Subjective emotional responses to IAPS pictures in patients with borderline personality disorder, cluster-C personality disorders, and non-patients.

According to Linehan (1993), emotion dysregulation is a central feature of borderline personality disorder (BPD). We hypothesized that patients with BPD are emotionally hyperresponsive. For BPD treatment, it is important to evaluate this hypothesis, because, if it is supported, therapeutic interventions could be designed to help patients to better manage hyperemotional reactions. We investigated the subjective reactions (in terms of valence and arousal) of patients with BPD to visual emotional stimuli of the International Affective Picture System (IAPS). We hypothesized that, compared to patients with Cluster-C personality disorders and non-patients, BPD patients would show higher scores on the arousal dimension and higher negative scores on the valence dimension when rating IAPS pictures with varying degrees of arousal and valence. Ratings of valence and arousal for 40 IAPS pictures were collected from 39 borderline personality disorder (BPD), 36 patients diagnosed with Cluster-C personality disorders (PD), and a group of 226 non-patients. Contrary to expectations, BPD patients did not differ from the non-patients. This indicates that their self-report scores do not reflect hypersensitivity. We found that patients with BPD showed lower scores on arousal than Cluster-C PD patients. The scores on valence suggested that Cluster-C PD patients also experienced more positive emotions than BPD patients.

As tears go by: Baby tears trigger more brain activity than adult tears in nulliparous women.

The current functional magnetic resonance imaging study examines brain activity during the perception of infant and adult tears. Infant tears evoke stronger responses in the visual cortex than adult tears, indicating that infant tears are highly salient. In addition, our study shows that infant tears uniquely activate somatosensory pain regions, which could stimulate actions directed at the elimination of the source of pain. Shedding tears may be a strong means to elicit the parent's sharing of the infant's feelings, thereby strengthening caregiver-infant bonding and securing infant survival.

Crying Without Tears: Dimensions of Crying and Relations With Ocular Dryness and Mental Well-Being in Patients With Sjögren's Syndrome.

This study examined dimensions of crying and its relations with ocular dryness and mental well-being in patients with Sjögren's syndrome, a systemic autoimmune disease with dryness as primary symptom. Three-hundred patients with Sjögren's syndrome completed questionnaires on crying, dryness, and well-being. The crying questionnaire revealed four dimensions: "Cryability" (comprising both crying sensibility and ability to cry), Somatic consequences, Frustration, and Suppression. Compared to 100 demographically-matched control participants from the general population, patients scored low on Cryability and high on Somatic consequences and Frustration. The crying dimensions generally showed significant but weak associations with ocular dryness and mental well-being in patients. This is the first quantitative study indicating that crying problems are more common in patients with Sjögren's syndrome than in the general population. Perhaps, patients who experience problems with crying could be helped to rely on other ways of expressing emotions than crying in tear-inducing situations.

Longitudinal associations between maternal disrupted representations, maternal interactive behavior and infant attachment: a comparison between full-term and preterm dyads.

This prospective study examined whether or not a mother's representations of her infant were more often disrupted after premature childbirth. Furthermore, the study examined if different components of maternal interactive behavior mediated the relation between maternal disrupted representations and infant attachment. The participants were mothers of full-term (n = 75), moderately preterm (n = 68) and very preterm infants (n = 67). Maternal representations were assessed by the Working Model of the Child Interview at 6 months post-partum. Maternal interactive behavior was evaluated at 6 and 24 months post-partum, using the National Institute of Child Health and Human Development Early Care Research Network mother-infant observation scales. Infant attachment was observed at 24 months post-partum and was coded by the Attachment Q-Set. The results reveal that a premature childbirth does not necessarily generate disrupted maternal representations of the infant. Furthermore, maternal interactive behavior appears to be an important mechanism through which maternal representations influence the development of infant attachment in full-term and preterm infants. Early assessment of maternal representations can identify mother-infant dyads at risk, in full-term and preterm samples.

From the father's point of view: how father's representations of the infant impact on father-infant interaction and infant development.

Despite the knowledge that fathers uniquely contribute to the development of their infants, relatively few studies have focused on the father-infant relationship during early infancy. In the present longitudinal study we included 189 fathers and examined whether their early attachment representations of the infant predicted future quality of father-infant interaction. We also investigated whether these representations were related to the infant's development. Paternal attachment representations were assessed by the Working Model of Child Interview (WMCI) at 6 months post-partum and classified fathers' representations as 'balanced' or 'unbalanced' (disengaged or distorted). At 24 months, father-infant interaction was videotaped and analyzed by the NICHD coding scales. Further, the Peabody Picture Vocabulary Test (PPVT-III) was administered to evaluate the infant's verbal development. Results revealed that fathers' early attachment representations of the infant predict the quality of future father-infant interaction, with balanced representations more strongly associated with more favorable behaviors in fathers and infants. In addition, paternal interactive behavior appears an important mechanism through which paternal representations influence the development of the infant. These results underline the importance of early identification of fathers with unbalanced attachment representations, and we therefore recommend that more attention should be directed to the quality of the early father-infant relationship in clinical settings.

