Conversion and somatization disorders; dissociative symptoms and other characteristics

OBJECTIVE: There is a difference in classification of conversion disorder in ICD-10 and DSM-IV. Conversion disorder is included in dissociative disorders in ICD-10. In view of this, we aimed to clarify this discrepancy in the classification of this diagnosis. METHODS: We assessed 87 patients with conversion disorder and 71 patients with somatization disorder for sociodemographic characteristics, suicide ideation, psychiatric symptoms and dissociative symptoms using the Patient Information Form, the Dissociative Experience Scale (DES), the Symptom Check List (SCL-90-R) and the Suicide Ideation Scale. RESULTS: The number of the high school graduates, singles and students with conversion disorders was higher than the number of patients with the same characteristics who have somatization disorder. In conversion disorder, the SCL-90-R total score and the score in paranoid ideation, psychoticism subgroups were higher than the scores in somatization disorders. There were no statistical differences in suicide ideation and the total score of dissociative symptoms between the two disorders. The number of patients whose total DES score of 30 and above was higher in conversion disorders. DISCUSSION: As a result of this present study, we concluded that to enlighten the concepts of conversion, further somatization and dissociation studies are necessary.     

Clinical features related to statin-associated muscle symptoms

Introduction: Statins reduce cardiovascular disease risk and are generally well tolerated, yet up to 0.5% of statin-treated patients develop incapacitating muscle symptoms including rhabdomyolysis. Our objective was to identify clinical factors related to statin-associated muscle symptoms (SAMS). Methods: Clinical and laboratory characteristics were evaluated in 748 statin-treated Caucasians (634 with SAMS and 114 statin-tolerant controls). Information was collected on statin type, concomitant drug therapies, muscle symptom history, comorbidities, and family history. Logistic regression was used to identify associations. Results: Individuals with SAMS were 3.6 times (odds ratio [OR] 3.60, 95% confidence interval [CI] 2.08-6.22) more likely than statin-tolerant controls to have a family history of heart disease. Additional associations included obesity (OR 3.08, 95% CI 1.18, 8.05), hypertension (OR 2.24, 95% CI 1.33, 3.77), smoking (OR 2.08, 95% CI 1.16, 3.74), and statin type. Discussion: Careful medical monitoring of statin-treated patients with the associated coexisting conditions may ultimately reduce muscle symptoms and lead to improved compliance. Muscle Nerve 59:537–537, 2019     

Severity of self-reported insomnia in adults with epilepsy is related to comorbid medical disorders and depressive symptoms

BackgroundFew studies have systematically investigated insomnia in adults with epilepsy.MethodsWe performed a prospective cross-sectional investigation of the prevalence, severity, and comorbidities of insomnia in 90 adults with epilepsy using a battery of self-reported instruments and polysomnography. We quantified insomnia severity using the Insomnia Severity Index (ISI).ResultsFifty-nine of 90 (65.5%) adults with epilepsy reported insomnia (ISI ≥ 8), moderate or severe (ISI ≥ 15) in 28.9%. Good agreement between standard clinical diagnostic criteria and ISI was found for patients with ISI scores < 8 and ≥ 15. Scores on the modified Beck Depression Inventory (mBDI) (r = 0.25, p = 0.021), the original BDI (r = 0.32, p = 0.002), and self-reported total sleep duration (TSD) (r = − 0.3, p = 0.006) were significantly related to ISI score. A multiple regression model found that decreased TSD (ß = − 0.93, p = 0.007), head trauma (ß = 4.37, p = 0.003), sedative–hypnotic use (ß = 4.86, p = 0.002), AED polytherapy (ß = 3.52, p = 0.005), and asthma/COPD (ß = 3.75, p = 0.014) were predictors of a higher ISI score. For 63 patients with focal epilepsy, an increased mBDI (ß = 0.24, p = 0.015), decreased TSD (ß = − 1.11, p = 0.008), asthma/COPD (ß = 4.19, p = 0.02), and epilepsy surgery (ß = 5.33, p = 0.006) were significant predictors of an increased ISI score. Patients with temporal lobe epilepsy (TLE) showed a trend for greater severity compared with those with extra-TLE (ß = − 2.92, p = 0.054).ConclusionsOur findings indicate that severity of insomnia in adults with epilepsy is more likely to be associated with comorbid medical and depressive symptoms and less likely to be directly related to epilepsy. Good agreement between standard clinical diagnostic criteria for insomnia and the ISI for subjects without insomnia symptoms and for those with moderate-to-severe symptoms supports the use of this instrument in epilepsy research.     

