ABSTRACT
Central serous chorioretinitis serosa is repeatedly brought into aetiological considerations with a rather unspecific concept of distress. Depressive disorder represents a specific stressor, which is known in cardiology or diabetology as a significant risk factor. In the present case report, the clinical correlation between a central serous chorioretinitis and a depressive disorder is shown from a psychosomatic point of view, comparing a sequentially-reactive understanding of the disorder complex with a preferable model of simultaneous entanglement.
Subject(s)
Central Serous Chorioretinopathy/diagnosis , Central Serous Chorioretinopathy/psychology , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/psychology , Adult , Antidepressive Agents/therapeutic use , Central Serous Chorioretinopathy/therapy , Combined Modality Therapy , Fluorescein Angiography , Humans , Male , Patient Admission , Psychophysiologic Disorders/therapy , Psychotherapy , Statistics as Topic , Stress, Psychological/complications , Tomography, Optical Coherence , Vision, Low/diagnosis , Vision, Low/psychology , Vision, Low/therapyABSTRACT
In contemporary U.S. doctor's series, the characters are usually represented by good-looking or typical character actors. The aim of our pilot study was to investigate whether the long-term impact of this format on German television viewers could have an influence on the choice of doctor in Germany. Two different groups of people anticipating TV consumption patterns were questioned: a first group of younger adults who knew theTV series was asked to judge their doctor choice using a web-based survey tool with respect to three criteria (sympathy, expertise and own treatment preference). The second group of adults beyond the 40th year of life who need not know theTV series were shown photos of the serial figures. Study participants should select the "doctor" of which they would most likely want to be treated and this based on two predetermined reasons (sympathy or expertise). Our results indicate that stereotypical images of doctors found high approval only in the first group of people, while the participants in the second group decided in majorityfora more realistic representation of average appearance.
Subject(s)
Drama , Fantasy , Physician's Role/psychology , Stereotyping , Television , Adult , Attitude , Clinical Competence , Female , Humans , Male , Physician-Patient Relations , Social Media , Surveys and Questionnaires , Young AdultABSTRACT
The epigenetic sensor BRD4 (bromodomain protein 4) is a potent target for anti-cancer therapies. To study the transcriptional impact of BRD4 in cancer, we generated an expression signature of BRD4 knockdown cells and found oxidative stress response genes significantly enriched. We integrated the RNA-Seq results with DNA-binding sites of BRD4 generated by chromatin immunoprecipitations, correlated these with gene expressions from human prostate cancers and identified 21 top BRD4 candidate genes among which the oxidative stress pathway genes KEAP1, SESN3 and HDAC6 are represented. Knock down of BRD4 or treatment with the BRD4 inhibitor JQ1 resulted in decreased reactive oxygen species (ROS) production and increased cell viability under H2O2 exposure. Consistently, a deregulation of BRD4 diminished the KEAP1/NRF2 axis and led to a disturbed regulation of the inducible heme oxygenase 1 (HMOX1). Without exogenous stress induction, we also found BRD4 directly targeting the HMOX1 promoter over the SP1-binding sites. Our findings provide insight into the transcriptional regulatory network of BRD4 and highlight BRD4 as signal transducer of the cellular response to oxidative stress.
