Neuropathic pain and primary somatosensory cortex reorganization following spinal cord injury

Complex Regional Pain Syndrome type 1 (CRPS1) is a complication after trauma or surgery. Its pathophysiology is still a matter of debate, and psychological factors have been suggested to play a role, although their influence is unclear. The aim of this study was to investigate the evidence for the influence of psychological factors on the onset and maintenance of CRPS1 in adults. In a systematic review, articles were selected using Cochrane, Pubmed/Medline, Psychinfo, and Cinahl since 1980. Only original articles and empirical studies were included. Based on these selection criteria, 31 articles were identified. Studies were evaluated and weighted using a quality assessment instrument. The few prospective studies do not report a relationship between CRPS1 and depression, anxiety, neuroticism, or anger. The results of the retrospective/cross-sectional studies yield contradictory results regarding psychological problems in patients with CRPS1. A majority show no association, and studies with a higher methodological quality lean to a conclusion of no relationship between psychological factors and CRPS1. The majority of included studies (N = 24; 77%) had only a poor to moderate methodological quality. Although many patients with CRPS1 are stigmatized as being psychologically different, this literature review identified no relationship between CRPS1 and several psychological factors. Only life events seemed to be associated with CRPS1: patients who experienced more life events appeared to have a greater chance of developing CRPS1. More studies with greater methodological quality and more participants should be performed on the association between psychological factors and the development and course of CRPS1.     

The development and evaluation of a telepsychiatry service for prisoners

The introduction of increasingly sophisticated telecommunication systems seems to offer opportunities to respond to some of the key problems around structural and spatial inequalities in access to health care. There is evidence which suggests that serious mental health problems are common among prisoners and psychiatric comorbidity is the norm. Many prisoners have complex mental health needs, but more often than not these remain unaddressed. Telepsychiatry is one strategy to improve the accessibility and quality of mental health care in the prison setting. This paper firstly reviews the current prison health care system and then describes a research study which is focused on the development and evaluation of a telepsychiatry service for prisoners. This study has investigated what is lost or gained in a psychiatric assessment when it is conducted via telepsychiatry. The researcher compared the inter-rater reliability between two raters interviewing 80 participants in an observer/interviewer split configuration in telepsychiatry and same room settings. The measure used was the Comprehensive Psychopathology Rating Scale. Prisoners and prison staff also took part in semi-structured interviews which focused on their satisfaction and acceptability of the telepsychiatry service. A cost comparison of the telepsychiatry service with the existing visiting service was conducted. This paper outlines the study design and focuses on the potential impact that telepsychiatry may have upon the practice setting.     

Testing the sequential model of pain processing in irritable bowel syndrome: a structural equation modeling analysis.

Pain, the cardinal feature of irritable bowel syndrome (IBS), is a multidimensional phenomenon with sensory and affective dimensions. Price's pain processing model was used to delineate four a priori sequentially related stages (pain sensation intensity, immediate pain unpleasantness, long-term suffering, and pain-related behavior). Although prior research with both healthy individuals and somatic pain patients supports the model in general, its applicability to IBS is unclear. Our goal was to extend the scope of the sequential model and test its fundamental tenets using structural equation modeling (SEM) with data obtained from 168 Rome II diagnosed IBS patients (19% male, 81% female). A secondary goal was to assess the relationship between a set of contextual factors associated with IBS (age, gender, trait anxiety) and the four pain stages. Results were consistent with a successive order of pain processing such that the pain sensation directly impacts pain unpleasantness, which, in turn, leads to suffering and illness behaviors. However, contrary to a model with strictly successive stages, pain sensation had independent effects on illness behaviors over and above pain affect. The effect of anxiety on illness behavior was mediated by suffering, while psychopathology directly influenced pain sensation and pain unpleasantness but not later stages. Age was related to pain sensation and illness behaviors but not pain affect. Gender tended to be more strongly associated with more distal pain stages (e.g., pain affect) vis-a-vis its effects on pain sensation. These data are generally supportive of a four-stage pain processing model.     

The Rorschach test and Gilles de la Tourette’s syndrome: A pilot case–control study

Background: To date only three studies, all lacking a control group, have investigated the personality style underlying tic disorders or Tourette’s syndrome (TS), using the projective Rorschach test. Despite the recent controversy about its proper use in clinical practice and research, the Rorschach test may be useful to explore personality organization in TS. The research hypothesis under investigation in this exploratory study was that young TS patients exhibit a peculiar personality organization, with significantly increased indicators of poor emotional control, aggression, anxiety and depression, on the Rorschach test, compared to healthy controls. Methods: We analyed the Rorschach protocols of 17 newly diagnosed paediatric TS patients and 17 age- and sex-matched healthy controls. Results: Compared with the controls young TS patients recorded significantly lower mean percentages of F and F+ responses and a significantly higher number of FM and FC responses, thus showing reduced control of emotions and difficulty in integrating aggressivity. Furthermore, associations emerged between comorbidity with ADHD and increased emotional instability and between severity of tics and of OCD and a pattern of emotional hyper-control and application of rigid defensive mechanisms. Conclusions: These results seem to confirm the existence of a peculiar personality style in young TS patients and may have important implications, both pathogenetic and therapeutic.     

