Symbolic function explored in children with epilepsy and headache.

AIM: When the body gets ill, the attack on the ability to think is one of the possible effects that can be observed. The aim of this study is to explore symbolic functions in children with epilepsy and primary headache. METHODS: Fifty five little patients have been recruited from the Neuropsychiatry infant Clinic of the University of Palermo; 48 males (61%) and 27 females (39%), all suffering from epilepsy (53-71%) and primary headache (22-29%), their ages varying from 7 to 11 (average: 9.4+/-1.2). Subjects that had never suffered from chronic or neurological diseases were also recruited as a control group. The control group was levelled with the group to be tested in age and number (75 subjects), age (range: 7-11; average: 9.1+/-9) sex (males: 48-61%; females: 27-39%). The instruments that have been used were: colored progressive matrices in order to measure the development of the cognitive functions; semi-structured interview on dreams in order to estimate the quality of the mentalization; drawing stories technique in order to estimate the quality of the psychological suffering; fairytales method of Düss in order to observe the defensive strategies used by the subjects. RESULTS: The cognitive performances were the same in the two groups. The answers to the semi-structured interview on dreams were different as far as coherent theory on dreams and memory of the last dream and its quality are concerned. The Drawing stories technique and the Fairytales method of Düss with the children in the clinical group - especially the epileptic patients - showed a high presence of psychical suffering, unprocessed or impossible to process. CONCLUSIONS: The results allow to estimate a psychological suffering, focusing onbody sickness and to discriminate some specific ways of constriction of the imaginary, linked to either repression or to splitting/dissociation.

Deficit in the discrimination of nonverbal emotions in children with obesity and their mothers.

OBJECTIVE: Referring to the alexithymia construct and Bruch's clinical observations, this study investigated the ability to decode nonverbal signs of emotion in obese boys and girls, and their mothers. METHOD: A group of 10 boys and 11 girls with obesity and their mothers, and a control group were tested. Both mothers and children were asked to recognize a set of 32 brief film sequences interpreted by four actors expressing four emotions (anger, sadness, fear, happiness) with two intensity levels. Each sequence was presented first without sound, second without video, and finally with video and sound. RESULTS: As expected, boys and girls suffering from obesity and their mothers showed a reduced ability to decode visual and verbal signs of emotion compared to the control group. DISCUSSION: This result may be interpreted in accordance with the alexithymia construct, and suggests the importance of developing therapeutic strategies to face alexithymic characteristics in obese children and their mothers.

Autonomic reactivity during viewing of an unpleasant film.

The effect of an aversive, high-arousing film on heart rate, respiratory sinus arrhythmia, and electrogastrographic activity (EGG) was investigated. Previous studies have indicated a larger heart-rate deceleration for visual stimuli depicting surgery or blood compared to neutral content, and this phenomenon is similar to the bradycardia observed in animals in response to fear. The heart-rate deceleration is clearly parasympathetically driven, and it is considered a general index of attention. An accurate index of cardiac vagal tone can be obtained by means of quantification of the amplitude of respiratory sinus arrhythmia. The relationship between cardiac vagal tone and EGG is complex, but animal research has shown that suppressing vagal activity dampens gastric motility. We have investigated whether a movie depicting surgery is associated with greater heart-rate deceleration, larger increase in respiratory sinus arrhythmia, and greater increase in EGG activity compared to a neutral movie. In addition, if both respiratory sinus arrhythmia and EGG are indices of vagal tone, a positive correlation between these physiological responses was expected. Analysis indicated an effect of the surgery movie on heart rate and respiratory sinus arrhythmia, but not on EGG activity. Moreover, the expected correlation was not found. Implications for future studies are discussed.

Short-term outcome of rhinoplasty for medical or cosmetic indication.

