Crying Without Tears: Dimensions of Crying and Relations With Ocular Dryness and Mental Well-Being in Patients With Sjögren's Syndrome.

This study examined dimensions of crying and its relations with ocular dryness and mental well-being in patients with Sjögren's syndrome, a systemic autoimmune disease with dryness as primary symptom. Three-hundred patients with Sjögren's syndrome completed questionnaires on crying, dryness, and well-being. The crying questionnaire revealed four dimensions: "Cryability" (comprising both crying sensibility and ability to cry), Somatic consequences, Frustration, and Suppression. Compared to 100 demographically-matched control participants from the general population, patients scored low on Cryability and high on Somatic consequences and Frustration. The crying dimensions generally showed significant but weak associations with ocular dryness and mental well-being in patients. This is the first quantitative study indicating that crying problems are more common in patients with Sjögren's syndrome than in the general population. Perhaps, patients who experience problems with crying could be helped to rely on other ways of expressing emotions than crying in tear-inducing situations.

Longitudinal associations between maternal disrupted representations, maternal interactive behavior and infant attachment: a comparison between full-term and preterm dyads.

This prospective study examined whether or not a mother's representations of her infant were more often disrupted after premature childbirth. Furthermore, the study examined if different components of maternal interactive behavior mediated the relation between maternal disrupted representations and infant attachment. The participants were mothers of full-term (n = 75), moderately preterm (n = 68) and very preterm infants (n = 67). Maternal representations were assessed by the Working Model of the Child Interview at 6 months post-partum. Maternal interactive behavior was evaluated at 6 and 24 months post-partum, using the National Institute of Child Health and Human Development Early Care Research Network mother-infant observation scales. Infant attachment was observed at 24 months post-partum and was coded by the Attachment Q-Set. The results reveal that a premature childbirth does not necessarily generate disrupted maternal representations of the infant. Furthermore, maternal interactive behavior appears to be an important mechanism through which maternal representations influence the development of infant attachment in full-term and preterm infants. Early assessment of maternal representations can identify mother-infant dyads at risk, in full-term and preterm samples.

Assessing the impact of chemotherapy-induced peripheral neurotoxicity on the quality of life of cancer patients: the introduction of a new measure.

PURPOSE: To investigate the impact of chemotherapy-induced neurotoxicity on daily activities and quality of life (QoL) of cancer patients. METHODS: QoL of all patients visiting the oncological outpatient ward of the Maxima Medical Centre in the Netherlands from October 2006 until March 2007 treated with taxanes, vinca-alkaloids and/or platinum compounds (n = 88) was compared with the QoL of patients that did not receive these treatments yet (n = 43). Patient-reported neuropathy symptoms were evaluated with the newly developed Chemotherapy Induced Neurotoxicity Questionnaire (CINQ) and the Functional Assessment of Cancer Therapy/Gynaecologic Oncology Group/Neurotoxicity (FACT/GOG-Ntx) questionnaire. RESULTS: Patients treated with chemotherapy reported significantly more complaints of neuropathy (p < 0.001) and more paresthesias and dysesthesias in the upper (p < 0.001; p < 0.01) and lower extremities (p < 0.001) compared to those not treated with chemotherapy. They additionally experienced problems with fine motor function (e.g., getting (un)dressed, writing, and picking up small objects). Moreover, cold-induced paresthesias were frequently reported. Overall, patients indicated that their neuropathy had a negative effect on QoL. CONCLUSIONS: The newly developed CINQ and the FACT/GOG-Ntx results suggest a considerable negative impact of patient-reported neuropathy symptoms on daily activities and QoL in cancer patients treated with chemotherapy. However, further validation of the CINQ is needed.

Posttraumatic stress disorder, anxiety and depression following pregnancies conceived through fertility treatments: the effects of medically assisted conception on postpartum well-being.

