NONVERBAL TREATMENT OF NEUROSIS—Techniques for General Practice

“Psychosomatic medicine” does not demand that the general practitioner function as a psychiatrist; rather, it is a psychiatric orientation that can increase the effectiveness of purely medical treatment for such conditions as neuroses. The general practitioner to whom the patient turns may achieve permanent results with nonverbal techniques where formal psychotherapy would be impracticable or unacceptable.The first aim is to relieve pressure so that the patient can regain his mental balance and thereby his self-confidence. Arts, hobbies, sports, and the like can be prescribed rather specifically according to the patient''s personality and needs. Nutrition can be improved simply at first by prescribing needed additions to diet rather than imposing restrictions. Vitamin deficiency may by itself be the cause of neurosis or more serious mental disease, whereas psychic stress by itself may create a need for additional vitamin intake. Hormone therapy may be extremely helpful but must be based on clear indication and limited to specific purposes.Since lack of sleep and rest quickly impairs mental function, it is important for neurotic persons to learn relaxation as a necessity for sleep. Sedatives may be used in a crisis but should be abandoned as soon as possible.With all drugs there are problems of excess and habituation. The least, the mildest, the shortest dosage is the ideal.The initial steps of psychotherapy are available to any physician: Establishing rapport, noting how complaints are stated, encouraging ventilation, winning confidence rather than immediate results.     

The Mental Health Consequences of the Recession: Economic Hardship and Employment of People with Mental Health Problems in 27 European Countries

Objectives

A period of economic recession may be particularly difficult for people with mental health problems as they may be at higher risk of losing their jobs, and more competitive labour markets can also make it more difficult to find a new job. This study assesses unemployment rates among individuals with mental health problems before and during the current economic recession.

Methods

Using individual and aggregate level data collected from 27 EU countries in the Eurobarometer surveys of 2006 and 2010, we examined changes in unemployment rates over this period among individuals with and without mental health problems.

Results

Following the onset of the recession, the gap in unemployment rates between individuals with and without mental health problems significantly widened (odds ratio: 1.12, 95% confidence interval: 1.03, 1.34). This disparity became even greater for males, and individuals with low levels of education. Individuals with mental health problems living in countries with higher levels of stigmatizing attitudes regarding dangerousness of people with mental illness were more vulnerable to unemployment in 2010, but not 2006. Greater agreement that people with mental health problems have themselves to blame, was associated with lower likelihood of unemployment for individuals with and without mental health problems.

Conclusion

These findings study suggest that times of economic hardship may intensify social exclusion of people with mental health problems, especially males and individuals with lower education. Interventions to combat economic exclusion and to promote social participation of individuals with mental health problems are even more important during times of economic crisis, and these efforts should target support to the most vulnerable groups.     

Genetic disorders presenting as “schizophrenia”. Karl bonhoeffer's early view of the psychoses in the light of medical genetics

There is overwhelming empirical evidence for the influence of genetic factors in the etiology of schizophrenic psychoses. An appreciable and still increasing number of exogenous factors have been known for decades that are capable of inducing psychoses that present as "schizophrenia" or are more or less similar to it. In this article, genetic disorders--chromosomal abnormalities and Mendelian diseases--are summarized that may be associated with such psychoses. These disorders frequently but not necessarily exhibit additional physical symptoms. Although the majority of schizophrenic psychoses can so far not be explained by exogenous factors or well-defined genetic disorders, the proportion of these etiologies among all cases may be higher than presumed so far, because they evade detection. Data from the literature are discussed in the light of Karl Bonhoeffer's early concept of exogenous reaction types and modern medical genetics.     