Temperament and character traits in patients with bipolar disorder and associations with comorbid alcoholism or anxiety disorders

Temperament and character traits may determine differences in clinical presentations and outcome of bipolar disorder. We compared personality traits in bipolar patients and healthy individuals using the Temperament and Character Inventory (TCI) and sought to verify whether comorbidity with alcoholism or anxiety disorders is associated with specific personality traits. Seventy-three DSM-IV bipolar patients were compared to 63 healthy individuals using the TCI. In a second step, the bipolar sample was subgrouped according to the presence of psychiatric comorbidity (alcoholism, n=10; anxiety disorders; n=23; alcoholism plus anxiety disorders, n=21; no comorbidity, n=19). Bipolar patients scored statistically higher than the healthy individuals on novelty seeking, harm avoidance and self-transcendence and lower on self-directedness and cooperativeness. Bipolar patients with only comorbid alcoholism scored statistically lower than bipolar patients without any comorbidity on persistence. Bipolar patients with only comorbid anxiety disorders scored statistically higher on harm avoidance and lower on self-directedness than bipolar patients without any comorbidity. Limitations of this study include the cross-sectional design and the small sample size, specifically in the analysis of the subgroups. However, our results suggest that bipolar patients exhibit a different personality structure than healthy individuals and that presence of psychiatric comorbidity in bipolar disorder is associated with specific personality traits. These findings suggest that personality, at least to some extent, mediates the comorbidity phenomena in bipolar disorder.     

Protection or Vulnerability? A Meta‐Analysis of the Relations Between the Positive and Negative Components of Self‐Compassion and Psychopathology

Self‐compassion is increasingly explored as a protective factor in relation to psychopathology. The Self‐Compassion Scale (SCS) and its Short Form variant (SCS‐SF) are the most widely used instruments for measuring this psychological construct, and previous studies have indeed shown that the total score of this scale is negatively associated with psychopathology. In this article, we point out that half of the items of the SCS and SCS‐SF are positive indicators of self‐compassion and directly refer to the three key components of self‐kindness, common humanity and mindfulness, while the other half of the items are negative indicators of the construct and reflect the precise opposite of the key components, namely self‐judgment, isolation and over‐identification. A meta‐analysis was conducted including 18 studies that reported on the positive and negative indicators of self‐compassion as indexed by the SCS/SCS‐SF and their relations to various types of psychopathology. Results showed that positive indicators of self‐compassion were negatively associated with psychopathology, which confirms their hypothesized protective influence. However, the negative indicators were positively linked to psychopathology, suggesting that these scales tap increased vulnerability to mental health problems. Moreover, tests comparing the strength of the relations between various SCS/SCS‐SF counterparts (i.e., self‐kindness versus self‐judgment, common humanity versus isolation and mindfulness versus over‐identification) and psychopathology showed that the negative indicators were significantly stronger linked to mental health problems than the positive indicators. This provides support for the idea that the use of a total self‐compassion score of the SCS or SCS‐SF, which typically includes the reversely scored negative subscales, will probably result in an inflated relationship with symptoms of psychopathology. Copyright © 2016 John Wiley & Sons, Ltd.     

Reflective functioning: A review

Reflective functioning offers an empirically grounded framework for the assessment of mentalization. This article briefly outlines the theory of mentalization and the development of the Reflective Functioning (RF) scale (Fonagy, Target, Steele, & Steele, 1998). It then offers a review and discussion of empirical studies of parental RF regarding the role of RF in linking adult and child attachment and parental RF in the context of psychopathology. Furthermore, empirical studies on RF in relation to different psychiatric populations and to the role of RF in psychotherapy process and outcome are reviewed and discussed. Although research on RF is still relatively limited, evidence seems to support the relevance of RF as an empirical measure in the fields of attachment, psychopathology and psychotherapy research. However, the RF scale has certain limitations due to the extensiveness of the measure, which future research should take into account.     

The association between psychological factors and the development of complex regional pain syndrome type 1 (CRPS1) — A prospective multicenter study

The objective of this study was to investigate the association between psychological factors and complex regional pain syndrome type 1 (CRPS1). A prospective multicenter cohort study was performed involving the emergency room of three hospitals, and patients age 18 years or older, with a single fracture, were included in the study. At baseline (T0), participants completed a questionnaire covering demographic, psychological (Symptom Checklist‐90), and medical variables. At plaster removal (T1) and at T2, the participants completed a questionnaire addressing symptoms of CRPS1. Psychological factors that were analysed were agoraphobia, depression, somatization, insufficiency, (interpersonal) sensitivity, insomnia, and life events. In total, 596 consecutive patients were included in the study, and 7.0% were diagnosed with CRPS1. None of the psychological factors predicted the development of CRPS1. The scores on the Symptom Checklist‐90 subscales fell into the range of the general population and were, in most cases, average or below average when compared with those of pain patients or psychiatric patients. No empirical evidence supports a diagnosis of CRPS1 patients as psychologically different, and the current results indicate that there is no association between psychological factors and CRPS1.