Abnormal illness behavior of patients with functional somatic symptoms: relation to psychiatric disorders.

Functional somatic symptoms are highly associated with hypochondriasis, anxiety, and depressive disorders. Despite the absence of an organic disorder, underlying psychological distress of patients with functional somatic symptoms may result in abnormal illness behavior such as inadequate treatment seeking or overuse of medical services. Using the Illness Behavior Questionnaire (IBQ), we examined the illness behavior of Japanese patients visiting a general medicine clinic whose physical symptoms were considered functional. We used the General Health Questionnaire-30 to classify patients with functional somatic symptoms as those with and without psychological distress. Patients with distress (n=35) reported more physical complaints and higher IBQ scores than did patients without distress (n=22). The IBQ profile of patients with psychological distress was identical to that of patients diagnosed with either hypochondriasis or major depression. The illness behavior of patients without psychological distress was indistinguishable from that of patients whose physical symptoms were attributed to organic disease. These results further support the hypothesis that functional somatic symptoms may be associated with hypochondriasis and major depression, the pathology of which may contribute to the development of abnormal illness behavior.     

Metric and structural equivalence of core cognitive abilities measured with the Wechsler Adult Intelligence Scale-III in the United States and Australia

Equivalence of the psychological model underlying Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) scores obtained in the United States and Australia was examined in this study. Examination of metric invariance involves testing the hypothesis that all components of the measurement model relating observed scores to latent variables are numerically equal in different samples. The assumption of metric invariance is necessary for interpretation of scores derived from research studies that seek to generalize patterns of convergent and divergent validity and patterns of deficit or disability. An Australian community volunteer sample was compared to the US standardization data. A pattern of strict metric invariance was observed across samples. In addition, when the effects of different demographic characteristics of the US and Australian samples were included, structural parameters reflecting values of the latent cognitive variables were found not to differ. These results provide important evidence for the equivalence of measurement of core cognitive abilities with the WAIS-III and suggest that latent cognitive abilities in the US and Australia do not differ.     

Depression in temporal lobe epilepsy surgery patients: an FDG-PET study

PURPOSE: Depression is common in temporal lobe epilepsy (TLE) and after temporal lobectomy, and its etiology is obscure. In nonepileptic depression (including depression associated with other neurologic disorders), a consistent PET imaging finding is frontal lobe hypometabolism. Many TLE patients have hypometabolism involving frontal regions. Thus in data available from routine clinical assessments in an epilepsy surgery unit, we tested the hypothesis that the pattern of hypometabolism, particularly in the frontal lobe, may be associated with the depression seen in patients with TLE and TLE surgery. METHODS: We studied 23 medically refractory TLE patients who underwent anterior temporal lobectomy and who had preoperative FDG-PET scanning. All patients had pre- and postoperative psychiatric assessment. By using statistical parametric mapping (SPM-99), patterns of hypometabolism were compared between patients who had a preoperative history of depression (n=9) versus those who did not (n=14) and between those in whom postoperative depression developed (n=13) versus those in whom it did not (n=10). A significant region of hypometabolism was set at p<0.001 for a cluster of >or=20 contiguous voxels. RESULTS: Patients with a history of depression at any time preoperatively showed focal hypometabolism in ipsilateral orbitofrontal cortex compared with those who did not (t=4.64; p<0.001). Patients in whom depression developed postoperatively also showed hypometabolism in the ipsilateral orbitofrontal region (t=5.10; p<0.001). CONCLUSIONS: Although this study is methodologically limited, and other explanations merit consideration, orbitofrontal cortex dysfunction, already implicated in the pathophysiology of nonepileptic depression, may also be relevant to the depression of TLE and temporal lobectomy.     

Depressed mood and memory impairment in temporal lobe epilepsy as a function of focus lateralization and localization

