Guilt is effectively induced by a written auto-biographical essay but not reduced by experimental pain.

Introduction: The aim of the present study was (1) to validate the method of guilt-induction by means of a written auto-biographical essay and (2) to test whether experimental pain is apt to alleviate the mental burden of guilt, a concept receiving support from both empirical research and clinical observation. Methods: Three independent groups of healthy male participants were recruited. Group allocation was not randomized but within group pain/sham administration was counterbalanced over the two test-days. Groups were tested in the following consecutive order: Group A: guilt induction, heat-pain/sham, N = 59; Group B: guilt induction, cold-pressure-pain/sham, N = 43; Group C: emotionally neutral induction, heat-pain/sham, N = 39. Guilt was induced on both test-days in group A and B before pain/sham administration. Visual analog scale (VAS) guilt ratings immediately after pain/sham stimulation served as the primary outcome. In a control group C the identical heat-pain experiment was performed like in group A but a neutral emotional state was induced. Results: A consistently strong overall effect of guilt-induction (heat-pain: p < 0.001, effect size r = 0.71; CPT-pain p < 0.001, r = 0.67) was found when compared to the control-condition (p = 0.25, r = 0.08). As expected, heat- and cold-pressure-stimuli were highly painful in all groups (p < 0.0001, r = 0.89). However, previous research supporting the hypothesis that pain is apt to reduce guilt was not replicated. Conclusion: Although guilt-induction was highly effective on both test-days no impact of pain on behavioral guilt-ratings in healthy individuals could be identified. Guilt induction per se did not depend on the order of testing. The result questions previous experimental work on the impact of pain on moral emotions.

Negative Mood Regulation Expectancies (NMRE) as a Moderator of the Association Between Stress and Treatment Outcomes in Interdisciplinary Chronic Pain Treatment.

OBJECTIVE: Negative mood regulation expectancies (NMRE) describe the expectancies of an individual regarding his or her ability to regulate or reduce negative mood states by certain cognitive or behavioral strategies. NMRE are closely associated with the actual emotion regulation and potentially buffer the negative psychological and physical health consequences of stress. In the context of chronic pain, stress plays a central role, as long-term stress can have additional negative consequences regarding pain and its progression. The present study investigated the relationship of NMRE with treatment outcome, and more importantly, its buffering role in the association between stress and treatment outcomes. METHOD: Two hundred six chronic pain inpatients (fulfilling the International Classification of Diseases, 10th Revision [ICD-10] diagnosis of F45.41) of an interdisciplinary treatment completed standardized self-report questionnaires at intake and discharge. Hierarchical linear regression analyses were used to test the main effects of the Negative Mood Regulation Scale-Short Form on pain intensity, pain-related disability, and psychological distress as treatment outcomes and its moderating role in the association of stress and the 3 outcome measures. RESULTS: A significant main effect of NMRE on treatment outcome was only found for psychological distress. However, for all 3 outcome measures, a significant moderating effect of NMRE on the association between stress level and treatment outcome was found. DISCUSSION: NMRE appear to play an important role for the outcome of inpatient treatment for chronic pain. Due to their buffering effect on the negative association between stress and therapy outcome, they should be targeted in the treatment of chronic pain.

Reckless Generosity, Parkinson's Disease and Dopamine: A Case Series and Literature Review.

BACKGROUND: Impulse control disorders (ICDs) are a frequent side effect of dopamine replacement therapy (DRT) in Parkinson's disease (PD). Reckless generosity might expand the spectrum of known ICDs. CASES: Over 18 months, we encountered three PD patients exhibiting reckless generosity under DRT, leading to disastrous financial and social consequences. LITERATURE REVIEW: Except for another case series describing reckless generosity in three PD patients, only one study has examined generosity in PD patients; with findings suggesting that PD patients with ICDs are less sensitive to the aversive aspects of the lack of reciprocation in social settings. Studies with healthy individuals suggest that increased availability of dopamine might reduce social discounting and promote egalitarian behavior, and thereby increase generous behavior towards strangers. Genetic studies show that polymorphisms in dopamine D4 receptors influence generous behavior. CONCLUSIONS: Reckless generosity in PD patients with DRT might be underreported and should therefore be carefully be screened for by clinicians. A potential mechanism underlying this ICD-related behavior might be a sensitization of the mesolimbic and mesocortical dopaminergic system, leading to reduced social discounting and maladaptive reward-learning. Further research is needed to investigate the prevalence and underlying mechanisms of reckless generosity in PD patients.

