Somatic Background Research Articles

Créer pour intégrer

ObjectiveThe aim of this study is to examine the relationship between psychoanalytic metapsychology and the somatic background of lived experience, in order to explore the question of the place of creation in the current psychic process. It is based on the hypothesis that the work of integrating subjective experience recorded at the somatic level presupposes the creation of a form compatible with psychic functioning. MethodologyIt is therefore based on a specific methodology for research into metapsychological modeling, the main thrust of which consists in trying to identify not just one particular statement, but above all the process of theorization that can be identified throughout Freud's texts. In this sense, it is presented as a “clinical theory.” The analysis of the process of theorization, while of course focusing on the propositions that Freud spells out in his texts, is above all centered on an analysis of their sequence, and hence of a certain form of associativity. This method of reading, based on a consideration of the associativity of the texts, assumes the hypothesis of a “transference” from Freud to the “metapsychological witch,” a transference that testifies to the fact that Freud is continuing the self-analytical work begun in the Interpretation of Dreams. For our purposes here, this methodology is epistemologically supported by both work and research from developmental psychology and in certain statements from the neurosciences. ResultsIn order to articulate psychoanalytic metapsychology more closely to the somatic background of subjective experience, it is necessary to deconstruct the hypothesis of a perception-consciousness system – a hypothesis born of an illusion of the ego in relation to the speed of cerebral processes – in order to emphasize that perception is a somatic process that is highly organized by the complexity of the cerebral operations that determine its form. Giving perception back its place in the soma also requires us to change our conception of the drive, the thrust of which cannot be separated from the impact of subjective experience on the subject's life. Finally, this paradigmatic inflection allows us to delve deeper into the role and function of the ego's core-envelopes, highlighting their dialectic role in the creation of forms compatible with psychic functioning. DiscussionThe challenge of the paradigmatic evolution thus implied is to open the way to a new consideration of the archaic processes that are very active in a whole series of narcissistic suffering. It should thus open the way to a type of construction-reconstruction work on early experiences and their impact on the rest of psychic development, but also on traumatic experiences that have many points in common with them. ConclusionMetapsychology is alive and evolving under the pressure of both clinical and neuroscientific developments, as well as the evolution of our knowledge in early developmental psychology (and in fetal psychology). Thanks to this evolution, it seems increasingly necessary and heuristic to perfect its articulation with the biological basis of human functioning.

Thromboembolic Complications and Its Relationship with the State of the Blood Coagulation and Anticoagulation System in Acute Calculous Cholecystitis

Postoperative thromboembolic complications worldwide tend to increase in frequency, which is the cause of disability and mortality. The authors note that the risk of developing feasibility study can vary significantly depending on the nature of the operation, its duration, the type of anesthesia and the general somatic background of the patient. There are no existing schemes for the use of drugs for this disease, and methods for the prevention of feasibility studies are carried out without taking into account the state of the blood coagulation and anti–coagulation system. Patients suffering from obesity are most prone to EFT. Among obese individuals, calculous cholecystitis is more common than in people with normal body weight. Therefore, there is an urgent need for further study of the state of the blood coagulation and anticoagulation system in obese patients with ACC.

Therapeutic Feasibility of the Natural Products in the Heart Complaints: An Overview.

Heart pain is the most frequent complaint leading patients to seek medical help. Functional heart symptoms, especially chest pain, are prevalent and, according to the International Classification of Diseases (ICD-10), are described as "somatoform autonomous functional disorders of the cardiovascular system." The problem lies in the fact that pain does not always have a somatic background, that is, it may be related to crucial underlying heart disease. The population does not know how to differentiate somatic pain from significant ischemic symptoms, and based on the patient's complaints, traditional medicine ends up treating other underlying cardiac diseases. Many unsuccessful unconventional therapies have been proposed in recent years, including herbal medicines that seek to disrupt the disease's pathogenesis. The present review summarizes research carried out in the last 5 years on natural products' heart complaints, including myocardial ischemia, arrhythmia, and heart failure. Several herbal medicines may be used as a replacement or complementary treatment strategy. A total of 17 medicinal plants have shown promising results in preclinical studies. However, human clinical trials are scarce; only two have been presented. Generally, the data are bland, and many issues have been raised about herbal therapies' safety, efficacy, and mode of action. Besides, relevant clinical trials, future perspectives, and possible clinical applications are discussed.

