Assessment of psychological distress in the setting of medical disease.

The biopsychosocial model of disease has recently been depicted as the basis for a renewed emphasis on the multiaxial diagnostic system of the DSM-IV. The authors challenge this stance, underscoring the clinical inadequacies of the DSM-IV in the setting of medical disease, particularly the chapters concerned with somatoform disorders and psychological factors affecting medical conditions. Diagnostic criteria which are based on the clinical insights derived from psychosomatic research in the past decades may offer new opportunities to psychosomatic medicine and consultation-liaison psychiatry. The development of the Diagnostic Criteria for Psychosomatic Research (DCPR), encompassing alexithymia, type A behavior, irritable mood, demoralization, disease phobia, thanatophobia, health anxiety, illness denial, functional somatic symptoms secondary to a psychiatric disorder, persistent somatization, conversion symptoms and anniversary reaction, is described. Preliminary results obtained with the combination of DSM and DCPR criteria appear to be promising.     

Psychosomatic medicine: some past and current concepts.

Recognition of the body-mind dilemma goes back to antiquity. Growth in medical knowledge has produced an ever increasing emphasis on physiological deviations and somatic pathology--which too often is not accompanied by sufficient attention to the total patients. Psychosomatics is now the term often used by those who believe that illness in man is not usually caused by a single etiological agent. The American Psychosomatic Society succeeded in correlating biological processes with psychodynamics. The Academy of Psychosomatic Medicine had its roots in the belief that psychosomatic medicine belonged to all of medicine. Its goals were to close the gap between medicine and psychiatry. The Japanese Psychosomatic Society chose the best of both in setting its goals. Dunbar's personality profiles and Alexander's concept of specific conflicts are reviewed. Depression is seen to be a common core. Further correlations between depression and psychosomatic illness are evidenced by the work of Greene, Schmale and Engel. The contributions of Nemiah and Sifneos are reviewed. Many psychosomatic patients are noted to be incapable of expressing adequate feelings, which may account for the frequent failure of classical psychoanalytic techniques. The history of research is also reviewed. The role of biochemistry, neurophysiology and psychopharmacology in the understanding and management of psychosomatic problems is examined.     

Psychological factors affecting medical condition: a new proposal for DSM-V

The DSM category of "psychological factors affecting medical condition" had virtually no impact on clinical practice. However, several clinically relevant psychosomatic syndromes have been described in the literature: disease phobia, persistent somatization, conversion symptoms, illness denial, demoralization, and irritable mood. These syndromes, in addition to the DSM definition of hypochondriasis, can yield clinical specification in the category of "psychological factors affecting medical condition" and eliminate the need for the highly criticized DSM classification of somatoform disorders. This new classification is supported by a growing body of research evidence and is in line with psychosomatic medicine as a recognized subspecialty.     

The curious 2000-year case of asthma

Millions worldwide have asthma, with the numbers succumbing increasing sharply in the past two decades. After 2000 years of scientific study, who succumbs to asthma when is as puzzling as who regains health when and how. The discipline of psychosomatic medicine and science investigates and treats diseases like asthma that typically confound general medicine. Still psychosomatic medicine, like general medicine, only manages but does not remedy asthma, which can currently only be in remission but not cured. This historical review reveals the progress and missteps that have been made in the study and treatment of asthma by comparing the general medicine approach with the major research findings on asthma published over 60 years in Psychosomatic Medicine. Research has identified antecedent, collateral, and subsequent factors to scientifically describe and control this disease in terms of diagnosis, management, and treatment. Paradoxically and regrettably, the prognosis for those with asthma is worse than ever. Curious also that a noninfectious disease should spread so rapidly and mostly for specific groups identified by variables like age, gender, ethnicity, and socioeconomic status. Furthermore, partial, not full, family concordance indicates merely genetic influence, not determination. General medicine now focuses on enumerating the range of environmental and situational triggers, or stimuli, producing asthma and describing the pathophysiology of bronchial inflammation. With a more comprehensive multifactorial approach, psychosomatic medicine seems well suited to investigate further the physiological, psychological, social, and environmental factors implicated in this medical conundrum. A future challenge for psychosomatic medicine is to stem the tide of rising prevalence and cure the disease of asthma.     