Adverse childhood experiences and mental health problems in a nationally representative study of heterosexual,homosexual and bisexual Danes

Non‐heterosexual persons more often report adverse childhood experiences (ACEs) than heterosexuals, and they generally bear a greater burden of mental health challenges. However, population‐based data on this topic are scarce. In a nationally representative study within the Project SEXUS, one of the world''s largest cohort studies on sexual health, we used data from 57,479 individuals in Denmark to explore the interplay between ACEs and mental health problems among self‐identified heterosexual, homosexual and bisexual persons, and among self‐identified heterosexuals with or without same‐sex sexual experience. Compared to heterosexuals, non‐heterosexual persons were more likely to report most of the studied ACEs, with odds ratios (ORs) for the ACE category “abuse” ranging from 1.38 to 1.75 for homosexual women, from 1.76 to 2.65 for homosexual men, from 2.52 to 3.64 for bisexual women, and from 1.58 to 6.07 for bisexual men. Furthermore, non‐heterosexual persons had consistently and statistically significantly higher odds for mental health problems (ORs: 1.50 to 4.63). Combinations of ACEs with a non‐heterosexual identity resulted in markedly elevated odds for mental health problems, particularly among bisexual individuals. This included high odds for suicidal thoughts/attempts among bisexual persons with a history of “neglect” (women: OR=12.82; men: OR=35.24) and “abuse” (women: OR=11.81; men: OR=11.65). Among self‐identified heterosexuals, combinations of ACEs with same‐sex sexual experience were associated with consistently elevated odds for mental health problems (ORs: 2.22 to 12.04). The greater burden of ACEs among self‐identified homosexuals and, most notably, bisexuals may account for part of their excess risk of mental health problems. These findings emphasize the public health importance of preventive measures to minimize the burden of ACEs and avert their harmful long‐term effects. Moreover, they highlight the need to safeguard the welfare of children and adolescents with non‐conforming expressions of sexuality.     

Studies of higher nervous activity in functional phychoses.

Psychiatric illnesses can be conceived of as experiments of nature, providing a variety of pathopsychological mechanisms which may elucidate normal psychological processes. Clinically the reactive psychoses are predominantly psychogenic reaction types. They present disturbances of higher nervous activity, similar to those of the neuroses. The unconditional reflex activity is practically as in normal controls, and the most outstanding finding was the large effect of psychodynamic complex structures. This is a physiological parallel to the clinical manifestations with great concern over experienced mental trauma. In the manic-depressive psychoses the most characteristic feature is a marked disturbance of unconditional reflex activity. This factor may be an important physiological mechanism underlying the more biological than psychodynamic reaction type and partly explain the changes of mood and associated interferences with sleep, body weight, sexual activity, aggression and other instinctual and vegetative functions. Schizophrenic psychoses also present changes of unconditional reflex activity, predominantly in the direction of inhibition of response. In addition there are severe dissociations within and between the three levels of unconditional reflexes and the two signaling systems. It is suggested that schizophrenia represents a functional maladaptation, which can be explained from the principles of autokinesis and schizokinesis established by Gantt in animal experiments. Prognostic models based on experimentally established impairment of performances were shown to predict long-term risks of schizophrenic defects just as well as models based on constellations of clinical symptoms. I would predict that psychophysiology and experimental psychology will become increasingly more important for establishing diagnosis and prognosis in the functional psychoses. The data of this article point toward a basis for a prophylactic psychiatry.     

Psychiatric problems in the aged: a reconsideration

The numerically important mental disorders found in the senescent population are reviewed from the point of view of their relationship to the process of ageing. Only two direct relationships are seen: the acute confusional states due to the age-linked decline in stress resistance; and the neurotic reactions due to the diminished capacity for rapid and adequate adjustment to the more subtle but chronic sociopsychological changes the aged individual is so frequently exposed to in our society. The chronic dementing processes of the senium, senile and arteriosclerotic dementia, are more likely to occur at an advanced age, but apparently are not the final outcome of cerebral and/or cerebrovascular ageing, although the ageing process seems to favour their phenotypical manifestation. The functional psychoses may occur at an advanced age but are not directly related to the process of ageing.     

