Psychosomatic Patients Research Articles

Study of the Work of a Community Medical Emergency Service with Psychosomatic and Psychiatric Patients

The study aims to: (a) assess the incidence of functional/psychosomatic (FP) and psychiatric (P) calls to the Community Emergency Medical Service (during the night, week-ends, public holidays, when the primary care physicians are not on duty) and to determine the type of response provided; (b) highlight the diagnostic, relational, therapy and assistance problems involved in an approach to these patients at an emergency call level by a young, nonspecialist physician. The study data show that the quantitative importance of FP and P patients, as noted in the literature, is equally valid for emergency. But the study also highlights the numerous difficulties these patients cause to nonspecialist physicians. Liaison psychiatrist activity should find excellent growth potential in this new direction.

Patterns of Self-Definition of Asthma Patients and Normal Persons in the Freiburg Personality Inventory

The concept of the specificity of psychosomatic diseases (Alexander) is being differentiated at the time. In order to clarify some aspects of this problem, we want to investigate whether types of self-rating of normal persons differ from those of patients with bronchial asthma. In a second step we shall examine whether those types of self-rating can be found also in expert rating and third the differences between the two groups concerning their help-seeking behavior. For the purpose of this investigation the data of 135 patients with bronchial asthma (who had been investigated at the Heidelberg University Medical Department between 1979 and 1982) and of 330 persons of the Mannheim Cohort Study (who are a representative sample of the average urban population) have been reanalyzed. By means of the Freiburg Personality Inventory (FPI) data cluster analyses have been done. Evaluated by a group of 5 (5-cluster solution) the patterns of self-rating of patients with bronchial asthma do not differ significantly from those of normal persons. They had a high correlation to the expert rating and to other social-medically important outer criteria. The results indicate that the specificity of psychosomatic patients in relation to normal persons is not very convincing in a pattern of self-rating on the level of the FPI. Therefore, further research in this field seems to be necessary.

Interaction Regulations Used by Schizophrenic and Psychosomatic Patients: Studies on Facial Behavior in Dyadic Interactions

This paper is part of an extensive research project that is trying to examine transference and countertransference processes objectively. We have used a methodology that describes and analyzes interactive behavior patterns observed between different groups of patients with psychic disturbances and their interaction partners, who are uninformed about their problems. Thus far, we have completed several studies centered around the question of whether it is possible to identify specific interaction strategies in groups of patients of different nosological categories. Related to this question was the investigation of the specificity of the response patterns of their interaction partners. The patients consisted of stutterers (stuttering openly or not, Krause 1982a), schizophrenics (Krause et al. 1989), and psychosomatic patients (Sänger-Alt et al. 1989). This line of inquiry has rather severe consequences for the research strategies, which have been described elsewhere (Krause et al. 1989). In this paper, we will present for the first time a synopsis of patterns of facial behavior observed in different groups of patients and their healthy partners, and in healthy subjects interacting with each other.

Neurotic and psychosomatic disorders interdependence in terms of the search activity concept

There are no correlations between MMPI Hysteria (Hs) and Depression (D) scales in psychosomatic patients in contrast to other patients with somatic disturbances, neurotic disturbances, and in healthy subjects. The roles of depression and hypochondria in the dynamics of psychosomatic disturbances are discussed according to the search activity concept. It is suggested that hypochondriacal complaints are prognostically favorable in comparison with anxiety-depression complaints.

Therapy Expectation in Different Groups of Patients with Chronic Diseases

In a questionnaire study on 865 patients suffering from different psychosomatic and somatopsychic disorders their therapy expectations were analyzed. The complete scale of the test holds 47 items (Cronbach's alpha = 0.91) grouped into for subscales: subjective experience of the disease (subscale 1, ii items, alpha = 0.76), lay concept (subscale 2, 8 items, alpha = 0.71), general attitudes and expectations concerning treatment (subscale 3, 8 items, alpha = 0.81) and previous experiences with psychotherapeutic concepts of treatment (20 items, alpha = 0.86). The results of the study show that patients with a prominent somatopsychic disorder have a significantly lower motivation for psychotherapy than typical psychosomatic and psychiatric patients. Therefore characteristically neurotic patients with predominant psychic symptoms present the highest motivation for psychotherapy. The results for the different subgroups of patients were discussed with regard to the different factors of therapy expectations and to the indication for psychotherapy.

The role of the general practitioner in the care of mentally disturbed subjects in the general population--results of the Upper Bavarian Study.

