The randomized clinical trial results of the anxiety treatment in patients with somatoform dysfunction and neurotic disorders.

The existing treatments for somatoform dysfunction (SfD), reaction to severe stress (RSS), and adjustment disorders (AjD) are insufficiently effective and safe. Anxiolytic drug Tenoten proved effective in clinical trials (CT). The aim of this multicenter double-blind placebo-controlled randomized CT was to investigate the safety and efficacy of Tenoten in the treatment of anxiety in adults with SfD, RSS, AjD and other neurotic disorders (oNDs). 390 adult patients with SfD, RSS and AjD or oNDs with the Hospital Anxiety and Depression scale-anxiety (HADS-A) score ≥ 11 were randomized into 4 groups (n = 127 in Tenoten group 1 (4 tablets/day); n = 131 in Tenoten group 3 (8 tablets/day), n = 132 in combined Placebo group 2 + 4). The changes from baseline in the mean Hamilton Anxiety Rating Scale (HAM-A) score in groups 1 and 3 after 12 weeks were the primary outcome. The decrease of the HAM-A score from 18.81 ± 5.81 to 7.26 ± 4.63 (in group 1) and from 18.38 ± 4.3 to 6.40 ± 4.02 (in group 3) was observed post-treatment (pgroup 1/placebo = 0.0055, pgroup 3/placebo < 0.0001). Overall, 46 adverse events (28 in the Tenoten groups and 18 in the Placebo) were reported without any difference between the study groups. Tenoten performed significantly more effective than placebo in the anxiety treatment of adults with SfD, RSS, AjD and oNDs (clinicaltrials.gov NCT03036293).

Dimensions of neurotic personality and its selected predictors in individuals with arterial hypertension. / Wymiary osobowosci nerwicowej i jej wybrane predyktory wsród osób z nadcisnieniem tetniczym.

OBJECTIVES: To assess of the levels of neurotic personality dimensions in a group of patients with arterial hypertension compared to healthy individuals. To test the relationship between the overall neurotic personality score and satisfaction with life as well as tendency to notice and attach importance to the positive aspects of life, experience, and oneself in a clinical sample. METHODS: Neurotic Personality Questionnaire (KON-2006) by Aleksandrowicz, Klasa, Sobanski, and Stolarska (2007), Satisfaction With Life Scale (SWLS) by Diener et al., and the P Scale by Caprara (2009). RESULTS: Individuals with arterial hypertension (N =81) are distinguished by significantly higher levels of twenty (out of twenty-four) neurotic personality dimensions than controls without arterial hypertension (N =88). Overall neurotic personality score correlates negatively with life satisfaction and the evaluation of positive aspects of life. CONCLUSIONS: The present study adds to the knowledge on the psychosocial aspects of ill people's functioning and sets directions of work for multidisciplinary teams seeking to improve patients' quality of life.

Antecedents and consequences of unawareness of memory impairment in dementia.

OBJECTIVE: To assess the prevalence, antecedents, and consequences of unawareness of memory impairment in dementia. METHOD: Persons (n = 1,862) from a geographically defined community without dementia at enrollment subsequently underwent clinical classification (248 with dementia, 611 with mild cognitive impairment, 1,003 with no cognitive impairment), memory testing, and self-appraisal of memory. Memory performance was regressed on self-appraised memory, and the residuals served as an index of memory awareness. After clinical classification, participants completed brief cognitive testing at 3-year intervals for up to 15 years. RESULTS: When unawareness was defined as a score at or below thresholds ranging from the 15th to 25th percentiles, it was more common in dementia (67%-83%) and mild cognitive impairment (15%-33%) than in no cognitive impairment (2%-6%; all p < .001). A continuous measure of awareness (M = 0.00, SD = 0.61) was reduced by 0.37-unit in mild cognitive impairment (SE = 0.04, p < .001) and 1.04-unit in dementia (SE = 0.06), p < .001) compared with those without cognitive impairment, and these associations were weaker in Black persons than White persons (estimate for dementia by race = 0.37, SE = 0.12, p = .003; estimate for mild cognitive impairment by race = 0.30, SE = 0.08, p < .001). Higher premorbid neuroticism was associated with better memory awareness in dementia. Higher memory awareness was not related to mortality in mild cognitive impairment or dementia but had a marginal association with slower cognitive decline in mild cognitive impairment. CONCLUSIONS: Unawareness of memory impairment is a common manifestation of dementia, particularly in White persons, but is not strongly related to adverse disease outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Marital processes linking economic hardship to mental health: The role of neurotic vulnerability.

