Emotional processing in panic disorder and its subtypes: An fMRI study using emotional faces.

BACKGROUND: Inconsistent findings regarding the pathophysiology of panic disorder (PD) could result from clinical heterogeneity. Identifying subtypes could enhance insights into the neurobiological substrates of PD. METHODS: An emotional faces fMRI paradigm was used in a group of PD patients (n = 73) and healthy controls (n = 58). The overall PD group was further divided into three previously identified subtypes: a cognitive-autonomic (n = 22), an autonomic (n = 16) and an aspecific (n = 35) subtype. Differences in brain activity levels in response to emotional facial expressions between groups were examined for six regions of interests, namely the amygdala, ventromedial prefrontal cortex, anterior cingulate, fusiform gyrus, lingual gyrus and insula. RESULTS: PD patients showed lower activity in the rostral anterior cingulate in response to angry faces than healthy controls, which was mainly driven by the autonomic subtype. No significant differences were found in other brain regions when comparing PD patients with controls or when comparing across PD subtypes. LIMITATIONS: Sample sizes in subgroups were relatively small CONCLUSIONS: The role of the rostral anterior cingulate cortex for emotional processes critical in panic disorder is highlighted by this study and provides, albeit preliminary, evidence for the use of a subtype approach to advance our neurobiological insights in PD considering its involvement in the appraisal of autonomic viscero-sensory symptoms.

Tinnitus and anxiety disorders: A review.

BACKGROUND: The most common form of tinnitus is a subjective, auditory, and distressing phantom phenomenon. Comorbidity with depression is high but other important psychiatric disorders such as anxiety disorders have received less attention. The current paper reviews the literature on the associations between tinnitus and anxiety disorders and the underlying pathophysiology, and discusses the clinical implications. METHODOLOGY: PubMed and Web of Science were searched for all articles published up until October 2014 using combinations of the following search strings "Tinnitus", "Anxiety disorder", "Panic Disorder", "Generalized Anxiety Disorder", "Post traumatic stress disorder", "PTSD" "Social Phobia", "Phobia Disorder", "Obsessive Compulsive Disorder", "Agoraphobia". RESULTS: A total of 117 relevant papers were included. A 45% lifetime prevalence of anxiety disorders is reported in tinnitus populations, while an important overlap in associated (sub)cortical brain areas and cortico-subcortical networks involved in attention, distress, and memory functions is suggested. A disturbed hypothalamic-pituitary-adrenal axis function can be found in tinnitus and in anxiety disorders but, in comorbidity, the direction of the dysfunction is unclear. CONCLUSION: Comorbidity is high and screening for and treatment of anxiety disorders is recommended in moderate to severe tinnitus, as, given the overlap in the structural and functional brain circuitries involved, theoretically, their management could improve (subjective) levels of tinnitus although further empirical research on this topic is required.

Locus of control and metabolic control.

Previous studies designed to establish in diabetic patients the relationship between metabolic control and locus of control are controversial. The aim of the present study was to find answers to the following questions: is there a link between an internal locus of control and improved metabolic control? Is this true for type I and type II diabetic subjects? Is this improved metabolic control linked directly, or even indirectly, with the locus of control by types of behaviour, such as for example a greater desire for information concerning the disease (knowledge) and closer adherence to doctors' recommendations (compliance)? Sixty-one patients (36 type I and 25 type II) on insulin therapy were compared according to the type of their locus of control using two different questionnaires (Rotter and Wallston). The extent of their knowledge about diabetes was also assessed; self-monitoring of blood glucose (SMBG) was considered to be a measure of compliance, while the HbA1 level was considered to be an indicator of metabolic control. The study compared the influence of the type of locus of control on the various parameters. The results indicate that, irrespective of the questionnaire, type I "internals" exhibited better metabolic control (p < 0.05) than type I "externals", even with a lower level of knowledge of diabetes (p < 0.01) and less frequent SMBG (p < 0.05). However, the benefits of internality as regards metabolic control were not as great when this internality was extreme.(ABSTRACT TRUNCATED AT 250 WORDS)

[Role of freedom in psychiatric theories]. / Place de la liberté dans les théories psychiatriques.