Subject(s)
Intracellular Signaling Peptides and Proteins/metabolism , NF-E2-Related Factor 2/metabolism , Nuclear Proteins/metabolism , Transcription Factors/metabolism , Azepines/pharmacology , Base Sequence , Binding Sites , Cell Cycle Proteins , Cell Survival/drug effects , DNA, Neoplasm/metabolism , Gene Expression Regulation, Neoplastic/drug effects , Gene Knockdown Techniques , Heme Oxygenase-1/genetics , Heme Oxygenase-1/metabolism , Humans , Kelch-Like ECH-Associated Protein 1 , Male , Models, Biological , Molecular Sequence Data , Nucleotide Motifs/genetics , Oxidative Stress/drug effects , Oxidative Stress/genetics , Prostatic Neoplasms/genetics , Prostatic Neoplasms/pathology , Protein Binding/drug effects , Protoporphyrins/pharmacology , Reactive Oxygen Species/metabolism , Sp1 Transcription Factor/metabolism , Transcription, Genetic/drug effects , Triazoles/pharmacologyABSTRACT
BACKGROUND: Clinically relevant posttraumatic stress disorders are almost always associated with physical symptoms, which are, on the one hand, classified as somatoform and, on the other hand, may also present as somatic comorbidities. The psychological, neurobiological, endocrinological and immunological correlations are only now beginning to be understood. Thereby, integration into a meaningful biopsychosocial model is still pending. PURPOSE: The following article gives a concise summary of the knowledge concerning the relationship between body and psyche in posttraumatic stress spectrum disorders and provides the neuroscientific foundation which could establish a biological link between the phenomenologies of the disorder. RESULTS: Neurobiological data on posttraumatic disorders and somatoform disorders are diverse and not uniform. This is even more true when it comes to those disorders that are within the intersection of these two entities and, above all, their special features in the elderly. Psychophysiological, neuroanatomical, endocrine-immunological, genetic, and epigenetic factors play an important role here. With regard to posttraumatic stress disorder, for example, higher autonomic reactivity was observed, which indicates an acquired general sensitization of the nervous system.
Subject(s)
Brain/physiopathology , Models, Neurological , Models, Psychological , Somatoform Disorders/physiopathology , Somatoform Disorders/psychology , Stress Disorders, Post-Traumatic/physiopathology , Stress Disorders, Post-Traumatic/psychology , Aged , Aged, 80 and over , Female , Humans , Male , Middle AgedABSTRACT
Post-traumatic stress disorder (PTSD) occurs most frequently in the general population after traffic accidents and affects up to 15 % of those involved. Mental and physical comorbidity, preliminary damage or injury can herald the development of PTSD, but the scope of social support after the accident plays a crucial role in whether and to what extent potential PTSD develops. Against this background, preventive and injury reduction aspects of the interaction between insurance companies and their customers are conceivable, which could also positively affect health economic and aspects of job or customer satisfaction.
Subject(s)
Accidents, Traffic/economics , Accidents, Traffic/statistics & numerical data , Health Care Costs/statistics & numerical data , Stress Disorders, Post-Traumatic/economics , Stress Disorders, Post-Traumatic/rehabilitation , Germany/epidemiology , Humans , Prevalence , Stress Disorders, Post-Traumatic/epidemiologyABSTRACT
The etiopathology of somatoform disorders can only be understood against the background of an integrated biopsychosocial model. Cultural and historical influences must be taken into account as well as contemporary settings of scientific or medical priorities. In this context the emphasis on neurobiological findings can be interpreted as the non-accidental struggle for legitimacy of both patients and physicians. Altogether the available data on factors influencing the formation and maintenance of somatoform symptoms has to be described as both diverse and unspecific and thus points to a challenging research program in the coming years.
Subject(s)
Models, Psychological , Somatoform Disorders/diagnosis , Somatoform Disorders/etiology , Humans , Somatoform Disorders/psychologyABSTRACT
Persistent pain is not a normal part of aging. Nevertheless, many older patients have long-lasting, more or less medically unexplained pain symptoms and, consequently, are often severely disabled, incur high health care costs, and have high comorbidity rates. Moreover, the effects of early traumatization, especially due to wars, and even below the level of posttraumatic stress disorder (PTSD) are apparent. However, the developmental and neurobiological underpinnings of somatoform pain disorder, especially in pain-prone elderly patients, and its correlations with a history of war traumatization even decades after the incident remain unclear. Furthermore, a management strategy for this disorder tailored to older people and their special needs is lacking. Adequate therapeutic regimens such as adjusted psychotherapeutic procedures for elderly patients can only be promoted through a better understanding of the neurobiological and biographical underpinnings of this still controversial disorder.
