Effect of transcutaneous vagus nerve stimulation on stress-reactive neuroendocrine measures in a sample of persons with temporal lobe epilepsy.

OBJECTIVE: Dysregulation of stress-reactive neuroendocrine measures, as well as subjective stress, have been found to worsen epilepsy. Transcutaneous vagus nerve stimulation (tVNS) is a relatively new treatment option for epilepsy. We were interested in its effect on the activity of the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS) as well as subjective stress and tiredness in patients with temporal lobe epilepsy (TLE). METHODS: Twenty patients (age 44 ± 11 years, 13 women) were enrolled in the study. They were free of seizures for more than 1 year. All took part in two sessions with 4 h of stimulation (tVNS vs. sham) in a randomized order. Saliva samples and subjective stress and tiredness levels were measured at five time points each session (before and after stimulation and three time points every hour in between). Data were analyzed using repeated measures analysis of variance as well as paired t-tests. RESULTS: There was a dampened salivary cortisol (sCort) decrease during tVNS (time × condition effect: F[2.38, 38.15] = 6.50, P = 0.002, partial η2 = 0.29). Furthermore, we detected a dampened increase in salivary flow rate during tVNS (time × condition effect: F[3.28, 55.67] = 2.82, P = 0.043, partial η2 = 0.14). There was neither a difference in overall sCort or salivary alpha-amylase (sAA) levels nor in subjective stress or tiredness levels between conditions. sAA levels at the last measurement point were slightly higher during tVNS (t(19) = 2.26, P = 0.035, d = 0.51), but this effect failed to reach significance when controlled for multiple comparisons. SIGNIFICANCE: Our results partially support that tVNS influences the regulation of stress-reactive neuroendocrine systems (namely the HPA axis and ANS) in epilepsy. More research with larger samples is needed on the difference between short-term and repeated long-term stimulation.

Increasing preoperative cognitive reserve to prevent postoperative delirium and postoperative cognitive decline in cardiac surgical patients (INCORE): Study protocol for a randomized clinical trial on cognitive training.

Introduction: Postoperative delirium (POD) and postoperative cognitive decline (POCD) can be observed after cardiosurgical interventions. Taken together, these postoperative neurocognitive disorders (PNCDs) contribute to increased morbidity and mortality. Preoperative risk factors of PNCD, such as decreased neuropsychometric performance or decreased cognitive daily activities, can be interpreted as reduced cognitive reserve. This study aims to build up cognitive reserves to protect against the development of PNCD through preoperative, home-based, cognitive training. Methods: The planned research project is a monocentric, two-arm randomized controlled intervention study involving 100 patients undergoing elective cardiac surgery with extracorporeal circulation. Patients will be assigned to a training group or control group. The intervention involves a standardized, paper-and-pencil-based cognitive training that will be performed by the patients at home for ~40 min per day over a preoperative period of 2-3 weeks. The control group will receive neither cognitive training nor a placebo intervention. A detailed assessment of psychological functions will be performed ~2-3 weeks before the start of training, at the end of the training, during hospitalization, at discharge from the acute clinic, and 3 months after surgery. The primary objective of this study is to investigate the interventional effect of preoperative cognitive training on the incidence of POD during the stay in the acute clinic, the incidence of POCD at the time of discharge from the acute clinic, and 3 months after surgery. Secondary objectives are to determine the training effect on objective cognitive functions before the surgery and subjective cognitive functions, as well as health-related quality of life 3 months after surgery. Discussion: Should it become evident that the use of our cognitive training can both reduce the incidence of POCD and POD and improve health-related quality of life, this intervention may be integrated into a standardized prehabilitation program.

Neuropsychological Assessment of Cognitive Impairment in Kidney Transplantation (NAsKiT) and its related risk factors: a study protocol.