OBJECTIVE: Memory disorders and depressed mood are prominent psychological symptoms of temporal lobe epilepsies (TLEs). We examined the interaction of depressive mood and memory as a function of focus localization. METHODS: One hundred fifty-two TLE patients with right mesial (n=37, RTLE-AHS), right lateral (n=31, RTLE-LAT), left mesial (n=42, LTLE-AHS), and left lateral (n=42, LTLE-LAT) lesions and epilepsies underwent comprehensive presurgical evaluation and neuropsychological assessment of mood and memory. Univariate and multivariate analyses of covariance (ANCOVAs) and partial correlation analyses were performed to reveal interactions of depression and memory as a function of focus localization. RESULTS: No differences between the study groups were revealed for depression, indicating a general risk of 30% for depressed mood (BDI>12) in patients with TLE. ANCOVAs revealed significant main effects of focus side (left: verbal learning deficits; right: figural learning deficits) and site (mesial at disadvantage) on learning and memory scores. Correlation analyses revealed interactions between memory and mood only in LTLE-LAT patients. CONCLUSIONS: Although the data provide evidence that side and site of the epileptogenic region differentially affect material specific memory performance, there was no evidence of a specific temporal target region for depressive mood. In the majority of the patients, depressed mood and memory impairment appeared as independent rather than as related symptoms of TLE. In LTLE-LAT, however, mood was significantly related to verbal and figural memory performance. Epilepsy-driven pathological left temporofrontal circuits are discussed as a prerequisite for the coupling of mood disorders and memory impairment in this specific patient subgroup which is also known from the psychiatric major depression syndrome.     

Case Identification of Mood Disorders in Asian American and Caucasian American College Students

Past studies have sometimes found that Asian American participants score higher on checklists that measure psychological distress compared to Caucasian American participants. However, studies using diagnostic interviews have not found corresponding elevated rates of mood disorders in Asian American participants. In the present study, Asian American (n = 238) and Caucasian American students (n = 556) completed checklist measures of distress (the Beck Depression Inventory, BDI and the Mood and Behavior Questionnaire, MBQ) and a subsample of students (n = 118) received a diagnostic interview. Asian American students had higher BDI scores, but the groups did not differ on either the MBQ, a measure closely tied to DSM criteria for major depression, or on rates of current mood disorders. Elevated BDI scores overestimate rates of mood disorders, particularly in Asian American students.     

Correlates of psychological distress in elderly patients with congestive heart failure

OBJECTIVE: High levels of psychological distress have been reported in patients with congestive heart failure (CHF), resulting in increased morbidity and mortality. Yet, little is known about its associated factors. The purpose of this study is to identify the significant demographic, clinical and psychosocial correlates of psychological distress in CHF patients. METHODS: Cross-sectional data were obtained from a sample of a consecutive series of hospitalized CHF patients (n = 227) with measures of psychological distress, functional status, symptom status, social support and health perception. Objective clinical variables were obtained from the hospital records. RESULTS: High levels of psychological distress, in particular, depression, were found in patients with CHF. In hierarchical regression analysis, poorer perceived emotional-informational support, higher levels of fatigue, poorer health perception and not living with family were identified as the significant correlates of psychological distress. These correlates, in total, explained 49% of the variance for the scores of psychological distress. None of the objective clinical variables demonstrated a significant contribution that accounted for psychological distress in CHF patients. CONCLUSION: The findings highlight the importance of addressing social support for CHF patients. Assisting this vulnerable patient group to cope with fatigue and to cultivate a positive health perception are also highly prioritized treatment goals.     

Relaxation and guided imagery program in patients with breast cancer undergoing radiotherapy is not associated with neuroimmunomodulatory effects

OBJECTIVE: Treatment of breast cancer is usually associated with significant psychological stress. In this study, we examined the effects of relaxation and visualization therapy (RVT) on psychological distress, cortisol levels, and immunological parameters of breast cancer patients undergoing radiotherapy. METHODS: Participants were randomly assigned to either the experimental (n=20) who underwent group RVT for 24 consecutive days or control group (n=14) who were on radiotherapy only. Psychological scores (stress, anxiety, and depression) were measured by structured clinical interviews. Salivary cortisol was assessed along the day. Lymphocytes were isolated and cultured to measure T-cell proliferation and sensitivity to glucocorticoids (GCs). RESULTS: RVT was effective to reduce stress, anxiety, and depression scores (all P<.05). However, cortisol levels as well as proliferation remained unchanged following RVT. Although T cells of experimental group were more sensitive to GCs than cells of controls at baseline, no changes were noted following RVT. Cortisol levels were positively correlated to anxiety and depression scores and inversely correlated to T-cell proliferation and sensitivity to GCs. CONCLUSION: We conclude that the psychological intervention was capable to attenuate the emotional distress presented during radiotherapy treatment. A longer RVT or worse psychological morbidity at baseline may be necessary to translate psychological into biological changes.     

Dance movement therapy improves emotional responses and modulates neurohormones in adolescents with mild depression

This study assessed the profiles of psychological health and changes in neurohormones of adolescents with mild depression after 12 weeks of dance movement therapy (DMT). Forty middle school seniors (mean age: 16 years old) volunteered to participate in this study and were randomly assigned into either a dance movement group (n = 20) or a control group (n = 20). All subscale scores of psychological distress and global scores decreased significantly after the 12 weeks in the DMT group. Plasma serotonin concentration increased and dopamine concentration decreased in the DMT group. These results suggest that DMT may stabilize the sympathetic nervous system. In conclusion, DMT may be effective in beneficially modulating concentrations of serotonin and dopamine, and in improving psychological distress in adolescents with mild depression.     

