Aug 18, 2015 - Department of Psychological Medicine; Psychiatry-Yale. University School ... the electronic medical record from Yale New Haven Hospital. The.
Abstracts Psychother Psychosom 2015;84(suppl 1):1-82 DOI: 10.1159/000438780
Abe T, Kato F, Mizuno Y, Fukunaga M Department of Psychosomatic and General Internal Medicine, Kansai Medical University, Osaka, Japan Introduction: Central sensitization is one of the major conditions that constitutes chronic pain, and is influenced by various kinds of biopsychosocial factors. Pain intensity and anxiety will increase hypersensitivity to experimental pain stimuli, while depression will decrease it. Although it is well known that there is high comorbidity between chronic pain and major depressive disorder, it is still difficult to evaluate the pathological condition of chronic pain because of its heterogeneity. In this research, we investigated the relationship between pain intensity and depression which caused the change of pain threshold. Methods: We studied 76 patients with chronic non-malignant pain. Pain intensity and depression were assessed by Short-form McGill Pain Questionnaire (SF-MPQ) and Beck Depression Inventory (BDI). Electrical pain tolerance thresholds (PTT) were measured at asymptomatic regions, and subjects were divided into low PTT group and the others group by 10th percentile values for PTT in controls. Results: The low PTT group accounted for 22% of the subjects. Within the demographic and psychological data, there were no significant differences when compared between two sub-groups. Pain intensity significantly showed positive correlation with depression in both all subjects and the others group, but not in the low PTT group. Conclusions: In this study, the decrease of PTT reflected less correlation between pain intensity and depression. Thus, PTT at asymptomatic regions can be a good indicator of the central sensitization formed by the effects of depression in chronic pain.
Data analysis of psychosomatic medicine consults from a trauma medical-surgical floor Aguilar-Zanatta J, Desan HP Department of Psychological Medicine; Psychiatry-Yale University School of Medicine Introduction: There is limited research associating trauma surgery patients and psychiatric illness. The purpose of this chart review is finding and classifying characteristics of patients that received a psychiatric consultation after admission by the trauma surgery service from 2009 to 2010. Methods: The data source came from the electronic medical record from Yale New Haven Hospital. The platform in use at the time was Sunrise Clinical Manager. Eligible charts required a psychiatric consultation placed by the trauma surgery service at Yale New Haven’s East Pavilion 6-4. A retrospective data analysis of the charts with psychiatric consults was done and common characteristics among the consults recorded including: nature of trauma event, psychiatric diagnosis associated with the consult, psychiatric medications received before and/or after consultation, percentage of alcohol or illicit substances as the
culprit of the psychiatric consultation or trauma event, and disposition after the consultation. Results: Notable results from this review include: alcohol involved in some aspect of the consultation 26%, illicit substances 21%, antipsychotic medications were recommended 24%, and 37% of the consults during this time interval were delirium evaluations. Limitations: Limitations included a large variability of information recorded in the consultation as some consults were more thorough than others.
Prevalence and correlates of depression among patients attending a HIV/AIDS clinic in a teaching hospital in South East Nigeria Aguocha C1, Uwakwe R2, Diwe K3, Enwere O4, Duru C3 1 Department of Internal Medicine, Imo State University, Owerri, Nigeria 2Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria 3Department of Community Medicine, Imo State University, Owerri, Nigeria 4Department of Internal Medicine, Imo State University Teaching Hospital, Orlu, Nigeria
Introduction: Depression is one of the commonest psychiatric complications associated with HIV/AIDS and is five times more common among People Living with HIV/AIDS (PLWHA) than in the apparently healthy population. The aim of this study was to determine the prevalence and factors associated with depression among HIV patients attending clinics in a tertiary hospital in South East Nigeria. Methods: A cross-sectional descriptive survey carried out on 271 patients aged 18 years and above receiving Highly Active Antiretroviral Treatment (HAART). Sociodemographic questionnaire and Patient Health Questionnaire-9 were used to collect information about the patients. Results: About 39.1% of the respondents were identified as depressed, out of which 24.5%% were mildly depressed, 50% moderately depressed, and 24.5% were severely depressed. Mean age of diagnosis was higher among males (38.7 ± 11.2 years) than females (32.7 ± 7.9years) (p < 0.002). A higher proportion of males (76.5%) were married while more of the females were widowed (p < 0.0001). Conclusions: The relatively high prevalence of depression among attendees at the HIV/AIDS clinic underscores the need for routine depression screening.
