Are psychological skills necessary in treating all physical disorders?

OBJECTIVE: To explore both the wider issue of the need for psychological skills in the management of all physical disorders and that of the role of liaison psychiatry in providing care and in working with medical colleagues. METHOD: The author draws on the literature in general, and specifically on his extensive research and clinical experience of patients with acute and chronic physical symptoms and associated psychological symptoms, particularly accident victims and those with chest pain and diabetes. He also draws on his experience in establishing national and international organizations for consultation-liaison psychiatry. RESULTS: It is argued that psychological skills are fundamental in the management of all physical disorders. CONCLUSIONS: Liaison psychiatry must ensure that psychological skills are part of the treatment of all physical disorders.     

Somatically expressed psychological distress and alexithymia in adolescence--reflecting unbearable emotions?

The characteristics of five 11- to 15-year-old patients with somatic symptoms and alexithymia in conjunction with psychological distress are reported. The findings are compared with the existing literature. Preceding somatic disorders and difficulties at school and in peer relationships were found. Family violence was evident in two cases. We postulate that the developmental tasks of adolescence were complicated by the threat of disability, disease, and death. The parents were incapable of expressing their feelings either in general or because of their recent traumatic experiences. Our findings suggest that unbearable emotions often precede the combination of preadolescent and adolescent alexithymia and somatization in clinically relevant cases.     

Why does the general practitioner overlooks psychological disorders in his patient?

Physicians have a major screening function in the care of patients suffering from psychological disorders. Often, psychosocial disorders are overlooked in primary care. The study presented here investigates factors correlating with the identification of psychosocial disorders in primary care. Physician-patient consultations of 120 patients with psychological disorders of 16 primary care practices were analyzed with respect to doctor-patient interactions using Structured Analysis of Social Behavior (SASB). In addition, reported complaints, length of consultations and identification of psychological disorders by the physicians were analyzed. The physicians identified 60.8 % of the psychological disorders. There was a significant association between physician's identification of psychological disorders and (1) the severity of the disorder, (2) the number of complaints reported during consultation (3) the pattern of physician-patient interaction. A high frequency of interaction patterns referred to as complementary and controlling in terms of SASB categories, interferes with identification of psychological disorders. The study shows that the interactional process during primary care consultation is associated with physicians' identification of psychological disorders.     

Prevalence of psychological distress,depression and suicidal ideation in an indigenous population in Panamá

Objective

The aim of this study was to investigate the prevalence of serious psychological distress (SPD), depression, and suicidal ideation in an adult Indigenous population in Panamá.

Methods

Data were collected from 211 Kuna adults using a paper-based survey. Depression and suicidal ideation were measured using the Patient Health Questionnaire (PHQ-9), and SPD was measured using the Kessler-6. Univariate analyses were used to describe demographic variables, followed by chi² tests to compare differences in demographic variables for each of the mental health outcomes (depression, serious psychological distress, suicidal ideation). A regression model, adjusted for all demographic variables, was then run for each mental health outcome to understand independent correlates.

Results

Within the sample surveyed, 6.2% (95% CI 3.4–10.4) reported serious psychological distress, 32.0% (95% CI 25.7–38.9) reported depression, and 22.9% (95% CI 17.4–29.1) reported suicidal ideation. Significant demographic differences existed with 14% of individuals between the age of 60–90 and 17% of individuals with no education reporting SPD. Women were nearly 5 times more likely to report depression than men (OR 4.90, 95% CI 1.27–19.00) and those with higher incomes were less likely to report depression (OR 0.32, 95% CI 0.13–0.78).

Conclusion

High levels of depression, SPD, and suicidal ideation were present in an Indigenous Kuna community in Panamá. Women and individuals with low income were more likely to report depression, and SPD was more common in older individuals and those with low levels of education. Suicidal ideation was high across all demographic factors, suggesting that a community-wide program to address suicide may be warranted.

     

Does defense style or psychological mindedness predict treatement response in major depression?