Could implantable cardioverter defibrillators provide a human model supporting the learned helplessness theory of depression?

Affective symptoms were examined retrospectively in 25 patients following placement of implantable cardioverter defibrillators (ICD) which can produce intermittent shocks without warning in response to cardiac ventricular arrhythmias. The number of ICD random, uncontrollable discharge shocks and pre-ICD history of psychological distress (i.e., depression and/or anxiety) were documented in all patients using a demographics questionnaire and a standardized behavioral/psychological symptoms questionnaire (i.e., Symptom Checklist-90 Revised). ICD patients were dichotomized into two groups: those without a history of psychological distress prior to ICD (n = 18) and those with a history of psychological distress prior to ICD (n = 7). In ICD patients without a prior history, results indicated that quantity of ICD discharge shocks was significantly predictive of current reported depression (r = 0.45, p = 0.03) and current reported anxiety (r = 0.51, p = 0.02). Conversely, in patients with a reported history of psychological distress, there was no significant relationship found between quantity of discharge shocks and current reported depression or anxiety. This study may provide evidence in support of a human model of learned helplessness in that it supports the notion that exposure to an unavoidable and inescapable aversive stimulus was found to be related to patients' reported depression. Further studies may wish to prospectively consider a larger sample as well as a more comprehensive assessment of premorbid psychological symptoms.     

Insulin-treated diabetes patients with fear of self-injecting or fear of self-testing: psychological comorbidity and general well-being.

OBJECTIVE: To examine psychological functioning and self-management behaviours of Dutch adult patients with insulin-requiring diabetes mellitus suffering from extreme fear of self-injecting (FSI) and/or fear of self-testing (FST). METHODS: A cross-sectional survey was performed in a sample of insulin-treated diabetes patients (n=1275; 51.1% male; age 49.7+/-15.8 years; 58.0% Type 1 diabetes), assessing FSI and FST. Patients completed the questionnaires concerning trait/state anxiety, depression, fear of hypoglycemia, diabetes-related distress, diabetes self-care activities, and general well-being. Comparisons were made on these measures between patients with extremely high scores on FSI and/or FST (> or = 95th percentile) and the other patients. Patients with extreme scores on FSI and/or FST were invited to take part in a second survey to assess the prevalence of major depression, common fears/phobias, and psychoneuroticism. RESULTS: People with extreme FSI/ FST scores, as compared to the other patients, reported higher levels of trait/state anxiety and depression. This group also reported more fear of hypoglycaemia and diabetes-related distress, had lower levels of general well-being, and reported less frequent self-monitoring of blood glucose. The second survey showed 11.1% of patients with extreme FSI/FST reporting scores indicating major depression. Prevalence of scores greater than or equal to the high scores on phobias (38.0-63.3%) and psychoneuroticism (27.8%) were consistently higher than norm group prevalences. DISCUSSION: Extreme levels of FSI and/or FST are associated with high diabetes-related distress, poor general well-being, and psychological comorbidity, as well as poorer adherence to the diabetes treatment regimen. It is concluded that patients with extreme FSI/FST are often burdened with more than this specific phobia.     

Differential aberrant sprouting in temporal lobe epilepsy with psychiatric co-morbidities

Psychiatric co-morbidities in epilepsy are common in patients with temporal lobe epilepsy (TLE). Pathological alterations in TLE are well characterised; however, neuropathologic data are relatively scale regarding the association between psychiatric diseases and epilepsy. Our objective was to evaluate the clinical data of 46 adult TLE patients with and without psychiatric co-morbidities and to correlate the data with hippocampal neuronal density and mossy fiber sprouting. Accordingly, patients were grouped as follows: TLE patients without history of psychiatric disorder (TLE, n=16), TLE patients with interictal psychosis (TLE+P, n=14), and TLE patients with major depression (TLE+D, n=16). Hippocampi from autopsies served as non-epileptic controls (n=10). TLE+P exhibited significantly diminished mossy fiber sprouting and decreased neuronal density in the entorhinal cortex when compared with TLE. TLE+P showed significantly poorer results in verbal memory tasks. TLE+D exhibited significantly increased mossy fiber sprouting length when compared with TLE and TLE+P. Further, a higher proportion of TLE+D and TLE+P presented secondarily generalised seizures than did TLE. Our results indicate that TLE patients with psychiatric disorders have distinct features when compared with TLE patients without psychiatric co-morbidities and that these changes may be involved in either the manifestation or the maintenance of psychiatric co-morbidities in epilepsy.     

