Equine seroprevalence of West Nile virus antibodies in the UK in 2019.

BACKGROUND: West Nile virus (WNV) is a single-stranded RNA virus that can cause neurological disease in both humans and horses. Due to the movement of competent vectors and viraemic hosts, WNV has repeatedly emerged globally and more recently in western Europe. Within the UK, WNV is a notifiable disease in horses, and vaccines against the virus are commercially available. However, there has been no investigation into the seroprevalence of WNV in the UK equine population to determine the extent of vaccination or to provide evidence of recent infection. METHODS: Equine serum samples were obtained from the Animal and Plant Health Agency's equine testing service between August and November 2019. A total of 988 serum samples were selected for horses resident in South East England. WNV seroprevalence was determined using two enzyme-linked immunosorbent assays (ELISAs) to detect total flavivirus antibodies and WNV-specific immunoglobulin M (IgM) antibodies. Positive IgM results were investigated by contacting the submitting veterinarian to establish the clinical history or evidence of prior vaccination of the horses in question. RESULTS: Within the cohort, 274 samples tested positive for flavivirus antibodies, of which two subsequently tested positive for WNV-specific IgM antibodies. The follow-up investigation established that both horses had been vaccinated prior to serum samples being drawn, which resulted in an IgM-positive response. All the samples that tested positive by competition ELISA were from horses set to be exported to countries where WNV is endemic. Consequently, the positive results were likely due to previous vaccination. In contrast, 714 samples were seronegative, indicating that the majority of the UK equine population may be susceptible to WNV infection. CONCLUSIONS: There was no evidence for cryptic WNV infection in a cohort of horses sampled in England in 2019. All IgM-seropositive cases were due to vaccination; this should be noted for future epidemiological surveys in the event of a disease outbreak, as it is not possible to distinguish vaccinated from infected horses without knowledge of their clinical histories.

Unresolved trauma in fibromyalgia: A cross-sectional study.

This study examined the prevalence of unresolved attachment-related trauma and its association with physical and psychological health status in 34 patients with fibromyalgia. Unresolved trauma was assessed with the Adult Attachment Interview. In addition, participants completed self-report measures of childhood trauma, fibromyalgia-related health status and depression. Of the sample, 50 per cent was classified as unresolved on the Adult Attachment Interview. Neither interview-based ratings of unresolved trauma nor self-reported childhood sexual or physical abuse were associated with health outcomes. Only for self-reported emotional abuse, a positive correlation with depression emerged. The implications of the findings are discussed.

Self-reported symptoms of pain and depression in primary fibromyalgia syndrome and rheumatoid arthritis.

BACKGROUND: Primary fibromyalgia syndrome (FMS) is associated with substantial psychiatric comorbidity. The aim of the present study was to investigate the interrelationship between self-reported symptoms of depression and pain in FMS compared with rheumatoid arthritis (RA). METHODS: In a cross-sectional study, 100 patients with FMS and 50 patients with RA were compared with regard to depression and psychopathology using the Symptom Check List (SCL-27). Group comparisons were calculated by parametric and non-parametric tests. The association between pain intensity and depression was determined by correlation analyses and multivariate statistical procedures (CATREG). RESULTS: Pain intensity was significantly higher in FMS compared with RA. FMS patients also scored significantly higher on all subscales of the SCL-27 including the depression scale and the General Symptom Index (GSI) (P < 0.001). These group differences remained stable even after correcting for pain intensity. Correlation analyses revealed an association between pain intensity and depression in FMS but not in RA (R = 0.419, P < 0.001). CONCLUSION: FMS patients in tertiary referral centers suffer from higher levels of pain intensity than RA patients. Depression predicts levels of pain in FMS but not in RA and is therefore an important target of intervention.

Is brief psychodynamic psychotherapy in primary fibromyalgia syndrome with concurrent depression an effective treatment? A randomized controlled trial.

OBJECTIVE: There are no studies investigating the efficacy of short-term psychodynamic psychotherapy in primary fibromyalgia syndrome (FMS). We conducted a randomized controlled trial evaluating an adapted form of individual short-term psychodynamic psychotherapy (ASTPP) versus primary care management (TAU). The study focused on FMS patients with psychiatric comorbidity. METHODS: Forty-six female patients with FMS and an International Classification of Diseases, 10th Revision diagnosis of a comorbid depression or anxiety disorder were recruited in a hospital setting. Participants were randomized to receive either ASTPP (25 sessions, 1 session/week) or TAU (4 consultations/6 months). Outcome measures included the Fibromyalgia Impact Questionnaire (FIQ), the Hospital Anxiety and Depression Scale (HADS), the Pain Disability Index, the Symptom Checklist 27 and the health-related quality of life. Primary endpoints of the outcome assessment were the FIQ total score and the HADS depression scale at 12-month follow-up. RESULTS: Both treatments were effective in reducing the FIQ total score (ES=0.56 and ES=0.75, respectively). Intent-to-treat analyses failed to provide evidence suggesting a marked superiority of individual psychodynamic psychotherapy as compared to TAU. CONCLUSIONS: A high-standard routine treatment focusing on the improvement of health behavior and including antidepressant and analgesic medication is equally effective as a short-term individual psychodynamic psychotherapy in improving fibromyalgia-related symptoms.

