Understanding Emotions: Origins and Roles of the Amygdala.

Emotions arise from activations of specialized neuronal populations in several parts of the cerebral cortex, notably the anterior cingulate, insula, ventromedial prefrontal, and subcortical structures, such as the amygdala, ventral striatum, putamen, caudate nucleus, and ventral tegmental area. Feelings are conscious, emotional experiences of these activations that contribute to neuronal networks mediating thoughts, language, and behavior, thus enhancing the ability to predict, learn, and reappraise stimuli and situations in the environment based on previous experiences. Contemporary theories of emotion converge around the key role of the amygdala as the central subcortical emotional brain structure that constantly evaluates and integrates a variety of sensory information from the surroundings and assigns them appropriate values of emotional dimensions, such as valence, intensity, and approachability. The amygdala participates in the regulation of autonomic and endocrine functions, decision-making and adaptations of instinctive and motivational behaviors to changes in the environment through implicit associative learning, changes in short- and long-term synaptic plasticity, and activation of the fight-or-flight response via efferent projections from its central nucleus to cortical and subcortical structures.

A Measure of Suffering in relation to Anxiety and Quality of Life in IBS Patients: Preliminary Results.

Irritable bowel syndrome (IBS) is a chronic gastrointestinal (GI) disorder with a severe impact on quality of life (QoL). We explored the relationship of a visual measure of suffering, the PRISM-RII, with quality of life (QoL) and anxiety measures in IBS patients. Participants were 44 IBS patients who completed several questionnaires and kept a symptom diary for two weeks. The measures used were PRISM-RII (self-illness separation (SIS); illness perception measure (IPM)); IBS-36 (IBS health related QoL); SF-36 (physical and mental health related QoL); State-Trait Anxiety Inventory (STAI-T); Visceral Sensitivity Index (VSI; GI-specific anxiety); and a symptom diary. SIS was negatively correlated to VSI, while IPM was negatively correlated to SIS and the physical component of SF-36 and positively to VSI and symptom severity. We found significant differences between participants who perceive their illness as small and those who perceive it as medium in SIS, symptom severity, VSI, and the mental component of SF-36. Participants, who perceived their illness as small, represented their illness as more distant, showed lower average symptom severity, and had lower GI-specific anxiety and higher QoL. The results indicate that IPM and SIS can be useful in discriminating patients with more prominent psychological difficulties and QoL impairment.

Diagnosis of Irritable Bowel Syndrome: Role of Potential Biomarkers.

Irritable bowel syndrome is a disorder diagnosed on symptom-based criteria without inclusion of any objective parameter measurable by known diagnostic methods. Heterogeneity of the disorder and overlapping with more serious organic diseases increase uncertainty for the physician's work and increase the cost of confirming the diagnosis. This paper is an attempt to summarize the efforts to find adequate biomarkers for irritable bowel syndrome, which should shorten the time to diagnosis and reduce the cost. Most of the reviewed papers were observational studies from secondary care institutions. Since publication of the Rome III criteria in 2006, most recent studies use these for the recruitment of IBS patients. This is a positive step forward as future studies should use the same criteria, facilitating comparison of their results. Among the studied biomarkers, most evidence is provided for fecal calprotectin. Cutoff values for fecal calprotectin have still to be investigated prior to inclusion in the irritable bowel syndrome diagnostic algorithm.

Fecal Calprotectin and serum chromogranin A as potential biomarkers of irritable bowel syndrome symptom severity.

Irritable bowel syndrome (IBS) is a disorder of the lower gastrointestinal (GI) tract, which manifests as abdominal pain and/or discomfort accompanied by altered bowel function, in the absence of structural pathology. The onset and precipitation of IBS is the result of an interaction among several factors, including psychological distress, altered GI sensation and processing of sensory information as well as GI inflammation. These factors have varying contributions to disorder etiology in different patients, and in line with that, there is now emerging evidence about a low-grade inflammation in a subgroup of IBS patients. Because IBS diagnosis is based on the ROME III criteria, with the exclusion of structural pathology, patients are often exposed to numerous invasive and unpleasant tests. In order to decrease the cost of repeated testing, while simultaneously alleviating patients' anxiety, research should be aimed at detecting cost-effective biomarkers. We hypothesize chromogranin A (CgA) and fecal Calprotectin (FC) could be used to eliminate possible organic causes of IBS symptoms. Also, we hypothesize FC could be helpful in detecting IBS patients with low-grade inflammation. Forty-eight outpatients with IBS (76% females) completed a set of psychosocial measures (HRQoL, STAI, BDI, VSI, SF-36), and their FC and CgA levels were obtained. We found elevated CgA levels in 4 patients, but CgA levels were not related to any of the psychological measures used. Elevated FC levels were found in 12 patients. FC levels significantly correlated with the physical component of health related quality of life (HRQoL) (r48=-.42, p<.01). In addition, one-way ANOVA's were performed to test possible differences in psychosocial measures depending on the patient's FC status. The analysis showed only one significant difference. Patients with the highest levels of FC had significantly lower physical component of HRQoL compared to the other two groups of patients.