Psychological effects of rhinoplastic operations were evaluated in male and female patients who had sought surgical correction because of psychological distress caused by the appearance of the nose or because of a medical referral to correct functional disorders. Seventy-two patients selected by gender and operation motivation were asked to fill out the MPI and the IPAT Anxiety scale 2-3 months before and 8 months after the operation. Results at follow-up highlighted a significant decrease of the mean Neuroticism and Anxiety scores and an increase in Extroversion scores in the group as a whole. The psychological benefits gained by the female patients were greater than those of the males. Patients whose motivation was exclusively aesthetic were, overall, more psychologically distressed than those with a functional motivation.

Five-year follow-up of cosmetic rhinoplasty.

The psychological impact of rhinoplasty for aesthetic reasons on psychological well-being is controversial. The aim of the present study is to assess short- and long-term psychological changes in patients who underwent rhinoplasty. Seventy-nine patients, without traumatic lesions, who presented for cosmetic surgery, completed the MPI scales for Neuroticism and Extroversion and the IPAT scale for Anxiety, 3 months before and 6 months and 5 years after surgery. Results showed a significant decrease of anxiety and neuroticism in both postoperative evaluations and an increase on the Extroversion scale only at the 6-month follow-up. Psychological distress persisted in most patients after the operation.

Illness behavior, affective disturbance and intestinal transit time in idiopathic constipation.

Patients with constipation differ not only from healthy subjects but can also be categorized into two groups: slow transit constipation (STC) and normal transit constipation (NTC) using measures of total intestinal transit time (TITT). We investigated the role of illness behavior and affective state in 45 NTC and 29 STC patients as compared with 20 healthy subjects. All subjects completed the Illness Behavior Questionnaire (IBQ), the Symptom Questionnaire (SQ), and the CES-D to assess illness behavior, psychological distress, and depression. The constipated patients reported more psychological distress than healthy subjects. Within the constipated group, the NTC subjects had significantly higher scores on the IBQ dimensions of hypochondriasis and disease affirmation. Our results suggest that even among constipated patients psychological distress is prominent and that measures of illness behavior help to discriminate among different pathophysiological groups.

Modifications of electrogastrographic activity during the viewing of brief film sequences.

The experiment assessed the effects of two film sequences, a pleasant documentary and a distressful scene, on electrogastrographic (EGG), electromyographic (EMG), and heart-rate responses during digestion by 30 healthy students. The physiological measures were recorded before and during the projection of each film sequence. At the end of each viewing period, subjects completed a self-rating questionnaire on the emotional experience. Analysis yielded a significant increase in heart-rate and EMG values during the viewing of the film sequences and a significant decrease in amplitude of the 3 cycles per minute (cpm) wave of EGG during the unpleasant film. The type of film sequence had also a statistically significant effect on the self-ratings of emotional states.

Decoding difficulties of facial expression of emotions in mothers of children suffering from developmental obesity.

BACKGROUND: The relationship between developmental obesity and emotional problems has been particularly studied by Bruch. According to this author, the main reason for early-onset obesity has to be found in the difficulty of some mothers to adequately distinguish between emotional manifestations and the child's real need for food. In this paper an experiment was carried out in order to test the relationship between developmental obesity and poor ability to recognize facial expressions of some basic emotions. METHODS: A group of 20 mothers whose children suffered from serious early-onset obesity (experimental group) and another group of 20 mothers, whose children had slight overweight problems arising long after the first year of life (control group), were tested. Both mothers and their children were asked to recognize a set of facial expressions of emotions. 42 slides of facial expressions of emotions (anger, sadness, disgust, surprise, fear, happiness and neutral faces) were presented to subjects who were asked to mark on an answer sheet the name of the emotion expressed by the actor's face. RESULTS: A significant difference between the groups was found: a larger number of errors in the recognition of facial expression of emotions was made by mothers and their children in the experimental group. Furthermore a positive linear correlation between the number of errors made by the mothers and that made by their children was present. CONCLUSIONS: The findings do support Bruch's clinical observations. Further studies concerning other emotional signs (either nonverbal or verbal) are needed in order to assess the importance of emotional decoding difficulties in developmental obesity.

