The Association of Sensory Responsiveness with Somatic Symptoms and Illness Anxiety

Background

Somatoform Disorders or Somatic Symptom and Related Disorders are a major public health problem.The pathophysiology underlying these disorders is not yet understood.

Purpose

The aim of this study was to explore if sensory responsiveness could contribute to a better understanding of pathophysiological mechanisms underlying two key symptoms of Somatoform Disorders, namely somatic symptoms and illness anxiety.

Methods

We measured vibrotactile perception thresholds with the HVLab Perception Meter and examined their association with somatic symptoms, illness anxiety and trait anxiety. A sample of 205 volunteers participated in the study.

Results

Sensory responsiveness was neither associated with somatic symptoms (β?=??0.01; 95 % confidence interval (CI), ?0.37, 0.39) nor trait anxiety (β?=??0.07; 95 % CI, ?0.30, 0.07). However, lower vibrotactile perception thresholds were associated with increased scores of the overall illness anxiety scale (β?=??0.65; 95 % CI, ?1.21, ?0.14) and its constituent subscale disease conviction (β?=??2.07; 95 % CI, ?3.94, ?0.43).

Conclusions

Our results suggest that increased sensory responsiveness is associated with illness anxiety and hence should be examined further as potential target within the etiopathology of somatoform disorders.

     

Do stress coping strategies influence chronotype-related differences in sleep quality?

Background

Chronotype manifestation often has a broad influence on sleep quality. One possible explanation for daytime impairments in evening types is the concept of “social jetlag”. Social jetlag is caused by an incompatibility between circadian preference and the socially accepted rhythm. This can be declared as a social stressor.

Objective

The association between chronotype, stress coping, and sleep quality was assessed in a pilot study.

Materials and methods

A total of 75 female adults aged 20–41 years participated in the study and completely answered all questions. Various questionnaires including sociodemographic data, information about sleep quality (Pittsburgh Sleep Quality Index, PSQI), chronotype (morningness–eveningness questionnaire, MEQ), and stress coping (Stress Coping Style Questionnaire, SVF78) were applied.

Results

Heightened use of maladaptive coping strategies is associated with a reduction in sleep quality. Chronotypes did not differ in terms of sleep quality and the coping strategies used.

Conclusion

Maladaptive coping strategy use seems to have a negative influence on sleep quality. Preventive education in adaptive stress coping strategies and avoidance of maladaptive stress coping thus seems useful to reduce these adverse influences on sleep quality.

     

Association of physical activity and sedentary behavior with depression and anxiety symptoms during pregnancy in a multiethnic cohort of Asian women

Objectives

This study aimed to investigate associations of physical activity (PA) and sedentary behavior (SB) with depression and anxiety symptoms during pregnancy among Chinese, Malay, and Indian women.

Methods

Women answered PA and SB (sitting time and television time) interview questions and self-completed the Edinburgh Postnatal Depression Scale (EPDS) and State-Trait Anxiety Inventory (STAI) questionnaires, at week 26–28 gestation. Sufficient levels of PA (≥600MET-minutes/week) and higher sitting time (≥7 h/day) were determined. Associations of PA and SB with probable antenatal depression (EPDS-score ≥15), higher state anxiety (score ≥42), and higher trait anxiety (score ≥43) were determined by logistic regression analysis.

Results

Among the 1144 pregnant women included in the study, 7.3, 22.5, and 23.6 % had probable antenatal depression, higher state anxiety, and higher trait anxiety symptoms, respectively. In the adjusted models, women with sufficient level of PA were less likely to have probable antenatal depression (OR 0.54, 95 % CI 0.31–0.94, p?=?0.030) and higher trait anxiety symptoms (OR 0.68, 95 % CI 0.48–0.94, p?=?0.022). PA was not associated with state anxiety symptoms. SB was not associated with any of the investigated outcomes.

Conclusions

Sufficient PA was associated with a reduced likelihood of probable antenatal depression and trait anxiety symptoms. Further investigation of these findings is warranted to determine cause-effect relationships and identify potential preventive strategies.

