SOMS-2) in primary care (PC) settings. Methods: An adapted version of the SOMS-2 was filled in by persons attending a PC unit. All medically unexplained symptoms were further ascertained in a clinical interview and by contacting the patient's physicians and examining medical records, attaining a final clinical symptom evaluation (FCSE). An interview yielded the diagnosis of Clinical Somatization (CS) and the diagnosis of current depressive and anxiety disorders. Results: From the eligible subjects, 167 agreed to participate and 34.1% of them were diagnosed with somatization. The correlation between the number of self-reported and FCSE symptoms was 0.63. After excluding symptoms with low frequency, low discriminative power and not correlated with the overall scale, 29 were retained in the final version. A cut-off of 4 symptoms gave a sensitivity of 86.0% and a specificity of 95.5% on the FCSE and 56.1% and 93.6% at selfreport. Stability in the number of symptoms after 6 months was good (k = 0.57). Conclusions: The 29 symptoms version of the SOMS-2 with a cut-off of 4 showed a high specificity and sensitivity, being reliable as a referral tool for further specialized diagnosis. [ABSTRACT FROM AUTHOR]

Psychosomatic illness that personality takes place important role in their ethiopathogenesis are common throughout the world. In order to understand the etiology of psychosomatic illness, it is considered that studies with Temperament and Character Inventory (TCI) which investigates the personality according to psychobiological model contribution the important data. Therefore, studies carried with TCI were investigated in Pubmed and Turk Psychiatry Archive in the 1991 to 2009. It was investigated that studies about somatization, dermatologic illness, headache, physical medicine, angina, irritable bowel syndrome, and asthma. The most important and common result is that the mean of Harm Avoidance (HA) scores are high. So, the mean of HA scores still remain high despite covariate of effect of depression and anxiety, this dimension of TCI is important construct for impact to psychosomatic pattern. It is also showed that HA have state and trait character. These findings confirmed that serotonergic systems get involved in process of psychosomatic organization. In a lot of studies the mean of Self Direction sub-dimension, which considered for basic dimension to mature personality, in psychosomatics groups was found lower than normal healthy control hence, process of illness affects the personality. Since importance in etiology of dimensions of TCI for understanding of psychosomatic illness, it must be carried with longitudinal study. [ABSTRACT FROM AUTHOR]

Abstract: Somatic symptoms are often important in the treatment of major depressive disorder (MDD). The aim of this open-labeled trial was to examine the efficacy of mirtazapine for the treatment of MDD with clinically significant somatic symptoms, as compared with venlafaxine. A total of 126 patients with MDD (score ≥18 on the Hamilton Rating Scale for Depression-17) were included in both the intent-to-treat (n =73 in the mirtazapine group and n =53 in the venlafaxine group) and completer analysis (n =51 and n =37, respectively). After treatment, both treatment groups showed similar improvements in depressive symptoms. Repeated measures analysis of variance for the intent-to-treat population revealed that there were no significant differences in mean change of the Symptom Check List-90-Revised (SCL-90-R) somatization subscores between the two groups. For completers, there was a significant time×treatment interaction in the SCL-90-R somatization subscores, but the differences between the two groups at endpoint did not reach statistical significance in post-hoc analysis. In conclusion, this study suggests that overall efficacies of mirtazapine and venlafaxine are similar for the treatment of overall symptoms in MDD, and both drugs may be useful for the treatment of somatic symptoms in MDD patients. [Copyright &y& Elsevier]

Abstract: Objective: To investigate the frequency and characteristics of psychiatric co morbidity in a group of vertiginous children. Methods: A retrospective review of patient notes between years 2000 and 2006 in the ENT clinic of Helsinki University Hospital. Patients were identified from the clinic database, based on hospital discharge codes. Results: 119 children were examined because of vertigo. Nine vertiginous children had purely psychogenic vertigo. The main psychiatric diagnosis was depression. The prevalence of somatoform disorders was 2.5%. According to our study the main predictors of a psychogenic vertigo were constant or frequent vertigo usually with coexisting headaches, absence from school and problems with relationships at school or home. Conclusion: Somatisation should always be kept in mind while dealing with vertiginous children. A thorough clinical work-up is needed to rule out potential illnesses, but as soon as the possibility of somatisation comes to mind, psychiatric consultation is recommended. [Copyright &y& Elsevier]

