Multidimensional Disorder Research Articles

The Association between Pressure Pain Thresholds, Conditioned Pain Modulation, Clinical Status, and Sleep Quality in Fibromyalgia Patients: A Clinical Trial Secondary Analysis.

Background: Fibromyalgia (FM) is a complex multidimensional disorder primarily characterized by chronic widespread pain, significantly affecting patients' quality of life. FM is associated with some clinical signs found with quantitative sensory testing (QST), sleep disturbance, or psychological problems. This study aims to explore the associations between pressure pain thresholds (PPTs), conditioned pain modulation (CPM), clinical status, and sleep quality in FM patients, offering insights for better clinical management and assessment tools. Methods: This secondary analysis utilized data from a clinical trial involving 129 FM patients. Various assessments, including the Fibromyalgia Impact Questionnaire (FIQ), Pain Catastrophizing Scale (PCS), State-Trait Anxiety Inventory (STAI), and Jenkins Sleep Scale (JSS), were employed to evaluate the clinical and psychological status and sleep quality. PPTs and CPM were measured to understand their relationship with clinical parameters. Results: Our findings revealed that PPTs and CPM are not significantly associated with the clinical status or sleep quality of FM patients. Instead, pain catastrophizing and anxiety state showed a stronger correlation with the impact of fibromyalgia and sleep disturbances. These results highlight the importance of psychological and cognitive factors in managing FM. Conclusions: The study suggests that while PPTs and CPM may not be reliable biomarkers for clinical status in FM, the use of comprehensive assessments including FIQ, PCS, STAI, and JSS can provide a more accurate evaluation of patients' condition. These tools are cost-effective, can be self-administered, and facilitate a holistic approach to FM management, emphasizing the need for personalized treatment plans.

An exploratory investigation of the association between severities of the adverse impact of stuttering and co-occurring disorders

ABSTRACT Stuttering is a multi-dimensional disorder that affects diverse life aspects of people who stutter. This study aimed to investigate the association between severities of the adverse impact of stuttering and co-occurring disorders. Thirty adults who stutter (mean age, 37.6 ± 14.1 years; 26 males and four females) participated in this study. The Liebowitz Social Anxiety Scale (LSAS-J), Autism-Spectrum Quotient short form (AQ-10-J), and Conners’ Adult ADHD Rating Scales (CAARS) were used to assess symptoms of social anxiety disorders (SAD), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD), respectively. The index of ratio of disfluencies (RDF) was calculated to assess cluttering. The Japanese version of the Overall Assessment of the Speaker’s Experience of Stuttering for Adults (OASES-A-J) was used to assess the adverse impact of stuttering. A moderate positive correlation was found between the LSAS-J and OASES-A-J scores. Inattention and ADHD symptoms total scores were significantly correlated with the OASES-A-J scores. The adverse impact of stuttering was associated with symptoms of co-occurring disorders, namely, SAD, ADHD, and cluttering. A negative correlation was observed between the RDF and OASES-A-J Section III score. Cluttering symptoms were associated with less communication impact in daily situations. This study sheds light on the importance of comprehensive assessments from professionals with relevant expertise for adults who stutter.

Online Questionnaire with Fibromyalgia Patients Shows Negative Correlations between Disease Severity and Adherence to Mediterranean Diet.

Fibromyalgia (FM) is a multidimensional disorder in which intense chronic pain is accompanied by a variety of psychophysical symptoms that impose a burden on the patients' quality of life. Despite the efforts and the recent advancement in research, FM pathogenesis and effective treatment remain unknown. Recently, the possible role of dietary patterns and/or components has been gaining attention. The current study aimed to investigate a potential correlation between adherence to the Mediterranean diet (MedDiet) and FM severity in a sample of Italian FM patients. An online survey was designed, composed of customized questions and validated questionnaires with the aim of investigating the intensity and type of pain, the presence of other psychophysical symptoms, the overall impact of FM, general food and lifestyle habits, and adherence to the MedDiet. The collected responses were analyzed for descriptive statistics, linear regression, and propensity score analyses. The results show that, despite considerable use of pharmaceuticals and supplements, FM participants suffered from a high-severity grade disease. However, those with good adherence to the MedDiet experienced a lower pain intensity and overall FM impact. A propensity score analysis indicates a positive influence of the MedDiet against FM severity, thus unveiling the need for well-designed intervention studies to evaluate the therapeutic potential of different dietary patterns.