Background: The aim of this study was to define the impact of defense style and psychological mindedness (PM) on the prognosis of major depressive disorder (MDD) in patients treated with either fluoxetine (FLX) or short‐term psychodynamic psychotherapy (STPP) in a randomized comparative study. Method: 50 patients with MDD received either STPP or FLX treatment for 16 weeks. The Hamilton Depression Rating Scale (HDRS) was the outcome measure completed at baseline and in the follow‐ups at 4‐ and 12‐months. Patients completed the Psychological Mindedness Scale (PMS) and the Defense Style Questionnaire at the baseline. Results: In the FLX group recovery measured by the decrease in the HDRS during the 4‐month follow‐up associated with baseline mature defense style (r=?.59, P=.015). There were no correlations between the PMS‐scores and the outcome measures in either treatment groups nor defense status and the outcome in the STPP group. Conclusion: Mature defense style predicts good response to FLX therapy in major depression. This association was not found in the psychotherapy group. The results may imply that patients with immature defenses benefit relatively more from brief psychotherapy than medication. PM measured by the PMS was not useful in predicting recovery in MDD. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

How ubiquitous are physical and psychological complaints in young and middle adulthood?

OBJECTIVES: To investigate continuity and change of self-reported physical and psychological complaints in young adults over a period of 20 years. STUDY DESIGN AND SETTING: The Zurich Study--a long-term panel survey in psychiatric epidemiology--is based on a stratified sample of 591 subjects born in 1958 (women) and 1959 (men). The sample strata combine SCL-90-R high-scorers and low-scorers in a 2:1 ratio. Up to now, the Zurich Study has included six interviews between 1979 and 1999, i.e. 20 years of life in young adults. We analysed the longitudinal frequency data of a variety of physical and psychological complaints, as well as information about subjective suffering and use of professional help. The analyses utilised on the McNemar's test, the Q-test and Markov chain models. RESULTS: Sleep disorders, depression, menstruation, backache, headache, stomach and bowel complaints yielded cumulative prevalence rates of 80% or higher. Physical and psychological complaints systematically differ with respect to the change patterns between 1979 and 1999. Moreover, strong differences were found in view of subjective suffering and use of professional help. CONCLUSIONS: Even though many self-reported physical and psychological complaints are very common in young adulthood, the underlying dynamics and the implications largely differ. It seems to be crucial whether respondents use somatic glasses or psychological lenses.     

How equitable are psychological therapy services in South East London now? A comparison of referrals to a new psychological therapy service with participants in a psychiatric morbidity survey in the same London borough

Purpose

Psychological therapy services are sometimes characterised as being small and inequitable, with an over-representation of white middle class women. The ‘Improving Access to Psychological Therapies (IAPT)’ initiative is a programme in England that attempts to make evidence-based therapies accessible to more people more equitably. The aim of this study is to assess whether an IAPT service is delivering an equitable service a London borough. Patients using services at the Southwark IAPT service (n = 4,781) were compared with a sub-group of participants in the South East London Community Health study (SELCOH) with diagnosable mental health problems and who were also resident in Southwark (n = 196).

Methods

We compared Southwark IAPT patients and SELCOH participants on equity criteria of age, gender, ethnicity, occupational status and benefits status. To investigate if referral pathways influenced equity, patients referred by their general practitioner (GP pathway) (n = 3,738) or who self-referred (self-referral pathway) (n = 482) were compared with SELCOH participants.

Results

Southwark IAPT patients significantly differed from SELCOH participants on all our equity criteria and similar differences were found with GP pathway patients. However, self-referrals did not differ from the SELCOH group on age, gender, ethnicity and benefit status.

Conclusions

When compared to a community sample with diagnosable mental disorders, health disparities were found with the overall Southwark IAPT service and with GP pathway patients. Although unemployed people did access IAPT, fewer disparities were found with the self-referral pathway patients, suggesting that the IAPT self-referral pathway may be important in reducing inequitable access to services.     

Phenotypic characterization of γδ T cells mobilized in response to acute psychological stress

