Development of the 12-Item Facial Complaints Evaluation Scale (FaCES-12).

OBJECTIVES: Chronic rhinosinusitis and related rhinologic disorders are common in routine otolaryngologic practice. Common presenting symptoms include nasal obstruction, facial pain, facial pressure, headache, and a subjective feeling of the face feeling "swollen," a perceptual distortion. No validated scale exists to assess facial pain in addition to perceptual distortion or headache. The objective was to develop a novel scale for assessment of facial symptoms experienced by patients presenting for rhinologic evaluation. METHODS: This was a prospective validation cross-sectional study. A patient questionnaire, the 12-item Facial Complaints Evaluation Scale (FaCES-12), was created to evaluate facial symptoms based on clinical experience and the literature, including severity and timing of facial pain, facial pressure, facial perceptual swelling, and headache. Each item was assessed utilizing an 11-point Likert scale ranging from 0 to 10 in severity. Data was collected prospectively from 210 patients in 1 private and 2 academic otolaryngologic practices from August to December 2019 along with the PROMIS Pain Intensity Scale 3a and 22-Item Sino-nasal Outcome Test. Construct validity was determined using Pearson correlation and exploratory factor analysis. Internal consistency and test-retest reliability were assessed by calculating Cronbach's alpha and assessing test-retest scores. RESULTS: A new 12-item scale named FaCES-12 was developed. FaCES-12 demonstrated high reliability with a Cronbach's alpha of .94 and high test-retest reliability (r = .90). The scale revealed very strong correlation with the PROMIS Pain Intensity Scale 3a (r = .81) and moderate correlation with the Sino-nasal Outcome Test (r = .48). Exploratory factor analysis demonstrated the scale contained interrelated variables that measured unique components of facial sensations. CONCLUSION: The FaCES-12 is a valid and reliable instrument for use in the evaluation of facial symptoms. Further research into the application of this scale is warranted.

Síndrome do Impostor: Desafios e Prevenções / Síndrome del impostor: Desafíos y Prevenciones / Síndrome do Impostor: Desafios e Prevenções

The imposter syndrome is an emerging phenomenon that requires immediate attention from researchers and health professionals. This phenomenon is characterized by an inability to internalize one's status and success, and therefore has significant potential to adversely affect personal and professional development. The literature has presented a range of challenges related to the impostor syndrome in the field of education and medicine from several case studies. As far as is known, these studies are not concerned with proposing means of preventing the development and minimizing the impacts of the syndrome. This study aims to investigate the challenges and types of prevention of IS that are being proposed by the literature. The investigation was carried out through a systematic mapping through Kitchenham's guidelines, without a period and a specific target audience. 14 articles were analyzed, which included: there are challenges in the academic and professional context, specifically in the health area; and as prevention of IS, 5 studies of the 12 primary ones included the following types of prevention: health and well-being program; two workshops; and group coaching program. It is hoped that this study can contribute as a warning about the lack of strategies, approaches and planning for the prevention of the Impostor Syndrome, in addition to engaging public and private health organizations to prioritize the public and mental health of the human population.

El síndrome del impostor es un fenómeno emergente que requiere atención inmediata por parte de investigadores y profesionales de la salud. Este fenómeno se caracteriza por la incapacidad de internalizar el estado y el éxito propios y, por lo tanto, tiene un potencial significativo para afectar negativamente el desarrollo personal y profesional. La literatura ha presentado una gama de desafíos relacionados con el síndrome del impostor en el campo de la educación y la medicina a partir de varios estudios de casos. Hasta donde se sabe, estos estudios no se preocupan por proponer medios para prevenir el desarrollo y minimizar los impactos del síndrome. Este estudio tiene como objetivo investigar los desafíos y los tipos de prevención de SI que están siendo propuestos por la literatura. La investigación se llevó a cabo a través de un mapeo sistemático a través de las pautas de Kitchenham, sin un período y un público objetivo específico. Se analizaron 14 artículos, que incluyeron: hay desafíos en el contexto académico y profesional, específicamente en el área de la salud; y como prevención de SI, 5 estudios de los 12 primarios incluyeron los siguientes tipos de prevención: programa de salud y bienestar; dos talleres; y programa de coaching grupal. Se espera que este estudio pueda contribuir como una alerta sobre la falta de estrategias, enfoques y planificación para la prevención del Síndrome del Impostor, además de involucrar a las organizaciones de salud públicas y privadas para priorizar la salud pública y mental de la población humana.