Background: Somatoform disorders are an important factor in functional disability and role impairment, though their independent contribution to disability has been unclear because of prevalent medical and psychiatric comorbidity.Objectives: To assess the extent of the overlap of somatization with other psychiatric disorders and medical problems, to compare the functional disability and role impairment of somatizing and non-somatizing patients, and to determine the independent contribution of somatization to functional disability and role impairment.Design: Patients were surveyed with self-report questionnaires assessing somatization, psychiatric disorder, and role impairment. Medical morbidity was indexed with a computerized medical record audit.Participants: Consecutive adults making scheduled visits to their primary care physicians at two hospital-affiliated primary care practices on randomly chosen days.Measurements: Intermediate activities of daily living, social activities, and occupational disability.Results: Patients with somatization, as well as those with serious medical and psychiatric illnesses, had significantly more impairment of activities of daily life and social activities. When these predictors were considered simultaneously in a multivariable regression, the association with somatization remained highly significant and was comparable to or greater than many major medical conditions.Conclusions: Patients with somatization had substantially greater functional disability and role impairment than non-somatizing patients. The degree of disability was equal to or greater than that associated with many major, chronic medical disorders. Adjusting the results for psychiatric and medical co-morbidity had little effect on these findings. [ABSTRACT FROM AUTHOR]

Objective: To investigate the distribution of psychological characteristics and pain reporting among women with vulvar vestibulitis syndrome (VVS).Methods: In this exploratory study, 109 women with VVS completed a battery of questionnaires to assess pain with intercourse and psychological characteristics (e.g. somatization, anxiety, distress). The distribution of these characteristics was compared, first with a conventional binary classification schema (primary and secondary) and subsequently with a 3-category schema (primary, latent primary, secondary).Results: Severity of pain with intercourse did not differ among the subgroups using either classification schema. Women with primary VVS consistently showed higher levels of somatization, anxiety, and distress compared with those with secondary VVS. Using a 3-tiered classification system, we found no difference between latent primary diagnosis and the other 2 groups (primary and secondary).Conclusion: This study highlights the critical need for research on subtype definition and the role of psychological factors in VVS. [ABSTRACT FROM AUTHOR]

Introduction Recent studios have shown an increase in psychiatric symptomatotogy in medical students and physicians during their professional practice. Some studies show that these professionals have a higher prevalence of psychiatric symptoms than the general population. This phenomenon is a consequence of the particular conditions of this professional activity, and, in the case of students, of high academic demands that lead to stressful situations that interfere with their academic performance and the development of clinical skills, which may have repercussions on their relationship with their patients. The predominant symptoms are anxiety depression and stress, as well as substance use; there has also been an increase in the number of students with suicide attempts. Most of these problems occur during the first two years of the degree course as well as the internship year. Depression is masked by anger, by virtue of the fact that it is an internalized form of anger. It has also been documented that there is a significant link between certain personality traits and the presence or absence of mental symptoms, regardless of the situations to which people ore exposed. The feature with the highest association with the presence of symptomatology is neuroticism, while the personality traits that are most conducive to the achievement of academic success and better adaptation and, therefore, a lower number of symptoms are empathy and kindness. The purpose of this study was to establish a diagnosis of the mental health and personality traits of medical students in the high performance groups and compare them with those of the groups of students that performed poorly during the first two years of the degree course. This transversal exploratory study involved the participation of 370 students from the UNAM Medical School: 220 belonged to the high performance groups, called educational quality nuclei (NUCE), while 150 were repeat students. The variables considered were: age, sex, type of group NUCE or repeat), academic year (first or second year of the degree), place of origin and type of high school from which they had graduated (public or private). Two instruments were used to measure personality traits and psychiatric symptomatology: the Big Five Personality Trails and the Symptom Check List-90. The results of the study show that in both groups (repeat students and NUCE) over 85% were from the Federal District. Repeat students were mainly women (85.3%) and students from public schools (93.6%). As for the high performance group NUCE), 83.1% were from private schools and just 16.9% from public schools. Repeat students showed personality traits that included neuroticism and very little openness compared with the high performance groups, which displayed traits of greater openness and less neuroticism, with p<0.01. In general, students from NUCE groups showed traits of greater extraversion, empathy and diligence compared with repeaters. Psychiatric symptomatology was more severe among the repeat group than the NUCE group (p<0.05). The psychiatric symptomatology displayed by both groups included: obsession-compulsion depression and anxiety. In the comparisons, the two groups showed significant differences in total symptomatology. There were also differences in the following symptomatology, by order of importance: phobia, interpersonal sensitivity, somatization, anxiety, obsessive-compulsive disorder and psychoticism (p<0.05). Differences were found between academic years, with second-year students showing greater symptomatology; women displayed the greatest symptomatology. No differences were found for the interaction between sex and academic year.… [ABSTRACT FROM AUTHOR]

