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[Assessing psychosomatic aspects of chronic orofacial pain syndrome].

BACKGROUND: The diagnosis of COS is often formulated when classification fails for the lack of clear symptoms or persisting complaints in spite of evidence-based dental care. PATIENTS AND METHODS: Eight patients suffering from COS and referred to us by the Dental Clinic of the Munich University were invited to complete the self-rating SASB-Intrex questionnaire. In addition, the patients were examined in a clinical psychodynamic interview. RESULTS: All patients suffered from undefined, very often bizarre, complaints of the teeth, oral cavity, and face. These dysesthetic syndromes occurred after previous dental interventions. However, the complaints surpass symptomatic pain due to local aetiologies or neurological causes. There was clinical evidence of underlying unconscious conflicts, e. g., concerning control vs. submission. All patients showed clinically-relevant psychosomatic co-morbidity which could be formulated as cyclic maladaptive interpersonal patterns. CONCLUSION: COS patients are often not sufficiently examined and undergo multiple, sometimes irreversible and invalidating dental or surgical interventions. Given their exclusively somatic attribution style, referral to psychotherapy is frequently unsuccessful. Characteristic cyclic maladaptive interaction patterns may contribute to the chronification process. This study shows the difficulties and chances of an interdisciplinary diagnosis and treatment program.

Adaptation, Psychological↗
PubMed2002

Conversion sensory symptoms associated with parietal lobe infarct: case report, diagnostic issues and brain mechanisms.

This case report suggests that diagnostic difficulties and brain mechanisms related to conversion disorder associated with cerebral lesions differ from those related to conversion disorder without cerebral lesions. A 35-year-old divorced woman was admitted to a psychiatric inpatient unit with multiple physical complaints. The symptoms first appeared 5 years previous and 2 months after a sexual assault. Three years later, she began to experience ill-defined sensory symptoms confined to the left half of her body (splitting the midline). Results of neurologic consultations were equivocal because of the subjective nature of the complaints, which were viewed as conversion symptoms. A magnetic resonance imaging scan demonstrated an old infarct in the right parietal lobe, suggesting a physical origin of the patient's symptoms. However, normal somatosensory-evoked responses from the affected area contributed little to establishing the diagnosis. The results of all further investigations to identify causes of the vascular pathology were negative. The multiple ill-defined somatic symptoms, the distribution of sensory symptoms and the resolution of symptoms with psychotherapy established the diagnosis of conversion disorder superimposed on a pre-existing right parietal lesion. This case highlights the importance of clinical features in establishing a diagnosis such as this. We suggest that reactivation of implicit sensory memories (represented at the thalamic level and resulting from decreased corticofugal inhibitions due to the lesion) may contribute to the formation of sensory conversion symptoms in individuals with parietal lobe lesions.

Adult↗
PubMed1989

[Comparative analysis of the clinical effectiveness of reflexotherapy and psychopharmacotherapy in the treatment of neurotic disorders in dermatology patients].

Comparative studies on the efficacy of a multiple-modality treatment of patients with chronic dermatoses (atopic dermatitis, eczema, psoriasis), including reflexotherapy (RT) and drug psychotherapy (DPT), have shown high clinical efficacy of RT in cases with hysterical and moderately expressed anxiety-depressive disorders and of DPT in pronounced depressive hypochondriac disturbances. Unlike DPT, RT has not been associated with side effects. Clinical results have been confirmed by the data of comprehensive clinical and psychological examinations of the patients in the course of treatment.

Acupuncture Therapy↗
PubMed1994

[When patient and therapist disagree--discrepancies in evaluation of change].