Late-life anxiety disorders among Puerto Rican primary care patients: impact on well-being, functioning, and service utilization

With the growing population of older Hispanic adults there is a need for additional research on the mental health care of this patient group. This study explored the impact of anxiety disorders on the health status of 291 older (>/=50 years) Puerto Rican primary care patients (n = 65 with anxiety disorders, n = 226 without anxiety disorders). All analyses controlled for potential confounding variables, including depression diagnosis and physical health burden. Logistic regression indicated that anxiety disorders were associated with higher psychological distress, suicidality, and emergency room service utilization, as well as lower instrumental functioning and perceived health quality. Analysis of covariance indicated that both anxiety disorder status and history of ataque de nervios were related to higher percentages of lifetime somatic symptoms. These data highlight the need for improved recognition and treatment of anxiety disorders in older Puerto Rican adults.     

Psychological test characteristics of depressed and panic patients

This study compared the psychological test performance of patients with major depression (MD) (n = 23), patients with panic disorder (PD) (n = 20), and normal subjects (n = 24). Results indicated that scores of normal subjects were significantly less pathological than those of both patient groups on almost all psychological test scales, but that the test performance of the two patient groups did not differ. The only difference between the two patient groups was on the level of self-reported and observer-rated depression. Both patient groups exhibited significant personality pathology, and the rate of personality disorders diagnosed by the Millon Clinical Multiaxial Inventory (MCMI) (base rate greater than 84) was 73% for PD patients and 86% for MD patients. The problems of assessing personality during episodes of MD and PD and the possible overdiagnosis of personality disorders by the MCMI are discussed.     

Superstitiousness and perceived anxiety control as predictors of psychological distress

It has been suggested that superstitiousness may be a subclinical manifestation of obsessive-compulsive symptomatology. The present study examined whether the relationship between superstitiousness and obsessive-compulsive symptoms was exclusive or whether superstitiousness was a less specific construct. A sample of undergraduates (n=191) completed measures associated with superstitiousness, obsessive-compulsive symptoms, symptoms of anxiety disorders other than obsessive-compulsive disorder (panic symptoms, agoraphobic cognitions, worry, and social fears), general psychological distress (anxiety, depression, and stress), and perception of anxiety control. Results indicated a gender difference in superstitiousness exists, with females being significantly more superstitious than males. Little relationship was found between superstitiousness and the other constructs in males, whereas moderate relationships were found between superstitiousness and the other constructs in females. The suggestion that superstitiousness is nonspecific and related more to perception of control than any specific form of psychological distress is discussed.     

Temporal lobe epilepsy with sensory aura: interictal glucose hypometabolism

Patients with mesial temporal lobe epilepsy (mTLE) exhibit marked depressions of the regional cerebral glucose metabolism (rCMRGlu) in the mesiotemporal region. We hypothesised that patients with temporal lobe epilepsy (TLE) who have a bilateral somatosensory or acoustic ( = temporolateral/SII-) aura can be differentiated from mTLE by rCMRGlu depressions primarily involving temporo-perisylvian locations. We therefore used this ictal semiology as a clinical criterion to define a subgroup of such patients and measured the rCMRGlu in 16 patients with TLE as evident from interictal and ictal EEG-video monitoring. Clinically, they presented with medically refractory complex partial seizures and were subjected to presurgical evaluation. The pattern of the interictal rCMRGlu in the TLE patients was different from that observed in patients with mTLE and showed significant depressions ipsilateral to the epileptic focus in mesial temporal and lateral temporal regions but spared the thalamus. The neocortical metabolic depressions were spatially more extended in right than in left TLE patients. Magnetic resonance images (MRI) were either normal (n = 5) or revealed unilateral or bilateral hippocampal atrophy/sclerosis (n = 7), or temporal or extratemporal focal cortical dysplasia (n = 4). The selected TLE patients presented here comprise a heterogeneous group showing most pronounced metabolic depressions in the lateral temporal cortex. Thus, our data suggest that non-invasive metabolic imaging can assist in identifying the neocortical symptomatogenic zone in putative temporo-perisylvian lobe epilepsy.     