Polymorphism in the Human Serotonin Transporter Gene in Endogenous Psychoses

Associations of the VNTR-17 and 5-HTTLPR polymorphisms of the serotonin transporter gene with affective disorders, including depression, have been found. These polymorphisms were analyzed in two groups of Russian probands: patients with endogenous psychoses and control individuals without mental disorders (423 and 277 persons, respectively). No associations were found between VNTR-17 genotypes or alleles and the diseases. However, the frequency of10/10 (VNTR-17) homozygotes increased with age in both patients and healthy persons. The results of the analysis of the 5-HTTLPR polymorphism suggest an association of the short (s) allele of the 5-HTTLPR polymorphism with schizophrenia and schizoaffective psychoses, but not with affective disorders.     

Pain Perception in the Elderly Patient: An Overview of Issues

The control of pain is an issue of major importance for older patients. As the proportion of elderly persons in society grows, these problems take on particular humanitarian and economic significance. Review of the literature indicates that the sensory mechanisms subserving pain in older persons are not unique, but painful pathologic states are more likely to occur in old age. Stereotypes of the older person have led to insufficient management and overmedication of this patient population. Moreover, the complex nature of chronic pain in the aged patient has not been appreciated by health care professionals. The literature points to an urgent need for more data that will shed light on the nature of pain problems in old age.     

Endocrine Treatment of Transsexual Persons: Extensive Personal Experience

ObjectiveThe Endocrine Society’s recently published clinical practice guidelines for the treatment of transsexual persons acknowledged the need for further information on transsexual health. We report here the experience of one provider with the endocrine treatment of transsexual persons over the past 2 decades.MethodsData on demographics, clinical response to treatment, and psychosocial status were collected on all transsexual persons receiving cross-sex hormone therapy since 1991 at the endocrinology clinic at Albany Medical Center, a tertiary care referral center serving upstate New York.ResultsThrough 2009, a total 192 male-to-female (MTF) and 50 female-to-male (FTM) transsexual persons were seen. These patients had a high prevalence of mental health and psychiatric problems (over 50%), with low rates of employment and high levels of disability. Mental health and psychiatric problems were inversely correlated with age at presentation. The prevalence of sex reassignment surgery was low (31% for MTF). The number of persons seeking treatment has increased substantially in recent years. Cross-sex hormone therapy achieves very good results in FTM persons and is most successful in MTF persons when initiated at younger ages.ConclusionTranssexual persons seeking hormonal therapy are being seen with increasing frequency. The dysphoria present in many transsexual persons is associated with significant mood disorders that interfere with successful careers. Starting therapy at an earlier age may lessen the negative impact on mental health and lead to improved social outcomes. However, significant barriers exist, such as insufficient insurance coverage, which limit comprehensive care. (Endocr Pract. 2013;19:644-650)     

Do calendrical savants use calculation to answer date questions? A functional magnetic resonance imaging study

Calendrical savants can name the weekdays for dates from different years with remarkable speed and accuracy. Whether calculation rather than just memory is involved is disputed. Grounds for doubting whether they can calculate are reviewed and criteria for attributing date calculation skills to them are discussed. At least some calendrical savants possess date calculation skills. A behavioural characteristic observed in many calendrical savants is increased response time for questions about more remote years. This may be because more remote years require more calculation or because closer years are more practised. An experiment is reported that used functional magnetic resonance imaging to attempt to discriminate between these explanations. Only two savants could be scanned and excessive head movement corrupted one savant''s mental arithmetic data. Nevertheless, there was increased parietal activation during both mental arithmetic and date questions and this region showed increased activity with more remote dates. These results suggest that the calendrical skills observed in savants result from intensive practice with calculations used in solving mental arithmetic problems. The mystery is not how they solve these problems, but why.     

