A psychosomatic perspective on endometriosis – a mini review

Purpose: Endometriosis is an extremely disabling and long-term medical condition, characterized by the presence of endometrial-like tissue outside the uterus, usually manifesting as cramping, menstrual and ovulation pain, lower abdominal and/or pelvic pain, chronic fatigue, dyspareunia, and infertility. Endometriosis is often co-morbid with psychological distress that worsens the quality-of-life of affected women. Methods: The main aim was to review the current evidence about the management of endometriosis from a psychosomatic perspective. The literature was synthesized and summarized in a narrative format. The literature search was conducted using PubMed, based on reports, review articles, meta-analysis, overviews and guidelines published in English in the last 15 years. Results: Five main topics are covered and discussed: pathogenesis of endometriosis, endometriosis and psychological features, endometriosis and psychiatric comorbidity, early life stress as predisposing factor for pain sensitization; and implications for treatment. Conclusions: The available literature clearly emphasizes that it is important to consider and to treat the comorbidity of endometriosis with psychological factors that affect pain management

Chronic Pain, Dopamine and Depression: Insights from Research on Fibromyalgia

There have been several indications that pain and reward are partly mediated by similar neural pathways in the central nervous system, and that these common pathways are related to both the dopamine (DA) and the opioid systems. Several studies have demonstrated the analgesic effects of rewarding stimuli or activities on positive affective states. On the other hand, chronic pain was shown to impair several aspects of reward processing by possibly altering pain-reward interactions. However, the precise mechanisms of the mutual pain-reward interaction are unclear and few studies have investigated the influence of pain on rewards and vice versa in humans. Therefore, we aim to summarize recent findings on the neuroanatomical and molecular chances associated with chronic pain conditions, particularly fibromyalgia syndrome (FMS) with a focus on the dopamine system. Recent findings on the mechanisms involved in the alterations of the brain reward circuit in chronic pain and FMS as well as the role of DA in the pathophysiology of FMS and other chronic pain conditions will be discussed. Furthermore, we aim to discuss the interplay between the dopaminergic reward system and depression in chronic pain, as the prevalence of co-morbid depression in chronic pain is quite high

Posttraumatic Stress Disorder as a Consequence of Acute Cardiovascular Disease

Purpose of Review: To provide an update of the current evidence of cardiac disease–induced posttraumatic stress disorder (CDI-PTSD) with a focus on acute coronary events. Recent Findings: A cardiovascular disease, particularly a life-threatening cardiac event is often a highly stressful experience that can induce PTSD in patients and their caregivers, taking a chronic course if left untreated. There are several features distinguishing CDI-PTSD from “traditional” PTSD induced by external trauma, namely enduring somatic threat, inability to avoid trauma-related cues and hyperarousal with internal body sensations leading to constant fear of recurrent cardiac events. An increased risk of recurrent CVD events may be explained by pathophysiological changes, an unhealthy lifestyle and non-adherence to cardiac treatment. A trauma-focused approach might be useful to treat CDI-PTSD. Summary: Treatment options for patients and caregivers as well as long-term effects of trauma-focused interventions on physical and mental health outcomes should be future research directions

Mental health markers and protective factors in students with symptoms of physical pain across WEIRD and non-WEIRD samples – a network analysis

Background: Studies conducted in Western societies have identified variables associated with chronic pain, but few have done so across cultures. Our study aimed to clarify the relationship between specific mental health markers (i.e., depression, anxiety, posttraumatic stress disorder [PTSD], perceived stress) as well as specific protective factors (i.e., social support and self-efficacy) related to physical pain among university students across non-WEIRD and WEIRD samples. Method: A total of 188 university students (131 women and 57 men) were included in the study. We used network analysis to ascertain mental health markers especially central to the experience of physical pain. Results: No statistically significant difference was found between mental health markers (i.e., depression, anxiety, perceived stress, and PTSD) and protective factors (i.e., social support and self-efficacy) associated with physical pain symptoms for Swiss students versus Indian students (M = 0.325, p = .11). In addition, networks for Swiss versus Indian students did not differ in global strength (S = 0.29, p = .803). Anxiety was the most central mental health marker, and social support was the most important protective factor related to physical pain in both countries. However, for Swiss students, perceived stress, and for Indian students, PTSD symptoms were central mental health markers related to physical pain. Conclusion: Our results identify factors that may serve as important treatment targets for pain interventions among students of both countries before it becomes chronic

Effect of Early Psychological Counseling for the Prevention of Posttraumatic Stress Induced by Acute Coronary Syndrome at Long-Term Follow-Up.