Psychosomatic characterization of adjustment disorders in the medical setting: some suggestions for DSM-V

BACKGROUND: Adjustment disorders have been found to be the most frequent psychiatric diagnosis in the medically ill. Problems have been raised, however, as to their clinical value. The aim of the study was to characterize the psychosomatic features of adjustment disorders. METHODS: One hundred patients with medical illness and a diagnosis of adjustment disorder according to DSM-IV criteria were interviewed according to the Diagnostic Criteria for Psychosomatic Research (DCPR) system, consisting of 12 clusters. RESULTS: A considerable overlap was shown between adjustment disorders and DCPR clusters related to abnormal illness behavior (health anxiety, tanatophobia, nosophobia and illness denial) (54%), somatization (functional somatic symptoms secondary to a psychiatric disorder, persistent somatization, conversion symptoms and anniversary reaction) (37%) and demoralization (33%). Only 13 of the patients with adjustment disorders did not present any DCPR syndromes. LIMITATIONS: The study is cross-sectional and does not allow to determine the prognostic features of DCPR categorization. CONCLUSION: The clinical information which derives from the concomitant application of the DCPR might improve and make more specific the treatment of patients with adjustment disorders.     

Psychosomatic assessment of skin diseases in clinical practice

BACKGROUND: Psychiatric disorders are frequent in dermatology patients, and many studies pointed out complex, mutual relationships between psyche and skin. Our aim was to provide a systematic psychosocial evaluation of a large and heterogeneous population of patients with skin diseases, including assessments of quality of life, psychiatric status according to the DSM-IV and psychological conditions with psychosomatic relevance according to established criteria (Diagnostic Criteria for Psychosomatic Research, DCPR). METHODS: We studied 545 dermatological inpatients aged 18-65 years, free from dementia and cognitive impairment. They completed the Skindex-29 and the 12-item General Health Questionnaire (GHQ-12) and were administered the SCID-I and the Structured Interview for Psychological Conditions of Psychosomatic Relevance by a trained mental health professional blinded to questionnaire scores. RESULTS: Overall, 38% of patients received a DSM-IV diagnosis. The most common diagnoses were mood (20%) and anxiety disorders (16%); 48% of patients also received a DCPR diagnosis. The most common were demoralisation, irritable mood, type A behaviour and various forms of abnormal illness behaviour. Adjusting for gender, age, and education, the presence of DSM-IV or DCPR diagnoses was significantly associated with high scores on the GHQ-12 and on the Functioning and Emotions scales of the Skindex-29. Also, DCPR diagnoses were significantly associated with high scores on the Symptoms scale of the Skindex-29. CONCLUSIONS: These findings highlight the high frequency of psychosocial problems in patients with skin disease and suggest that the joint use of DSM-IV and DCPR criteria may help identify those patients in whom psychiatric issues are worthy of increased clinical attention.     

Psychosomatic symptoms in preadolescent children

As part of a Finnish national epidemiological study on child psychiatric disorders, psychosomatic symptoms were studied in a sample (n = 1,100) of 8-year-old children on the basis of self-report questionnaires by the children, their parents and teachers. Psychosomatic symptoms were common, although constant symptoms were rare. There were no sex differences in the occurrence of symptoms, but interesting differences were observed in associations between symptoms and other factors. Psychosomatic symptoms were strongly associated with depression scores and school performance.     

Psychosomatic illness as a result of a deficit in ego-structure under consideration of the genetic. Dynamic, structural, and group dynamic point of view.

Psychosomatic illness is an illness of ego-structure as a result of a narcissistic deficit reassembling the phenomenology of anaclitic depression in regard to the mother and the primary group. Psychosomatic illness has to be understood on a scale of ego-illnesses related to identity defects. The psychosomatic symptom restitutes the integration of the personality and constitutes the identity of a psychosomatic patient. The role of group dynamics is particularly stressed in relation to psychogenetics, psychodynamics, and the change of symptoms.     

Quality of life in cardiovascular disease

Psychosomatic understanding of the consequences of cardiovascular disorders has had relatively little influence on the separate literature describing quality of life and evaluating interventions. This is partly because psychosomatic research has been too narrowly focussed but mainly because concepts and measures of quality of life take a limited view of its psychological aspects and neglect the significance of individual meaning. There is a need for more research which is based on carefully selected specific measures of quality of life chosen as being of particular importance to patients and to the hypotheses being tested. It is also essential to be aware of the wide range of individual response to cardiovascular disorders. Review of syndromes shows that there is considerable scope to improve understanding of the psychological aspects of quality of life and to develop and evaluate psychological interventions.     

