Psychosomatic Patients Research Articles

Perceived Changes in Anxiety Symptom Burden During Treatment with Bryophyllum pinnatum: A Prospective, Single-Arm Study

Background/Objectives: Bryophyllum spp. preparations are widely used in Anthroposophic Medicine, most often for mental and behavioral disorders, including anxiety. Studies in animals revealed various anxiolytic and neurosedative effects for Bryophyllum pinnatum. We set out to investigate the effectiveness of Bryophyllum 50% chewable tablets, a product registered without indication by means of notification in Switzerland, in the treatment of anxiety symptoms in psychiatric and psychosomatic patients. Methods: A total of 99 patients with anxiety symptoms were recruited from the waiting list for an inpatient stay at the hospital “Klinik Arlesheim”, Department of Psychiatry and Psychosomatics; of these, 54 completed the study and returned fully completed questionnaires. Patients were treated with Bryophyllum 50% chewable tablets (350 mg tablets, made from leaf press juice, 3 × 2 per day; Weleda AG Arlesheim, Switzerland) and filled out questionnaires at baseline and after two and three weeks of tablet intake. The primary endpoint of the study was the change in anxiety symptoms measured with the Beck Anxiety Inventory (BAI). Results: A clinically relevant decrease in BAI score from baseline (27.4 ± 12.0) to after two (22.4 ± 12.1; p < 0.001) and three (20.6 ± 12.9; p < 0.001) weeks of treatment was observed. Additional improvements were observed in the secondary endpoints (including in depression, sleep quality, and stress); tolerability and compliance were very good. Conclusions: The results suggest that Bryophyllum 50% chewable tablets have beneficial effects on anxiety-related symptoms. Since the study design does not allow us to conclude causality between treatment and observed improvements, a randomized clinical trial is urgently needed.

Neurodevelopmental Impairments in Adult Psychosomatic Patients.

Background/Objectives: Neuropsychological, neurodevelopmental, or minimal cerebral dysfunctions (MCD) can be found in many patients with mental disorders. They can be masked by other symptoms, impair the course of the illness, and impair work and social participation. Despite a long history of research, there is still a lack of data on the spectrum, prevalence, and consequences of these dysfunctions in patients with chronic illness. In this study, we compared patients with and without a history of neurocognitive problems in childhood for present neuropsychological dysfunctions. Methods: A convenience sample of 1453 psychosomatic inpatients completed the MCD scale, assessing neurodevelopmental issues in childhood and current neuropsychological dysfunctions. Additional assessments were the Attention Deficit Hyperactivity Self Rating Scale (ADHS-SB) and the Symptom Checklist 90 (SCL-90). Results: Significant early neurodevelopmental problems were reported by 8.87% of the patients. This group also reported a significantly higher rate of MCD symptoms and general psychosomatic symptoms (SCL-90) as compared with other patients. Conclusions: There is a notable prevalence of neuropsychological dysfunctions in psychosomatic patients in general, and especially in those with early neurodevelopmental problems. To adequately address specific potentially participation-relevant impairments, a broader diagnostic approach is necessary, including exploration of MCD history and present neuropsychological dysfunctions.

Illness perception in functional neurological disorder: low illness coherence and personal control

IntroductionIllness perception refers to patients’ subjective representations and appraisals of somatic and mental symptoms. These are relevant for self-management and outcome. In clinical practice, patients with functional neurological disorder (FND)...

Effectiveness of Integrating Quality of Life-Based Therapy and Phototherapy on Emotion Regulation, Depression, and Anxiety in Psychosomatic Patients

The current research was conducted to examine the effectiveness of integrating quality of life-based therapy and phototherapy on improving emotion regulation and reducing depression and anxiety in psychosomatic disorder patients in Isfahan city. This study was quasi-experimental, and its design was experimental and control with pre-test, post-test, and follow-up. The statistical population consisted of psychosomatic patients in Isfahan city. The statistical sample included 30 patients with psychosomatic disorders, who were conveniently selected and non-randomly assigned into two groups: experimental (15 participants) and control (15 participants). The research tools included: Gratz's Emotion Regulation Questionnaire (2004), Beck's Depression Inventory (1990), and Beck's Anxiety Inventory (1990). Descriptive statistics (mean and standard deviation) and inferential statistics (analysis of variance with repeated measures) were used for data analysis. The results indicated that integrating quality of life-based therapy and phototherapy was effective in improving emotion regulation, depression, and anxiety.