A síndrome do impostor é um fenômeno emergente que requer atenção imediata dos pesquisadores e profissionais de saúde. Este fenômeno é caracterizado pela incapacidade de internalizar o próprio status e sucesso, e, portanto, tem um potencial significativo para afetar adversamente o desenvolvimento pessoal e profissional. A literatura tem apresentado uma gama de desafios da síndrome do impostor relacionados na área da educação e área médica a partir de diversos estudos de casos. Até onde se sabe, esses estudos não se preocupam em propor meios de prevenção para o desenvolvimento e minimização de impactos da síndrome. Este estudo tem por objetivo investigar os desafios e os tipos de prevenção da SI que estão sendo propostos pela literatura. A investigação foi realizada por meio de um mapeamento sistemático através das orientações de Kitchenham, sem um período e um público alvo específico. Foram analisados 14 artigos, dos quais constaram: há desafios no contexto acadêmico e profissional, especificamente na área da saúde; e como prevenção da SI, 5 estudos dos 12 primários constaram os seguintes tipos de prevenção: programa de saúde e bem-estar; dois workshops; e programa de coaching em grupo. Espera-se que este estudo possa contribuir como um alerta sobre a ausência de estratégias, abordagens e planejamento para a prevenção da Síndrome do Impostor, além de engajar as organizações de saúde pública e privada a priorizar a saúde pública e mental da população humana. 

Strange face illusions: A systematic review and quality analysis.

BACKGROUND: Strange face illusions describe a range of visual apparitions that occur when an observer gazes at their image reflected in a mirror or at another person's face in a dimly lit room. The illusory effects range from mild alterations in colour, or contrast, to the perception of distorted facial features, or new strange faces.The current review critically evaluates studies investigating strange face illusions, their methodological quality, and existing interpretations. METHOD: Searches conducted using Scopus, PubMed, ScienceDirect and the grey literature until June 2022 identified 21 studies (N = 1,132; healthy participants n = 1,042; clinical participants n = 90) meeting the inclusion criteria (i.e., providing new empirical evidence relating to strange face illusions). The total sample had a mean age of 28.3 years (SD = 10.31) and two thirds (67 %) of participants tested to date are female. Results are reported using the Preferred Reporting Items for Systematic Reviews and meta-Analyses (PRISMA) guidelines. The review was preregistered at the Open Science Framework (OSF: https://osf.io/ek48d). RESULTS: Pooling data across studies, illusory new strange faces are experienced by 58% (95%CI 48 to 68) of nonclinical participants. Study quality as assessed by the Appraisal Tool for Cross-Sectional Studies (AXIS) revealed that 3/21 (14.28%) studies were rated as high, 9/21 (42.86%) as moderate and 9/21 (42.86%) as low quality. Whilst the items relating specifically to reporting quality scored quite highly, those relating to study design and possible biases were lower and more variable. Overall, study quality accounted for 87% of the variance in reporting rates for strange faces, with higher quality being associated with lower illusion rates. The prevalence of illusions was also significantly greater in samples that were older, had higher proportions of female participants and for the interpersonal dyad (IGDT) compared to the mirror gaze paradigm (MGT). The moderating impact of study quality persisted in a multiple meta-regression involving participant age, paradigm type (IGDT vs MGT) and level of feature distortion. Our review point to the importance of reduced light levels, face stimuli and prolonged eye fixation for strange face illusions to emerge. CONCLUSION: Strange face illusions reliably occur in both mirror-gazing and interpersonal gazing dyad paradigms. Further research of higher quality is required to establish the prevalence and particularly, the mechanisms underpinning strange face illusions.

