bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vulnerability to Stress and Physical and Mental Illness
Authors: Amaral A.P. , Serra A. Vaz 
Published: March 2009

Aims:The purpose of this study was to examine whether vulnerability to stress is associated with physical and mental illness. We have two main goals:1.Studying the importance of vulnerability to stress in the state of health of the individual;2.Examining the effects of interactions between the life events, vulnerability to stress and social support in physical and mental symptoms.Method:Multivariate analyses were used in a sample of 255 subjects of general population, evaluated in four different moments, spaced of three months. Regression analysis was used to identify the factors explaining the state of health, at every moment.Results:The results suggest that vulnerability to stress emerge as the larger predictor of changes in health status of individuals in each moment of assessment. Its role is strongest regarding mental health. The longitudinal study suggest two interactions:1.The interaction between life events and factor 1 of vulnerability to stress (perfectionism and low tolerance to frustration), which might explain the changes that occur in mental health.2.The interaction between life events, the factor 7 of vulnerability to stress (deprivation of affection and rejection) and social support explains the changes that occur in physical health, along the study.Conclusion:Findings suggest the importance of vulnerability to stress in physical and mental health.
Obsessive-compulsive Symptoms in Primary Dystonia: Reactive and Psychogenic or Primary and Neurophysiological?
Authors: Barahona-Corrêa B. , Bugalho P. , Guimarães J. , Xavier M. 
Published: March 2009

Introduction:Primary dystonia (PDy) is an idiopathic neurological disorder causing involuntary muscle contraction. Its pathophysiology is believed to involve basal-ganglia (BG) dysfunction. A possible association with Obsessive-compulsive symptoms (OCS) is regarded as further evidence of BG involvement but remains controversial due to contradictory research data. We proposed to answer three questions:1.Do PDy patients have high OCS scores?2.Are OCS in PDy reactive?3.Does botulinum toxin treatment (BT) influence PDy psycopathology?Subjects:45 patients with blepharospasm, spasmodic torticollis, writer's cramp; 43 patients with hemifacial spasm, cervical spondilarthropathy, peripheral hand neuropathy; 27 healthy volunteers.Assessment: non-structured DSM-IV based psychiatric interview; Symptom Checklist 90 Revised (SCL-90R); Yale-Brown Obsessive-Compulsive Scale (YBOCS); Unified Dystonia Rating Scale (UDRS).Results:PDy patients scored significantly higher than controls and healthy controls on the YBOCS (11.1 ± 7.24; 5.98 ± 4.33; 2.07 ± 0.92, both p< 0.001). Controls’ mean score was also significantly higher than healthy subjects’. Controls scored higher than PDy and healthy subjects on the SCL-90R somatization scale. BT treated PDy patients had significantly lower anxiety and somatization but higher UDRS and similar YBOCS ratings compared to untreated patients.Discussion:Higher ratings of OCS but not of depression, anxiety or somatization in PDy patients suggests a neurophysiological origin for OCS in PDy. However, diseased controls also scored higher than healthy subjects, suggesting that OCS may nevertheless be partly reactive in PDy. BT may decrease anxiety/depressive symptoms but not OCS, lending further strength to a possible neurophysiological aetiology for OCS in PDy.
Genetics of Intermediate Phenotypes in Suicidal Behavor - Focus on Aggression
Authors: Rujescu D. , Hartmann A. , Schneider B. , Thalmeier A. , Schnabel A. , Maurer K. , Moeller H. , Giegling I. 
Published: March 2009

Family and twin studies point towards a partial heritability of suicidal behavior. We investigated the role of a comprehensive set of genes in this behavior. Their selection was driven by results from post mortem and genetic studies. 250 suicide attempters with various psychiatric disorders were compared with 2200 volunteers which were randomly selected from the general population. All subjects were administered standard psychiatric interviews including SCID as well as self-report questionnaires for anger-related traits. Especially, aggressive-impulsive behavior has been studied and associations with these intermediate phenotypes will be presented.Additionally a large-scale gene expression analysis using cDNA-microarrays to identify new candidate-genes for suicide was conducted. We found several genes to be differentially expressed in the orbitofrontal cortex of suicide completers. Cross-validation experiments using quantitative RT-PCR validated a few genes so far. These genes have been genotyped in our patients and controls and associations with suicidal behavior and intermediate phenotypes, like aggression and impulsivity will be presented.
Severity of Somatic Morbidity and Anxiety: Pathological Realangst
Authors: Linden M. , Muschalla B. 
Published: March 2009