Are owners' reports of their dogs' 'guilty look' influenced by the dogs' action and evidence of the misdeed?

While dog owners claim that their dogs' greeting behaviour after having performed a misdeed indicates the dogs' 'guilt', current experimental evidence suggests that dogs show these 'guilty look' behaviours as a response to being scolded by their owners. Given reports that 'guilty look' behaviours are shown also in the absence of being scolded, we investigated whether the dogs' own actions or the evidence of a misdeed might serve as triggering cues. We manipulated whether or not dogs ate a 'forbidden' food item and whether or not the food was visible upon the owners' return. Based on their dogs' greeting behaviour, owners stated that their dog had eaten the food no more than expected by chance. In addition, dogs' greeting behaviours were not affected by their own action or the presence or absence of the food. Thus, our findings do not support the hypothesis that dogs show the 'guilty look' in the absence of a concurrent negative reaction by their owners.

Cognitive behavioral approach to understanding irritable bowel syndrome.

Irritable bowel syndrome (IBS) is considered a biopsychosocial disorder, whose onset and precipitation are a consequence of interaction among multiple factors which include motility disturbances, abnormalities of gastrointestinal sensation, gut inflammation and infection, altered processing of afferent sensory information, psychological distress, and affective disturbances. Several models have been proposed in order to describe and explain IBS, each of them focusing on specific aspects or mechanisms of the disorder. This review attempts to present and discuss different determinants of IBS and its symptoms, from a cognitive behavioral therapy framework, distinguishing between the developmental predispositions and precipitants of the disorder, and its perpetuating cognitive, behavioral, affective and physiological factors. The main focus in understanding IBS will be placed on the numerous psychosocial factors, such as personality traits, early experiences, affective disturbances, altered attention and cognitions, avoidance behavior, stress, coping and social support. In conclusion, a symptom perpetuation model is proposed.

Attentional biases in irritable bowel syndrome patients.

BACKGROUND AND OBJECTIVE: According to the cognitive behavioural model of irritable bowel syndrome (IBS) selective attention to visceral stimuli is one of the pathophysiological mechanisms in IBS. We aimed to investigate attentional biases in patients with IBS and to explore the relationship between neuroticism, trait anxiety, visceral anxiety and indices of attentional biases. METHODS: Twenty-seven patients completed the global/local task and the modified Stroop task (using 4 word categories: neutral, symptom-related, emotionally and situationally relevant) while 28 healthy persons completed the Stroop task only. Both groups also filled out a set of psychological questionnaires. RESULTS: The results show two distinct attentional biases in patients with irritable bowel syndrome. The index of global precedence was negatively correlated with neuroticism (r=-.41, P<.05) while there was no correlation of global precedence with trait and visceral anxiety. We found Stroop facilitation (F[3,81]=3.98, P<.02) specifically for situational threat words. Also, there were positive correlations between trait anxiety, visceral anxiety and the Stroop facilitation index for situational threat words (r=.43 and r=.47, P<.05). In the control group, we found neither Stroop facilitation nor interference. But, facilitation index of emotional words was positively correlated with neuroticism (r=.40, P<.05), which is in line with the "emotion congruent attentional bias" in the general population. CONCLUSIONS: Neuroticism was associated with the reduction in global precedence observed in the global/local task. Trait anxiety and visceral anxiety were associated with Stroop facilitation elicited by situational threat words, which are of particular concern for patients with irritable bowel syndrome. These specific situations do not elicit an attentional bias in healthy participants, which might indicate that the observed facilitation to situational threat words is unique for IBS patients.

Binge eating as a determinant of emotional state in overweight and obese males with cardiovascular disease.

OBJECTIVES: The present study investigates the association between depression, anxiety and binge eating at baseline with weight-change after an approximately 1-year period in a clinical sample of obese adult males with cardiovascular disease. METHODS: At the time of the first measurement, the sample consisted of 69 overweight and obese men (age range between 36 and 74); 34 patients attended a follow-up measurement 6-17 months after the first measurement, and completed selected psychological instruments. RESULTS: After the follow-up period, only 28.7% patients' lost weight, 29.9% patients' had the same weight, and finally 41.4% patients' gained weight. When comparing the first and the second assessments, the level of anxiety and depression is relatively stable. Men, who, at the time of the second assessment, gained weight, and were binge eating at baseline, were more depressed and anxious in comparison with the other two groups of patients. CONCLUSIONS: It is necessary to focus primarily on binge eating symptoms as a part of weight reduction treatment as well as to treat anxiety and depression in CVD patients. Binge eating is an eating disorder per se, and therefore it is important to treat it before the person starts weight reduction procedures as part of the risk prevention treatment for CVD patients.