Suicidal Ideation in University Students: a Rorschach Assessment / Ideação Suicida em Estudantes Universitários: Avaliação com Rorschach / Ideación Suicida en Estudiantes Universitarios: Evaluación con Rorschach

Abstract University students are particularly susceptible to suicidal ideation and behavior due to issues inherent to this vital lives' moment. The Rorschach test can help to understand these students' suffering. The objective was to evaluate perception, thinking, stress, and distress in the Rorschach test domains in university students attended at a public university mental health service, comparing students with suicidal ideation with those without it. A total of 36 students aged 18 or over were assessed. The instruments were: Rorschach Performance Assessment System (R-PAS), Columbia Suicide Severity Rating Scale (C-SSRS) and Self Report Questionnaire (SRQ-20). Two analyses were performed using Wilcoxon Mann-Whitney test, according to the presence of suicidal ideation in the last 30 days (SRQ-20) and in the last six months (C-SSRS). Statistically significant differences were found in the two analyses, indicative of greater perceptual distortion in students without suicidal ideation and of stress and distress in students with ideation.

Resumo Estudantes universitários são particularmente suscetíveis a ideação e comportamento suicidas decorrentes de problemas inerentes a este momento vital. O método de Rorschach pode contribuir na compreensão do sofrimento destes estudantes. O objetivo do estudo foi avaliar os domínios percepção, pensamento, estresse e angústia no Rorschach de estudantes universitários atendidos em serviço de saúde mental de universidade pública, comparando estudantes com ideação suicida com aqueles sem ideação. Foram avaliados 36 estudantes com 18 anos ou mais. Os instrumentos foram: Rorschach Performance Assessment System (R-PAS), Escala de Avaliação do Risco de Suicídio de Columbia (C-SSRS) e Self Report Questionnaire (SRQ-20). Foram realizadas duas análises com teste de Wilcoxon Mann-Whitney, segundo a presença de ideação nos últimos 30 dias (SRQ-20) e nos últimos 6 meses (C-SSRS). Foram observadas diferenças estatísticas significativas nas duas análises, indicativas de maior distorção perceptiva nos alunos sem ideação suicida e de angústia e estresse nos estudantes com ideação.

Resumen Estudiantes universitarios son particularmente susceptibles a ideación y comportamiento suicida debido a problemas inherentes a este momento vital. El Rorschach puede ayudar a comprender su sufrimiento. El objetivo fue evaluar los dominios percepción, pensamiento, estrés y angustia en el Rorschach de universitarios atendidos en un servicio de salud mental de universidad pública, comparando estudiantes con ideación suicida con aquellos sin esa ideación. Se evaluaron 36 estudiantes de pregrado y posgrado de 18 años o más. Los instrumentos fueron: Rorschach Performance Assessment System, Escala Columbia para Evaluar la Seriedad de la Ideación Suicida (C-SSRS) y Self Report Questionnaire (SRQ-20). Se realizaron dos análisis con Wilcoxon Mann-Whitney test, según la presencia de ideación en los últimos 30 días (SRQ-20) y en los últimos 6 meses (C-SSRS). Hubo diferencias estadísticamente significativas en los dos análisis, indicativas de mayor distorsión perceptiva en estudiantes sin ideación suicida y de angustia y estrés en estudiantes con ideación.

Multisensory perceptual distortion including auditory distortions in Alice in Wonderland syndrome: a case report.

Alice in Wonderland syndrome (AIWS) is a rare perceptual disorder characterized mainly by perceptual distortions of visual objects and one's own body. While there are many case reports of visual and somatosensory distortions associated with AIWS, little is known about auditory distortion. Therefore, we present the case of a 22-year-old right-handed woman who described having auditory as well as visual and somatosensory distortion experiences and a family history of AIWS. The subject reported experiencing multisensory perceptual distortions, where she sees other people's faces as larger and hears their voices as louder at the same time. This particular case suggests that auditory distortion - which contributes to constructing the perception of the surrounding space and the body - may also be characterized as a perceptual symptom of AIWS.

Factors associated with body image perception of adolescents.

