Treatment of atopic dermatitis: A comparison of psychological and dermatological approaches to relapse prevention.

Compared the effectiveness of 4 group treatments for atopic dermatitis, a chronic skin disorder characterized by severe itching and eczema: dermatological educational program (DE), autogenic training as a form of relaxation therapy (AT), cognitive-behavioral treatment (BT), and the combined DE and BT treatments (DEBT). BT comprised relaxation, self-control of scratching, and stress management. Group treatments were also compared with standard medical care (SMC). Assessments at 1-year follow-up showed that the psychological treatments (AT, BT, and DEBT) led to significantly larger improvement in skin condition than intensive (DE) or standard (SMC) dermatological treatment, accompanied by significant reductions in topical steroids used. Results corroborate preliminary reports that psychological interventions are useful adjuncts to dermatological treatment in atopic dermatitis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Non-acceptance of prosthetic appliances at the focus of forensic consequences

Non-acceptance of prosthetic appliances is not only a clinical problem; it also gives rise to legal proceedings. Not every case of non-acceptance is psychogenically induced, there are often somatic and even iatrogenic causes. Objective treatment deficiencies are subject to forensic sanctions irrespective of any underlying psychosomatic illness. If the dentist is to manage non-acceptance in a responsible way not open to forensic consequences, competent clinical and psychological skills are needed.     

Triangulation in nursing research: issues of conceptual clarity and purpose

Discussing the need for psychological treatment of a dermatological condition with children and families can be a daunting task. Families must be given accurate information about the role of psychological or behavioral factors in the exacerbation or maintenance of their child's condition; however, this information must be presented in a way that families and children do not feel criticized or judged. This article discusses nondrug treatments of skin diseases.     

Biofeedback-based behavioral treatment for chronic tinnitus: Results of a randomized controlled trial.

Many tinnitus sufferers believe that their tinnitus has an organic basis and thus seek medical rather than psychological treatments. Tinnitus has been found to be associated with negative appraisal, dysfunctional attention shift, and heightened psychophysiological arousal, so cognitive-behavioral interventions and biofeedback are commonly suggested as treatments. This study developed and investigated the efficacy of a biofeedback-based cognitive-behavioral treatment for tinnitus. In total, 130 tinnitus patients were randomly assigned to an intervention or a wait-list control group. Treatment consisted of 12 sessions of a biofeedback-based behavioral intervention over a 3-month period. Patients in the wait-list group participated in the treatment after the intervention group had completed the treatment. Results showed clear improvements regarding tinnitus annoyance, diary ratings of loudness, and feelings of controllability. Furthermore, changes in coping cognitions as well as changes in depressive symptoms were found. Improvements were maintained over a 6-month follow-up period in which medium-to-large effect sizes were observed. The treatment developed and investigated in this study is well accepted and leads to clear and stable improvements. Through demonstration of psychophysiological interrelationships, the treatment enables patients to change their somatic illness perceptions to a more psychosomatic point of view. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conceptualizing and defining psychosomatic disorders.

The concept of psychosomatic illnesses as physical problems resulting from emotional stress is questioned as one that may have outlived its usefulness. A broader definition involving all behavioral concomitants of illness is suggested. The new conception encompasses (a) organic problems created by difficulties in learning and development rather than affect, (b) organic problems created by deviation in personality and character rather than affect, (c) psychological disturbance created indirectly by physical illness, and (d) psychological disturbance created directly by physical illness. Several illustrations of the newly defined types of psychosomatic disorders are given. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of psychological and pharmacological treatments for nocturnal enuresis.

Provides a quantitative integration of research on the effectiveness of psychological and pharmacological treatments for nocturnal enuresis. With the use of experiments that compared treatments with either no treatment or another form of treatment, this article assesses (1) the overall effectiveness of psychological and pharmacological treatments, (2) the relative effectiveness of specific types of treatments, and (3) moderators of treatment effectiveness including investigator allegiance. Findings from the review confirm that enuretic children benefit substantially from treatment. However, more children improve from psychological than from pharmacological interventions. Moreover, psychological treatments involving a urine alarm are most likely to yield benefits that are maintained once treatment has ended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosomatic research today: a clinician's overview

Emphasis is placed on the opportunities and importance, at this time, of continuing with clinically oriented psychosomatic research. For instance, the multidimensional studies of sleep and of depression are beginning to throw new light on psychosomatic processes, and so too are the studies of life events and illness. Short-term prospective clinical investigations provide an attractive framework for such work and they can be complementary to long-term survey studies investigating relationships between constitutional characteristics including personality, and social conditions and disease. There are some useful new tools for measureing psychological characteristics.     

