Psychosomatic Medicine

Obesity is generally a life-long problem with numerous weight-related complications. The relationship between body weight and risk of developing a significant disease, as well as total mortality and morbidity, has been examined in many epidemiological studies. Such studies provide insight into biological relationships. I addition to negative physical effects, obesity may also have deleterious psychological and social effects on the individual concerned. It is not obesity as a physical state that creates a psychological burden for many obese individuals, but rather the people or society who create this burden and suffering. Discrimination and prejudice may have adverse effects on the psychological well-being of a subgroup of obese persons. The psychological consequences of obesity are described in this chapter. Furthermore, the possible specific psychopathology of obese individuals in clinical settings, e.g., binge eating disorder and body dissatisfaction, are discussed. The second p...

Objective: Previous studies of sex hormone concentrations in depression yielded inconsistent results. However, the activation of the hypothalamic-pituitary-adrenal system seen in depression may negatively affect gonadal function at every level of regulation. The objective of this study was to explore whether major depressive episodes are indeed associated with an alteration of gonadal function. Methods: Testosterone, pulsatile LH secretion, FSH, and cortisol were assessed using frequent sampling during a 24-hour period in 15 male inpatients with major depression of moderate to high severity and in 22 healthy comparison subjects (age range 22-85 years). Results: An analysis of covariance model showed that after adjustment for age only, daytime testosterone (p Ͻ .01), nighttime testosterone (p Ͻ .05), and 24-hour mean testosterone secretion (p Ͻ .01) were significantly lower in the depressed male inpatients. There was also a trend for a decreased LH pulse frequency in the depressed patients (p Ͻ .08). Conclusions: Gonadal function may be disturbed in men with a depressive episode of moderate to high severity. Key words: major depression, testosterone, LH, FSH, cortisol, men.

Objective: Lactation has been associated with attenuated hormonal responses to exercise stress in humans. This study was designed to determine the effect of lactation on hypothalamic-pituitary-adrenal axis, autonomic nervous system, and anxiety responses to psychological stress. Method: The Trier Social Stress Test was administered to 24 lactating women, 13 postpartum nonlactating women, and 14 healthy control women in the early follicular phase of the menstrual cycle. Lactating women were stressed at least 40 minutes after last feeding their infant. Results: ACTH, cortisol, heart rate, diastolic blood pressure, systolic blood pressure, and subjective anxiety ratings were all significantly increased in response to the psychological stress (all p Ͻ .0001). There were no differences among the three groups in any of these responses to the stress. However, postpartum nonlactating women did have a persistently higher systolic blood pressure and lower cardiac vagal tone than the lactating women and control subjects. In addition, the typical negative correlation between cardiac vagal tone and heart rate was consistently higher in lactating women than nonlactating postpartum women and controls, which suggests stronger vagal control of heart rate in lactating women. In addition, there was no change in oxytocin or allopregnanolone in response to the stress, and baseline oxytocin and allopregnanolone levels did not differ among the three groups. Conclusions:

Objective: Depression and insomnia are closely linked, yet our understanding of their prospective relationships remains limited. The aim of the current study was to investigate the directionality of association between depression and insomnia. Methods: Data were collected from a prospective population-based study comprising the most recent waves of the Nord-TrLndelag Health Study (HUNT) (the HUNT2 in 1995Y1997 and the HUNT3 in 2006Y2008). A total of 24,715 persons provided valid responses on the relevant questionnaires from both surveys. Study outcomes were onset of depression or insomnia at HUNT3 in persons not reporting the other disorder in HUNT2. Results: Both insomnia and depression significantly predicted the onset of the other disorder. Participants who did not have depression in HUNT2 but who had insomnia in both HUNT2 and HUNT3 had an odds ratio (OR) of 6.2 of developing depression at HUNT3. Participants who did not have insomnia in HUNT2 but who had depression in both HUNT2 and HUNT3 had an OR of 6.7 of developing insomnia at HUNT3. ORs were only slightly attenuated when adjusting for potential confounding factors. Conclusions: The results support a bidirectional relationship between insomnia and depression. This finding stands in contrast to the previous studies, which have mainly focused on insomnia as a risk factor for the onset of depression.

This article reviews the principles and skills involved with psychosomatic medicine and their potential ability to improve global health care. New awareness of the escalating global public health impact of noncommunicable diseases, including chronic medical conditions and mental disorders, has stimulated interest in determining how best to organize health services. Home to the biopsychosocial model, the field of psychosomatic medicine is well-suited to inform such efforts by virtue of its emphasis on crossdisciplinary collaboration and specialized knowledge at the interface of medicine and psychiatry that takes into account individual and contextual influences on health. Consistent with the principles of psychosomatic medicine, promising strategies to improve global health care include integrating mental health care into primary care, applying the chronic care model in programs aimed at enhancing disease selfmanagement, and using innovative models such as Internetbased therapy and telemedicine to increase access to quality care.