Development of a Structural Model of Quality of Life for Cardiac Patients Based on Health Locus of Control and Illness Perception with the Mediating Role of Alexithymia

Objective: This study aimed to develop a structural model of the quality of life for cardiac patients based on health locus of control and illness perception with the mediating role of alexithymia in the cardiac patient population visiting hospitals in Tehran. Methods and Materials: The research method was correlational. A total of 281 patients were selected through purposive sampling and responded to the Minnesota Living with Heart Failure Questionnaire, the Illness Perception Questionnaire, the Multidimensional Health Locus of Control Scale, and the Toronto Alexithymia Scale. Data analysis was conducted using structural equation modeling. Findings: The results indicated that the structural model of quality of life for cardiac patients based on health locus of control and illness perception, mediated by alexithymia, was a good fit. Additionally, there was a significant positive relationship between health locus of control and illness perception with quality of life (p < 0.05), a significant negative relationship between alexithymia and quality of life (p < 0.05), and a significant negative relationship between health locus of control and illness perception with quality of life (p < 0.05). Conclusion: Attention to health locus of control and providing training to strengthen internal locus of control, designing psychological interventions based on illness perception, and training in emotional expression and management for psychosomatic patients like those with cardiac conditions are recommended.

Comparison of the effectiveness of intensive short-term dynamic psychotherapy (ISTDP) and existential therapy on the signs and symptoms of psychosomatic patients referred to Imam Khomeini Hospital in Tehran

Comparison of the effectiveness of intensive short-term dynamic psychotherapy (ISTDP) and existential therapy on the signs and symptoms of psychosomatic patients referred to Imam Khomeini Hospital in Tehran

EMG measured reaction time as a predictor of invalid symptom report in psychosomatic patients

Background: Symptom validity tests (SVTs) and performance validity tests (PVTs) are important tools in sociomedical assessments, especially in the psychosomatic context where diagnoses mainly depend on clinical observation and self-report measures. This study examined the relationship between reaction times (RTs) and scores on the Structured Inventory of Malingered Symptomatology (SIMS). It was proposed that slower RTs and larger standard deviations of reaction times (RTSDs) would be observed in participants who scored above the SIMS cut-off (>16). Methods: Direct surface electromyography (EMG) was used to capture RTs during a computer-based RT test in 152 inpatients from a psychosomatic rehabilitation clinic in Germany. Correlation analyses and Mann-Whitney U were used to examine the relationship between RTs and SIMS scores and to assess the potential impact of covariates such as demographics, medical history, and vocational challenges on RTs. Therefore, dichotomized groups based on each potential covariate were compared. Results: Significantly longer RTs and larger RTSDs were found in participants who scored above the SIMS cut-off. Current treatment with psychopharmacological medication, diagnosis of depression, and age had no significant influence on the RT measures. However, work-related problems had a significant impact on RTSDs. Conclusion: There was a significant relationship between longer and more inconsistent RTs and indicators of exaggerated or feigned symptom report on the SIMS in psychosomatic rehabilitation inpatients. Findings from this study provide a basis for future research developing a new RT-based PVT.

Perception, experience and use of moments of change - a qualitative investigation.

Objectives: In psychotherapeutic change processes, in addition to gradual changes, specific single special moments are described as a starting point for change. We investigated the perception of these moments of change (CMs) from the patient's perspective: What does each patient perceive and experience in a CM? Methods: A qualitative, explorative study of CMs was conducted by means of semi-structured questionnaires as well as qualitative interviews with patients (n = 12). Grounded theory was used for the analysis. Results: CMs were noticed by an "explicit mode of perception" based on physical, emotional and cognitive aspects. In addition, we found a "transcending mode of experience" that involved changes in consciousness and self-experience. CMs showed a "specific transformative pattern" and were preserved as "experience anchors". Conclusions: The intensification of consciousness, transformation of self-experience, and intense prototypical experience of a change process appeared particularly impressive. With the help of CMs, access could be gained to an embodied and implicit experience, which could subsequently be symbolised and used as an "experience anchor". This could be useful especially for the treatment of psychosomatic patients.