Objective Psychological consequences of myocardial infarction (MI) are substantial, as 4% of all MI patients develop posttraumatic stress disorder (PTSD) and 12% clinically relevant posttraumatic stress symptoms (PTSS). The study investigated the course and development within 12 months of MI-induced PTSS to gain novel insights in potentially delayed response to early trauma-focused counseling aimed at preventing the incidence of MI-induced PTSS. Methods In the MI-SPRINT two-group randomized controlled trial, 190 MI-patients were randomly allocated to receive a single-session intervention of either trauma-focused counseling or an active control intervention targeting the general role of stress in patients with heart disease. Blind interviewer-rated PTSS (primary outcome) and additional health outcomes were assessed at 12-month follow-up. Results 12-month follow-up of outcomes were available for 106 (55.8%) of 190 participants: In the entire sample, one patient (0·5%, 1/190) who received trauma-focused counseling developed full PTSD. There was no significant difference between trauma-focused counseling and stress counseling regarding total score of interviewer-rated PTSS (p > 0.05). The only group difference emerged in terms of more severe hyperarousal symptoms in the trauma-focused counseling group in the ITT analysis, but not in the completer analysis. Conclusions No benefits were found for trauma-focused counseling after 12 months when compared with an active control intervention. PTSD prevalence in the present study was low highlighting a potential beneficial effect of both interventions. Further studies are needed to determine the most accurate approach of counseling

The Influence of Personality Traits on Specific Coping Styles and the Development of Posttraumatic Stress Symptoms following Acute Coronary Syndrome: A Cluster Analytic Approach

Objective: A growing body of literature suggests a relationship between personality traits and posttraumatic stress disorder (PTSD) symptoms after acute coronary events (ACS). However, specific personality profiles have not been examined in patients after ACS. Thus, the aim of the present study was to examine personality profiles created from response patterns on the resilience, alexithymia and type D personality (TDP) scales and to examine associations with PTSD symptoms, symptom clusters and coping styles among a sample of ACS patients. Methods: A cluster analytic approach was utilized to identify risk profiles based on personality variables and a series of ANOVAs in 154 patients. Post hoc analyses were conducted to examine the relationship between each profile, and interviewer-rated PTSD symptoms and different coping styles. Results: The analyses indicated a three-cluster solution, including low- (high resilience, low alexithymia and non-TDP), medium- (average resilience, average alexithymia and non-TDP) and high-risk (low resilience, high alexithymia and TDP) profiles. Clusters differed significantly in all three coping subscales. At 3-month follow up, clusters differed significantly in all three PTSD subscales (re-experiencing, avoidance and hyperarousal). At 12-month follow up, the differences remained significant for the hyperarousal subscale only. Conclusions: The personality profiles identified and the respective associations to PTSD symptoms and coping strategies highlight the potential impact for the psychological adjustment following ACS

Positive psychosocial factors and the development of symptoms of depression and posttraumatic stress symptoms following acute myocardial infarction.