Emotional perception in patients with eating disorders in comparison with depressed patients.

OBJECTIVE: Emotion regulation is a key issue for many psychiatric and psychosomatic disorders, including eating disorders. Eating disordered patients (EDP) show high levels of depressive comorbidity, and there is much uncertainty about disorder-specific deficits. This study is aimed at delineating disorder-specific disturbances of emotional perception in EDP. METHOD: Fifty-two EDP were compared with 35 depressed patients (DP) and 25 healthy controls. They rated their emotional experience when viewing visual emotional stimuli. Emphasis was placed on the patients' perception of their own emotions and not on the recognition of emotions in others. Severity of depression was assessed by the Beck Depression Inventory. RESULTS: Eating disordered patients and DP reported less anger than healthy controls-independent of the severity of depression. In addition, DP showed increased levels of disgust when confronted with anger stimuli. Happiness was rated less in EDP and DP, which was associated with severity of depression. There were no differences between the EDP subgroups bulimia nervosa and anorexia nervosa. CONCLUSION: Eating disordered patients and DP showed alterations of emotional perception of anger, an emotion which is closely linked to interpersonal difficulties. Alterations in emotional perception of EDP and DP might be due to more general emotion regulation disturbances. In order to detect more subtle differences between psychiatric subgroups, more sophisticated investigation tools are needed. Increased disgust ratings in DP merit further investigation.

Somatoform disorders as disorders of affect regulation: a development perspective.

This paper considers the role of disturbances in affect regulation in the development and course of somatoform disorders. We first give an overview of contemporary theories in the field of psychosomatic medicine that links deficits in emotion regulation to the process of somatization, and then review recent empirical research that focuses on the association between affect regulation and somatoform disorders, with an emphasis on studies investigating the alexithymia construct. Overall, the findings suggest that somatoform disorders are linked to a diminished capacity to consciously experience and differentiate affects and express them in an adequate or healthy way. It must be noted, however, that this result has not been obtained exclusively for somatoform disorders. A promising approach to further our understanding of the developmental roots of impaired affect regulation in somatoform disorders is attachment research. The attachment research reviewed in this paper indicates that a dismissing status of attachment is linked to defensive forms of processing and expressing emotions. We present some new data that not only provide empirical support of a high proportion of dismissing attachment in somatoform disorders but also suggest that the degree to which somatoform disorder patients employ dismissing attachment strategies is strongly related to affect dysregulation. Finally, some implications for psychotherapeutic interventions in patients with somatoform disorders are considered.

Somatoform disorders as disorders of affect regulation: a study comparing the TAS-20 with non-self-report measures of alexithymia.

OBJECTIVE: To determine the role of undifferentiated and dysregulated affects in somatoform disorders by using a multimethod assessment approach of alexithymia. METHODS: Forty patients with ICD-10 somatoform disorders (SoD) and 20 healthy controls, matched for age, education and sex, were included in the study. Alexithymia was assessed using the Toronto Alexithymia Scale (TAS-20), the Affect Consciousness Interview (ACI), and the Levels of Emotional Awareness Scale (LEAS). All classifications were made blinded with regard to clinical status. RESULTS: Scores of the ACI and the TAS-20 showed that alexithymia is higher in SoD than in healthy controls. No differences were found on the LEAS. In terms of the multidimensionality of the alexithymia construct, our results indicate a specific positive association between SoD and a proneness to experience undifferentiated affects. The three subfactors of the TAS-20 were differentially related to non-self-report measures of alexithymia and to negative affectivity (NA). Only the cognitive facet of the TAS-20 (externally oriented thinking [EOT]) was related to the LEAS and the ACI. In contrast, the affective facets of the TAS-20-difficulties identifying feelings (DIF) and difficulties describing feelings (DDF)-were substantially related to NA. CONCLUSION: The findings highlight the important role of impaired affect regulation and NA in the process of somatization.

Attachment representation and illness behavior in somatoform disorders.

Somatoform disorders are characterized by high health care utilization and conflictual interactions with health care providers. The aim of the present study was to explore whether patterns of insecure attachment are a prominent feature of somatoform disorder. In addition, the links between insecure attachment and health care utilization were evaluated. Thirty-seven patients with an International Classification of Diseases, 10th Revision diagnosis of somatoform disorders and 20 healthy control subjects matched for age, sex, and education were administered the Adult Attachment Interview. Psychological symptoms and health care utilization were assessed using various self-report measures. There was a clearly higher incidence of insecure attachment in the somatoform group compared with the nonclinical control subjects. In the somatoform group, dismissing attachment occurred approximately twice as frequently as the preoccupied pattern of attachment. The results provide evidence for an association between health care utilization and insecure attachment. Insecure attachment in somatoform disorder may underlie problems in interpersonal functioning and in health care behavior.