Chapter 21 - Nocturnal enuresis in children: The role of arginine–vasopressin

Nocturnal enuresis is the involuntary pass of urine during sleep beyond the age of 5 years. It is a common condition in childhood and has an impact on the child's well-being. Research into the pathophysiology of the condition in the last decades has led to a paradigm shift, and enuresis is no longer considered a psychiatric disorder but rather a maturation defect with a somatic background. An excess urine production during sleep is a common finding in children with enuresis and disturbances in the circadian rhythm of arginine-vasopressin (AVP) is found in the majority of children with nocturnal polyuria. Children with enuresis and nocturnal polyuria lack the physiologic increase in AVP levels during sleep and treatment with the AVP analogue desmopressin can restore this rhythm and lead to dry nights. The reasons for this aberrant circadian AVP rhythm are not established. Furthermore, not all children with enuresis and nocturnal polyuria can be successfully treated with desmopressin suggesting that factors beyond renal water handling can be implicated such as natriuresis, hypercalciuria, and sleep-disordered breathing. The advances in the research of the genetic background of the condition may shed further light on the enuresis pathophysiology.

Multifocal or Metastatic B-RAF (V600E) Glomus Tumor in the Parotid and Neck: A Case Report Including Cytologic, Histologic, and Molecular Features

Abstract Glomus tumor is a perivascular mesenchymal neoplasm that usually occurs as a solitary painful lesion of the distal extremities. It can also rarely occur in other anatomic locations, for example, the nasal cavity, trachea, stomach, and kidney. Although most tumors are benign, metastasis occurs in a small subset. Criteria for aggressive behavior remain incompletely defined, and the issue of defining metastasis is complicated by the occurrence of multifocal tumors. Here, we report a case of a multifocal glomus tumor involving the parotid gland (2 cm), ipsilateral sternocleidomastoid-clavicular soft tissue (1.5 cm), and ipsilateral subcutaneous tissue overlying the mastoid process (<4 mm) in a young man in his mid-20s. All 3 lesions were identical histologically, with typical features of an otherwise benign glomus tumor with uniform diploid-appearing nuclei and no mitotic activity. Very focal infiltrative growth was present. A prominent hemangiopericytoma pattern was present throughout, but no vascular invasion outside the nodules was identified. Molecular genomic analysis revealed an identical BRAF V600E point mutation in all 3 tumors in a wild-type BRAF somatic background, with similar patterns of genomic gains in 3 loci, consistent with a clonal origin. Criteria for predicting the behavior of glomus tumor are reviewed.

Importance of clinical methods of diagnostics of early inflammatory changes developing in tissue of periimplantate zone beside somatic patients

Early diagnostics of the inflammatory changes in soft tissue of surrounding innerbone dental implants under disadvantage somatic background, promotes well-timed undertaking necessary hygienic and medical action of implantological nature, which the primary task is a warning the further spreading the inflammatory process in subjecting to bone fabrics, from condition which depends not only period of the operation implant’s themselves, but also installed on them prosthetic design.

Risk of developing gestational diabetes in women after assisted reproductive technologies

Hypothesis/aims of study. Gestational diabetes mellitus (GDM) is one of the leading causes of perinatal morbidity and mortality. The use of assisted reproductive technologies (ART) is an independent risk factor for the development of GDM. Among other risk factors are overweight, diabetes burdened heredity, previous GDM, previous birth weight more than 4 kgs, stillbirth, miscarriage in history, glucosuria, polyhydramnios in this pregnancy, age over 30 years, polycystic ovary syndrome. The most significant risk factor for GDM is excess weight before pregnancy. The aim of this study was to investigate the risks of GDM in patients after ART.
 Study design, materials, and methods. 342 case histories of women with single pregnancy for the period 2014–2017 were studied on archival material. The main group consisted of 234 women with single pregnancy after ART. The comparison group comprised 108 medical records of fertile women with a history of single pregnancy that occurred spontaneously. The exclusion criteria in the comparison group were pregestational diabetes mellitus and severe extragenital pathology.
 Results. The incidence of GDM was significantly higher in the group of women in whom pregnancy occurred after ART compared to the comparison group (15.4 ± 0.4% and 5.5 ± 0.4% respectively). In the main group, patients were more likely to have overweight, extragenital pathology and pregnancy complications.
 Conclusion. The increase in the frequency of GDM among patients after ART is probably associated with late reproductive age, initially negative somatic background at the time of entry into the IVF protocols, as well as long-term hormone therapy during pregnancies after ART, starting from early terms.