BACKGROUND: Association of cognitive impairment with chronic kidney disease has been reported over the last decade. Individuals show better cognitive performance after kidney transplantation than individuals on dialysis but are more likely to be affected by cognitive impairment than age-matched comparison groups. Better knowledge of the prevalence as well as course and profile of cognitive impairment is important for the design of future studies assessing the clinical impact of cognitive impairment and developing management strategies. The goal of our study is to examine the extent of cognitive impairment before and after transplantation and to derive a distinct profile of cognitive function using standard neurocognitive tests. Furthermore, we aim to assess whether transplantation per se leads to an improvement in cognitive performance. METHODS: We are conducting a prospective single-center cohort study involving 100 kidney transplant individuals. Individuals who are wait-listed to receive a kidney transplantation or have already received one will be included in this study. Individuals will undergo a battery of detailed neurocognitive tests at baseline (in part before surgery), and then 3 and 12 months afterwards. Furthermore, the enrolled patients will complete a validated German version of the Cognitive Failure Questionnaire for self-assessment (s-CFQ) as well as the Hospital Anxiety and Depression Scale -Deutsche (HADS-D), a self-report screening instrument with two scales that capture anxiety and depression. In addition, a hair sample will be taken at each measurement time point for the determination of hair cortisol levels as a parameter for the cumulative hypothalamic-pituitary-adrenocortical axis activity over the previous three months. The primary outcome measure will be (a) the effect of kidney transplantation on the cognitive performance up to 12 months after transplantation and (b) the course of cognitive performance following kidney transplantation over time. DISCUSSION: The results of our study have potentially important implications for the prevention and treatment of cognitive impairment in kidney transplant individuals. By increasing our knowledge of the neurocognitive profile and assigning the corresponding deficits, it might be possible to create an individualized training program to positively impact cognitive deficits in kidney transplant patients.

The Effect of Intranasal Oxytocin on the Association Between Couple Interaction and Sleep: A Placebo-Controlled Study.

OBJECTIVE: Although most people in romantic relationships cosleep, biosocial modulators of sleep quality have only recently come into focus. Oxytocin (OT) might be one such modulator, as it had been shown to increase social attachment and safety. We investigated the association between everyday life couple interaction and sleep quality, as well as the effects of OT on this association. METHODS: Eighty heterosexual couples ( N = 160 individuals, mean [standard deviation] age = 28 [5] years) were randomized to self-administer a) 32 international units of intranasal OT or b) placebo during 5 consecutive days. Each morning, they reported on sleep quality, and on subjective feelings of closeness and valence of couple interaction at a maximum of four times a day. Data were analyzed using hierarchical linear models. RESULTS: Subjective closeness ( B = 0.43, t (73) = 3.80, p < .001) and valence (negative - positive) of couple interaction ( B = 0.50, t (73) = 3.91, p < .001) were positively associated with sleep quality. Persons with OT reported higher levels of sleep quality than those without ( B = 0.47, t (74) = 2.32, p = .023). The association between closeness and sleep quality was stronger with OT than without (OT by closeness: B = 0.31, t (72) = 2.29, p = .025; OT by valence of interaction: B = 0.27, t (72) = 1.77, p = .081). Whereas the effect of couple interaction on sleep quality was strong in men, the OT effects were especially pronounced in women. CONCLUSIONS: Our results suggest that enhancing closeness and positive couple interaction in cosleeping partners might be a way to improve sleep quality. The moderating effects of OT and sex on the association between couple interaction and sleep quality can have important implications for sleep therapy.Trial Registration: The study was preregistered at ClinicalTrials.gov ("Oxytocin, Couple Interaction, and Wound Healing" study, identifier NCT01594775). The present analyses were not preregistered.

Age-related changes in oral sensitivity, taste and smell.

Oropharyngeal sensitivity plays a vital role in the initiation of the swallowing reflex and is thought to decline as part of the aging-process. Taste and smell functions appear to decline with age as well. The aim of our study was to generate data of oral sensitivity in healthy participants for future studies and to analyse age-related changes and their interdependence by measuring oral sensitivity, taste, and smell function. The experiment involved 30 participants younger than and 30 participants older than 60. Sensitivity threshold as a surrogate of oral sensitivity was measured at the anterior faucial pillar by electrical stimulation using commercially available pudendal electrode mounted on a gloved finger. Smell and taste were evaluated using commercially available test kits. Mean sensitivity was lower in young participants compared to older participants (1.9 ± 0.59 mA vs. 2.42 ± 1.03 mA; p = 0.021). Young participants also performed better in smell (Score 11.13 ± 0.86 vs 9.3 ± 1.93; p < 0.001) and taste examinations (Score 11.83 ± 1.86 vs 8.53 ± 3.18; p < 0.001). ANCOVA revealed a statistical association between sensitivity and smell (p = 0.08) that was moderated by age (p = 0.044). Electrical threshold testing at the anterior faucial pillar is a simple, safe, and accurate diagnostic measure of oral sensitivity. We detected a decline of oral sensitivity, taste, and smell in older adults.Trial registration: Clinicaltrials.gov, NCT03240965. Registered 7th August 2017- https://clinicaltrials.gov/ct2/show/NCT03240965 .

