The Psychosomatic Arc in Therapy

The psychosomatic arc, based on an idea of Nossrat Peseschkian in 1988, was further developed by the author from 1994 on to visualize the process of body and mental symptoms caused by life events and microtraumatic situations of everyday life. A semi-structured psychosomatic treatment process is described by which to understand the function and language of psychosomatic symptoms more easily. Keywords: psychosomatic arc, positive psychosomatic, positive psychotherapy, psychosomatic disorders, visualization in psychosomatic treatment

Temporoparietal Connectivity Within Default Mode Network Associates With Clinical Improvements in Schizophrenia Following Modified Electroconvulsive Therapy

Although modified electroconvulsive therapy (ECT) has been reported to be effective for the treatment of schizophrenia (SCZ), its action mechanism is unclear. To elucidate the underlying ECT mechanisms of SCZ, this study used a longitudinal cohort including 21 SCZ patients receiving only antipsychotics (DSZ group) and 21 SCZ patients receiving a regular course of ECT combining with antipsychotics (MSZ group) for 4 weeks. All patients underwent magnetic resonance imaging (MRI) scans at baseline (t1) and follow-up (t2) time points. A matched healthy control (HC) group included 23 individuals who were only scanned at baseline. Functional connectivity (FC) within the default mode network (DMN) was evaluated before and after ECT. Significant interaction of the group over time was found in FC between angular gyrus (AG) and middle temporal gyrus (MTG). Post-hoc analysis showed a significantly enhanced FC of left AG(AG.L) and right MTG (MTG.R) in the MSZ group relative to the DSZ group. In addition, the right AG (AG.R) showed significantly enhanced FC between MTG.R and left MTG (MTG.L) after ECT in the MSZ group, but no in the DSZ group. In particular, the FCs change in AG.L-MTG.R and AG.R-MTG.R were positively correlated with the Positive and Negative Syndrome Scale (PANSS) negative score reduction. Furthermore, the FC change in AG.L-MTG.R was also positively correlated with the PANSS general psychopathology score reduction. These findings confirmed a potential relationship between ECT inducing hyperconnectivity within DMN and improvements in symptomatology of SCZ, suggesting that ECT controls mental symptoms by regulating the temporoparietal connectivity within DMN.

Later Chronotype Correlates With Severe Depression in Indonesian College Students

Background and Objective The correlation between late chronotype and depression has been well documented, but reports from the equatorial area, where the sun shines throughout the year with less seasonal variation, are limited. In the present research study, we sought to 1) examine the relationship between the chronotype and mental health symptoms in an Indonesian student population and 2) explore the characteristics of those who lie at the extreme chronotype and psychometry.Methods This is a cross-sectional questionnaire-based study including undergraduate students in an Indonesian university (n = 493). We used the Munich Chronotype Questionnaires and the Depression, Anxiety, and Stress Scale to assess the chronotype and mental symptoms, respectively. Following this, a follow-up with an in-depth interview on the selected population at the extreme end of the chronotype was performed as an exploratory approach to identify their common characteristics.Results Among the tested parameters, the depression score was significantly associated with chronotype (p = 0.003), replicating previous findings from other areas with higher latitudes. The correlation persisted when males and females were analyzed separately (p = 0.008 and 0.037, respectively). A follow-up qualitative analysis revealed a potential subclinical, unrealized depression among the subjects; our findings revealed the use of smartphones during or before bedtime as a common factor among those with later chronotypes.Conclusions There is a correlation between depression score and chronotype among Indonesian college students, where subjects with later chronotype are more likely to have a higher depression score.

Does the Number of Reasons for Seeking Care and Self-Rated Health Predict Sick Leave during the Following 12 Months? A Prospective, Longitudinal Study in Swedish Primary Health Care

Background: Sick leave has major social and economic consequences for both individuals and society. Primary Health Care (PHC) meets people who seek care before they risk going on sick leave. This study examined the impact of self-perceived health on sick leave within 12 months for workers seeking care in PHC. Methods: The study had a prospective longitudinal design with 271 employed, non-sick-listed patients aged 18–64 years seeking care for physical and/or mental symptoms at PHC. In a logistic regression, an estimation of the odds ratio (OR) for belonging to the group workers with >14 days of sick-leave (W-SL) was made. Results: A high number of reasons when seeking care, with an OR of 1.33 (confidence interval 1.14 to 1.56), and lower self-rated health, with an OR of 1.45 (confidence interval 1.10 to 1.91), were determinants for sick leave at 12 months after adjusting for covariates and confounders. Mental symptoms constituted the main reason for seeking care, followed by musculoskeletal pain, and significant differences in proportions regarding most symptoms were shown between the groups with and without sick-leave >14 days. Conclusion: Health care professionals in PHC need to be aware of the risk of future sick leave at comorbidity and low self-perceived health. Preventive rehabilitation interventions should be offered to improve health and prevent sick leave for this group.