Subject(s)
Combat Disorders/epidemiology , Pain/epidemiology , Somatoform Disorders/epidemiology , Stress Disorders, Post-Traumatic/epidemiology , Warfare , Combat Disorders/psychology , Humans , Pain/psychology , Prevalence , Somatoform Disorders/psychology , Stress Disorders, Post-Traumatic/psychology , United States/epidemiologyABSTRACT
Clinical pathways (CP) are considered to be a tool of clinical process management describing the optimal route for diagnostic and therapeutic medical treatment of a specified patient. Apart from economic aspects CPs can make a contribution to optimization of health quality management as well as to improvement of medical staff and both patient satisfaction and patient safety whereas the feasibility and acceptance of evidence-based medicine guidelines are often found to be low. In order to stimulate critical discussion by offering the opportunity to easily gain first practical experience, a free web-based clinical pathway system for diagnosis and treatment for patients with fibromyalgia syndrome (FMS) will be presented.
Subject(s)
Critical Pathways/organization & administration , Decision Support Techniques , Fibromyalgia/therapy , Internet , Evidence-Based Medicine , Fibromyalgia/diagnosis , Humans , Patient Education as Topic , Patient Satisfaction , Practice Guidelines as Topic , Software , Surveys and QuestionnairesABSTRACT
The resting state of the human brain is intrinsically organized by the so-called default mode network (DMN) which comprises cortical midline structure as well as lateral parietal and temporal areas. The activity of this system increases during self-oriented thinking, e.g. during a resting state but decreases during externally oriented attention and specific cognitive tasks. This review article provides a historical and methodological outline of the DMN model and describes its functional anatomy and putative functions. Based on the empirical literature the clinical implications of alterations of the DMN architecture and its role in various mental disorders are discussed.
Subject(s)
Brain/physiopathology , Cognition , Mental Disorders/physiopathology , Models, Neurological , Nerve Net/physiopathology , Animals , HumansABSTRACT
BACKGROUND: Multisomatoform disorder is characterised by severe and disabling bodily symptoms, and pain is one of the most common and impairing of these. Furthermore, these bodily symptoms cannot be explained by an underlying organic disorder. Patients with multisomatoform disorder are commonly found at all levels of healthcare and are typically difficult to treat for physicians as well as for mental health specialists. AIMS: To test whether brief psychodynamic interpersonal therapy (PIT) effectively improves the physical quality of life in patients who have had multisomatoform disorder for at least 2 years. METHOD: We recruited 211 patients (from six German academic outpatient centres) who met the criteria for multisomatoform disorder for a randomised, controlled, 12-week, parallelgroup trial from 1 July 2006 to 1 January 2009 (International Standard Randomised Controlled Trial Number ISRCTN23215121). We randomly assigned the patients to receive either 12 weekly sessions of PIT (n = 107) or three sessions of enhanced medical care (EMC, n = 104). The physical component summary of the Short Form Health Survey (SF-36) was the pre-specified primary outcome at a 9-month follow-up. RESULTS: Psychodynamic interpersonal therapy improved patients' physical quality of life at follow-up better than EMC (mean improvement in SF-36 score: PIT 5.3, EMC 2.2), with a small to medium between-group effect size (d = 0.42, 95% CI 0.15-0.69, P = 0.001). We also observed a significant improvement in somatisation but not in depression, health anxiety or healthcare utilisation. CONCLUSIONS: This trial documents the long-term efficacy of brief PIT for improving the physical quality of life in patients with multiple, difficult-to-treat, medically unexplained symptoms.
