Dysfunction of stress responsive systems as a risk factor for functional somatic syndromes

The etiology of functional somatic syndromes or disorders (FSDs) is generally considered to be a multifactorial interplay between psychological, biological, and social factors. One of the most investigated biological factors is stress responsive system dysfunction. Despite more than twenty years of research of the autonomic nervous system and the hypothalamic-pituitary-adrenal axis, however, it is yet unknown whether dysfunctions in these systems play a causal role in the etiology of FSDs and whether they are generic or FSD-specific. In this review, we will give an overview of available evidence on whether or not alterations in these stress responsive systems can be considered causal risk factors of FSDs. We conclude that although not necessary factors for FSDs in general, lowered cardiac vagal activity and hypocortisolism may be pivotal in the etiology and treatment strategy in subgroups of subjects with a FSD. Such subgroups need to be better identified.     

Sleep investigations in erectile dysfunction

Regarding the aetiology of erectile dysfunction, beside numerous organic causes in many cases psychological factors play an important role. The pathophysiological mechanisms underlying the so-called psychogenic erectile dysfunction are not yet understood. Based on a neurobiological approach to psychogenic erectile dysfunction, polysomnographic investigations were carried out with the aim of identifying possible alterations of the sleep EEG. 24 male patients with psychogenic erectile dysfunction without detectable organic factors or other mental disorders were studied in the sleep laboratory, as well as an age-matched control group without sexual dysfunctions. Beside a reduction of sleep efficacy, the most prominent finding was a shortening of REM latency in the patients compared to the controls. Moreover, spectral analysis revealed a reduced theta power for all sleep stages and a reduced delta power for stage II and slow wave sleep in the patients. The findings support the point of view that psychogenic erectile dysfunction is an organic disorder of the brain. The sleep EEG abnormalities may reflect dysregulations in limbic structures which are suggested to be involved in the pathophysiology of sexual dysfunctions. As these alterations had also been reported for other mental disorders, particularly depression, they appear to be non-specific biological abnormalities for different psychiatric syndromes, including psychogenic erectile dysfunction.     

Behavioral disturbances in dementia

Psychological symptoms and behavioral abnormalities are common and prominent characteristics of dementia. They include symptoms such as depression, anxiety psychosis, agitation, aggression, disinhibition, and sleep disturbances. Approximately 30% to 90% of patients with dementia suffer from such behavioral disorders. There are complex interactions between cognitive deficits, psychological symptoms, and behavioral abnormalities. A large number of standardized, reliable, and well-validated instruments for assessing the behavioral and psychological symptoms of dementia have been developed in order to evaluate the efficacy of treatment. Neurodegenerative processes in various brain areas, particularly in the frontotemporal cortex and limbic regions, leading to cholinergic, serotonergic, and noradrenergic neurotransmitter dysfunctions constitute the biological matrix of behavioral symptoms, whereas psychological factors and personality traits play a modifying role. A large number of pharmacological, psychoeducational, psychotherapeutic, and social strategies have been developed to improve the quality of life of patients and their caregivers.     

What are the effects of antipsychotics on sexual dysfunctions and endocrine functioning?

The literature is reviewed and preliminary results of new studies are presented showing that treatment with classical antipsychotics, as well as risperidone, induces sexual dysfunctions in 30-60% of the patients. These antipsychotics also frequently induce amenorrhoea and galactorrhoea. Although comparative studies are rare, it is likely that prolactin-sparing antipsychotics, as recently shown in a randomized trial of olanzapine versus risperidone, induce less sexual side effects.From these studies, it becomes apparent that prolactin elevation induced by classical antipsychotics and risperidone is probably a factor in inducing sexual dysfunctions, amenorrhoea and galactorrhoea. The role of other factors inducing sexual dysfunctions like sedation, proportional, variant -blockade, testosterone, dopamine, and serotonin is discussed. Finally, it is concluded that sexual and hormonal effects of antipsychotics, although clearly important, are often neglected in research as in clinical practice. Lowering the dosage or switching to a prolactin-sparing antipsychotic often reduces sexual side effects, amenorrhoea, and galactorrhoea.     

Cognition in mania and depression: Psychological models and clinical implications

Affective disorders, including bipolar disorder and major depressive disorder, are highly prevalent throughout the world and are extremely disabling. Diagnostic and Statistical Manual criteria and psychological models strongly implicate cognitive dysfunctions as being integral to our understanding of these disorders. We review the findings from studies that have used neurocognitive tests and functional imaging techniques to explore abnormal cognition in affective disorders. In particular, we highlight the evidence for cognitive dysfunctions that persist into full clinical remission, and the recent trend toward the use of “hot” processing tasks, involving emotionally charged stimuli, as a means of differentiating between the cognitive underpinnings of mania and depression. The clinical relevance of these developments is discussed.     