The Physical, Psychological, and Social Day-to-Day Experience of Women Living With Endometriosis Compared to Healthy Age-Matched Controls—A Mixed-Methods Study

Background: Endometriosis is characterized by lesions of endometrial tissue outside the uterus. Chronic pain is considered as main symptom, but challenges can relate to various physical, mental, and social aspects of the women's lives. The aim of our study was to gain a holistic understanding of the everyday reality of women with endometriosis compared to healthy controls.Methods: The total sample comprised 12 hormone-free endometriosis patients (EP) and 11 age-matched healthy women (HC). A mixed-methods design was used comprising semi-structured interviews, standardized questionnaires and a comprehensive diary to assess pain ratings and various mental and physical symptoms over the course of a menstrual cycle. Interviews were recorded, transcribed, and evaluated according to phenomenological analysis using the MAXQDA software.Results: Interviews showed that living with endometriosis was associated with an impairment in everyday life. Physical strains, especially pain, high levels of psychological distress, and social limitations have been reported. Living with endometriosis affected the patients' personality and they “no longer felt like themselves.” Physical and psychological symptoms were reported to interfere with social interaction and participation. Evaluation of the standardized questionnaires revealed significant impairments in EP compared to HC in regard to anxiety and depression scores (both p < 0.001; Hospital Anxiety and Depression Scale), mental and physical quality of life (both p < 0.001; Short-Form Health Survey-12), stress ratings (p < 0.001; Patient Health Questionnaire-15) and functional well-being (p < 0.001; Functional Well-being-7). The highest levels of mean pelvic pain and dyschezia were observed in EP during menstruation, but mean pain ratings and dyschezia were increased in EPs compared to HP during the whole cycle. EP reported mental symptoms (e.g., depressed mood or anxiety) mainly during menstruation, while HC did not show any mental symptoms during the cycle. In addition, physical symptoms were elevated during the entire cycle in EPs (all p < 0.01).Discussion: The mixed-methods approach enabled to interpret the interviews, the standardized questionnaires, and the symptom diary in a broader context of everyday life. The symptoms do not appear to act independently, but rather influence each other. This leads to a complex interplay of physical, mental, and social impairments, with pain often being the starting point.

Beck Depression Inventory (BDI-IA) adapted for HIV: Psychometric properties, sensitivity & specificity in depressive episodes, adjustment disorder & without symptomatology

Introduction. The Beck Depression Inventory (BDI-IA) is the most widely used instrument for assessing depression symptoms. Although it has been validated in the Mexican population, it has not been tested in people living with HIV (PLWH), who tend to have symptoms difficult to distinguish from those associated with viral infection. Objective. We obtained the psychometric properties, sensitivity, specificity, and cut-off points to distinguish between a depressive episode, adjustment disorder and no symptoms. Method. Prospective study with 2,022 PLWH (88% men), who completed the BDI-IA between 2016 and 2017. Subjects had a mean age of 31.9 ± 9.3 years, with 12.0 ± 5.6 years of schooling, and 4.5 ± 4.3 years since diagnosis. The differentiation of items, internal consistency, factor analysis, and calculation of sensitivity and specificity were tested. Results. A Cronbach’s alpha coefficient of .91 was obtained. Through factorial analysis with orthogonal rotation (average intercorrelations r = .40, KMO .929), we obtained three factors: general factor of depression, somatic, and cognition, which explained 39.7%, 6.01%, and 5.49% of the variance, respectively. Only the items in the first factor (the short version with 12 items) were tested. With a cut-off point of 11, it had 85.5% sensitivity and 76% specificity [(AUC) = .865, 95% CI [.83, .90], p ≤ .001], and distinguished major depressive disorder from cases without mental symptoms. Discussion and conclusion. We show that the short version of the BDI-IA is reliable, valid, sensitive, and specific for evaluating depression symptoms comorbid with HIV infection.

Behavioral parameters evaluation after homeopathic Zincum metallicum treatment: a transgenerational study in mice