This study aimed to confirm the status of body image perception by adolescents in South Korea and identify the associated factors using the data from the 14th Korea Youth Risk Behavior Survey (KYRBS) conducted in 2018. The KYRBS is a government-approved statistical survey performed annually and an anonymous self-administered online survey conducted in middle and high school students. The data for this study were downloaded from the KYRBS web site and analyzed through complex sample analysis. Body image distortion was found in 40.3% (under-perception 26.5%, over-perception 13.8%) of the boys and 39.7% (under-perception 14.4%, over-perception 25.3%) of the girls. The factors associated with body image distortion were school achievement, weight control, school, school type and exercise in school gym class in boys and school achievement, weight control, and economic status in girls. These results indicated that intervention programs for the accurate perception of body image should be provided to adolescents and these programs should consider gender difference in factors associated with adolescents' body image distortion.

Facilitatory Effect of Intermittent Repetitive Transcranial Magnetic Stimulation on Perceptual Distortion of the Face.

Orofacial pain patients often report that the painful facial area is "swollen" without clinical signs - known as perceptual distortion (PD). The neuromodulatory effect of facilitatory repetitive transcranial magnetic stimulation (rTMS) on PD in healthy individuals was investigated, to provide further support that the primary somatosensory cortex (SI) is involved in facial PD. Participants were allocated to active (n = 26) or sham (n = 26) rTMS group in this case-control study. PD was induced experimentally by injecting local anesthesia (LA) in the right infraorbital region. PD was measured at baseline, 6 min after LA, immediately, 20 and 40 min after rTMS. Intermittent theta-burst stimulation (iTBS) as active rTMS and sham rTMS was applied to the face representation area of SI at 10 min after LA. The magnitude of PD was compared between the groups. The magnitude of PD significantly increased immediately after iTBS compared with sham rTMS (P = .009). The PD was significantly higher immediately after iTBS compared to 6 min after LA (P = .004) in the active rTMS group, but not in the sham rTMS group (P = .054). iTBS applied to a somatotopic-relevant cortical region appears to facilitate facial PD further supporting the involvement of SI in the processing of one´s own face and PD. PERSPECTIVE: This study provides information on neural substrate responsible for processing of perceptual distortion of the face which is speculated to contribute to the chronification of orofacial pain. The findings of this study may aid in mechanism-based management of the condition in orofacial pain disorders and possibly other chronic pain states.

Does body scanning through visual imagery improve perception and function in patients after anterior cruciate ligament-reconstruction? An exploratory study.

INTRODUCTION: Many people who have undergone Anterior Cruciate Ligament (ACL)-reconstruction do not return to their pre-injury level, with nonphysical factors recognized as barriers to recovery. Fear of movement has been linked to body schema distortions, and interventions directed at the body schema have shown potential to improve function. OBJECTIVE: 1) Describe participants' ability to perform a visual imagery intervention (Body Scan); 2) investigate knee perception differences; 3) investigate if Body Scan led to improvements in perceptual differences; and 4) determine if some individuals improved in functional measures following the intervention. METHODS: A single-arm intervention study was undertaken in people >12-month post ACL-reconstruction (n = 30). Body Scan was delivered using a standardized script developed for this study. Participants were assessed regarding their capacity to perform the Body Scan, perceptual differences between the knees and how perception changed following the intervention. Functional measures (vertical hop, triple hop, mSEBT, quadriceps strength, and hamstring strength) were taken. RESULTS: 96.7% were able to perform a Body Scan, with 93.1% demonstrating a difference in perception between the knees. Of participants with perceptual differences, 92.5% demonstrated improvement in perception following the intervention. Ten participants had a clinically significant improvement in a functional measure following the intervention. CONCLUSION: Most participants could perform Body Scanning. The majority perceived perceptual differences between operated and non-operated knees, and reported more symmetric perception following the intervention. One-third of participants also showed improvements in a functional performance measure. Results suggest this intervention may be a helpful adjunct to rehabilitation post ACL-reconstruction, with further research warranted.

Attentional Capture from Looming Alters Perception.