Psychobiological Mechanisms in Somatic Symptom Disorder and Depressive Disorders: An Ecological Momentary Assessment Approach.

OBJECTIVE: Persistent somatic symptoms cause strong impairment in persons with somatic symptom disorder (SSD) and depressive disorders (DDs). Specific negative psychological factors (NPFs), such as catastrophizing, negative affectivity, and behavioral avoidance, are assumed to contribute to this impairment and may maintain symptoms via dysregulations of biological stress systems. We examined the associations between NPF and somatic symptoms in the daily life of women with SSD or DD and investigated the mediating role of psychobiological stress responses. METHODS: Twenty-nine women with SSD and 29 women with DD participated in an ecological momentary assessment study. For 14 days, intensity of and impairment by somatic symptoms, NPF, and stress-related biological measures (cortisol, alpha-amylase) were assessed five times per day using an electronic device and saliva samples. Multilevel models were conducted. RESULTS: The greater the number of NPF, the higher the concurrent and time-lagged intensity of and impairment by somatic symptoms in both groups (12.0%-38.6% of variance explained; χ2(12) p < .001 for all models). NPFs were associated with higher cortisol levels in women with DD and with lower levels in women with SSD (interaction NPF by group: B = -0.04, p = .042 for concurrent; B = -0.06, p = .019 for time-lagged). In women with SSD, lower cortisol levels were associated with higher intensity at the next measurement time point (group by cortisol: B = -1.71, p = .020). No mediation effects were found. CONCLUSIONS: NPFs may be considered as transdiagnostic factors in the development and treatment of impairing somatic symptoms. Our findings will allow the development of new treatment strategies that use ecological momentary intervention approaches focusing on NPF.

The effects of music listening on somatic symptoms and stress markers in the everyday life of women with somatic complaints and depression.

Despite a growing body of literature documenting the health-beneficial effects of music, empirical research on the effects of music listening in individuals with psychosomatic disorders is scarce. Using an ambulatory assessment design, we tested whether music listening predicts changes in somatic symptoms, subjective, and biological stress levels, and examined potential mediating processes, in the everyday life of 58 women (M = 27.7 years) with somatic symptom disorder (SSD) and depressive disorders (DEP). Multilevel models revealed that music listening predicted lower subjective stress ratings (p ≤ 0.02) irrespective of mental health condition, which, in turn, predicted lower somatic symptoms (p ≤ 0.03). Moreover, specific music characteristics modulated somatic symptoms (p = 0.01) and autonomic activity (p = 0.03). These findings suggest that music listening might mitigate somatic symptoms predominantly via a reduction in subjective stress in women with SSD and DEP and further inform the development of targeted music interventions applicable in everyday life.

Differential associations between fatigue and psychobiological stress measures in women with depression and women with somatic symptom disorder.