Dysfunction of respiratory system in patients with diabetes mellitus and coronary artery disease

Aims: we aimed to estimate the main parameters characterizing respiratory pulmonary function in patients with isolated type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD), as well as with their combination.
 Materials and methods: the study included 198 patients divided into 3 groups: I with isolated CAD [94 (47.5%)], II with T2DM without the signs of CAD [64 (32.3%)], III with combined CAD and T2DM [40 (20.2%)]. The assessment of carbohydrate and lipid metabolism, as well as the measurement of inflammatory markers were performed using unified clinical and biochemical methods. Respiratory pulmonary function and diffusion lung capacity (Dlco) were assessed using Elite Dl-220v body plethysmograph.
 Results: the parameters reflecting the respiratory pulmonary function and the level of gas diffusion through alveolar-capillary membrane (ACM) in patients with CAD both with and without diabetes was within the normal values. The exception was the level of residual volume, which was below the prognostic values in all the studied groups. At the same time, in diabetic patients with CAD the values of forced and slow vital lung capacity, forced expiratory volume for 1-second, as well as the level of diffusion were significantly lower as compared to the corresponding values in patients with isolated CAD and didnt differ in comparison with the values of diabetic patients except for the level of diffusion. It should be noted that a number of respiratory parameters had a correlation relationships with glycemic level, inflammatory markers and with the indicators characterizing dyslipidemia and myocardial dysfunction.
 Conclusions: in the course of the study it was found out that the diabetic patients had respiratory system dysfunction in comparison to the patients with isolated CAD. The presence of diabetes in patients with CAD worsens not only the somatic background but probably contributes to the respiratory dysfunction in the form of lower velocity and volumetric parameters, but also in the indicator showing respiratory metabolism.

A case of neonatal jaundice in the newborn child with burdened somatic background

Jaundice is one of the most frequent metabolic disorders detected in the newborn period. Neonatal jaundice is most likely to be physiological, it is a transient condition and does not require treatment, at the same time it can be a symptom of a serious disease which requires diagnosis and therapy. It is presented a clinical case of conjugational jaundice in newborn from mother with diabetes, with manifestations of hemorrhagic disease. The peculiarity of this case is a complicated course of this disease with hypoxic lesions of the central nervous system and partial intestinal obstruction. In this observation it is shown the effectiveness of the therapy with early diagnosis of the disease and the complications before the appearance of the developed clinical picture.

Comprehensive Evaluation of Protein Coding Mononucleotide Microsatellites in Microsatellite-Unstable Colorectal Cancer.

Approximately 15% of colorectal cancers exhibit microsatellite instability (MSI), which leads to accumulation of large numbers of small insertions and deletions (indels). Genes that provide growth advantage to cells via loss-of-function mutations in microsatellites are called MSI target genes. Several criteria to define these genes have been suggested, one of them being simple mutation frequency. Microsatellite mutation rate, however, depends on the length and nucleotide context of the microsatellite. Therefore, assessing the general impact of mismatch repair deficiency on the likelihood of mutation events is paramount when following this approach. To identify MSI target genes, we developed a statistical model for the somatic background indel mutation rate of microsatellites to assess mutation significance. Exome sequencing data of 24 MSI colorectal cancers revealed indels at 54 million mononucleotide microsatellites of three or more nucleotides in length. The top 105 microsatellites from 71 genes were further analyzed in 93 additional MSI colorectal cancers. Mutation significance and estimated clonality of mutations determined the most likely MSI target genes to be the aminoadipate-semialdehyde dehydrogenase AASDH and the solute transporter SLC9A8 Our findings offer a systematic profiling of the somatic background mutation rate in protein-coding mononucleotide microsatellites, allowing a full cataloging of the true targets of MSI in colorectal cancer. Cancer Res; 77(15); 4078-88. ©2017 AACR.