     

Childhood Abuse,Religious Involvement,and Substance Abuse Among Latino-American Men in the United States

Purpose

Childhood abuse/victimization and subsequent substance abuse are significant behavioral health problems among developed countries. In the United States (U.S.), however, few studies have examined whether this early trauma exacerbates adulthood substance abuse, viewed as a negative coping strategy, among Latino-American men. Furthermore, little is known about how collectivist cultural factors (i.e., ethnic identity, social support, and religious involvement), indicating potentially positive coping resources, were related to substance abuse in this largest minority-male population.

Method

We investigated Latino-American men (N?=?1127) in a nationally representative U.S. sample, using logistic regression analysis adjusting known demographic and acculturation correlates.

Results

The results identified considerably elevated rates of childhood physical abuse/victimization (35.7 %) and lifetime substance abuse (17.3 %). Childhood physical (not sexual) abuse/victimization was positively associated with lifetime substance abuse, alongside age, being U.S.-born, and perceived discrimination. Latino-American men with lifetime substance abuse reported more religious coping.

Conclusion

Findings may contribute to the design of culturally competent behavioral care.

     

Subjektive schlafbezogene Parameter bei Patienten mit Autismus-Spektrum-Störung

Background

Sleep disorders are common in children and adolescents with autism spectrum disorder. Little is known, however, about sleep in adult patients.

Objectives

Cross-sectional analysis of subjective sleep-related parameters in patients with autism spectrum disorder and healthy control participants.

Materials and methods

Twenty-nine patients with autism spectrum disorder and 50 healthy control participants were investigated using a questionnaire battery and sleep diaries. All analyses were controlled for depression and anxiety.

Results

Patients with autism spectrum disorder had more severe insomnia symptoms, stronger dysfunctional beliefs and attitudes about sleep, an increased sleep effort, and a higher cognitive arousal compared to the control group. In addition to this, the sleep diary data showed earlier bedtimes in those with autism spectrum disorder.

Conclusions

In patients with autism spectrum disorder, sleep onset and sleep maintenance difficulties seem to be accompanied by cognitive alterations that are typically observed in insomnia patients. In light of this, it appears to be worthwhile to investigate the efficacy of cognitive behavioral treatment for insomnia in this patient group.

     

Type D Personality and Sleep Quality in Coronary Artery Disease Patients With and Without Obstructive Sleep Apnea: Mediating Effects of Anxiety and Depression

Purpose

The study aimed to examine the association between type D personality trait and sleep quality in coronary artery disease (CAD) patients with and without obstructive sleep apnea (OSA) and to explore the mediating effects of anxiety and depression symptoms.

Method

A cross-sectional study was performed in 879 CAD patients attending cardiac rehabilitation program (mean age 57.8 years; SD?=?9.0; 75% men). Participants underwent full-night polysomnography and were classified in OSA (n?=?349) and no OSA (n?=?530) groups. Patients were evaluated for type D personality, subjective sleep quality (Pittsburgh sleep quality index), and symptoms of anxiety and depression (hospital anxiety and depression scale).

Results

Patients with type D personality reported poorer subjective sleep quality than non-type D patients irrespective of the presence of OSA. Type D and negative affectivity (NA) were associated with worse subjective sleep quality in patients with OSA and without OSA. The mediational analysis revealed that type D and NA were indirectly associated with Pittsburgh sleep quality index through anxiety and depression symptoms in no OSA and OSA patients.

Conclusion

In CAD patients, type D personality and NA are associated with worse subjective sleep quality and this association is mediated by depression and anxiety symptoms irrespective of OSA presence.

     

Investigating the Effectiveness,Acceptability and Impact on Healthcare Usage of Providing a Cognitive-Behavioural Based Psychological Therapy Service for Patients with Primary Antibody Deficiency

Purpose

Patients with primary antibody deficiency report poorer quality of life and higher rates of anxiety and depression than the general population. Cognitive-behavioral therapy has been shown to be a valuable treatment for patients with other long-term physical health conditions, improving well-being and enabling them to manage their symptoms more effectively. The aim of this project was to establish the feasibility and effectiveness of providing cognitive-behavioral based therapy to patients with primary antibody deficiency.

Methods

Forty-four patients completed a course of psychological therapy. Participants completed a series of self-report measures examining psychological and physical health, and service usage, prior to starting treatment and following their final session. They also provided feedback on their experience of treatment.

Results

Patients showed improvements in anxiety, depression, insomnia and fatigue. There was a high level of acceptability of the service and the potential for long-term cost savings to the NHS.