Gamma-delta (γδ) T lymphocytes are versatile cells that play key roles in bacterial clearance, wound repair, and delayed-type hypersensitivity reactions. Recently we showed that these cells are mobilized into the blood during acute psychological stress. γδ T lymphocytes are a heterogeneous population of cells, and the current study aimed to characterize the effects of stress on distinct γδ T cell populations.Twenty-nine healthy participants completed a 12 min speech task. Blood samples were taken after a resting baseline, during the last two minutes of the task, and after a 15 min recovery period. Flow cytometry was used to investigate the response of memory phenotypes (i.e. Naïve, Central memory, Effector Memory, and CD45RA⁺ Effector Memory (EMRA)) within the δ1 and δ2 γδ T cell populations. Cells were further analysed on expression of adhesion molecules (CD11a, CD62L) and the NK-receptor CD94.Both the δ1 and δ2 subsets were mobilized during stress, and for both subsets, EMRA cells were mobilized to a much greater extent than the other memory phenotypes. Analysis of migration markers revealed that mobilized cells had a predominantly tissue migrating phenotype (CD11a^hiCD62L^lo/neg) and expressed high levels of the NK-receptor CD94.The current findings indicate that stress primarily mobilizes γδ memory cells that have high cytotoxic capability, tissue homing potential, and the capacity for rapid, innate-like target recognition. This selective mobilization possibly provides protection in contexts when tissue damage and antigen exposure are more likely to occur.     

Experimental studies of psychological interventions with athletes in competitions: why so few?

During the past three decades, behavioral practitioners have been applying techniques to improve the performance of athletes. To what extent are interventions, designed to improve the directly and reliably measured performance of athletes in competitions, based on experimental demonstrations of efficacy? That is the question addressed by this review. All issues of three behavioral journals and seven sport psychology journals, from 1972 through 2002, were examined for articles that addressed the above question. Fifteen articles were found that met the inclusion criteria, yielding an average of only one published study every 2 years. This article reviews those articles, discusses reasons for the dearth of research in this area, and makes recommendations for much needed future research.     

Factors associated with long-term functional outcomes and psychological sequelae in Guillain–Barre syndrome

To examine factors impacting long-term health-related outcomes in survivors of Guillain–Barre syndrome (GBS). Seventy-six consecutive patients with definite GBS admitted to the Royal Melbourne Hospital (1996–2009) were reviewed in the neurorehabilitation clinics. They underwent a structured interview designed to assess the impact of GBS on their current activity and restriction in participation using validated questionnaires: Functional Independence Measure (FIM), Perceived Impact of Problem Profile (PIPP) and Depression Anxiety Stress Scale (DASS). Their sociodemographic and disease severity data were obtained from the medical record. The 76 patients [60% male, mean age 56 years, median time since GBS 6 years (range 1–14 years)] showed good functional recovery (median motor FIM score 90). However, 16% reported moderate to extreme impact on their ability to participate in work, family, and social activities; and 22% substantial impact on mood, confidence and ability to live independently. More reported moderate to extreme depression (18%), anxiety (22%) and stress (17%) compared with the normative Australian population (13%). Factors associated with poorer current level of functioning and wellbeing included: females, older patients (57+ years), acute hospital stay (>11 days), those treated in intensive care and those discharged to rehabilitation. No associations were found between the Medical Research Council (MRC) Motor Scale Rating scores at admission, nor time since GBS diagnosis (≤6 vs. >6 years) on outcomes used. Conclusion: GBS is complex and requires long-term management of psychological sequelae impacting activity and participation.     

Does psychological distress vary between younger and older adults in health and disease?

ObjectiveThe effect of age on psychological distress remains controversial and it is unclear how a chronic medical illness influences this association. We aimed to compare the level of psychological distress between younger and older patients with chronic medical conditions attending hospital specialty clinics and to test whether a different pattern emerges when comparisons with individuals without long-term conditions are made.MethodsIn 519 individuals without chronic medical conditions and 949 patients with established severe chronic medical illnesses, we compared psychological distress (GHQ-28 and SCL-90R) between younger (< 65, N = 1040) and older (≥ 65, N = 428) participants after controlling for gender, marital status, education and primary diagnosis in multiple logistic regression models.ResultsAmong the healthy participants, a greater proportion of older individuals presented mild/moderate psychological distress (p = .026), predominantly depressive and somatization symptoms. Among the medical patients, both age groups presented elevated levels of psychological distress, but a greater proportion of younger patients had severe psychological distress (p = .016), predominantly depressive, anxiety and hostility symptoms. Younger patients reported similarly high levels of somatization symptoms compared to older patients. The odds of being assessed with severe psychological distress were significantly greater for younger individuals with physical illnesses, independently of gender, marital status, education and primary diagnosis.ConclusionsMedical patients from both age groups had significant psychological distress symptoms scores. Younger patients with chronic medical illnesses were more vulnerable to severe psychological distress, including symptoms of anxiety, depression, hostility and somatization. Therefore, clinicians should direct efforts to recognize these symptoms in order to prevent further functional impairment.     