The role of the general practitioner in the care of mentally disturbed non-institutionalised persons aged 20 years and older was examined. Data were based on the representative community sample of the Upper Bavarian Field Study with a sample size of 1495 interviewees--aged 20 years and older. The 5-year prevalence of mental illness according to the definition used was 32.8%. 38.5% of all persons, identified as cases, consulted their general practitioner because of psychiatric or emotional problems. Females and the elderly were most likely to have received treatment by their general practitioner. The majority of treated persons were neurotic and psychosomatic patients. The general practitioner provided care for more psychiatric patients than the psychiatrist and for 25% of all "cases", without additional psychiatric consultation.

Psychosomatic patients in a psychiatric clinic.

This study reports lifetime prevalence of certain "psychosomatic disorders" in psychiatric patients in India. The "psychosomatic disorders" studied were peptic ulcer, bronchial asthma, rheumatoid arthritis, ischemic heart disease and irritable bowel syndrome. One percent of psychiatric patients had these psychosomatic illnesses. Ten of the fifteen cases had two psychosomatic illnesses. Patients with psychosomatic disorders were significantly more often older in age (p = 0.003) and from an urban background (p = 0.05) as compared to other psychiatric patients. Depression was the commonest diagnosis, and was significantly (p = 0.01) more often diagnosed in the psychosomatic patients. Psychosis was not diagnosed in patients with psychosomatic disorders. This article emphasizes the need for identifying concomitant psychosomatic problems in psychiatric patients for their appropriate management.

Empirical Hypotheses on the Psychotherapeutic Treatment of Psychosomatic Patients in Short and Long-Term Time-Unlimited Psychotherapy

In the Heidelberg Follow-Up Project, the results of psychoanalytically oriented treatment in a practice-oriented design are investigated. The patient sample is not homogeneous with regard to the diagnosis; the sample (n = 209) comprised primarily psychoneurotic and psychosomatic patients. All treatments were intended as long-term psychotherapies. The duration of therapy as well as the number of sessions actually realized may be regarded as one result of therapy. This situation, which is not quite ideal in the classical clinical experiment, allows us to develop the following empirical hypotheses: (1) The relationship between the therapeutic effort (e.g. treatment duration and number of sessions) and the results of psychotherapy can be mapped by a dose-effect model. The formal characteristics, especially the shape of the corresponding graphs, are similar for four different evaluation levels. Within the context of a dose-effect model, a treatment duration of about 2.5 years or respectively a number of sessions of about 160 seem to be most beneficial. (2) If we split up the total sample of patients into two subgroups (group 1: patients with psychoneurotic symptoms or non-chronified bodily dysfunctions; group 2: patients with psychosomatic illnesses or chronified bodily dysfunctions) and repeat the analysis, we obtain similar results for both groups of patients. The dose-effect graphs are of similar shape but differ in height. There is a slight tendency in patient group 2 that a treatment duration of up to 3.5 years may be associated with increased success rates.

The Concept of Alexithymia in the Light of the Work of Bion

ABSTRACT. Bion's work on the genesis, agenesis and dysgenesis of thought, and its subsequent development, allows us to delineate two fundamental mechanisms which are used to avoid the painful anxieties associated with the birth of a thought. These anxieties, which are perhaps best covered by the term catastrophic anxiety, may be avoided by evacuation of the elements that thought is born from, or by the conversion of these elements into pseudo‐elements or lies. The clinical concept of alexithymia, which evolved from work with psychosomatic patients, illustrates how these mechanisms may be manifested clinically by disordered thought and psychosomatic illness.

Alexithymia and Somatization

The construct of alexithymia has been postulated as a predisposing factor in psychosomatic illness. The alexithymia construct has achieved wide currency in psychosomatic research and theorizing despite its doubtful psychometric foundations. Also, the question of between-group variability in alexithymia has not been addressed. In this study we proposed and tested a Rorschach measure of alexithymia on four groups of psychosomatic patients (back pain, gastrointestinal, dermatology, migraine headache). It was hypothesized that psychosomatic groups would be more alexithymic than nonpatients. To examine the question of between-group variability in alexithymia, it was hypothesized that back pain patients would be more alexithymic than other psychosomatic groups. Both hypotheses were supported. Additionally, exploratory comparisons between psychosomatic groups revealed a number of differences between the groups in basic personality processes. The findings show promise for the use of the Rorschach test as an alexithymia measure. Based on the current study, heterogeneous grouping of psychosomatic patients in research designs and treatment programs appear to be a highly questionable procedure.