Stressful events and psychological symptoms in patients with functional urinary disorders.

The relationship between micturition, stressful events, and psychological symptoms was studied in 58 female patients with functional micturition disorders (urethral syndrome) and 21 control patients. All received three questionnaires (Symptom Questionnaire, Illness Behavior Questionnaire, and the Biographic Questionnaire). Analysis highlighted the appearance of the urethral syndrome in highly stressful situations and the increase in the patient's anxiety, depression, dysphoria, hostility, and irritability. A tendency to complain of other psychophysiologic symptoms was also noted.

Fibromyalgic syndrome: depression and abnormal illness behavior. Multicenter investigation.

This study reports psychological symptoms assessed in 327 patients with fibromyalgia (FS) in a multicenter investigation. Two self-report scales, in their validated Italian translations, were used for screening: the CES-D (the Center of Epidemiologic Studies-Depression) developed at the NIMH for measuring depression and the Illness Behavior Questionnaire (IBQ) developed by Pilowsky and Spence. The cutoff point of 23 in the CES-D scores revealed about 49% of the fibromyalgic patients as depressed. In analyzing patterns of illness behavior patients with FS showed a high score on IBQ scales of disease conviction, psychological versus somatic focusing and denial. CES-D scores showed significant correlations with illness behavior scales. These results and their implications for the treatment of fibromyalgic patients are discussed.

Effects of an emotional negative stimulus on the cardiac, electrogastrographic, and respiratory responses.

The experiment investigated the effects of two film sequences, one neutral and the other emotional, on the cardiac (ECG), electrogastrographic (EGG) and respiratory activities of 24 healthy students during digestion. The physiological activity was recorded before and during the projection of each film sequence. 12 subjects were shown a neutral film sequence and 12 an emotional film sequence. At the end of each viewing period, each subject completed a self-rating questionnaire on the emotional experience. Analysis indicated, with respect to the previewing (baseline) values, an increase in cardiac and respiratory rates and a decrease in electrogastrographic rates during the viewing of the film sequences. Changes in the EGG rate (baseline to viewing) were negatively correlated with the changes in ECG and respiratory rates, whereas the changes in these latter two were positively correlated. In comparing the effects of the neutral and emotional scenes the only significant result was the heart-rate increase in subjects watching the emotional sequence. Also, the self-rating of emotional experience varied with the emotional value of the sequence.

Hypochondriacal fears and beliefs in pregnancy.

Illness attitudes were evaluated in 26 pregnant women and 26 control subjects matched for sociodemographic variables, by means of a self-rating scale, on 3 different occasions. For each trimester of pregnancy, women displayed more hypochondriacal fears and beliefs and conviction of disease (disease phobia) than normal controls. In the third trimester, they also reported more fear of dying and bodily preoccupations. The findings should alert physicians to ask their pregnant patients whether they are preoccupied with fear of dying, or are concerned that they suffer from an undiagnosed physical illness, or dread a specific illness such as cancer or heart disease. Hypochondriacal fears and beliefs are liable to affect well-being and the health attitudes of pregnant women. If properly recognized, they may effectively be treated.

Rating depression and anxiety after mastectomy: observer versus self-rating scales.

Paykel's Clinical Interview for Depression (CID), an observer-rated scale, and Kellner's Symptom Questionnaire (SQ), a self-rating inventory, were administered to twenty-six patients with breast cancer: 1) the day prior to discharge after mastectomy or lumpectomy, 2) after six months, during a follow-up outpatient visit. There were no significant changes in depression and anxiety (except for self-rated anxiety) and, indeed, there were very high test-retest correlations. Observer and self-rated assessments were significantly related, and these correlations improved on outpatient follow-up. DSM-III-R diagnoses of affective illness (mood and anxiety disorders) based on pre-established cut-offs of the CID, showed considerable stability, particularly as to major depressive illness.