[Consequences of aversive childhood experiences: effects on the neuroendocrine system]. / Konsequenzen aversiver Kindheitserfahrungen: Auswirkungen auf das neuroendokrine System.

Consequences of aversive childhood experiences: effects on the neuroendocrine system Abstract. Childhood experiences of stress due to neglect, physical, psychological or sexual abuse lead in many cases to permanent changes in the stress-regulating neuroendocrine processes. Epidemiological studies already showed 20 years ago that the extent of childhood stressors correlates with the occurrence of various somatic, functional and psychological diseases in adulthood and that cumulative stressors are also reflected in a significantly reduced average life expectancy. The altered stress-related endocrine system is of major importance with regard to the pathogenesis of the secondary somatic, functional and psychological disorders mentioned above.

[Long-term consequences of aversive childhood experiences: effects on pain processing]. / Langzeitkonsequenzen aversiver Kindheitserfahrungen: Auswirkungen auf die Schmerzverarbeitung.

Long-term consequences of aversive childhood experiences: effects on pain processing Abstract. Childhood experiences of stress due to neglect, physical, psychological or sexual abuse often lead to lasting changes in pain processing. Clinically, this is shown, among other things, in an increased sensitivity to pain, a stronger negative-affective connotation of pain and ultimately an increased risk of pain disorders in adulthood. George L. Engel already postulated in the 1960s a child's experience of stress can affect later pain behaviors. This narrative review sets out to summarize the current state of knowledge.

[Long-term consequences of aversive childhood experiences: effects on the incidence of psychiatric illnesses]. / Langzeitkonsequenzen aversiver Kindheitserfahrungen: Auswirkungen auf die Inzidenz psychiatrischer Erkrankungen.

Long-term consequences of aversive childhood experiences: effects on the incidence of psychiatric illnesses Abstract. Early childhood stress experiences through physical, psychological and sexual abuse as well as emotional or physical neglect often lead to permanent changes in the psychological well-being. Clinically, this is shown among other things in an increased incidence of various psychiatric disorders. This narrative survey aims to summarize the current status of existing studies on early childhood stress experiences and related psychiatric consequences. Scientific publications from the online libraries PubMed, PsycINFO and GoogleScholar served as the database. The search was conducted under the keywords Adversive Childhood Events (ACE), Adverse Childhood, Childhood Trauma, Psychiatric Disorders, Health Consequences as well as their German translations. The search resulted in 46 studies to be considered.

[Long-term consequences of aversive childhood experiences: effects on cerebral structures]. / Langzeitkonsequenzen aversiver Kindheitserfahrungen: Auswirkungen auf zerebrale Strukturen.

Long-term consequences of aversive childhood experiences: effects on cerebral structures Abstract. Early childhood stress experiences due to neglect, and physical, psychological or sexual abuse can lead to permanent changes in central nervous structures. The central nervous system generally shows a very high plasticity in early childhood. Objectively, these influences are reflected in functional and structural-morphological changes in certain brain areas. Subjectively, they are manifested through changes in cognitive, emotional, perceptive and social experiencing. This review aims to summarize the current status of the limited number of studies with human subjects on the consequences of early childhood stress experiences with focus on the central nervous system.

[Functional body disorders]. / Funktionelle Körperbeschwerden.