Background:Pathological anxiety is typically characterized by the absence of a real threat or danger. But, a persistent reason for anxiety, such as a severe life threatening illness, does not prevent the development of additional pathological anxieties, which has been described as “Pathological Realangst”.The question is to what degree pathological realangst can be explained by the real threat or preexisting anxiety.Method:209 patients (37,8% female) of a cardiology inpatient unit were given the State-Trait-Anxiety-Inventory, the Heart-Anxiety-Questionnaire, and the Progression Anxiety Questionnaire. Treating physicians gave a rating on the severity of somatic morbidity including subjective suffering, short and long term prognosis, impairment in daily living, degree of acute and chronic multimorbitity, and objective parameters of the cardiac condition.Result:Global or specific ratings on the severity of somatic morbidity did not correlate with general or heart related anxiety. Correlation coefficients ranged between .001 and a maximum of .22 (heart anxiety and subjective suffering).Conclusion:The results speak against the assumption that the threat by the illness is the explanation for the present anxiety. Instead, anxious patients who are suffering from a somatic illness are also afraid of their health status and present this as cause of their anxiety. Inspite of the persistent threat this anxiety is pathological i.e. realangst. It should be treated like other anxiety disorders, although it is more difficult to convince the patient and possibly their treating physicians that the present anxiety is not “normal” but pathological and in need of treatment.
Diagnosis and Assessment of Female sexual Dysfunction(s)
Authors: Balon R. 
Published: March 2009

The first challenge in diagnosing female sexual dysfunction(s) originates in our diagnostic system. The traditional model of classifying sexual dysfunction is anchored in the sexual response cycle: desire - arousal - orgasm - resolution. However, as some experts have pointed out, this classification may be problematic in the area of female sexuality. Both the diagnoses of female hypoactive sexual desire disorder (FHSDD) and female arousal disorder (FSAD) probably need to be redefined and refined. Examples include adding the lack of responsive desire to the FHSDD criteria and creating categories of subjective FSAD and genital FSAD.The second challenge in diagnosis female dysfunction is the lack of solid diagnostic instruments, diagnosis-specific laboratory assays and other specific testing. Specific measures of female sexual functioning, such as Female Sexual Functioning Index, Profile of Female Sexual Functioning, Sexual Function Questionnaire, Sexual Desire and Interest Inventory, and Female Sexual Distress Scale were mostly developed as outcome measures. No solid diagnostic instrument for sexual dysfunction exists, not even a version of the Structured Clinical Interview for DSM sexual dysfunctions. The contribution of imaging techniques, such as ultrasonography, magnetic resonance imaging or thermography, to the diagnosis is unclear, and these techniques are far (if ever) from clinical use.Thus, a detailed comprehensive clinical interview combined with physical examination, possibly a gynecological examination, and in some cases laboratory hormonal testing remains the cornerstone of diagnosing and assessing female sexual dysfunctions.
Issues in Differential Diagnosis of Sesxual Dysfunction: Mental and Physical Dysorders
Authors: Zemishlany Z. 
Published: March 2009

Sexuality is the ultimate union of mind and body; sexual functioning or dysfunction depends on complex bio-psycho-social conditions.Sexual dysfunction (SD) may be primarily due to physical disorders, including endocrinologic (diabetes, androgen deficiency, hyperprolactinemia, hypothyroidism and hyperthyroidism), cardiovascular and pelvic illnesses. SD can be secondary or indirectly related to impairments of the physical disorder such as fatigue, weakness and bladder incontinence, or to the psychosocial stress of the illness. Not only the disease itself, but the treatment prescribed, may also cause sexual impairment.SD is prevalent among psychiatric patients and maybe related to both the psychopathology and the psychopharmacology. SD has been reported in as many as 30%-60% of patients with schizophrenia treated with antipsychotic medication, up to 78% of individuals with depression treated with antidepressants and up to 80% in patients suffering from anxiety disorder. Eating disorders and personality disorders, mainly borderline personality disorder, are also associated with SD.Psychosocial factors, like interpersonal relationships, length of relationship, lifestyle, socioeconomic class and cultural background have been shown to correlate with SD, especially in hypoactive sexual desire disorder in women.An evaluation of SD should take into consideration the primary sexual functioning, the physical and mental disorders, the various medications and the psychosocial factors.It is recommended to identify the specific cause of the SD and to treat the patient according to the individual's mental disorder, physical disorder and interpersonal relationship.
Imaginative Death Experience in Hypochondriasis
Authors: Prasko J. , Latalova K. , Raszka M. 
Published: March 2009

