Psychic Factors Research Articles

A natural approach to treatment of inflammatory bowel disease

Inflammatory bowel disease (IBD) comprises a spectrum of chronic inflammatory disorders whose precise aetiology remains elusive, although genetic, immunological and psychic factors are known to play a pathogenic role. Standard medical therapy includes corticosteroid in the acute phase, mesalazine or immunomodulants to maintain remission and biological agents for refractory and/or severe cases. Since the precise causation of IBD remains unclear, treatment is currently aimed at treating symptoms or, at best, general rather than specific pathophysiological changes, which accounts for the sometimes mediocre and unsatisfactory results often observed in clinical practice. Moreover, most of the drugs currently employed to treat IBD exert untoward effects, especially during long-term treatment. Recently a body of evidence has suggested a distinct role of enteric microbial flora in inducing and maintaining intestinal inflammation through a complex interplay with the gut immune system. Accordingly, certain antibiotics such as metronidazole and ciprofloxacin have been successfully employed, especially in Crohn's disease [1]. In view of the side-effects of prolonged administration of systemic antibiotics, rifaximin, a poorly absorbed, locally acting antibacterial agent, has also been tested, with promising results [1]. A safer and even more attractive therapeutic alternative is offered by probiotics, with or without the addition of prebiotics, a ‘natural’ approach to IBD treatment. In this issue of the Journal, Damaskos and Kolios [2] provide an exhaustive and interesting overview of the role of alterations in intestinal microflora (so-called dysbiosis) in IBD and the possible therapeutic effect of probiotics in restoring the balance, thus reducing or preventing intestinal inflammation. What is clear from the available clinical data and needs to be emphasized is the concept that probiotics, far from being all alike, exhibit profound differences in their mechanisms of action and therefore in their therapeutic effects, even within the same genre. Another important observation is that the observations carried out in experimental models do not necessarily predict what will actually take place in clinical practice. For example, Lactobacillus strains were found to attenuate colitis induced by various agents, but in the clinical setting proved to be ineffective in preventing relapse of Crohn's disease in both adults and children [3–5]. In contrast, the yeast Saccharomyces boulardii, when added to mesalazine, has been shown to maintain remission of inactive Crohn's disease more effectively than mesalazine alone [6]. On the other hand, the probiotic mixture named VSL #3, although sometimes providing disappointing results in experimental models, has been shown in several clinical trials to prevent recurrence of pouchitis [2]. On the whole, it appears that each single probiotic agent has to be separately tested in clinical practice, time-consuming and irritating though this process can be. As for prebiotics, the scenario is even more confusing due to the scarcity of well-performed clinical studies. Hence it is almost impossible to draw definite conclusions about the potential role of combinations of pro- and prebiotics (synbiotics) in intestinal disorders as a whole and in IBD in particular. As aptly observed by Damaskos and Kolios [2], mixtures expected to act synergistically might fail to exhibit the predicted results, and so many combinations of probiotics and prebiotics can be postulated that the number of trials to be performed is overwhelming. In conclusion, there is a sound rationale for the use of probiotics in the treatment of IBD. From the published studies some probiotics (S. boulardii, VSL #3) appear to be clinically effective, whereas others either do not offer any substantial benefit or are still to be evaluated in controlled trials. Prebiotics can enhance the efficacy of probiotics alone, but the quality and quantity of the studies available so far are too limited to identify the most effective synbiotic combinations.

Dangerous Discourses: Anxiety, Desire, and Disability

The pleasure and danger of sexuality thematizes erotic desire as always accompanied by a certain anxiety. Although some anxiety is material and precautionary, I address the issue somewhat differently through investigating the psychic factors at play in the western imaginary. Discomfort with manifestations of erotic desire is most clearly invoked by differential embodiment where the challenge to the normative body not only results in disqualification from discourses of sexuality but also raises the contested question of who is to count as a sexual subject. My purpose is not to inquire empirically into the ways that people with disabilities are denied sexual subjectivity but to ask what is at stake in the cultural imaginary that requires such a closing down of possibilities. I develop a psychoanalytic approach to sexually marked anomalous embodiment and ask what part the link between desire and lack plays in thwarting a positive model of disability and sexuality.