Psychotic disorder of organic etiology, in the context of sarcoidosis. A case report

IntroductionNeurosarcoidosis is an uncommon cause of psychosis. It courses with an affectation of the brain, the spinal cord and other areas of the nervous system. It associates both neurological and psychiatric symptoms: cranial mononeuropathy, myelopathy or radiculopathy meningitis, neuroendocrine dysfunction, dementia, delusions, hallucinations.ObjectivesTo review in Pub-Med about neuropychiatric manifestarions of neurosarcoidosis.MethodsWe describe the case of 60-year-old woman diagnosed with long evolution schizoaffective disorder with a recent decompensation in the context of a stressful situation. As somatic background to highlight: cognitive impairment (encephalic bilateral and symmetrical frontal atrophy in cranial magnetic resonance) and a probable sarcoidosis with hilia and mediastinal lymph nodes without histologic confirmation. She was hospitalized at the acute care unit because of a descompensation of her schizoaffective disorder. The patient was distressed, with delirious speech, sensoperceptive hallucinations, hypothymia and weigth loss.ResultsFirstly we evaluate the lack of clinical improvement with an anti-psychotic drug in previous hospitalizations. For that reason, we thought in organic mental disorder as an alternative diagnosis. We started treatment with corticosteroids in spite of we did not observe a decompensation of sarcoidosis. In a few days it was remarked a clinical improvement and remission of the delusional and affective clinic.ConclusionsIt is needed to complete the study and continue the monitoring of the patient to see the evolution and drug response. The diagnosis of neurosarcoidosis should be kept in mind for patients with both neurologic and psychiatric symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Abstract CT135: Uncovering the genomic heterogeneity of multifocal breast cancer

Abstract Background: Multifocal breast cancer (MFBC), defined as multiple synchronous unilateral lesions of invasive breast cancer, is relatively frequent and has been associated with more aggressive features than unifocal cancer. Here, we aimed to investigate the genomic heterogeneity between MFBC lesions sharing similar histo-pathological parameters.Material and methods: The characterization of different lesions from 36 patients with ductal MFBC involved the identification of non-silent coding mutations in 360 protein-coding genes (171 tumour and 36 matched normal samples). We selected only patients with lesions presenting the same grade, ER and HER2 status. Mutations were classified as ‘oncogenic’ in case of recurrent substitutions reported in COSMIC or truncating mutations affecting tumour suppressor genes. All mutations identified in a given patient were further interrogated in all samples from that patient through deep re-sequencing using an orthogonal platform. Whole genome rearrangement screen was further conducted in 8/36 patients.Results: Twenty-four patients (67%) had substitutions/indels shared by all their lesions, of which 11 carried the same mutations in all lesions, and 13 had lesions with both common and private mutations. Three-quarters of those 24 patients shared oncogenic variants. The remaining 12 patients (33%) did not share any substitution/indels, with inter-lesion heterogeneity observed for oncogenic mutation(s) in genes such as PIK3CA, TP53, GATA3 and PTEN. Genomically heterogeneous lesions tended to be further apart in the mammary gland than the homogeneous ones. Genome-wide analysis of a limited number of MFBC nevertheless identified a common somatic background in all studied MFBC, including those with no mutation in common between the lesions. Conclusion and perspectives: As the number of molecular targeted therapies increases and trials driven by genomic screening are ongoing, our findings, based on the targeted sequencing of cancer genes in 36 MFBC tumors, highlight the presence of genomic inter-lesion heterogeneity in one-third of the cases despite similar pathological features. This implies that deeper molecular characterization of all MFBC lesions is warranted for the adequate management of those cancers. [CD, DF, and EP contributed equally to this work. PJC and CS contributed equally to this work.] Citation Format: Christine Desmedt, Debora Fumagalli, Elisabetta Pietri, Gabriele Zoppoli, Serena Nik-Zainal, Gunes Gundem, David Brown, Francois Rothe, Samira Majjaj, Anna Garuti, Enrico Carminati, Sherene Loi, Thomas Van Brussel, Marion Maetens, Laura Mudie, Delphine Vincent, Naima Kheddoumi, Luigi Serra, Ilaria Massa, Alberto Ballestrero, Dino Amadori, Roberto Salgado, Alexandre de Wind, Diether Lambrechts, Martine Piccart, Denis Larsimont, Peter J. Campbell, Christos Sotiriou. Uncovering the genomic heterogeneity of multifocal breast cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr CT135. doi:10.1158/1538-7445.AM2015-CT135

Uncovering the genomic heterogeneity of multifocal breast cancer.