INTRODUCTION Acute myocardial infarction (MI) is a potentially fatal condition, leading to high psychological distress and possibly resulting in the development of depressive symptoms and posttraumatic stress symptoms (PTSS). The aim of this study was to investigate the association of clusters of positive psychosocial factors (resilience, task-oriented coping, positive affect and social support) with both MI-induced depressive symptoms and PTSS, independent of demographic factors. METHODS We investigated 154 consecutive patients with MI, 3 and 12 months after hospital discharge. All patients completed the short version of the German Resilience Scale, the Coping Inventory for Stressful Situations (CISS), the Enriched Social Support Inventory (ESSI) and the Global Mood Scale (GMS). The level of interviewer-rated MI-induced posttraumatic stress disorder (PTSD) symptoms at 3- and 12-months follow-up was evaluated through the Clinician-Administered PTSD Scale (CAPS). Depressive symptoms were assessed at 3- and 12-month follow-up with the Beck Depression Inventory (BDI-II). RESULTS Three different clusters were revealed: (1) lonely cluster: lowest social support, resilience and average task-oriented coping and positive affect; (2) low risk cluster: highest resilience, task-oriented coping, positive affect and social support; (3) avoidant cluster: lowest task-oriented coping, positive affect, average resilience and social support. The clusters differed in depressive symptoms at 3 months (F = 5.10; p < 0.01) and 12 months follow-up (F = 7.56; p < 0.01). Cluster differences in PTSS were significant at 3 months (F = 4.78, p < 0.05) and 12 months (F = 5.57, p < 0.01) follow-up. Differences in PTSS subscales were found for avoidance (F = 4.8, p < 0.05) and hyperarousal (F = 5.63, p < 0.05), but not re-experiencing, at 3 months follow-up. At 12 months follow-up, cluster differences were significant for re-experiencing (F = 6.44, p < 0.01) and avoidance (F = 4.02, p < 0.05) but not hyperarousal. DISCUSSION The present study contributes to a better understanding of the relationships among different positive psychosocial factors, depressive symptoms and PTSS following acute MI. Future interventions may benefit from taking into account positive psychosocial factors to potentially reduce patients' depressive symptoms and PTSS after MI

Positive psychosocial factors and the development of symptoms of depression and posttraumatic stress symptoms following acute myocardial infarction

Introduction: Acute myocardial infarction (MI) is a potentially fatal condition, leading to high psychological distress and possibly resulting in the development of depressive symptoms and posttraumatic stress symptoms (PTSS). The aim of this study was to investigate the association of clusters of positive psychosocial factors (resilience, task-oriented coping, positive affect and social support) with both MI-induced depressive symptoms and PTSS, independent of demographic factors. Methods: We investigated 154 consecutive patients with MI, 3 and 12 months after hospital discharge. All patients completed the short version of the German Resilience Scale, the Coping Inventory for Stressful Situations (CISS), the Enriched Social Support Inventory (ESSI) and the Global Mood Scale (GMS). The level of interviewer-rated MI-induced posttraumatic stress disorder (PTSD) symptoms at 3- and 12-months follow-up was evaluated through the Clinician-Administered PTSD Scale (CAPS). Depressive symptoms were assessed at 3- and 12-month follow-up with the Beck Depression Inventory (BDI-II). Results: Three different clusters were revealed: (1) lonely cluster: lowest social support, resilience and average task-oriented coping and positive affect; (2) low risk cluster: highest resilience, task-oriented coping, positive affect and social support; (3) avoidant cluster: lowest task-oriented coping, positive affect, average resilience and social support. The clusters differed in depressive symptoms at 3 months (F = 5.10; p &lt; 0.01) and 12 months follow-up (F = 7.56; p &lt; 0.01). Cluster differences in PTSS were significant at 3 months (F = 4.78, p &lt; 0.05) and 12 months (F = 5.57, p &lt; 0.01) follow-up. Differences in PTSS subscales were found for avoidance (F = 4.8, p &lt; 0.05) and hyperarousal (F = 5.63, p &lt; 0.05), but not re-experiencing, at 3 months follow-up. At 12 months follow-up, cluster differences were significant for re-experiencing (F = 6.44, p &lt; 0.01) and avoidance (F = 4.02, p &lt; 0.05) but not hyperarousal. Discussion: The present study contributes to a better understanding of the relationships among different positive psychosocial factors, depressive symptoms and PTSS following acute MI. Future interventions may benefit from taking into account positive psychosocial factors to potentially reduce patients’ depressive symptoms and PTSS after MI