Clinical psychology in the management of pediatric skin disease

The role of psychological factors in certain dermatological conditions is not disputed; however, these processes have been much more thoroughly explored in adult populations than in pediatric populations. Therefore, this article reviews relevant adult and child studies. This article explores three aspects of psychological functioning as they relate to dermatological conditions and their treatment, specifically stress and emotional regulation, behavioral and environmental issues, and compliance. The goal of this article is to give the practicing dermatologist a working overview of psychological factors in pediatric skin disease which will facilitate good communication with families around these issues and referral for adjunctive psychological treatment as needed.     

Cell biological analysis with respect to cause of fibrous opacification of the anterior capsule after cataract extraction

To assess whether juvenile-onset epilepsy or motor disability is complicated by an increased number of mental health disorders or experience of psychosomatic symptoms in young adulthood, we studied 81 subjects with epilepsy and 52 with motor disabilities at the age of 19 to 25 years and compared them with 211 controls. The main diagnostic tool, the Present State Examination, was administered to those attending the interviews in person who were of normal intelligence; there were 62, 38, and 123 subjects in the three categories, respectively. Compared with the controls, the subjects with epilepsy showed an equal prevalence of psychiatric disorders whereas those with motor disabilities had a significantly higher prevalence, particularly of depressive disorders. The reported prevalence of psychosomatic symptoms confirmed this main result. Psychological illness affected everyday life of two out of five subjects with motor disabilities, but only half of those in the other two groups. It is concluded that motor disability since childhood, but not epilepsy, could be a factor that increases susceptibility to psychiatric morbidity, especially depression, and causes a large number of psychosomatic symptoms. The results challenge staff of clinics working with such adolescents to find individual approaches in preventing the negative influence of psychological disorders on social life.     

Recurrent vascular headache: Home-based behavioral treatment versus abortive pharmacological treatment.

This study compared the effectiveness of a home-based behavioral intervention with an abortive pharmacological intervention for treating recurrent migraine and mixed migraine and tension headaches. Relaxation training and thermal-biofeedback training were provided to 19 patients in a home-based treatment format that required minimal therapist contact, whereas 18 patients received ergotamine tartrate accompanied by a compliance-training intervention to assist them in making optimal use of the medication. The two treatments yielded similar reductions in headache activity (Ms?=?52% and 41%, respectively), psychosomatic symptoms, and daily life stress. However, the two treatments differed in (a) the timing of improvements, (b) their impact on analgesic medication use, and (c) the variables that predicted treatment response. The results highlight the role that psychological variables may play in pharmacological treatment and provide additional evidence that behavioral treatment can be effectively administered in a home-based treatment format. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological impacts of sexual contact between therapists or other health care practitioners and their clients.

14 females who had had sexual contact with their therapists/psychiatrists (Group 1), 7 females who had had sexual contact with their health care practitioners (principally physicians [Group 2]), and 10 females who had received counseling services but had not engaged in sexual contact with therapists (Group 3) were compared by administering a questionnaire on self-esteem, depression, attitudes, beliefs about sexual contact, emotional effects of treatment, sexual attitudes, and psychosomatic and psychological symptoms. In addition, data were obtained from Ss, who were primarily aged 26–45 yrs, on (1) history of sexual victimization, (2) marital status of therapist/physician, (3) who initiated sexual contact, and (4) frequency of sexual contact. Results show that Ss in Group 1 had greater mistrust of and anger toward males and therapists and a greater number of psychological and psychosomatic symptoms following the cessation of therapy than did Ss in Group 3. Ss in Groups 1 and 2 did not differ in psychological impacts. Severity of impacts were significantly related to the magnitude of psychological and psychosomatic symptoms prior to treatment, prior sexual victimization, and the marital status of the therapist or health practitioner. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distinctions without a difference: Direct comparisons of psychotherapies for alcohol use disorders.

To estimate the relative efficacy of alcohol use disorder treatments, the authors meta-analyzed studies that directly compared 2 bona fide psychological treatments. The authors accommodated problems with the inclusion of multiple treatment comparisons by randomly assigning a positive/negative sign to the effect size derived from each comparison and then estimating the extent to which effect sizes were heterogeneous. The authors' primary hypothesis was that the variability in effect sizes of bona fide psychological treatments for alcohol use disorders that were directly compared would be zero. For both alcohol measures and measures of abstinence, analyses indicate that effects were homogenously distributed about zero (I2 = 10.61, 0.00, respectively), indicating that different treatment comparisons yielded a common effect size that was not significantly different from zero. Analyses also indicate that allegiance accounted for a significant portion of variability in differences between treatments. Implications for the treatment of alcohol use disorders as well as research on the mechanisms responsible for the benefit of treatment are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analysis of treatments for panic disorder.