The following study concerns the interaction of different measures for therapeutic change. 1377 inpatients of a psychosomatic hospital were examined. Measures for change were the subjective global rating of the inpatient, the subjective global rating the psychotherapist, and the Symptom-Check-List SCL-90-R. To get additional information for possible predictive variables for discrepant judgements, also personality questionnaires and sociodemographic variables were considered. Results demonstrated only medium correlations between subjective ratings for change of the patient and the psychotherapist, although the same categories were used (R = 0.44). The correlations to measures of change of the self-rating-scales are even lower. Therefore we conclude that these measures focus to different information, because the common part of variance is low. Discrepancies between the judgement of therapists and patients can be found after all when the patient makes a negative rating. Predictive variables for discrepancies of the judgements for change of the psychotherapists and patients are: age, sex, phobic anxiety and bodily complaints. While younger patients tend to make better judgements than their therapists we find the contrary for elder patients. Women tend to make better judgements than their psychotherapists. We find also discrepancies in patients with multiple syndromes, when phobic anxiety and bodily complaints exist and are perhaps not adequately concerned in the psychotherapy.

Adult↗
PubMed1996

Medical management of the multiple chemical sensitivity patient.

Multiple chemical sensitivity (MCS) is a complex, chronic disorder characterized by multisystemic symptoms occurring in response to a wide variety of chemical odors or low-level exposures. The etiology is unknown but likely multifactorial. Patient evaluation includes a comprehensive history with a review of past medical records and a physical examination with specific attention to the affected organ systems. Laboratory evaluation is dependent on past testing and patient symptoms. It should be individualized and, although standard baseline tests are helpful, exhaustive testing is not. The evaluation is primarily designed to exclude diseases requiring specific medical therapy. Treatment approaches vary considerably depending on the treating physician and patient responsiveness; many have been adapted from those used for similar chronic illness of unknown etiology. Therapies utilized in MCS patients include supportive care, behavioral techniques, including desensitization, psychotherapy, chemical avoidance, and clinical ecology regimens such as provocation-neutralization protocols. The advantages and disadvantages of these approaches are discussed and the use of clinical ecology regimens is discouraged. A multidisciplinary approach similar to those used in chronic pain patients may be beneficial. Regardless of the treatment chosen, the goal should be to decrease patient disability.

Behavior Therapy↗
PubMed2006

Satisfaction with mental health care among people with multiple sclerosis in urban and rural areas.

OBJECTIVES: This study explored urban and rural differences in mental health needs and treatments among people with multiple sclerosis, as well as their satisfaction with access to and quality of mental health care. METHODS: Data were collected in a nationwide survey of 1,518 people with multiple sclerosis. RESULTS: More than 40 percent of people with multiple sclerosis in each urban or rural area had received a diagnosis of depression, and more than 90 percent of them received mental health services, regardless of location of residence. However, rural residents were significantly less likely than their urban counterparts to receive the recommended combined medication and psychotherapy for treatment of depression. CONCLUSIONS: Current mental health care systems, even in rural areas, are capable of reaching out to patients with neuromedical illnesses, such as multiple sclerosis. Patients perceive some limitations in quality and accessibility, and recommended treatment differs between urban and rural areas.

Adult↗
PubMed2004

Social support as a buffer in the relationship between treatment for depression and T-cell production of interferon gamma in patients with multiple sclerosis.

OBJECTIVE: This study examined the buffering effects of social support on the relationship between depression and autoaggressive immune function in multiple sclerosis (MS). METHODS: Fourteen participants with comorbid diagnoses of MS and major depressive disorder received 16 weeks of psychotherapy or antidepressant medications. Depression and T-cell production of interferon-gamma (IFN-gamma), a lynchpin in MS pathogenesis, were assessed at baseline and posttreatment. Social support was assessed at baseline. RESULTS: Both depression and T-cell production of IFN-gamma were significantly reduced over the 16 weeks of treatment. There was a significant interaction between change in depression, change in IFN-gamma, and social support (R(2)=.26, P=.03) such that social support served as a buffer. CONCLUSION: These results support the hypothesis that social support buffers the effects of change in depression on IFN-gamma production. However, these findings should be viewed as preliminary due to the small sample size and the absence of a control condition.

