[Measuring alexithymia in fibromyalgia: the need for a multimodal measurement method to replace the TAS-20]. / Alexithymie bij fibromyalgie: meetinstrumenten; argumenten voor een multimodale benadering.

BACKGROUND: In an earlier publication that investigated alexithymia in fibromyalgia, we showed the Toronto Alexithymia Scale was the only instrument being used to measure alexithymia. AIM: To find out which instruments are currently available for measuring alexithymia, to compare the psychometric properties of these instruments and to decide whether some of the test methods involved should be used to give extra value to alexithymia research. METHOD: We conducted a systematic review of the literature in Medline/PubMed with a number of search terms. We selected articles relating to psychometric properties of the tests performed and decided whether they could be influenced by negative affect. RESULTS: We found that 14 different instruments were used to measure alexithymia. From our evaluation we excluded tests which had weak psychometric properties or had been inadequately assessed. There remained three observation scales and two self-report questionnaires, which had been adequately validated and whose relative strengths and weaknesses were compared. CONCLUSION: In view of these findings, we recommend that in studies of alexithymia in fibromyalgia a multimodal measurement method should be used rather than only the tas-20.

[Hyperkinetic disorders in children and adolescents in Germany: administrative prevalence and regional differences regarding the frequency of diagnosis assignment]. / Hyperkinetische Störungen bei Kindern und Jugendlichen in Deutschland: Administrative Prävalenz und regionale Unterschiede in der Diagnosehäufigkeit.

OBJECTIVE: To analyse the administrative prevalence and regional differences in hyperkinetic disorder (HK) diagnoses in Germany. METHODS: The administrative prevalence of HK (ICD-10 F90) was analysed for 3,6 million children, up to 18 years old and in the whole year 2009 insured by the AOK, using health insurance data. Additionally, administrative prevalence changes between 2006 and 2008 were investigated. The prevalence analyses were differenciated according to postal code areas and regions of the associations of statutory health insurance physicians (SHIP-regions). RESULTS: The analyses revealed a continous increase of the administrative HK-prevalence between 2006 (2,8 %) and 2009 (3,8 %). The administrative prevalence was notably lower in the city states Bremen, Hamburg and Berlin, but rather high in four of five SHIP-regions in the New Laender. 14 % of children with HK were diagnosed with HK and ICD-10 F98.8. In 47 % these different diagnoses had been coded by different physicians. CONCLUSIONS: Regional differences in administrative prevalence rates and discrepancies in diagnosis coding by different physicians may indicate uncertainties regarding HK-diagnosis in routine health care. Future studies should analyse these associations more detailed.

Extinción diferencial de los acontecimientos vitales en pacientes depresivos / Differential extinction of life events in depressed patients

Introducción: La pérdida constituye un aspecto central de la mayoría de los acontecimientos vitales (AV) que llevan a la depresión. En este trabajo investigamos si aquellos AV que suponen una pérdida importante generan un mayor impacto en la génesis de la enfermedad y si tienen un mayor tiempo de extinción que el resto de los sucesos. Método: Utilizamos una muestra de casos y controles de 50 pacientes deprimidos que habían sido diagnosticados con un episodio depresivo en los 6 meses previos a la entrevista, 50 controles sanos y una muestra comunitaria de 609 mujeres. La Life Events and Difficulties Schedule (LEDS) se aplicó a todos los sujetos. Se utilizó un método estadístico de extinción diferencial que segrega los AV según la existencia de acontecimientos importantes de pérdida. Resultados: En ambas muestras, los pacientes depresivos presentaban un incremento significativo de AV graves en las 52 semanas previas al desencadenamiento del trastorno. La mejor diferenciación entre grupos se correspondió con los tiempos de extinción más elevados. La diferencia de medias de la amenaza residual en la muestra comunitaria entre AV con pérdida y sin ella en sujetos depresivos y controles fue significativamente más alta en los AV con pérdida. Conclusiones: El método de extinción diferencial que segrega los AV en función de la existencia de pérdida o no permite una mejor diferenciación entre pacientes depresivos y controles. Aquellos AV que suponen una pérdida importante generan un mayor impacto en la génesis de la enfermedad y tienen un mayor tiempo de extinción que el resto de los sucesos

Examining classification criteria: a comparison of three cut score methods.

This study compared 3 different methods of creating cut scores for a screening instrument, T scores, receiver operating characteristic curve (ROC) analysis, and the Rasch rating scale method (RSM), for use with the Behavioral and Emotional Screening System (BESS) Teacher Rating Scale for Children and Adolescents (Kamphaus & Reynolds, 2007). Using the BESS norm data set, we compared the methods across 7 classification indices. Additional information about accuracy was used with a subset of children who had been given a prior diagnosis for selected disorders. The results showed that the methods were generally in concordance, with similarities identified across methods. RSM and ROC analysis methods performed similarly, with both methods identifying the same optimal cut-point. The method based on T scores appeared to be more conservative, identifying a lower cut score as optimal.

Introduction to the special issue on personality assessment in medical settings.

