Research on Somatization and Somatic Symptom Disorders: Ars longa, vita brevis.

The new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition defines somatic symptom and related disorders as long-standing somatic symptoms that are associated with disproportionate thoughts, feelings, and behaviors, irrespective of whether or not a medical cause for these symptoms can be determined. In this Special Section of Psychosomatic Medicine, several articles address diagnostic issues and the central nervous system correlates of somatic symptom and related disorder and document new developments in its treatment.

Use of Rorschach tests at the Nuremberg war crimes trial: A forgotten chapter in history of medicine.

Seventy years ago, psychiatrists and psychologists had unusual access to the Nazi leaders awaiting trial by the International Military Tribunal in Nuremberg. Early leaders in the field of psychosomatic medicine were instrumental in facilitating these interviews as well as arranging for the administration of psychological testing with the Rorschach inkblot test. These observations were kept under wraps for decades and there remains controversy even now about what these Rorschachs revealed-demonic psychopaths or just morally corrupt individuals.

Depressive symptoms and spiritual wellbeing in asymptomatic heart failure patients.

Depression adversely predicts prognosis in individuals with symptomatic heart failure. In some clinical populations, spiritual wellness is considered to be a protective factor against depressive symptoms. This study examined associations among depressive symptoms, spiritual wellbeing, sleep, fatigue, functional capacity, and inflammatory biomarkers in 132 men and women with asymptomatic stage B heart failure (age 66.5 years ± 10.5). Approximately 32 % of the patients scored ≥10 on the Beck Depression Inventory, indicating potentially clinically relevant depressive symptoms. Multiple regression analysis predicting fewer depressive symptoms included the following significant variables: a lower inflammatory score comprised of disease-relevant biomarkers (p < 0.02), less fatigue (p < 0.001), better sleep (p < 0.04), and more spiritual wellbeing (p < 0.01) (overall model F = 26.6, p < 0.001, adjusted R square = 0.629). Further analyses indicated that the meaning (p < 0.01) and peace (p < 0.01) subscales, but not the faith (p = 0.332) subscale, of spiritual wellbeing were independently associated with fewer depressive symptoms. Interventions aimed at increasing spiritual wellbeing in patients lives, and specifically meaning and peace, may be a potential treatment target for depressive symptoms asymptomatic heart failure.

Somatic symptom disorder: an important change in DSM.

This paper describes the rationale for the new diagnosis of somatic symptom disorder (SSD) within DSM5. SSD represents a consolidation of a number of previously listed diagnoses. It deemphasizes the centrality of medically unexplained symptoms and defines the disorder on the basis of persistent somatic symptoms associated with disproportionate thoughts, feelings, and behaviors related to these symptoms. Data are presented concerning reliability, validity, and prevalence of SSD, as well as tasks for future research, education, and clinical practice.

Fatigue and Circadian Activity Rhythms in Breast Cancer Patients Before and After Chemotherapy: A Controlled Study.

BACKGROUND: Breast cancer (BC) patients often experience cancer-related fatigue (CRF) before, during, and after their chemotherapy. Circadian rhythms are 24-hour cycles of behavior and physiology that are generated by internal pacemakers and entrained by zeitgebers (e.g., light). A few studies have suggested a relationship between fatigue and circadian rhythms in some clinical populations. METHODS: One hundred and forty-eight women diagnosed with stage I-III breast cancer and scheduled to receive at least four cycles of adjuvant or neoadjuvant chemotherapy, and 61 controls (cancer-free healthy women) participated in this study. Data were collected before (Baseline) and after four cycles of chemotherapy (Cycle-4). Fatigue was assessed with the Short Form of Multidimensional Fatigue Symptom Inventory (MFSI-SF); circadian activity rhythm (CAR) was recorded with wrist actigraphy (six parameters included: amplitude, acrophase, mesor, up-mesor, down-mesor and F-statistic). A mixed model analysis was used to examine changes in fatigue and CAR parameters compared to controls, and to examine the longitudinal relationship between fatigue and CAR parameters in BC patients. RESULTS: More severe CRF (total and subscale scores) and disrupted CAR (amplitude, mesor and F-statistic) were observed in BC patients compared to controls at both Baseline and Cycle-4 (all p's<0.05); BC patients also experienced more fatigue and decreased amplitude and mesor, as well as delayed up-mesor time at Cycle-4 compared to Baseline (all p's<0.05). The increased total MFSI-SF scores were significantly associated with decreased amplitude, mesor and F-statistic (all p's<0.006). CONCLUSION: CRF exists and CAR is disrupted even before the start of chemotherapy. The significant relationship between CRF and CAR indicate possible underlying connections. Re-entraining the disturbed CAR using effective interventions such as bright light therapy might also improve CRF.

A biological substrate for somatoform disorders: importance of pathophysiology.

Somatoform disorders are troubling to both patients and physicians. The diagnosis regrettably relies on the presence of subjective distress in the absence of objective findings. As a result, there is always the possibility that a diagnosis will be "missed." There is a clear underlying physiology of distress, which implies that there is a two-way street--both psychosomatic and somatopsychic in terms of production and experience of somatoform symptoms. Studies on communication pathways from the immune system to the brain provide exciting new information on the pathophysiology of inflammation-associated symptoms.