All the theories of mind used in the treatment of mental illnesses are based on one or another kind of determinism. Therefore, psychiatrists are obliged to conceive the subjective free will of their patients as a psychological function that their theories do not explain. As a result of it, they encounter many difficulties in the ethical aspects of their therapeutical choices. Following the ideas of A. Pichot, F. Varela and Ph. Meire, the author proposes an autoreferential conception of the cerebral functions and its link with mind. He shows how it is possible to give a theoretical place to human free will. He indicates the clinical advantages of such a model, giving the free will of the patient a therapeutical role, and making the ethical choices of the psychiatrist easier.

To control or to be controlled? From health locus of control to morphine control during patient-controlled analgesia.

We postulated that patients with an internal locus of control, i.e. those who like to control their health problems themselves, would adapt more adequately to the 'patient-controlled analgesia' technique as compared to patients with an external health locus of control, who do not believe in their own control. Since contradicting studies have been published on this matter, we investigated relations between the demand for analgesics, perceived pain in the postoperative phase, and the health locus of control in the postoperative context of cardiac surgery. Findings demonstrate distinct utilization patterns between subjects with internal or external locus of control concerning total morphine consumption, number of unsatisfied demands and reduction of perceived pain.

[Prevalence of human immunodeficiency virus infection in a psychiatric population in Central Africa]. / Prévalence de l'infection par le virus de l'immunodéficience humaine dans une population psychiatrique en Afrique Centrale.

In an African population of 292 women, hospitalised for psychiatric reasons, the seropositivity for HIV was clearly found higher than in the general corresponding population; this was particularly significant for first hospitalisations; furthermore, the seropositivity became twice as high in the group hospitalised several times. The HIV, known for neurotropism, seems responsible for a psychic fragility factor, favorising psychiatric breakdowns as well as their recurrences. No specific psychiatric diagnosis appears to be related to the seropositive patients. This study suggest that psychiatric breakdowns are already favoured in the period preceeding immunodeficiency symptoms (AIDS or ARC).

[Lasthénie de Ferjol syndrome. Apropos of a case]. / Le syndrome de Lasthénie de Ferjol. A propos d'une observation.

After a brief review of literature, the authors report a case of the "Lasthénie de Ferjol" syndrome. From clinical observations, they establish theoretical landmarks and underline the necessity for searching the meaning.

[Crisis work challenged in emergencies]. / Le travail de la crise à l'épreuve de l'urgence.

This paper present a statistical study on the population of 775 psychiatric emergencies that arrived at the emergency service of Saint-Luc Hospital in Brussels (Belgium), between September 1, 1986 and December 31, 1986. The first request of the patient is medical, whereas his relatives expect that the abnormal and disturbing aspects of the patient's behaviour be taken in charge. From the point of view of diagnosis, two populations are clearly identified: psychiatric disorders (or psychiatry in emergency) and couple or family crisis situations, these representing the most specific aspect of psychiatric emergencies. The model of crisis interaction-intervention developed to address these emergencies is presented.

[Denial and coronary disease. A reconsideration of the denial mechanism in psychosomatic diseases and particularly in coronary disease]. / Déni et maladie coronarienne. Pour une reconsidération topique du mécanisme de déni dans les maladies psychosomatiques et la maladie coronarienne en particulier.

Recent research has shown that patients with life-threatening illnesses have improved chances of survival and enhanced abilities to manage situational anxiety and depression if, instead of recognizing the seriousness of their illness, they employ the psychological defense mechanism of denial. Denial as a coping style provides indeed marked benefits for the patient, at least during acute hospital recovery, but seems to be possibly maladaptative in the long run after hospital discharge. The present study is an attempts to review the different findings related to the use of denial by the coronary patient. The concept and its use are re-examined from the very different standpoints of the patient, the cardiologist and the psychologist, in a psychodynamic, a systemic and a psychosomatic perspective. Even if clinically meaningful, denial is also revisited through both the ethical and the epistemological approaches.

[Hypochondriasis. Symptom at the crossroad or a road crossing the syndromes?]. / L'hypocondrie. Symptôme à la croisée des chemins ou chemin à la croisée des syndromes?

Even if widely described, hypochondriasis remains a multidimensional concept which has to be carefully reconsidered: different meanings are indeed involved in its use, coming from historical and classical psychiatry, and from psychoanalysis as well as from the new trends in psychosomatic medicine and liaison psychiatry. The syndrome/symptom confusion has to be avoided. It also appears that some light should be shed on the concept of the term "hypochondriasis", which has been used abusively in modern psychiatry.