Studies suggest looming motion represents a special class of attentional capture stimulus due to behavioral urgency: the need to act upon objects moving toward us in an environment. In particular, one theory suggests that faster reaction times to targets cued by looming relative to receding motion are driven by post-attentional, motor-priming processes beyond the attentional capture effects seen with other stimulus qualities such as color pop-out. The present study tested this theory using a relative size judgment task where targets were pre-cued by looming and receding optic flow fields. Results show systematic increases in the perceived size of targets that were cued by looming flow fields, consistent with previous attentional capture studies using onset cues. These results challenge theories attributing behavioral changes from looming motion to motor-priming alone.

On Perception and Consciousness in HPPD: A Systematic Review.

Hallucinogen-persisting perception disorder (HPPD) features as a diagnostic category in the DSM-5, ICD-11, and other major classifications, but our knowledge of the phenomenology of the perceptual symptoms involved and the changes in consciousness during the characteristic "flashbacks" is limited. We systematically evaluated original case reports and case series on HPPD to define its phenomenology, associated (psycho)pathology, and course. Our search of PubMed and Embase yielded 66 relevant publications that described 97 people who, together, experienced 64 unique symptoms of HPPD. Of these, 76% concerned symptoms characteristic of Alice in Wonderland syndrome, over 50% non-visual symptoms, and 38% perceptual symptoms not clearly linked to prior intoxication states. This is in contrast with the DSM-5 diagnostic criteria for HPPD. Even though less than half of the patients showed a protracted disease course of over a year, a third achieved remission. However, in patients with co-occurring depression (with or without anxiety) HPPD symptoms persisted longer and treatment outcomes were more often negative. Thus, unlike the acute stages of psychedelic drug intoxication, which may be accompanied by altered states of consciousness, HPPD is rather characterized by changes in the content of consciousness and an attentional shift from exogenous to endogenous phenomena. Since HPPD is a more encompassing nosological entity than suggested in the DSM-5, we recommend expanding its diagnostic criteria. In addition, we make recommendations for clinical practice and future research.

Zulliger R-Optimized Application in Children Victims of Sexual Violence and Cancer / Zulliger Aplicação R-Otimizada em Crianças Vítimas de Violência Sexual e com Câncer / Aplicación R-Optimizada de Zulliger en Niños Víctimas de Violencia Sexual y Cáncer

Abstract Child sexual violence can cause serious damage to the psychosocial development of its victims. Assessments in this context require the use of several psychological tests with proven validity for this purpose. This study aimed to assess children victims of sexual violence using the Zulliger R-Optimized application. The sample consisted of 37 children of both sexes, aged from seven to 13 years old (M = 10.92), distributed in three groups: Sexual Violence Victims (SVV), Cancer Patients (CP) and the Non-Victim Group (NVG). The statistical analyses were performed using the Mann-Whiney and one-way ANOVA tests. The Zulliger variables concerning the clusters Interpersonal Relationship (GHR, PHR, GHR:PHR, p), Self-Image (MOR) and Processing (W:M) showed statistical differences when the SVV group was compared to the other groups. The Zulliger R-Optimized application shows promising results in assessing SVV children, indicating its usefulness for assessments in this context.

Resumo A violência sexual infantil pode gerar graves prejuízos para o desenvolvimento psicossocial de suas vítimas. As avaliações nesse contexto requerem o uso de vários testes psicológicos que possuem evidências de validade para este fim. Este estudo teve como objetivo avaliar crianças vítimas de violência sexual com o Zulliger aplicação R-Otimizada. A amostra consistiu em 37 crianças com idade entre 7 e 13 anos (M = 10,92), de ambos os sexos, distribuídas em três grupos: Vítimas de Violência Sexual (VVS), Pacientes com Câncer (PC) e Grupo de Não-Vítimas (GNV). Realizou-se tratamento estatístico por meio dos testes Mann-Whiney e Anova de uma via. Variáveis do Zulliger concernentes aos agrupamentos de Relacionamento Interpessoal (GHR, PHR, GHR:PHR, p), Autoimagem (MOR) e Processamento (W:M) apresentaram diferenças estatísticas quando o grupo VVS foi comparado aos outros grupos. O Zulliger aplicação R-Otimizada apresenta resultados promissores na avaliação de crianças VVS, indicando sua utilidade em avaliações desse contexto.