Coping with Stresses in Daily Living: A pilot study

Abstract This pilot study examines how people cope with the stresses in daily living within the framework of Richard Lazarus's concept of the adaptational significance of Hassles and Uplifts. The study aimed to: (a) explore the type, frequency and intensity of Hassles and Uplifts in daily living in a Malaysian cultural setting; (b) to investigate the utility of Hassles and Uplifts of psychosomatic patients for therapy. Eight men and 128 women completed the Hassles and Uplifts Scales and further data were obtained from self-reports. Similarities and differences between men and women are compared and contrasted. A case study is used to illustrate the application of Hassles and Uplifts in stress management.

THE “PSYCHOSOMATIC FAMILY” RECONSIDERED: DIABETES IN CONTEXT–A REPLY

Minuchin, Rosman and Baker's (1978) Psychosomatic Families: Anorexia Nervosa in Context, is a work that does demonstrate that physiological disturbance of some, very specifically defined, diabetic patients serves a function in their families. Statistical analyses of the original data are reported which strongly support the original conclusions; Coyne and Anderson's (1988) presentation of the methodology and findings of the original study is shown to substantially misrepresent information actually presented in the book. Review of the literature they cite was informative about some aspects of poorly controlled diabetes for a variety of populations but not relevant for psychosomatic patients; however, some of it supported our findings. Responsibility for “constraining” and/or “providing momentum” for the field is rejected and precise and rigorous thinking encouraged in developing both studies and critiques.

Neurotransmitter systems and personality measurements: a study in psychosomatic patients and healthy subjects.

A comparative study performed in psychosomatic patients (PG) and healthy subjects (HG) reveals several correlations between personality measurements (Minnesota Multiphasic Personality Inventory, Sensation Seeking Scale, Susceptibility to Punishment), and biochemical variables (in serum: MHPG, acetylcholinesterase, calcium, melatonin; and in platelets: monoamine oxidase B, serotonin, calcium proteins). The relationship between some Sensation Seeking subscales and the enzymatic activities evaluated (negative with MAO and positive with AChase) and the opposite sign relationship between serotonin and some scales of MMPI in both groups studied (negative in the PG and positive in the HG) are noteworthy.

The difficult patient, the difficult group

This paper is wri t ten about one session of a difficult psychotherapy group, seen on videotape at the fall conference of the Eastern Group Psychotherapy Society in 1985 and discussed by a panel. The panel comprised the two therapists and the supervisor of the group--Ms. Thera, Dr. Junior and Dr. Senior--and three professionals in the field with three different frames of reference: Dr. Ormont, Dr. Tut tman and Dr. Agazarian. My own approach was that of ~the group-as-a-whole. When I first listened to the tape I was searching for live examples of the Theory of the Invisible Group, my own formulation of group-as-a-whole thinking. I also wanted to discover if listening to the voice of this videotaped group would yield insights into the dynamics of this group that would not have been apparent if I had confined my listening to the voices of the individual members. This, for me, is the test of theory. If theory can help us see things or do things or understand things that we could not without theory, then it is useful and important. As it seems very important for us not to ~fight in the field about whether there is such a thing as the group-as-a-whole which is different from the sum of the individual interpersonal interactions, I suggest two hypotheses as a framework for evaluating the following ideas. First, that from the individual perspective, all behavior that occurs in a group can be explained as a function of innerpersonal and interpersonal dynamics. Second, with equal validity, one can observe the exact same events in the group from the group-as-a-whole perspective and explain all behavior as a function of group roles and group-asa-whole dynamics. One of the most unusual and helpful foundations for this paper was the generosity with which Dr. Senior, Dr. Junior and Ms. Thera shared their inner experience in relation to this group and the supervisory issues around it. Supervision has a major impact on the way therapists frame their experience in group and on their leadership behavior. So one group system, the group of supervisor and therapists, existed both inside and outside the boundary of the therapy group, and influenced the way the therapists behaved in the group, as we shall see later. This outpatient group of psychosomatic patients must have indeed been very difficult for Dr. Junior and Ms. Thera, two relatively novice group therapists. When Ms. Thera read the history of the group, she quoted some of the things that the group had said in relation to Frank, one of their members who had died of cancer. I am going to present these quotes, first suggesting that probably

Correlation of thyroxine and thyroid-stimulating hormone with personality measurements: a study in psychosomatic patients and healthy subjects.