Multifocal breast cancer (MFBC), defined as multiple synchronous unilateral lesions of invasive breast cancer, is relatively frequent and has been associated with more aggressive features than unifocal cancer. Here, we aimed to investigate the genomic heterogeneity between MFBC lesions sharing similar histopathological parameters. Characterization of different lesions from 36 patients with ductal MFBC involved the identification of non‐silent coding mutations in 360 protein‐coding genes (171 tumour and 36 matched normal samples). We selected only patients with lesions presenting the same grade, ER, and HER2 status. Mutations were classified as ‘oncogenic’ in the case of recurrent substitutions reported in COSMIC or truncating mutations affecting tumour suppressor genes. All mutations identified in a given patient were further interrogated in all samples from that patient through deep resequencing using an orthogonal platform. Whole‐genome rearrangement screen was further conducted in 8/36 patients. Twenty‐four patients (67%) had substitutions/indels shared by all their lesions, of which 11 carried the same mutations in all lesions, and 13 had lesions with both common and private mutations. Three‐quarters of those 24 patients shared oncogenic variants. The remaining 12 patients (33%) did not share any substitution/indels, with inter‐lesion heterogeneity observed for oncogenic mutation(s) in genes such as PIK3CA, TP53, GATA3, and PTEN. Genomically heterogeneous lesions tended to be further apart in the mammary gland than homogeneous lesions. Genome‐wide analyses of a limited number of patients identified a common somatic background in all studied MFBCs, including those with no mutation in common between the lesions. To conclude, as the number of molecular targeted therapies increases and trials driven by genomic screening are ongoing, our findings highlight the presence of genomic inter‐lesion heterogeneity in one‐third, despite similar pathological features. This implies that deeper molecular characterization of all MFBC lesions is warranted for the adequate management of those cancers. © 2015 The Authors. Pathological Society of Great Britain and Ireland.

EPA-1620 – The challenge of treating bipolar disorder in elderly people

Background Bipolar affective disorder in the elderly is a complex entity not only in its clinical dimension but also in its therapeutic management. Elderly patients are very sensitive to pharmacological secondary effects. The objective of this study is to longitudinally analyze the pharmacological route of a sample of outpatients above 65 years old. Method Review of clinical histories and data collection from a sample of 12 patients over 65 years old. Results Current age Years of evolution Somatic background Previous treatment Cause of modification Current treatment Side effets N1 79 59 Arrhythmia, high blood pressure Lithium Renal failure gabapentine Tremor, drowssiness N2 76 60 Cholecistectomy Haloperidol, lithium biperiden, zolpidem Extrapyramidal syndrome Lithium, trazodone, lorazepam Distal tremor, cognitive impairment N3 72 25 Ischemic heart disease, high blood pressure, VHB. Essential tremor, cognitive impairment Fluoxetine, lamotrigine Inefective Quetiapine, valproic acid Worsening Cognitive impairment, drowsiness Oxcarbazepine Neutropenia Haloperidol Extrapyramidal syndrome olanzapine Gain Weigth N4 68 38 Diabetes mellitus Tryciclic antidepressants, valproic acid, lithium Drowsiness, gastric discomfort, fatigue Risperidone, zolpidem Tremor, dependence on zolpidem Conclusions Most of the patients experienced at least three drugs prior to their current treatment. The fundamental reason for changes were intolerable adverse effects and, in one of them, irreversible (kidney failure). The trend is to replace drugs by atypical antipsychotic or antiepileptic ones. The prescription of gabapentin is not based on scientific evidence but with a positive response. The available literature is still limited to justify these decisions based on clinical experience, somatic background and tolerance of the patient.