Visual tracking disorders in schizophrenia. Review of the literature and methodological considerations]

Since Holzman expressed the hypothesis that eye-tracking dysfunctions might be a genetic indicator of schizophrenia, the researches on the performances of schizophrenics in eye-tacking tasks have been numerous. The correlation between the results of all these researches leaves little doubt on the existence of eye-tacking dysfunctions in schizophrenics. But these distrubances must be precised. Up to now, the studies have used tests that were too complex in their interpretation (pendulum test) and they have been limited to a global appreciation of eye-tacking. To take into account the psychological parameters that may interfere with success in this type of tests, the coming researches should focus on elementary eye-motor activities.     

Facteurs psychologiques et de personnalité dans le binge-drinking chez les jeunes

For years, a large number of studies have demonstrated the harmful effects of alcohol consumption on the brain and therefore on behavior and cognition. These studies first aimed at identifying the consequences of alcohol abuse consumption, more specifically in pathologies such as alcohol-dependence or Korsakoff syndrome. Researchers then also started to focus on vulnerabilities to alcohol consumption, especially in hyper fast alcohol consumption called binge-drinking (BD). Indeed BD, which is a particularly dangerous form of alcohol consumption, is usually observed in adolescents and young adults. Typically, young people tend to adopt this way of drinking in order to reach a massive and expeditious intoxication. The aim of this paper is to present the bibliographic data available on the main risk factors to BD and to describe the main measurement tools for investigating these factors in clinical researches. The interaction between psychological dysfunctions and BD is not well understood. For a better understanding of the links between binge-drinking and psychological and personality factors in terms of vulnerability or risk, studies have investigated on affective factors (depression and anxiety), personality characteristics (impulsivity and sensation seeking) and drinking motives (coping, improvement, compliance and wellness). Although different factors are often associated with BD in adolescents and young adults, it is still not clear whether these factors are the consequences of alcohol consumption or a reflection of pre-morbid abnormalities predisposing individuals to excessive alcohol consumption. Furthermore, results are not unequivocal and various distinct personality profiles seem to emerge. Thus, these questions are still not fully resolved and further studies are needed to understand the complex relationships between BD and the various psychological or personality factors. The need for investigating these factors in clinical studies is nevertheless important with regard to therapeutic interventions. Indeed, the identification of specific profiles involved in a binge-drinking type of consumption could allow an adaptation of the contents of therapeutic programs by targeting a specific mechanism. For example, recent findings have revealed that when factors such as impulsivity are considered, therapeutic intervention is more effective.     

Health practice at the technologic/folk interface: witchcraft as a culture-specific diagnosis.

"Witchcraft illness" is a widespread belief among many people, even after acculturation to technological concepts of illness etiology. Two cases are presented to show that such beliefs can complicate physical or psychological dysfunctions, or themselves can be the primary origin of physical or psychological dysfunctions. In both instances, witchcraft beliefs take on a dynamic of their own and must be resolved both in terms of the patient's culture as well as the clinician's treatment plan. Considering such phenomena from the vantage point of family systems provides useful insights into etiology as well as amelioration. The latter requires engaging all parties in the health care system-clinician, patient, family, and indigenous health caretakers.     

An interpretative model of early indicators of specific developmental dyslexia in preschool age: a comparative presentation of three studies in Greece

The detection of specific factors of the developmental dyslexia at an early stage, and the identification of the role of those factors responsible for its manifestation, is a fundamental area of study on dyslexia in the recent literature. The objective of the present study is to clarify that dysfunctions in the following specific domains contribute in a causal model to the occurrence of dyslexia at an early stage: phonological awareness, psychomotor ability (body shape, spatio-temporal orientation, grapho-motor ability and laterality), perception, memory, attention, prereading and prewriting skills. The results of three studies, --carried out in Greece--which revealed the above factors as main predictors of the early onset of Specific Developmental Dyslexia (SDD) and confirmed the importance of intervention methods to it, led us to the construction of the proposed, causal model. The findings of these three studies converge on the perspective that the understanding, diagnosis and treatment of dysfunctions in the above domains, from preschool age, enable the early and reliable prevention of future difficulties in the learning process of children.     