Multi-session transcutaneous spinal cord stimulation prevents chloride homeostasis imbalance and the development of hyperreflexia after spinal cord injury in rat

Spasticity is a complex and multidimensional disorder that impacts nearly 75% of individuals with spinal cord injury (SCI) and currently lacks adequate treatment options. This sensorimotor condition is burdensome as hyperexcitability of reflex pathways result in exacerbated reflex responses, co-contractions of antagonistic muscles, and involuntary movements. Transcutaneous spinal cord stimulation (tSCS) has become a popular tool in the human SCI research field. The likeliness for this intervention to be successful as a noninvasive anti-spastic therapy after SCI is suggested by a mild and transitory improvement in spastic symptoms following a single stimulation session, but it remains to be determined if repeated tSCS over the course of weeks can produce more profound effects. Despite its popularity, the neuroplasticity induced by tSCS also remains widely unexplored, particularly due to the lack of suitable animal models to investigate this intervention. Thus, the basis of this work was to use tSCS over multiple sessions (multi-session tSCS) in a rat model to target spasticity after SCI and identify the long-term physiological improvements and anatomical neuroplasticity occurring in the spinal cord. Here, we show that multi-session tSCS in rats with an incomplete (severe T9 contusion) SCI (1) decreases hyperreflexia, (2) increases the low frequency-dependent modulation of the H-reflex, (3) prevents potassium-chloride cotransporter isoform 2 (KCC2) membrane downregulation in lumbar motoneurons, and (4) generally augments motor output, i.e., EMG amplitude in response to single pulses of tSCS, particularly in extensor muscles. Together, this work displays that multi-session tSCS can target and diminish spasticity after SCI as an alternative to pharmacological interventions and begins to highlight the underlying neuroplasticity contributing to its success in improving functional recovery.

Symphonic resonance: optimizing hypnotic suggestions with music to harmonize depression and rumination

ABSTRACT Depression is a complex, multi-dimensional disorder that is recognized as a leading cause of human suffering and disability. A wide variety of treatments, both physical and psychological, have been developed to lessen the burden on depressed individuals and those they may affect. Hypnosis has been shown to be an effective vehicle for delivering psychological treatments for alleviating depression in a number of studies, but it is always a challenge to increase the effectiveness of suggestions given in hypnosis. The addition of music to enhance hypnotic approaches has been studied and received substantial support for its potential effectiveness. This article explores the merits of incorporating music into the delivery of hypnosis sessions and offers specific recommendations for the use of rhythmic methods as a means of deepening hypnosis and increasing the impact of one’s suggestions for reducing depressive ruminations. Five case examples are provided to illustrate the successful use of this integrative approach to treatment.

Stories of Hope: Young People's Personal Narratives About ADHD Put Into Context of Positive Aspects.

There is a growing acceptance that ADHD is a multi-dimensional disorder in which not all symptoms are associated with deficits or functional impairments. This article contributes to research on the positive aspects of the diagnosis, specifically understanding the positive aspects of living with ADHD. The empirical data was based on individual interviews and self-narratives of 10 young adults with ADHD. Narrative analysis was implemented when investigating their stories. The findings showed that challenges with the diagnosis were not necessarily stably occupied, and for some, the diagnosis was thought of as a benefit and something they would not have been without. Four stories highlighted particularly the context of positive aspects: (1) insight and strategies, (2) targeted efforts, (3) balanced energy, and (4) social skills. These aspects were correlated to both the individual's strengths as well as the strengths and support that could be related to their societal and cultural environment.

Anorexia Nervosa in Adolescence: A Comprehensive Study of Multidimensional Factors Associated with Symptom Severity 1 Year Following the Diagnosis.

The overarching goal of this study was to examine the unique contribution of psychological, familial, and friendship factors in explaining anorexia nervosa (AN) symptom severity 1 year following diagnosis among a sample of adolescent girls. A second objective was to determine whether friendship factors mediated the association between psychological and/or familial factors and AN symptom severity. This study included 143 adolescent girls under the age of 18 diagnosed with AN (M = 14.84, SD = 1.31). Participants were recruited from specialized eating disorder treatment programs. At admission (T1), participants completed a set of self-report questionnaires measuring psychological, familial, and friendship factors. AN symptom severity was assessed 1 year later (T2). Results of hierarchical regression analysis revealed that greater general psychological maladjustment at T1 (b = .26; se = .03; p = .00) was associated with greater AN symptom severity at T2. Greater alienation from friends at T1 (b = 1.20, se = .53, p = .03) also predicted greater AN symptom severity at T2, above and beyond the influence of adolescent girls' general psychological maladjustment. Finally, the mediating role of alienation from friends in the association between general psychological maladjustment at T1 and AN symptom severity at T2 was also identified. AN is a multidimensional disorder with a prognosis that involves both psychological and social factors. The results stemming from the present study shed light on the role of peer as a mechanism through which general psychological maladjustment is linked to AN symptom severity 1 year following diagnosis.