Conclusion

Psychological therapy based on the cognitive-behavioral model of treatment appears to be a valuable treatment for patients with primary antibody deficiency and comorbid mental health difficulties.

     

Abstracts 2016

Background

Musculoskeletal pain is associated with comorbidity, extensive use of health services, long-term disability and reduced quality of life. The scientific literature on effects of treatment for musculoskeletal pain is inconclusive.

Purpose

The purpose of this study is to compare a multidisciplinary intervention (MI), including use of the novel Interdisciplinary Structured Interview with a Visual Educational Tool (ISIVET), with a brief intervention (BI), on effects on mental and physical symptoms, functioning ability, use of health services and coping in patients sick-listed due to musculoskeletal pain.

Method

Two hundred eighty-four adults aged 18–60, referred to a specialist clinic in physical rehabilitation, were randomized to MI or BI. Patients received a medical examination at baseline and completed a comprehensive questionnaire at baseline, 3 months and 12 months.

Results

Both groups reported improvements in mental and physical symptoms, including pain, and improved functioning ability at 3 and 12 months, but the MI group improved faster than the BI group except from reports of pain, which had a similar course. Significant interactions between group and time were found on mental symptoms (anxiety (p?<?0.05), depression (p?<?0.01), somatization (p?<?0.01)) and functioning ability (p?<?0.01) due to stronger effects in the MI group at 3 months. At 3 and 12 months, the MI group reported significantly less use of health services (general practitioner (p?<?0.05)). At 12 months, the MI group reported better self-evaluated capability of coping with complaints (p?<?0.001) and they took better care of their own health (p?<?0.001), compared to the BI group.

Conclusion

The results indicate that the MI may represent an important supplement in the treatment of musculoskeletal pain.

     

Hepatic mobilization of zinc after an experimental surgery,and its relationship with inflammatory cytokines release,and expression of metallothionein and Zip14 transporter

Objective

To study the relationship between the release of inflammatory cytokines and mobilization of zinc into liver, and the expression of metallothionein and Zip14 transporter after an abdominal surgery in rats.

Materials

Thirty-five male Wistar rats were subjected to experimental surgical stress, then the subgroups of five animals were killed at 3, 6, 9, 12, 16, 20 and 24 h. Matched groups without surgery were used as controls.

Methods

Zinc levels were determined by AAS, intracellular zinc by zinquin and dithizone staining. Hepatic metallothionein was assayed by a Cd-saturation method, and IL-1β, IL-6, and TNF-β by immunoassays. Zip14 expression was analyzed by real-time RT-PCR, and protein level by immunohistochemistry and Western blot.

Results

Experimental surgery produced a hypozincemia, and the increase of hepatic zinc also produced the release of IL-1β, IL-6 in serum, and the increase of hepatic MT. Histochemistry showed a decrease of free zinc at 3–6 h, but an increase at 9 h (zinquin); meanwhile, total intracellular zinc increased after 9 h (dithizone). RNAm and protein levels of Zip14 were elevated between 6 and 20 h after surgery.

Conclusion

Biochemical changes described in this work could be part of the APR, and directed to respond to the damage produced during surgical trauma.

     

The Stability of Type D Personality in Dialysis Patients

Purpose

Type D personality has been identified as an independent risk factor for survival in cardiovascular disease (CVD) patients. As CVD is present in about 50% of dialysis patients, it is of clinical interest to assess the prevalence of type D personality, the association with depressive and anxiety symptoms, and stability of type D personality in dialysis patients.

Methods

Data was used from two consecutive measurements of the DIVERS study, a prospective cohort study among chronic dialysis patients in the Netherlands. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and the Type D Scale-14 (DS14) were used to assess depressive and anxiety symptoms and type D personality, respectively. The association of type D personality was assessed with analysis of variance F test. Stability of type D personality, depressive, and anxiety symptoms were determined by calculating Cohen’s κ, and by determining the positive agreement.

Results

In total, 349 patients were included of which 249 patients had two measurement points. The prevalence of type D personality was 21% and type D personality was associated with depressive and anxiety symptoms (P < 0.01). Over a 6-month period, Cohen’s κ was 0.52, 0.56, and 0.61 for type D personality, depressive, and anxiety symptoms, respectively. Sixty-one, 73, and 73% had a stable type-D personality, depressive, and anxiety symptoms, respectively.