Male sexual disorders following stroke: an overview

Stroke is one of the leading causes of death and disability throughout the world. Although physical and cognitive impairments after stroke have been well studied, little information is known about one of the crucial aspect of the quality of life of stroke patients, namely, sexual functioning and satisfaction. Poststroke sexual dysfunctions seem to be very common since in men affected by stroke, a decline in libido and poor or tailed erection and ejaculation are frequently observed. Sexual disorders after stroke are thought to be due to multiple etiologies, including both organic (i.e., lesion localization, premorbid medical conditions, and medications) and psychosocial (i.e., fear of recurrences, loss of self-esteem, role changes, anxiety, and depression). Thus, exploration in sexual dysfunctions and sexual counseling by trained professionals should be a part of stroke rehabilitation. The aim of this review is to evaluate the burden of stroke on sexual function taking into account the complex interaction between neurological, psychological, and relational factors.     

Assessing dysfunction using refined cognitive methods

Instruments currently being used to assess cognitive dysfunction do not grant us the granularity to pinpoint the specific cognitive impairments associated with various disorders. With the advent of sophisticated neuroimaging methods and lesion data, we are in a better position to understand the component processes of the various psychological functions. Here we describe 2 such functions and elucidate how the same refined cognitive methods that are being used to understand the processes underlying these functions can be applied to exploring dysfunctions associated with various psychological disorders.     

Reduction of sexual dysfunction: by-product of cognitive-behavioural therapy for psychological disorders?

The purpose of the study was to assess changes in sexual dysfunctions among patients undergoing cognitive-behavioural therapy for a psychological disorder. Examinations were made of 451 unselected outpatients (68.1% female, mean age = 36.0 years) of a university outpatient clinic. Using the German version of the Massachusetts General Hospital Sexual Functioning Questionnaire before and after treatment, they rated their sexual interest, ability to become sexually aroused and to achieve erection or lubrication and orgasm, and their general sexual satisfaction. Almost two-thirds of the patients (63.2%) reported having a sexual dysfunction prior to therapy. Sexual dysfunctions improved in a significant number of patients but only after successful treatment for the psychological disorder. Even after the primary disorder had fully remitted, a sexual dysfunction was still present in about 45% of the patients who were originally affected. Results for patients suffering primarily from depression were similar to those who suffered from other psychological disorders. Although many of the co-morbid sexual dysfunctions of patients receiving CBT clearly improve or entirely remit, a relevant portion of patients continues to report sexual dysfunctions. Recognition of sexual dysfunctions and their integration into case formulations should therefore be improved.     

Maintaining a balanced perspective on risk

This paper discusses the psychological approach to the treatment of sexual problems. The focus is on sexual dysfunctions, rather than sexual deviations. The history of psychological therapy for sexual dysfunction is briefly outlined, and the major approaches commented on. The current status of this field is reviewed. It is argued that a broad-based behavioural approach is the treatment of choice for these problems, with contributions from cognitive therapy and the systems theory approach where appropriate. A discussion of the practice of therapy is also provided.     

Sexual impotence: clinical and existential context]

A simple classification in global impotence and erective impotence appears closer to reality than more sophisticated but more arbitrary classification. In the majority of cases, impotence reflects a global psychological dysfunction. Psychogenic impotents are most of the time inferiorized subjects alledging organic or other non justified factors to their disorder. Generally, they are peaceful, obsessive, often hypothymic; they express disgust for the body, suffer various somatic dysfunctions due to the sexual stasis; they have difficulties in communicating with things and beings. As compared to erective impotents, it seems that the global impotents have a more rigid father, are among the younger sibblings and have more brothers and sisters. The author describes further some observations of partners and of couples, as well as etiological and prognostic factors.     

Le fonctionnement émotionnel lors de la douleur chronique : état de la question

Pain mobilizes numerous psychological variables, which involve the interaction of cognitions (attention, interpretation of the situation), feelings (fear, anger, anxiety) and behaviors (immobilization, avoidance). These various aspects generally have an adaptive role, necessary for the conservation of the body. However, in chronic pain, these mechanisms can become dysfunctional and cannot answer their initial function, and can even influence the appearance of psychopathologies. In this framework, feelings and emotional processing play an important role in the modulation of the intensity of sensory and emotional aspects of pain. In this particular case, suppression, emotional avoidance and alexithymia are associated with a greater intensity of the sensory or emotional aspects of pain. Although recent studies have employed relatively rigorous methodological devices, sometimes they used many tools which do not yet measure the dysfunction directly. Furthermore, emotional suppression was mainly studied during anger, which constitutes a specific phenomenon that cannot be generalized to all emotions. New studies are to be envisaged which would allow in particular the study of the effect of unregulated (insufficient control of experience or emotional expression) and untreated (arousing intrusive thoughts and the obstinacy of the emotional experience) emotions, defined by Baker et al. (2007), and the use of a tool permitting the differentiation and measurement of all possible dysfunctions. They could also allow for the control of the concomitant presence of various emotional dysfunctions in participants. Ideally, the realization of forward-looking studies could define the nature of the links between emotional dysfunctions and chronic pain.     