OBJECTIVE: Medically unexplained fatigue is a burdensome, widespread symptom, and a frequent complaint in depressive disorders (DDs) as well as somatic symptom disorder (SSD). Heightened stress levels are a likely cause of fatigue, although the temporal associations, as well as the role of the stress-reactive hypothalamic-pituitary-adrenal (HPA) axis, are not yet completely understood. We were interested in the differences between DD and SSD regarding general, mental, and physical fatigue, as well as associations between psychobiological stress measures (representing different time frames) and fatigue in these groups. METHODS: Fifty-eight women (29 with DD, 29 with SSD) reported subjective recent fatigue and chronic stress levels, as well as levels of depression and somatic complaints using baseline questionnaires. Furthermore, they completed an ambulatory assessment period comprising measurements of fatigue, subjective stress, and salivary cortisol five times a day for 14 consecutive days. Salivary cortisol was obtained as a measure of within-day HPA axis activity, and hair cortisol concentration was obtained as a measure of accumulated HPA axis activity of the preceding three months. RESULTS: Women with DD reported higher levels of general and mental fatigue than did women with SSD, which was explained by their higher level of depression. Physical fatigue levels did not differ between groups. In both groups, momentary general, mental, and physical fatigue levels were associated with momentary subjective stress but not with chronic stress. Momentary salivary cortisol levels were positively associated with mental fatigue, while hair cortisol concentration was not. CONCLUSIONS: There are differences in fatigue profiles between DD and SSD, which should be accounted for in future research and practice (e.g., individualized treatment strategies focusing on mental or physical fatigue, depending on which fatigue dimension is prominent).

Facilitation of oral sensitivity by electrical stimulation of the faucial pillars.

Dysphagia is common in neurological disease. However, our understanding of swallowing and its central nervous control is limited. Sensory information plays a vital role in the initiation of the swallowing reflex and is often reduced in stroke patients. We hypothesized that the sensitivity threshold of the anterior faucial pillar could be facilitated by either electrical stimulation (ES) or taste and smell information. The sensitivity threshold was measured by ES in the anterior faucial pillar region. The measurement was repeated 5 min after baseline. Thirty minutes after baseline, the participants underwent a test for taste and smell. Immediately after the test, the ES was repeated. Thirty healthy volunteers with a mean age of 27 ± 5.1 participated in the trial. Mean sensitivity threshold at baseline was 1.9 ± 0.59 mA. The values 5 min after baseline (1.74 ± 0.56 mA, p = 0.027) and 30 min after baseline (1.67 ± 0.58 mA, p = 0.011) were significantly lower compared to the baseline, but there was no difference between the latter (p = 0.321). After 5 min, a potentially facilitating effect was found on oral sensitivity by ES of the faucial pillar area. Thirty minutes later, this effect was still present.Trial registration Clinicaltrials.gov, NCT03240965. Registered 7th August 2017- https://clinicaltrials.gov/ct2/show/NCT03240965 .

Flexible endoscopic evaluation of swallowing (FEES) to determine neurological intensive care patients' oral diet.

PURPOSE: Dysphagia is common in critically ill neurological patients and is associated with a high mortality and morbidity. Data on the usefulness of flexible endoscopic examination of swallowing (FEES) in neurological intensive care unit (ICU) patients are lacking, raising the need for evaluation. METHOD: FEES was performed in neurological intensive care patients suspected of dysphagia. We correlated findings with baseline data, disability status, pneumonia and duration of hospitalisation, as well as a need for mechanical ventilation or tracheotomy. RESULT: This analysis consisted of 125 patients with suspected dysphagia. Most of the patients (81; 64,8%) suffered from acute stroke. Dysphagia was diagnosed using FEES in 90 patients (72%). FEES results led to dietary modifications in 80 patients (64%). The outcome at discharge was worse in dysphagic stroke patients diagnosed by FEES as compared to non-dysphagic stroke patients (p = 0.009). Patients without oral diet had higher need for intubation (p = 0.007), tracheotomy (p = 0.032) and higher mortality (p < 0.001) in comparison to patients with at least small amounts of oral intake. CONCLUSION: As the clinical assessment of the patients often classified the dysphagia incorrectly, the broad use of FEES in ICU patients might help to adequately adjust patients' oral diet. This knowledge might contribute to lower mortality and morbidity.

Development and Validation of a Brief Measure of Self-Management Competence: The Self-Management Self-Test (SMST).