Patients with health-anxiety are very often unable to describe concrete consequences of their putative somatic diseases. They block their thoughts due to anxiety attended this thoughts. The health-anxious patients try not to think about illness at all, by attempting to control their thoughts or by distraction. Our method is based on therapeutic dialogue, using Socratic questioning, and inductive methods which force patient to think beyond actual blocks.In second step, patients are asked to think out all other possibilities of newly discovered future. They are forced to imagine the worse consequences of all dread situations. Dialogue is led through one's serious illness status, with its somatic, psychological and social consequences, and the dying experience to the moment of death, which has to be described with all related emotions and details. Further, we ask patients to fantasize and constellate possible "after death experiences". In the next session the patient brings a written conception of the redoubtable situation previously discussed. Than we work with this text as in imaginative exposure therapy.This method seems to be quite effective and not too time-consuming. Several patients with health-anxiety underwent this exposure in our therapeutical groups. All of these patients profited from this therapy, as confirmed by follow-up data.Participants will learn:•conceptualization of health anxiety with the patient;•Socratic questioning with the hypochondriacal patient;•how to apply the exposure to the imaginative death experience.Supported by the research project No. 1M0517 from Ministry of Education, Youth and Sports, the Czech Republic.
Organizing the Work in German-speaking Countries: The ICD10-questionnaire in 2008
Authors: Zielasek J. 
Published: March 2009

In the revision of the International Classification of Mental Disorders (currently 10th revision, hence ICD-10), an international scientific partnership network group was founded by the World Health Organisation (Chair: N. Sartorius, Geneva) in order to review the international scientific evidence of putative significance for the revision of ICD-10 in different language areas. The group of German-speaking countries was founded during the annual congress of the German Society of Psychiatry, Psychotherapy and Nervous Diseases in 2007. The core group consists of representatives from Austria, Germany, Switzerland and representatives of other German-speaking countries.A major task of the German-speaking group was to design and test an international survey questionnaire addressing the perceived need for changes to the classification criteria in ICD-10 for mental disorders, the scientific rationale for such proposals, and a general assessment of the foodnes of fit with which the current classification criteria represent the respective mental disorders. The survey was started in August 2008 and results will be presented in this symposium.The results of and experiences with this questionnaire are expected to influence the questionnaires to be distributed in other language areas, allowing for regional or national differences to be reflected, but also allowing a comparison with previous editions used when ICD-10 was developed. Taken together, the questionnaire is expected to yield insights into the perceived need to adjust ICD-11 to comply with new scientific evidence, but also with practical clinical experiences with its predecessors.
Issues in Implementing Family Work in Services
Authors: Fadden G. 
Published: March 2009

Family work for psychosis has a strong evidence base demonstrating that a marked reduction in relapse rates can be achieved when information and support is offered to the family, and when relatives are helped to develop effective strategies to deal with the challenging situations they face. In some countries such as the UK, the strength of the evidence base has resulted in the development of guidelines and policies stipulating that families should receive appropriate interventions. In other countries, where such policies do not exist, whether or not families receive support tends to depend on the interests of individual clinicians.Those attempting to implement family work in routine mental health services can encounter various obstacles. Some staff do not posses the skills to deliver family work. Some services, particularly in adult mental health, concentrate on the individual with the mental health difficulties and are not aware of the importance of the person's social network in their recovery. Some managers do not prioritise family work or facilitate their staff in having the time needed for training or for implementing this type of intervention.This paper will outline effective strategies for ensuring that evidence-based family interventions are available to the families of those with psychosis and other serious mental health difficulties. These will include strategies to address the following:•Organisational issues;•Training of staff;•Supervision;•Role of management;•Involving family members to advocate for change;•Changing service structures to ensure the delivery of family work.
Implementing Family Supportive Interventions for Schizophrenia in Public Mental Health Centres
Authors: Fiorillo A. , Magliano L. , Maj M. 
Published: March 2009

Studies aimed at implementing supportive treatments for families in clinical practice report that after a training course 7 to 27 percent of professionals apply these treatments in clinical work and a mean of 1.4 to 1.7 families per trainee receive these interventions.We carried out a study in 23 Italian mental health centres in order to explore the feasibility of providing psychoeducational interventions for persons with schizophrenia and their families in routine conditions.Two professionals from each center attended three monthly training sessions for psychoeducational interventions. After the training, each professional provided informative sessions on schizophrenia to five families of service users with schizophrenia, which consisted of three meetings with each family on clinical aspects of schizophrenia, drug treatments, and detection of early signs of relapse. Each professional then provided the intervention to families for six months.Thirty-eight of the 46 participants completed the training course, and 34 provided the intervention to 71 families. Twenty-nine of the 34 provided the entire intervention to the families and five of the 34 held only informative sessions on schizophrenia. Ninety-one percent of the participants who completed the study reported difficulties in integrating the intervention with their work responsibilities, and 96 percent acknowledged the positive effect that the intervention had on the center's relationship with patients with schizophrenia and their families.These results support the idea that it is possible to introduce psychoeducational interventions in mental health centres after a relatively brief period of training and supervision.
The FAPS Study on Severe Mental Illness: Views on the Implementation of Psychoeducational Family Work in Portuguese Settings
Authors: Pereira M. Gonçalves , Papoila A. , Xavier M. 
Published: March 2009