Adult↗
PubMed1987

Anorexia nervosa: an object relations approach to primary treatment.

Concurrent behaviour therapy and psychotherapy in the treatment of anorexia nervosa creates significant problems in the development of a therapeutic alliance and in the multiple roles staff are required to assume. Our protocol was developed to keep treatment personnel in their usual roles so that their various treatment skills could be fully utilised. A physician treated the anorexia with naso-gastric feeding, freeing the psychotherapist to act in the usual manner. This avoided role confusion, and the split of 'bad' and 'good' treatment personnel was appropriate and therapeutic, rather than pathological. Four successful cases are described.

Adolescent↗
PubMed1999

Psychological and neuropsychological predictors of coping patterns by patients with multiple sclerosis.

To determine the relative contribution of psychological and neuropsychological (NP) variables to the prediction of patterns of coping with disease-related stressors and satisfaction with their coping efforts, 56 patients with multiple sclerosis (MS) were administered the Ways of Coping Checklist, the Symptom Checklist-90-Revised, and a battery of NP tests chosen for their sensitivity to MS. Higher levels of psychological distress were associated with greater use of emotion-focused coping strategies and reduced perceived effectiveness of the coping strategies employed. Psychological distress was not related to the use of problem-focused strategies and NP variables did not predict coping style or effectiveness. MS patients who display heightened psychological distress may be good candidates for psychotherapeutic interventions aimed at improving perceived coping effectiveness.

Adaptation, Psychological↗
PubMed1998

Neuropsychological aspects of multiple sclerosis.

Since S. Rao's ["Neuropsychology of Multiple Sclerosis: A Critical Review," A Journal of Clinical and Experimental Neuropsychology, Vol. 85, pp. 503-542] (1986) seminal review, considerable research has been undertaken on the neuropsychological consequences of multiple sclerosis. This review incorporates the research literature of the last decade in presenting an overview of the current state of our knowledge concerning the etiology, course, symptoms, assessment, consequences, and treatment of multiple sclerosis (MS). The concept of subcortical dementia is revisited in light of the most recent literature documenting the neuropsychological deficits in patients with MS. The view that cognitively heterogeneous patient groups may disguise more specific patterns of focal neuropsychological impairment is considered. A critical review of the recent literature is also presented, detailing the degree to which recent research has addressed the areas of research need identified by Rao in 1986. Given recent advances in our knowledge, the need for more attention to be directed toward the evaluation of rehabilitation and psychological intervention is highlighted.

Activities of Daily Living↗
PubMed2002

Conversion motor paralysis disorder: overview and rehabilitation model.

It is important to consider a differential diagnosis between paralysis on an organic basis and paralysis and disability due to psychological mechanisms in people with physical impairment secondary to trauma, without evidence of organic etiology. We review the most dramatic type of conversion disorder (CD)-'Conversion Motor Paralysis'. Recent important medical literature concerning the accepted treatment and rehabilitation management will be reviewed and discussed. The inter-disciplinary in-patient team management approach in a rehabilitation setting offers the benefits of a comprehensive assessment and treatment. The diagnosis is temporary and conditional, since there may be a long delay until the appearance of organic findings. A complete medical assessment is essential in order to rule out any possibility of an organic etiology. In as many as 25% to 50% of patients diagnosed as conversion, an organic medical diagnosis was found.

Behavior Therapy↗
PubMed1992

Depression in adults with diabetes.

Depression in diabetes is a prevalent and chronic condition. The etiology is unknown but is probably complex; and biological, genetic, and psychological factors remain as potential contributors. Several neuroendocrine and neurotransmitter abnormalities common to both depression and diabetes have been identified, adding to etiological speculations. Pharmacotherapy of depression may improve both mood and glucose regulation in diabetes, although controlled studies of the efficacy of psychotherapy and pharmacotherapy for depression in diabetes are not yet available. Depression has potential interactions with diabetes on multiple levels and remains an important clinical focus independent of the medical disease.

Adult↗