A 11C raclopride PET study of dopamine activity, pain perception and reward processes in patients with fibromyalgia

Findings suggest that pain and reward are mediated by similar neural pathways in the central nervous system (CNS) and that these pathways are related to both the dopamine (DA) and opioid system. While DA has well described roles in motivational states, reward processing and motor functions, a role for dopaminergic neurotransmission in modulating pain perception and natural analgesia has also been demonstrated. Striatal dopaminergic neurotransmission has been found to be altered in chronic pain syndromes such as burning mouth, atypical facial pain and Fibromyalgia syndrome (FMS). FMS is a chronic, painful musculoskeletal disorder characterized by widespread pain, disturbed non restorative sleep, fatigue, and cognitive alterations and an increased incidence of depressive symptoms. The neuropathophysiology of FMS is still poorly understood. Based on the proposition that a disruption of normal dopaminergic neurotransmission may make a substantial contribution to the pathophysiology of FMS, the prevailing motive for this project was to investigate the modulation of pain perception by DA in FMS patients compared to healthy controls using the [11C] raclopride Positron Emission Tomography (PET) method. Because chronic pain has been suggested to impair reward processing and because FMS is often associated with depression - a condition in which the neural processing of rewards has been shown to be disabled, we tested whether the dopaminergic responses to financial rewards were impaired in FMS and whether this impairment could differentiate between FMS patients with and without depression. We investigated DA D2/D3 receptor availability at rest and subjective ratings of pain related to the administration of painful thermal stimulation in 17 healthy subjects, 13 subjects fulfilling the American College of Rheumatology (ACR) classification criteria for FMS without psychiatric comorbidity, and 11 subjects meeting the ACR criteria for FMS and the criteria for major depressive disorder (MDD) (Report 1). Additionally, we measured the endogenous DA release associated with unpredictable monetary rewards during Bolus-plus- Infusion [11C] raclopride PET scanning in the same population (Report 2). Findings from report 1 surprisingly revealed no differences in striatal D2/D3 receptor availability between FMS patients with and without co-morbid MDD compared to healthy controls. Furthermore, different associations between D2/D3 receptor availability and pain perception were found between FMS patients and healthy subjects. Our results suggested that alterations in the dopaminergic system appear to be linked to pain sensitivity and secondly, that depression could influence pain perception in FMS patients. Report 2 provided evidence for increased DA release to unpredictable monetary rewards in FMS patients compared to healthy controls which was more prominent in FMS patients with co-morbid depression. These results suggested dysfunctional DA responses to monetary rewards in FMS patients relative to healthy controls and that the dysfunctional reward circuitry could be associated with co-morbid depression in the pathology of FMS. This work presents compelling evidence for alterations in the dopaminergic system as well as dysfunctional DA responses to monetary rewards in FMS. These findings provide further insight into the neuropathophysiology of FMS by addressing common neural bases of FMS and depression

Relationship between behavioral and mood responses to monetary rewards in a sample of Indian students with and without reported pain

Physical pain has become a major health problem with many university students affected by it worldwide each year. Several studies have examined the prevalence of pain-related impairments in reward processing in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries but none of the studies have replicated these findings in a non-western cultural setting. Here, we aimed to investigate the prevalence of physical pain symptoms in a sample of university students in India and replicate our previous study conducted on university students in Switzerland, which showed reduced mood and behavioral responses to reward in students with significant pain symptoms. We grouped students into a sub-clinical (N = 40) and a control group (N = 48) to test the association between pain symptoms and reward processes. We used the Fribourg reward task and the pain sub-scale of the Symptom Checklist (SCL-27-plus) to assess physical symptoms of pain. We found that 45% of the students reported high levels of physical symptoms of pain and interestingly, our ANOVA results did not show any significant interaction between reward and the groups either for mood scores or for outcomes related to performance. These results might yield the first insights that pain-related impairment is not a universal phenomenon and can vary across cultures