Posttraumatic stress disorder, anxiety and depression following pregnancies conceived through fertility treatments: the effects of medically assisted conception on postpartum well-being.

OBJECTIVE: To compare the postpartum prevalence of Posttraumatic Stress Disorder (PTSD), anxiety and depression in women who conceived via medically assisted conception (MAC) and women who conceived naturally. STUDY DESIGN: All women (n = 907) who delivered under supervision of four independent midwifery practices and three hospitals in the Netherlands during a 3-month period were asked to complete questionnaires on demographic, logistic, psychosocial and obstetric characteristics two to six months postpartum. In this cross-sectional study PTSD was measured with the Traumatic Event Scale-B; anxiety and depression were measured with the Hospital Anxiety and Depression Scale. RESULTS: The response rate was 47% (428 participants). No significant differences were found in the prevalence of PTSD (0.0% vs. 1.3%; odds ratio [OR] = 0.0, confidence interval [CI]: 0-infinity), anxiety (28.1% vs. 22.2%; OR = 1.4, CI: 0.6-3.1) and depression (9.4% vs. 14.6%; OR = 0.6, CI: 0.8-2.0) between the 32 women who conceived via MAC and the 396 women who conceived naturally. CONCLUSION: We did not find significant differences in the prevalence of PTSD, anxiety and depression between women who conceived via MAC and women who conceived naturally.

Assessing the impact of chemotherapy-induced peripheral neurotoxicity on the quality of life of cancer patients: the introduction of a new measure.

PURPOSE: To investigate the impact of chemotherapy-induced neurotoxicity on daily activities and quality of life (QoL) of cancer patients. METHODS: QoL of all patients visiting the oncological outpatient ward of the Maxima Medical Centre in the Netherlands from October 2006 until March 2007 treated with taxanes, vinca-alkaloids and/or platinum compounds (n = 88) was compared with the QoL of patients that did not receive these treatments yet (n = 43). Patient-reported neuropathy symptoms were evaluated with the newly developed Chemotherapy Induced Neurotoxicity Questionnaire (CINQ) and the Functional Assessment of Cancer Therapy/Gynaecologic Oncology Group/Neurotoxicity (FACT/GOG-Ntx) questionnaire. RESULTS: Patients treated with chemotherapy reported significantly more complaints of neuropathy (p < 0.001) and more paresthesias and dysesthesias in the upper (p < 0.001; p < 0.01) and lower extremities (p < 0.001) compared to those not treated with chemotherapy. They additionally experienced problems with fine motor function (e.g., getting (un)dressed, writing, and picking up small objects). Moreover, cold-induced paresthesias were frequently reported. Overall, patients indicated that their neuropathy had a negative effect on QoL. CONCLUSIONS: The newly developed CINQ and the FACT/GOG-Ntx results suggest a considerable negative impact of patient-reported neuropathy symptoms on daily activities and QoL in cancer patients treated with chemotherapy. However, further validation of the CINQ is needed.

[Medically unexplained somatic symptoms are not unexplainable, misunderstood or vague physical complaints]. / Medisch onverklaarde somatische symptomen zijn geen onverklaarbare, onbegrepen of vage lichamelijke klachten.

BACKGROUND: In the current literature and in clinical practice a very wide range of terms is used to describe medically unexplained somatic symptoms; this gives rise to a number of problems. AIM: To propose an unambiguous multidisciplinary terminology which can solve a number of problems. METHOD: A literature search was conducted using the database PiCarta and references in the literature found via that database. results The terms used in the current literature and the meanings they are given are very diverse and in several instances the terms and meanings are confusing, inaccurate or unclear. CONCLUSION: The use of the terms 'medically unexplained somatic symptoms' and 'unexplained somatic symptoms' is a possible solution for many of the problems that arise.

Suffering in psoriasis patients: its relation with illness severity and subjective well-being.