Evaluation of patients with symptomatic dermographism

Dermographism or 'simple' dermographism, which has been noted in about 1.5% to 5% of healthy individuals, is regarded as a normal physiological phenomenon. However, in symptomatic dermographism (SD), even light pressure or rubbing from clothes may provoke widespread weal-and-flare reactions with itching and burning. It is one of the dermatologic diseases that negatively impacts quality of life. We aimed to reveal triggering factors and/or associated clinical conditions in patients with SD. Forty patients (28 women and 12 men) with SD whose ages varied between 7 and 65 (30.3 +/- 10.7) participated in the study. Patients having chronic idiopathic urticaria, other types of physical urticaria and cutaneous/systemic mastocytosis were excluded. The diagnosis of SD was confirmed by stroking the skin of the back with a tongue blade. This procedure elicited within minutes a linear weal with a flare and severe itching. In light of the history, physical examination, skin prick test (SPT) with aeroallergens and laboratory results, a possible relationship of certain triggering factors and/or associated diseases (psychic factors, atopy, thyroid diseases, diabetes, menopause, infectious, systemic or malignant diseases, history of scabies, and history of drug reaction) to SD were investigated. The duration of SD varied between 10 days and 10 years (mean: 20.8 months). Psychic factors were found to play the initial triggering role in 12 patients (30%). Five patients (12.50%) were atopic, and they had SPT reactivity to house dust mites. Three female patients (7.50%) defined that their complaints began following drug-induced urticarial rash. Two patients (5%) had hyperthyroidism, and one of the patients with SD of 1-month duration had type-II diabetes mellitus. A female patient defined that her complaints began during the onset of menopausal period. SD was observed with scabies in one patient; and after poststreptococcal glomerulonephritis in a 7-year-old girl. No autoimmune, malignant or other systemic diseases were found in patients with SD. Contrary to commonly held opinion, SD may be associated with some diseases and/or triggered by some conditions. In this study, a close temporal relationship between the appearance of SD and psychic factors, drug reactions and scabies was documented. The relation between SD and atopy, hyperthyroidism, diabetes mellitus, menopause and glomerulonephritis seemed unclear.

Effect of Benzo[a]pyrene on the Immune Status of Mice with Anxious-Depressive Syndrome

We studied the effect of benzo[a]pyrene on cells of lymphoid organs, energy metabolism of blood lymphocytes, and immunological reactivity in mice with anxious depressive syndrome produced by social stress. Benzo[a]pyrene exhibited a more pronounced immunotoxic activity in anxious-depressive animals, which was more than a simple sum of the effects produced by adverse ecological and psychic factors.

A psicologia médica na Universidade do Estado do Rio de Janeiro: um estudo de caso

A presente pesquisa teve como proposta realizar um estudo de caso no serviço de psicologia médica da Universidade do Estado do Rio de Janeiro (UERJ). Foi investigado como os princípios teóricos da psicologia médica aplicaram-se em uma instituição de ensino e assistência. Os pressupostos iniciais deste campo tinham uma vertente contestatória em relação à medicina. Questionavam os padrões nos quais a prática médica havia se estruturado. Pretendiam modificar a relação médico-paciente dando-lhe uma conotação mais humanizada, e também almejavam construir um modelo para a gênese da doença, onde os fatores psíquicos passariam a ser considerados elementos fundamentais na formação das enfermidades somáticas. A partir da análise dos dados, pôde-se concluir que a inserção da psicologia médica na UERJ retrata uma trajetória institucional marcada por dificuldades e lutas políticas, que implicaram em uma gradual modificação de seu propósito de origem. Perdeu-se o caráter crítico e contestador, para transformar-se em uma espécie de adendo da medicina.

Psychologische Faktoren in der Entstehung und Behandlung der Adipositas

The prevalence of obesity has distinctly increased in almost all industrial countries in the past decades and is considered today to be one of the most important health problems. In Germany, between 12 and 18% of the adult population is obese. Besides the known risk factors such as arterial hypertension, lipometabolism disorders and type-2 diabetes mellitus, obesity is connected to severe psychosocial burdens. The genesis of obesity is multifactorial, besides genetic factors environmental ones such as an increase in hypercaloric food and at the same time a reduction of physical activity play a decisive role. Whereas earlier mainly psychic factors were discussed in the genesis of obesity, and here especially the question as to which personality variables are most frequently associated with obesity, the discussion in the past decades has increasingly shifted towards psychosocial consequences. It does, however, seem justified to adhere to a "psychogenesis" of obesity in a subgroup of obese people. Psychosomatic/psychiatric disorders lead to a change in eating behavior and physical exercise, the result being a sustained positive energy balance with overweight and obesity. This paper describes the psychosocial problems of obese people with an emphasis on the question of psychiatric co-morbidity in general and eating disorders in particular. The results of mainly behavioral therapeutically oriented treatment concepts are presented and school-overlapping concepts discussed.