Abstract 1112: Whole exome and whole genome sequence analysis of lung adenocarcinoma.

Abstract Lung adenocarcinoma is the leading cause of cancer-related death worldwide. Recent molecular characterization of this disease through large-scale sequencing efforts has identified distinct subsets driven by mutant oncogenes or kinase fusion proteins, many of which can be inhibited with targeted therapies. Despite these advances, almost half of all lung cancers still lack an identifiable driver. Here, we describe the genomic profiling of 230 normal-paired lung adenocarcinoma samples included as part of The Cancer Genome Atlas (TCGA) effort. All samples were subjected to whole exome analysis, copy number profiling and a subset were also subjected to whole genome sequencing. Mutation calling was performed with the MuTect algorithm. To identify significantly mutated genes, we used the MutSig CV algorithm, a statistically rigorous analysis that takes into account nucleotide context, gene-expression, replication time, and somatic background mutation rate. Mutation rate in lung adenocarcinoma was quite high with an average of 242 mutations/tumor observed (median: 161, range: 11-1328). In total, we identified mutations in over 13,500 genes of which 10 genes reached statistical significance (q<0.1). One significant gene was excluded from further analyses as it was not expressed in RNA-seq data. In addition to mutant genes with established roles in lung adenocarcinoma (e.g. TP53, KRAS, STK11, EGFR, RB1, KEAP1, and BRAF), we also identified other statistically significant mutant genes whose role in lung tumorigenesis is presently unclear. These included mutations in the RNA-binding protein RBM10, and the integrin protein ITGAL. Although statistically insignificant by a small degree, we also identified mutations in the splicing factor U2AF1, and the SWI/SNF complex proteins SMARCA4 and ARID1A. We are currently analyzing whole genome sequences to confirm these events, and identify known and novel fusion events that may be contributing to tumorigenesis. In conclusion, we have analyzed the exomes of 230 lung adenocarcinoma samples and identified known and unknown mutations in this disease. Ultimately, these data will be integrated with ongoing expression, methylation, pathway, miRNA, and proteomic analyses. At its conclusion, this effort will represent the most comprehensive profiling of lung adenocarcinoma samples to date, and will provide a detailed integrative picture of the molecular mechanisms contributing to this disease. Citation Format: Juliann Chmielecki, Mara Rosenberg, Marcin Imielinski, Bryan Hernandez, Michael Lawrence, Andrey Sivachenko, Kristian Cibulskis, Douglas Voet, Carrie Sougnez, Stacey Gabriel, Gad Getz, Matthew Meyerson, The Cancer Genome Atlas Research Network. Whole exome and whole genome sequence analysis of lung adenocarcinoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1112. doi:10.1158/1538-7445.AM2013-1112

P02-565 - Study on organic hallucinosis: The charles-bonet syndrome

IntroductionIn 1890 Ball defined hallucinations as perceptions without real object with sharp features and embodiment of that approach actual sensory perceptions.Objective and methodsWe present the case of an elderly woman with cataract. Previously we maked a review of the literature and its controversies.ResultsAn 82 year old woman was referred to psychiatry for primary care physician for evaluation of visual hallucinations of 3 ½ months of evolution. Among somatic background are collected: arterial hypertension, cataracts and increased intraocular tension.The detection of the picture is casual, for the comments that the patient makes to his daughter. She says that she sees her husband died 6 years ago, on the stairs. Reported to have a house full of people describing in detail the number of people and the characteristics of them. She claims that under the bed see rats and dogs.She was conscious and oriented. No significant objective emotional impact of visual hallucinations. Is euthymic and without anxiety clinic. Complex visual hallucinations are objectified. The content of thought has developed a delusional elaboration of hallucinations with partial insight.The primary care physician began treatment with haloperidol, the patient presenting extrapyramidal symptoms, so it was discontinued and olanzapine was started up to 10 mg. The clinical picture resolved completely within a few days.ConclusionsCharles Bonnet described in the 1760s. Morsier is the first called the Charles Bonnet syndrome as a persistent or recurrent visual hallucinosis in older people with serious visual impairment and psychically healthy.