Functional body disorders Abstract. By definition, functional disorders cannot be conceptualized bio-morphologically at the organ level. They originate on the basis of dysregulated control processes and perceptional alterations at a superordinate level of the organism. Under excessive stress, any vegetatively regulated system might develop functional disorders. Hence they can also be observed in veterinary medicine. The «incongruence¼ between the organic findings and the symptoms reported represents a diagnostic challenge, which general practitioners, due to the high prevalence of functional disorders are confronted with on a daily basis. Therefore a comprehensible explanatory model is needed in order to build trust and to motivate the patient for treatment. The new S3 guidelines «functional disorders¼ provide constructive and pragmatic information for the adequate treatment of patients with functional disorders.

Rethinking the criteria for fibromyalgia in 2019: the ABC indicators.

PURPOSE: Diagnostic criteria for fibromyalgia have been subject to debate and controversy for many years. The preliminary diagnostic criteria introduced in 2010 and 2011 have been criticized for different reasons, including questionable diagnostic specificity and a lack of an etiopathogenetic foundation. The "ABC indicators" presented in this study reflect a further development of the 2011 criteria and refer to (A) algesia, (B) bilateral, axial-symmetric pain distribution, and (C) chronic distress. PATIENTS AND METHODS: We compared the diagnostic performance of the ABC indicators with that of the 2011 criteria by analyzing the data of 409 inpatients with chronic functional pain divided into two subgroups of pain patients: Those with whole-body pain and those with pain not involving the whole body. Under the premise that FM phenotypically represents a whole-body pain disorder, sensitivity, specificity, correct classification and diagnostic odds ratios were calculated. RESULTS: The 2011 criteria demonstrated a specificity of 68.1%, a sensitivity of 75.5%, a correct classification of 71.0% and a diagnostic odds ratio of 6.56 (CI: 4.17-10.31). The ABC indicators achieved a specificity of 88.3%, a sensitivity of 62.3%, a correct classification of 78.6%, and a diagnostic odds ratio of 12.47 (CI: 7.30-21.28). CONCLUSION: The ABC fibromyalgia indicators demonstrated better specificity, lower sensitivity, and better overall diagnostic effectiveness than the original 2011 criteria.

Resting-state functional connectivity remains unaffected by preceding exposure to aversive visual stimuli.

While much is known about immediate brain activity changes induced by the confrontation with emotional stimuli, the subsequent temporal unfolding of emotions has yet to be explored. To investigate whether exposure to emotionally aversive pictures affects subsequent resting-state networks differently from exposure to neutral pictures, a resting-state fMRI study implementing a two-group repeated-measures design in healthy young adults (N = 34) was conducted. We focused on investigating (i) patterns of amygdala whole-brain and hippocampus connectivity in both a seed-to-voxel and seed-to-seed approach, (ii) whole-brain resting-state networks with an independent component analysis coupled with dual regression, and (iii) the amygdala's fractional amplitude of low frequency fluctuations, all while EEG recording potential fluctuations in vigilance. In spite of the successful emotion induction, as demonstrated by stimuli rating and a memory-facilitating effect of negative emotionality, none of the resting-state measures was differentially affected by picture valence. In conclusion, resting-state networks connectivity as well as the amygdala's low frequency oscillations appear to be unaffected by preceding exposure to widely used emotionally aversive visual stimuli in healthy young adults.

Continuous theta burst stimulation over the left dorsolateral prefrontal cortex decreases medium load working memory performance in healthy humans.

The dorsolateral prefrontal cortex (DLPFC) plays a key role in working memory. Evidence indicates that transcranial magnetic stimulation (TMS) over the DLPFC can interfere with working memory performance. Here we investigated for how long continuous theta-burst stimulation (cTBS) over the DLPFC decreases working memory performance and whether the effect of cTBS on performance depends on working memory load. Forty healthy young subjects received either cTBS over the left DLPFC or sham stimulation before performing a 2-, and 3-back working memory letter task. An additional 0-back condition served as a non-memory-related control, measuring general attention. cTBS over the left DLPFC significantly impaired 2-back working memory performance for about 15 min, whereas 3-back and 0-back performances were not significantly affected. Our results indicate that the effect of left DLPFC cTBS on working memory performance lasts for roughly 15 min and depends on working memory load.

Motor threshold predicts working memory performance in healthy humans.