Time trends in mental well-being: the polarisation of young people’s psychological distress

Purpose

Previous research on time trends of young people’s mental health in Britain has produced conflicting findings: evidence for deterioration in mental health during the late 20th century followed by stability and slight improvement during the early 21st century is contrasted with evidence showing continued deterioration. The present study adds to the evidence base by assessing time trends in means, variances, and both low and high psychological distress scores covering a similar period.

Methods

GHQ-12 (Likert scale) was regressed on time (adjusting for age) using a sample of young people aged 16–24 between 1991 and 2008 from the British Household Panel Study. Change in variance was assessed using Levene’s homogeneity of variance test across 9-year intervals. Polarisation was assessed by a comparison of the prevalence of scores ≥1 standard deviation and ≥1.5 standard deviations above and below the pooled mean.

Results

There was a small but significant increase in mean GHQ-12 among young women (b 0.048; 95% CI 0.016, 0.080) only. Variance increased significantly (p < 0.05) across 9-year intervals in seven out of nine comparisons for women and in six out of nine comparisons for men. There were significant increases in low (OR: 1.19; 95% CI 1.05, 1.35), high (OR: 1.27; 95% CI 1.13, 1.42), and very high scores (OR: 1.42; 95% CI 1.23, 1.64) for young women, and increases in low (OR: 1.39; 95% CI 1.21, 1.59) and very low (OR: 1.53; 95% CI 1.21, 1.92) scores for young men.

Conclusions

The evidence suggests a polarisation of the psychological distress of young women in Britain between 1991 and 2008.

     

Functional disability and psychological well-being in later life: Does source of support matter?

Objectives: This study explored the buffering effects of instrumental and emotional support from different sources against the impact of increasing functional disability on depression and life satisfaction.

Methods: Random effects modeling was utilized with data from a nationwide longitudinal study in Taiwan. A total of 6722 observations from 2856 elders over a seven-year period served as subjects of this study.

Results: The results suggested that instrumental support from family members and formal organizations as well as emotional support from families, friends and formal organizations was significantly associated with better psychological well-being among the elderly in Taiwan. In addition, receiving instrumental support from family members and formal organizations can moderate the linkage between increasing functional disability and depression.

Conclusion: The results emphasize the importance of encouraging a partnership between natural helpers and health care professionals. A good integration between formal and informal networks could more effectively meet the needs of the frail older adults and their families. This study also calls for more attention to the cultural competence of health care policy and service delivery.     

A new psychological intervention: “512 Psychological Intervention Model” used for military rescuers in Wenchuan Earthquake in China

Objective

We sought to compare the efficacy of the “512 Psychological Intervention Model” (that is, “512 PIM”, a new psychological intervention) with debriefing on symptoms of post-traumatic stress disorder (PTSD), anxiety and depression of Chinese military rescuers in relation to a control group that had no intervention.

Method

We conducted a randomized controlled trial with 2,368 military rescuers 1?month after this event and then at follow-up 1, 2 and 4?months later to evaluate changes in symptoms of PTSD, anxiety and depression based on DSM-IV criteria, respectively.

Results

Baseline analysis suggested no significant differences between the study groups. Severity of PTSD, anxiety and depression decreased over time in all three groups, with significant differences between the groups in symptoms of PTSD (P?<?0.01). Compared with the debriefing and control group, significant lower scores of PTSD and positive efficacy in improving symptoms of re-experiencing, avoidance and hyperarousal were found in the “512 PIM” group.

Conclusion

“512 PIM” was an effective psychological intervention for military rescuers in reducing symptoms of PTSD, anxiety and depression after a crisis.     

What is the specific importance of therapeutic factors in the psychological treatment of social phobia?

This article describes the psychological interventions developed or adapted specifically for the treatment of social phobia. Two main strategies have been identified : anxiety reduction and improvement of social functioning. Exposure and cognitive restructuring are the main procedures for anxiety reduction. For the improvement of social functioning, social skills training is the principal procedure. The outcomes on a short and long term basis are analyzed and compared to psychopharmacology. Tasks (homework) to be performed in real-life situations between sessions are considered as an essential element of all interventions. However, these tasks are guided by the different theoretical principles inherent to each approach.