Depression and anxiety as risk factors for bladder pain syndrome Amaral AD1, Marques-Pinto A2, Novais C1, Ribeiro AM1, Costa I1 1Psychiatry
Department, Clínica de Psiquiatria e Saúde Mental do Centro Hospitalar de São João, Oporto, Portugal 2Urology Department, Centro Hospitalar do Porto, Oporto, Portugal
1
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Decreased pain threshold caused by less correlation between pain intensity and depression in chronic pain
Published online: August 18, 2015
Disrupted white matter integrity in anterior corona radiata of patients with anorexia nervosa Sato Y1, Aizawa E2, Sekiguchi A3,4, Kotozaki Y5, Sugiura M4, Taki Y3,6, Hashizume H4, Kochiyama T7, Kawashima R4, Fukudo S1,8 1Department
of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan 2Department of Mental Disorder Research, National Center of Neurology and Psychiatry, Tokyo, Japan 3Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan 4Department of Advanced Brain Science, Smart Ageing International Research Center, Institute of Development, Aging and Cancer Tohoku University, Sendai, Japan 5 Devision of Clinical Research, Fukushima Medical University, Fukushima, Japan 6Division of Developmental Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan 7Primate Research Institute, Kyoto University, Kyoto, Japan. 8 Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan Introduction: Patients with Anorexia Nervosa (AN) show structural change in the brain such as atrophy. Although white matter of AN patients has been evaluated with Diffusion Tensor Imaging (DTI) technique, results were inconsistent and inconclusive. Methods: A total of 19 AN patients (14 restrictive type and 5 binge-purge type) and 22 healthy controls (HC) were participated in this study. All were female and right-handed. This study was approved by the Ethics Committee of Tohoku University Graduate School of Medicine. Images of all participants were acquired with 3.0 T MRI scanner. Fractional Anisotropy (FA) was calculated and compared between two groups. Results: There was no difference in age between AN patients (20 ± 4 years) and HC (19 ± 2 years). Body Mass Index of AN patients (14.4 ± 1.9 kg/m2) was lower than that of HC (20.0 ± 1.5 kg/m2) (two sample t-test, p < 0.01). Eating Attitude Test (EAT)-26 of AN patients (19.5 ± 15.9) was lower than that of HC (6.4 ± 5.7 kg/m2) (p < 0.01). FA in the anterior corona radiata and corpus callosum were significantly lower in AN patients than in HC. Conclusions: Anterior corona radiata is a component of the limbic-thalamo-cortical circuit, which plays an important role for cognitive and emotional regulation. Disrupted white matter integrity in anterior corona radiata of patients with anorexia nervosa may be relevant with the onset and maintenance of the disease.
Involvement of hippocampus in chronic fatigue syndrome Saury JM
ME/CFS rehabilitation unit, Danderyd University Hospital, Stockholm In this presentation, we concentrate on the role of the hippocampus in the development and perpetuation of chronic fatigue syndrome (CFS) and attempt to show that this focus provides an understanding of some puzzling facets of patients’ difficulties to follow treatments and improve and guide us in the need for rehabilitation strategies. New knowledge of hippocampal function has shown that impairment not only disturb the capacity to encode and retrieve new events but also the ability to navigate in the environment, to think forward, to imagine new scenarios, and make predictions about the future. The hippocampus is also an important actor in the regulation of stress and chronic stress has a detrimental effect on its integrity and on neuroplasticity. There are several comorbidities in CFS associated with defective function of the hippocampus formation, namely subjective memory impairments, one of the most common complaints of patients with CFS, infections and inflammation, especially if they are chronic, are detrimental for the functional integrity of the hippocampus. Chronic stress, one of the main active components of CFS, is known to affect the hippocampal regulation of the hypothalamic-pituitaryadrenal (HPA) axis. There is also a connection between inactivity, which is a major consequence of the illness, and neurogenesis in the hippocampus. Sleep disturbances and the presence of depressive thoughts are also known to affect the hippocampus. We discuss the implications of these results for the rehabilitation of patients with chronic fatigue syndrome.