In a meta-analysis, the authors compared the effectiveness of psychological and pharmacological treatments for panic disorder. Percentage of agoraphobic Ss in the sample and duration of the illness were unrelated to effect size (ES). Type of dependent variable was generally unrelated to treatment outcome, although behavioral measures yielded significantly smaller ESs. Dependent measures of general anxiety, avoidance, and panic attacks yielded larger ESs than did depression measures. Choice of control was related to ES, with comparisons with placebo controls greater than comparisons with exposure-only or "other treatment" controls. Psychological coping strategies involving relaxation training, cognitive restructuring, and exposure yielded the most consistent ESs; flooding and combination treatments (psychological and pharmacological) yielded the next most consistent ESs. Antidepressants were the most effective pharmacological intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward the incorporation of costs, cost-effectiveness analysis, and cost-benefit analysis into clinical research.

Most research in clinical psychology and related disciplines does not measure, report, or analyze costs, cost-effectiveness, or cost–benefit analysis. Reasons for this are discussed. It may be thought, for example, that costs are trivial to measure. Data are presented to show that the values of resources consumed in treatment (i.e., costs) actually can be quite complex to assess accurately and completely. Research findings are assembled to show that costs, as experienced by clients, may be beneficial to assess in that they can be significantly related to the outcomes of treatment. Empirical findings also show that costs also can be useful to measure because costs and outcomes can be related inversely rather than directly (i.e., clients may benefit most from treatments that cost less than several viable alternatives). Finally, perceived impediments to assessing costs and to cost-effectiveness and cost–benefit analysis in psychology are considered. Dialogue is encouraged on the scientific study of relationships between (1) monetary and other costs, (2) treatment techniques and treatment delivery systems, and (3) psychological and economic outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stability of Older Adults' Preferences for Life-Sustaining Medical Treatment.

The use of instructional advance directives assumes that preferences for life-sustaining medical treatment remain stable over time and across changes in life condition. A sample of 332 older adults recorded their preferences for 4 life-sustaining treatments in 9 illness scenarios. These preferences were elicited again 1 and 2 years after the original interview. Overall, preferences for life-sustaining treatment were moderately stable over time, but stability varied significantly across judgments. Preferences were most stable for illness scenarios that were most and least serious and for decisions to refuse treatment. Age, gender, education, and prior completion of an advance directive were all related to preference stability, and evidence indicated that declines in physical or psychological functioning resulted in decreased interest in life-sustaining treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Pure Types are Rare.

Reviews the book, Pure Types Are Rare by Irwin Silverman. This is a provocative book. In it, Silverman, with ambitious abandon, sets out to denude the "medical model of mental illness" of its Emperor's Clothing. Unceremoniously, Silverman strips away the clothing of the medical model: psychiatric diagnoses are unreliable and invalid, labels are applied at the whim of the psychodiagnostician; mental illness bears no resemblance to physical disease, mental "illness" is a myth; biological causes of mental illness do not exist; biological treatments serve only to mask the real social and psychological causes of madness; psychotherapy is no treatment at all, there are no "treatment" principles or methods. What remains after Silverman's assault on the medical model? The medical model as Emperor remains, albeit naked. Silverman views the medical model and the entire mental health enterprise as an Emperor indeed: it is a political ideology that serves to control the socially and economically impoverished. Silverman goes on to offer an alternative to the medical model, a social psychological perspective on madness. He favours a view of madness as a social role which may be adopted by a person in the process of coping with life conflict. Silverman attacks practically all of the important assumptions and practices of psychiatry and clinical psychology. His radical social perspective on mental illness is at such odds with the common psychological perspective that, obviously, most psychologists, be they practitioners or researchers, will not like this book. Silverman insists on too radical a departure from our common beliefs. Despite the reviewer's disagreement with Silverman's radical social perspective on mental illness, he thinks that this is a worthwhile book. While the reviewer disagrees with his premise that clinical practices are exclusively or primarily political in essence, the reviewer does agree that there are essential social and political functions served by our practices. Silverman relentlessly and effectively uncovers important social and political meanings of diagnostic and treatment practices. This, according to the reviewer, is the strength of the book. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic fatigue syndrome--a disease entity or an unspecified psychosomatic disorder?

In spite of its nature as an often severe and disabeling disease, it is still unclear, whether the Chronic Fatigue Syndrome (CFS) is an entire disease of its own right or not. Moreover, there is a growing evidence that patients with CFS belong to an inhomogeneous group with different etiologic constellations. Specific somatic factors, e.g. viruses, seem to be less important for onset than certain personality-traits like depressiveness and workaholism. These traits lead to an increased vulnerability to unspecific psychological or biological stressors that may cause chronic fatigue by complex psychosomatic interferences. Concerning diagnosis, there are no specific methods or results available, the same is true for pharmacological treatment. As a consequence, practitioners should be aware not to miss a somatic disease causing fatigue, and, parallel to this, start right from the beginning talking about the psychosomatic background of CFS. Furthermore, psychotherapy has shown to be effective in CFS.     