The spouse as a possible anginal warning system in silent myocardial ischaemia.

It has been previously shown that undercomplaining behaviour is involved in the 'silence' of Silent Myocardial Ischaemia (SMI). By means of symptom checklists completed blindly by both the patient and his spouse we found that: (1a) at an individual level, even in non-cardiac related symptoms areas (everyday illnesses), SMI patients have a lower propensity to complain than symptomatic patients; yet (1b) they describe the same level of worrying about symptoms as painful patients. (2) At a second level, when looking at patient-spouse discrepancies it appears that the spouse of the SMI patient describes the patient as having not only more symptoms but also as being less worried than he reports. On the contrary, the spouse of the symptomatic patient generally describes the patient as having fewer symptoms than he does and as being more worried by the symptom's appearance than he reports. These data support the denial hypothesis in SMI and allow us to consider the spouse not only as a good anamnestic collaborator in order to avoid information biases in SMI but also as a potential warning system that could be used in prevention and treatment strategies related to SMI.

[Silent myocardial ischemia. Psychosomatic viewpoint]. / L'ischémie myocardique silencieuse. Le point de vue psychosomatique.

Recent research has shown that myocardial ischemia, even in a severe form, may occur without anginal symptoms. The pathophysiology of such silent ischemic episodes and cardiac ischemic pain in general remain unclear. The aim of this study is to investigate the possible interaction between undercomplaining and denial mechanisms with pain acceptance, in order to see if such psychological factors may be of value in understanding the clinical difference between silent and painful ischemia in coronary artery diseased patients. The psychosomatic approach appears to be relevant for the study of cardiac pain and a new understanding of silent myocardial ischemia is thus proposed and discussed.

Metabolic and psychological evolution of insulin dependent diabetic patients during a 6 months insulin-pen treatment.

The aim of the study is to assess whether an insulin pen-treatment (NovopenR) could be of interest in 10 type I insulin dependent diabetic patients (C-peptide: 0.04 +/- 0.01 pmol/ml, mean +/- SEM), with metabolic and psychological parameters being together taken into account. The daily insulin doses were comparable during the previous treatment with conventional syringes (2-3 daily injections of ActrapidR and MonotardR) and the pen therapy: 0.65 +/- 0.05 vs 0.68 +/- 0.04 U/kg b.w. The metabolic control assessed by HbA1 levels was unchanged before and after 6 months pen treatment: 10.7 +/- 0.7 vs 10.9 +/- 0.6%, respectively. However, fructosamine increased from 2.89 +/- 0.26 to 3.92 +/- 0.20 mmol/l (p less than 0.01) during pen treatment. The psychological objective variables showed no significant changes after pen treatment. In contrast, the staff ratings about the patients attitude toward illness and the spouse evaluation of subjective well-being increased from 40.2 +/- 8.4 to 49.5 +/- 7.8 (p = 0.03) and 34.8 +/- 23.4 to 51.1 +/- 21.1 (p = 0.04), respectively. In conclusion, in a limited group of patients, a multiple injection regimen by pen treatment did not lead to an improved metabolic control. However, subjective psychological tests showed that some aspects of well-being tended to improve.

[The criminal responsibility of the mental patient]. / La responsabilité pénale du malade mental.

The authors analyze the issue of the penal responsibility raised by the psychiatrists as expert witnesses. According to the A.P.A. Commission on this issue, they stress the incompatibility between the judicial and the psychiatric concepts. The issue does not belong to the psychiatric domain as such but resides within the boundaries of philosophy and ethics. The enduring ambiguity pervades more the psychiatrist than the legal profession. The authors agree with the A.P.A. Commission in maintaining the issue of responsibility, failing which there would be a serious ethical drawback. However, this should be the judge exclusive power. The psychiatrist is limited to staying within a therapeutic point of view, this includes a psychiatric diagnosis, the potential therapy, if any, and a prognosis as well. Owing to the sociological and criminological aspects, the expert report should be done by a multidisciplinary team. The authors wish an official attitude on these matters from the concerned professional associations in Belgium, up to their American colleagues.