Distress attributed to negative symptoms in schizophrenia

The purpose of the study was to examine (1) to which negative symptoms schizophrenia patients attribute distress and (2) whether clinical variables can predict the levels of reported distress. With the help of a research assistant, 86 hospitalized patients completed a self-rating scale for negative symptoms. The 21 items of the self-rating scale were taken from the Scale for the Assessment of Negative Symptoms (SANS). A psychiatrist rated the patients on a number of scales, including the SANS. When patients reported particular symptoms, they were asked whether those symptoms bothered or distressed them. Answers to this question were highly dependent on the type of symptom involved. Distress was most often attributed to symptoms in the subscale avolition-apathy. Patients were also asked how much they were bothered or distressed. Again, high levels of distress were most often attributed to items in the subscale avolition-apathy. A summary score was developed for the level of reported distress: the distress score. Regression analysis showed that distress scores were not associated with the observed severity of negative symptoms or with the level of psychiatric disability. High distress scores were best predicted by the combination of high scores for depression and high scores for insight into positive symptomatology. However, this model explained only a quarter of the variance in distress scores.     

Psychological variables in chronic migraine with medication overuse before and after inpatient withdrawal: results at 1-year follow-up

Investigations on psychological variables and migraine have confirmed a strong association between migraine and depression or migraine and anxiety disorders. In particular patients suffering from chronic migraine with medication overuse have an elevated risk of mood and anxiety disorders, which may compromise treatment efforts. The aim of this study was to investigate a group of patients suffering from CM with medication overuse before and after inpatient withdrawal program after a long-term follow-up to examine clinical indexes and psychological variables changes in particular anxiety and depression by using Spielberger State-Trait Anxiety Inventory (STAI) 1, 2 and Zung Self-rating Depression Scale (Zung) tests, in order to verify if a specific psychological pattern in these patients is present, and if changes in psychological variables correspond with clinical improvement. The changes of clinical indexes and of psychological parameters are discussed and analyzed in order to address the most adequate therapeutic strategy for this kind of patients.     

Semantic memory in partial epilepsy: verbal and non-verbal deficits and neuroanatomical relationships

Semantic memory was evaluated in 124 epilepsy patients, including 84 with left (n=44) or right temporal lobe epilepsy (TLE) (n=40) and 40 with left (n=25) or right frontal lobe epilepsy (FLE) (n=15), in order to determine their verbal and visual deficits, and the neuroanatomical relationships between them. The controls were 35 healthy subjects. Semantic memory was assessed by means of Picture Naming, Picture Pointing, the verbal Pyramid and Palm Trees Test (PPTT), the visual PPTT, Object Decision Hard, and Drawing From Memory. Episodic memory was assessed by means of the Short Story, Rey's Complex Figure, the Verbal and Visual Selective Reminding Procedure and Brown-Peterson Procedure. Factor analysis of the epilepsy patients distinguished their semantic memory scores from other neuropsychological domains. The semantic memory factor was significantly related to the side of the epileptic region, with lower scores in the left hemisphere and left TLE patients. In comparison with the controls, the left TLE patients were significantly impaired on Picture Naming, Picture Pointing, and Object Decision Hard. Subsequent analyses showed that, in comparison with the controls and the right TLE patients, the left TLE patients with lateral temporal lobe lesions were impaired in Picture Naming whereas, in comparison with the controls, the left TLE patients with mesial temporal lobe lesions were impaired in Object Decision Hard. On the contrary, the episodic memory factor was not related to the side of the epileptic region, and a few material-specific tests revealed opposite impairments in the left and right hemisphere patients. These results show that left TLE may cause semantic memory deficits involving verbal and visual information. Unlike the material-specific pattern of episodic memory, this pattern of impairment is in line with the view of an amodal semantic store in which all of the information about a thing overlaps. The semantic memory impairment may reflect damage in the lateral and mesial temporal lobe regions that impair neocortical functions in storing and retrieving information or hippocampal functions in processing meaningful stimuli.     

A comparison of emotional and cognitive intelligence in people with and without temporal lobe epilepsy

Medial temporal lobe structures have been hypothesized to be important in emotional intelligence (EI) and social cognition. There is some evidence associating temporal lobe epilepsy (TLE) with impairments in social cognition. This study aimed to establish whether TLE is also associated with deficits in EI. Sixteen patients with TLE and 14 controls without epilepsy matched for age and current intelligence quotient were compared on measures of EI, recognition of facial expressions of emotion, and distress. Results indicated that patients with TLE showed both impaired EI and impaired recognition of facial expressions. They also reported greater psychological distress, which correlated negatively with EI. It is suggested that some of the psychosocial problems experienced by patients with TLE can be conceptualized as the consequences of deficits in EI, possibly resulting from epilepsy-related disruption to medial temporal lobe functioning.