Empirically supported individual and group psychological treatments for adult mental disorders.

The experimental literature on individual and group psychological treatments for adult disorders is reviewed. For each of the 11 disorders or problems covered, treatments that fall into the following categories, as defined by D. L. Chambless and S. D. Hollon (1998), are identified: efficacious and specific, efficacious, and possibly efficacious. Behavioral and cognitive–behavioral treatments dominate the lists, especially in the anxiety disorders, with notable exceptions. Reasons for the hegemony of the behavioral and cognitive modalities are discussed, and some limitations of the empirically supported treatment concept are addressed. Continued research is recommended on Aptitude?×?Treatment interactions, cost–benefit ratios, and generalization of treatments to a variety of patient populations, therapists, and treatment settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disorders of eating behavior--early detection and treatment possibilities in general practice

According to recent epidemiological investigations, one-third of younger women perceive themselves to be overweight. A quarter show disturbed eating habits such as continuous dieting, compulsive calorie counting or ruminations about eating and body weight. The ratio of young women to men with eating disorders is 10:1. Eating disorders, like other psychosomatic disorders, have a multifactorial origin. Biological, psychological, interpersonal and sociocultural factors are of varying importance in the development of the disorder. Apart from somatic aspects, the psychological component is of particular importance not only for the assessment of severity, but also for prognosis. Because patients with anorectic features often refuse help and patients with bulimia often suffer from a sense of shame and guilt, it is the physician's chore to note symptoms relevant to the clinical picture and to outline possibilities for therapeutic intervention. Furthermore, in the treatment of eating disorders it is important to recognise personal limitations and to decide upon appropriate treatment measures in collaboration with the patient when possible.     

Psychological and sexual aspects of the menopause and HRT

Despite the clinical impressions that there are considerable psychological benefits from HRT, there is only clear evidence for amelioration of psychological symptoms (including improvement in cognitive function) in women who have undergone a surgical menopause. Otherwise in the natural menopause it remains unclear which, if any, non-sexual psychological symptoms respond directly to oestrogen except as a secondary response to reduction in physical symptoms. Overall, it has to be said that there is little scientific backing for hormonal treatment of psychological problems on their own around the time of the natural menopause. In most cases psychological treatment or counselling will be more appropriate than HRT. It must be remembered that the prevalence of psychological symptoms in the menopause and gynaecology clinic is high just as it is in all hospital settings. The task is to identify which women: 1. Have a predominance of psychological symptoms and might have psychiatric disorders. They may have presented in the clinic because they also happen to be menopausal, but it may well be that the psychiatric disorder has a quite independent aetiology. They will benefit from specific treatment for that disorder. 2. Have, and complain of, low moods or other non-specific psychological symptoms and have presented in the clinic because they are menopausal. They might benefit from practical, supportive help with current and ongoing stresses and strains. 3. Present appropriate menopausal complaints and only on enquiry reveal their psychological problems. In particular, disorders such as depressive illness, anxiety states and alcohol abuse can present with physical symptoms including ones which mimic vasomotor ones. This group may well be non-responders to HRT. Women requiring particular consideration might be those with other health problems (particularly chronic ones that might carry on in to old age) who are possibly more at risk of developing depression as they pass through the menopause. There is clearer evidence that HRT has beneficial effects on sexual function. When sexual symptoms are presented it is worth clarifying the exact features contributing to the complaint. Is it a problem of sexual interest, of infrequency of sexual activity, of vaginal dryness and dyspareunia, or is it a mixture of these complaints? Reduction of sexual interest and reduced sexual activity with the partner and possibly orgasm may accompany the menopause. Oestrogens have been shown to have some beneficial effect on sexual desire. Where oestrogen alone is ineffective, testosterone is usually beneficial. This treatment effect is particularly clear in surgically menopausal women. Non-menopausal aspects of the sexual relationship must be considered too. These aspects include the quality of the relationship, the sexual performance of the partner (since sexual desire decreases in both sexes with age), and age-related changes in self-image. These issues may need to be addressed at a simple health education level or with specific counselling. Although a woman's motivation or desire might change as a result of HRT, on its own this will not influence the frequency of intercourse or response during intercourse unless the partner variables permit this. The situation is more straightforward when problems of postmenopausal vaginal dryness and dyspareunia are the key issues. Oestrogens have been shown to be highly effective in such circumstances. It is also worth noting that regular and continued sexual activity has been found to protect against vaginal dryness.