Beliefs about emotions predict psychological stress related to somatic symptoms.

Previous research has shown that the more people believe their emotions are controllable and useful (BECU), the less they generally report psychological distress. Psychological distress, in turn, impacts health outcomes, and is among the most frequently reported complaints in psychotherapeutic and psychosomatic practice. We aimed to examine how BECU predicts psychological distress related to somatic symptoms in a prospective sample from the general population and to replicate this association in two cross-sectional samples of psychosomatic patients. We applied a panel design with an interval of 2 weeks between T1 and T2 in general-population panel-participants (N = 310), assessing BECU and psychological distress related to somatic symptoms via validated self-report measures. Moreover, we cross-sectionally replicated the relationship between BECU and psychological distress in a clinical sample of psychosomatic outpatients diagnosed with somatoform disorders (n = 101) or without somatoform disorders (n = 628). BECU predicted over and above the lagged criterion panel-participants' psychological distress related to somatic symptoms, β = -.18, p < .001. BECU was also cross-sectionally related to psychological distress in our clinical replication-sample of psychosomatic outpatients diagnosed with somatoform disorders, rS (87) = -.33, p = .002 and in those without, rS (557) = -.21, p < .001. BECU as a malleable way of thinking about emotions predicted psychological distress related to somatic symptoms in general-population panel-participants and correlated with the same in two clinical replication samples. BECU thus becomes a promising treatment target in psychotherapeutic approaches.

The impact of emotional stimuli on response inhibition in an inpatient and day-hospital patient psychosomatic cohort.

To correctly recognize and respond to your counterpart's emotion is essential for a successful get-together. To ensure this, emotional processes and inhibitory control are linked and interact with each other. However, this interaction can be altered in several mental disorders. In a group of psychosomatic patients, we investigated possible differences in the response inhibition between neutral and emotional stimuli and whether a psychosomatic inpatient and day-hospital patient treatment influences response inhibition profiles. One hundred and one patients, diagnosed with different psychiatric diagnoses (77 women, 41.43 ± 13.13 years), completed an emotional stop-signal task (ESST) and an impulsive behavior scale upon admission in an inpatient and day-hospital patient treatment on a psychosomatic ward (T0) and at discharge (T1). Patients with depressive disorders completed the test again after 1 year (follow-up measurement T2, n = 22). Emotional stimuli were angry and neutral faces. Stop-signal reaction time (SSRT) and stop-signal delay (SSD) were calculated as the main behavioral parameters. We found a significantly higher SSRT for neutral than angry faces at both admission (8.538 ms, p < 0.001) and discharge (11.142 ms, p < 0.001), with a matching higher SSD for angry than neutral faces at both timepoints (T0: 8.360 ms, p < 0.001, T1: (6.950 ms, p < 0.001). The SSRT for angry faces significantly decreased after treatment (-8.485 ms, p = 0.0110). For neutral faces, the decrease failed to reach significance (-5.881 ms, p = 0.250). A significant decrease in SSRT for neutral faces in patients with depressive disorders was found 1 year after discharge compared with admission (-19.040 ms, p = 0.0380). Our data demonstrate a decreased response inhibition for neutral compared with emotional stimuli and an improved response inhibition for angry faces after discharge in a psychosomatic inpatient and day-hospital patient cohort. Additionally, patients with depressive disorders displayed a significantly better response inhibition for neutral faces 1 year after discharge compared with the baseline measurement. With this study, we provide more evidence for altered emotional response inhibition in different mental disorders and a hint that psychosomatic inpatient and day-hospital patient treatment may help to normalize it, even if the effects remained small and it needs further research to prove causality.