Subject(s)
Outcome Assessment, Health Care/statistics & numerical data , Pain Management/methods , Pain/psychology , Primary Health Care/statistics & numerical data , Psychotherapy, Brief/methods , Somatoform Disorders/therapy , Adolescent , Adult , Aged , Antidepressive Agents/therapeutic use , Anxiety , Attitude to Health , Depressive Disorder, Major/psychology , Depressive Disorder, Major/therapy , Germany , Humans , Middle Aged , Pain/etiology , Quality of Life , Severity of Illness Index , Somatoform Disorders/psychology , Young AdultABSTRACT
Besides the responses to nociceptive stimuli other neural function modes of the brain are necessary to obtain a comprehensive understanding of pain processing in humans. During a resting state without extrinsic stimulation the human brain generates spontaneous low frequency fluctuations of neural activity. This intrinsic activity does not reflect random background noise but is highly organized in several networks. Based on the findings of recent functional imaging studies, the role of these resting state networks in acute and chronic pain is discussed.
Subject(s)
Brain/physiopathology , Nerve Net/physiopathology , Nociceptors/physiology , Pain/physiopathology , Brain Mapping , Chronic Pain/physiopathology , Gyrus Cinguli/physiopathology , Humans , Neural Inhibition/physiology , Pain Threshold/physiology , Periaqueductal Gray/physiopathology , Spinothalamic Tracts/physiopathology , Thalamus/physiopathology , Trigeminal Nuclei/physiopathologyABSTRACT
Illness behaviour involves cultural, situational and personal predispositions. World Wide Web search statistics provided by internet applications like Google Insights for Search have the potential to facilitate our research on the distribution of mental disorders, our understanding of both sociocultural imprintings and trends in psychophenomenology and could make a remarkable contribution to medical research and public health.
Subject(s)
Biomedical Research/trends , Information Systems/trends , Internet , Search Engine/trends , Suicide, Attempted/psychology , Whiplash Injuries/therapy , Data Interpretation, Statistical , Humans , Mass Behavior , Patient Education as Topic , Public HealthABSTRACT
INTRODUCTION: In spite of intensive research, chronic recurrent cystitis is etiologically a still insufficiently understood clinical picture. CASE REPORT: A 52-year-old patient presented with recurrent cystitis that had been treated exclusively somatically for years for which at least a psychosomatic co-pathogenesis of magnitude of the discomfort was diagnostically representable as well as being of therapeutic utility. CONCLUSION: In recollection of a bio-psychosocial understanding of human diseases, psychosomatic considerations should be undertaken at last but not least in patients with persistent cystitis.
Subject(s)
Cystitis/diagnosis , Cystitis/psychology , Somatoform Disorders/diagnosis , Somatoform Disorders/psychology , Chronic Disease , Combined Modality Therapy , Cooperative Behavior , Cystitis/therapy , Cystoscopy , Defense Mechanisms , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Depressive Disorder/therapy , Diagnosis, Differential , Female , Humans , Interdisciplinary Communication , Life Change Events , Marital Therapy , Middle Aged , Patient Admission , Psychoanalytic Therapy , Recurrence , Referral and Consultation , Somatoform Disorders/therapyABSTRACT
Introspective and self-referential in nature, the human brain's default mode network (DMN) is presumed to influence our behavior in response to the environment in predictive manner [Raichle ME, Gusnard DA (2005) J Comp Neurol 493:167-176; Bar M (2009) Philos Trans R Soc Lond B Biol Sci 364:1235-1243]. In the current study, we hypothesize that the strength of DMN-connectivity contributes to distinct introspective psychological processes in every-day social life such as the intuitive understanding of other people through inner representation of their affective states -e. g. his or her pain. 19 healthy individuals underwent functional MRI scanning, which consisted of a resting-state-scan followed by the presentation of visual stimuli depicting human limbs in painful and non-painful situations. After scanning, participants were asked to evaluate the stimuli in terms of pain intensity perceived from the first person perspective. Independent component analysis (ICA) demonstrated that higher integration of the left medial orbitofrontal cortex (BA 32) into the anterior default mode network (aDMN) was associated with higher post-scan pain ratings. Furthermore, the exposition to the "Pain"-pictures led to relative increases of aDMN-activity compared to "No Pain"-stimuli which were also correlated with the subjective pain intensity. The behaviorally predictive functional architecture during a task-free period supports the notion that the DMN serves as a "memory of the future" [Ingvar DH (1985) Hum Neurobiol 4:127-136] in terms of a neuronal cache, storing "a priori scripts," which are recalled to deal efficiently with upcoming environmental events. In addition, our results suggest that an individual predisposition to identify oneself with another's pain influences the automatic response of the DMN during the observation of painful situations.