This special issue of the Journal of Personality Assessment brings together 3 review articles and 5 research studies on personality assessment in medical settings that should help clinicians become more familiar with the current status of this field. In 1 review article, Sirri, Fabbri, Fava, and Sonino (2007/this issue) summarize evidence of a new approach to the assessment of psychological syndromes in somatizing patients based on the Diagnostic Criteria for Psychosomatic Research (Fava et al., 1995). The other reviews focus on 2 personality constructs widely used in investigations with medical patients. Kupper and Denollet (2007/this issue) review the Type D personality, whereas Lumley, Neely, and Burger (2007/this issue) provide an overview of alexithymia. Of the research articles, 2 also focus on alexithymia, specifically on the factor structure of the 20-item Toronto Alexithymia Scale (Bagby, Parker, & Taylor, 1994), which is the best-validated and most commonly used measure of alexithymia (Bagby, Taylor, Quilty, & Parker, 2007/this issue; Gignac, Palmer, & Stough, 2007/this issue). The other 3 research studies examine the relationship between specific personality dimensions (behavioral problems relevant to medicine, resiliency, and interpersonal sensitivity) and medical outcomes (adherence to treatment, coping with injury, and postsurgical sexual functioning) from medical samples of patients with HIV, spinal cord injury, and prostate carcinoma (Berry, Elliott, & Rivera, 2007/this issue; Cruess, Meagher, Antoni, & Millon, 2007/this issue; Siegel et al., 2007/this issue). Each article touches on the role person variables can play in the expression of medical problems.

Alexithymia in chronic fatigue syndrome: associations with momentary, recall, and retrospective measures of somatic complaints and emotions.

OBJECTIVE: The relationship between alexithymia and real-time momentary symptom assessments has not been reported. This cross-sectional study hypothesized that alexithymia would be a predictor of somatic symptoms using three different types of symptom measurement (momentary, recall, and retrospective) in the medically unexplained illness of chronic fatigue syndrome (CFS). In addition, it was hypothesized that negative affect would be a significant mediator of the relationship between alexithymia and somatic symptoms. Finally, the relation of alexithymia to physical illness attribution (a CFS illness predictor) was explored. METHODS: Participants were 111 adults with CFS. Alexithymia was assessed with the Toronto Alexithymia Scale. Momentary ratings of current symptoms and affect were recorded in electronic diaries carried for 3 weeks. Weekly recall of these momentary reports was also recorded. Retrospective measures included 6-month ratings of fatigue and pain, the Fatigue Severity Scale, the Brief Pain Inventory-Short Form, a CFS symptom measure, the Beck Depression Inventory-II, the Beck Anxiety Inventory, and an illness attribution rating. RESULTS: Partial correlations, controlling for age and sex, yielded no significant associations between general or specific forms of alexithymia and momentary ratings of fatigue or pain. On the other hand, a significant association, partially mediated by anxiety scores, was found between a specific form of alexithymia and a retrospective pain measure. Finally, physical illness attribution was not significantly associated with alexithymia. CONCLUSION: Based on assessments of real-time and retrospectively measured symptoms, these data provided only modest support for the alexithymia construct as a predictor of somatic symptoms in people with CFS.

Decreased cytotoxic lymphocyte counts in alexithymia.

BACKGROUND: Alexithymia is a psychological trait characterized by a difficulty in verbalizing feelings, which has been associated with a number of illnesses, including bronchial asthma and cancer. METHODS: In order to understand how psychological variables such as alexithymia affect physical health, we compared the lymphocyte subsets of men (n = 97, mean 30.6) rated as high and low alexithymic when measured by the Toronto Alexithymia Scale (TAS). We analyzed our data by considering alexithymia a categorical variable, using TAS scores of 62 and below, and 74 and above, and by considering alexithymia a continuous variable, using the mean TAS score (64.01) separating high from low alexithymia. RESULTS: When alexithymia was considered a categorical variable, highly alexithymic men had significantly lower numbers of the most cytotoxic natural killer (NK) subset, (CD57-CD16+ cells). When alexithymia was considered a continuous variable, in addition to the NK subset, killer effector T cell (CD8+CD11a+ cells) count was also significantly lower. These results were obtained after controlling for possible effects of smoking and alcohol intake. CONCLUSIONS: These results suggest that the negative modulation of cellular immunity, especially the cytotoxic lymphocytes, may be one mechanism which, combined with other factors that have a negative effect on the immune system such as stress, results in the association between alexithymia and ill health. It is suggested that future studies should, in addition to cell counts, attempt to identify the effects of psychological variables on the cytolytic activity of cytotoxic lymphocytes. Furthermore, follow-up studies should monitor the subjects over the years to demonstrate that alexithymia-mediated negative modulation of the immune system results in clinical pathologies.

Modelos multidimensionales de la sintomatología esquizofrénica / Multidimensional models of the schizophrenic symtoms

La distinción de 2 dimensiones en la esquizofrenia, representadas por los síntomas positivos y negativos, ha estimulado la investigación fisiopatológica, anatómica y psicofarmacológica. Los estudios han confirmado la utilidad de una aproximación multidimensional a la esquizofrenia, pero demuestran que la enfermedad no puede reducirse a sólo dos dimensiones. Se han propuesto modelos con 3 o más dimensiones, las que surgen fundamentalmente de la incisión de los síntomas positivos en diversos factores

[The subjective experience in catatonia: systematic study of 24 catatonic patients]. / Subjektives Erleben in der Katatonie: Systematische Untersuchung bei 24 katatonen Patienten.