不同年龄阶段伴躯体化症状抑郁症患者的临床特征及相关因素

目的 分析不同年龄阶段伴躯体化症状抑郁症患者的临床特征及相关因素。方法 纳入 2014 年 9 月至 2015 年 4 月在全国 11 家医院门诊就诊的 1 503 例抑郁症患者为研究对象,采用患者健 康问卷躯体症状群量表（PHQ-15）和 16 项抑郁症状快速评估量表（QIDS-SR16）评估患者躯体化症状及 抑郁症状的严重程度。PHQ-15 得分＜ 5 分为无躯体症状,≥ 5 分为有躯体化症状。采用 Spearman 相 关分析抑郁症患者躯体化症状与一般人口学资料及疾病相关资料的关系。以18～39岁（青年）、40～64岁 （中年）和≥ 65 岁（老年）进行年龄分层,采用累积比数 Logistic 回归分析不同年龄阶段抑郁症患者躯体化 症状的相关因素。结果 共 748 例（49.8%）抑郁症患者有躯体化症状,其中 82.6%（618/748）的患者躯体 症状是感到疲劳或无精打采。3 个不同年龄阶段患者背痛,胳膊、腿或关节疼痛,痛经或月经期间其他 的问题,性生活中有疼痛或其他问题的条目得分情况比较,差异有统计学意义（P＜ 0.05）。Spearman 相 关分析显示,抑郁症患者躯体化症状与伴躯体疾病、抗抑郁药治疗种类、合并镇静催眠药、QIDS-SR16 得分呈正相关（P＜ 0.05）,与受教育年限、首次发作年龄、合并抗精神病药呈负相关（P＜ 0.05）。以老 年患者为参照,累积比数 Logistic 回归分析显示,抗抑郁药治疗种类（OR=2.12,95%CI=1.38～3.26）;合 并镇静催眠药（OR=1.59,95%CI=1.14～2.22）、合并抗精神病药（OR=0.59,95%CI=0.39～0.90）、存在残留 症状（OR=11.07,95%CI=7.70～15.90）是青年患者躯体化症状的相关因素（P＜ 0.05）。合并镇静催眠药 （OR=1.51,95%CI=1.10～2.08）、合并抗精神病药（OR=0.45,95%CI=0.31～0.66）、存在残留症状（OR=9.59, 95%CI=6.89～13.34）是中年患者躯体化症状的相关因素（P＜ 0.05）。结论 不同年龄段抑郁症患者伴有 的躯体化症状存在区别,识别年龄相关躯体症状对于临床医生细化抑郁症伴随特征、实施个体化综合 干预是重要的。     

Single-wire recording of regional activity in the human masseter muscle

A new approach is presented for recording regional muscle responses by means of a single intramuscular wire electrode. The technique exploits differences in impedance due to the locations of the recording and indifferent electrodes and also relies upon bandpass filtering. The method is demonstrated by recording the activity of the right masseter muscle at three different sites during voluntary tooth clenching. The results indicate that satisfactory separation of regional muscle activity can be obtained and that the recorded signals can be sampled digitally for quantitative purposes. As this method for recording jaw muscle activity avoids the problem of variable interelectrode distances commonly associated with conventional bipolar wire electrodes, it is advantageous when recording from human muscles in the facial and intraoral regions.     

Convergence patterns of afferent information from the temporomandibular joint and masseter muscle in the trigeminal subnucleus caudalis

Convergence patterns of afferent information from the temporomandibular joint (TMJ) and the masseter muscle (Mm) in the trigeminal subnucleus caudalis in response to natural stimulation were examined in anesthetized rats for a better understanding of masticatory pain phenomena. All neurons tested (135) could be placed in one of the following three classes according to their responsiveness to natural stimulation in the TMJ and/or the Mm: Class I neurons, excited by only innocuous stimuli; Class II neurons, excited by only noxious stimuli; Class III neurons, excited by both. Afferent inputs from the TMJ and the Mm converged on 108 (80%) of the 135 neurons. Of these convergent neurons, 79% received nociceptive information from the TMJ and/or the Mm. The results suggest that convergent caudalis neurons that receive nociceptive information from the TMJ and/or the Mm may be important to referred pain associated with dysfunction of the masticatory system.     

应重视综合医院躯体化症状的识别

正综合医院躯体化(somatization)问题已经成为越来越严重的临床和公共健康问题。躯体化症状(somatization symptoms)系指体验和表述躯体不适但不能用已知的生理学或医学知识解释,将其归咎于躯体疾病,从而不断寻求医学帮助,亦称为医学难以解释的症状(MUS)。在综合医院的日常工作中,有相当一部分患者为躯体化症状,主诉缺乏病     

GABA system dysfunction in autism and related disorders: From synapse to symptoms

Autism spectrum disorders (ASDs) are neurodevelopmental syndromes characterised by repetitive behaviours and restricted interests, impairments in social behaviour and relations, and in language and communication. These symptoms are also observed in a number of developmental disorders of known origin, including Fragile X Syndrome, Rett Syndrome, and Foetal Anticonvulsant Syndrome. While these conditions have diverse etiologies, and poorly understood pathologies, emerging evidence suggests that they may all be linked to dysfunction in particular aspects of GABAergic inhibitory signalling in the brain. We review evidence from genetics, molecular neurobiology and systems neuroscience relating to the role of GABA in these conditions. We conclude by discussing how these deficits may relate to the specific symptoms observed.     