BACKGROUND: Self-management can be considered a way of dealing with oneself and relates to actions undertaken to create order, discipline, and control. The concept is closely linked to concepts of self-efficacy and self-regulation but can be distinguished from these. The Self-Management Self-Test (SMST) is a 5-item assessment scale designed to measure self-management competence in individuals with or without a psychiatric disorder (as screened using PHQ). The aim of this study was to validate the SMST in terms of convergent validity, the ability to differentiate, criterion validity, internal consistency, and test-retest reliability. METHODS: Eighty-seven adults hospitalized for treatment of major depression (clinical sample) and 595 individuals from the general population (population sample) filled out the SMST and 5 other stress-related psychometric instruments measuring similar constructs. All instruments were repeated 4 to 6 weeks later. Convergent validity, internal consistency, and test-retest reliability were tested based on data from the population sample. Convergent validity was determined by correlations with other stress-related psychometric instruments. Correlations in the range of r = -0.4 to -0.6 were expected. To test for criterion validity, the clinical sample was matched with a subsample from the population sample, consisting only of individuals without a psychiatric disorder as screened using PHQ (nonclinical subsample, n = 87). The ability to differentiate was based on receiver operating characteristic (ROC) curve analysis. RESULTS: Correlations between the SMST and the other stress-related tests were significant and in the expected direction and predominantly within the expected range (Pearson r = - 0.40 to -0.64). The correlation with the Multidimensional Fatigue Inventory-20, measuring fatigue, and with the dimensional scale for depression in the PHQ was higher than expected and referred to very similar items. Thus, convergent validity mainly lay within the expected range. Internal consistency was high (Cronbach α = 0.80), and test-retest reliability was fairly low (r = 0.71). The SMST showed a significant difference, t(157) = 7.97, P < .001, between the clinical sample (M = 9.36, SD = 3.39) and the nonclinical subsample (M = 12.94, SD = 2.47) with a large effect size (d = 1.3). The area under the ROC curve (AUC) was excellent (AUC = 0.81, SE = 0.034, P < .001), suggesting that the SMST can distinguish between the clinical and nonclinical samples. CONCLUSIONS: The SMST can be considered an effective self-rating test to assess self-management competence in individuals from the general population as well as in people with major depression. It may also be useful to detect treatment outcomes in people with major depression. The high internal consistency indicates that all 5 items are important for the test as a whole. The low test-retest reliability suggests sensitivity to change. The SMST is likely to differentiate particularly well at low levels of self-management competence, suggesting it may be a useful tool in studies investigating people with depression or other psychiatric disorders such as post-traumatic stress disorder. Furthermore, the SMST could be useful in assessing the effect of treatment interventions over time and evaluating patient-reported outcomes.

Effects of acute psychosocial stress on the hypothalamic-pituitary-thyroid (HPT) axis in healthy women.

OBJECTIVE: The individual set point of the hypothalamic-pituitary-thyroid (HPT) axis is largely genetically determined. Apart from this genetic predisposition, the HPT axis may also be malleable to environmental demands such as psychosocial stress. Indeed, previous research has indicated that critical life events often precede the onset of autoimmune thyroid diseases, and subtle abnormalities in HPT functioning are present in some patients with stress-related disorders such as depression. However, no studies have investigated whether exposure to psychosocial stress leads to an immediate activation of the HPT axis. METHODS: A total of N = 30 healthy women attended two laboratory appointments in a randomized order. An intravenous catheter was inserted at the beginning of each appointment. In the stress session, this was followed by the Trier Social Stress Test (TSST). Plasma samples to determine thyroid-stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4) were taken at baseline and 20, 50, and 110 min after the TSST started. In the control session, participants rested and were instructed to read magazines, while the sampling schedule was maintained. RESULTS: There was a significant rise in TSH concentrations in response to the TSST, with a peak observed 20 min after stressor onset, and a steady decline thereafter. No such response was observed in the control session. The TSST did not increase T3 or T4. CONCLUSION: The finding that acute psychosocial stress is able to elicit a significant increase in TSH is relevant to our understanding of a number of stress-related illnesses presenting with abnormalities of the HPT axis.

Development and Validation of a Brief Measure of Self-Management Competence: The Self-Management Self-Test (SMST).