OBJECTIVE: To compare the postpartum prevalence of Posttraumatic Stress Disorder (PTSD), anxiety and depression in women who conceived via medically assisted conception (MAC) and women who conceived naturally. STUDY DESIGN: All women (n = 907) who delivered under supervision of four independent midwifery practices and three hospitals in the Netherlands during a 3-month period were asked to complete questionnaires on demographic, logistic, psychosocial and obstetric characteristics two to six months postpartum. In this cross-sectional study PTSD was measured with the Traumatic Event Scale-B; anxiety and depression were measured with the Hospital Anxiety and Depression Scale. RESULTS: The response rate was 47% (428 participants). No significant differences were found in the prevalence of PTSD (0.0% vs. 1.3%; odds ratio [OR] = 0.0, confidence interval [CI]: 0-infinity), anxiety (28.1% vs. 22.2%; OR = 1.4, CI: 0.6-3.1) and depression (9.4% vs. 14.6%; OR = 0.6, CI: 0.8-2.0) between the 32 women who conceived via MAC and the 396 women who conceived naturally. CONCLUSION: We did not find significant differences in the prevalence of PTSD, anxiety and depression between women who conceived via MAC and women who conceived naturally.

Subjective emotional responses to IAPS pictures in patients with borderline personality disorder, cluster-C personality disorders, and non-patients.

According to Linehan (1993), emotion dysregulation is a central feature of borderline personality disorder (BPD). We hypothesized that patients with BPD are emotionally hyperresponsive. For BPD treatment, it is important to evaluate this hypothesis, because, if it is supported, therapeutic interventions could be designed to help patients to better manage hyperemotional reactions. We investigated the subjective reactions (in terms of valence and arousal) of patients with BPD to visual emotional stimuli of the International Affective Picture System (IAPS). We hypothesized that, compared to patients with Cluster-C personality disorders and non-patients, BPD patients would show higher scores on the arousal dimension and higher negative scores on the valence dimension when rating IAPS pictures with varying degrees of arousal and valence. Ratings of valence and arousal for 40 IAPS pictures were collected from 39 borderline personality disorder (BPD), 36 patients diagnosed with Cluster-C personality disorders (PD), and a group of 226 non-patients. Contrary to expectations, BPD patients did not differ from the non-patients. This indicates that their self-report scores do not reflect hypersensitivity. We found that patients with BPD showed lower scores on arousal than Cluster-C PD patients. The scores on valence suggested that Cluster-C PD patients also experienced more positive emotions than BPD patients.

A comparison of quality of life, disease impact and risk perception in women with invasive breast cancer and ductal carcinoma in situ.

We compared the health-related quality of life, impact of the disease, risk perception of recurrence and dying of breast cancer, and understanding of diagnosis of patients with ductal carcinoma in situ (DCIS) and invasive breast cancer 2-3 years after treatment. We included all women (N=211) diagnosed with DCIS or invasive breast cancer TNM stage I (T1, N0, and M0) in three community hospitals in the southern part of The Netherlands in the period 2002-2003. After verifying the medical files, 180 disease free patients proved eligible for study entry, 47 of whom had DCIS and 133 stage I invasive breast cancer. One-hundred and thirty-five patients returned a completed questionnaire (75% response). No significant differences were found between women with DCIS and invasive breast cancer on the physical and mental component scale of the RAND SF-36, nor on the WHO-5, which assesses well-being. In contrast, women with DCIS reportedly had a better physical health, better sex life and better relationships with friends/acquaintances than women with invasive breast cancer. Despite their better prognosis, the DCIS-group had comparable perceptions of the risk of recurrence and dying of breast cancer as women with invasive breast cancer. However, this did not appear to affect their well-being significantly.

[Medically unexplained somatic symptoms are not unexplainable, misunderstood or vague physical complaints]. / Medisch onverklaarde somatische symptomen zijn geen onverklaarbare, onbegrepen of vage lichamelijke klachten.

BACKGROUND: In the current literature and in clinical practice a very wide range of terms is used to describe medically unexplained somatic symptoms; this gives rise to a number of problems. AIM: To propose an unambiguous multidisciplinary terminology which can solve a number of problems. METHOD: A literature search was conducted using the database PiCarta and references in the literature found via that database. results The terms used in the current literature and the meanings they are given are very diverse and in several instances the terms and meanings are confusing, inaccurate or unclear. CONCLUSION: The use of the terms 'medically unexplained somatic symptoms' and 'unexplained somatic symptoms' is a possible solution for many of the problems that arise.