Conclusion

The presence of type D personality varies over time in dialysis patients. Therefore, type D personality is possibly more a state instead of a trait phenomenon.

     

Predictive medicine: outcomes,challenges and opportunities in the Synergy-COPD project

Background

Chronic Obstructive Pulmonary Disease (COPD) is a major challenge for healthcare. Heterogeneities in clinical manifestations and in disease progression are relevant traits in COPD with impact on patient management and prognosis. It is hypothesized that COPD heterogeneity results from the interplay of mechanisms governing three conceptually different phenomena: 1) pulmonary disease, 2) systemic effects of COPD and 3) co-morbidity clustering.

Objectives

To assess the potential of systems medicine to better understand non-pulmonary determinants of COPD heterogeneity. To transfer acquired knowledge to healthcare enhancing subject-specific health risk assessment and stratification to improve management of chronic patients.

Method

Underlying mechanisms of skeletal muscle dysfunction and of co-morbidity clustering in COPD patients were explored with strategies combining deterministic modelling and network medicine analyses using the Biobridge dataset. An independent data driven analysis of co-morbidity clustering examining associated genes and pathways was done (ICD9-CM data from Medicare, 13 million people). A targeted network analysis using the two studies: skeletal muscle dysfunction and co-morbidity clustering explored shared pathways between them.

Results

(1) Evidence of abnormal regulation of pivotal skeletal muscle biological pathways and increased risk for co-morbidity clustering was observed in COPD; (2) shared abnormal pathway regulation between skeletal muscle dysfunction and co-morbidity clustering; and, (3) technological achievements of the projects were: (i) COPD Knowledge Base; (ii) novel modelling approaches; (iii) Simulation Environment; and, (iv) three layers of Clinical Decision Support Systems.

Conclusions

The project demonstrated the high potential of a systems medicine approach to address COPD heterogeneity. Limiting factors for the project development were identified. They were relevant to shape strategies fostering 4P Medicine for chronic patients. The concept of Digital Health Framework and the proposed roadmap for its deployment constituted relevant project outcomes.

     

The Moderating Effect of Smoking Status on the Relation between Anxiety Sensitivity,Sexual Compulsivity,and Suicidality among People with HIV/AIDS

Purpose

The present study examined the moderating effect of cigarette smoking status on the relation between anxiety sensitivity (fear of the expected negative consequences of anxiety and bodily sensations) and hazardous alcohol consumption, sexual compulsivity, and suicidality.

Method

A series of multiple hierarchical regressions were used to test the proposed hypothesis among a sample of 94 persons living with HIV/AIDS in the USA (64.5 % male, M _age?=?48.3, SD?=?7.5). Fifty-seven percent of the participants (n?=?54) reported past-month smoking.

Results

The results indicated that those who reported smoking and had higher anxiety sensitivity demonstrated the highest rates of hazardous alcohol use, sexual compulsivity, and suicidality. Simple slope analyses indicated that anxiety sensitivity was associated with higher rates of hazardous alcohol use, sexual compulsivity, and suicidality among individuals who reported past-month smoking, but not among individuals who did not smoke.

Conclusion

The present results suggest that smoking status moderates the relation between anxiety sensitivity and hazardous alcohol use, sexual compulsivity, and suicidality among persons living with HIV/AIDS. These data add to a growing literature, suggesting that smoking has a negative impact among persons living with HIV/AIDS, which extends beyond physical health problems to a variety of clinically significant behavioral health sequelae.

     

Tinnitus,Traumatic Brain Injury,and Posttraumatic Stress Disorder in the Military

Purpose

Acoustic trauma is more prevalent in military settings, especially among individuals with combat-related military occupational specialties. Gunfire, improvised explosive devices, and mortar explosions are a few examples that may cause hearing degradation and tinnitus. It is possible that the same events that are associated with auditory problems can cause traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD).

Method

This paper reviews the distinct and overlapping symptoms of tinnitus, TBI, and PTSD, and how these disorders interact to synergistically promote negative outcomes.

Results

Tinnitus may serve as a significant contributor to symptoms of TBI and PTSD. Therefore, tinnitus subtypes could be identified as physiologically or psychologically based, or both.