Progress on mechanisms of age-related hearing loss.

Age-related hearing loss, or presbycusis, is a common cause of hearing loss in elderly people worldwide. It typically presents as progressive, irreversible, and usually affects the high frequencies of hearing, with a tremendous impact on the quality of life. Presbycusis is a complex multidimensional disorder, in addition to aging, multiple factors including exposure to noise, or ototoxic agents, genetic susceptibility, metabolic diseases and lifestyle can influence the onset and severity of presbycusis. With the aging of the body, its ability to clean up deleterious substances produced in the metabolic process is weakened, and the self-protection and repair function of the body is reduced, which in turn leads to irreversible damage to the cochlear tissue, resulting in the occurrence of presbycusis. Presently, oxidative stress (OS), mitochondrial DNA damage, low-grade inflammation, decreased immune function and stem cell depletion have been demonstrated to play a critical role in developing presbycusis. The purpose of this review is to illuminate the various mechanisms underlying this age-related hearing loss, with the goal of advancing our understanding, prevention, and treatment of presbycusis.

Impact of Pilates suspension with self-awareness on gait and metacognition in multiple sclerosis: Randomized, single-blinded and parallel-group trial

BackgroundExercise and self-awareness are popular in the management of people with MS (pwMS). The combination of these techniques for diminishing mental and cognitive imparements doesn't apply. Since the capacity to monitor one's mind and maintain balance and efficient mobility is fundamental for carrying out the daily affairs of pwMS, in this study we assess the effect of Pilates Suspension with Self-awareness on Gait and Metacognition of pwMS. We also evaluate whether metacognition is trainable and, if so, which component of self-awareness (mental and physical) would be instrumental in this improvement. MethodTwenty-four female PwMS who scored 2–6.5 on the EDSS were homogeneously divided into two intervention groups [one received pilates suspension training (PST) with Benson relaxation (PSBR), and the other received PST with Jacobson's progressive muscle relaxation (PSJR)] and one control group for 7 consecutive weeks. Relaxation training was used as a means to self-awareness. Due to the coronavirus pandemic around the world during the research process, baseline and postintervention tests and training sessions were held online. Dynamic Gait Index (DGI) and Metacognition Questionnaire-30 (MCQ-30), outcome measures were collected before and after the intervention. ResultsAnalysis of group data revealed significant improvement between baseline and intervention phases for Dynamic Gate Index (p = 0.002 for Benson relaxation and p = 0.001 for Jacobson's progressive muscle) and Metacognition Questionnaire-30 (p = 0.02 for Benson relaxation and p = 0.002 for Jacobson's progressive muscle).Conclusions: With regard to multidimensional disorders of pwMS, a combined training protocol is recommended for pwMS.

Effects of Smartphone Addiction, Social Media Addiction and Fear of Missing Out on University Students’ Phubbing: A Structural Equation Model

ABSTRACT Phubbing is a multidimensional disorder in which many addictions intersect due to the nature of smartphones. Therefore, determining the variables that predict the concept of phubbing, the chronic addiction of the digital age, is expected to provide important insights into this behavior. In this regard, the main purpose of the current research is to examine the impact of smartphone addiction, social media addiction, and fear of missing out (FoMO) on phubbing. Data for the study were collected from 208 students at a state university in Turkey. Randomly selected students were reached by the convenience sampling method. The study was conducted in the spring semester of the academic year 2021–2022. The data collection instruments used were a personal information form, the smartphone addiction scale, the social media scale, the FoMO scale, and the Phubbing scale. The obtained data were analyzed using the structural equation model. The research results show that smartphone addiction and social media addiction influence phubbing. On the other hand, FoMO was found to have no influence on phubbing.

Initial Validation of a Sacroiliac Joint-Specific Disability Questionnaire.