Subject(s)
Brain Mapping , Empathy/physiology , Neural Pathways/physiology , Stress, Psychological , Adult , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Models, Neurological , Models, Psychological , Photic StimulationABSTRACT
BACKGROUND: Asthma is a frequently disabling and almost invariably distressing disease that has a high overall prevalence. Although relaxation techniques and hypnotherapeutic interventions have proven their effectiveness in numerous trials, relaxation therapies are still not recommended in treatment guidelines due to a lack of methodological quality in many of the trials. Therefore, this study aims to investigate the efficacy of the brief relaxation technique of functional relaxation (FR) and guided imagery (GI) in adult asthmatics in a randomized controlled trial. METHODS: 64 patients with extrinsic bronchial asthma were treated over a 4-week period and assessed at baseline, after treatment and after 4 months, for follow-up. 16 patients completed FR, 14 GI, 15 both FR and GI (FR/GI) and 13 received a placebo relaxation technique as the control intervention (CI). The forced expiratory volume in the first second (FEV(1)) as well as the specific airway resistance (sR(aw)) were employed as primary outcome measures. RESULTS: Participation in FR, GI and FR/GI led to increases in FEV(1) (% predicted) of 7.6 +/- 13.2, 3.3 +/- 9.8, and 8.3 +/- 21.0, respectively, as compared to -1.8 +/- 11.1 in the CI group at the end of the therapy. After follow-up, the increases in FEV(1) were 6.9 +/- 10.3 in the FR group, 4.4 +/- 7.3 in the GI and 4.5 +/- 8.1 in the FR/GI, compared to -2.8 +/- 9.2 in the CI. Improvements in sR(aw) (% predicted) were in keeping with the changes in FEV(1) in all groups. CONCLUSIONS: Our study confirms a positive effect of FR on respiratory parameters and suggests a clinically relevant long-term benefit from FR as a nonpharmacological and complementary therapy treatment option.
Subject(s)
Asthma/therapy , Complementary Therapies , Imagery, Psychotherapy , Relaxation Therapy , Respiratory Hypersensitivity/therapy , Adult , Airway Resistance , Animals , Asthma/psychology , Combined Modality Therapy , Female , Follow-Up Studies , Forced Expiratory Volume , Humans , Male , Middle Aged , Plethysmography, Whole Body , Pyroglyphidae , Respiratory Hypersensitivity/psychology , Rhinitis, Allergic, Perennial/psychology , Rhinitis, Allergic, Perennial/therapy , Spirometry , Treatment OutcomeABSTRACT
BACKGROUND: Although there have been two reports suggesting that it is not necessary to obtain chest radiographs of all children with cancer who are hospitalized for fever and neutropenia, this practice continues. METHODS: Fifty-four children with cancer who were hospitalized for 108 episodes of fever and neutropenia were followed prospectively. Data on their respiratory signs and symptoms were collected on admission and throughout their hospital course. Chest radiographs were obtained at the discretion of the pediatric oncology attending physician and were interpreted by a pediatric radiologist. RESULTS: Pneumonia was documented by chest radiograph in 4 of the 108 episodes (3.7%) of fever and neutropenia. In 10 of the 108 episodes, the children had abnormal respiratory findings; this group included the 4 children with pneumonia documented by chest X-ray examination. None of the children with normal respiratory findings hospitalized for the remaining 98 episodes had pneumonia. Chest radiographs were not obtained for 40 of the 108 episodes of fever and neutropenia. None of the children with these 40 episodes had respiratory abnormalities and all recovered without a problem. Chest radiographs were obtained for the remaining 68 episodes of fever and neutropenia. Of the four children in this group with pneumonia documented by chest X-ray, two were diagnosed on admission, and another two whose initial radiographs were normal developed pneumonia later in their hospital course. There were no differences in age, absolute neutrophil count, temperature at presentation, or type of malignancy between the children who had chest radiographs and the children who did not. CONCLUSIONS: Pneumonia is an uncommon cause of infection in children with cancer hospitalized for fever and neutropenia. Therefore, the authors believe it is not necessary to obtain a chest radiograph in children with no respiratory abnormalities who are hospitalized for fever and neutropenia. [See editorial on pages 1009-10, this issue.]