Conclusions

Additional research is warranted to determine the common and unique symptoms and associated neurological pathways of tinnitus, TBI, and PTSD. Brief treatment recommendations are provided, including a multidisciplinary approach for the physical and psychological distress associated with tinnitus.

     

Psychometric Properties of an Arabic Pain Anxiety Symptoms Scale-20 (PASS-20) in Healthy Volunteers and Patients Attending a Physiotherapy Clinic

Purpose

The aim of this study was to cross-culturally adapt the PASS-20 questionnaire for use in Libya.

Methods

Participants were 71 patients (42 women) attending the physiotherapy clinic, Ibn Sina Hospital, Sirt, Libya for management of persistent pain and 137 healthy unpaid undergraduate students (52 women) from the University of Sirt, Libya. The English PASS-20 was translated into Arabic. Patients completed the Arabic PASS-20 and the Arabic Pain Rating Scales on two occasions separated by a 14-day interval. Healthy participants completed the Arabic PASS-20 on one occasion.

Results

The internal consistency (ICC) for pain patient and healthy participant samples yielded a good reliability for the total score, cognitive anxiety, fear of pain, and physiological anxiety. The test-retest reliability of the Arabic PASS-20 score showed high reliability for the total score (ICC = 0.93, p < 0.001), escape/avoidance (ICC = 0.93, p < 0.001), fear of pain (ICC = 0.94, p < 0.001), and physiological anxiety subscales (ICC = 0.96, p < 0.001) and good reliability for the cognitive anxiety (ICC = 0.85, p < 0.001). Inspection of the Promax rotation showed that each factor comprised of five items were consistent with the theoretical constructs of the original PASS-20 subscales.

Conclusion

The Arabic PASS-20 retained internal consistency and reliability with the original English version and can be used to measure pain anxiety symptoms in both pain and healthy individual samples in Libya.

     

Clinical Characteristics and Referral Patterns of Outpatients Visiting a Japanese Psychosomatic Medicine Clinic

Background

The definition of psychosomatic medicine is not consistent across countries.

Purpose

The study purpose was to clarify the applicability of the definition of psychosomatic illness issued by the Japanese Society of Psychosomatic Medicine to different types of referral in a university hospital.

Methods

The sample consisted of 1067 outpatients visiting a psychosomatic clinic. Participants completed questionnaires to assess degrees of somatization, depression, anxiety, and psychosocial stress after completing clinical interviews based on the Diagnostic and Statistical Manual, Fourth Edition, Text Revision. All subjects were classified into psychosomatic and non-psychosomatic groups, and the non-psychosomatic group was further divided into three additional groups: depression, anxiety, and other.

Results

In total, 398 (37 %) of the subjects were placed in the psychosomatic group. The percentage of the psychosomatic group was 46 % in those referred within the hospital, 37 % in those referred outside the hospital, and 28 % in those without referral from physicians. Concerning the non-psychosomatic group, 269 (25 %) were placed in the depression group, 229 (22 %) in the anxiety group, and 171 (16 %) in the other group. Membership in the psychosomatic group was positively associated with age and the severity of somatosensory amplification (both p?<?0.05), but negatively associated with the severity of depression and anxiety as well as the classification of non-referral (all p?<?0.05).

Conclusions

Although patients with psychiatric disorders, including depressive and anxiety disorders, are frequently seen in the Japanese psychosomatic clinic, patients who are diagnosed with psychosomatic illnesses tend to have been referred by physicians within the hospital. The concept of psychosomatic medicine needs to be further developed to assist both clinical practitioners and patients.

     

Sleep Quality in Ulcerative Colitis: Associations with Inflammation,Psychological Distress,and Quality of Life

Purpose

Treatment of ulcerative colitis (UC), given its chronicity and its associated disruptive and often distressing symptoms, is increasingly focusing on maximizing patient quality of life. Poorer quality of life has been found among patients with poor sleep quality, which is much more common in patients with UC than in the general population and may be associated with inflammation and psychological distress.

Method

Forty-seven patients with UC (n?=?11 flaring) completed measures of sleep quality, depression, state anxiety, gastrointestinal-related anxiety, perceived stress, and quality of life. Measures of inflammation were also obtained.

