1,721,308 research outputs found
The clinical inadequacy of the DSM-5 classification of somatic symptom and related disorders: an alternative trans-diagnostic model
No full textThe Diagnostic and Statistical of Mental Disorders, Fifth Edition (DSM-5) somatic symptom and related disorders chapter has a limited clinical utility. In addition to the problems that the single diagnostic rubrics and the deletion of the diagnosis of hypochondriasis entail, there are 2 major ambiguities: (1) the use of the term "somatic symptoms" reflects an ill-defined concept of somatization and (2) abnormal illness behavior is included in all diagnostic rubrics, but it is never conceptually defined. In the present review of the literature, we will attempt to approach the clinical issue from a different angle, by introducing the trans-diagnostic viewpoint of illness behavior and propose an alternative clinimetric classification system, based on the Diagnostic Criteria for Psychosomatic Research
Understanding Health Attitudes and Behavior
No full textIndividual attitudes and behavior related to health and disease are major components of clinical encounters. These factors shape lifestyle, presentation of symptoms, access to patient care, interactions between patients and physicians, adherence to medical advice, response to treatment. Health attitudes and behavior may range from anxiety and worry about illness, to various forms of denial, such as delay of seeking care and lack of adherence to treatment. When attitudes result in health-damaging behavior they may be particularly difficult to understand and become a source of frustration to both physicians and patients. Devising appropriate responses by health care providers may contribute to improving final outcomes and decrease health care costs. In particular, health behavior is likely to play a major role in the process of convalescence, in self-management of chronic conditions, in determining a state of recovery, and whenever a rehabilitation process is involved. Understanding the spectrum of health attitudes and behavior is also crucial for motivating people to make beneficial changes (lifestyle medicine), as well as for implementing safety procedures in the community.</p
Italian adaptation of the Parental Attitudes Scales
No full textThe present study explored the psychometric properties of the Italian version of the Parental Attitude Scales (PAD). The PAD are a 46-item self-report questionnaire that were developed to assess three parental attitudes dimensions: Pleasure-Displeasure, Arousal-Non Arousal, DominanceSubmissiveness. A total of 483 parents (235 males; mean age = 42.9 ± 6.1 years) completed the PAD as well as measures of theoretically and conceptually related constructs. A sub-sample of 59 participants completed the PAD a second time in order to explore the test-retest reliability. The results from Principal Axis Factoring (PAF) did not support the original three-factor solution. The three factors explained 22.9% of the total variance; the factor loadings were low, and on the basis of the correlation matrix, many items saturated on more than one factor. Internal consistency was moderately acceptable, temporal stability and concurrent validity was questionable. The Italian version of the PAD showed weaknesses from a psychometric point of view
Behavioral Toxicity Revisited: Iatrogenic Comorbidity in Psychiatric Evaluation and Treatment
No full textIn 1968, DiMascio and Shader provided a conceptual framework for behavioral toxicity of psychotropic drugs (ie, the pharmacological actions of a drug that, within the dose range in which it has been found to possess clinical utility, may produce alterations in mood, perceptual, cognitive, and psychomotor functions that limit the capacity of the individual or constitute a hazard to one's well-being). A drug effect such as sedation or motor stimulation may be considered adverse for one patient and yet therapeutic and desired for another patient; within the same patient, it may be of value at one stage of one's illness and adverse at a later stage. The concept of behavioral toxicity encompasses adverse events that may be limited to the period of drug administration and/or persist long after their discontinuation. These latter phenomena can be subsumed under the rubric of iatrogenic comorbidity. Behavioral toxicity may ensue with any type of medical drug. Examples related to antidepressant drug use (onset of suicidality and aggression, switching from unipolar to bipolar course, withdrawal phenomena upon discontinuation, postwithdrawal persistent disorders) are discussed. Consideration of potential vulnerability to adverse events including behavioral toxicity should be placed in the context of the benefits that treatment may entail
Rasch Analysis and Its Relevance to Psychosomatic Medicine
Full text linkRasch analysis, an application of item response theory, has been widely applied to the validation of assessment measures, particularly those developed by clinimetric techniques. The main aims of this editorial are to foster further development of valid clinimetric measures by explaining the Rasch method, noting variables generated by Rasch analysis and their interpretation. This is intended to highlight validation data to be included in papers or presentations on clinimetric tools and to assist readers in appraising papers on clinimetric measures
Depressive, anxious, withdrawal symptoms, and craving as possible predictors of abstinence maintenance in smokers attending a 12-week quitting program
Full text linkBACKGROUND INFORMATION: Depressive, anxious, withdrawal symptoms, and craving might affect differently the probability to maintain abstinence after quitting smoking.