Objective: To examine the relationship between childhood trauma and prevalence of cardiovascular disease (CVD) (either coronary disease or stroke) in Type 1diabetes (DM). Methods: From an original cohort of 725 African Americana with Type 1 DM, 444 (61.2%) were reexamined as part of a 6-year follow-up. In both examinations, patients underwent a structured clinical interview to determine their medical history and a detailed ocular examination. At follow-up, patients completed the Childhood Trauma Questionnaire, Hostility and Direction of Hostility Questionnaire, and Beck Depression Inventory. Diabetic patients who had CVD and those had not developed CVD at the 6-year follow-up were compared for their experience of childhood trauma at the same time controlling for the presence of known risk factors for CVD. Results: Of the 393 patients at risk, 60 (15.3%) had developed any CVD, 52 (12.9%) had coronary disease, and 16 (3.8%) had a stroke at the 6-year follow-up. On univariate analysis, childhood trauma was significantly associated with 6-year incidence of any CVD (p Ͻ .01), coronary disease (p Ͻ .05), and stroke (p Ͻ .01). Childhood trauma scores were also significantly associated with depression (p Ͻ .001) and hostility (p Ͻ .001) scores, age (p Ͻ .05), and renal disease (p Ͻ .05). In primary multivariate analyses, childhood trauma predicted CVD independent of age, body mass index, blood pressure, and proteinuria. Secondary analyses suggested that association between the 6-year incidence of CVD and childhood trauma was also independent of depression ratings. Conclusion: Childhood seems to be an independent risk factor for the incidence of CVD in Type 1 DM.

Objective: To investigate whether physical fitness is decreased in patients with major depressive disorder (MDD) in comparison to matched healthy controls because low physical fitness has been shown to be associated with metabolic syndrome or autonomic dysfunction. Cardiovascular morbidity and mortality are known to be increased in patients with MDD. Furthermore, the effect of a single exhaustive exercise task on heart rate recovery (HRR) and mood was examined. Methods: Peak oxygen consumption (VO 2 peak), maximum workload (Ppeak), and individual anaerobic threshold (IAT) were assessed in 22 patients suffering from MDD and 22 controls in a stepwise exhaustion protocol, using spirometry and lactate diagnostics. HRR was detected within the first minute after recovery. The Self-Assessment Manikin (SAM) was used to assess mood before and after exercise. Results: VO 2 peak, Ppeak, and IAT were decreased significantly in patients, indicating reduced physical fitness in MDD as compared with control subjects. A single exercise exhaustion significantly improved mood in patients, but not in controls. Mood improvement in patients correlated with maximum lactate levels. Significantly reduced HRR values in patients further point to an elevated cardiovascular risk profile and autonomic dysfunction. Conclusions: Our results indicate reduced physical fitness in patients with MDD. Thus, special training programs should be developed to improve their cardiovascular risk profile. In addition, the intriguing finding of a correlation between lactate levels and mood changes should be followed up in future studies to unravel putative mechanisms. Key words: physical fitness, peak oxygen consumption, individual anaerobic threshold, heart rate recovery, major depressive disorder, autonomic nervous system.

Objective-Caffeine increases cortisol secretion in people at rest or undergoing mental stress. It is not known whether tolerance develops in this response with daily intake of caffeine in the diet. We therefore tested the cortisol response to caffeine challenge after controlled levels of caffeine intake.

Liver disease is a common cause of morbidity and mortality in the United States and elsewhere. Arising from infectious, hereditary, or toxin-induced sources, the detection of liver disease often requires a high index of suspicion. Clinical presentations are highly variable and are often accompanied by neuropsychiatric symptoms. This fact, along with an increased incidence of liver disease among patients with primary psychiatric disorders and the presence of varied drug use, complicates the tasks of providing care to patients with liver disease. To assist the consultation-liaison psychiatrist, the authors present the first of a two-part series focused on psychiatric issues in liver disease.

Objective: First popularized as neurasthenia in the late 1800s by American George Beard, asthenia has been viewed by Russian psychologists and flight surgeons as a major problem that affects cosmonauts participating in longduration space missions. However, there is some controversy about whether this syndrome exists in space; this controversy is attributable in part to the fact that it is not recognized in the current American psychiatric diagnostic system. Methods: To address this issue empirically, we retrospectively examined the data from our 4 1/2-year, NASA-funded study of crew member and mission control interactions during the Shuttle/Mir space program. Three of the authors identified eight items of stage 1 asthenia from one of our measures, the Profile of Mood States (POMS). Scores on these items from 13 Russian and American crew members were compared with scores derived from the opinions of six Russian space experts. Results: Crew members' scores in space were significantly lower than the experts' scores on seven of the eight items, and they generally were in the "not at all" to "a little" range of the item scales. There were no differences in mean scores before and after launch or across the four quarters of the missions. There were no differences in response between Russian and American crew members. Conclusions: We could not demonstrate the presence of asthenia in space as operationally defined using the POMS. However, the POMS addresses only emotional and not physiological aspects of the syndrome, and the subject responses in our study generally were skewed toward the positive end of the scales. Further research on this syndrome needs to be done and should include physiological measures and measures that are specific to asthenia.