Injustice and Embitterment: Crucial Stressors in Psychosomatic Patients

Objective: “Disorders specifically associated with stress” are receiving increasing attention in clinical practice, research, and modern classification systems of mental disorders. This includes not only reactions to “extremely threatening or horrific events” as it is characteristic for “post-traumatic stress disorders” but also a variety of day-to-day experiences. Examples are experiences of injustice, humiliation, or breach of trust which can have dire psychological consequences such as feelings of embitterment, a strong and crippling emotion. This study investigated the frequency of feelings of injustice and concomitant embitterment across different areas of daily life of psychosomatic patients. Methods: In an observational archival study, 200 inpatients of a department of behavioral medicine filled in the “Differential Life Burden Scale, DLB-Scale” and the “Post-Traumatic Embitterment Scale, PTED-Scale” which asks for experiences of injustice and embitterment. Results: More than half of all patients (58.5%) reported about very or extremely unjust and unfair life events and 51.5% additionally about feelings of embitterment. This was primarily associated with complaints about problems in the family and the workplace and was accompanied by an impairment of well-being. Conclusions: The findings indicate that experiences of injustice and embitterment are frequently seen in psychosomatic inpatients and should get special attention.

Biopsychosocial complexity in functional neurological disorder

BackgroundFunctional Neurological Disorder (FND) is considered a biopsychosocial disorder nowadays, with chronicity in >50% of cases. The INTERMED Self-Assessment Questionnaire (IMSA) assesses the various domains and indicates biopsychosocial complexity. ObjectiveFND patients were compared with a sample of psychosomatic (PSM) patients as well as post-stroke patients. MethodsThe three samples (N = 287 altogether) were largely in inpatient and day clinic psychotherapeutic treatment or inpatient neurological rehabilitation. The IMSA covers all three biopsychosocial domains as well as health care utilisation in the time frame of the past, the present and the future. In addition, affective burden (GAD-7, PHQ-9), somatoform symptoms (PHQ-15), dissociation (FDS) and quality of life (SF-12) were evaluated. ResultsFND and PSM patients scored highly in the IMSA, with ≥70% regarded as complex, compared to 15% of post-stroke patients. Affective, somatoform and dissociation scores were high in FND and PSM patients. Mental and somatic quality of life were lower in these groups compared to post-stroke patients. DiscussionFND patients showed high biopsychosocial strain, similar to a typical sample of inpatient and day clinic, i.e. severely affected, PSM patients, and they were more affected than post-stroke patients. These data emphasize that FND should be evaluated with a biopsychosocial perspective. The IMSA likely represents a valuable tool, which has to be assessed by further longitudinal studies.

Wisdom-related attitudes in psychosomatic patients and in a convenience sample

Wisdom-related attitudes in psychosomatic patients and in a convenience sample

Reliability and validity of the brief psychosomatic symptom scale (BPSS) in patients from general hospitals

ObjectivesTo verify the Brief Psychosomatic Symptom Scale (BPSS) among patients with psychosomatic-related disorders in general hospitals and determine the threshold of BPSS. MethodsThe BPSS is a shortened 10-item version of the psychosomatic symptoms scale (PSSS). Data from 483 patients and 388 healthy controls were included for psychometric analyses. Internal consistency, construct validity, and factorial validity were verified. The threshold of BPSS in distinguishing psychosomatic patients from healthy controls were determined using receiver operating characteristic (ROC) curve analysis. The ROC curve of the BPSS was compared with that of the PSSS and patient health questionnaire-15 (PHQ-15) by using Venkatraman's method with 2000 times Monte-Carlo simulations. ResultsThe reliability of the BPSS was good with Cronbach's α of 0.831. BPSS was significantly correlated with PSSS (r = 0.886, P < 0.001), PHQ-15 (r = 0.752, P < 0.001), PHQ-9 (r = 0.757, P < 0.001) and GAD-7 (r = 0.715, P < 0.001), which indicated good construct validity. ROC analyses demonstrated that the AUC of the BPSS was comparable with that of PSSS. The gender-specific threshold of BPSS was determined as ≥8 in males and ≥ 9 in females. ConclusionsThe BPSS is a brief and validated instrument for screening common psychosomatic symptoms.

Nature-Based Therapy in Individuals with Mental Health Disorders, with a Focus on Mental Well-Being and Connectedness to Nature-A Pilot Study.