Behavioral medicine programs in teaching hospitals

Behavioral medicine is a relatively new interdisciplinary field which combines biomedical and behavioral science knowledge, and applies them to prevention, diagnosis, treatment and rehabilitation. Behavioral medicine programs provide a valuable service to patients with chronic illness, psychosomatic or functional disorders, treatment noncompliance, and behavioral risk factors. Behavioral medicine faculty are also active in teaching and research on patient behavior, interviewing skills, health promotion and counseling, and management of chronic illnesses. However, the survival of behavioral medicine programs in teaching hospitals depends on their economic viability and academic status. Positive action is needed to ensure their continued growth and development.     

Psychosomatic medicine, behavioral medicine, just plain medicine

Neurally mediated physiologic responses fulfill all of the criteria for behavior and obey all of the laws of behavior subject to the anatomic and physiologic constraints inherent in their structures and functions. It is illogical and wrong to assert that neurally mediated responses interact with behavior. THEY ARE BEHAVIOR. These principles are a legitimate and necessary part of the training of all medical students, residents, and fellows. The conceptual basis of psychosomatic practice does not need to be derived from the dualistic notions of psychoanalysis or from the dualistic notions of biobehaviorism. Psychosomatic medicine is an integral aspect of medical practice. It needs to exist because people act and react differently from one another, and because the same person acts and reacts differently from one situation to another. Psychosomatic medicine is not psychiatry in medicine. Each of the specialties and each of the subspecialties encounters its own set of psychosomatic problems; and treatment strategies to resolve these problems need to be integrated into the clinical practice of that discipline.     

Insomnia and well-being

Most Americans have occasional problems with insomnia. The relationship of insomnia to illness is well known. However, insomnia may also relate to lower levels of well-being. Although there are various definitions of well-being, one of the most clearly articulated and comprehensive models identifies 2 overarching constructs, psychological well-being and subjective well-being. The purpose in the present study was to assess the relationship between insomnia symptoms and the dimensions of psychological and subjective well-being, adjusting for the potential confound of comorbid physical and psychological illness. The data for the present study came from the National Survey of Midlife Development in the United States, a survey of community-dwelling adults. After adjustment for demographic characteristics and a wide range of chronic mental and physical health conditions, insomnia symptoms were found to have a significant relationship with both psychological and subjective well-being but a stronger relationship to subjective well-being. These data suggest that insomnia symptoms have a stronger relationship to enjoying life than to the perception that one has a meaningful life.     

Genetics in psychosomatic medicine: research designs and statistical approaches

It has become increasingly clear that genetic factors influence many of the behaviors and disease endpoints of interest to psychosomatic medicine researchers. There has been increasing interest in incorporating genetic variation markers into psychosomatic research. In this Statistical Corner article, we build on the valuable experiences gained during two workshops for "starters in the field" at the American Psychosomatic Society and the Society for Psychophysiological Research to review two common genetically informative research designs for human studies: twin and genetic association studies. We outline statistical techniques for each and, for genetic association studies, address special topics, including the treatment of race and ethnicity, gene x gene and gene x environment interaction, haplotype analysis, and power and sample size. Finally, we discuss the issue of nonreplication and interpretation of results derived from genetic association studies. We hope this overview of twin and genetic association designs will support and stimulate thoughtful applications of genetic approaches within psychosomatic medicine.     

Liaison psychiatry as a systems approach to behavior.

In this overview, the psychosomatic theory is discussed from an evolutionary perspective. From its initial concern with relationship between emotions and physiology through psychopathology and anatomo-physio-pathology to socio-psycho-pathophysiology, psychosomatic medicine and its theory is presently viewed as an empiric science utilizing a number of conceptual approaches derived from developmental psychology, classical psychiatry, physiology, sociology and anthropology. These are applied to the study and care of patients in ambulatory and inpatient settings, which are the arenas of the consultation-liaison activity and may be viewed as the clinical laboratories of psychosomatic medicine. In these laboratories, a new language has developed which is largely phenomenological and which attempts to utilize theoretical concepts from several disciplines in explaining the illness illness phenomenon in the present. As such, the practitioner of Liaison Psychiatry is a general systems analyst who analyzes the illness situation of the patient and his attendants in an attempt to decipher the identified problem, explaining it by utilizing selected theoretical concepts from the basic sciences of behavior. Psychosomatic theory is seen as an evolving and bridging science attempting to integrate and combine particulate theory into a more comprehensive synthesis.     