Effects of two tasks and two levels of difficulty upon surface electrogastrograms.

The effects of differentiation, novelty, and difficulty of ability tasks upon electrogastrographic activity of healthy subjects during digestion were investigated. Electrical recording of activity of the stomach by means of surface electrodes was performed in 40 healthy volunteers before and after easy or hard tasks. 20 subjects had to complete puzzles; the others had mental arithmetic. Both groups were matched in terms of scores on easy and difficult tasks. Baseline recordings were performed before each trial. The number of waves with peak amplitude greater than 100 mu v on electrogastrographic recording during each time span was measured, using a visual analysis. There was a significant decrease in number of waves/min, during task performance. A more pronounced decrease was produced by subjects working on puzzles than those working on mental calculation and by subjects working on easy tasks than those working on difficult tasks when the easy preceded the difficult ones. A larger decrease was obtained when the tasks of comparable difficulty were performed first. Emotional correlates such as anger and irritability were suggested to play a role in the interpretation of results.

Hypochondriacal symptoms in pregnancy.

Illness attitudes were evaluated in 26 pregnant women and 26 control subjects matched for sociodemographic variables, by means of a self-rating scale, on three different occasions. In each trimester of pregnancy, women displayed more hypochondriacal fears and beliefs and conviction of disease (disease phobia) than normal controls (p less than 0.001). The findings should alert physicians to ask their pregnant patients whether they are preoccupied with fear of dying, or are concerned that they suffer from an undiagnosed physical illness, or dread a specific illness such as cancer or heart disease. Hypochondriacal fears and beliefs are liable to affect the well-being and health attitudes of pregnant women. If properly recognized, they may effectively be treated.

Urethral syndrome: a study in psychosomatic urology.

The authors studied a sampling of 50 female patients diagnosed with urethral syndrome (urinary symptoms and pain without infection or organic lesion) on purpose to explore some psychological aspects. The evaluation procedure began with a complete urodynamic examination followed by a clinical interview. After this all patients were given three questionnaires: Symptom Questionnaire, Illness Behaviour Questionnaire and a Biographic Questionnaire prepared specifically for this study. Statistical analysis of the data showed higher levels of hostility, irritability, anxiety, dysphoria and depression in the group of patients than in the control group. There was also a marked tendency to suffer from psychophysiological symptoms.

Cardiac neurosis and psychopathology.

Psychiatric illness according to DSM-III-R criteria was investigated in 54 consecutive patients suffering from cardiac neurosis (neurocirculatory asthenia or Da Costa's syndrome). Thirty-seven of the 54 patients (68.5%) were found to suffer from a psychiatric disorder. Generalized anxiety disorder, social phobia and panic disorder accounted for most of the diagnoses. Panic disorder was frequently preceded by (and associated with) generalized anxiety, phobic avoidance and hypochondriasis. The results should alert the physician to inquire for symptoms of an anxiety disorder when a patient presents with cardiac neurosis.

Psychosomatic assessment of hirsute women.

Psychiatric illness, psychological distress and illness behavior were investigated in 30 hirsute women and 30 nonhirsute healthy control subjects matched for sociodemographic variables. The majority of patients showed a good psychological adaptation to illness: they did not report significantly more anxiety, depression, and abnormal illness behavior than controls. One-sixth of the patients, however, suffered from a clinically meaningful affective disorder. Further, hirsute patients displayed significantly more hostility and irritable mood than controls (p less than 0.01).

Psychological reactions to ultrasound. Examination during pregnancy.

Twenty women underwent ultrasound examination three times during low-risk pregnancy. Before and after ultrasonography, the Symptom Questionnaire was applied to evaluate changes in psychological distress. Anxiety, depression, somatic symptoms, and hostility significantly decreased after the patients received video and verbal feedback during the first ultrasound examination. Such changes were consistently observed also during the subsequent two examinations.