Changes in self-reported symptoms of depression and physical wellbeing in healthy individuals following a Taiji beginner course – Results of a randomized controlled trial Schitter AM1, Nedeljkovic M1, Ausfeld-Hafter B1, Fleckenstein J1,2 1
University of Bern, Institute of Complementary Medicine IKOM, Bern, Switzerland 2 Goethe-University Frankfurt, Department of Sports Medicine, Institute of Sports Medicine, Frankfurt, Germany
Introduction: Taiji is a mind-body practice being increasingly investigated for its therapeutic benefits in a broad range of mental and physical conditions. The aim of the present study was to investigate potential preventive effects of Taiji practice in healthy individuals with regard to their depressive symptomatology and physical wellbeing. Methods: A total of 70 healthy Taiji novices (mean age 35.5 years) were randomly assigned to a Taiji intervention group, i.e. Taiji beginner course (Yang-Style Taiji, 2 hours per week, 12 weeks) or a waiting control group. Self-reported symptoms of depression (CES-D) and physical wellbeing (FEW16) were assessed at baseline, at the end of the intervention, as well as two months later. Results: Physical wellbeing in the Taiji group significantly increased when comparing baseline to follow up (FEW-16 sum scale T(27) = 3.94, p = 0.001, 95% CI 0.17 - 0.55). Pearson’s correlation coefficients displayed a strong negative relationship between self-reported symptoms of depression and physical wellbeing (p’s < 0.001, r‘s ≥ -.54). Conclusions: In this randomized controlled trial we found significant evidence that a Taiji beginner course of three months duration elicits positive 62
Psychother Psychosom 2015;84(suppl 1):1-82 DOI: 10.1159/000438780
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while having social resources for supporting ibasho. Our results also suggest that, for Hikikomori undergoing treatment, the promotion of social activities, particularly in relation with staff at their ibasho, might be linked with a reduction of their interpersonal tension.
The effect of sleep deprivation on pain perception: A meta-analysis Schrimpf M1, Liegl G1, Boeckle M1, Geisler P2, Leitner A1, Pieh C1,3 1Department
of Psychotherapy and Biopsychosocial Health, Danube-University Krems, Krems, Austria b Department of Psychiatry and Psychotherapy, University Hospital Regensburg, Regensburg, Germany c Department of Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany Introduction: There is large evidence for an interaction of sleep and pain. However, the size of this effect and thereby the clinically relevance is vague. We conducted a meta-analysis to quantify the effect of sleep deprivation on pain perception. Methods: PubMed, Cochrane, Psyndex, PsycInfo, and Scopus was searched for Sleep AND pain AND (“sleep restriction“ OR “sleep deprivation“ OR “sleep loss” OR “sleep interruption” OR “hyperalgesia” OR “total sleep deprivation” OR “partial sleep deprivation” OR sleep fragmentation”). Studies were included that investigated 1. sleep deprivation (total or partial) or sleep restriction and 2. pain (any kind of pain measurement, e.g., VAS or pain threshold). Results: Five eligible studies (190 subjects) for the between-group analysis and 10 studies (266 subjects) for the within-group analysis were identified. Sleep deprived conditions showed a medium effect to non-sleep deprived conditions in the between group analysis (SMD = 0.62 95% CI 0.12 - 1.12; z = 2.43; p < 0.05) and a large effect in the within-group analysis (SMD = 1.49 95% CI 0.82 - 2.17; z = 4.35; p < 0.0001). Test for heterogeneity was not significant in the between-group analysis (Q = 5.29; df = 4; p = n.s.) and significant in the within-group analysis (Q = 53.49; df = 9; p < 0.0001). Conclusions: This meta-analysis confirms the effect of sleep deprivation on pain perception. A medium effect (SMD = 0.62) was found for the between group analysis and a large effect (SMD = 1.49) for the within group analysis. Although this meta-analysis is based on experimental studies, a medium to large effect on pain perception seems clinically relevant.