Background: ZINCUM METALLICUM (ZM) is a homeopathic medicine whose materia medica is defined by diverse behavioral and mental symptoms, including depression. Moreover, as a microelement, zinc itself is involved in several functions of Central Nervous System, including development and cell maturity during the intra-uterus life. Aims: Herein, the putative transgenerational effects of different homeopathic potencies of ZM upon behavioral parameters in P and F1 generations were evaluated. Methodology: Since mice and the tail suspension test (TST) are references for evaluating antidepressant agent activity, the TST together with the open field test (OPT) and the elevated plus maze test (EPM) were used to analyze offspring behavioral parameters. All animal procedures were in agreement with the Brazilian ethical research practices and were approved by the institutional ethical committee (CEUA-UNIP) under the protocol 156/2013. Four groups of seven females Balb/C mice were exposed to 0,1mL of ZM 5cH, 30cH, 200cH and lactose 5cH, diluted in 250mL of drinking water, during pregnancy and post partum period, in a total of 31 days. The flasks were coded before the remedies administration and all experimental procedures, including statistical analysis were done in blind. The parents were previously distributed in a Completely Randomized Design for the mates, according to the TST previous results. Mothers were re-evaluated for TST after weaning and mice of F1 generation were evaluated for TST, EPM and OPT when they reached two months old. According to the time of immobilization in TST, animals were classified as healthy (h), intermediate (i) and depressed (d) (< 116; 117-180 and >180 seconds of immobilization, respectively). Results: No significant changes were seen among the groups regarding to the number of newborns, sex proportions, TST, OPT and EPM behavioral parameters, besides the fact that the treatment with ZM 200cH was associated to the majority of healthy F1 mice (male: n=8: 7h+1i+0d; female: n=8: 8h+0i+0d), in relation to the number of delivery per group (Fisher test, p ≤ 0.01). Treatment with ZM 5cH, instead, produced reduced number of pups with no male mouse among F1 generation. We conclude that the treatment of pregnant females with ZM 200cH produced the best results in F1 generation regarding reproduction and behavioral parameters and the treatment with ZM 5cH reduced births in relation to control. The involved mechanisms have to be elucidated in the next steps of the study.

Why is formulation daunting? A response to Bagster et al.’s ‘instructions’ for developing skills in formulation

Objective: To explore the theme identified by Bagster et al.1 in their selective psychiatric literature review that formulation can appear daunting. Conclusion: Formulation is understandably daunting, even though it occurs in all human encounters. The plural nature of mental symptoms is such that anxiety-provoking intuitive judgement is required at all points in both the process and explication of formulation, a type of instinctive guessing. There are no rules for this, because the laws of vertical integration of systems are not established. Guidelines are more appropriate than ‘instructions’. Much of the wider mental health and clinical reasoning literature addresses intuitive judgement, but the current psychiatric literature tends to focus on pattern recognition as a deliberative cognitive act of Type 2 processes. Arguably this reductionism adds to the dauntingness. Anxiety detected about the intuitive judgement involved can be addressed in supervision, taking into account the psychological mindedness of the trainee.

The Association Between Neuroticism and Premenstrual Syndrome Symptoms.

Background and objectives: Premenstrual syndrome includes physical and mental symptoms occurring cyclically during the secretory phase. The present study aimed to specify the association between neuroticism and the severity of premenstrual syndrome symptoms. Method: This cross-sectional study was conducted on 223 students of Kerman University of Medical Sciences in 2019 November 17. Chi-square and Fisher’s exact tests were used to analyze the relationship between qualitative variables; stepwise logistic regression was employed to assess the factors affecting the syndrome symptoms, and Mann–Whitney U test was used to compare the scores of the Daily Record of Severity of Problems chart in two groups. Findings: 223 female students completed the first stage information. The mean score of the questionnaire was 151.72±100.11. Moreover, 77.6% of the students had the syndrome. The severity of symptoms was mild, moderate, severe, and highly severe in 53.6, 42, 3.6, and 0.7%, respectively. There was a significant relationship between premenstrual syndrome and neuroticism scores. Students with PMS had higher scores in all of the subscales (neuroticism including anxiety, stress, despair,..) (P<0.001). Conclusion: It seems that there is a relationship between neuroticism (anxiety, stress, despair) and the severity of PMS symptoms. Therefore, it is recommended that therapists and counselors consider these factors to treat and mitigate the severity of PMS symptoms.

C-Reactive Protein Levels and Gadolinium-Enhancing Lesions Are Associated With the Degree of Depressive Symptoms in Newly Diagnosed Multiple Sclerosis

Background: Inflammation is essential for the pathogenesis of multiple sclerosis (MS). While the immune system contribution to the development of neurological symptoms has been intensively studied, inflammatory biomarkers for mental symptoms such as depression are poorly understood in the context of MS. Here, we test if depression correlates with peripheral and central inflammation markers in MS patients as soon as the diagnosis is established.Methods: Forty-four patients were newly diagnosed with relapsing-remitting MS, primary progressive MS or clinically isolated syndrome. Age, gender, EDSS, C-reactive protein (CRP), albumin, white blood cells count in cerebrospinal fluid (CSF WBC), presence of gadolinium enhanced lesions (GE) on T1-weighted images and total number of typical MS lesion locations were included in linear regression models to predict Beck Depression Inventory (BDI) score and the depression dimension of the Symptoms Checklist 90-Revised (SCL90RD).Results: CRP elevation and GE predicted significantly BDI (CRP: p = 0.007; GE: p = 0.019) and SCL90RD (CRP: p = 0.004; GE: p = 0.049). The combination of both factors resulted in more pronounced depressive symptoms (p = 0.04). CSF WBC and EDSS as well as the other variables were not correlated with depressive symptoms.Conclusions: CRP elevation and GE are associated with depressive symptoms in newly diagnosed MS patients. These markers can be used to identify MS patients exhibiting a high risk for the development of depressive symptoms in early phases of the disease.