Freud's early clinical theory (1894-1896): outline and context.

The author points out that all Freud's publications and lectures from the period 1894-1896 had the aim of establishing an aetiological theory of the neuroses and psychoses. Freud found that the clinical pictures covered by the theory had a sexual aetiology and were distinguishable from each other by specific mechanisms. Numerous references are presented to show that what the author calls Freud's early clinical theory had its roots in contemporary neuropathology and psychiatry, and the prevailing views in these disciplines are discussed. He was able to build on the work of predecessors such as Möbius in regard to the causal role of psychic factors. Whereas Freud was of his time in attempting to redefine the category of 'neurasthenia' and adducing the familiar concept of 'sexual noxae', his originality lay in the elevation of these factors, hitherto seen as external, to the status of 'true' causes. In the author's view, the rejection met with by Freud's early clinical theory was due to its pre-experiential 'vision' of the sexual aetiology of the neuroses rather than to its content. She notes that Freud differed from his contemporaries on the concept of and systematic part played by sexuality, as well as on the central role of psychic mechanisms (i.e. of defence).

Frieda Fromm-Reichmann - Her Years in Germany 1889-1933

Frieda Fromm-Reichmann became famous with her intensive psychotherapy of psychotic patients which she developed in Chestnut Lodge where she worked, after having left Nazi Germany, from 1935 until her death in 1957. The paper outlines her life and work in Germany. Studying medicine in Königsberg (East Prussia), she wrote her dissertation about pupillary changes in schizophrenia and worked during World War 1 under the famous neurologist Kurt Goldstein with brain injured soldiers. They both differentiated between somatic and psychic factors in neurologic patients and published articles about neurotraumatology including aphasia. Between 1920 and 1923, she worked in the psychotherapeutic sanatorium Weisser Hirsch in Dresden under J.H. Schultz where she treated neurotic and psychotic patients. In these years, she started her training analysis and her psychoanalytic teaching and publishing. From 1924 to 1933 she led a kosher psychoanalytic sanatorium in Heidelberg, co-founded the Frankfurt Psychoanalytic Society and gave university lectures in psychoanalysis in Frankfurt and Heidelberg. She became a close friend of Georg Groddeck who treated also somatically ill patients with psychoanalysis. ? Her great promoters furthered different important attitudes which got very important for Fromm-Reichmann later: Goldstein the natural scientific discipline, Fromm the political view, Groddeck the therapeutic optimism.

REPLY TO ZUCKER: FOSTERING, NOT FORCING

Arthur Zucker objects that I have wrongly insisted that people believe in the actual existence of anything they can talk about, and so the thesis that belief in an afterlife is based on talking about the dead rests on a false assumption. But my view in the article is not such a deterministic one, and I agree with Zucker that "language does no forcing." The ordinary way we can talk about the dead encourages but does not force us to credit the dead with reality. Other psychic and social factors would play a part in such a belief.

Accuracy of 3 brief screening questions for detecting partner violence in the emergency department

