Prevention of major depression in complex medically ill patients: preliminary results from a randomized, controlled trial

Background: Depression is highly prevalent in patients with physical illness and is associated with a diminished quality of life and poorer medical outcomes. Objective: The authors evaluated whether a multifaceted intervention conducted by a psychiatric consultation-liaison nurse could reduce the incidence of major depression in rheumatology inpatients and diabetes outpatients with a high level of case complexity. Method: Of 247 randomized patients, the authors identified 100 patients with a high level of case complexity at baseline and without major depression (65 rheumatology and 35 diabetes patients). Patients were randomized to usual care (N = 53) or to a nurse-led intervention (N = 47). Main outcomes were the incidence of major depression and severity of depressive symptoms during a 1-year follow-up, based on quarterly assessments with standardized psychiatric interviews. Results: The incidence of major depression was 63% in usual-care patients and 36% in the intervention group. Effects of intervention on depressive symptoms were observed in outpatients with diabetes but not in rheumatology inpatients. Conclusion: These preliminary results based on subgroup analysis suggest that a multifaceted nurse-led intervention may prevent the occurrence of major depression in complex medically ill patients and reduce depressive symptoms in diabetes outpatients. (Psychosomatics 2009; 50: 227-233)

The Dutch language version of the Toronto structured interview for Alexithymia: reliability, concurrent validity, and factor structure

The aim of this study was to evaluate the psychometric properties of the Dutch version of the Toronto Structured Interview for Alexithymia (TSIA) in a clinical sample. The TSIA and the 20-item Toronto Alexithymia Scale (TAS-20) were administered to 85 psychiatric inpatients and to 76 medical outpatients with the symptom of tinnitus. Both internal and inter-rater reliability were acceptable. Confirmatory factor analyses supported the hierarchical, 4-factor structure with 4 lower-order factors nested within 2 higher-order latent factors, previously obtained with English, German, and Italian versions. Concurrent validity was supported by significant correlations between the TSIA and the TAS-20 total scores although there were some differences between the psychiatric subsample and the medical subsample. While further studies are needed to assess the convergent and discriminant validity of the TSIA, the results support its use as a measure of alexithymia

Memory for Emotionally Provocative Words in Alexithymia: A Role for Stimulus Relevance

Alexithymia is associated with emotion processing deficits, particularly for negative emotional information. However, also common are a high prevalence of somatic symptoms and the perception of somatic sensations as distressing. Although little research has yet been conducted on memory in alexithymia, we hypothesized a paradoxical effect of alexithymia on memory. Specifically, recall of negative emotional words was expected to be reduced in alexithymia, while memory for illness words was expected to be enhanced in alexithymia. Eighty-five high or low alexithymia participants viewed and rated arousing illness-related ( pain ), emotionally positive ( thrill ), negative ( hatred ), and neutral words ( horse ). Recall was assessed 45 min later. High alexithymia participants recalled significantly fewer negative emotion words but also more illness-related words than low alexithymia participants. The results suggest that personal relevance can shape cognitive processing of stimuli, even to enhance retention of a subclass of stimuli whose retention is generally impaired in alexithymia

Modulation of Long-Term Memory by Arousal in Alexithymia: The Role of Interpretation

Moderate physiological or emotional arousal induced after learning modulates memory consolidation, helping to distinguish important memories from trivial ones. Yet, the contribution of subjective awareness or interpretation of arousal to this effect is uncertain. Alexithymia, which is an inability to describe or identify one’s emotional and arousal states even though physiological responses to arousal are intact, provides a tool to evaluate the role of arousal interpretation. Participants scoring high and low on alexithymia (N = 30 each) learned a list of 30 words, followed by immediate recall. Participants then saw either an arousing (oral surgery) or neutral video (tooth brushing). Memory was tested 24-h later. Physiological response to arousal was comparable between groups, but subjective response to arousal was impaired in high alexithymia. Yet, delayed word recognition was enhanced by arousal regardless of alexithymia status. Thus, subjective response to arousal, i.e., cognitive appraisal, was not necessary for memory modulation to occur

The group-based social skills training SOSTA-FRA in children and adolescents with high functioning autism spectrum disorder - study protocol of the randomised, multi-centre controlled SOSTA - net trial