The article substantiates the prospects of using a holistic approach to maintaining and strengthening the human psycho somatic health. The holistic approach is associated here with evidence based clinical medicine, rather than, as is often the case, with alternative medical practices. The author demonstrates that the holistic approach is closely connected with the systemic vision of the human organism, its consideration as a complex system or a risky structure in accordance with the conception of self organized criticality within the framework of systems science. To understand psychosomatic health, the methodological significance of the conception of enactivism in modern cognitive science is also shown.
В статье обосновывается перспективность применения холистического подхода к поддержанию и укреплению пси хосоматического здоровья человека. Холистический подход связывается с доказательной клинической медициной, а не, как часто бывает, с альтернативными медицинскими практиками. Демонстрируется, что холистический под ход тесно взаимосвязан с системным видением человеческого организма, рассмотрением человека как сложной си стемы или рискованной структуры в соответствии с концепцией самоорганизованной критичности в рамках науки о системах. Показывается также, что для понимания психосоматического здоровья методологически значима кон цепция энактивизма в современной когнитивной науке. Ключевые слова: энактивизм, проблема сознания и тела, психосоматика, самоорганизованная критичность, слож ные системы, холизм, холистическая медицина.

Objective: To answer two questions about the nature of the relationship between anorexia nervosa (AN) and dimensional temperament traits: Which traits are comorbid with AN? Which traits share transmitted liabilities with AN? Methods: A community sample of 1002 same-gender female twins was selected with respect to participation in two earlier waves of data collection. Measures of eating disorder diagnoses and features were ascertained through interview and continuous measures of temperament were ascertained from self-report measures. Results: Four temperaments were comorbid with AN, namely, higher levels of perfectionism (concern over mistakes, personal standards, doubt about actions), and higher need for organization. Comparison between the female co-twins of AN probands and controls (who had never had an eating disorder) showed that the former group reported higher levels of personal standards, organization, and reward dependence. The association between personal standards and reward dependence remained when controlling for the temperament of the proband or control in monozygotic twins. Conclusions: The evidence overall supports the suggestion that AN may represent the expression of a common underlying familial liability to a temperament style that reflects a striving for perfectionism, a need for order, and a sensitivity to praise and reward. The nature of the shared risk factors is likely to be, in part, genetic.

In addition to repeated reexperiencing of the event, the delayed effects of severe psychological trauma, i.e., post traumatic stress disorder (PTSD), present a paradoxical mix of symptoms. There is enhancement of the self-preservative catecholamine states; anger and fear with a contrasting sense of meaninglessness and a blunting of the emotional responses of the attachment behavior so critical for species preservation. Hormonally, there is a striking separation of the catecholamine response, which stays elevated and that of the hypothalamo-pituitary-adrenal (HPA) axis, which may remain at normal levels. Pathophysiologically, the reexperiencing of the trauma and the arousal may be associated with dysfunction of the locus coeruleus, amygdala and hippocampal systems. This article explores the consequences of an additional dysfunction: a dissociation of the hemispheres that appears to be responsible for the alexithymic avoidance and failure of the cortisol response that so often follow severe psychological trauma. There is neurophysiological evidence that the left and right hemispheres subserve different emotional sets that correspond to “control” and “appraisal,” i.e., very approximately to the self and species preservative behavioral complexes, respectively. Several studies point to physiological dissociation of hemispheric functions during alexithymia. This raises the question: What has been lost if in this condition the right side no longer fully contributes to integrated cerebral function? Right hemispheric damaged children lose critical social skills and in adults the related sense of familiarity critical for bonding is lost. Such losses of social sensibilities may account for the lack of empathy and difficulties with bonding found in sociopathy and borderline personality: conditions now believed to result from repeated psychological trauma during development. On the other hand, systems that promote right hemispheric contributions provide solacing access to a “Higher Power.” They also appear to protect against socially disordered behavior, substance abuse, the failure of the HPA axis and some aspects of the pathophysiology of chronic disease.

Most research on psychosomatic processes has been
limited by its reliance on very general psychological
concepts, such as emotional states and personality traits.
Looking at construing especially as it occurs specifically
in its relational context may break us out of this impasse.
As long as we investigate a general process such as
"anxiety" or "stress" we will only learn very general things
about the associated physiology - such as general arousal
levels. The framework of Family Construct Psychology is introduced as potentially valuable in formulating and carrying out research on psychosomatic processes.

I. Psychosomatic Medicine: A Critical Appraisal:

The modern medical practitioner attempts to account for the various aspects of illness by considering them all together and, in doing so, adopts a biopsychosocial approach. As a general medical orientation, psychosomatic medicine finds its main purpose in pursuing such an approach.