Malgré plusieurs dispositifs pour protéger les femmes victimes de violences conjugales, la répétition de la violence d’une génération à l’autre et l’énigme suscitée par le maintien du lien de certaines femmes à leur partenaire violent nous ont conduites à étudier les déterminants et la dynamique psychiques à l’œuvre dans leur couple.Au cours d’entretiens de recherche, nous avons sollicité le témoignage de femmes séparées de leur partenaire du fait de ces violences. Nous avons effectué une analyse de contenu et de l’énonciation pour repérer les enjeux inconscients à l’œuvre dans leur histoire conjugale et familiale.Au-delà de l’intériorisation d’éléments culturels d’identités de genre, la répétition des violences subies vise à réélaborer les données infantiles.Ces résultats indiquent la nécessité de croiser prises en charge sociétale et individuelle dans la prévention des violences conjugales.Despite the several devices to protect women victims of domestic violence, the recurrence of violence from one generation to the following one, and the enigmatic noticing that some women maintain the link with their violent partners led us to study the psychic factors and dynamics at work in their relationship.Clinical research was conducted with 26 women victims of domestic violence. The women interviewed had all been separated from their partners for some months. Most of them were fragile both from the point of view of their social integration and of their mental state. We were able to request interviews with them through the associations that support them, and we guaranteed them their anonymity. We conducted an analysis of the content and of the form of their answers to identify unconscious issues at work in their conjugal and family history.We can find in the history of these women an active process in the transgenerational transmission of violence: if the individual and family history includes the internalization of cultural elements of gender identities and relationships between genders and generations, continued violence and recurrence of violence would have to be understood as an attempt to stage again and/or to elaborate childhood experiences.The study highlights the need to think the treatment of domestic violence through two main methods of remediation: at the societal level through education in gender equality, and at the individual level, through a psychotherapeutic support for women, including in their link with their children, that would allow them to solve their childhood history; the impulsive force of which can defy death.

Psychic structure and life events in chronic prostatitis: A controlled study

Fifty patients with chronic prostatitis were studied both somatically and with psychiatric interview, psychologic projective tests, and mapping of 68 significant life events occurring during the past 4 years. The control group consisted of age- and sex-matched patients with acute appendicitis. They were studied with the same psychologic tests and questioned about the same life events. Patients with chronic prostatitis proved to be more disordered psychically than the controls (t test, P = 0.016). The patients with chronic prostatitis had experienced more significant life events during the 4-year period mapped than the controls had (57.2% of all). It seems likely that the onset, course, and recurrence of this disease are influenced by psychic factors. Treatment should therefore also include individually adequate sychotherapy.

Overlap of buspirone with lorazepam, diazepam and bromazepam in patients with generalized anxiety disorder: Findings from a controlled, multicentre, double‐blind study

AbstractIn a controlled, randomized, multicenter, double‐blind study involving 335 patients with generalized anxiety disorder, buspirone (Busp) was compared to lorazepam, diazepam or bromazepam in order to test its global efficacy, preferential effectiveness in defined subgroups of patients or symptoms, latency of action and safety and tolerability. Apart from minor differences, the dropout rate, the number of subjects for whom the dose was increased, the number of capsules taken daily, the modifications of HRSA, VAS 100 mm, CGIS and CGSRS, the curves of improvement over time, the effectiveness on the somatic and psychic factors of the HRSA, the responsiveness of depressed and non‐depressed anxious patients, and the profiles of adverse events indicated clinical equivalence between the azaspirodecanedione and the comparison benzodiazepines.

Psychotherapeutic treatment of patients with functional voice disorders

Psychic factors in the development and maintenance of functional voice disorders call for a psychotherapeutic treatment of dysphonic patients. The voice symptom is considered as a creative achievement of the patient to cope with an internal conflict using the ego function of speaking in the social context. A large number of dysphonic patients require an orientation of psychotherapy towards their symptoms. Symptom-centered short-term psychotherapy on a psychoanalytic basis concentrates on a symptom focus which, being a generalized description of cognitive, affective and behavioural elements of speech-conflict situations, structures the psychotherapeutic work with the material of the manifestations of voice complaints in the psychosocial context. Working out the psychodynamic conflict constellation underlying the voice symptomatics enables the patients to develop alternatives of coping with the internal affective conflict and of arranging interaction patterns with emotionally significant persons.

Social, psychic and mental factors affecting nutritional behavior.

Social, psychic and mental factors affecting nutritional behavior.

Extracts from an Article: The Campaign of the European Congresses

JUST AS THE REVOLUTION OF 1848 WAS PRECEDED BY A ‘campaign of banquets’, so, a hundred years later, the European revolution was announced by a ‘campaign of congresses’ spread over the years 1947–49. These congresses expressed the state of mind, and stimulated the major trends, of a heterogeneous and many-sided movement — a movement curiously inefficient in its tactics, and direct in its strategy, but to which the Council of Europe owes its existence, and because of which the Community of the Six has been able to take shape and to win the acceptance of public opinion, and hence of the parliaments and governments responsible to public opinion in those days.Historians may argue that the congresses achieved nothing — and indeed we do not normally expect congresses to achieve much. Members of the same profession meet together to sit through tedious sessions and enjoy themselves all the better afterwards. But in those days, a strange driving passion, unknown to this generation, inspired the militants of Europeanism, and induced them to prefer the nightly labours of commissions and operas. It is the sense of this driving passion which must be communicated, if we are to convey the psychological and historical reality of the campaign of congresses, and pay due tribute to the influence it exerted. Their action should not be considered as that of a general seizing a military position, a law-giver imposing a legal structure, or even a medicine effecting a cure. Rather should it be regarded as a concerted concentration of psychic and psychological factors which prepare the ground and enable the organism to resorb certain poisons, overcome certain inhibitions and liberate new energies. It is such profound metamorphoses which really deserve the name of revolution.