Both enduring neurotic vulnerabilities and economic hardship have been shown to negatively influence marital behaviors, which have physical and mental health consequences. However, because most previous research is fragmented and has focused on the early years of marriage or relatively short periods of time, their long-term effects are unclear. Using data from the Iowa Midlife Transitions Project, with a sample of 370 married couples providing data from 1991 to 2001, we assessed enduring personal and couple vulnerabilities, trajectories of family economic hardship, and couples' marital hostility using a comprehensive dyadic model to ascertain their influence on subsequent mental health. Couple marital hostility trajectories and neurotic vulnerabilities (both additively and interactively) were associated with changes in both spouses' depressive symptoms. Results also indicated that couples' marital hostility trajectories link trajectories of family economic hardship to subsequent changes in husbands' and wives' depressive symptoms. Last, associations between economic hardship trajectories, marital hostility trajectories, and depressive symptoms were moderated by couples' neurotic vulnerability as captured by a product term of husbands' and wives' neurotic vulnerability. In general, these associations were amplified for couples with a high level of couple vulnerability and weakened (or altogether absent) for those with a low level of vulnerability. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Changes in intensity of neurotic symptoms associated with reduction of suicidal ideation in patients who underwent psychotherapy in the day hospital for the treatment of neurotic and behavioral disorders. / Zmiany w nasileniu objawów nerwicowych wiazace sie z redukcja mysli samobójczych u pacjentów poddanych psychoterapii w dziennym oddziale leczenia nerwic i zaburzen behawioralnych.

OBJECTIVES: Analysis of associations between changes in the intensity of neurotic symptoms and reduction of suicidal ideation (SI) or lack of SI reduction, in patients who underwent a course of intensive psychotherapy conducted in integrative approach with predominance of psychodynamic approach in a day hospital. METHODS: Symptom Checklist KO"O" and Life Inventory completed by 461 women and 219 men treated in the psychotherapeutic day hospital due to neurotic, behavioral or personality disorders between 2005-2013. During the qualification for the therapy 134 women and 80 men reported SI, of whom 84.3% and 77.5% respectively improved. RESULTS: The reduction of neurotic symptoms intensity was greater in patients of both genders who improved in terms of SI than in those who did not. This referred to global intensity of neurotic symptoms (OWK coefficient) in both genders (p<0.001), as well as to the majority of the neurotic symptoms subtypes in both genders (p<0.05): Phobic disorders, Other anxiety disorders, Obsessive-compulsive disorders, Conversions and dissociations, Autonomic disorders, Somatization disorders, Neurasthenia, Avoidance and dependence, Sexual dysfunctions, Dysthymia; and in case of women (p<0.05): Hypochondriasis, Depersonalization and derealization, Impulsiveness and histrionism and Non-organic sleep disorders. CONCLUSIONS: The results show effectiveness and comprehensiveness of intensive psychotherapy as a treatment method that leads to improvement in terms of both SI and neurotic symptoms. This suggests that the applied therapy may be effective in preventing suicidality in this group of patients. The observed associations also point in favor of hypothesis on similarities in etiopathogenesis of and partly identical personality-related factors predisposing to SI and neurotic disorders.

Despersonalización y relación de objeto / The depersonalization and object relations

El autor parte de una descripción fenomenológica de la despersonalización para pasar enseguida a buscar sus características fundamentales desde una perspectiva psicoanalítica. Para ello se centra en el estudio de las relaciones de objeto, prestando especial atención a las que denomina pregenitales y sobre todo a las de tipo oral. Postula puntos de fijación importantes en este nivel, describiendo relaciones de tipo narcisista con importantes vínculos de dependencia, funcionamientos en todo o nada, cargados de una importante avidez, y postulando que la despersonalización surge precisamente en momentos en que algo de esta relación falla (como en rupturas, abandonos o momentos en que las re composiciones en la relación se desajustan) (AU)

The author begins with a phenomenological description of depersonalization, going on to look for its fundamental characteristics from a psychoanalytic perspective. To do this, focus is placed upon the study of object relations, paying particular attention to those he refers to as pregenital and especially those of an oral type. He postulates significant fixation points at this level, describing narcissistic object relationships with significant links of dependence, all-or-nothing functioning, cathected with substantial greed, and suggesting that the depersonalization emerges precisely at times when something in this relationship fails (such as breakups, being left, or times when "adjustments" in the relationship break clown) (AU)

La disociación en niños y adolescentes: la variabilidad en la expresión clínica a propósito de dos casos / Dissociation in children and adolescents: the variability in clinical expression in relation to two cases

