EXPLORING ALEXITHYMIA IN SOMATIZATION USING RORSCHACH PSYCHODIAGNOSTICS

It has been classically postulated that alexithymia is related to a pervasive inability of emotional recognition and expression. This leaves some individuals little choice but to somatise unprocessed emotions commonly caused by internal conflicts. The present study thus aimed to explore the nature of conflicts, controls and stress tolerance, affect, self-perception, and interpersonal perception and behavior in somatization patients with alexithymia. 30 individuals of both sexes and of the age range 20-50 years, diagnosed with somatization disorder and alexithymia, were purposively undertaken for the study. Toronto Alexithymia Scale 20, Sack’s Sentence Completion Test and the Rorschach Test – Exner’s Comprehensive System were used to screen for alexithymia, to measure conflicts and the other aforementioned domains respectively. Results revealed that conflicts related to self-concept, sex, and family were primarily present in this sample. Characteristic patterns of underlying vulnerabilities seemed to account for poor stress tolerance, affective complications, negative self-perception, and maladaptive interpersonal functioning. It is suggested that alexithymia and a tendency to develop conflicts in somatization are based on the foundation of certain fundamental personality predispositions. Identifying said personality patterns could aid in appropriate and effective goal-setting in psychotherapy, specific to this otherwise treatment-resistant patient population.

A meningitis carcinomatosa komplex megjelenése

Összefoglaló. Az emlőtumor miatt kezelt, majd gondozott beteget – több tünetmentes év után – fejfájás, szédülés, ataxia, megváltozott, furcsa viselkedés, emlékezetzavar és dezorientáció miatt neurológiai, majd belgyógyászati osztályokon vizsgálták. Az alapos kivizsgálás ellenére a tüneteit magyarázó organikus eltérést nem igazoltak, ugyanakkor már a kezdetektől felmerült a szomatizációs tünetképzés lehetősége, ezért pszichiátriai osztályos felvételére került sor. Az elvégzett vizsgálatok, illetve a klinikai kép regresszív állapotot valószínűsítettek. Terápiás próbálkozásaink ellenére a páciens állapota romlott, végül a megismételt neurológiai vizsgálatok meningitis carcinomatosát igazoltak. Az esettel szemléltetni kívánjuk, hogy a beteg premorbid működési nívója, személyiségstruktúrája hogyan képes befolyásolni az ellátószemélyzetet, milyen külső és belső konfliktusokat válthat ki. A diagnózishoz vezető folyamat bemutatásával fel kívánjuk hívni a figyelmet az interdiszciplináris együttműködés fontosságára. Orv Hetil. 2021; 162(43): 1744–1748. Summary. Our patient with known breast cancer in her past medical history was hospitalized – after several asymptomatic years – for headache, dizziness, ataxia, changed behaviour and disorientation. Thorough internal and neurologic investigations did not find any disease underlying her symptoms, therefore the possibility of somatization disorder was raised. Despite lege artis therapeutic interventions carried out on the psychiatry ward, the patient’s condition deteriorated and repeated neurological examinations eventually revealed carcinomatous meningitis. With this case, we would like to illustrate how the patient’s premorbid function level and personality features might influence the attitude and opinion of the health care personnel, and what kind of external and internal conflicts might be triggered. By presenting the complexity of the diagnostic work-up, we would like to emphasize the importance of interdisciplinary cooperation in the interest of our patients. Orv Hetil. 2021; 162(43): 1744–1748.

Depression, Anxiety, Somatization Disorder, and Adjustment Disorder in Older Patients with Exudative Age-related Macular Degeneration

Purpose: The aim of this study was to analyze the prevalence of depression, anxiety, somatization disorder, and adjustment disorder in older patients diagnosed with exudative age-related macular degeneration (AMD) and to evaluate the relationship between exudative AMD and psychological disease.Methods: The 2016 Health Insurance Review and Assessment Service-Aged Patient Sample was applied in this study. The subjects were divided into two groups: AMD patients undergoing intravitreal injection treatment and a control group. Comorbidities were evaluated using the Charlson Comorbidity Index.Results: A total of 1,319,052 subjects were selected, of which 3,134 were in the exudative AMD group receiving intravitreal injections. The average age of the subjects was 74.7 ± 6.7 years, and 41.8% were male. In patients with exudative AMD, the prevalence of depression, anxiety, somatization disorder, and adjustment disorder were 16%, 20%, 0.5%, and 0.4%, respectively; in particular, the prevalence of depression and adjustment disorder were significantly higher than in the control group. In multivariate regression analysis, exudative AMD was a significant factor of depression (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.08-1.31, p < 0.001) and adjustment disorder (OR 2.47, 95% CI 1.47-4.18, p < 0.001). However, the association between AMD and anxiety or somatization disorder was not statistically significant.Conclusions: Exudative AMD showed a significant association with psychiatric disease, such as depression, and requires close clinical attention.