The psychosomatic physician postulates "that mind and body are two inseparably linked aspects of man" ([9], p. 12). Such an approach is 'holistic', "in that it implies a view of the human organism as a whole, a mind-body complex" ([9], p. 12). Lipowski distinguishes several themes in current psychosomatics: the search for physiological mediating pathways between psyche and soma in fields such as neuro-endocrinology and neuroimmunology; the search for correlations of psychological "stress" and physiological effect; and the investigation of the psychosocial response to physical illness ([9],' pp. 8-9). In addition, psychosomatics is concerned with the interaction of psychological, social and physiological factors in health and illness and with the therapeutic consequences issuing from this holistic, i.e., biopsychosocial view ([9], p. 12). According to Lipowski, in psychosomatics, the "old" notion of causality is abandoned and replaced by the notion of "reciprocal interaction" so that it is impossible to say that physical events are caused by psychological events, or vice versa ([9], p. 14). Since every illness is invariably physiological' as well as psychological, all disorders are psychosomatic and there is no privileged list of psychosomatic disorders. Ironically, if this were to be generally acknowledged, the very term "psychosomatic" would be quite superfluous [22,.23]. .

But given the holistic starting point of the psychosomatic approach, how can medical research effectively proceed? Out of his concern that holism cannot conceivably allow for research, Lipowski sees a need to split and reduce this holism through "methodological reductionism":

"Furthermore, one needs to draw a distinction between methodological and theoretical reductionism. The former implies a research strategy involving a deliberate decision to abstract from, and hence disregard one or two classes of variables so as to be able to study the effects on behavior of variables belonging to only one class, say biological or psychological. This is a heuristically .valuable investigative strategy, one that appears indispensable for progress in our field ([10], p. 61)."

Hence, psychosomatics can be characterized by a holistic (i.e., biopsychosocial) starting point, the abandonment of classical "causality", psychophysiological correlations and methodological reductionism.

We may ask if this psychosomatic approach is able to offer a genuinely complete account of patients and their environment in health and in illness. And if not, are we able to suggest an alternative?

This experimental study explored whether the physical symptoms of cold, pain and itchiness could be generated by visual cues, whether they varied in the ease with which they could be generated and whether they were related to negative affect. Participants were randomly allocated by group to watch one of three videos relating to cold (e.g. ice, snow, wind), pain (e.g. sporting injuries, tattoos) or itchiness (e.g. head lice, scratching). They then rated their self-reported symptoms of cold, pain and itchiness as well as their negative affect (depression and anxiety). The researcher recorded their observed behaviour relating to these symptoms. The results showed that the interventions were successful and that all three symptoms could be generated by the visual cues in terms of both self-report and observed behaviour. In addition, the pain video generated higher levels of anxiety and depression than the other two videos. Further, the degree of itchiness was related to the degree of anxiety. This symptom onset process also showed variability between symptoms with self-reported cold symptoms being greater than either pain or itchy symptoms. The results show that physical symptoms can be generated by visual cues indicating that psychological factors are not only involved in symptom perception but also in symptom onset.

This forthcoming (rewritten) paper argues for the significance of swearing as a different type of language (a "proto-language") - one that serves to project and express unbearable, pre-verbal frustration, fear and feelings about Life's struggle, as well as truly awesome beauty. It is pitched somewhere in the psyche as an intermediary between feeling and action, before thinking makes its mark as a modifying agent.

A detailed exploration of the various unconscious meanings of different types of swearing modes is undertaken, and swearing is revealed as a complex and important form of emotional communication, notwithstanding its basis in the "primitive" origins of infantile anxiety.
The paper - originally a conference presentation with audio and video excerpts - is currently being updated (from its pre HBO-Netflix original form) because times have changed significantly in the past decade re Swearing no longer being quite the taboo that it once was.
During "renovations" this draft for the conference presentation is being made available, temporarily, and comments are welcomed - although the audio-visual elements are absent, and some paragraphs are still in shorthand form.

Objective: This study examined aspects of the transactional model of hostility and health by investigating relationships among hostility, interpersonal interactions, and ambulatory blood pressure in a healthy community sample. Materials and Methods: Participants included 65 female and 39 male healthy adults between the ages of 18 and 46 years. Ambulatory blood pressure (ABP) and diary data on mood and social interactions were obtained every 20 minutes for 1 day. Mixed models regression analyses were used to evaluate the relationships among hostility, interpersonal interactions, and ABP. Results: Trait hostility was positively associated with the frequency and intensity of negative interactions and was negatively associated with the frequency and intensity of positive interactions. Interacting with others was associated with increases in systolic blood pressure (SBP) and diastolic blood pressure (DBP). The magnitude of the increase in blood pressure was positively associated with the degree to which the interaction was perceived as negative. Hostility was not directly associated with ABP/heart rate (HR) or ABP/HR responses during any interactions or negative interactions. However, there was an interaction between hostility and negative interaction intensity for DBP, suggesting that hostility moderates the effects of negative interactions on DBP. Specifically, increases in the intensity of negative interactions were associated with increases in DBP for participants with high, but not low, hostility. Conclusions: The results provide partial support for the notion that hostility may be associated with risk for cardiovascular disease through its effects on interpersonal interactions and their cardiovascular correlates.