Tobacco-Related Mortality among Persons with Mental Health and Substance Abuse Problems

The rate of cigarette smoking is greater among persons with mental health and/or substance abuse problems. There are few population-based datasets with which to study tobacco mortality in these vulnerable groups. The Oregon Health Authority identified persons who received publicly-funded mental health or substance abuse services from January 1996 through December 2005. These cases were then matched to Oregon Vital Statistics records for all deaths (N= 148,761) in the period 1999-2005. The rate of tobacco-related death rates was higher among persons with substance abuse problems only (53.6%) and those with both substance abuse and mental health problems (46.8%), as compared to the general population (30.7%). The rate of tobacco-related deaths among persons with mental health problems (30%) was similar to that in the general population. Persons receiving substance abuse treatment alone, or receiving both substance abuse and mental health treatment, were more likely to die and more likely to die prematurely of tobacco-related causes as compared to the general population. Persons receiving mental health services alone were not more likely to die of tobacco-related causes, but tobacco-related deaths occurred earlier in this population.     

Single mothers in Ontario: sociodemographic,physical and mental health characteristics

OBJECTIVE: To examine the sociodemographic, physical and mental health characteristics of single mothers in Ontario. DESIGN: Cross-sectional. SETTING: Ontario. PARTICIPANTS: Ontario residents aged 15 years or older who participated in the Ontario Health Supplement survey conducted between December 1990 and April 1991; of 9953 eligible participants, 1540 were mothers with at least 1 dependent child (less than 16 years of age). OUTCOME MEASURES: Prevalence rates of sociodemographic, physical and mental health characteristics. RESULTS: Single mothers were significantly more likely than the mothers in 2-parent families to be poor, to be 25 years of age or less, to have mental health problems (dissatisfaction with multiple aspects of life, affective disorder ever and 1 or more psychiatric disorders in the past year or ever) and to use mental health services. When compared by income level, poor single mothers had a higher prevalence of all mental health outcomes measured; the difference was significant for anxiety disorder in the past year or ever and for 1 or more psychiatric disorders in the past year or ever. In a logistic regression analysis, single-mother status was found to have the strongest independent effect on predicting mental health morbidity and utilization of mental health services; the next strongest was low income. CONCLUSIONS: Single mothers are more likely to be poor, to have an affective disorder and to use mental health services than mothers in 2-parent families. The risk of mental health problems is especially pronounced among poor single mothers. Further studies are needed to determine which aspects of single motherhood, apart from economic status, affect mental health outcomes.     

Effectiveness of motivational interviewing and physical activity on prescription on leisure exercise time in subjects suffering from mild to moderate hypertension

Background

Depression and anxiety disorders have a high disease burden and as many as 15% of young people report mental health problems. Binge drinking, which is a particularly harmful way of consuming alcohol, is common among secondary school students. The aim of this study was to examine the association between binge drinking and self-reported mental health in boys and girls aged 12 to 18 years.

Findings

This cross-sectional analysis was performed on data collected by the Community Health Service (GGD) Brabant Zuidoost, the Netherlands, in 2007. In this Youth Survey, 10 090 randomly selected adolescents aged 12 tot 18 years were each sent a letter, a questionnaire, and a user name and log-in code for if they preferred to complete the Internet version of the questionnaire. Mental health was assessed using the Mental Health Inventory (MHI-5), a short 5-item questionnaire to detect feelings of depression and anxiety. Participants were asked about current alcohol consumption, their relationship with their parents, drug use, and sociodemographic data. Corrected for confounders, binge drinking and mental health problems were associated in the 12 to 15 year old girls (OR 2.43; 95% CI 1.86-3.17, p = 0.000) and boys (OR 1.64, 95% CI 1.19-2.27, p = 0.003). The majority of the 16 to 18 year old adolescents had been binge drinking in the previous 4 weeks (69.6% boys and 56.8% girls). In this age group, boys with mental health problems were less likely to be classified as binge drinkers than were boys without mental health problems (OR 0.63, 95% CI 0.45-0.87, p = 0.005). No such association between binge drinking and mental health was found in girls of this age.