Please, Find It and Fix It

The setting appropriate treatment goals and expectations cannot be overemphasized when confronted with patients in this category. In some instances, the demand for a cure is a manipulative tactic. In other cases, it can a profound preoccupation ones symptoms, their cause, and eradication. Pain catastrophizing, repeated submission to, if not a request for, unproven and unconventional diagnostic testing and treatments is not uncommon. Reassurance, and diagnostic testing that fails to reveal a catastrophic cause are dismissed. Patients with some forms of somatization disorder suffer from an underlying psychiatric/psychological problem. Their willingness to undergo potential destructive procedures, such as surgery, in the search of a cure puts them at great peril for worsening of their condition.

Common mental disorders among patients attending monk healers and primary health care centres in Thailand: a cross-sectional study

Background This study aimed to assess the rate of common mental disorders in patients consulting monk healers or health centres in Thailand. Methods Patients consecutively consulting monk healers or health centres were assessed with screening measures of three common mental disorders (major depressive, general anxiety and somatization disorder). Results The prevalence of any common mental disorder was significantly higher in patients attending monk healers (31.1%) than those attending primary care health centres (22.3%) (P < 0.001). Likewise, the prevalence of each common mental disorder was significantly higher in clients attending monk healers (major depressive disorder 21.0%, generalized anxiety disorder 8.1%, and somatization disorder 19.0%) than in patients attending health centres (major depressive disorder 15.8%, generalized anxiety disorder 3.5%, and somatization disorder 12.5%). In adjusted logistic regression analysis among patients of monk healers, female sex, being single, divorced, separated or widowed, and low social support were associated with any common mental disorder. Among patients of a health centre, lower education, not employed, high debt status and low social support were associated with any common mental disorder. Conclusion The study found a higher prevalence of common mental disorders in patients consulting monk healers than primary care centre attendees, calling for integrated management of common mental disorders.

A retrospective observational study comparing somatosensory amplification in fibromyalgia, chronic pain, psychiatric disorders and healthy subjects

ObjectivesSomatosensory amplification (SA) has been described as an important feature of somatoform disorders, and an “amplifying somatic style” has been reported as a negative connotation of body perception. As widespread pain (WSP) in fibromyalgia (FM) is due to a central sensitization (CS) rather than organic alterations, there has been discussion as to whether FM is equivalent to or distinct from somatization disorder (SD). Assuming SD and FM are two distinct entities, an increase in somatic amplification should be expected only in subjects who have SD, regardless of the type of pain they experience. Purpose of the study was to explore the magnitude of SA in FM, and whether this depends on the association with SD.MethodsFM (n=159) other forms of chronic pain (OCP, n=582), psychiatric (Psy, n=53) and healthy (H, n=55) subjects were investigated using the Somatosensory Amplification Scale (SSAS), Illness Behavior Questionnaire, (IBQ), Italian Pain Questionnaire (IPQ), and Cold Pressor Test (CPT) in a retrospective observational study.ResultsFM subjects displayed higher SSAS scores than the other groups. High SSAS score was associated with FM (OR=8.39; 95%CI: 5.43–12.46) but not OCP. Although FM has the highest prevalence of SD (x2=14.07; p=.007), high SSAS scores were associated with SD in OCP but not in FM.ConclusionsUnlike in OCP, in FM high SSAS scores were independent of the presence of SD. From a biopsychosocial perspective, SSAS may be a factor associated with the onset of FM.

Quality of life among patients with common mental disorders attending monk healers and primary care clinics in Thailand

Purpose Common mental disorders are not only highly prevalent in primary health-care settings but also negatively affect patients’ quality of life (QoL). This study aims to assess the levels of QoL among patients with common mental disorders seeking care from a monk healer or primary care setting and to determine the comparative QoL of users in two different types of care settings in Thailand. Design/methodology/approach Consecutively attending clients or patients (N = 1251) of three faith healing or three health centres were assessed with measures of depression, anxiety and somatization disorder and QoL. Findings The overall QoL was 67.8 and among the four QoL domains, social QoL was the highest (72.3), followed by physical QoL (69.4), environmental QoL (64.8) and psychological QoL (64.6). In adjusted linear regression analyses, sociodemographic factors, such as higher educational level, being employed, having high debt and consulting a health centre, were associated with higher overall QoL. Compared to being a client with a monk healer, patients at a health centre had a higher overall QoL, environmental and psychological QoL. Having a general anxiety or major depressive disorder was negatively associated with overall QoL and all four QoL sub-domains, whereas somatization disorder was not associated with any QoL sub-domains. Originality/value To the best of the authors’ knowledge, this is the first study to investigate QoL in common mental disorder attenders with a monk healer in comparison with primary care patients. Primary care patients with a common mental disorder had significantly higher overall QoL (p<0.01), higher psychological QoL (p<0.001) and higher environmental QoL (p<0.001) than clients with a common mental disorder attending monk healers. This study extends previous research showing a negative association between anxiety and depressive disorders and QoL calling for integration of QoL in the management of common mental disorders in both complementary and public primary care in Thailand.