Objective: Somatic symptoms are prevalent in the community, but at least one third of the symptoms lack organic explanation. Patients with such symptoms have a tendency to overuse the health care system with frequent consultations and have a high degree of disability and sickness compensation. Studies from clinical samples have shown that anxiety and depression are prevalent in such functional conditions. The aim of this study is to examine the connection between anxiety, depression, and functional somatic symptoms in a large community sample. Method: The HUNT-II study invited all inhabitants aged 20 years and above in Nord-Trøndelag County of Norway to have their health examined and sent a questionnaire asking about physical symptoms, demographic factors, lifestyle, and somatic diseases. Anxiety and depression were recorded by the Hospital Anxiety and Depression Scale. Of those invited, 62,651 participants (71.3%) filled in the questionnaire. A total of 10,492 people were excluded due to organic diseases, and 50,377 were taken into the analyses. Results: Women reported more somatic symptoms than men (mean number of symptoms women/men: 3.8/2.9). There was a strong association between anxiety, depression, and functional somatic symptoms. The association was equally strong for anxiety and depression, and a somewhat stronger association was observed for comorbid anxiety and depression. The association of anxiety, depression, and functional somatic symptoms was equally strong in men and women (mean number of somatic symptoms men/women in anxiety: 4.5/5.9, in depression: 4.6/5.9, in comorbid anxiety and depression: 6.1/7.6, and in no anxiety or depression: 2.6/3.6) and in all age groups. The association between number of somatic symptoms and the total score on Hospital Anxiety and Depression Scale was linear. Conclusion: There was a statistically significant relationship between anxiety, depression, and functional somatic symptoms, independent of age and gender.

Objective: Melissa officinalis (lemon balm) is contemporaneously used as a mild sedative and/or calming agent. Although recent research has demonstrated modulation of mood in keeping with these roles, no studies to date have directly investigated the effects of this herbal medication on laboratory-induced psychological stress. Methods: In this double-blind, placebo-controlled, randomized, balanced crossover experiment, 18 healthy volunteers received two separate single doses of a standardized M. officinalis extract (300 mg, 600 mg) and a placebo, on separate days separated by a 7-day washout period. Modulation of mood was assessed during predose and 1-hour postdose completions of a 20-minute version of the Defined Intensity Stressor Simulation (DISS) battery. Cognitive performance on the four concurrent tasks of the battery was also assessed. Results: The results showed that the 600-mg dose of Melissa ameliorated the negative mood effects of the DISS, with significantly increased self-ratings of calmness and reduced self-ratings of alertness. In addition, a significant increase in the speed of mathematical processing, with no reduction in accuracy, was observed after ingestion of the 300-mg dose. Conclusion: These results suggest that the potential for M. officinalis to mitigate the effects of stress deserves further investigation.

Alexithymia is a personality trait characterised by difficulty identifying and describing subjective emotional feelings, a restricted imagination, and an externally oriented style of thinking. Individuals with high levels of this trait are at risk of developing several common psychiatric disorders. The concept of alexithymia has evolved considerably over the past twenty years, and this important new work responds to the need for a definitive book on the subject. The research, theory and clinical issues surrounding alexithymia are discussed in depth, examining the psychological, biological and social aspects of the construct and their related outcomes. Featuring contributions from researchers and clinicians in the field of emotion processing and regulation, chapters include methods for assessing and reducing alexithymia, and research findings from diverse fields of scientific enquiry including genetics, neuroimaging studies, emotion regulation, attachment and trauma research, and comorbidities with a number of psychiatric and medical disorders. • Discusses the state of the art alexithymia research-there has not been a comprehensive book on the topic for more than twenty years • Demonstrates the relationship between alexithymia and various medical and psychiatric disorders, and offers therapeutic interventions for reducing this personality trait • The book will help to develop more integrative research and interventions in the future

Objectives: This study examined prospectively (1971)(1972)(1973)(1974)(1975)(1976)(1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988) the relationship between anger-coping responses, gender, and mortality (N ϭ 91) in a representative sample of men (N ϭ 324) and women (N ϭ 372), aged 30 to 69, from the Tecumseh Community Health Study. Methods: Anger-coping was measured by responses to hypothetical unfair anger-provoking situations. Cox proportional hazard regressions were used adjusted for seven health risk factors (age, smoking, relative weight, systolic blood pressure (SBP), bronchial problems, FEV 1 , and cardiovascular (CV) risk). Results: Men's suppressed anger interacted significantly with SBP and also with bronchial problems to predict both all-cause and CV mortality. Women showed direct relationships between suppressed anger and early mortality (all-cause, CV, and cancer). Women also showed an interaction of spouse-suppressed anger and SBP for all-cause and CV mortality. Data suggest men who expressed their anger died earlier of cancer (N ϭ 16) deaths. Conclusions: Suppressed anger at the time of an unjust attack may become chronic resentment (intermittent rage or hatred) about which little is known and requires research. The design for future research should experimentally measure both suppressed anger-coping responses (after an unfair attack) and morbidity (eg, blood pressure, bronchitis, immune disorder, etc.) to predict prospectively to earlier mortality.