Resumen La violencia sexual infantil puede causar daños al desarrollo psicosocial de las víctimas. Evaluaciones en este contexto requieren uso de exámenes psicológicos que tienen evidencia de validez para este propósito. Este estudio tuvo como objetivo evaluar niños víctimas de violencia sexual con lo Zulliger aplicación R-Optimizada. La muestra consistió en 37 niños de 7 a 13 años (M = 10.92), ambos sexos, distribuidos en tres grupos: Víctimas de Violencia Sexual (VVS), Pacientes con Cáncer (PC) y Grupo de No-Víctimas (GNV). El tratamiento estadístico se realizó utilizando las pruebas de Mann-Whiney y Anova de una vía. Variables de Zulliger para las agrupaciones de Relaciones Interpersonales (GHR, PHR, GHR:PHR, p), Autoimagen (MOR) y Procesamiento (W:M) mostraron diferencias estadísticas cuando el grupo VVS se comparó con los otros grupos. Zulliger aplicación R-Optimizada muestra resultados prometedores en la evaluación de niños VVS que indican su usabilidad en las evaluaciones en este contexto.

Effect of repetitive transcranial magnetic stimulation on altered perception of One's own face.

BACKGROUND: Chronic orofacial pain (COP) patients often perceive the painful face area as "swollen" without clinical signs; such self-reported illusions of the face are termed perceptual distortion (PD). The pathophysiological mechanisms underlying PD remain elusive. OBJECTIVE: To test the neuromodulatory effect of repetitive transcranial magnetic stimulation (rTMS) on PD in healthy individuals, to gain insight into the cortical mechanisms underlying PD. METHODS: PD was induced experimentally by injections of local anesthetic (LA) around the infraorbital nerve and measured as perceived size changes of the affected area. Participants were randomly allocated to inhibitory rTMS (n = 26) or sham rTMS (n = 26) group. The participants rated PD at baseline, 6 min after LA, immediately, 20 and 40 min after rTMS. The rTMS (inhibitory and sham) was applied to face (lip) representation area of primary somatosensory cortex (SI) as an intervention at 10 min after the LA, when the magnitude of PD is large. As inhibitory rTMS, continuous theta-burst stimulation paradigm (50 Hz) for 40s was employed to inhibit cortical activity. RESULTS: We demonstrated a significant decrease in the magnitude of PD immediately and 20 min after the application of inhibitory rTMS compared with sham rTMS (P < 0.006). In two control experiments, we also showed that peripheral muscle stimulation and stimulation of a cortical region other than the lip representation area had no effect on the magnitude of the PD. CONCLUSIONS: Inhibitory rTMS applied to a somatotopical-relevant cortical region modulates PD of the face in healthy individuals and could potentially have therapeutic implications for COP patients.

Distorted body weight perception and its gender differences in middle-aged adults: population based study.

BACKGROUND: Increasing interest in appearance and the growing preference for a beautiful body can lead to physical and psychological problems due to an inappropriate body image perception. As such, there is a need to identify what factors may contribute to an inappropriate body image. The purpose of this study was to examine the presence of distorted body weight perception among middle-aged Koreans and identify gender differences and other factors that contribute to a distorted body image regarding body weight. METHODS: Data on 8363 middle-aged adults (aged 45-64 years) from the Korea National Health and Nutrition Examination Survey were analyzed using complex samples analysis considering weight, stratification variables, and cluster variables. The difference between perceived body image regarding body weight and actual body mass index was used to assess distorted body weight perception. Socioeconomic status, health behaviors, daily energy consumption, and psychological status (depression and stress) were assessed for their relationship to distorted body weight perception. RESULTS: Results showed that a distorted body image regarding body weight was more prevalent among middle-aged men (45.3%) than women (25.7%). Age, income, perceived health status, and health behaviors were significantly associated with distorted body weight perception in middle-aged men, whereas psychological factors were associated with distorted body weight perception in middle-aged women. CONCLUSIONS: Further research on distorted body weight perception is needed to gain understanding of the gender differences between middle-aged men and women in Korea. Furthermore, to the results of the study can be used as a basis for developing various education, health mediation, and public health promotion interventions and programs to address body weight perception in middle-aged adults.