In times of social and ecological crises, such as COVID-19 with lockdowns and implementing the impact of climate change, mental health degrades. Being outdoors in nature can be health-promoting, can decrease depression, and increase mental well-being. This pilot study investigated the relationships between nature-based therapy, mental health, and individuals' connectedness to nature. We hypothesize that nature-based therapy has a positive impact on individual mental health and connectedness to nature. A mixed-method approach was used to evaluate the effectiveness of nature-based therapy for young psychosomatic patients. The results demonstrated improvements in mental well-being and connectedness to nature through therapy. Additionally, depression scores decreased. Patients reported the importance of the therapist setting the space, the supportive environment, the poems that fostered the nature connection, improvement at the soul level, and overall doing something meaningful. Every patient experienced nature-based therapy as effective. To conclude, the study gives a first insight into the processes of nature-based therapy in the German population at work and the effectiveness of nature-based therapy. Further questions, e.g., season effects, longitudinal effects, and whether patients with low connectedness to nature gain more out of the intervention remain unanswered.

First results from post-COVID inpatient rehabilitation.

COVID-19 is associated with various symptoms and psychological involvement in the long term. In view of the multifactorial triggering and maintenance of the post-COVID syndrome, a multimodal therapy with somatomedical and psychotherapeutic content is expedient. This paper compares the psychological stress of post-COVID patients and their course in rehabilitation to psychosomatic and psychocardiological patients. Observational study with control-groups and clinical, standardized examination: psychological testing (BDI-II, HELATH-49), 6-MWT as somatic parameter, two measurement points (admission, discharge). Sample characteristics, including work related parameters, the general symptom-load and the course of symptoms during rehabilitation are evaluated. At admission in all measures post-COVID patients were significantly affected, but less pronounced than psychosomatic or psychocardiological patients (BDI-II post-COVID = 19.29 ± 9.03, BDI-II psychosomatic = 28.93 ± 12.66, BDI-II psychocardiology = 24.47 ± 10.02). During rehabilitation, in all complaint domains and sub-groups, symptom severity was significantly reduced (effect sizes ranging from d = .34 to d = 1.22). Medium positive effects were seen on self-efficacy (d = .69) and large effects on activity and participation (d = 1.06) in post-COVID patients. In the 6-MWT, the walking distance improved by an average of 76.43 ± 63.58 meters (d = 1.22). Not a single patient deteriorated in walking distance, which would have been a possible sign of post exercise malaise (PEM). Post-COVID patients have a slighter psychological burden as psychocardiological or psychosomatic patients. Although rehabilitation is not curative, post-COVID patients benefit significantly from the interventions and there were no signs of PEM.

Comparative impact of yoga and ayurveda practice in insomnia: A randomized controlled trial.

Insomnia is connected with a lifted hazard for neurocognitive dysfunction and psychiatric disarranges. Clinical observations of psychosomatic patients indicate that their distorted somatopsychic functioning necessitates their practice of yoga-like therapy. Sleep and its modifications and management have also been explained well in ayurveda. This study aimed to compare the effectiveness of Yoga and Nasya Karma on the sleep quality, stress, cognitive function, and quality of life of people suffering from acute insomnia. It was an open-label, randomized controlled trial. A total of 120 participants were randomly (computer-generated randomization) equally allocated to three groups, yoga group (G-1), ayurveda group (G-2), and control group (G-3). All the groups were assessed on the first day before the start of the yoga regime and the 48th day. Participants in the study were included in the age group of 18 to 45 years, fulfilling DSM-V criteria for insomnia, physically fit for the yoga module, and Nasya procedure. Outcomes were measured by the Pittsburgh Sleep Quality Index (PSQI) questionnaire, Perceived Stress Scale (PSS), cognitive failure questionnaire, and WHO Quality of Life Scale-Brief (WHOQOL-Brief). Proportions and frequencies were described for categorical variables and compared using the Chi-square test. ANOVA (one-way) and post hoc analysis, Bonferroni test, were performed for multiple comparisons in groups at a significance level of P < 0.05 using SPSS (23 version). A total of 112 participants were analyzed as per protocol analysis. All groups have observed significant mean differences for stress (<0.05) and sleep quality (<0.05). All five aspects of quality of life - general health (<0.05), physical health (<0.01), psychological health (<0.05), social health (<0.05), and environmental health (<0.05) - had a significant mean difference in all three groups. All three aspects of cognitive failure, forgetfulness (<0.05), distractibility (<0.05), and false triggers (<0.01) had a significant mean difference in scores for all three groups. Yoga practice was effective, followed by ayurveda and the control group in reducing stress and improving sleep, cognitive function, and quality of life.