Cognitive functions, such as working memory, depend on neuronal excitability in a distributed network of cortical regions. It is not known, however, if interindividual differences in cortical excitability are related to differences in working memory performance. In the present transcranial magnetic stimulation study, which included 188 healthy young subjects, we show that participants with lower resting motor threshold, which is related to higher corticospinal excitability, had increased 2-back working memory performance. The findings may help to better understand the link between cortical excitability and cognitive functions and may also have important clinical implications with regard to conditions of altered cortical excitability.

On the formation of figurative representations: An integrative psychoanalytic-neurobiological framework.

This article approaches the process of symbolization with a formalized framework that aims to integrate psychoanalytic and neurobiological findings. The authors propose a framework consisting of unconscious and conscious areas. Each of the areas provides networks for storing memories. Psychoanalytically, mental networks contain memories either unconscious or conscious. Neurobiologically, there are subunits of neuronal networks crucial for the storage and recall of memories. Communication between these networks is based on selective memory recall in order to form, for example, figurative representations.

Cortisol reduces recall of explicit contextual pain memory in healthy young men.

Remembering painful incidents has important adaptive value but may also contribute to clinical symptoms of posttraumatic stress disorder and chronic pain states. Because glucocorticoids are known to impair memory retrieval processes, we investigated whether cortisol affects recall of previously experienced pain in healthy young men. In a double-blind, placebo-controlled crossover study, 20 male participants were presented pictures, half of them combined with a heat-pain stimulus. The next day, the same pictures were shown in the absence of pain. Cortisol (20 mg) administered 1h before retention testing reduced recall of explicit contextual pain memory, whereas it did not affect pain threshold or pain tolerance.

Distress and alexithymia in lung recipients - psychosocial strains and associations with chronic allograft dysfunction.

QUESTIONS UNDER STUDY: In recent years, distress and alexithymia have been recognised as psychosocial factors related to both somatic and psychosomatic diseases. In this study distress and alexithymia and their associations with physical parameters were investigated in lung recipients. METHODS: The study, which included 76 patients after a lung transplant, measured psychological distress (Symptom Checklist, SCL-K-9) and alexithymia (Toronto Alexithymia Scale, TAS-20). Physical health was assessed by means of lung function (FEV1), exhaled nitric oxide (eNO), and comorbidity (CCI) at the time of the questionnaire survey. A bronchiolitis obliterans syndrome (BOS) was assessed at the time of the questionnaire survey and one year later. RESULTS: Mean values of distress were found to be significantly higher in lung recipients than in a normal community sample, and mean values of alexithymia were significantly higher in lung patients than in healthy persons. There is a significant positive correlation between distress and BOS at the time of the questionnaire survey (p = .008). Distress is a predictor for new-onset BOS one year after the questionnaire survey (p = .026). No significant correlations were found between alexithymia and physical parameters. CONCLUSIONS: Lung transplants go hand-in-hand with increased alexithymia and psychological distress. In addition, psychological distress may contribute to the development of BOS. This association underlines the importance of psychosocial support after lung transplantation.

Lung function, sociodemographic characteristics, and psychological reaction to transplant associated with chronic stress among lung recipients.

Chronic stress is a well-known consequence of somatic diseases. In this study, we investigated whether physical, sociodemographic, or transplant-related psychological factors were associated with the patient's chronic stress level. A cross-sectional study enrolling 76 patients measured chronic stress (Screening Scale, Screening Subscale of Chronic Stress of the Trier Inventory for the Assessment of Chronic Stress) and the emotional effects of the transplant (Transplant Effects Questionnaire), as well as physical and sociodemographic conditions (lung function, bronchiolitis obliterans syndrome, working status, and parenting). Chronic stress after a lung transplant was significantly lower than in a normal community sample. In the multiple regression analysis, worries concerning the transplant were significantly associated with the patient's chronic stress, but not with physical or sociodemographic parameters, nor with interactions between physical and psychological parameters. These results underscore the importance of transplant-related worries, regardless of the patient's current state of health.