The Diagnostic Criteria for Psychosomatic Research (DCPR) represent a diagnostic and conceptual framework that aims to translate psychosocial variables derived from psychosomatic research into operational tools whereby individual patients can be identified. A set of 12 syndromes was developed: disease phobia, thanatophobia, health anxiety, illness denial, persistent somatization, functional somatic symptoms secondary to a psychiatric disorder, conversion symptoms, anniversary reaction, irritable mood, type A behavior, demoralization, and alexithymia. The aim of this article is to survey the research evidence that has accumulated on the DCPR in several clinical settings (cardiology, oncology, gastroenterology, endocrinology, primary care, consultation psychiatry, nutrition, and community), to examine prevalence and specific diagnostic clusters of the more prevalent DCPR syndromes, and to review their clinical utility in terms of clinical decision, prediction of psychosocial functioning, and treatment outcomes. The implications for classification purposes (DSM-V) are also discussed.

The Somatoform Disorders are a group of problems in which people suffer from somatic symptoms or worry about bodily illness or deformity that cannot be accounted for by an organic medical condition or another psychiatric disorder such as depression or anxiety.  In this chapter we review what is known about the Somatoform Disorders. We argue that, just as the notion of ‘psychophysiological disorder’ has been replaced by that of “Psychological Factors Affecting Physical Condition”—a shift from a categorical, disorder-based scheme to one of diagnosing specific situations—so too should the Somatoform Disorders be reconceptualized as symptoms or patterns of illness behavior that interact with other medical and psychiatric conditions. As illness behavior, Somatoform Disorders can be best typified and understood in terms of dimensions rather than categories, processes rather than symptoms and signs, and social contexts rather than isolated behaviors. We think this dimensional and contextual approach to somatization not only fits the research data better than the individual psychopathology oriented perspective, it also has useful implications for clinical assessment and treatment. Rethinking the category of Somatoform Disorders from a social and cultural perspective will allow us to avoid some of the negative attitudes and stigmatization that plague patients who receive these diagnoses

Objective: Mindfulness-Based Stress Reduction (MBSR) is a clinical program, developed to facilitate adaptation to medical illness, which provides systematic training in mindfulness meditation as a self-regulatory approach to stress reduction and emotion management. There has been widespread and growing use of this approach within medical settings in the last 20 years, and many claims have been made regarding its efficacy. This article will provide a critical evaluation of the available state of knowledge regarding MBSR and suggestions for future research. Methods: A review of the current literature available within the medical and social sciences was undertaken to provide an evaluation regarding what we know about the construct of mindfulness, the effectiveness of MBSR, and mechanisms of action. Results: There has been a paucity of research and what has been published has been rife with methodological problems. At present, we know very little about the effectiveness of this approach. However, there is some evidence that suggests that it may hold some promise. Conclusions: The available evidence does not support a strong endorsement of this approach at present. However, serious investigation is warranted and strongly recommended.

The prevalence as well as predictors of psychiatric disorders (Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV] axis I and II) in patients with fibromyalgia syndrome (FMS) was evaluated. Method: One-hundred fifteen patients with FMS participated in the Structured Clinical Interview for DSM-IV to assess current mental disorders. In addition, patients completed standardized questionnaires regarding pain, pain impact, anxiety, depression, posttraumatic stress disorder-like symptoms, and sexual and physical abuse. Results: Patients were grouped into one of three psychosocial subgroups based on responses to the Multidimensional Pain Inventory (MPI)-Dysfunctional (DYS), Interpersonally Distressed (ID), and Adaptive Copers (AC). Axis I diagnoses were present in 74.8% of the participants overall with the DYS subgroup mainly reporting anxiety and the ID group mood disorders. The AC group showed little comorbidity. Axis II diagnoses were present in only 8.7% of the FMS sample. Conclusion: These results suggest that FMS is not a homogeneous diagnosis, but shows varying proportions of comorbid anxiety and depression dependent on psychosocial characteristics of the patients. The results demonstrate the importance of not treating patients with FMS as a homogeneous group. Assessment should not only examine the presence of widespread pain and the number of tender points, but also the presence of affective distress. Treatment should focus both on physical and emotional dysfunction.

Objective: To analyze in a prospective cohort study if depressive symptoms are an independent predictor of mortality in kidney transplant recipients. Methods: Data from 840 transplanted patients followed at a single outpatient transplant center were analyzed. Sociodemographic parameters and clinical data were collected at enrollment (between August 2002 and February 2003). Participants completed the Center for Epidemiologic Studies-Depression (CES-D) scale. Depression was defined as CES-D score of Ն18. Data on 5-year outcomes (death censored graft loss or mortality) were collected. Results: The prevalence of depression was 22%. Mortality was higher (21% versus 13%; p ϭ .004) in patients with versus without depression. In a multivariate Cox proportional hazard model, both the baseline CES-D score (hazard ratio for each 1-point increase ϭ 1.02; 95% confidence interval, 1.00 -1.04) and the presence of depression at baseline (hazard ratio presence ϭ 1.66; 95% confidence interval, 1.12-2.47) were significantly associated with mortality. The baseline CES-D score also significantly predicted death censored graft loss (hazard ratio for each 1-point increase ϭ 1.03; 95% confidence interval, 1.01-1.05). Conclusion: Depressive symptoms are an independent predictor of mortality in kidney transplanted patients.