OBJECTIVE: The objective of this study was to assess depressive, anxious, nicotine withdrawal symptoms, and craving in a sample of smokers attending a smoking cessation program over a period of 12 weeks.
METHODS: A naturalistic study was conducted in which 78 smokers were consecutively recruited for a 12 week evaluation program. Socio-demographic data and clinical information were collected, rating scales were used to assess anxious and depressive symptoms, nicotine dependence, withdrawal symptoms, and craving.
RESULTS: Of the 78 recruited smokers, 17 remained abstinent and 61 reverted to smoking during the period of 12 weeks. The probability of maintaining abstinence was increased when low depressive symptoms or low craving occurred during the cessation program.
CONCLUSION: The present results strengthen the importance of assessing depressive symptoms and craving over the follow-up of a physician-assisted smoking cessation program to detect abstaining smokers at risk to relapse
Current Psychosomatic Practice
Full text linkPsychosomatic research has advanced over the past decades in dealing with complex biopsychosocial phenomena and may provide new effective modalities of patient care. Among psychosocial variables affecting individual vulnerability, course, and outcome of any medical disease, the role of chronic stress (allostatic load/overload) has emerged as a crucial factor. Assessment strategies include the Diagnostic Criteria for Psychosomatic Research. They are presented here in an updated version based on insights derived from studies carried out so far and encompass allostatic overload, type A behavior, alexithymia, the spectrum of maladaptive illness behavior, demoralization, irritable mood, and somatic symptoms secondary to a psychiatric disorder. Macroanalysis is a helpful tool for identifying the relationships between biological and psychosocial variables and the individual targets for medical intervention. The personalized and holistic approach to the patient includes integration of medical and psychological therapies in all phases of illness. In this respect, the development of a new psychotherapeutic modality, Well-Being Therapy, seems to be promising. The growth of subspecialties, such as psychooncology and psychodermatology, drives towards the multidisciplinary organization of health care to overcome artificial boundaries. There have been major transformations in health care needs in the past decades. From psychosomatic medicine, a land of innovative hypotheses and trends, many indications for changes in the current practice of medicine are now at hand. The aim of this critical review is to outline current and potential clinical applications of psychosomatic methods
The Potential Role of Iatrogenic Comorbidity in the Interaction between Pharmacotherapy and Psychotherapy in Anxiety Disorders
No full textThe combination of pharmacotherapy and psychotherapy in the setting of anxiety disorders is often viewed as a potential source of augmentation of clinical effects, with little attention paid to the potential occurrence of negative events. In most of the studies, however, if benefits ensued, they were modest and likely to fade. Further, 4 high-quality and well-designed individual studies suggest that the addition of a benzodiazepine or an antidepressant to cognitive behavioral treatment of anxiety disorders could be detrimental compared to placebo at follow-up. The aim of this review was to outline a novel hypothesis, which needs to be adequately tested but may shed some new light on this interaction. Any type of psychotropic drug treatment, particularly after long-term use, may increase the risk of experiencing additional psychopathological problems that do not necessarily subside with discontinuation of the drug or of modifying responsiveness to subsequent treatments. The changes are persistent and not limited to a short phase, such as in the case of withdrawal reactions, and cannot be subsumed under the generic rubrics of adverse events or side effects. The term 'iatrogenic comorbidity' refers to unfavorable modifications in the course, characteristics, and responsiveness of an illness that may be related to treatments that were administered previously. The likelihood of iatrogenic comorbidity needs to be considered in clinical practice: The concurrent use of pharmacotherapy and psychotherapy may yield advantages in the short term, but its costs at some later point in time may largely outweigh such benefits
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