Health, self-regulation of bodily signals and intelligence: review and hypothesis.

Childhood IQ and adult morbidity and mortality are known to be linked even beyond socioeconomic variables. Yet, their interrelations are insufficiently understood. It has been suggested that bodily sensations play a fundamental role in health-related self-regulation and that intelligence can influence the information processing of these somatic signals. This assumption is supported by reports on the influence of IQ on the exteroceptive (e.g. visual and auditory) and interoceptive (e.g. autonomic nervous system and posture) perception and processing of somatic information. Based on these findings the hypothesis of Psychosomatic Intelligence (PI) is introduced as an additional conceptual framework to probe the link between childhood IQ and adult health status. It implies a specific cognitive ability concerning the perception, interpretation, and self-regulation of bodily sensations. In this model, somatic signals are considered to reflect both intra-individual processes and individual-environment interactions. Based on this hypothesis the influence of intelligence on cognitive efforts to self-regulate somatic phenomena is amenable to systematic testing.

Psychosomatic medicine in primary care: influence of training.

BACKGROUND: General practitioners (GPs) are often confronted with patients presenting somatic symptoms presumed to be decisively modulated by psychosocial factors. OBJECTIVES: We aimed to explore GPs' reported clinical routine in dealing with these patients according to the GPs' level of training in psychosomatic medicine. METHODS: A structured postal questionnaire survey was conducted among all Austrian GPs with a standardized training background in psychosomatic medicine (three levels of training; duration between one and six years) as well as in a random national sample of Austrian GPs without such training, resulting in four study subgroups. RESULTS: Respondents estimated that between 20% and 40% of their patients presenting somatic symptoms need psychosocial factors to be addressed. Study subgroups differed significantly concerning their reported diagnostic and therapeutic routine behavior patterns. Some diagnostic approaches such as clarification of lay etiology increased linearly with the level of training. The proportion of patients receiving corresponding treatment in the GP's own practice was also reported to increase with the level of training (no training: 35%, levels one and two: 46%, level three: 54%), although all subgroups estimated that over 20% of patients do not receive any corresponding treatment. CONCLUSIONS: Results point at the clinical relevance of a general training in psychosomatic medicine in primary care. They also suggest specific training effects that need to be substantiated in observational studies.

[Austrian Network for Psychosomatic Medicine: background, development and participation]. / Aktuelle Informationen aus der Deutschen Gesellschaft für Psychosomatische Medizin und Arztliche Psychotherapie.

OBJECTIVES: Physicians as well as the general public need easy access to information on regional psychosomatic treatment options as can be provided by a network website. We therefore set out to explore the readiness of the Austrian psychosomatic community to participate in a network for Psychosomatic Medicine and actively contribute to its website. METHODS: All Austrian psychosomatic societies and all psychosomatic in-patient facilities were addressed personally and/or by letter. Through articles published in medical journals, physicians in private practices specialized in psychosomatic-psychotherapeutic medicine were also invited to participate. RESULTS: All departments of medical psychology and psychotherapy, all psychosomatic societies and all psychosomatic in-patient facilities in Austria decided to participate in this network. In addition, 100 physicians in private practice applied for registration in the network. DISCUSSION: These results support the network concept and have led to its implementation, and clearly, the network should be further developed. The first precondition for its functioning seems to be met.

Depressive symptoms following herpes simplex encephalitis--an underestimated phenomenon?

OBJECTIVE: In view of the herpes simplex virus' neurotropism for the limbic system and the temporal lobe, little is known about potential negative effects of this necrotizing encephalitis on affective functioning and health-related quality of life (HRQoL) after recovery. We therefore set out to explore an association between herpes simplex virus encephalitis (HSE) and both depressive symptoms and HRQoL. METHODS: A structured telephone interview was conducted in 26 subjects (F/M=10/16; age at follow-up, 49.3+/-15.0 years; range, 29-80) at a mean time interval of 5.2+/-3.1 years (range, 1-11) after their initial diagnosis of HSE. WHO-5 Well-Being Index (WHO-5) was used as screening instrument for depression, and Short Form-12 was used as HRQoL instrument. We also determined the spatial extent of morphologic abnormalities on magnetic resonance imaging (MRI). RESULTS: Ten of the interviewees (38.5%) had a WHO-5 score below 13, which is considered indicative of a depressive disorder. Accordingly, concerning their HRQoL, patients felt more impaired by affective than by physical symptoms. MRI ratings and WHO-5 score were not correlated. CONCLUSIONS: While this pilot study does not allow to establish a causal relationship with focal brain damage, findings suggest both a high frequency of depressive symptoms and a low quality of life with respect to mental health following HSE. These results should be confirmed by a prospective trial.

[Psychosomatic medicine and psychotherapy in Austria]. / Psychosomatik und Psychotherapie in Oösterreich.

In present-day Austria, psychosomatic medicine and psychotherapy enjoy significantly more sociopolitical and cultural recognition perhaps as a heritage from the days of the Austrian monarchy -- than is reflected in their real presence. This development can be traced back to prewar times and the repudiation of the destructive national socialistic ideology. There is an immanent conflict between specialization in psychosomatic medicine and psychotherapy as an independent field of medicine and the integration of a psychosomatic basic approach into the general fields of medicine. The organization of psychotherapy is doubly anchored in the laws governing medical practice (PSY diploma) and the statutes governing the practice of psychotherapy; this, however, has not resolved the sensitive and only partially creative tension between the two. Austrian medical health politics are currently characterized by renewed efforts to organize the field of psychosomatic medicine. Should medical psychology and psychotherapy, internal medicine, psychiatry or general medicine provide the foundations for this new organization? This conflict is crucial since it will influence the further development of the entire medical field.

[Empowerment in diabetes mellitus: theory and practice]. / Empowerment bei Diabetes mellitus: Theorie und Praxis.

Since 1989 the concept of empowerment and the promotion of self-care management have been generally proposed for Diabetes care. The bio-psycho-social concept of empowerment aims at encouraging the patient to develop self-care management for Diabetes treatment that is evidence-based and in accordance with the patient's goals and life style. It therefore promotes the patient's autonomy. With regard to HbA1c and life-quality parameters, it has been proven to be effective. Prerequisites for implementing empowerment as therapeutic intervention are: interest in the individual reality of the patient, a patient-centred communication style and an adequate time management. In this article we describe the theoretical aspects of the concept of empowerment and propose practical recommendations for the empowerment of patients suffering from Diabetes mellitus.