Background: While medical criteria have been well established for each end-organ system, psychosocial listing criteria are less standardized. To address this limitation, we developed and tested a new assessment tool: the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT). Methods: The SIPAT was developed from a comprehensive review of the literature on the psychosocial factors that impact transplant outcomes. Five examiners blindly applied the SIPAT to 102 randomly selected transplant cases, including liver, heart, and lung patients. After all subject's files had been rated by the examiners, the respective transplant teams provided the research team with the patient's outcome data. Results: Univariate logistic regression models were fit in order to predict the transplant psychosocial outcome (positive or negative) using each rater's SIPAT scores. These results show that SIPAT scores are highly predictive of the transplant psychosocial outcome (P Ͻ 0.0001). The instrument has excellent inter-rater reliability (Pearson's correlation coefficient ϭ 0.853), even among novice raters. Conclusions:

Intervention au colloque du CIPS au Sénat le 17 juin 2006 A paraître chez EDK Le corps réel et le corps imaginaire, loin de représenter deux entités distinctes, renvoient aux deux réalités qui définissent l'être et sa condition même d'existence. Deux réalités qui s'interpénètrent constamment selon des degrés variables et qui rendent compte d'autant de modes d'expression qu'il existe de combinaisons entre ces deux instances.

The purpose of this experimental study was to supplement and expand on clinical research demonstrating that the provision of social support is associated with lower levels of acute pain. Methods: Undergraduates (52 men and 49 women) performed the cold pressor task either alone or accompanied by a friend or stranger who provided active support, passive support, or interaction. Pain perception was measured on a 10-point scale. Results: Participants in the active support and passive support conditions reported less pain than participants in the alone and interaction conditions, regardless of whether they were paired with a friend or stranger. Conclusions: These data suggest that the presence of an individual who provides passive or active support reduces experimental pain.

In the past few years there has been a dramatic increase in the number of psychoanalytic publications on the topic of psychosomatic illness, including edited collections and special editions of psychoanalytic journals. This paper is a critical conceptual review of the topic of psychosomatic illness using the material contained in a number of these recent publications as a basis, but also drawing on other works by the key authors of the publications discussed herein. This paper proposes that currently there appear to be two schools of thought around the origin, development, and treatment of psychosomatic symptoms. The first of these is the well-established "Paris School of Psychosomatics." The second approach does not formally exist, but is referred to in this paper as the "Attachment approach" since there are a number of authors who theorize about the treatment of psychosomatic symptoms in a similar and important way. The paper will compare and contrast the two a...

To investigate whether a support intervention (warm touch enhancement) influences physiological stress systems that are linked to important health outcomes. Growing evidence points to a protective effect of social and emotional support on both morbidity and mortality. Methods: In this study, 34 healthy married couples (n ϭ 68), aged 20 to 39 years (mean ϭ 25.2 years), were randomly assigned to a "behavior monitoring" control group or participated in a 4-week intervention study in which clinic levels of plasma oxytocin, 24-hour ambulatory blood pressure, and salivary cortisol and alpha amylase were obtained pre and post intervention, at the same time salivary oxytocin was taken at home during weeks 1 and 4. Results: Salivary oxytocin was enhanced both early and late in the intervention group and alpha amylase was reduced at post treatment in intervention group husbands and wives relative to controls. Husbands in the intervention group had significantly lower post treatment 24-hour systolic blood pressure than the control group. Conclusion: Increasing warm touch among couples has a beneficial influence on multiple stress-sensitive systems. Key words: ambulatory blood pressure, oxytocin, alpha amylase, cortisol, social support, cardiovascular functioning, health.

Objective: This study examined the relationships between reported history of childhood sexual abuse (CSA), psychological distress, and medical utilization among women in a health maintenance organization (HMO) setting. Methods: Participants were 206 women aged 20 to 63 years who were recruited from an HMO primary care clinic waiting area. Participants were classified, using screening questionnaires and the revised Symptom Checklist 90, as 1) CSA-distressed, 2) distressed only, 3) CSA only, or 4) control participants. Medical utilization rates were generated from the computerized database of the HMO for 1) nonpsychiatric outpatient, 2) psychiatric outpatient, 3) emergency room (ER), and 4) inpatient admissions. Results: CSA-distressed and distressed only groups both used significantly more nonpsychiatric outpatient visits than CSA only and control participants but were not different from one another. CSA only and control participants did not differ on nonpsychiatric outpatient utilization. CSA-distressed participants used significantly more ER visits and were more likely to visit the ER for pain-related complaints than other participants. Among CSA-distressed participants, those who met criteria for physical abuse had significantly more ER visits than those who did not. There were no differences among the four groups in inpatient utilization rates. Conclusions: Psychological distress is associated with higher outpatient medical utilization, independent of CSA history. History of CSA with concomitant psychological distress is associated with significantly higher ER visits, particularly for those with a history of physical abuse. History of CSA without distress is not associated with elevated rates of medical utilization. Screening for psychological distress, CSA, and physical abuse may help to identify distinct subgroups with unique utilization patterns. Key words: sexual abuse, medical utilization, psychological distress, pain.