Erythrocyte sedimentation rate - possible role in determining the existence of the low grade inflammation in Irritable Bowel Syndrome patients.

Irritable Bowel Syndrome (IBS), the most prevalent functional gastrointestinal disorder, is best described by the presence of recurrent symptoms of abdominal pain, diarrhea and/or constipation. It has been thought that IBS is stress-related disorder with no known structural abnormalities, e.g. infectious, biochemical or metabolic causes. But, recent evidence suggests that inflammation within the gastrointestinal tract may be of great importance in the pathogenesis of IBS. Our question is could the conventional and widely available general biological markers of inflammation such as erythrocyte sedimentation rate (ESR) be indicator of microscopic inflammatory process in some IBS patients? We hypothesize that mild inflammation in IBS patients could be detected by meaning of a sensitive but cheap and ubiquitous test - ESR. Furthermore we assume that ESR would be related with the disease severity index and decreased general and disease-specific health-related quality of life (HRQoL). A pilot study has been conducted with 86 outpatients (65% female) with IBS, average age 47.76 (SD=13.68). The preliminary results were partly in favor of our hypothesis. They showed that IBS patients with higher ESR expressed lower disease-specific HRQoL (e.g. they expressed more bowel symptoms, social and emotional disturbances related to disease). No significant correlations were found between ESR and the disease severity as well as general HRQoL.

Gender related differences in quality of life and affective status in patients with inflammatory bowel disease.

According to the literature, quality of life has been shown to be reduced in females compared with males with Inflammatory Bowel Disease (IBD). Psychosocial factors are also playing an important role in IBD, especially emotional lability. The aims of study was to investigate the sex differences in general and specific health-related quality of life (HRQoL), anxiety and depression in IBD patients. Hundred and twelve outpatients of the Gastroenterology Division, Clinical Hospital Centre Rijeka, were enrolled in our study and divided in two groups: 50 females (31 with ulcerative colitis, UC and 19 with Crohn disease, CD) and 62 males (30 with UC and 32 with CD), age range 19 to 74 (M = 41.46; SD = 13.06). Most patients have been in long clinical remission or with mild disease according to Clinical Disease Activity Index (CDAI) score for CD and Clinical Activity Index (CAI) score for UC. There were significant differences in physical (F = 13.96, p < .0001) and mental (F = 9.44, p < .001) component of the general HRQoL, emotional domain ((F = 9.26, p < .001) and bowel symptoms (F = 7.04, p < .001) of the Inflammatory Bowel Disease Quality of life (IBDQoL), as well as, in anxiety (F = 7.03, p < .001) and depression (F = 12.09, p < .0001) between men and women with IBD. Women have expressed significantly lower level of the general HRQoL and more emotional disturbances connected with their disease as well as more frequent bowel symptoms compared with men. Effect sizes of those differences were large. Results of this study confirm that women with IBD are more prone to the negative impact of the disease on their HRQoL than men. Women with higher level of depression and anxiety experienced more emotional disturbances, bowel and systemic symptoms and lower general HRQoL. These results should deserve more considerations in the clinical treatment of IBD patients.

Differences in the health-related quality of life, affective status, and personality between irritable bowel syndrome and inflammatory bowel disease patients.

OBJECTIVES: To investigate differences in the health-related quality of life (HRQoL), number of stressful life events, affective status, and some personality characteristics between patients with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) as well as their possible role in disease activity. METHODS: Fifty-six IBS outpatients, age range 25-75 years (mean = 48.64; SD = 13.04) and 43 outpatients with IBD, age range 19-74 years (mean = 42.90; SD = 15.44), participated in this study. Patients filled out the following questionnaires: Short-Form 36 Health Survey, Beck Depression Inventory, Spielberger's Trait-Anxiety Inventory, Big Five Inventory, and Stressful Life Events Questionnaire. RESULTS: There were significant differences in the physical component (F = 10.80, P<0.001) of the general HRQoL as well as in anxiety (F = 7.23, P<0.01) and neuroticism (F = 8.90, P<0.01) between patients with IBS and IBD. IBS patients showed a significantly higher level of anxiety and neuroticism and better physical aspects of general HRQoL compared with IBD patients. The results of standard regression analyses indicated that a significant predictor (beta = -0.44, P<0.01) for the perceived disease activity in IBS was neuroticism as a personality trait. CONCLUSION: The results of this study show that the patients with IBS are more prone to the effect of psychosocial variables on gastrointestinal symptoms compared with patients with organic gastrointestinal diseases such as IBD. IBS patients experienced a higher level of anxiety and expressed a higher level of neuroticism as a personality trait compared with IBD patients.