Catatonic patients are often not able to communicate their subjective experiences behind their "fassade of immobility." Therefore was retrospectively (3 weeks later) investigated subjective experiences in 24 catatonic patients with a self-assessment-scale especially for catatonia developed by us. Our results showed that catatonic patients subjectively experience less their altered movements but rather cognitive, i.e. ambivalence, or affective, i.e. intense emotions which couldn't be controlled, alterations. According to our results we were able to distinguish an emotive (intense anxiety) from a non-emotive, i.e. cognitive (predominating ambivalence), subtype in catatonia with regard to subjective experience.

Percepción de la enfermedad mental en pacientes de consulta médica general / Perception of mental illness in patients of medical general practice

Se presentan los datos de un proyecto de investigación desarrollado en el Instituto Mexicano de Psiquiatría, en el que se aplicó una cédula que tuvo como objetivo: conocer la manera en que los pacientes perciben y definen a las enfermedades mentales; y determinar el nivel de conocimiento que poseen sobre ellas, así como sus posibilidades de tratamiento. La población de estudio se formó con pacientes de entre 18 y 64 años de edad que acudieron con el médico general familiar a solicitar atención en un centro de salud, ubicado en el suroeste de la ciudad de México. Se realizó un muestreo aleatorio sistemático de uno de cada dos pacientes, quienes fueron incluidos en la muestra de estudio. En esta primera versión, el instrumento fue desarrollado por los investigadores responsables del proyecto. La escala consta de cinco reactivos; el primero se responde afirmativa o megativamente, los cuatro siguientes corresponden a preguntas referentes al concepto que se tiene de problema o trastorno emocional, psiquiátrico, psicológico o nervioso, así como a dónde y con quién acudir. Por último, se cuenstiona el significado de tres conceptos: enfermedad mental, trastorno emocional y psiquiatra. Esta cédula fue aplicada mediante entrevista directa por psicólogos previamente calificados en su manejo, así como en los métodos y los procedimientos. También se aplicó una ficha de identificación. De esta forma la muestra de estudio quedó integrada por 461 pacientes, de los cuales la mayoría fueron mujeres jóvenes, casadas o en unión libre, de escolaridad primaria, y que de acuerdo a su nivel de escolaridad, ocupación e ingreso, podríamos identificar como de nivel medio-bajo y bajo. Con respecto a la pregunta ¿Sabe usted lo que es un trastorno o problema de tipo emocional?, más de la mitad de los pacientes (57.5 por ciento) reportó " no saber". Al cruzar esta variable con la de escolaridad, encontramos diferencias estadísticamente significativas (p= .001). También se pudo determinar el hecho de que relacionaran o identificarran al trastorno emocional con "tener problemas y no poder resolverlos", así como el que la "familia" y el "Centro de salud" fueran las opciones más viables en una posible búsqueda de ayuda y atención.

Ansiedade e ansiolíticos na prática clínica / Anxiety and anxiolitics in clinical practice

O Distúrbio Generalizado de Ansiedade (DAG) constitui-se em um quadro clínico de grande freqüência, que acarreta sofrimento e pertubaçäo no desempenho do indivíduo. Este estado deve ser diferenciado da ansiedade normal e dos distúrbios ansiosos orgânicos. O autor faz uma análise crítica do emprego dos ansiolíticos no tratamento da DAG em termos de riscos e benefícios, enfatizando a necessidade de uma abordagem global do paciente, através de instrumentos terapêuticos múltiplos

Sensibilidade do diferencial semântico na caracterizaçäo de termos previamente classificados como designadores de diferentes intensidades de alguns estados subjetivos / Sensibility of the semantic differential in the characterization of terms previously classified as indicators of different intensities of selected subjective states

Foi testada a sensibilidade do Diferencial Semântico (DS) em relaçäo a variaçöes de intensidade de um mesmo estado subjetivo. Universitários de 1§ ano (161 Ss) receberam uma folha com 10 grupos de palavras sinônimas. De cada grupo deveriam selecionar três palavras usando um duplo critério: as de uso mais freqüente e que, simultaneamente, representassem níveis de intensidade fraco, médio e intenso do estado subjetivo designado. As palavras resultantes desta primeira fase foram reavaliadas, dois meses depois, por 146 Ss da mesma amostra, utilizando-se a versäo modificada do DS descrita por Engelmann. Os resultados mostram que o DS foi sensível a variaçöes de intensidade. O grau de atribuiçäo de uma característica a um determinado estado subjetivo varia se o termo que o designa representa uma ou outra intensidade desse estado. Säo feitas consideraçöes metodológicas sobre as vantagens de se utilizar palavras que designam diferentes intensidades dos estados subjetivos avaliados em estudos deste tipo