Changes following denervation to the masseter muscle☆

BACKGROUND： Masseter muscle nerve is often injured in mandible osteotomy. What changes in food intake and masseter muscle will be brought after masseter muscle nerve injury？ OBJECTIVE： This study was designed to selectively establish animal models of denervated masseter muscle and investigate the effects of severing masseter muscular nerve on masseter muscle and animal＇s food intake. DESIGN, TIME AND SETTING： A randomized controlled animal experiment was performed at the Laboratory Animal Center, Nanfang Hospital, Southern Medical University from September to November 2005. MATERIALS： A total of 50 healthy, adult, SPF-grade, New Zealand rabbits, of both genders, were used to develop an animal model of selectively denervated masseter muscle. METHODS： Five rabbits were randomly selected as normal controls. According to various mutilation methods, the remaining animals were randomly divided into 3 experimental groups, with 15 rabbits in each group： masseter muscular neural stem denervated, masseter muscular neural superior branch-denervated, and masseter muscular neural inferior brancb-denervated groups. Self-control comparison was performed on each animal. The right masseter muscle served as the experimental side, and the left masseter muscle served as the control side. In each group, 3 time points （2, 8, and 24 weeks post-surgery） were allotted for observation. MAIN OUTCOME MEASURES： At the pre-set time points, masseter muscular thickness was measured with a Logic 500 color Doppler ultrasonic diagnostic apparatus. Masseter muscle tissue was resected for hematoxylin eosin staining. Masseter muscular fiber diameter and area were measured with an optical microscope. Masseter muscle tissue was sectioned and nicotinamide adenine dinucleotide tetrazolium oxidoreductase （NADH-TR） and adenosine triphosphatase staining were performed. Following staining, the sections were quantitatively analyzed using an IBAS200 image analyzer. RESULTS： Post-surgery food intake： No abnormal food intake was fou     

强迫及相关障碍的核心特征与治疗

《精神障碍诊断与统计手册(第5版)》(DSM-5)中,强迫及相关障碍的代表性疾病是强迫症、躯体变形障碍、囤积障碍。这组障碍均涉及频繁的害怕、担心、冲动性的强迫思维,可伴有仪式化的强迫行为。患者缺乏弹性,耗费大量精力维持不良的行为模式。强迫症的诊断要求存在强迫思维和/或强迫行为,每天耗时1小时以上。躯体变形障碍患者沉湎于自己感受到的外貌缺陷并过度照镜子或过度修饰缺陷。囤积障碍是指持续收集或难以丢弃没有实际价值的物品,占据了生活空间,导致安全与健康隐患。强迫及相关障碍的治疗方法包括SSRIs类药物治疗、心理咨询等。     

双相及相关障碍的核心特征与治疗

《精神障碍诊断与统计手册(第5版)》(DSM-5)将双相及相关障碍从心境障碍中独立出来,与抑郁障碍分为两章。双相障碍是一类受遗传因素影响较大的精神障碍,其代表性疾病是双相Ⅰ型障碍、双相Ⅱ型障碍和环性心境障碍。躁狂发作是双相Ⅰ型障碍诊断的必要条件,且不再要求个体必须有重性抑郁发作史。双相Ⅱ型障碍需有轻躁狂发作和重性抑郁发作史。环性心境障碍从开始发病,至少有半数时间经历多次轻躁狂期和抑郁期,但未符合轻躁狂发作或重性抑郁发作的诊断标准。双相及相关障碍的治疗方法包括心境稳定剂治疗、心理咨询、电休克治疗等。     

Somatoform disorders, somatization and abnormal illness behaviour

Somatization and abnormal illness behaviour (AIB) often co-exist, and their inter-relationship appears to be complex. Patients with somatization are often observed to demonstrate abnormal illness behaviour. On the other hand, somatization has been explained in terms of abnormal illness behaviour. The exact cause-effect or any other relationship is not fully understood. This review examines the available evidence to understand these two clinically important, common and interrelated phenomena, their measurements and management. Many studies have confirmed that occurrence of multiple somatic symptoms as the chief or presenting complaints are highly suggestive of abnormal illness behaviour. Recognition of AIB in somatoform disorders is important in order to avoid unnecessary tests, inappropriate treatment, and to prevent encouragement and reinforcement of abnormal behaviours.     

躯体症状及相关障碍的核心特征与治疗

《精神障碍诊断与统计手册(第五版)》(DSM-5)中,有4种躯体症状障碍。患这一谱系障碍的患者共同特征是:存在明显的对躯体健康的担心,更可能去医疗机构而不是寻求心理健康服务。躯体症状障碍的个体寻求帮助主要是试图解释躯体不适。疾病焦虑障碍的个体可能存在一些躯体不适,但主要问题是持续担心生病(或将要生病),这种担心比任何轻度的躯体症状更损害日常生活。转换障碍的个体会出现一个突然的、严重的躯体问题,包括丧失能力,如突然的瘫痪或癫痫,可能导致去急诊室或医院紧急就诊。做作性障碍的个体知道自身并不存在躯体问题,但仍会以躯体不适为主诉寻求帮助,或掩盖他们故意引起躯体问题的事实。治疗躯体症状及相关障碍,以良好的医患关系为基础,通过认知行为疗法或团体治疗帮助个体理解此类疾病的信念和行为,抗抑郁药和抗焦虑药可以缓解患者的疼痛、焦虑、易激惹、恐慌心境。