大学生心理应激模型的初步构建

目的：探讨大学生的心理应激过程并初步构建大学生心理应激模型。方法：以880名高校大学生为研究对象，采用结构方程模型技术（SEM）建立生活事件、应对方式、社会支持、个性特征、自我效能等因素对心身健康的作用途径。结果：①生活事件既对大学生心身健康直接产生作用，又通过应对方式、社会支持、个性特征、自我效能这砦中介因素间接产生作用，并且从路径系数上反映出间接作用大于直接作用。②自我效能是重要的心理中介因素，与应对方式、社会支持、个性特征相比，在生活事件和大学生心身健康之间似乎起着更为直接的中介作用。结论：研究为揭示大学生心身健康的作用机制、有效开展大学生心理卫生工作和更好地增进大学生心身健康水平提供r初步的理论依据。     

The intellectual crisis of psychiatric research

The aim of this paper was to examine the intellectual crisis and the potential sources of reveille in clinical research in psychiatry. Current prevailing conceptual models in psychiatry are critically examined, with particular reference to neurobiology, clinical psychopharmacology, assessment, and the therapeutic process. Biological reductionism, neglect of individual responses to treatment, massive propaganda from the pharmaceutical industry, misleading effects of psychometric theory on clinical assessment, and lack of consideration of multiple therapeutic ingredients and of the role of psychological well-being are identified as major sources of an intellectual crisis in psychiatric research. The conceptual crisis of psychiatry is shared by other areas of clinical medicine and stems from a narrow concept of science that neglects clinical observation, the basic method of medicine. A unified concept of health and disease may yield new clinical insights in psychiatric disorders, and may result in therapeutic efforts of more enduring quality than current strategies.     

慢性乙型肝炎患者心身症状和应对方式对生活质量的影响

目的 :研究慢性乙型肝炎患者的心身症状水平和应对方式对生活质量的影响。方法 :对 15 2名住院慢性乙肝病人用慢性肝病问卷 (CLDQ)、症状自评量表 (SCL - 90 )、医学应对问卷 (MCMQ)进行调查。结果 :慢性乙肝患者SCL - 90得分与常模和对照组有显著差异 ,各因子与CLDQ各维度呈负相关 ,以SCL - 90总均分 0 .4 4为划界分将病人分成阳性组和阴性组 ,阳性组CLDQ各维度得分均低于阴性组。患者面对应对低于常模 ,回避和屈服应对高于常模 ,阳性组比阴性组患者更倾向于采用回避和屈服应对 ,这两种消极的应对方式与生活质量呈负相关。结论 :慢性乙肝患者的心身症状及不良的应对方式对患者的生活质量有较大影响 ,要想通过心理干预减轻患者心身症状 ,提高患者的生活质量 ,重点应该放在改变不良应对方式上     

Evaluating the psychometric properties of the Mental Health Continuum-Short Form (MHC-SF)

There is a growing consensus that mental health is not merely the absence of mental illness, but it also includes the presence of positive feelings (emotional well-being) and positive functioning in individual life (psychological well-being) and community life (social well-being). We examined the structure, reliability, convergent validity, and discriminant validity of the Mental Health Continuum-Short Form (MHC-SF), a new self-report questionnaire for positive mental health assessment. We expected that the MHC-SF is reliable and valid, and that mental health and mental illness are 2 related but distinct continua. This article draws on data of the LISS panel of CentERdata, a representative panel for Longitudinal Internet Studies for the Social Sciences (N = 1,662). Results revealed high internal and moderate test-retest reliability. Confirmatory factor analysis (CFA) confirmed the 3-factor structure in emotional, psychological, and social well-being. These subscales correlated well with corresponding aspects of well-being and functioning, showing convergent validity. CFA supported the hypothesis of 2 separate yet related factors for mental health and mental illness, showing discriminant validity. Although related to mental illness, positive mental health is a distinct indicator of mental well-being that is reliably assessed with the MHC-SF.