Understanding and Treatment of Patients with Persistent Somatic Complaints Through the Lens of Contemporary Attachment Theory

2017 ◽  
Vol 11 (3) ◽  
pp. 205-222 ◽  
Author(s):  
Patrick Luyten ◽  
Celine De Meulemeester
Keyword(s):  
Clinical Practice ◽  
Attachment Theory ◽  
Recent Progress ◽  
Somatic Complaints ◽  
Vicious Cycle ◽  
Epistemic Trust ◽  
Reliable Source ◽  
Somatic Disorders ◽  
Primary Attachment ◽  
Attachment Strategy

This paper describes recent progress in our understanding of patients with persistent somatic complaints, based on a broad and integrative attachment approach. Attachment theory indeed provides a powerful lens through which to understand patients with persistent somatic complaints and the often extremely negative states in which they find themselves. It was Bowlby's genius to describe how the attachment system is activated in times of threat and distress and normatively serves to seek the proximity of others in an attempt to co-regulate stress. Yet, this primary attachment strategy typically increasingly fails when faced with the continuous distress associated with chronic somatic complaints. What often ensues is a negative vicious cycle characterised by an excessive reliance on secondary attachment strategies (either hyperactivation or deactivating the attachment system), problems with (embodied) mentalizing, and severe problems with epistemic trust, that is, trust in others as a reliable source of knowledge, including knowledge of the patient's physical and mental state. These issues are discussed in relation to Bowlby's original formulations and contemporary thinking about persistent somatic complaints and functional somatic disorders. We also summarise implications for clinical practice.

scholarly journals New Era for Next-Generation Sequencing in Japan

Cancers ◽  
2019 ◽  
Vol 11 (6) ◽  
pp. 742 ◽  
Author(s):  
Masayuki Takeda ◽  
Kazuko Sakai ◽  
Takayuki Takahama ◽  
Kazuya Fukuoka ◽  
Kazuhiko Nakagawa ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Next Generation Sequencing ◽  
Solid Tumor ◽  
Recent Progress ◽  
Medical Curriculum ◽  
Next Generation ◽  
Multiple Cancer ◽  
New Era ◽  
Gene Panels ◽  
Generation Sequencing

Recent progress in understanding the molecular basis of cancer—including the discovery of cancer-associated genes such as oncogenes and tumor suppressor genes—has suggested that cancer can become a treatable disease. The identification of driver oncogenes such as EGFR, ALK, ROS1, BRAF and HER2 has already been successfully translated into clinical practice for individuals with solid tumor. Next-generation sequencing (NGS) technologies have led to the ability to test for multiple cancer-related genes at once with a small amount of cells and tissues. In Japan, several hospitals have started NGS-based mutational profiling screening in patients with solid tumor in order to guide patients to relevant clinical trials. The Ministry of Health, Labor, and Welfare of Japan has also approved several cancer gene panels for use in clinical practice. However, there is an urgent need to develop a medical curriculum of clinical variant interpretation and reporting. We review recent progress in the implementation of NGS in Japan.

scholarly journals Clinical practice guidelines: on what evidence is our clinical practice based?

1996 ◽  
Vol 20 (6) ◽  
pp. 363-366 ◽  
Author(s):  
Sarah Marriott ◽  
Claire Palmer
Keyword(s):  
Experimental Data ◽  
Clinical Practice ◽  
Practice Guidelines ◽  
Recent Progress ◽  
Work Group ◽  
Clinical Settings ◽  
Literature Reviews ◽  
Different Types ◽  
Research Findings ◽  
Many Sources

Many sources of evidence inform clinical practice, including research findings, patients' views, and clinical experience. This article describes recent progress in developing what will be the College's first guideline, The Assessment and Management of Violence In Clinical Settings. The design of the programme acknowledges the diversity of evidence in this area, by drawing a distinction between different types of evidence. Evidence is systematically identified and its quality appraised by the Work Group, through commissioning literature reviews. Initial recommendations will be based on experimental data. The methods used to consider non-experimental data, particularly expert opinion, will be described in more detail in a later article in this series.

Breaking a Vicious Cycle

2013 ◽  
Vol 5 (196) ◽  
pp. 196cm6-196cm6 ◽  
Author(s):  
Daniel F. Hayes ◽  
Jeff Allen ◽  
Carolyn Compton ◽  
Gary Gustavsen ◽  
Debra G. B. Leonard ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Research And Development ◽  
Clinical Utility ◽  
Tumor Biology ◽  
Tumor Biomarker ◽  
Vicious Cycle ◽  
Standard Clinical Practice ◽  
Regulatory Standards ◽  
Guidelines Development ◽  
Biology Research

Despite prodigious advances in tumor biology research, few tumor-biomarker tests have been adopted as standard clinical practice. This lack of reliable tests stems from a vicious cycle of undervaluation, resulting from inconsistent regulatory standards and reimbursement, as well as insufficient investment in research and development, scrutiny of biomarker publications by journals, and evidence of analytical validity and clinical utility. We offer recommendations designed to serve as a roadmap to break this vicious cycle and call for a national dialogue, as changes in regulation, reimbursement, investment, peer review, and guidelines development require the participation of all stakeholders.

scholarly journals What do we know about sleep paralysis?

2018 ◽  
Vol 19 (3) ◽  
pp. 174-184
Author(s):  
Paulina Wróbel-Knybel ◽  
Michał Flis ◽  
Rafał Dubiel ◽  
Hanna Karakuła-Juchnowicz
Keyword(s):  
Mental Disorders ◽  
Rem Sleep ◽  
Cultural Context ◽  
Somatic Symptoms ◽  
The Body ◽  
Somatic Complaints ◽  
Bibliographic Databases ◽  
Sleep Paralysis ◽  
Somatic Disorders ◽  
Hypnagogic Hallucinations

Summary Introduction: Sleep paralysis (SP) is a condition that widely occurs among people all over the world. It has been known for thousands of years and is rooted in the culture of many countries. It arouses strong emotions, though still little is known about it. The clinical picture of the disorder can be very diverse. It is often accompanied by hypnopompic and hypnagogic hallucinations, somatic complaints and the feeling of intense anxiety. A feeling of paralysis in the body with inhibited consciousness is always observed with the experience. SP pathophysiology is not fully understood, however, most theories explaining this phenomenon are based on the assumption that it results from dysfunctional overlap of REM sleep and wakefulness. It is experienced by healthy people, but it is more often associated with somatic and mental disorders, which is why it is becoming an object of interest for researchers. Aim: The aim of this work is to present the most important information about the disorder known as sleep paralysis - its history, cultural context, pathophysiology, prevalence, symptomatology, coexistence with other somatic and mental disorders as well as diagnostics and available forms of prevention and treatment. Materials and methodology: The available literature was reviewed using the Google Scholar bibliographic databases searching the following keywords: sleep paralysis, REM sleep parasomnias, sleep disorder, night terrors and time descriptors: 1980-2018. Results 1. Sleep paralysis has already been described in antiquity, and interpretations related to its occurrence are largely dependent on culture and beliefs. 2. Symptomatology of the disorder is very diverse: both mental and somatic symptoms are present. 3. The pathophysiology of the disorder has not been fully explained. The basis of most theories regarding sleep paralysis is the assumption that it results from the dysfunctional overlap of REM sleep and wakefulness. 4. The prevalence of SP at least once in a lifetime is 7.6% in the general population, although it is estimated that it is much more frequent in people with various mental and somatic disorders. 5. Treatment of SP is associated with a change in lifestyle and the use of pharmacotherapy and psychotherapy.

Sign in / Sign up

Export Citation Format

Share Document