The influence of psychotherapy on the outcome of patients with rheumatoid arthritis – A case study Schueler-Schneider A Frankfurt, Germany Introduction: The effectiveness of a psychoanalytic psychotherapy in the treatment of rheumatic diseases is clearly illustrated by the case at hand. Case description: A today 58-year-old Turkish patient was treated in 1987 at a psychosomatic ward in Frankfurt for the first spurt of chronic polyarthritis. Severe pain in the fingers and wrists with radiological changes, max. ESR, RF, and CRP confirmed the diagnosis. She could no longer work in her
profession as a precision engineer. The 6-month hospitalization included three sessions per week psychoanalysis, physical, and antiphlogistic therapy. The basic therapy with gold and methotrexate had to be cancelled due to incompatibility. The trusting doctor-patient relationship corresponded to the good fatherdaughter relationship. The patient had lived 11 years in Germany and married a German one year before the admission to the hospital without their parents' knowledge. She feared that she would therefore be expelled from the Turkish family. After solving the conflict, the journey was prepared despite pain symptoms. The patient returned after six weeks without symptoms. The parents accepted the marriage which is still in existence today. She takes antiphlogistics occasionally and travels annually to Turkey for a spa treatment. A rheumatoid thrust has never reoccurred. Comment: Chronically rheumatic diseases often (20% to 91%) associates with anxiety- and depression disorders. Only medical treatment leads to a better outcome, improves the quality of life and reduces the treatment costs. In many cases there is no psychotherapeutic treatment. There should be further research into the reasons for this.
Do patients in rehabilitation with adjustment disorder differ from patients with depression while and after psychosomatic rehabilitation? Schweiberer D1 2, Neu R1, Köllner V1 2 1
Department for Psychosomatic Medicine, Mediclin Bliestalkliniken, Blieskastel, Germany 2Faculty of Medicine, Saarland University, Homburg/Saar, Germnay Introduction: Adjustment Disorders (AD) are often used as a residual category of diagnosis. Especially relating to job strain AD are often used in context with the experience of burnout or mobbing. We observed whether patients with AD differ from those with depression. Methods: A total of 100 patients in psychosomatic rehabilitation, treated on a special station for workplace related strain (71 female/ 29 male; age 49.84 ± 8.73 years), attended this study. Seventy-three achieved the criteria of a depressive disorder, 23 of AD. To measure psychiatric symptoms we used Health-49, BDI-II, and Burnout-Screening-Scales I-III (BOSS I-III) which detect job strain, somatic disorders, and resources, at admission of rehabilitation (T0), at discharge (T1), and six month after discharge (T2). Results: Patients with AD showed at T0 and T1 less strain than patients with depressive disorder. Both groups could benefit from the psychosomatic rehabilitation in the same degree despite of the different base levels. Relating to the inability to work both groups did not differ at any time. Those who were inability to work decreased from 45% at T0 to 9.5% at T2. Conclusions: Patients with AD have as expected less psychopathology strain at T0 and T1 than patients with depressive disorders. Regarding the state of employment both groups are similar strained and both groups benefit equal and lasting from the psychosomatic rehabilitation. Future studies should research whether patients in psychosomatic rehabilitation with AD have more specific strains and whether they need the same treatment in rehabilitation as patients with depressive disorders.
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effects with respect to physical wellbeing in healthy individuals, with improvements pronouncing over time. Physical wellbeing was shown to have a strong relationship with depressive symptoms. Based on these results, the consideration of Taiji as one therapeutic option in the development of multimodal approaches in the prevention of depression seems justifiable.