BACKGROUND: Self-management can be considered a way of dealing with oneself and relates to actions undertaken to create order, discipline, and control. The concept is closely linked to concepts of self-efficacy and self-regulation but can be distinguished from these. The Self-Management Self-Test (SMST) is a 5-item assessment scale designed to measure self-management competence in individuals with or without a psychiatric disorder (as screened using PHQ). The aim of this study was to validate the SMST in terms of convergent validity, the ability to differentiate, criterion validity, internal consistency, and test-retest reliability. METHODS: Eighty-seven adults hospitalized for treatment of major depression (clinical sample) and 595 individuals from the general population (population sample) filled out the SMST and 5 other stress-related psychometric instruments measuring similar constructs. All instruments were repeated 4 to 6 weeks later. Convergent validity, internal consistency, and test-retest reliability were tested based on data from the population sample. Convergent validity was determined by correlations with other stress-related psychometric instruments. Correlations in the range of r = -0.4 to -0.6 were expected. To test for criterion validity, the clinical sample was matched with a subsample from the population sample, consisting only of individuals without a psychiatric disorder as screened using PHQ (nonclinical subsample, n = 87). The ability to differentiate was based on receiver operating characteristic (ROC) curve analysis. RESULTS: Correlations between the SMST and the other stress-related tests were significant and in the expected direction and predominantly within the expected range (Pearson r = -0.40 to -0.64). The correlation with the Multidimensional Fatigue Inventory-20, measuring fatigue, and with the dimensional scale for depression in the PHQ was higher than expected and referred to very similar items. Thus, convergent validity mainly lay within the expected range. Internal consistency was high (Cronbach α = 0.80), and test-retest reliability was fairly low (r = 0.71). The SMST showed a significant difference, t(157) = 7.97, P < .001, between the clinical sample (M = 9.36, SD = 3.39) and the nonclinical subsample (M = 12.94, SD = 2.47) with a large effect size (d = 1.3). The area under the ROC curve (AUC) was excellent (AUC = 0.81, SE = 0.034, P < .001), suggesting that the SMST can distinguish between the clinical and nonclinical samples. CONCLUSIONS: The SMST can be considered an effective self-rating test to assess self-management competence in individuals from the general population as well as in people with major depression. It may also be useful to detect treatment outcomes in people with major depression. The high internal consistency indicates that all 5 items are important for the test as a whole. The low test-retest reliability suggests sensitivity to change. The SMST is likely to differentiate particularly well at low levels of self-management competence, suggesting it may be a useful tool in studies investigating people with depression or other psychiatric disorders such as post-traumatic stress disorder. Furthermore, the SMST could be useful in assessing the effect of treatment interventions over time and evaluating patient-reported outcomes.

Poor night's sleep predicts following day's salivary alpha-amylase under high but not low stress.

Although sleep is linked to physiological stress systems like the autonomic nervous system (ANS), research is still limited regarding night-and-day interactions between nocturnal sleep characteristics, stress, and diurnal parameters of salivary alpha-amylase (sAA) as a surrogate marker of ANS activity. Fifty healthy university students rated their chronic stress burden and completed two five-day periods of ecological momentary assessment - under everyday conditions of both low stress (beginning of semester) and high stress (final examination preparation). Participants collected saliva six times daily and reported on the previous night's sleep (quality, latency, duration, disturbances) immediately after awakening. Additionally, a sub-sample wore actigraphs recording 'time in bed'. In contrast to previous assumptions, poor sleep predicted lower sAA awakening values, more decreased awakening responses, and steeper diurnal slopes the following day only under high stress, but not under low stress. Diurnal sAA parameters did not predict the following night's sleep characteristics. The sAA profile does not seem to be sensitive to everyday occurring sleep variations, but rather seems to be an indicator of more prolonged stress induced ANS dysregulation.

Treatment processes during exposure and cognitive-behavioral therapy for chronic back pain: A single-case experimental design with multiple baselines.

Our aim was to evaluate isolated elements of psychological pain treatments and explore treatment effects on biological stress markers. We employed a single-case experimental design with multiple baselines. Matching pairs of twelve participants (chronic low back pain >6 months; elevated pain-related fear) were randomly assigned to graded in vivo exposure (EXP) or cognitive-behavioral therapy (CBT) in a yoked design. Primary assessments were taken during baseline (7-26 days), treatment (23-44 days) and at 6-months follow-up (11-30 days) including changes in pain symptoms, disability, pain-related fear, acceptance, body confidence, self-efficacy, and positive thoughts. Psycho-educational, behavioral, cognitive, and exposure interventions were compared to baseline. EXP exhibited immediate middle-to-large effects; CBT's small-to-middle effects were delayed. Within the EXP approach, change mainly occurred during exposure but not during psycho-educational sessions. Overall cortisol was lower in EXP than CBT at post-treatment. We recommend integrating exposure elements in the management of CLBP to increase its efficacy. Psycho-educational sessions might not be necessary or should be adapted, e.g. with stronger focus on motivational aspects. Since CBT seemed to produce delayed effects, core CBT interventions such as cognitive restructuring might be added after exposure treatment to sustain therapeutic effects.