Somatosensory amplification as a possible source of subjective symptoms behind modern health worries

The theoretically hypothesized connection between modern health worries (MHWs) and somatosensory amplification (SSA), as well as the factor structure of the Hungarian version of the MHW scale were investigated in a cross-sectional questionnaire study. A total of 163 university students (mean age = 21.3± 2.70 yrs; 44.2% male) and 145 patients (mean age = 49.4±17.51 yrs; 31.7% male) visiting their general practitioners (GPs) completed questionnaires assessing MHWs, SSA, subjective somatic symptoms (PHQ-15), and trait anxiety (STAI-T). The previously described four-factor structure of the MHW scale was confirmed using confirmatory factor analysis (CFA). In the linear regression analysis, participants' age and SSA scores were positively related to MHWs even after controlling for gender, anxiety, and subjective somatic symptom scores. The conclusions are that: MHWs are indicators of cognitive, behavioral and social level of sensitization for health-related concerns; SSA can provide the somatic background process for generation and/or misattribution of subjective somatic symptoms; better understanding of the cognitive-emotional background of MHWs could help to determine possible interventions.

Assessment of Neuropathic Pain in Primary Care

Management of patients presenting with chronic pain is a common problem in primary care. Essentially, the classification of chronic pain falls into 3 broad categories: (1) pain owing to tissue disease or damage (nociceptive pain), (2) pain caused by somatosensory system disease or damage (neuropathic pain), and (3) pain without a known somatic background. Key challenges in developing a targeted holistic approach to treatment include appropriate diagnosis of the cause or causes of pain; identifying the type of pain and assessing the relative importance of its various components; and determining appropriate treatment. In clinical examination, sensory abnormalities are the crucial findings leading to a diagnosis of neuropathic pain, for which pharmacotherapy with antidepressants and anticonvulsants represents the cornerstone of medical treatment. Chronic neuropathic pain is underrecognized and undertreated, yet primary care physicians are uniquely placed on the frontlines of patient management, where they can play a pivotal role in treatment and prevention through diagnosis, therapy, follow-up, and referral. This review provides guidance in understanding and identifying the neuropathic contribution to pain presenting in primary care; assessing its severity through patient history, physical examination, and appropriate diagnostic tests; and establishing a rational treatment plan.

Cost of illness studies in health care: a comparison of two cases

Cost of illness (COI) studies describe the economic burden of disease on society. In this article a standard procedure for a COI study is developed, including the explicit definition of the disease, choice of relevant variables and appraisal of direct and indirect costs. COI studies can be incidence-based or prevalence-based. The adjustment of cost figures for time preferences and the performance of a sensitivity analysis are presented. The standard methodology is applied to diseases in two different areas. The first disease category is dyspepsia, a complaint with a rather somatic background. The second is schizophrenia, a mental syndrome. In performing COI studies in practice, however, researchers are forced to deviate, in many aspects, from the theoretical standards. In this article these choices, and the reasons behind these choices, are explained. Furthermore, we discuss certain problems regarding the reluctance to make a diagnosis regarding certain diseases, the reliability and the validity of the sources used and the absence of certain figures. The value of the information derived from COI studies for policy-making is assessed.

Psychiatry, morphology and behaviour genetics (author's transl)

No organic substrate is known for endogenous psychoses, neuroses and behaviour disorders. Therefore genetic studies have to depart from the behavioural level. This approach has yielded the empirical risk figures which depend on genetic and environmental factors. Beyond this level behaviour genetics endeavours to clarify the genetic mechanisms underlying normal and abnormal behaviour. In the schizophrenias f.i. several stretegies have been developed to approach the genetic basis: Mathematial models as to the mode of inheritance; use of modified classificatory and diagnostic criteria for genetic analysis; search for phenomena representing steps between genotype and phenotype and showing a clear mode of inheritance, f.i. biochemical or electrophysiological characters. In case the neurotransmitters are not changed in quality or total quantity but in compartmentation in the genetic defect might be localized in the pre- or postsynaptic membranes or receptors. Genetic factors are also involved in nonpsychotic behaviour disorders but to a lesser degree. They can be demonstrated even in psychoses with somatic background.