In four independent studies, sex differences in cortisol responses to psychological stress were investigated in healthy adolescents and adults (total n = 153). Public speaking and mental arithmetic in front of an audience (Studies 1-3) reliably induced increases in free cortisol levels in both sexes with 2-to 4-fold increases above baseline levels. Mean cortisol responses were 1.5-to 2-fold higher in men compared with women. In Study 3, cortisol profiles were additionally investigated after human corticotropin-releasing hormone (h-CRH) and bicycle ergometry until exhaustion. Here, both sexes showed very similar adrenocortical responses. Furthermore, men showed elevated cortisol levels in anticipation of the psychological stress situation without actually having to perform the tasks (Study 4). Under this condition cortisol concentration was unchanged or decreased in women. From these data we conclude that the observed sex difference does not reflect an overall lower responsiveness of the female adrenal cortex. Although these studies do not provide conclusive data, we suggest sex differences in cognitive and/or emotional responses to distressing psychosocial situations which in turn may influence cortisol secretion.

This study examined the cardiovascular mechanisms governing differential blood pressure changes during the emotions of joy, sadness, fear, and anger. Heart rate, blood pressure, stroke volume, peripheral vascular resistance, cardiac output, and indices of myocardial contractility were measured during fear, anger, joy, sadness, physical action, and neutral imagery conditions in 27 right-handed male volunteers screened for imagery ability, alexithymia, anxiety, and depression. Anger imagery, rather than fear, was accompanied by the largest effects on the cardiovascular system. Increased diastolic blood pressure in anger was associated with maintained levels of peripheral vascular resistance and increased cardiac output and heart rate compared with changes during neutral imagery. Sadness produced a distinct pattern with moderate increases in blood pressure and vascular resistance and a decrease in cardiac output compared with changes during neutral imagery. Fear, action, and joy produced similar blood pressure changes in which systolic pressure increased and diastolic pressure was relatively unchanged. The measurement of cardiac output and determination of vascular resistance changes during emotional imagery demonstrate that previously observed emotion-specific blood pressure responses are produced by underlying patterns of cardiovascular activation, which differ between the major categories of emotions.

Objectives: This study examined the relationship between coping and psychosocial adaptation in cancer patients over time and across distinct clinical events. Methods: In a prospective longitudinal study 74 patients with breast cancer were observed for 3 to 5 years at 3-to 6-month intervals. A total of 684 interviews were conducted at different observation points. Three rating scales were used to assess coping and adjustment: first, the Bernese Coping Modes, an observer rating scale devised to elicit 26 coping modes aggregated in this paper as the five Basic Coping Strategies of support, self-control, denial, diverting, and negative-emotional; second, an observer rating scale to ascertain psychosocial adaptation; and third, a self-rating scale as a measure of either emotional distress or well-being. Results: a) When aggregated in illness stages, coping and distress data on the observed clinical time points showed greater variability than time measures alone (analysis of variance (ANOVA) for repeated measures p <.001). b) A significant relationship between the Basic Coping Strategies and psychosocial adaptation was demonstrated using discriminant and correlational analysis. Furthermore, in stage-dependent Pearson r correlations [p <.O5 to .001), a clear-cut relationship was found for hospitalization, chemotherapy, and rehabilitation, but not for convalescence and metastasis, c) A positive relationship was demonstrated between psychosocial adaptation and strategies that can be generally categorized as good forms of coping such as support and self-control, and, to a lesser degree, diverting and denial. Conversely, poor coping exerted a negative effect on almost all illness stages and on most criteria of adjustment. Conclusions: In long-term studies on psychosocial adaptation and coping, stage-related measures should be preferred to time measures alone. The implications of different strategies for the psychological treatment of cancer patients are discussed.

La relation à autrui, quand elle prend la forme de la relation thérapeutique, implique de devoir en saisir quelques rouages essentiels. Tels sont les enjeux soutenus dans cet article qui tente de cerner deux concepts majeurs que sont l'empathie et l'intersubjectivité.

Tomabechi Gizō (1880–1959), a chemical magnate and politician, was one of twenty shihan (Master-level) students trained by Usui Mikao (1865–1926), the founder of Usui Reiki Therapy (Usui Reiki Ryōhō). The final chapter of Tomabechi's (co-authored) memoir describes his experiences with Usui Reiki Therapy, his theories of health and disease, and his recommendations to maintain health.

This is the first time this text has been fully translated from Japanese. It is under a Creative Commons - Attribution 4.0 license, which means you can freely share part or all of this work, so long as you attribute the translator.