Differences in life attitudes between general population and hospitalized psychosomatic patients: a comparative cross-sectional study

ABSTRACT To compare the extent to which value-based life attitudes measured by means of the Life Attitude Profile (LAP-R) could differ between the general population and people suffering from mental disorders hospitalized in a psychosomatic ward. Cross-sectional comparative study between a sample of general population (n = 409) and a sample of unselected patients (n = 147) at admission in a psychosomatic ward. Comparisons were carried out by means of Cronbach’s alpha, correlation matrix, t-tests, robust multivariate linear regression models (MLRM), and using propensity scores. The internal consistency of LAP-R is good (alpha = 0.90). Divergent validity with BFI dimensions is widely given. In MLRM general population scored higher for the indexes ‘personal meaning’ and ‘existential transcendence’, whereas psychosomatic patients for the dimensions ‘responsibleness’, ‘death acceptance’, ‘goal seeking’ and especially ‘existential vacuum’. Sex, partnership and schooling display few associations. Neuroticism is negatively and agreeableness positively associated with life attitudes considered as protective. Norm values and differences were stratified by age ranges. This study demonstrates that basic human attitudes like personal transcendence, personal meaning, having a biographically supported mission in life, and belief in a reason for existence are so fundamental for individuals that they are to some degree given independently of having a mental disorder or not. Neuroticism is a risk trait and agreeableness a protective trait facing life attitudes. The findings of this study indicate that people suffering from mental disorders treated in a specialized psychosomatic unit in a general hospital have important value-based resources and simultaneously higher levels of existential vacuum that have to be considered in treatment planning but should also be embedded in a therapeutic alliance. The existential vacuum deserves special consideration in the treatment of patients, especially facing risk of suicide.

The effectiveness of transdiagnostic treatment on pain anxiety, distress intolerance and sleep disorders in psychosomatic patients who suffer from migraine

Introduction: Migraine headache is a common, painful, severe and debilitating in chronic conditions which can be characterized by recurrent and unilateral moderate to severe attacks. Aim: The aim of this study was to determine the effectiveness of transdiagnostic treatment on pain anxiety, distress intolerance and sleep disorders in psychosomatic patients who suffer from migraine. Method: The present study was a quasi-experimental study that benefited from a pretest-posttest design with a control group. The statistical population included patients with migraine referred to a psychiatrist in Urmia in the second half of 2020, who were randomly divided into control and experimental groups with 15 patients in each group. Measurement tools included Distress Intolerance Questionnaire (Simmons &amp; Gaher, 2005), Pain Anxiety Scale (McCracken &amp; et al, 1992) and Sleep Disorders Questionnaire (Mohammadi &amp; et al, 2009). Data were analyzed using multivariate analysis of covariance in SPSS-26 software. Results: The results showed that considering ETA squares, there was a statistically significant difference between the control and experimental groups (p&lt;0.001). Therefore; it can be claimed that changes and improvements in about 92% of pain anxiety, 91.6% of distress intolerance and 82.1% of sleep disorders have been due to the effectiveness of transdiagnostic treatment intervention. Conclusion: The results showed that transdiagnostic treatment can be used in conjunction with drug interventions for migraine patients who can also be effective in reducing emotional symptoms, pain anxiety, distress intolerance and sleep disorders in these individuals.

Роль клинического психолога в коррекции психосоматических расстройств

Clinical psychology is an interdisciplinary scientific and practical area of activity that is currently viewed as essential for comprehensive approach to therapy and rehabilitation of patients with various disorders. The paper describes the role of clinical psychologist in working with psychosomatic patients; the clinical psychologist's responsibilities and the differences between these specialists and representatives of related specialties are also explained.