Significance of allergy in asthma from a behavioral medicine viewpoint.

The interaction between allergic and psychic factors in bronchial asthma is reexamined using more recent allergologic and psychological methods (e.g. behavioral analysis, PRIST). 44 asthma outpatients are examined according to three allergy parameters in two groups ('high' vs. 'low' allergy potential). No significant differences of personality, psychosocial or behavioral analysis data are found between groups. An interaction between allergic potential and psychic factors in bronchial asthma in the sense of less psychopathological findings in patients with 'higher' allergic potential is not found.

Atherosclerosis precursors in Finnish children and adolescents. XI. Psychological aspects.

The role of psychic risk factors in the early history of atherosclerosis was studied in 3,596 Finnish children and adolescents, aged 3, 6, 9, 12, 15, and 18 years. The family atmosphere, behavioural pattern and self-esteem were tested. The results showed that the abuse of alcohol by the parents and daily smoking by the child were the factors most clearly indicating the existence of psychic problems. The results showed that boys manifested in every age group behaviour most disposed to coronary heart disease (CHD). Furthermore, low serum HDL-cholesterol, high serum triglycerides, thick triceps skinfold and self-esteem problems coexisted and they can be supposed to independently contribute to the aetiology of CHD.

Psychic factors determining the long-term adaptation of colostomy and ileostomy patients.

The long-term psychosocial adaptation of 34 colostomy patients, operated on for rectal or colonic cancer, and 32 ileostomy patients, operated on for colitis ulcerosa, was examined on average 6.5 years after the operation. The methods used were Heidelberg Colostomy Questionnaire, Beck's Depression Inventory, Block's Ego Resiliency Scale and the Rorschach Inkblot Test. The results showed that the first pre- and postoperative psychic reactions were particularly strong and similar in both groups but the later adaptation was in every respect better in the ileostomy group. The necessity of guidance and psychic support was obvious.

Polydipsia, water intoxication and psychosis

Water intoxication and hyponatremia secondary to compulsive water drinking may lead even to death. Perhaps the problem of undue drinking of water among mental patients deserves increased attention. Our purpose has been to evaluate this issue in a given mental hospital, to investigate psychic and psychosocial factors related to this symptom, and to find out possible cases of water intoxication in polydipsia patients. Another aim has been to study the effect of furosemide on the serum sodium levels within this patient group.

Pre-scientific medicines: Their extent and value

Pre-scientific medicines are immensely widespread involving about 80% of the world's population. This is a consequence of the connection between many pre-scientific medicines and religion, whereby many people resort to personal, domestic and popular medicines initially, because of the lack of any suitably scientifically trained staff. The environment, soil and climate, diversifies the various systems of pre-scientific medicine so that it is necessary to distinguish between those in arid zones, equatorial forests, cold climates and at great heights. The study of pre-scientific medicines has great implications for scientific research. Vast areas of research are available just in drugs, whether of animal, vegetable or mineral origin. Then there are the physical treatments, attention to the five sense-organs (melotherapy, coreotherapy, chromatotherapy, osmatictherapy, gustative and tactile sensations) which involve provocation of reflexes and releases of hormones, which can explain the success of many pre-scientific medicines. Then there are interesting therapies based on the psychic factors such as occurs in possession worship, trances, dreams, stress and emotional shocks. Certainly pre-scientific therapies have their own curative efficacy that stems from the phenomena described above. Pre-scientific medicines are no less important in the social field: the possibilities for information exchange between traditional and scientific medicine and the attempts to introduce pre-scientific medicines to other peoples who lack suitable scientific health assistance, because of the absence of enough technically trained personnel, make pre-scientific medicines extremely valuable.