Low back pain is a multidimensional disorder that can originate from a variety of pain generators, including the sacroiliac (SI) joint. Although the Oswestry Disability Index (ODI) is often used in SI joint treatment studies, the effects of the SI joint on functional disability are likely different from those of other low back pain generators. Thus, we developed the Denver SI Joint Questionnaire (DSIJQ) and performed validation testing in patients (n=24) with SI joint-specific pain at baseline, +2 weeks, and +6 months. Psychometric analyses included test-retest reliability, internal consistency, content validity, convergent criterion validity, divergent criterion validity, and responsiveness. The DSIJQ showed good test-retest reliability (intraclass correlation coefficient=0.87), internal consistency (Cronbach's alpha=0.842), content validity (<30% floor/ceiling effects), convergent criterion validity (r=0.89; P<.001), and divergent criterion validity (r=-0.33; P=.12). The DSIJQ was correlated with performance on two physical function tests: Timed Upand-Go (r=0.53; P=.008) and 5 Minute Walk (r=-0.52; P=.009). The DSIJQ showed better responsiveness than the ODI (standardized response mean and effect size, 1.14 and 1.45 for DSIJQ and 0.75 and 0.81 for ODI). Overall, the DSIJQ performed well on all psychometrics. Importantly, we validated the DSIJQ with patients' ability to complete two tests of physical functioning. Moreover, the DSIJQ was more sensitive to changes in SI joint disability than the ODI. These psychometrics suggest the DSIJQ is appropriate for evaluating SI joint disability and detecting changes in disability after targeted SI joint treatment. [Orthopedics. 2023;46(6):345-351.].

DNA Hypomethylation Is Associated with Increased Inflammation in Peripheral Blood Neutrophils of Children with Autism Spectrum Disorder: Understanding the Role of Ubiquitous Pollutant Di(2-ethylhexyl) Phthalate.

Autism spectrum disorder (ASD) is a multidimensional disorder in which environmental, immune, and genetic factors act in concert to play a crucial role. ASD is characterized by social interaction/communication impairments and stereotypical behavioral patterns. Epigenetic modifications are known to regulate genetic expression through various mechanisms. One such mechanism is DNA methylation, which is regulated by DNA methyltransferases (DNMTs). DNMT transfers methyl groups onto the fifth carbon atom of the cytosine nucleotide, thus converting it into 5-methylcytosine (5mC) in the promoter region of the DNA. Disruptions in methylation patterns of DNA are usually associated with modulation of genetic expression. Environmental pollutants such as the plasticizer Di(2-ethylhexyl) phthalate (DEHP) have been reported to affect epigenetic mechanisms; however, whether DEHP modulates DNMT1 expression, DNA methylation, and inflammatory mediators in the neutrophils of ASD subjects has not previously been investigated. Hence, this investigation focused on the role of DNMT1 and overall DNA methylation in relation to inflammatory mediators (CCR2, MCP-1) in the neutrophils of children with ASD and typically developing healthy children (TDC). Further, the effect of DEHP on overall DNA methylation, DNMT1, CCR2, and MCP-1 in the neutrophils was explored. Our results show that the neutrophils of ASD subjects have diminished DNMT1 expression, which is associated with hypomethylation of DNA and increased inflammatory mediators such as CCR2 and MCP-1. DEHP further causes downregulation of DNMT1 expression in the neutrophils of ASD subjects, probably through oxidative inflammation, as antioxidant treatment led to reversal of a DEHP-induced reduction in DNMT1. These data highlight the importance of the environmental pollutant DEHP in the modification of epigenetic machinery such as DNA methylation in the neutrophils of ASD subjects.

Hypo- or hyperfunction? Differential relationships between compulsive sexual behavior disorder facets and sexual health.