A comparative study performed in psychosomatic patients and healthy subjects reveals different profiles of thyroxine (T4) and thyroid-stimulating hormone (TSH) correlations with personality measurements (Minnesota Multiphasic Personality Inventory (MMPI); Sensation-Seeking Scale (SSS), and Susceptibility to Punishment Scale (SP). Three distinct sets of results may be enumerated, namely: (1) a negative correlation between sensation-seeking and TSH; (2) a positive correlation between the most indicative scales predisposing to depression-anxiety (hypochondriasis, depression, social introversion, susceptibility to punishment) and T4, and (3) the Hypomania Scale (Ma) showed a significant negative correlation with T4 in the patient group and a positive but nonsignificant relationship in the healthy group.

Relationships between Jenkins Activity Survey scores and responsivity of the dopaminergic system in psychosomatic disorders.

First, the Jenkins Activity Survey (JAS) was administered to 150 healthy subjects and 127 psychosomatic patients. Next, the responsivity of the dopaminergic system of the hypothalamo-pituitary gland was measured in 81 of these psychosomatic patients by examining the effect of bromocriptine on plasma growth hormone levels. Subjects were classified as either responders or nonresponders based on their secretion patterns. Multidimensional scaling techniques successfully discriminated between healthy subjects, psychosomatic responders and psychosomatic nonresponders using the items of the JAS. Implications for treating nonresponder psychosomatics in Japan are discussed.

Empirical study of alexithymia: methodology and results.

Starting with a review of selected examples of empirical studies on the concept of alexithymia, this paper then presents a new perspective that helps to integrate these diverse results. Studies are grouped into two types: those employing instruments (questionnaires, ratings) that directly assess alexithymia, and experimental studies. Studies of the first type are found to be inconclusive in that the search for a personality trait of alexithymia in psychosomatic patients has not been very fruitful. The evidence from experimental studies, however, does allow for some interesting interpretations: The apparent diversity in results can be resolved, if certain crucial dimensions are analyzed. On the stimulus side, interpersonal relevance and the degree of subjective involvement are found to be crucial, as results pointing towards alexithymia are mainly found when both of these are high. On the measurement side, large variations in results can be explained by reference to the "depth" of measurement level. On a more superficial or cognitive level, it is possible to find indications of alexithymia, whereas on a deeper, more unconscious level, psychosomatic patients' response to experimental stimuli are similar to that of controls. The implications of this are that alexithymia, rather than being understood as a personality trait, should be seen as a label for a set of coping behaviors that occurs in specific situations only.

Representation of psychosomatic disturbances: metaphor and metonymy.

The purpose of this study was to explore the expressive capacities of our psychosomatic patients. We invited them to represent their illness in a drawing through the design test. Following this, we investigated 43 patients affected with bronchial asthma, 30 patients affected with refractory massive obesity and compared them with a control group of 25 'normal' subjects (medical students in a situation where stress and anxiety were strongly suspected as they were awaiting to sit for an examination in the Medical School). The two patient groups showed quite relevant differences as to their own expressive modalities in the use of metaphor and metonymy, which are considered as the graphic representation means of the illness.

Verbal measures of anxiety and hostility under monological and dialogical conditions. A study on a mixed patient sample.

Anxiety and hostility scores (Gottschalk-Gleser method of verbal content analysis) were studied in a mixed patient sample comprising psychosomatic, functional, and neurotic patients under two speech-eliciting conditions: monological and dialogical. Hostility scores did not differ between conditions. Mutilation, diffuse and total anxiety scores were significantly higher in interview than in monologue. In this condition, separation anxiety was expressed more often. Some intercorrelations between variables were found in both conditions, mostly involving hostility, while others hold either for monological or interview data. Factor analysis disclosed different factor structures for the two conditions. An interaction between speech-eliciting condition and diagnostic subgroup is suggested. The implications of these findings for descriptive psychiatric research are discussed.

長期絶食時の脂質代謝

Lipids metabolism during prolonged fasting (10-days complete fasting) has been studied in 23 psychosomatic patients (9 male and 14 female, average 29.2 y. o.), who had no metabolic disease.During the fasting period, serum F.F.A. and Cholesterol levels significantly elevated (p<0.001).In the lipoprotein fraction, LDL-cholesterol and LDL-triglyceride (d: 1.006-1.063) significantly elevated by fasting (p<0.001), but VLDL-triglyceri de (d;<1.006) decreased (p<0.05).The increase of LDL reflected the increase of LDL2-fraction (d; 1.019-1.063), and this was related to thyroid hormone levels. T3 levels decreased during prolonged fasting (p<0.01).It was considered that increase of LDL was related to the decrease of LDL-receptor activity which was dependent on T3-levels.