Tailoring a cognitive behavioural model for unexplained physical symptoms to patient's perspective: a bottem-up approach.

The prevalence of unexplained physical symptoms (UPS) in primary care is at least 33%. Cognitive behavioural therapy has shown to be effective. Within cognitive behavioural therapy, three models can be distinguished: reattribution model, coping model and consequences model. The consequences model, labelling psychosocial stress in terms of consequences rather than as causes of UPS, has high acceptance among patients and is effective in academic medical care. This acceptance is lost when applied in primary care. To increase acceptance of the consequences model among patients in primary care, we tailor this model to patient's perspective by approaching the model from bottom-up instead of top-down. Subsequently, we use this tailored model in an easily accessible group training. We illu

Normative data for the Hospital Anxiety and Depression Scale

Acknowledgments The authors would like to thank all those involved in the EpiFunD study for their role in collecting the data used in this study, particularly the principal investigators Gary Macfarlane (University of Aberdeen) and John McBeth (Keele University, and the University of Manchester) who allowed use of the EpiFunD dataset. The EpiFunD study was funded by Arthritis Research UK (formerly the Arthritis Research Campaign), Grant Number: 17552.Peer reviewedPostprin

Serotonin transporter gene, childhood emotional abuse and cognitive vulnerability to depression

Meta-analyses evaluating the association between the serotonin transporter polymorphism (5-HTTLPR) with neuroticism and depression diagnosis as phenotypes have been inconclusive. We examined a gene–environment interaction on a cognitive vulnerability marker of depression, cognitive reactivity (CR) to sad mood. A total of 250 university students of European ancestry were genotyped for the 5-HTTLPR, including SNP rs25531, a polymorphism of the long allele. Association analysis was performed for neuroticism, CR and depression diagnosis (using a self-report measure). As an environmental pathogen, self-reported history of childhood emotional abuse was measured because of its strong relationship with depression. Participants with the homozygous low expressing genotype had high CR if they had experienced childhood emotional maltreatment but low CR if they did not have such experience. This interaction was strongest on the Rumination subscale of the CR measure. The interaction was not significant with neuroticism or depression diagnosis as outcome measures. Our results show that 5-HTTLPR is related to cognitive vulnerability to depression. Our findings provide evidence for a differential susceptibility genotype rather than a vulnerability genotype, possibly because of the relatively low levels of abuse in our sample. The selection of phenotype and environmental contributor is pivotal in investigating gene–environment interactions in psychiatric disorders

Tratamiento psicológico en el trastorno de somatización : eficacia y propuestas de intervención

This review analyze randomized controlled studies carried out both in somatization disorder and in undifferentiated somatoform disorder patients that had been treated using two kind of interventions: 1. A consultation letter referred by a mental health specialist to the patient's family doctor and 2. Using cognitive-behaviour therapy. In these studies some variables such as the setting, the content, the number of sessions, the outcome, the foUow-up, etc. has been assessed. We summarize the main conclusions on psychological interventions developed up to the moment in these patients and we propose new stepped cognitive-behavioural therapies to implement in the future in somatization disorder patients.Este trabajo de revisión analiza los estudios controlados randomizados realizados tanto en pacientes con trastorno de somatización como en pacientes con trastorno somatomorfo indiferenciado que han sido tratados mediante dos tipos de intervenciones: 1. Mediante la remisión de una carta de interconsulta por parte de un especialista de salud mental a atención primaria y 2. mediante terapia cognitivo-conductual. En estos estudios se analizan variables como el entorno, el contenido de la terapia, el formato, el número de sesiones, las variables de resultado, el tiempo de seguimiento, etc. Se resumen las principales conclusiones de las intervenciones psicológicas realizadas hasta el momento en estos pacientes y se realizan propuestas para nuevos terapias cognitivo- conductuales en escalado a realizar en el futuro en pacientes con trastorno de somatización

Introduction and psychometric validation of the prison personnel trauma measure (PPTM)

Objective The aim of the study was to create and validate a brief self-report measure of trauma exposure specific to personnel employed within a prison environment which exhibits predicative validity for a number of adverse psychological conditions shown to be a consequence of working within such prison environments. Method The Prison Personnel Trauma Measure (PPTM), Hospital Anxiety and Depression Scale (HADS) and the Posttraumatic Stress Disorder Checklist–Civilian Version (PCL-C) were administered to 1995 Prison Personnel in England and Wales. Dimensionality and construct validity of the PPTM were investigated using confirmatory factor analysis. Two alternative models of the PPTM were specified and tested using Mplus with WLSMV estimation. Results The three-factor model of the PPTM offered the best representation of the data. The results suggest that the PPTM consists of three sub scales: self-harm/death, violence and environment. Good composite reliability and differential predictive validity were observed. Conclusion This brief measure can be used to ascertain potential vulnerability to the subsequent development of adverse psychological symptoms (PTSD, anxiety and depression) amongst prison personnel for specific trauma related experiences that are known to be an inherent part of certain occupational roles within a prison environment

The course of symptoms in the first 27 months following bereavement: A latent trajectory analysis of prolonged grief, posttraumatic stress, and depression

Background: Much remains unknown about the course of grief in the early months following bereavement, including the prevalence and timing of a recovery trajectory, whether specific symptoms mark a failure to recover, and the co-occurrence of chronic prolonged grief (PG), posttraumatic stress (PTS) and depression symptoms. Methods: Two hundred fifty-nine participants completed PG, PTS and depression questionnaires up to eleven times every six weeks during the two years post-bereavement. We used Latent Class Growth Mixture Modeling (LCGMM) to identify subgroups of bereaved individuals sharing similar trajectories for each disorder. We used repeated measures ANOVA to evaluate differences in individual symptoms between trajectories. Finally, we investigated to what extent chronic trajectories of these three disorders co-occurred. Results: Three trajectories of PG symptoms emerged: resilient (66.4%), chronic (25.1%) and acute recovery (8.4%). The overall severity and symptom profile of the acute recovery group were indistinguishable from that of the chronic group through 6 months post-bereavement, followed by reduction in PG from 6 to 18 months post-bereavement. Chronic PTS in the first-year post-bereavement tended to co-occur with chronic PG and/or chronic depression. Conclusions: Twenty five percent of those with initial elevations in grief recovered in the period of 6 to 12 months post-bereavement. These findings highlight the clinical importance of severe grief in the initial months following loss, but also suggests caution in diagnosing a grief disorder within the first-year post-bereavement