Previous studies linking compulsive sexual behavior disorder (CSBD) and sexual health have shown mixed results, which could be due to the fact that different CSBD facets may have differential relationships with sexual functioning. As CSBD is a multidimensional disorder, we wanted to investigate whether distinct CSBD domains are differentially related to sexual health. Two online studies were conducted-the first on a convenience sample (812 Polish participants; mean [SD] age,22.07[5.91] years) and a replication study on a representative sample of Polish adults (n = 1526;43.02 [14.37]). Hierarchical regression was employed with sexual functioning as a predicted variable and CSBD symptoms as predictors. The Compulsive Sexual Behavior Disorder Scale was used to assess CSBD symptoms, and the Arizona Sexual Experience Scale was used to measure sexual dysfunction. In study 1, CSBD salience (β = -.20, P < .001) predicted hyperfunction (ie, stronger sex drive, easier sexual arousal, easier vaginal lubrication/penile erection, easier ability to reach an orgasm, and more satisfying orgasms). Yet, CSBD negative consequences (β = .15, P = .001) and dissatisfaction (β = .22, P < .001) predicted hypofunction (ie, weaker sex drive, more difficulties in sexual arousal, greater difficulties in vaginal lubrication/penile erection, less ability to reach an orgasm, and less satisfying orgasms). Similar results were found in study 2: salience (β = -.26, P < .001) and relapse (β = -.11, P = .004) predicted hyperfunction, while negative consequences (β = .12, P < .001) and dissatisfaction (β = .12, P < .001) predicted hypofunction. Our results stress the importance of assessing the severity of each group of symptoms in patients with CSBD to better understand possible difficulties in their sexual functioning. Our studies are the first to evaluate the effects of each CSBD domain on sexual health. We also replicated results obtained from a convenience sample on a representative sample. The cross-sectional design of the current studies does not allow causal relations to be tested, so future longitudinal research should be carried out. We also gathered data from a general population-thus, it is important to replicate these results on patients diagnosed with CSBD. Our research points out the differential impact of CSBD domains on sexual health: salience and relapse are related to sexual hyperfunction, while negative consequences and dissatisfaction to hypofunction.

What underlies emotion regulation abilities? An innovative programme based on an integrative developmental approach to improve emotional competencies: Promising results in children with Prader-Willi syndrome.

This study aimed to test the effect of a new training programme on emotional competencies, named EMO-T, and to show the value of an integrative developmental approach. This approach postulates that the emotion regulation disturbances commonly observed in neurodevelopmental disorders are the consequence of potential disruptions in the prerequisite emotion skills. This integrative approach is particularly suitable in the case of complex and multidimensional disorders such as Prader-Willi syndrome (PWS), a rare genetic disease. We examined the emotion expression, recognition, comprehension, and regulation skills in 25 PWS children aged 5-10 and 50 typically developing children (TD) aged 3-10. After a pre-test session, half of the PWS children participated in the EMO-T programme with their regular therapist for 6 weeks, while the other half continued their usual rehabilitation programme. Two post-test sessions were conducted, one at the end of the programme and one 3 months later. At pre-test, PWS children displayed a deficit in the four emotional competencies (EC). PWS children who participated in the EMO-T programme showed a significant and sustainable post-test improvement regarding voluntary expression and emotion recognition abilities, such that the level reached was no longer different from the baseline level of TD children. They also tended to improve in their emotion regulation, although they received no specific training in this skill. These results support that emotion regulation abilities require prerequisite emotion skills, which should be more fully considered in current training programmes. Because emotion regulation disorders strongly impact all areas of life, an integrative developmental approach appears crucial especially in the case of neurodevelopmental disorders. Further studies should be conducted to explore this perspective.

Delirium in a surgical context from a nursing perspective: A hybrid concept analysis.

The term delirium has been defined in medical diagnosis criteria as a multidimensional disorder, and the term acute confusion is included in nursing classifications. Delirium can be a serious complication assessed in a patient after a surgical procedure. Still, the patient's delirium frequently remains unrecognised. Care of patients with delirium after surgical procedure is complex, and it challenges nursing expertise. From the nurses' viewpoint, delirium is associated with ambiguity of concepts and lack of knowledge. Therefore, reseach on how nurses perceive patients with delirium in a surgical context is needed. The aim of this study was to describe the concepts of delirium and acute confusion, as well as the associated dimensions, in adult patients in a surgical context from the nursing perspective. The study used Schwartz and Barcott's hybrid concept analysis with theoretical, fieldwork, and final analytical phases. Surgical wards, surgical intensive care units, and post-anaesthesia care units. A systematic literature search was performed through Pubmed (Medline), Cinahl, PsycInfo, and Embase. Registered nurses and licensed practical nurses (n=105) participated in the fieldwork phase. In the theoretical phase, the concepts' working definitions were formulated based on a systematic literature search with the year limitations from 2000 until February 2021. At the fieldwork phase, the nurses' descriptions of patients with delirium were analysed using the deductive content analysis method. At the final analytical phase, findings were combined and reported. The concepts of delirium, subsyndromal delirium, and acute confusion are well defined in the literature. From the perspective of the nurses in the study, concepts were seen as a continuum not as individual diagnoses. Nurses described the continuum of delirium as a process with acute onset, duration, and recovery with the associated dimensions of symptoms, symptom severity, risk factors, and early signs. The acute phase of delirium was emphasised, and preoperative or prolonged disturbance did not seem to be relevant in the surgical care context. Patients' compliance with care may be decreased with the continuum of delirium, which might challenge both patients' recovery from surgery and the quality of nursing care. In clinical practice the nurses used term confusion inaccurately. The term acute confusion might be used when illustrating an early stage of delirium. Nurses could benefit from further education where the theoretical knowledge is combined with the clinical practice. The discussion about the delirium, which covers the time both before surgery and after the acute phase should be increased.