The integration of cardiovascular behavioral medicine and psychoneuroimmunology: new developments based on converging research fields

The immune system plays a role in the progression of coronary artery diseases and its clinical manifestations as acute coronary syndromes. It is well established that psychological factors can act as risk factors for acute coronary syndromes. This review describes psychoneuroimmunological pathways involved in coronary disease progression and documents that the stage of coronary disease is a major determinant of pathophysiological mechanisms accounting for the association between psychological risk factors, immune system parameters, and acute coronary syndromes. Chronic psychological risk factors (e.g., hostility and low socioeconomic status) are important at early disease stages, episodic factors (e.g., depression and exhaustion) are involved in the transition from stable to unstable atherosclerotic plaques, and acute psychological triggers (e.g., mental stress and anger) can promote myocardial ischemia and plaque rupture. The psychoneuroimmunological pathways are described for each of these three types of psychological risk factors for acute coronary syndromes.     

Do children with autism spectrum disorders have motor learning difficulties?

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social and communication impairments as well as a wide range of behavioral symptoms. For years, motor disturbance reported in ASD has not been treated as a core deficit because of the overwhelming problems in sociability and communication. Recent studies, however, reveal that motor deficits are also fundamental to ASD presentation and contribute to the core symptoms of ASD. Untreated motor problems can persist well into adolescence and adulthood, resulting in long-term physical, psychological, and behavioral issues in individuals with ASD. Thus, the ability to understand and address the overall picture of a child with ASD, including motor dysfunction, has become a critical need. This review focuses on sensorimotor adaptation and motor sequence learning in children with ASD and presents related evidence that compromised motor learning may play a critical role in motor dysfunctions of ASD. It addresses possible factors that explain controversial findings in the literature and discusses potential strategies for facilitating motor learning. Future intervention studies should address the importance of motor learning beyond social and language domains in ASD.     

Neuropsychological deficits in depressive disorders

Neuropsychological deficits are considered a significant feature of depression both for their differential value in the diagnostics and the underlying pathophysiology of depressive disorders. The studies reviewed in the present paper predominantly focus on memory disorders as well as frontal-lobe associated dysfunctions such as deficits of attentional performance and executive functions. Despite heterogeneous results in the literature, there is emerging evidence that executive functions and anterograde memory performance are those domains predominantly affected in depressive disorders. The fact that not all depressive patients display neuropsychological deficits rather indicates a dominant role of moderating variables. We discuss the following variables possibly intervening with type and degree of neuropsychological dysfunction: [1] severity and remission of depressive disorders, [2] age of patients and age at the first manifestation of a depressive disorder, [3] psychological factors such as motivation and coping with failure, [4] type and efficacy of antidepressive drug treatment, [5] duration of the stay as inpatients, [6] number of depressive episodes, and [7] gender. Furthermore, we discuss the theory of a dysfunction of fronto-striatal circuits as an underlying mechanism of depressive disorders. The majority of neuropsychological findings seem to support this theory.     

Gender differences in unipolar depression: an update of epidemiological findings and possible explanations

OBJECTIVE: To give an update on epidemiological findings on sex differences in the prevalence of unipolar depression and putative risk factors. MATERIAL AND METHODS: Systematic review of the literature. RESULTS: Recent epidemiological research yields additional evidence for a female preponderance in unipolar depression, holding true across different cultural settings. Current explanations include artefacts, genetic, hormonal, psychological and psychosocial risk factors. Rather consistently, intrapsychic and psychosocial gender role related risk factors have been identified which may contribute to the higher depression risk in women. Gender role aspects are also reflected in endocrine stress reactions and possibly influence associated neuropsychological processes. CONCLUSION: There is a need for more integrative models taking into account psychological, psychosocial, and macrosocial risk factors as well as their interactions, which also connect these factors with physiological and endocrine responses. Furthermore, it is conceivable that across the life span, as well as across cultural settings, individual risk factors will add with varying emphasis to the higher prevalence of depression in women.