Itch Perception and Skin Reactions as Modulated by Verbal Suggestions: Role of Participant's and Investigator's Sex.

This study investigated sex-specific differences in itch perception and skin reactions, as modulated by verbal suggestions, and the role of the investigator's sex. Healthy volunteers (50 males, 50 females), divided into 4 groups, were tested by male and female investigators. Itch was induced via prick testing with sodium chloride and histamine in 4 runs; 2 control conditions (with no exaggerated verbal comments about expected itch) and 2 experimental conditions (with exaggerated verbal comments). After 5 min, wheal and flare reactions were measured and itch intensity was rated by subjects on a numerical rating scale. Exaggerated verbal suggestions resulted in higher itch intensity ratings in the sodium chloride and histamine condition, and higher unpleasantness ratings and a wheal of greater extent in the sodium chloride condition, as well as a flare of greater extent in the histamine condition. The magnitude of the differences between the exaggerated verbal suggestion conditions and respective control conditions was only significantly different between male and female investigators concerning flare size in the histamine condition. There were no differences between male and female participants. Therefore, sex differences may play only a minor role in nocebo-induced itch perception.

[Blended-learning in psychosomatics and psychotherapy - Increasing the satisfaction and knowledge of students with a web-based e-learning tool]. / Blended-Learning in der Psychosomatik und Psychotherapie - Erhöhung der Zufriedenheit und Fachkompetenz Studierender durch Einsatz eines web-basierten E-Learning-Tools1.

OBJECTIVES: To improve the synergy of established methods of teaching, the Department of Psychosomatics and Psychotherapy, University Hospital Münster, developed a web-based elearning tool using video clips of standardized patients. The effect of this blended-learning approach was evaluated. METHODS: A multiple-choice test was performed by a naive (without the e-learning tool) and an experimental (with the tool) cohort of medical students to test the groups' expertise in psychosomatics. In addition, participants' satisfaction with the new tool was evaluated (numeric rating scale of 0-10). RESULTS: The experimental cohort was more satisfied with the curriculum and more interested in psychosomatics. Furthermore, the experimental cohort scored significantly better in the multiple-choice test. CONCLUSION: The new tool proved to be an important addition to the classical curriculum as a blended-learning approach which improves students' satisfaction and knowledge in psychosomatics.

[Evaluation of the clinical course Psychosomatics and Psychotherapy employing standardized patients]. / Evaluation des Praktikums " Psychosomatik und Psychotherapie" mit standardisierten Patienten.

OBJECTIVE: Since the Winter Term 2008/2009 the Medical School of the University of Muenster, Germany, has used standardized patients in the clinical course Psychosomatic Medicine and Psychotherapy with fourth-year undergraduate students performing bio-psycho-social anamnesis on these standardized patients. We wanted to evaluate the influence of the course on the empathy of the students. METHODS: A total of 107 students participated in the standardized patient program during the Winter Term 2009/2010, with 90 (84.1 %) completing the Jefferson Scale of Physician Empathy before and after the course. In addition, we conducted a standard evaluation of the medical faculty. RESULTS: The pre-post comparison revealed a significant increase in empathy (d = 0.331, p = .001). The standard evaluation yielded a high satisfaction among the course participants, though several students did assess the course critically. CONCLUSION: The implementation of a standardized patient program in psychosomatics and psychotherapy proved to be of value, since it increased empathy of the students and received a positive evaluation. To prevent the students from being humiliated, it is of particular importance to implement a gentle and tactful feedback.

Significant differences in central imaging of histamine-induced itch between atopic dermatitis and healthy subjects.

BACKGROUND/AIM: This is the first investigation of the central processing of itch in the brain in 8 subjects with atopic dermatitis (AD) in comparison to 6 healthy controls (HC), comparing histamine-induced itch related activations in the frontal, prefrontal, parietal, cingulate cortex, thalamus, basal ganglia and cerebellum. METHODS: We employed 1% histamine-dihydrochlorid-iontophoresis of the left hand, recorded H2(15)O-PET-scans and perception of itch intensity on a numeric rating scale. RESULTS: There was no significant difference in perceived itch intensity between AD and HC. Significant increase in rCBF was found in HC in the contralateral somatosensory and motor cortex, midcingulate gyrus, and ipsilateral prefrontal cortex; in AD: in the contralateral thalamus, somatosensory, motor and prefrontal cortex and cerebellum, in the ipsilateral precentral, prefrontal, orbitofrontal cortex, insula, pallidum and cerebellum. More brain sites were activated in AD than in HC. Activation in AD was significantly higher in the contralateral thalamus, ipsilateral caudate and pallidum. CONCLUSIONS: We interpret our findings as possible central correlates of changes in the motor system in subjects with chronic itch, with activation of the basal ganglia possibly correlating to the vicious itch-scratch-circle in subjects with chronic itching skin diseases. However, further neuroimaging studies in healthy subjects and also in different skin diseases are needed to understand the complex mechanisms of the processing of itch.

Eye movement desensitization and reprocessing in the treatment of posttraumatic stress disorder in a patient with comorbid epilepsy.

Whether eye movement desensitization and reprocessing (EMDR) treatment of posttraumatic stress disorder (PTSD) causes reactivation of epilepsy is as yet unclear. A 34-year-old woman was treated in an inpatient multimodal psychotherapeutic setting with EMDR for PTSD resulting from sexual harassment and for a moderate depressive episode. She had been diagnosed with idiopathic generalized absence epilepsy in childhood, but had experienced no seizures under lamotrigine medication since 1999. After the second EMDR session, clinical seizures in the form of absences occurred, and were validated by electroencephalography. The seizures ceased after medication with benzodiazepines and an increase in the lamotrigine level. She underwent four more sessions of EMDR treatment successfully without further seizures. Possible triggers are discussed, especially as to whether EMDR treatment played a role in reactivating epilepsy. Further research and publications on the application of EMDR in epilepsy patients are needed.