Serum interleukin-23 levels: relation to depression, anxiety, and disease activity in psoriatic arthritis patients

ObjectivesAssessment of serum levels of IL-23 in PsA patients and its correlation with depression, anxiety, and disease activity.MethodsEighty psoriatic arthritis (PsA) patients and eighty healthy volunteers matched for age and gender were included in this observational case–control study. All participants suspected to detailed history, clinical assessment, PsA activity using Disease Activity Index for Psoriatic Arthritis (DAPSA) score, the severity and extent of psoriasis was assessed by the Psoriasis Area and Severity Index (PASI), and ultrasonographic assessments of the entheses were examined according to the Madrid Sonographic Enthesitis Index (MASEI). Depression and anxiety were assessed by Hospital Anxiety and Depression Scale (HADS). Serum IL-23 was measured and correlated with disease activity, depression, and anxiety.ResultsThere was no significant difference between patients and controls regarding demographic data. Thirty-six PsA patients (45%) had anxiety and 28 patients (35%) had depression, while in the control group, 16 persons (20%) had anxiety and 12 (15%) had depression, with significant differences between the 2 groups (p < 0.0001). There were significant differences in HADS anxiety and depression scores between patients and controls with significant positive correlations between HADS depression, anxiety scores and IL-23, DAPSA, PASI, and MASEI scores (p < 0.05). IL-23 was positively correlated with DAPSA, PASI, and HADS scores; we observed that interleukin 23, higher DAPSA, and PASI were independently associated with depression and anxiety.ConclusionSerum interleukin-23 levels were elevated in PsA patients and were found to be correlated with depression, anxiety, and disease activity.Key Points• Psoriatic arthritis is a multidimensional disorder with psychiatric drawbacks.• Interleukin-23 is a proinflammatory cytokines that was correlated with depression and anxiety in PsA patients.• Interleukin-23 was correlated with disease activity in PsA.• Depression and anxiety were positively correlated with disease activity in PsA.

Evaluation of the Effect of Taheri Consciousness Fields on Reducing Borderline Personality Disorders in Patients Visiting Psychology Clinic in the Capital of Iran

Every particle in the universe is influenced by different fields, such as gravitational field, electromagnetic field, weak nuclear force, and strong nuclear force. According to the theory of Mohammad Ali Taheri, the founder of two complementary medicines, Faradarmani &amp; Psymentology, there is another field with an immaterial and non-energetic nature, different from known physical fields, which is called Taheri Consciousness Fields (TCFs). These Fields can be currently examined only through empirical methods. One of the results of the application of TCFs is the diagnosis and treatment of mental disorders in human beings. Borderline personality disorder is a multidimensional disorder characterized by numerous deficiencies in interpersonal relationships, self-concept, and cognitive functions. This study aimed to investigate the possibility of reducing borderline personality disorder by being exposed to the TCFs. The present research method is quasi-experimental, including two control and experimental groups, and the pre-test scores are controlled during the analysis process. The statistical population was selected from clients with borderline personality disorder who visited one of the psychological clinics in Tehran’s District 5 in 2019. The statistical sample included 28 females diagnosed with borderline personality disorder using the Borderline Personality Questionnaire (STB). Selecting the sample was random, and they were assigned to the control and experimental groups. In this study, the experimental group included patients who were exposed to the TCFs for 60 minutes. In order to determine the effects of this treatment, the ANCOVA test with the pre-test control was used. The results demonstrated that 27% of the variance between the two groups was due to the effects of TCFs. Therefore, the main hypothesis of the research is confirmed. The MANCOVA test was also used to explore the sub-hypotheses. There was a significant difference between the two groups in the dependent variables and the effects of treatment were 32%, and also the statistical power indicated the sample size was relatively adequate. According to the results, the effect of TCFs in reducing disappointment, impulsivity, and Dissociative identity disorder/paranoia was 25% and 14%, respectively. Therefore, sub-hypotheses number 1 and 2 were confirmed, and sub-hypothesis number 3 about the effects on the Dissociative identity disorder/paranoia was rejected.