Thyroid Functioning and Fatigue in Women With Functional Somatic Syndromes - Role of Early Life Adversity.

Objective: Fatigue is a core feature of functional somatic syndromes (FSS). Fatigue is also prominent in patients with thyroid diseases, which is unsurprising given the role of the hypothalamic-pituitary-thyroid (HPT) axis in regulating physiological energy demands. Research in healthy women has shown that early life adversity is linked with alterations in the HPT axis. In view of the substantial prevalence of early life adversity in patients with FSS, our aim was to investigate whether HPT functioning is related to (a) fatigue, and (b) early life adversity in these patients. Methods:N = 33 female patients with FSS and n = 30 age-matched controls were recruited. Fasting morning blood samples were taken to determine thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), and thyroxine (fT4). General, physical, and mental fatigue were measured via the multidimensional fatigue inventory (MFI). Early life adversity was measured using the childhood trauma questionnaire (CTQ). Results: Patients with FSS did not differ from controls in any thyroid parameters (all p > 0.672). However, the lower the patients' TSH and the higher their fT4, the greater was their general (ß = -0.32, p = 0.064; ß = 0.35, p = 0.038) and physical (ß = -0.47, p = 0.007; ß = 0.32, p = 0.077) fatigue. In addition, emotional neglect (ß = -0.32, p = 0.057), physical neglect (ß = -0.60, p = 0.001), physical abuse (ß = -0.47, p = 0.015), and sexual abuse (ß = -0.40, p = 0.026) were linked with lower TSH. Conclusion: The lower TSH and the higher fT4, the more fatigue was reported by patients with FSS. In addition, lower TSH was linked with more early life adversity. Larger, prospective studies are warranted to determine whether HPT functioning may be a mediating pathway between early life adversity and fatigue in FSS.

Co-variation of fatigue and psychobiological stress in couples' everyday life.

OBJECTIVE: There is limited knowledge about how fatigue develops and worsens and what influences fluctuations in daily fatigue. Stress was found to influence fatigue, and being in a relationship seems to either increase or decrease stress depending on the couple interaction. In this study, co-variation of fatigue, self-reported stress, and biological stress markers in couples' everyday lives was investigated. Specifically, we examined a) whether momentary couple interactions moderated dyadic outcomes and b) whether and how stress and relationship measures influenced individual momentary fatigue. METHODS: Forty heterosexual couples (age: 28 ±â€¯5 years) reported subjective fatigue and stress levels 4 times a day for 5 consecutive days (1600 measures). Furthermore, participants reported whether they had interacted with their partner since the last data entry and, if so, they rated the valence of this interaction. Salivary cortisol (a measure of HPA axis activity) and alpha amylase (a measure of ANS activity) were analyzed as biological stress markers from saliva samples obtained at the same time points. Moment-to-moment data were analyzed using dyadic multilevel models to account for the nested design. RESULTS: Stress (women and men: p ≤ 0.001) and fatigue (women: p = .003, men: p = .020) showed patterns of co-variation within couples, especially if partners had interacted with each other since the previous data entry. Cortisol was also found to co-vary between partners (women: unstandardized coefficient (UC) = 0.12, p ≤ .001, men: UC = 0.18, p ≤ .001), whereas the regulation of alpha-amylase levels depending on the partner's levels was only present in women (UC = 0.11, p = .002). Valence of couple interaction was negatively associated with fatigue (women: UC = -0.13, p ≤ .001, men: UC = -0.06, p = .011). There was no momentary association of fatigue with an individual's own or the partner's subjective or biological stress markers. CONCLUSIONS: Fatigue and stress levels during the day seem to co-vary within couples. These associations were particularly strong when the partners had interacted with each other since the last measurement. These data underline the importance of social factors in fatigue and stress in everyday life.