Use of GHB compounds among college students.

There are increasing reports about the misuse of gamma hydroxybutyric acid (GHB) related compounds. The objective of this article is to examine the use of GHB-containing dietary supplements among college students. An anonymous survey was completed at a university health clinic. The survey asked participants about their experience using GHB compounds and their knowledge about the legal status of GHB and its addictive potential. Two hundred fifteen students responded to the survey. Twenty-eight percent had used GHRE and 19% had used GHB. Growth Hormone Release Extract (GHRE) users reported consumption 2-3 times per month and GHB users reported 1-2 times per month. Males tended to use GHB for euphoria and energy, while females tended to use the compounds for weight loss. GHB was particularly popular among homosexual and bisexual responders. There was little knowledge of the addictive potential and illegal status of GHB and related compounds. GHB compounds are commonly used among college students. Given the different reasons for use according to gender and sexual orientation, prevention programs need to sculpt their message according to the target audience.

Use of GHB compounds by HIV-positive individuals.

Gamma hydroxybutyrate (GHB) has been used by body-builders to enhance performance and by young adults in rave parties. Warnings have been posted about its addictive potential. The use of these dietary compounds is currently banned by the Food and Drug Administration, but they are widely available through the Internet and in certain communities. The purpose of the study was to examine the use of these compounds by HIV-positive individuals and to investigate their knowledge of the addictive potential of GHB and its related dietary compounds. One hundred HIV-positive individuals from the UCSD outpatient HIV clinic responded to an anonymous survey that inquired about their knowledge, use, and effects produced by GHB containing dietary compounds. The most common reported dietary compound beside GHB was Growth Hormone Release Extract (GHRE). Fifty-two percent of individuals reported using at least one GHB containing dietary compound. Gay subjects reported the highest use of GHB compounds (76.9%; p < or = 0.001). The most common effect reported by users was increased energy (71%). Only 24% of the total responders knew about GHB's addictive potential. Among reported users of GHB containing compounds, fourteen (27%) knew about its addictive potential and nine (17%) knew that the compound is illegal. This study shows that HIV-positive gay individuals attending our clinic are using GHB compounds. Reported GHB users have limited knowledge about its addictive potential and serious adverse effects. More controlled studies are needed to evaluate long-term effects of dietary compounds containing GHB, especially among HIV-positive individuals who are actively receiving antiretroviral treatment.

Sleep apnea: a model for studying cytokines, sleep, and sleep disruption.

Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder, characterized by repeated disruptions of breathing during sleep. The sleep fragmentation and accompanying hypoxemia lead to many negative consequences including cardiac arrhythmias, nocturnal hypertension, confusion, cognitive impairment, daytime sleepiness, as well as depressive symptoms. From the perspective of psychoneuroimmunology (PNI), OSA holds promise as a model for studying sleep and cytokines because of its many relevant characteristics, including neuroimmune interactions, mood changes, and behaviors that directly affect the course of the disorder. In this minireview we briefly summarize the existing literature on cytokines and sleep and then discuss work on cytokines and OSA. We believe that the study of OSA presents researchers with an excellent opportunity to tease apart the many complex and interwoven components of sleep that are relevant to PNI.

The internet for medical information about cancer: help or hindrance?

OBJECTIVE: The authors tested a strategy for screening Internet sites to identify those that provide scientifically accurate information regarding complementary/alternative medicine treatments commonly used by cancer patients. METHOD: Separate Internet searches were conducted for three complementary/alternative medicine treatments: floressence, amalaki, and selenium. Sites (N=194) were assessed according to four criteria: availability of online purchasing, inclusion of patient testimonials, description of the treatment as a "cancer cure," and description of the treatment as "having no side effects." The presence of any of these criteria was considered a "red flag" denoting questionable scientific accuracy of the site. Sites were categorized based on the number of red flags. MEDLINE searches were performed and peer-reviewed literature used to determine the scientific accuracy of sites. RESULTS: Over 90% of the sites for floressence and amalaki had at least one red flag. In these searches, sites with no red flags provided some scientifically accurate information, while sites with red flags provided a large amount of vague and inaccurate information. Less than one-quarter of sites for selenium had at least one red flag, and sites in this search generally provided scientifically accurate information, regardless of the number of red flags. CONCLUSIONS: There is a staggering amount of medical misinformation on the Internet. For cancer treatments that have not been rigorously studied, the red flag criteria offer a rapid way of screening Internet sites for likely scientific accuracy. It may be advisable for patients to avoid sites with one or more red flags.

Use of herbal medications among 200 psychiatric outpatients: prevalence, patterns of use, and potential dangers.

We documented the use rates of herbal medication among a population of psychiatric outpatients to identify patients at risk for drug-herb interactions. Data were collected on 200 patients who, as part of their routine evaluation, provided information regarding their use of herbs. Fifteen percent of patients were currently taking herbs, the majority for treatment of psychiatric symptoms. There were no significant differences in use patterns across gender or between age groups. None of the current users charts, including the "high risk" patients, indicated that treating physicians were aware of potentially dangerous drug-herb combinations. Use of herbal medication was common among this sample of psychiatric outpatients. These data are consistent with reports from other patient populations. It is important for psychiatrists to ask all patients about their use of herbs and provide education about potentially dangerous drug-herb interactions.