Results

Patients endorsed high rates of poor sleep quality, which was highly correlated with depression and poorer inflammatory bowel disease-related quality of life, but was generally not related to other areas of psychological functioning or inflammation. Sleep quality was significantly independently associated with depression and female gender.

Conclusion

Poor sleep quality is prevalent in patients with UC and is strongly related to depression, suggesting that sleep and mood are important areas to assess in patients with UC in order to inform tailored treatment to improve quality of life.

     

Location and gene-specific effects of methylprednisolone acetate on mitigating IL1β-induced inflammation in mature ovine explant knee tissue

Objective and design

To determine the ability of methylprednisolone acetate (MPA) to influence interleukin 1β (IL1β)-induced gene expression in ovine knee joint tissues.

Material or subjects

Ovine articular cartilage, synovium, and infrapatellar fat pad (IPFP) explants.

Treatment

Explants were treated with 10^?3 M or 10^?4 M MPA.

Methods

Explant treatment groups: (1) control (DMEM); (2) inflammation (IL1β); (3) IL1β + 10^?3 M MPA; or (4) IL1β + 10^?4 M MPA. Cell viability was assessed pre- and post-treatment. Expression of mRNA levels for inflammatory, degradative, anabolic, innate immunity, and adipose-related molecules was quantified via qPCR, and analyzed via the comparative C _T method.

Results

Except for IL8 in a subset of cartilage locations, matrix metalloproteinases (MMPs) were the only genes consistently affected by MPA. MPA mitigated IL1β-induced MMP3 expression levels in all regions of the articular cartilage, and in the synovium and IPFP, while MMP1 mRNA expression levels were significantly decreased with MPA after IL1β in the tibial plateau and synovium, but paradoxical increases in the IPFP. MMP13 mRNA expression levels exhibited significant decreases with MPA after IL1β in the femoral condyles, tibial plateau, synovium, and IPFP.

Conclusions

MPA treatment suppressed IL1β-induced mRNA levels for MMPs in articular cartilage, synovium, and IPFP and was found to be tissue-, location-, and gene-specific.

     

Sleep problems in adolescents with Asperger syndrome or high-functioning autism

Background

Autism is a neurodevelopmental disorder defined by deficits in social interaction, communication, and restricted repetitive behavior. Research studies indicate that children with autism spectrum disorders suffer from more sleep problems than the general population.

Objective

The aim of the study was to investigate sleep problems in adolescents with Asperger syndrome (AS) or high-functioning autism (HFA) and to further examine the association between sleep problems and problem behavior as well as autism symptom severity.

Methods

In this study, 15 adolescents diagnosed with AS or HFA (aged between 10–19 years) and one parent of each answered questions about sleep and sleep disturbances.

Results

A high prevalence of sleep problems (80?%) was found. The most frequently reported sleep problems were insomnia symptoms (80?%) and parasomnias (53?%). More sleep problems were associated with decreased daytime functioning, more precisely with more externalizing problem behavior and a higher autism symptom severity.

Conclusion

The results suggest that sleep problems are common in adolescents with AS or HFA and are connected to lower daytime functioning. Therefore, in clinical practice, individuals should routinely be screened for sleeping difficulties.

     

Examining the Associations Between Overeating,Disinhibition, and Hunger in a Nonclinical Sample of College Women

Background

Binge eating (BE) has long been identified as a correlate of overweight and obesity. However, less empirical attention has been given to overeating with and without loss of control (LOC) in nonclinical samples.

Purpose

The goal of the present study was to examine the association of (1) established correlates of BE, namely, weight and shape concerns, dietary restraint, and negative affect, and (2) three additional correlates, disinhibition, hunger, and interoceptive awareness (IA), to overeating in a nonclinical sample of college women.

Method

Female students (n?=?1,447) aged 18 to 21 years recruited from colleges in three Canadian metropolitan areas completed self-report questionnaires in class to assess sociodemographic and anthropomorphic characteristics, overeating, LOC, dietary restraint, negative affect, weight and shape concerns, IA, disinhibition, and hunger.

Results

The established correlates of BE were significant correlates of all types of overeating and explained 33 % of the variance. Disinhibition was the most strongly associated correlate of overeating.

Conclusions

Findings suggest that established correlates of BE are associated with other types of overeating such as objective overeating (OOE), as are disinhibition and hunger.