Body image in patients with somatoform disorder.

BACKGROUND: Although body-related problems are common in patients with somatoform disorder, research focusing on how patients with somatoform disorder perceive and evaluate their body is scarce. The present study compared differences in body image between patients with somatoform disorder and respondents from a general population sample. It also examined differences within the somatoform disorder group between men and women and between the diagnostic subgroups conversion disorder, pain disorder and undifferentiated somatoform disorder. METHODS: Data were obtained from 657 patients (67.5% female) with somatoform disorder (DSM-IV-TR 300.7, 300.11, 300.81, 300.82) and 761 participants (58.6% female) from the general population. The Dresden Body Image Questionnaire (DBIQ) was used to assess body image in five domains: body acceptance, vitality, physical contact, sexual fulfilment, and self-aggrandizement. Confirmatory factor analysis and analyses of variance were performed. Since differences in age and sex were found between the somatoform disorder sample and the comparison sample, analyses were done with two samples of 560 patients with somatoform disorder and 351 individuals from the comparison sample matched on proportion of men and women and age. RESULTS: Patients scored significantly lower than the comparison sample on all DBIQ domains. Men scored higher than women. Patients with conversion disorder scored significantly higher on vitality and body acceptance than patients with undifferentiated somatoform disorder and pain disorder. CONCLUSIONS: The mostly large differences in body image between patients with somatoform disorder and the comparison sample as well as differences between diagnostic subgroups underline that body image is an important feature in patients with somatoform disorder. The results indicate the usefulness of assessing body image and treating negative body image in patients with somatoform or somatic symptom disorder.

Body attitude, body satisfaction and body awareness in a clinical group of depressed patients: An observational study on the associations with depression severity and the influence of treatment.

BACKGROUND: Apart from changes in mood and cognition, depressive disorders are also characterized by changes in body experience, changes that largely influence daily functioning and aggravate distress. In order to gain more insight into this important issue, three domains of body experience - body attitude, body satisfaction and body awareness - and their associations with symptom severity of depression were studied pre- and post-treatment in a clinical sample of depressed patients in a multidisciplinary setting. METHODS: Body attitude (Dresden Body Image Questionnaire), body satisfaction (Body Cathexis Scale), body awareness (Somatic Awareness Questionnaire) and severity of depressive symptoms (Inventory of Depressive Symptomatology) were measured. Differences between pre-treatment and post-treatment scores were studied with paired t-tests. Associations between body experience and depression were analysed with Pearson correlations and partial correlations. RESULTS: At the start of treatment, patients scored significantly lower than a healthy comparison sample on body attitude and body satisfaction, but not on body awareness. After treatment, depression scores decreased with large effect sizes, scores for body attitude and body satisfaction increased with medium effect sizes and body awareness scores increased slightly. Medium pre-treatment and strong post-treatment associations were found between depression severity and body attitude and between depression severity and body satisfaction. LIMITATIONS: The design does not allow to draw causal conclusions. Because of the multidisciplinary treatment no information is available on the specific contribution of interventions targeting body experience. CONCLUSIONS: The study provides evidence for medium to strong associations in clinically depressed patients between body attitude, body satisfaction and depression.

Development of the interval endurance capacity in elite and sub-elite youth field hockey players.

OBJECTIVES: To gain more insight into the mechanisms that underlie the development of interval endurance capacity in talented youth field hockey players in the 12-19 age band. METHODS: A total of 377 measurements were taken over three years. A longitudinal model for interval endurance capacity was developed using the multilevel modelling program MLwiN. With the model, scores on the interval shuttle run test can be predicted for elite and sub-elite male and female field hockey players aged 12-19 years. RESULTS: A polynomial model of order 2 adequately represents development of the test scores over time. The fixed part of the model contains a different intercept and linear age term for boys and girls, and a common quadratic term; the random part of the model has a common level 2 variance and sex specific level 1 variances. The model was significantly improved by including differential effects of performance level for age and sex. A negative effect was found for percentage body fat, and positive effects for additional training and motivation. CONCLUSIONS: During adolescence, both male and female elite hockey players show a more promising development pattern of interval endurance capacity than sub-elite youth players. Percentage body fat, additional training hours, and motivation influence this development. However, differences between the individual players are still considerable.

Normal values of patellar and ankle tendon reflex latencies.

The clinical value of latency measurement of tendon reflexes in neurological patients has been reported by several authors. However, normal values are not readily comparable. In the present study, latencies and amplitudes of patellar (PTR) and ankle tendon reflexes (ATR) were measured at rest and after facilitation in 102 normal controls. A manually operated reflex hammer, tipped with electrically conductive rubber, ensured an immediate start of the sweep of the oscilloscope. Latencies showed a significant correlation with height (r = 0.70 for PTR and r = 0.72 for ATR, P < 0.0001) and to a lesser degree with age (r = 0.16 and r = 0.30, P < 0.0001). While amplitudes were highly variable, rendering them less useful for diagnostic purposes, latencies showed minimal intra-individual variability (CV 1.5 and 0.8%, respectively). Correlation of ATR-latency with the H-reflex latency of the soleus muscle was very high (r = 0.97, P < 0.0001). Comparison with three other hammer types yielded corresponding results with a hammer supplied with a piezo-electric element; however, significantly shorter latencies were found with a hammer with a microswitch, and with another hammer with a spring-contact, due to a delay from the tap on the tendon until the start of the sweep of the monitor.

Mechanical efficacy of the mobilising cervical support device (Mbrace).

This study evaluated the mechanical efficacy of a new "mobilising" cervical support device. This device has been developed in response to the requirements of whiplash patients to overcome the problems of heat and immobilisation which can occur in patients wearing conventional wrap-around cervical collars. All planes of cervical range of motion of 21 volunteer subjects without current or past cervical dysfunction were measured actively and passively under two conditions (no support and with cervical support) using the cervical range of motion (CROM) instrument. The results show that the mobilising cervical support device restricts hyperextension effectively while allowing substantial movement in other planes of motion (flexion, rotation and lateral bending). This potential mobility keeps nearly all muscles in the neck fit and problems of muscle atrophy, weakness and contraction, which can occur in patients using conventional cervical wrap around collars, can be avoided. Regarding mechanical efficacy, the mobilising cervical support device can be useful in the (early) mobilisation phase in patients needing gentle neck support after a soft tissue hyperextension or whiplash injury.

Influence of caffeine and caffeine withdrawal on headache and cerebral blood flow velocities.

Caffeine consumption may cause headache, particularly migraine. Its withdrawal also produces headaches and may be related to weekend migraine attacks. Transcranial Doppler sonography (TCD) has shown changes in cerebral blood flow velocities (BFV) during and between attacks of migraine. In order to examine whether headache and changes in BFV could develop from controlled caffeine alterations, 20 healthy volunteers without a headache history, underwent clinical evaluation, TCD and serum caffeine measurements on four occasions, comparing conditions of regular caffeine intake, caffeine withdrawal and "re-caffeination". After 24 h of complete caffeine abstinence, 10 suffered from moderate to severe headaches with complete recovery within 1 h after caffeine intake. The BFVs in both middle cerebral, both posterior cerebral and basilar arteries were higher following the withdrawal period, reaching statistical significance in the left middle cerebral basilar and both posterior cerebral arteries. BFVs decreased significantly within half an hour after caffeine intake in all subjects, and were similar to baseline values after 2 h. Our results emphasize the relationship between caffeine withdrawal, the development of headache and alterations in cerebral blood flow velocities. Also, these findings indicate that accurate interpretation of TCD measurements should account for the influence of caffeine on BFVs.