Background and aims:Caregiving consequences have been addressed through strategies including family psychoeducation. Groups for relatives are feasible and target part of family needs. Although some forms of family work (FW) influence prognosis of schizophrenia, there is lack of evidence that relatives’ groups lower relapse rates or improve patients’ social functioning per se. Effectiveness of this approach is to be adequately tested in Portugal. The Families of Psychotic Patients (FAPS) survey nested a quasi-experimental group intervention study.Methods:Non-randomised sampling: caregivers of patients with ICD-10 schizophrenia/related disorders, in Lisbon community mental health services (n=108). Relatives’ baseline assessments included caregiving consequences, distress, social support, coping and sense of coherence. Patients were given the BPRS,WHO-DASII and GAF. Family psychoeducational groups were offered to all caregivers and those who accepted were screened for illness-related information.Results:Needs for FW were not invariably expressed at baseline (adherence: 23,2%), but there were no intervention dropouts. Although satisfaction was remarkable, significant gains were only achieved in part of assessed outcomes: caregivers’ knowledge; some positive aspects of caregiving; social, practical and emotional support; positive communication.Conclusions:Strain does not imply adherence to FW, sometimes in discrepancy with staff's expectations (as in another Portuguese FW implementation trial, within the Psychoedutraining Study). Our group intervention, albeit remarkably valuable, did not improve patients’ parameters and failed to diminish relatives’ burden or distress in a straightforward way. Results must be cautiously interpreted (accounting for sampling bias), but re-emphasise one should tailor FW approaches to each family unit in each moment of intervention.
National Mental Health Plan: An Opportunity to Implement Psychoeducation in Portugal?
Authors: Xavier M. , Goncalves-Pereira M. , de Almeida J. Caldas 
Published: March 2009

It is well known that due to deinstitutionalization, faster discharge from wards and insufficient community resources, direct contact of the severe mentally ill patients with their families has increased a lot in the last years.In the last two decades, mental health services across Europe developed a diversified offer of programmes, including psychoeducation and family interventions, in order to ensure an effective response to the different care needs.In Portugal, the lack of planning and consistent support in the improvement of mental health services means that the country is lagging behind significantly in this field in relation to other European countries.Concerning the specific subject of psychoeducation and family interventions for psychotic patients and their families, its true that treatment in Portugal seldom comport with the best scientific evidence, but so far there has been no pressure on the services to change this oddly situation.The new National Mental Health Plan, launched in 2008, sets that i. People with mental disorders should be involved and participate in the planning and development of the services they benefit from, and that ii. Family members of the mentally ill should be considered as important partners in care provision, and encouraged to participate in this provision and to receive the necessary training and education.Based on these principles, the Mental Health Plan may be a critical opportunity to implement psychoeducation and family interventions in Portugal. The authors address this issue, discussing also the potential role of new models of contracting, financing, accounting and monitoring.
Course and Prediction of Caregiver Burden: Results of a 2-year Follow-up Study
Authors: Moeller-Leimkuehler A. , Obermeier M. 
Published: March 2009

Objective:The aim of the study was to identify the best predictors of the course of burden during a 2-year follow-up period. The study is part of the Munich 5-year follow-up study in relatives of first admitted patients with schizophrenia or depression.Method:A cohort of 60 key relatives was assessed based on a transactional stress model concerning objective and subjective burden, well-being, self-rated symptoms and global satisfaction with life. The stressors were defined as patients' illness variables, and the potential predictors included different dispositions and resources of the relatives. Effects were analyzed by regression models. In a first step, the main predictors of burden were identified at each assessment. In a second step, the resulting predictors were included in a Generalized Linear Modeling procedure.Results:Caregivers' burden improved significantly, but well-being and self-rated symptoms remained elevated. In the final regression model, expressed emotion, neuroticism, generalized negative stress response and life stressors resulted as the best predictors of burden. The effects were rather time invariant than time dependent.Conclusion:In order to effectively work on long-standing unfavourable patterns of stress response, family interventions should be long-term and targeted to vulnerable caregivers who could be identified by virtue of their personality traits.