El término disociación ha pasado de constituir una entidad nosológica a ser relegado a un síntoma, apareciendo disgregado en las diferentes clasificaciones internacionales actuales, lo que lo lleva a ser un concepto teórico, confuso y generador de controversia. El diagnóstico por exclusión que esto implica, hace que sea un trastorno infradiagnosticado en la práctica clínica, lo que trae consigo la escasez de publicaciones, especialmente en población infanto-juvenil. Se debe entender cómo la respuesta a un fenómeno postraumático expresándose clínicamente dependiendo de la propia resiliencia del sujeto. Se exponen dos casos clínicos contrapuestos (disociación mente-mente vs mentecuerpo) que han necesitado ingreso hospitalario. Se precisarían más publicaciones sobre esta patología, para ofrecer a los clínicos un enfoque amplio que facilite el diagnóstico de la disociación como entidad mórbida y no únicamente como diagnóstico de exclusión, así como su tratamiento y pronóstico

The term dissociation has gone from being a nosological conception to being relegated to a symptom, appearing nowadays, disintegrated into different international classifications, which leads to a theoretical, confusing and controversial concept generator. The diagnosis of exclusion that this entails, makes it an underdiagnosed disorder in clinical practice, which brings about the shortage of publications, especially in child population. It should be understood as the response to a post-traumatic phenomenon, variably expressed depending on the resiliency of the subject. We expose two counterposed clinical cases (mind-mind vs mind-body dissociation) that needed hospitalization. More publications focused on this disease are needed to offer clinicians a wide focus to help on diagnosis, treatment and prognosis as a disorder and not being only an exclusion-diagnosis syndrome

Chronic subjective dizziness: Analysis of underlying personality factors.

BACKGROUND: Chronic subjective dizziness (CSD) is characterized by persistent dizziness, unsteadiness, and hypersensitivity to one's own motion or exposure to complex visual stimuli. CSD may be triggered, in predisposed individuals with specific personality traits, by acute vestibular diseases. CSD is also thought to arise from failure to re-establish normal balance strategies after resolution of acute vestibular events which may be modulated by diathesis to develop anxiety and depression. OBJECTIVE: To confirm the role of personality traits linked to anxiety and depression (i.e., neuroticism, introversion, low openness) as predisposing factors for CSD and to evaluate how individual differences in these personality traits are associated with CSD severity. METHODS: We compared 19 CSD patients with 24 individuals who had suffered from periferal vestibular disorders (PVD) (i.e., Benign Paroxysmal Postural Vertigo or Vestibular Neuritis) but had not developed CSD as well as with 25 healthy controls (HC) in terms of personality traits, assessed via the NEO-PI-R questionnaire. RESULTS: CSD patients, relative to PVD patients and HCs, scored higher on the anxiety facet of neuroticism. Total neuroticism scores were also significantly associated with dizziness severity in CSD patients but not PVD patients. CONCLUSIONS: Pre-existing anxiety-related personality traits may promote and sustain the initial etiophatogenetic mechanisms linked with the development of CSD. Targeting anxiety-related mechanisms in CSD may be therefore a promising way to reduce the disability associated with CSD.

Factors associated with depression in older carers.

OBJECTIVE: Depression is an adverse outcome frequently seen in carers. With the increasing ageing population and reliance on informal carers, this study aims to identify factors associated with depression in carers in the older age group, using factors that have not been previously investigated. METHODS: We conducted a cross-sectional analysis of 202 older carers using the Geriatric Depression scale, demographics, personality traits, attitudes to ageing and other carer characteristics. RESULTS: Increased hours spent caring and higher levels of neuroticism were all factors associated with depression. The care-recipient diagnosis, other personality traits, attitudes to ageing, leisure-physical activity (PA) and domestic-PA were not significantly associated with depression. CONCLUSIONS: These findings have important implications for interventions to target at-risk carers.

[What do the doctors of different specialties know about sleep disorders and their treatment].

OBJECTIVE: To assessdoctor's knowledge on the relevance of the problem of sleep disorders, methods of their diagnosis and treatment. MATERIAL AND METHODS: The survey was conducted among90physicians of different the rapeuticspecialties of Kazan medical institutions. RESULTS: The doctors believe that main causes of sleep disorders are stressors (20%), depression (13%), neurosis (13%), chronic diseases (13%), asthenia (10%), pain (10%). An analysis of treatment prescribed to patients with sleep disorders revealed large differences. CONCLUSION: Physicians are not well informed about the problems of sleep disorders, have a small idea of the methods of sleepresearch and drugs for their treatment as well as of a sequence of operations that should be used to resolve this problem.

Repetición y creación en el proceso analítico. Introducción al tema monográfico / No disponible

No disponible

Depression in context of low neuroticism is a risk factor for stroke: a 9-year cohort study.