This study examined the explanatory models of depression, perceived relationships between diabetes and depression, and depression treatment experiences of low-income, Spanish-speaking, Hispanics with diabetes and depression. A purposive sample (n =19) was selected from participants enrolled in a randomized controlled trial conducted in Los Angeles, California (United States) testing the effectiveness of a health services quality improvement intervention. Four focus groups followed by 10 in-depth semi-structured qualitative interviews were conducted. Data were analyzed using the methodology of coding, consensus, co-occurrence, and comparison, an analytical strategy rooted in grounded theory. Depression was perceived as a serious condition linked to the accumulation of social stressors. Somatic and anxiety-like symptoms and the cultural idiom of nervios were central themes in low-income Hispanics'' explanatory models of depression. The perceived reciprocal relationships between diabetes and depression highlighted the multiple pathways by which these two illnesses impact each other and support the integration of diabetes and depression treatments. Concerns about depression treatments included fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking psychotropic medications. This study provides important insights about the cultural and social dynamics that shape low-income Hispanics'' illness and treatment experiences and support the use of patient-centered approaches to reduce the morbidity and mortality associated with diabetes and depression. [Copyright &y& Elsevier]

The article reports on the proper assessment of chronic low-back pain (cLBP) using the Brief International Classification of Functioning, Disability and Health (ICF) Core Sets. The objective of the research is to determine what clinical tests substantiates the body functional categories "muscle functions" and "emotional functions." Fifty-one patients underwent muscle function tests such as trunk muscle strength, endurance and postural performance, and emotional function tests such as the body experience, the Fear-Avoidance Beliefs Questionnaire (FABQ-D) and the Beck depression inventory. Back muscle endurance tests best examined muscle functions, while somatization best examined emotional functions.

This paper is a critique of the cross-cultural utility and validity of somatization in the diagnosis and treatment of psychological disorders. Somatization is defined as the process by which psychological distress is expressed as physical symptoms that have no known organic basis. Rather than a phenomenon limited to non-western cultures as commonly thought of in the past, somatization should be recognized as a universal experience found across cultures. It underscores the significant interrelationships between the mind/psyche and the body, an area embraced by some disciplines such as Jungian psychology and psychotherapy, but historically neglected by bioscience. This paper argues that the reputedly low prevalence of somatization observed in western cultures is an artifact, due to the overly restrictive diagnostic criteria used in clinical practice. This paper argues in favor of the retention of somatization as a valid concept in diagnosis, treatment, and in psychotherapy, especially at a time of increasing cultural diversity. [ABSTRACT FROM AUTHOR]

The expectation that Chinese people present distress somatically is a central prediction of cultural psychopathology and has been the subject of considerable theoretical speculation. At the same time, empirical studies have been infrequent and have yielded mixed results. The authors examined symptom presentation in Chinese (n = 175) and Euro-Canadian (n = 107) outpatients, using spontaneous problem report, structured clinical interview, and symptom questionnaire methods. All 3 methods yielded cross-culturally equivalent somatic and psychological symptom subscales. Chinese outpatients reported more somatic symptoms on spontaneous problem report and structured clinical Interview compared with Euro-Canadians, who in turn reported more psychological symptoms on all 3 methods. The relation between culture and somatic symptom presentation was mediated by a tendency toward externally oriented thinking. Difficulties with identifying emotions or describing them to others did not differ significantly across cultures, supporting a nonpathological interpretation of observed differences. Psychological symptom effects were larger and more consistent than somatic symptom effects; because other studies have confirmed the ubiquity of somatic presentations worldwide, these results suggest that Western psychologization may be more culturally specific than is Chinese somatization. [ABSTRACT FROM AUTHOR]

Objective: High suggestibility is widely regarded as an important feature of patients with medically unexplained symptoms (MUS), particularly those with multiple MUS [i.e. somatization disorder (SD)], although there are few empirical data attesting to this assumption. A study was therefore conducted to compare levels of non-hypnotic suggestibility in patients with SD and medical controls. Method: A modified version of the Barber Suggestibility Scale was administered to 19 patients with SD and 17 controls with an established organic dystonia. Results: Patients with SD were no more suggestible than control patients. Dystonia controls were more likely to deliberately comply with suggestions than the SD patients. Conclusion: Contrary to popular belief, high suggestibility is not necessarily a feature of SD. [ABSTRACT FROM AUTHOR]

Can group counselling help patients who present with symptoms that cannot be explained medically? Preliminary results of working with one such group are reported. Six patients in a primary care practice were offered weekly sessions for half a year. The findings suggest that the patients attended all group sessions. The patients reported experiences known to be related to group counselling, and when the group ended, patient reports show that the severity of their problems was reduced significantly (p<.001). Furthermore, during the six months after the group ended patients significantly (p<.025) reduced their visits to their general practitioners. These results seem to call for wider use of humanistic group counselling with somatising patients and further research into the impact of such form of counselling. [ABSTRACT FROM AUTHOR]