[The emotional burden of secrets. Consequences for somatic health and implications for health care]. / De emotionele belasting van geheimen. Gevolgen voor de somatische gezondheid en implicaties voor de hulpverlening.

BACKGROUND: There is increasing evidence that emotionally burdensome secrets may play a role in predisposing an individual to develop somatic symptoms. AIM: To provide an overview of the empirical evidence and theories concerning the relations between secrets and somatic health and to discuss the implications of these associations for health care. METHOD: We searched for peer-reviewed publications in Medline, ScienceDirect, Psycinfo and Web of Science, using as search terms 'secrecy', 'geheimhouding', 'self-concealment', 'disclosure', 'inhibition' and 'health'. RESULTS: Secrets are associated with an increased risk of somatic dysfunctioning, probably because they induce pathophysiological processes. The theories currently available provide adequate backing for further studies of this association. CONCLUSION: Secrets seem to provoke pathophysiological processes that can affect a person's physical wellbeing. This means that health care professionals must realize that the emotional burden of secrets may contribute to a patients somatic symptoms.

As tears go by: Baby tears trigger more brain activity than adult tears in nulliparous women.

The current functional magnetic resonance imaging study examines brain activity during the perception of infant and adult tears. Infant tears evoke stronger responses in the visual cortex than adult tears, indicating that infant tears are highly salient. In addition, our study shows that infant tears uniquely activate somatosensory pain regions, which could stimulate actions directed at the elimination of the source of pain. Shedding tears may be a strong means to elicit the parent's sharing of the infant's feelings, thereby strengthening caregiver-infant bonding and securing infant survival.

Risk, severity and predictors of physical and psychological morbidity after axillary lymph node dissection for breast cancer.

The aim of this study was to investigate the nature and severity of the arm complaints among breast cancer patients after axillary lymph node dissection (ALND) and to study the effects of this treatment-related morbidity on daily life and well-being. 400 women, who underwent ALND as part of breast cancer surgery, filled out a treatment-specific quality of life questionnaire. The mean time since ALND was 4.7 years (range 0.3-28 years). More than 20% of patients reported pain, numbness, or loss of strength and 9% reported severe oedema. None of the complaints appeared to diminish over time. Irradiation of the axilla and supraclavicular irradiation were associated with a 3.57-fold higher risk of oedema (odds ratio (OR) 3.57; 95% confidence interval (CI) 1.66-7.69) causing many patients to give up leisure activities or sport. Women who underwent irradiation of the breast or chest wall more often reported to have a sensitive scar than women who did not receive radiotherapy. Women <45 years of age had an approximately 6 times higher risk of numbness of the arm (OR 6.49; 95% CI 2.58-16.38) compared with those > or = 65 years of age; they also encountered more problems doing their household chores. The results of the present study support the introduction of less invasive techniques for the staging of the axilla, sentinel node biopsy being the most promising.

Psychosocial aspects of hyperprolactinemia.

Fourteen mildly hyperprolactinemic women and 14 matched controls were compared with respect to biographical data, self-reported emotional and somatic well-being, and cortisol production. The patients had significantly more often experienced a separation from their parents in childhood. No differences were found for cortisol levels and emotional and somatic well-being. Future studies also should focus on personality, coping, and defense mechanisms in order to explain these contrasting findings.

Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy.

AIMS: The use of axillary lymph node dissection (ALND) in women with breast cancer is associated with considerable morbidity. Sentinel node biopsy (SNB) removes the lymph node in the axillary basin indicative for receiving first lymphatic drainage from the breast. This study compares the nature and severity of physical morbidity among breast cancer patients who underwent primary surgery for breast cancer combined with either ALND or SNB. Also, it assesses influence of subsequent radiotherapy on morbidity. METHOD: Two hundred and thirteen ALND patients were compared with 180 SNB patients retrospectively. Morbidity was measured using a disease-specific quality-of-life questionnaire. RESULTS: Patients' demographic characteristics were alike. The axillary procedure is the strongest and most consistent factor in explaining differences in a variety of self-reported complaints. Patients having had SNB have a 3.2-fold lower risk of experiencing pain, a 5-fold lower risk of lymph oedema, a 7.7-fold lower risk of numbness, a 3.7-fold lower risk of tingling sensations, a 7.1-fold lower risk of loss of strength in arm/hand, a 3.6-fold lower risk of loss of active motion range of the arm and a 2.9-fold lower risk of impaired use of the arm. Axillary radiation therapy adds to complaints next to the axillary surgical procedure by increasing the risk of lymph oedema 2.4-fold and enhancing the risk of impaired use of the arm by 2.6-fold. Axillary radiation therapy does not explain lymph oedema by itself. CONCLUSION: SNB is associated with less morbidity compared to ALND in patients with primary breast cancer.