Conclusion

Girls and boys aged 12-15 years were classified as binge drinkers significantly more often when they reported poor mental health. Because binge drinking damages the brain, especially at a young age, it is important that health professionals are alert to possible binge drinking when young adolescents report mental health problems and should ask their patients about their drinking behaviour. Likewise, if youngsters under 16 present with binge drinking, they should be asked whether they are anxious or depressed.     

DYNAMICS AND MANAGEMENT OF SELF-INDUCED ERUPTIONS

Self-induced eruptions are always expressions of an emotionally disturbed person. They cover a wide variety of injuries and include aggravation of preexisting dermatoses, neurotic excoriations, mucocutaneous changes from compulsive movements, factitial dermatitis and trichotillomania. The emotional disturbances in such patients range from mild psychoneuroses to severe psychoses. Attention should be focused primarily on the emotional disturbance. The management of psychotic patients is the domain of the psychiatrist. But those unsuitable for psychiatric care and persons with mild psychoneuroses—who fortunately constitute the majority among patients with self-inflicted eruptions—should remain with their dermatologist or general physician and get from him effective supportive psychotherapy in addition to such treatment for the self-induced damage to the skin as may be indicated.     

Polymorphism in the human serotonin transporter gene in endogenous psychoses

Associations of the VNTR-17 and 5-HTTLPR polymorphisms of the serotonin transporter gene with affective disorders, including depression, have been found. These polymorphisms were analyzed in two groups of Russian probands: patients with endogenous psychoses and control individuals without mental disorders (423 and 277 persons, respectively). No associations were found between VNTR-17 genotypes or alleles and the diseases. However, the frequency of 10/10 (VNTR-17) homozygotes increased with age in both patients and healthy persons. The results of the analysis of the 5-HTTLPR polymorphism suggest an association of the short (s) allele of the 5-HTTLPR polymorphism with schizophrenia and schizoaffective psychoses, but not with affective disorders.     

Psychiatric Aspects of Ageing

Psychotic conditions due to structural brain disease of the senile and arteriosclerotic type are numerically less important than was formerly assumed. They account for about 25-30% of the psychiatric illnesses of the aged. Functional psychoses, particularly endogenous depressions, form an important part of these disorders. Their symptomatology and treatment are not essentially different from those of functional psychoses in the younger age groups. Among non-hospitalized old people, neurotic conditions represent the most frequently encountered type of mental disorders. Psychodynamic factors, operative in the older as well as the younger generations, and their interplay are responsible for the neurotic conditions of the elderly. These respond favourably to psychotherapy. Severe acute and subacute confusional states are caused in some aged people by physical and psychological stresses. These conditions have a serious prognosis but are amenable to proper treatment when diagnosed in time. They are the responsibility of the general practitioner and the general hospitals.     

Nonverbal treatment of neurosis; techniques for general practice

"Psychosomatic medicine" does not demand that the general practitioner function as a psychiatrist; rather, it is a psychiatric orientation that can increase the effectiveness of purely medical treatment for such conditions as neuroses. The general practitioner to whom the patient turns may achieve permanent results with nonverbal techniques where formal psychotherapy would be impracticable or unacceptable. The first aim is to relieve pressure so that the patient can regain his mental balance and thereby his self-confidence. Arts, hobbies, sports, and the like can be prescribed rather specifically according to the patient's personality and needs. Nutrition can be improved simply at first by prescribing needed additions to diet rather than imposing restrictions. Vitamin deficiency may by itself be the cause of neurosis or more serious mental disease, whereas psychic stress by itself may create a need for additional vitamin intake. Hormone therapy may be extremely helpful but must be based on clear indication and limited to specific purposes. Since lack of sleep and rest quickly impairs mental function, it is important for neurotic persons to learn relaxation as a necessity for sleep. Sedatives may be used in a crisis but should be abandoned as soon as possible. With all drugs there are problems of excess and habituation. The least, the mildest, the shortest dosage is the ideal. THE INITIAL STEPS OF PSYCHOTHERAPY ARE AVAILABLE TO ANY PHYSICIAN: Establishing rapport, noting how complaints are stated, encouraging ventilation, winning confidence rather than immediate results.     