Medical and psychological parameters in overweight and obese persons seeking treatment.

The aim of the study was to analyse psychological characteristics and medical parameters in obese and overweight to identify the possible psychosocial consequences of obesity that may occur along with the numerous medical problems associated with excess body weight. Analysis was made on 296 patients (103 males and 193 females, median age 50, range 16-81) divided in three groups, depending on their Body mass index (BMI). Group I included 41 patients with BMI ranging from 25 to 29.9, group II included 170 patients with BMI from 30 to 34.9, and group III 85 patients with BM > or =35. We compared medical (glucose, cholesterol, triglycerides, HDL-cholesterol, systolic and diastolic blood pressure, body fat percentage) and psychological parameters (anxiety, depression, pros and cons of losing weight, self efficacy and four stages of change) in the patients included in the study. Univariate analysis has shown statistically significant difference among obese and overweight patients in goal weight, systolic and diastolic blood pressure, body fat percentage, glucose and cholesterol serum level. People with higher BMI (>30) found more advantages (pros) over disadvantages (cons) of weight loss but the level of anxiety and depression did not differ significantly among those 3 groups of patients. The results have shown that overweight and obese people have serious medical problems. They also differ in some psychological characteristics which have to be taken into consideration. Therefore, approach to these patients should be multidisciplinary, including dietary care, physical activity, psychological and medical care.

Acne vulgaris: myths and misconceptions among patients and family physicians.

The objective of the study was to evaluate the health beliefs and knowledge about acne among acne patients and family physicians. A total of 100 patients referred to a dermatologist for management of acne vulgaris and 120 family physicians completed questionnaires. The questionnaires consisted of questions about health beliefs, the natural course of the disease, the causes of acne, and a set of questions about the knowledge of acne therapy. Acne was considered as a trivial and transitory condition by 52% of the acne patients and 44% of the family physicians. The overall score of correct answers pertaining to the causes of acne among the acne patients and family physicians was 11 and 15%, respectively. The percentage of correct answers regarding the natural course of the disease was 6% for both subsets of subjects. Acne was believed to be curable by 96% of acne patients. Most patients (66%) believed that acne would improve immediately after the first treatment. The knowledge of isotretinoin teratogenecity was reasonable among family physicians (55% correct answers), but it was much lower for other side effects (9%). The overall score of correct answers regarding antibiotic therapy among family physicians was only 21%. Impact of the disease was underestimated by family physicians and also by acne patients. Overall knowledge pertaining to the causes, natural course and therapy was very low. Myths and misconceptions still exist among patients but also among family physicians.

Roles of stress, stress perception and trait-anxiety in the onset and course of alopecia areata.

Clinical observations suggest that the nervous system, including psychological factors, can influence the onset and course of alopecia areata (AA). The aim of this study was to determine whether stressful life events, stress perception, and trait-anxiety are risk factors in the onset and course of AA. A group of 45 patients diagnosed with AA and a group of 45 healthy controls were participants in the study. The patients with AA were divided into two subgroups: patients with a first episode of AA and patients with recidivism of the disease. All participants completed questionnaires addressing sociodemographic, clinical and psychological aspects of their disorder. The frequency and types of stressful life events experienced over the previous six months were recorded. Lemyre and Tessier's Mesure de Stress Psychologique was used to measure emotional, cognitive, behavioral, and physiological aspects of distress. Anxiety was evaluated by the Spielberg's Trait Anxiety Inventory. The subgroups of AA and the control group, using the same numbers of subjects matched for age and sex, education level, marital and employment status, were statistically compared. The number of patients with four stressful life events over the previous 6 months was significantly higher in the group of AA patients with recidivism of disease compared to the control group (P=0.004). There were no differences among the other groups with respect to the frequency of life events. Examination of the relationships between the two groups regarding anxiety, as well as perceived distress, revealed that the groups differed significantly with respect to psychosocial variables studied. A significantly higher degree of trait-anxiety and perceived distress were observed among patients in both AA subgroups (first onset and recidivism of AA) than in the healthy control group. The highest scores for anxiety and stress perception among examined groups were obtained in the group with recidivism of AA (33.42 +/- 12.71 and 90.32 +/- 50.74, respectively). Trait-anxiety and stress perception constitutes risk factors that may influence the onset and exacerbation of AA. The present study does not provide evidence of a significant role of stress in the onset of AA. Life events may play an important role in triggering of some episodes.