Psychobiological factors related to human natural killer cell activity and hormonal modulation of NK cells in vitro.

The present report investigated whether percentages of circulating natural killer (NK) cells and NK cell activity (NKCA) are associated with psychological variables. Subjects (n = 95) were selected, based on a combination of low or high scores on questionnaires on daily hassles and self-reported symptoms, to create four extreme groups. NK cell percentages were different between two of the four groups, only when the analysis was not controlled for gender, life style and endocrine parameters. No evidence was found for a relationship between group membership and NKCA. NKCA, however, was found to differ between men and women and to be associated with percentages of NK cells and intracellular levels of cAMP. Furthermore, the hypothesis was tested, that hormone-induced changes in NKCA in vitro are dependent on the individual's current stress profile. To investigate this issue, NKCA was measured after cells had been incubated with hydrocortisone (10(-6) or 10(-7) M) or the beta-adrenergic agonist isoprenaline (10(-5) or 10(-7) M) in vitro. Changes in NKCA were found to be related to plasma adrenaline levels, but no evidence was found for involvement of psychological variables. It is concluded that, in the current setting, there is no association between the combination of scores on the two psychological questionnaires, and NKCA or hormone-induced changes therein.

Psychological aspects of in vitro fertilization: a review.

This paper reviews psychological research within the context of in vitro fertilization (IVF). The focus will be on psychological reactions before entering an IVF-procedure, during an IVF-treatment, and after both unsuccessful and successful IVF. The effects of psychosocial factors on the treatment outcome after IVF and interventions on conception rates will also be discussed. Undergoing an IVF-treatment is an emotional and physical burden, for both the woman and her partner. Research results suggest that couples entering an IVF-treatment program are, in general, psychologically well adjusted. Concerning reactions during the treatment, both women and men experience waiting for the outcome of the IVF-treatment and an unsuccessful IVF. as most stressful. Common reactions during IVF are anxiety and depression, while after an unsuccessful IVF, feelings of sadness, depression and anger prevail. After a successful IVF-treatment, IVF-parents experience more stress during pregnancy than 'normal fertile' parents. Mothers with children conceived by IVF express a higher quality of parent child relationship than mothers with a naturally conceived child. Research further suggests that psychosocial factors, like ineffective coping strategies, anxiety and/or depression are associated with a lower pregnancy rate following IVF-procedures. In addition, support has been found suggesting that stress reduction through relaxation training or behavioral treatment improves conception rates.

Stress research: its present status and issues for future developments.

In this article the contribution of nine approaches to stress research is discussed. These approaches are: (1) the biological approach; (2) the (classic) psychosomatic approach; (3) the life event approach; (4) interactionistic or transactional approaches; (5) life style and behavior; (6) group differences; (7) sociocultural (macro-)factors; (8) work and organizational psychology; and (9) intervention and prevention. It is concluded that, more and more, exchanges take place between different approaches and that the willingness to collaborate increases. Not only do we observe collaboration between different disciplines, there also are examples of an integration of laboratory research and field research. In addition, interest of animal workers for human research and vice versa seems to increase. Although it is realized that stress research has its own inherent characteristic problems (e.g. ethics), the authors feel that the future still can bring important progress.

Opposite hemisphere differences in movement related potentials preceding foot and finger flexions.