Subject(s)
Fever/etiology , Mass Chest X-Ray , Neutropenia/etiology , Pneumonia/diagnostic imaging , Adolescent , Adult , Child , Child, Preschool , Diagnosis, Differential , Female , Fever/diagnostic imaging , Hospitalization , Humans , Infant , Male , Neutropenia/diagnostic imaging , Pneumonia/complicationsABSTRACT
Male Sprague-Dawley rats underwent cardiac arrest and resuscitation, subsequently exhibiting posthypoxic myoclonus. The audiogenic posthypoxic myoclonus in these animals could be attenuated with the following drugs: 5-hydroxytryptophan (5-HTP, serotonin [5-HT] precursor), N-(3-trifluoro-methylphenyl)piperazine hydrochloride (TFMPP, 5-HT1B/1C/2 agonist), (+/-)-2,5-dimethoxy-4-iodoamphetamine hydrobromide (DOI, 5-HT2 agonist), and 1-(m-chlorophenyl)-biguanide hydrochloride (m-CPBG, 5-HT3 agonist). In contrast, the following drugs were ineffective: (+/-)-8-hydroxy-dipropylaminotetralin hydrobromide (8-OH-DPAT, 5-HT1A agonist), buspirone hydrochloride (5-HT1A agonist), 7-trifluoromethyl-4(4-methyl-l-piperazinyl)-pyrrolo[1,2- a]quinoxaline maleate (CGS 12066B, 5-HT1B agonist), ketanserin tartrate (5-HT2 antagonist), methysergide maleate (5-HT2 antagonist), fluoxetine (5-HT uptake blocker), and saline (vehicle). The data suggest that enhancement of serotonergic activity, particularly through 5-HT2 and 5-HT3 receptors, have therapeutic potential for the treatment of posthypoxic myoclonus.
Subject(s)
Hypoxia/complications , Myoclonus/drug therapy , Myoclonus/etiology , Serotonin Agents/pharmacology , Serotonin Agents/therapeutic use , Animals , Behavior, Animal/drug effects , Brain Stem/drug effects , Brain Stem/physiopathology , Heart Arrest/complications , Male , Rats , Rats, Sprague-Dawley , Receptors, Serotonin/drug effects , Synaptic Transmission/drug effectsABSTRACT
We have previously reported that rats exhibited audiogenic myoclonus at 3 days after cardiac arrest. This phenomenon peaked at 14 days, gradually tapered off at older ages, and disappeared in most rats by 60 days following cardiac arrest. Because treatment with the 5-HT2-selective agonist, (+/-)-1-2,5-dimethoxy-4-iodophenyl-2-aminopropane (DOI) significantly attenuated audiogenic myoclonus in these postcardiac-arrest rats, the involvement of 5-HT2 receptors in posthypoxic stimulus-sensitive myoclonus was suggested. In the current study, we, therefore, examined the binding properties of 5-HT2 receptors in the rat bain at various time points following cardiac arrest. The affinity constant of [3H]ketanserin binding to 5-HT2 receptors in cortical membranes of rats did not change. In contrast, Bmax values were found to be reduced at 3 and 14 days after cardiac arrest with some recovery after 60 days. Taken together with previous results, these results indicate that hypoactivity of central 5-HT2 neurotransmission may underlie the development of posthypoxic stimulus-sensitive myoclonus in rats.