OBJECTIVE: Depression predicts stroke; however, meta-analyses show significant heterogeneity. We hypothesize that the risk of depression on incident stroke is conditional upon the relative contribution of vascular disease and of neuroticism in the underlying pathways to depression in a specific patient. We examined whether depression increases stroke in persons with low neuroticism and without preexisting cardiac disease. METHODS: This was a population-based cohort study with 9-year follow-up (n = 2,050; ≥55 years, 52% female). The incidence of stroke was determined by self-report data as well as data from general practitioners and death certificates. Neuroticism was measured using the Dutch Personality Questionnaire and depression using the Center for Epidemiologic Studies-Depression scale. All data were analysed by Cox proportional hazards regression. RESULTS: A total of 117 incident cases of stroke occurred during follow-up. Among persons with a history of cardiac disease (n = 401), depression predicted incident stroke independent of neuroticism level with a hazard ratio (HR) of 1.05 (95% confidence interval [CI] 1.01-1.10) (p = 0.02). In persons without cardiac disease (n = 1,649), depression and neuroticism interacted significantly in predicting incident stroke (p = 0.028). Stratified analyses showed that depression predicted incident stroke in those with low neuroticism, HR 1.05 (95% CI 1.00-1.09) (p = 0.033), but not in those with high neuroticism, HR 1.01 (95% CI 0.96-1.05) (p = 0.82). CONCLUSIONS: In persons without preexistent cardiac disease, depression is only predictive for future stroke in absence of high neuroticism. This might be explained by the hypothesis that late-life depression in context of low neuroticism is a marker of subclinical vascular disease.

Neurocognitive moderation of associations between cannabis use and psychoneuroticism.

BACKGROUND: Cannabis use has been associated with neurocognitive impairments and psychopathology. The strength of such associations does however appear to depend on many different factors, such as duration and intensity of use, but also differential susceptibility due to genetic make-up and environmental influences. The present study investigated whether specific cognitive weaknesses moderated associations between cannabis use and psychoneuroticism, which may be considered one of the "softer" expressions of an extended psychosis phenotype. METHOD: One hundred and fifty (150) young adults (mean age: 24.7 years, SD: 3.7), mostly college students, performed three computerized neuropsychological tasks: a relatively easy social perception task (Face Recognition), a more complex social perception task combining emotion recognition and executive functioning (Matching Facial Emotions), and a more complex task requiring sustained attention and executive functioning (Sustained Attention-Dots). Participants self-reported on the extent to which they experienced psychological problems using the Symptom Checklist-90 (SCL-90). The SCL-90 total score (psychoneuroticism) was used as dependent variable in analyses of variance. RESULTS: Frequent and current cannabis users performed more poorly than nonusers on the three tasks. They also reported more psychoneuroticism than nonusers whether they were classified according to their lifetime use, their use during the past 12 months, or use during the past 4 weeks. Moderate and former users did not differ from nonusers. Relatively poor performance on the Matching Facial Emotions task, as opposed to performance on the Face Recognition and Sustained Attention tasks, augmented levels of experienced psychoneuroticism among frequent and current cannabis users. CONCLUSIONS: Relatively poor cognitive abilities appear to represent increased vulnerability to effects of frequent and current cannabis use on affective mental health, even among highly educated individuals. There seems to be some specificity as to which (combinations of) neurocognitive abilities may be most indicative, as moderating effects were only observed when participants had relatively poor complex social perception ability.

[Neurosis and genetic theory of etiology and pathogenesis of ulcer disease].

Based on the analysis of literature data and our own research, we have developed the original concept of etiology and pathogenesis of peptic ulcer disease. An analysis of the literature shows that none of the theories of pathogenesis of peptic ulcer disease does not cover the full diversity of the involved functions and their shifts, which lead to the development of ulcers in the stomach and the duodenum. Our neurogenic-genetic theory of etiology and pathogenesis of gastric ulcer and duodenal ulcer very best explains the cause-and-effect relationships in the patient peptic ulcer, allowing options for predominance in one or the other case factors of neurosis or genetic factors. However, it is clear that the only other: combination of neurogenic factor with genetically modified reactivity of gastroduodenal system (the presence of the target organ) cause the chronicity of the sores. The theory of peptic ulcer disease related to psychosomatic pathologies allows us to develop effective schema therapy, including drugs with psychocorrective action. On the basis of our theory of the role of Helicobacter pylori infection is treated as a pathogenetic factor in the development of peptic ulcer disease.

Influence of personality on the relationship between gray matter volume and neuropsychiatric symptoms in multiple sclerosis.