Nine right-handed subjects performed an experiment in which the recording of the readiness potential (RP) and of the contingent negative variation (CNV) was combined. A microswitch was pressed by a voluntary foot or finger movement. 4 sec later a visual stimulus was presented, to which the subject had to respond as quickly as possible by making the same movement. Four electrode positions were used: C3, C4, C'3 and C'4, the latter two in between Cz and C3 or C4, respectively. The RPs showed larger amplitudes over the hemisphere, contralateral to the finger movement. Moreover, although not significant, RPs showed larger amplitudes over the hemisphere, ipsilateral to the foot movement. Late CNV waves were larger at C3 prior to a finger response and at C'4 prior to a foot response. This result is an argument for the hypothesis of a common underlying mechanism of RP and CNV late waves. Moreover, it suggests that motor preparation is a selective process which is related to the activation of a specific area in the motor cortex.

CNV and EMG preceding a plantar flexion of the foot.

In 25 subjects CNV and EMG were recorded during a reaction time experiment with a fixed 4 sec foreperiod. The response was plantar flexion of the right foot. EEGs were recorded with four electrodes from the central area, two over each hemisphere. CNV amplitudes were larger over the ipsilateral than over the contralateral hemisphere. Amplitudes were smaller in the more lateral derivations. The late component of the CNV showed larger amplitudes when preceding relatively fast responses. EMG activity was recorded from the calf muscles of both legs. In the left leg it was not different during the intertrial interval and the foreperiod. A small but systematic increase in EMG activity was found during the foreperiod in the right leg. The increase was larger preceding fast responses, parallel to the amplitude changes in CNV late waves.

Hypertension and pain sensitivity: effects of gender and cardiovascular reactivity.

Repeatedly, hypertensives have been found to appraise physical stressors as less aversive than normotensives. The main aim of the present study was to examine the effects of gender and cardiovascular reactivity in the relationship between hypertension and appraisal of pain. Forty-two unmedicated hypertensives and 21 normotensive controls of both genders were exposed to an electric current stimulus, while various cardiovascular parameters and prestressor anxiety were measured. In general, hypertensive women, but not men, showed diminished pain sensitivity compared to their normotensive counterparts. When the analyses were repeated with controlling for cardiovascular reactivity, the between-group effects were no longer significant. The results indicate that (i) profound gender differences exist in hypertension-related pain sensitivity and (ii) these effects seem to be mediated, at least partly, by cardiovascular reactivity.

Hypertension and appraisal of physical and psychological stressors.

OBJECTIVE: In the operant conditioning of hypertension hypothesis, it is assumed that the frequently found diminished sensitivity to painful stimuli in hypertensives can be generalized to sensitivity to other stressors, including psychological stressors. The validity of this assumption is examined in the present study. METHODS: Unmedicated hypertensives (42) and normotensive controls (21) of both sexes were exposed to a physical stressor (electric current) and psychological active coping (mental arithmetic, free speech) and passive coping (unpleasant films) tasks, while indices of prestressor anxiety and task appraisal were measured. RESULTS: Hypertensive women, but not men, showed diminished pain sensitivity, together with lower prestressor anxiety and a tendency to lower negative appraisal of the tasks, compared to their normotensive counterparts. In addition, positive correlations were obtained between pain sensitivity and negative appraisal of psychological stressors involving interpersonal threat (speech) and passive coping (films). CONCLUSION: Preliminary support has been obtained for extrapolation of diminished pain appraisal to appraisal of some psychological stressors (although for a part only in women); an important assumption in the operant conditioning hypothesis of hypertension.

Psychosocial factors and pregnancy outcome: a review with emphasis on methodological issues.

This review focuses on the research concerning the relation between psychosocial factors and pregnancy outcome. The following four outcome measures are dealt with: (1) birth weight, (2) preeclampsia, (3) preterm labour, and (4) intrapartum complications. The most consistent finding concerns the association between maternal exposure to taxing situations and preterm delivery. Three possible pathways are hypothesized: (1) an indirect influence via unhealthy coping and life style behaviour, (2) a direct influence via stress-dependent hormones, and (3) an additional direct influence via psycho-immunological factors. Intervention studies aimed at improving pregnancy outcome show fairly mixed results. It is recommended that studies on the relationship between psychosocial factors and pregnancy outcome should employ a prospective design with due attention to chronic stressors, should include appropriate biochemical assessments, and multivariate techniques are applied.