Gazing rituals in body dysmorphic disorder.

BACKGROUND AND OBJECTIVES: Gazing rituals and selective attention to perceived flaws during gazing are considered as maintaining factors in cognitive-behavioral models for body dysmorphic disorder (BDD). This study investigated different durations of BDD-like gazing at different facial stimuli (an unfamiliar face, the participant's own face, and the participant's own reflection in the mirror) with regard to effects on dissociation, attractiveness evaluations and perceptual uncertainty. The aim of this study was to examine the hypothesized causal effects of gazing rituals on appearance preoccupation. METHODS: We asked 115 females to complete a face gazing paradigm with three different facial stimuli and, depending on the condition, different gazing durations. We also examined the influence of BDD symptom severity on the reactions to different facial stimuli. RESULTS: Five minutes of gazing significantly increased dissociation. Participants rated the attractiveness of self-relevant stimuli, especially the own photographed face, below average and lower than the unfamiliar face. LIMITATIONS: Limitations with regard to sample characteristics and experimental design are discussed. CONCLUSIONS: Our findings support cognitive-behavioral models for BDD and indicate that therapists may extend therapeutic interventions like mirror retraining by specific perceptual retraining with photographs of the patients.

Distorted distance perception to reachable points in people with chronic shoulder pain.

Perception is not simply a carbon copy of the real world, but is subject to distortions that may reflect protective drive. This study aimed to investigate whether people with chronic shoulder pain show perceptual distortions of space and body that may promote protective behavior. Eighty-four people with shoulder pain and 51 healthy controls participated. Participants estimated (1) distances to points on a cork-board within and outside reaching distance, and (2) the perceived length of their own arms. A novel measure of movement-related pain was also used to determine whether movement-related pain relates to perceptual distortion. Overall, distance and arm length estimates did not differ between groups, nor did participants perceive their arms to be of different length. However, a moderate correlation between movement-related pain and the index of distance perception was found within the pain group, specifically for distance estimates to points within reach. Our results suggest that distorted perception is not a typical consequence of chronic shoulder pain; however, that it may occur in cases where pain is strongly linked to movement. Our findings have implications for understanding avoidance of movement in people with persistent pain.

[Effectiveness of a Decalogue for cardiovascular prevention in diabetics]. / Efectividad del Decálogo de prevención cardiovascular en diabéticos.

INTRODUCTION: To assess the effects of a visual Decalogue aid on the degree of knowledge, control perception and improvement in cardiovascular risk factors (CVRF). MATERIAL AND METHODS: A Primary care randomised non-pharmacological trial of an educational intervention with a parallel control group, and blind evaluation in type 2 diabetic patients. Both groups received an educational intervention on the management of CVRF. The intervention group also received a visual Decalogue aid that showed the level of control patients have over the modifiable CVRF. A total of 50 patients were included in each group in order to identify an improvement of 50% in the multifactorial knowledge of CVRF. All patients received a reminder telephone call at 2 months, with masked evaluation of knowledge and CVRF control perception. In a 6 months visit the level of knowledge and real control of CVRF were re-evaluated. RESULTS: The study included 51 males and 49 females, with mean age of 62.9 years, a mean disease duration of 9.2 years, and low educational level. The level of knowledge, control perception, and real control at baseline was 55%, 80.4%, and 65.9%, respectively. After 2 months the level of knowledge in the Decalogue group increased by 16.5% more than in the conventional education group (73.6% vs. 63.2%; P<.05) and the overestimated control perception improved by 34.5% (P<.001) with no differences between groups, although concordance was better in the Decalogue group. At 6 months there was an overall increase 25.6% (P<.001) in the level of knowledge, with the previous difference between groups levelling off. The final CVRF control improved overall and in the Decalogue group by 6.4% (P<.005) and 9.4% (P<.001), respectively. The SCORE risk significantly decreased overall with no differences between groups. CONCLUSIONS: The educational intervention improves the overall level of knowledge, perception and control of CVRF. The CVRF Decalogue quickly increases the level of knowledge, and decreases the false subjective risk control perception. The benefit, however, becomes equal at 6 months with ongoing education interventions.