OBJECTIVE: Research has revealed an association between personality traits and health outcomes, and in multiple sclerosis (MS), there are preliminary data showing a correlation between personality traits and brain volume. We examined the general hypothesis that personality influences the relationship between gray matter volume (GMV) and cognitive/neuropsychiatric MS features. METHODS: Participants were 98 patients with MS who underwent magnetic resonance imaging and were tested with the Symbol Digit Modalities Test and the Neuropsychiatric Inventory, the latter providing measures of depression and euphoria that can be characteristic of MS, that is, cheerful indifference and disinhibition. Personality traits were assessed with the NEO Five Factor Inventory. We examined the correlation between personality traits and both GMV and symptoms, and then modeled mediation and moderation influences on the relationships between GMV and cognitive/neuropsychiatric features. RESULTS: Linear regression modeling revealed that GMV (r = 0.54, p < .001) and NEO Five Factor Inventory low conscientiousness (r = 0.36, p = .001) were associated with cognitive function, but no mediator or moderator effects were observed. However, conscientiousness mediated the relationship between GMV and symptoms of euphoria (p = .002). The moderator analysis revealed a significant influence of high neuroticism on the GMV-euphoria relationship (p = .029). CONCLUSIONS: Low conscientiousness and high neuroticism are associated with neuropsychiatric complications in MS, and each influences the relationship between GMV and euphoria. The findings suggest that patients with low conscientiousness are at higher risk for MS-associated cognitive dysfunction and neuropsychiatric symptoms, a conclusion that has implications for the emerging role of personality in clinical neuroscience.

Brain insulin dysregulation: implication for neurological and neuropsychiatric disorders.

Arduous efforts have been made in the last three decades to elucidate the role of insulin in the brain. A growing number of evidences show that insulin is involved in several physiological function of the brain such as food intake and weight control, reproduction, learning and memory, neuromodulation and neuroprotection. In addition, it is now clear that insulin and insulin disturbances particularly diabetes mellitus may contribute or in some cases play the main role in development and progression of neurodegenerative and neuropsychiatric disorders. Focusing on the molecular mechanisms, this review summarizes the recent findings on the involvement of insulin dysfunction in neurological disorders like Alzheimer's disease, Parkinson's disease and Huntington's disease and also mental disorders like depression and psychosis sharing features of neuroinflammation and neurodegeneration.

[The structure of psychopathology associated with addictive disorders, against alcohol addiction and the possibility of it's neurometabolic correction in the elderly].

The article presents the analysis of the structure and dynamics of psychopathology associated with addictive disorders in elderly patients with alcohol dependence. In terms of syndromic approach the structure of neurotic disease in elderly patients with a verified diagnosis of mental and behavioral disorders associated with alcohol consumption was evaluated. In the overall structure of neurotic pathology in these patients the analysis of symptoms of neurotic diseases, the research of the structure of syndromes and their dynamics were carried out, as well as the patient's attitude to the disease and to its manifestations was determined. A factor model of the pathogenesis of neurotic pathology connected with mental and behavioral disorders due to alcohol use in elderly patients was developed. The high clinical effectiveness of the drug "Cytoflavin" used in the reduction of psychiatric symptoms in patients aged from 62 to 74 years with a diagnosis of mental and behavioral disorders associated with alcohol consumption has been shown.

Self-reported cognitive decline on the informant questionnaire on cognitive decline in the elderly is associated with dementia, instrumental activities of daily living and depression but not longitudinal cognitive change.

BACKGROUND/AIM: A subjective history of cognitive decline is integral to dementia screening, yet there are few data on the accuracy of retrospective self-reports. We prospectively examined the longitudinal predictors of self-reported decline, including rate of cognitive change, clinical diagnosis, depressive symptoms and personality. METHODS: We used a large (n = 2,551) community-dwelling sample of older adults (60-64 years at baseline) and tracked their cognitive functioning over 3 waves across a period of 8 years. Individual rates of change in multiple domains of cognition, incident dementia and mild cognitive disorders, apolipoprotein E (APOE) ε4 genotype, level of education, depressive symptoms and personality were examined as predictors of wave 3 retrospective self-reported decline as measured by the Informant Questionnaire on Cognitive Decline in the Elderly. RESULTS: The rate of cognitive decline did not predict subjective decline. Significant predictors of self-reported decline included dementia diagnosis, problems with instrumental activities of daily living, depression and neuroticism at the time of self-report, as well as the presence of an APOE ε4 allele. CONCLUSIONS: In this relatively young cohort, retrospective self-report of cognitive decline does not reflect objective deterioration in cognition over the time period in question, but it may identify individuals in the initial stages of dementia and those with elevated psychological and genotypic risk factors for the development of dementia.