Psychological processing of transplantation in lung recipients: a quantitative study of organ integration and the relationship to the donor.

OBJECTIVES: Lung recipients undergo a complex psychological process, including organ integration and processing of attitudes towards the organ donor. DESIGN: Seventy-six lung recipients were asked to participate in a cross-sectional questionnaire study on the psychological processing of lung transplants. METHODS: The questionnaire consisted of statements describing aspects of organ integration and the patient's relationship with the donor. Furthermore, chronic stress/psychological distress (Screening Scale of the Trier Inventory; Symptom Checklist SCL-K-9) and the emotional effects of transplantation/immunosuppression (Transplant Effects Questionnaire; Medication Experience Scale for Immunosuppressants) were assessed. RESULTS: In general, lung recipients perceive the transplant as part of themselves (97.4%) and not as a foreign object (90%). One-third of patients still have frequent thoughts about the donor, whilst the majority (80.3%) do not believe that they have adopted the donor's characteristic traits. Factor analysis reveals the two-dimensional structure of the questionnaire items 'organ integration' (factor 1) and 'relationship to the donor' (factor 2). Poor organ integration predicts low adherence, low disclosure and high feelings of guilt, whilst a close donor relationship predicts chronic stress and psychological distress. CONCLUSIONS: Poor organ integration and a close relationship to the donor should be borne in mind in psychosocial treatment regarding the patient's adherence behaviour and psychological distress.

Psychological response and quality of life after transplantation: a comparison between heart, lung, liver and kidney recipients.

PRINCIPLES: Various non-specific questionnaires were used to measure quality of life and psychological wellbeing of patients after organ transplantation. At present cross-organ studies dealing specifically with the psychological response to a transplanted organ are non-existent in German-speaking countries. METHODS: The Transplant Effects Questionnaire TxEQ-D and the SF-36 Quality of Life Questionnaire were used to examine the psychological response and quality of life of 370 patients after heart, lung, liver or kidney transplantation. The organ groups were compared with regard to psychosocial parameters. RESULTS: 72% of patients develop a feeling of responsibility for the received organ and its function. This feeling is even stronger towards the patient's key relationships i.e. family, friends, the treatment team and the donor. 11.6% worry about the transplanted organ. Heart and lung patients report significantly fewer concerns than liver and kidney patients. Overall, only a minority of patients report feelings of guilt towards the donor (2.7%), problems in disclosing their transplant to others (2.4%), or difficulties in complying with medical orders (3.5%). Lung transplant patients show significantly better adherence. CONCLUSIONS: A feeling of responsibility towards those one is close to and towards the donor is a common psychological phenomenon after transplantation of an organ. Conscious feelings of guilt and shame are harboured by only a minority of patients. The fact that heart and lung patients worry less about their transplant might have primarily to do with the greater medical and psychosocial support in this group.

[Questionnaire on emotional response after organ transplantation: German validation of the Transplant Effect Questionnaire (TxEQ-D)]. / Fragebogen zur psychischen Verarbeitung einer Organtransplantation: Deutsche Validierung des Transplant Effects Questionnaire (TxEQ).

OBJECTIVES: The present study investigates a) whether the German version of the Transplant Effects Questionnaire (TxEQ-D), which measures the emotional response to an organ transplantation, has the same factorial structure as the English original version and b) whether the psychometric properties as well as the correlations with the scales of the SF-36 are comparable. METHODS: The questionnaire TxEQ was translated into German and filled out by 370 heart, lunge, liver and kidney transplant patients. Subsequently, factor and item analyses were conducted. The SF-36 was used to test validity. RESULTS: The TxEQ-D has the same factorial structure as the English version as well as comparable psychometric properties. The TxEQ-D factor "worry about transplant" shows the highest correlations with the 10 scales of the SF-36, the lowest correlations with the 10 scales of the SF-36 scales are found for the factor "adherence". CONCLUSIONS: The TxEQ-D is a useful screening instrument in psychosomatic research and in the psychotherapy practice to detect patients with problematic emotional responses to an organ transplantation.