Quantitative and qualitative assessment of sensory changes induced by local anesthetics block of two different trigeminal nerve branches.

OBJECTIVES: The aims were to use different techniques to assess the degree of sensory changes and magnitude of perceived size changes in the facial region induced by nerve blocks of two different trigeminal nerve branches in healthy participants. MATERIALS AND METHODS: This placebo-controlled study included 30 healthy volunteers. The participants underwent quantitative and qualitative sensory testing (QST and QualST) thrice: before, 10 min, and 2 h after mental (n = 15) and infraorbital (n = 15) nerve blocks and during control (saline) sessions. Perceived numbness, temperature changes, and perceptual distortion were also measured at all time points during the nerve block and control sessions. Differences in outcome parameters between the sessions and time points were analyzed using analyses of variance and McNemar's tests. RESULTS: There was a significant degree of sensory loss to most QST and all QualST parameters, with significant numbness and increased perceived size at the injection site 10 min and 2 h after the nerve blocks compared with saline (P < 0.030) and the baseline (P < 0.042). Two hours after the nerve blocks, the sensitivity was significantly closer to baseline than after 10 min to most of the QST parameters (P < 0.011). CONCLUSIONS: QST and QualST revealed that the nerve blocks in the orofacial region resulted in complete or partial blockade of afferent nerve fibers mediating thermal and mechanical function for more than 2 h with significant numbness and perceptual distortion. CLINICAL RELEVANCE: Both QST and QualST can provide information on the degree of blockade of afferent nerve fibers after nerve blocks in the orofacial region.

Development and preliminary validation of a brief behavioral measure of psychotic propensity.

Extensive research demonstrates that the dimensional assessment of psychotic manifestations is a primary strength of the Rorschach inkblot task, which provides an in vivo sample of problem-solving behavior and normative standards concerning the logic and coherence of thought processes and the typicality of perceptual representations. This article presents foundational research for the Thought and Perception Assessment System (TPAS), a Rorschach-based system designed to assess solely for disordered thinking and perceptual aberrations using either the standard 10-card set of inkblots or alternative 3-, 4-, and 5-card short forms. Using data from three patient samples (ns = 61, 93, and 133) and one nonpatient sample (n = 118), we document the equivalence of mean scores across the full and short-form card sets. We also document satisfactory interrater reliability and validity for the full and short forms, as well as strong part-whole reliability coefficients between the short forms and the full form. Consistent with psychometric theory and the principle of aggregation, each type of coefficient decreased as a function of decreasing the number of cards. We discuss implications and future applications in research and clinical assessment.

Multisensory modulation of experimentally evoked perceptual distortion of the face.

BACKGROUND: Chronic oro-facial pain patients often perceive the painful face area as "swollen" without clinical signs, that is a perceptual distortion (PD). Local anaesthetic (LA) injections in healthy participants are also associated with PD. OBJECTIVE: The aim was to explore whether PD evoked by LA into the infraorbital region could be modulated by adding mechanical stimulation (MS) to the affected area. METHODS: Mechanical stimulation was given with a brush and a 128-mN von Frey filament. Firstly, sixty healthy participants were randomly divided into three groups: (i) LA control, (ii) LA with MS, (iii) isotonic solution (ISO) with MS as an additional control condition. To further examine the role of a multisensory modulation, an additional experiment was conducted. Twenty participants received LA with MS (filament) in addition to visual feedback of their distorted face. The results of the two experiments are presented together. RESULTS: All three LA groups experienced PD; per contra, PD was not reported in the ISO group. MS alone did not change the magnitude of PD: brush (P = .089), filament (P = .203). However, when the filament stimulation was combined with additional visual information of a distorted face, there was observable decrease in PD (P = .002). CONCLUSION: The findings indicate the importance of multisensory integration for PD and represent a significant step forward in the understanding of the factors that may influence this common condition. Future studies are encouraged to investigate further the cortical processing for possible implications for PD in pain management.