Study of Depression in People Living with HIV/AIDS Attending Antiretroviral Treatment Center

Background: Depression, being the most common neuropsychiatric complication of HIV, is also associated with increased healthcare utilization, decreased quality of life, and poor adherence to antiretroviral therapy (ART). Depression is a multidimensional disorder affected by a variety of biological, psychological, and social determinants, and this relation becomes more complicated in HIV patients. The current study therefore aimed to assess the prevalence of depression in adult people living with HIV/AIDS using Patient Health Questionnaire 12 (PHQ12) and to study the various sociodemographic factors and clinical variables associated with depression in adult people living with HIV/AIDS. Materials and Methods: A cross-sectional study was conducted at an ART center in a tertiary care hospital in HIV/AIDS patients of 20–60 years of age. Sociodemographic and clinical characteristics were studied, and PHQ12 was used to assess depression. The χ2 test was applied to test association among depression, sociodemographic variables, and clinical variables of study subjects. Results and Conclusion: Out of the 372 study subjects 169 (45.4%) suffered from depression. Female sex, nuclear family, rural residence, lowered socioeconomic class (lower middle and below), illiteracy, widowed person, and opportunistic infection were significantly associated with depression (P &lt; 0.05) in people living with HIV/AIDS. There was no significant association between prevalence of depression and age group, religion, CD4 count, and WHO staging.

Building therapeutic alliances with patients in treatment for low back pain: A focus group study.

Low back pain is a multidimensional disorder and a biopsychosocial management approach is recommended. However, recent data indicates that physiotherapists mainly focus on biomechanical aspects in treatment and struggle with addressing psychosocial barriers for recovery. We wanted to explore how physiotherapists express their experiences of building therapeutic alliances within a biopsychosocial perspective of low back pain. Qualitative focus-group interviews were performed with five physiotherapists on two occasions with 6months in between. Data were analyzed within a hermeneutical perspective with decontextualization and recontextualization, and identification of themes. Four main themes were identified from the analyses: (1) An ideal standard: Presence, empathy and applying the biopsychosocial perspective is central for building therapeutic alliance. (2) Time-consuming: Active listening and personally adapted treatment is important and time-consuming. (3) Challenging area: Advanced clinical reasoning is needed to understand and modify complex barriers for recovery. Clinical experience is sometimes necessary to integrate the psychological and social domains into physiotherapy management. (4) The art of balancing: Important to apply sensitive communication to help patients gain new insight. Some heavy psychosocial demands on patients may be outside physiotherapists' professional competence. The physiotherapists in this focus group study expressed a shared view that therapeutic alliance should build upon person-centering, motivational communication, and facilitation of lifestyle adjustments within a biopsychosocial perspective of low back pain. Complex clinical reasoning necessary as the optimal cause-corrective treatment strategies were often not obvious. Time and tools to uncover and modify relevant psychological obstacles for recovery were perceived challenging and partly dependent on clinical experience. Addressment of psychosocial obstacles for recovery should be included in basic as well as postgraduate curriculums for physiotherapists. Collaborative practice support strategies like peer guidance and better platforms for interprofessional collaboration and decision support could contribute to improve practice in the psychosocial domain.

Genetics and Molecular Pathogenesis of Human Hydrocephalus.

Hydrocephalus is a neurological disorder with an incidence of 80-125 per 100,000 live births in the United States. The molecular pathogenesis of this multidimensional disorder is complex and has both genetic and environmental influences. This review aims to discuss the genetic and molecular alterations described in human hydrocephalus, from well-characterized, heritable forms of hydrocephalus (e.g., X-linked hydrocephalus from L1CAM variants) to those affecting cilia motility and other complex pathologies such as neural tube defects and Dandy-Walker syndrome. Ventricular zone disruption is one key pattern among congenital and acquired forms of hydrocephalus, with abnormalities in cadherins, which mediate neuroepithelium/ependymal cell junctions and contribute to the pathogenesis and severity of the disease. Given the relationship between hydrocephalus pathogenesis and neurodevelopment, future research should elucidate the genetic and molecular mechanisms that regulate ventricular zone integrity and stem cell biology.