The impact of a 6-year comprehensive community trial on the awareness, treatment and control rates of hypertension in Iran: experiences from the Isfahan healthy heart program

Background

Acute mental stress may contribute to the cardiovascular disease progression via autonomic nervous system controlled negative effects on the endothelium. The joint effects of stress-induced sympathetic or parasympathetic activity and endothelial function on atherosclerosis development have not been investigated. The present study aims to examine the interactive effect of acute mental stress-induced cardiac reactivity/recovery and endothelial function on the prevalence of carotid atherosclerosis.

Methods

Participants were 81 healthy young adults aged 24-39 years. Preclinical atherosclerosis was assessed by carotid intima-media thickness (IMT) and endothelial function was measured as flow-mediated dilatation (FMD) using ultrasound techniques. We also measured heart rate, respiratory sinus arrhythmia (RSA), and pre-ejection period (PEP) in response to the mental arithmetic and speech tasks.

Results

We found a significant interaction of FMD and cardiac RSA recovery for IMT (p = 0.037), and a significant interaction of FMD and PEP recovery for IMT (p = 0.006). Among participants with low FMD, slower PEP recovery was related to higher IMT. Among individuals with high FMD, slow RSA recovery predicted higher IMT. No significant interactions of FMD and cardiac reactivity for IMT were found.

Conclusions

Cardiac recovery plays a role in atherosclerosis development in persons with high and low FMD. The role of sympathetically mediated cardiac activity seems to be more important in those with impaired FMD, and parasympathetically mediated in those with relatively high FMD. The development of endothelial dysfunction may be one possible mechanism linking slow cardiac recovery and atherosclerosis via autonomic nervous system mediated effect.     

Does age affect the relationship between control at work and sleep disturbance for shift workers?

Among miners, shift work, aging and lack of control at work may be factors leading to increased sleep problems. Such risk factors may also operate in interaction, resulting in an even increased harm for sleep disruption. The present study aims at evaluating these relationships drawing on a sample of Australian mine and energy workers and their partners. The workers were mainly men. All performed shift work that included either nights (95%) or multiple shifts (92%), usually both (87%), while 36% were aged 50 years or above. The results show that low latitude over work activities is associated with higher sleep disturbances across the sample, though the effects are clearer amongst younger workers. By contrast, for younger workers, control over shift scheduling is not associated with sleep disturbances but for workers aged 50 or more, low control results in more sleep disturbance. Misalignment between shift workers and partner work schedules, and partner dissatisfaction with shift worker's employment and shift worker's work-life balance, are also associated with more sleep disturbances amongst shift workers.     

Failures of metacognition and lack of insight in neuropsychiatric disorders

Lack of insight or unawareness of illness are the hallmarks of many psychiatric disorders, especially schizophrenia (SCZ) and other psychoses and could be conceived of as a failure in metacognition. Research in this area in the mental health field h as burgeoned with the development and widespread use of standard assessment instruments and the mapping out of the clinical and neuropsychological correlates of insight and its loss. There has been a growing appreciation of the multi-faceted nature of the concept and of the different 'objects' of insight, such as the general awareness that one is ill, to more specific metacognitive awareness of individual symptoms, impairments and performance. This in turn has led to the notion that insight may show modularity and may fractionate across different domains and disorders, supported by work that directly compares metacognition of memory deficits and illness awareness in patients with SCZ, Alzheimer's disease and brain injury. The focus of this paper will be on the varieties of metacognitive failure in psychiatry, particularly the psychoses. We explore cognitive models based on self-reflectiveness and their possible social and neurological bases, including data from structural and functional MRI. The medial frontal cortex appears to play an important role in self-appraisal in health and disease.