Patterns of control beliefs in chronic fatigue syndrome: results of a population-based survey.

BACKGROUND: Chronic fatigue syndrome (CFS) represents a unique clinical challenge for patients and health care providers due to unclear etiology and lack of specific treatment. Characteristic patterns of behavior and cognitions might be related to how CFS patients respond to management strategies. METHODS: This study investigates control beliefs in a population-based sample of 113 CFS patients, 264 individuals with insufficient symptoms or fatigue for CFS diagnosis (ISF), and 124 well individuals. RESULTS: Controlling for personality and coping, individuals with low confidence in their problem-solving capacity were almost 8 times more likely to be classified as ISF and 5 times more likely to be classified as CFS compared to being classified as well. However there was a wide distribution within groups and individuals with "low confidence" scores were found in 31.7% of Well individuals. Individuals with low levels of anxiety and who were more outgoing were less likely to be classified as ISF or CFS. CONCLUSIONS: These findings suggest that fostering control beliefs could be an important focus for developing behavioral management strategies in CFS and other chronic conditions.

Influence of stress systems and physical activity on different dimensions of fatigue in female fibromyalgia patients.

OBJECTIVE: Fatigue is a defining characteristic and one of the most debilitating features of fibromyalgia syndrome (FMS). The mechanisms underlying different dimensions of fatigue in FMS remain unclear. The aim of the current study was to test whether stress-related biological processes and physical activity modulate fatigue experience. METHODS: Using an ambulatory assessment design, 26 female FMS patients reported general, mental, and physical fatigue levels at six time points per day for 14 consecutive days. Salivary cortisol and alpha-amylase were analyzed as markers of neuroendocrine functioning. Participants wore wrist actigraphs for the assessment of physical activity. RESULTS: Lower increases in cortisol after awakening predicted higher mean daily general and physical fatigue levels. Additionally, mean daily physical activity positively predicted next-day mean general fatigue. Levels of physical fatigue at a specific time point were positively associated with momentary cortisol levels. The increase in cortisol after awakening did not mediate the physical activity - fatigue relationship. There were no associations between alpha-amylase and fatigue. CONCLUSION: Our findings imply that both changes in hypothalamic-pituitary-adrenal axis activity and physical activity contribute to variance in fatigue in the daily lives of patients with FMS. This study helps to paint a clearer picture of the biological and behavioral underpinnings of fatigue in FMS and highlight the necessity of interdisciplinary treatment approaches targeting biological, behavioral and psychological aspects of FMS.

Classifying Fibromyalgia Syndrome as a Mental Disorder?-An Ambulatory Assessment Study.

PURPOSE: Fibromyalgia syndrome (FMS) is associated with psychological distress. The recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) raises the question of whether FMS is classifiable as "somatic symptom disorder" (SSD) and consequently as a mental disorder. To address this, the present ambulatory assessment study focuses on the everyday life occurrence of SSD symptoms in FMS and their predictive value concerning severity indicators of widespread pain. METHOD: Ambulatory data were assessed six times daily on 14 consecutive days via iPod. Twenty-eight women suffering from FMS indicated symptoms associated with SSD (somatic illness beliefs, health anxiety, time/energy devoted to pain, or health concerns) and momentary pain levels. Questionnaires regarding potential covariates (such as somatization, depression, health status) were completed at two additional sessions in the research laboratory. RESULTS: On average, SSD symptoms occurred three to four times daily and were mild to moderate in severity. Furthermore, these symptoms were both concurrently and prospectively associated with momentary pain intensity and subjective impairment by pain. Twenty percent of the variance in pain intensity and 28 % of the variance in subjective impairment were explained by momentary variables (SSD symptoms and intake of pain medication). Eighty-two percent of persons with FMS fulfilled the psychological SSD criterion when considering everyday occurring symptoms with at least mild severity. CONCLUSION: FMS might be diagnosed as a mental disorder according to DSM-5 in many cases. SSD symptoms proved to have predictive value for FMS severity and may thus have clinical relevance for diagnostic, prognostic, and intervention purposes.