Background: Group-based social skills training (SST) has repeatedly been recommended as treatment of choice in high-functioning autism spectrum disorder (HFASD). To date, no sufficiently powered randomised controlled trial has been performed to establish efficacy and safety of SST in children and adolescents with HFASD. In this randomised, multi-centre, controlled trial with 220 children and adolescents with HFASD it is hypothesized, that add-on group-based SST using the 12 weeks manualised SOSTA–FRA program will result in improved social responsiveness (measured by the parent rated social responsiveness scale, SRS) compared to treatment as usual (TAU). It is further expected, that parent and self reported anxiety and depressive symptoms will decline and pro-social behaviour will increase in the treatment group. A neurophysiological study in the Frankfurt HFASD subgroup will be performed pre- and post treatment to assess changes in neural function induced by SST versus TAU. Methods/design: The SOSTA – net trial is designed as a prospective, randomised, multi-centre, controlled trial with two parallel groups. The primary outcome is change in SRS score directly after the intervention and at 3 months follow-up. Several secondary outcome measures are also obtained. The target sample consists of 220 individuals with ASD, included at the six study centres. Discussion: This study is currently one of the largest trials on SST in children and adolescents with HFASD worldwide. Compared to recent randomised controlled studies, our study shows several advantages with regard to in- and exclusion criteria, study methods, and the therapeutic approach chosen, which can be easily implemented in non-university-based clinical settings. Trial registration: ISRCTN94863788 – SOSTA – net: Group-based social skills training in children and adolescents with high functioning autism spectrum disorder

То the theory and practice of psychosomatics

The article considers the main theoretical issues of psychosomatics. It provides an overview of psychosomatic genesis models. The hypotheses of psychobiological nature of cancer and the mechanism of the placebo effect have been under the study. The general model of psychosomatic work has been worked out. The article provides a brief overview of psychotherapeutic techniques used in the work with somatic diseases, where the main attention has been paid to the procedural and hypnotherapeutic techniques. It discusses the integration of psychosomatics and somatic medicin

The shock of the real: Psychoanalysis, modernity, survival

The contemporary relevance of psychoanalysis is being increasingly questioned; Off the Couch challenges this view, demonstrating that psychoanalytic thinking and its applications are both innovative and relevant, in particular to the management and treatment of more disturbed and difficult to engage patient groups. Chapters address: Clinical applications in diverse settings across the age range the relevance of psychoanalytic thinking to the practice of CBT, psychosomatics and general psychiatry the contribution of psychoanalytic thinking to mental health policy and the politics of conflict and mediation. This book suggests that psychoanalysis has a vital position within the public health sector and discusses how it can be better utilised in the treatment of a range of mental health problems. It also highlights the role of empirical research in providing a robust evidence base. Off the Couch will be essential reading for those practicing in the field of mental health and will also be useful for anyone involved in the development of mental health and public policies. It will ensure that practitioners and supervisors have a clear insight into how psychoanalysis can be applied in general healthcare

Parental bonding and alexithymia: A meta-analysis

Aim: The primary purpose of this meta-analysis was to explore, clarify and report the strength of the relationship between alexithymia, as measured by the Toronto Alexithymia Scale (TAS-20), and parenting style as measured by the Parental Bonding Instrument (PBI). Methods: Web of Science, PsycInfo, PubMed and ProQuest: Dissertations and Theses searches were undertaken, yielding nine samples with sufficient data to be included in the meta-analysis. Results: Evidence indicated moderate to strong relationships between maternal care and alexithymia, and between maternal care and two of the three TAS-20 alexithymia facets (Difficulties Describing Feelings and Difficulties Identifying Feelings, but not Externally Oriented Thinking). Moderate relationships were observed for both maternal- and paternal-overprotection and alexithymia respectively, and for overprotection (both maternal and paternal) and Difficulties Describing Feelings. Conclusion: This study is the first meta-analysis of the relationship between parenting styles and alexithymia, and findings confirm an especially strong association between maternal care and key elements of alexithymia. This review highlights the issues that still remain to be addressed in exploring the link between parenting style and alexithymia

Working with ambivalence: Making psychotherapy more accessible to young black people

The contemporary relevance of psychoanalysis is being increasingly questioned; Off the Couch challenges this view, demonstrating that psychoanalytic thinking and its applications are both innovative and relevant, in particular to the management and treatment of more disturbed and difficult to engage patient groups. Chapters address: clinical applications in diverse settings across the age range the relevance of psychoanalytic thinking to the practice of CBT, psychosomatics and general psychiatry the contribution of psychoanalytic thinking to mental health policy and the politics of conflict and mediation. This book suggests that psychoanalysis has a vital position within the public health sector and discusses how it can be better utilised in the treatment of a range of mental health problems. It also highlights the role of empirical research in providing a robust evidence base. Off the Couch will be essential reading for those practicing in the field of mental health and will also be useful for anyone involved in the development of mental health and public policies. It will ensure that practitioners and supervisors have a clear insight into how psychoanalysis can be applied in general healthcare