OBJECTIVE: The aim of the present study was to explore the relationship among subjective illness impact, subjective well-being, and psoriasis severity as assessed by dermatologists. Furthermore, subjective well-being of psoriasis patients was compared to available norm data. METHODS: Fifty-nine psoriasis patients participated in this study. The following measures were administered: (a) the Pictorial Representation of Illness and Self Measure - Revised (PRISM-R), yielding Self-Illness Separation (SIS), and Illness Perception Measure (IPM); (b) subjective health status; (c) life satisfaction, and (d) psychological well-being. In addition, the Psoriasis Area and Severity Index (PASI) was determined by dermatologists. RESULTS: Psoriasis patients scored significantly below the norm data on subjective health status and psychological well-being. No differences were found concerning life satisfaction. PASI failed to correlate significantly with any of the disease impact and subjective health measures. Neither did SIS correlate significantly with any of the subjective health measures, whereas IPM was negatively associated with subjective health status, life satisfaction, and psychologic well-being. In a regression analysis with PASI as the dependent measures, none of the subjective health measures showed up as a relevant predictor. CONCLUSION: In comparison with the norm data, psoriasis patients report less subjective health status and well-being whereas their life satisfaction is not affected. There is no clear association among illness impact, subjective well-being, and illness severity as assessed by dermatologists.

[The emotional burden of secrets. Consequences for somatic health and implications for health care]. / De emotionele belasting van geheimen. Gevolgen voor de somatische gezondheid en implicaties voor de hulpverlening.

BACKGROUND: There is increasing evidence that emotionally burdensome secrets may play a role in predisposing an individual to develop somatic symptoms. AIM: To provide an overview of the empirical evidence and theories concerning the relations between secrets and somatic health and to discuss the implications of these associations for health care. METHOD: We searched for peer-reviewed publications in Medline, ScienceDirect, Psycinfo and Web of Science, using as search terms 'secrecy', 'geheimhouding', 'self-concealment', 'disclosure', 'inhibition' and 'health'. RESULTS: Secrets are associated with an increased risk of somatic dysfunctioning, probably because they induce pathophysiological processes. The theories currently available provide adequate backing for further studies of this association. CONCLUSION: Secrets seem to provoke pathophysiological processes that can affect a person's physical wellbeing. This means that health care professionals must realize that the emotional burden of secrets may contribute to a patients somatic symptoms.

Is there a relationship between depression and crying? A review.

OBJECTIVE: To conduct a systematic examination of the relationship between depression and crying by reviewing all relevant theory and empirical data including the performance of crying items in measures of depression. METHOD: Review of the extant literature on depression and crying using PubMed, PsychInfo and Google Scholar databases. RESULTS: Scores on crying items of depression inventories correlate moderately with overall depression severity. Otherwise, there is surprisingly little evidence for the widespread claim that depression leads to more frequent and/or easier crying. There is also little empirical support for the competing claim that severely depressed individuals lose their capacity to cry. CONCLUSION: Current claims about the relationship between depression and crying lack a robust empirical foundation. Assessment instruments and diagnostic systems for mood disorders are inconsistent in how they handle crying as a symptom. Further work to investigate the causes and the context of crying in depressed patients is needed.

A comparison of quality of life, disease impact and risk perception in women with invasive breast cancer and ductal carcinoma in situ.

We compared the health-related quality of life, impact of the disease, risk perception of recurrence and dying of breast cancer, and understanding of diagnosis of patients with ductal carcinoma in situ (DCIS) and invasive breast cancer 2-3 years after treatment. We included all women (N=211) diagnosed with DCIS or invasive breast cancer TNM stage I (T1, N0, and M0) in three community hospitals in the southern part of The Netherlands in the period 2002-2003. After verifying the medical files, 180 disease free patients proved eligible for study entry, 47 of whom had DCIS and 133 stage I invasive breast cancer. One-hundred and thirty-five patients returned a completed questionnaire (75% response). No significant differences were found between women with DCIS and invasive breast cancer on the physical and mental component scale of the RAND SF-36, nor on the WHO-5, which assesses well-being. In contrast, women with DCIS reportedly had a better physical health, better sex life and better relationships with friends/acquaintances than women with invasive breast cancer. Despite their better prognosis, the DCIS-group had comparable perceptions of the risk of recurrence and dying of breast cancer as women with invasive breast cancer. However, this did not appear to affect their well-being significantly.

Long-term quality of life among Dutch prostate cancer survivors: results of a population-based study.

BACKGROUND: In this report, the authors describe the health-related quality of life (HRQL) of long-term prostate cancer survivors 5 to 10 years after diagnosis and compare it with the HRQL of an age-matched, normative sample of the general Dutch population. METHODS: The population-based Eindhoven Cancer Registry was used to select all men who were diagnosed with prostate cancer from 1994 to 1998. Nine hundred sixty-four patients received questionnaires (the 36-item Short Form Health Survey [SF-36] and the Quality of Life-Cancer Survivors questionnaire), and 780 of 964 patients responded (81%). RESULTS: Unselected, long-term prostate cancer survivors reported comparable HRQL scores but worse General Health Perceptions and better Mental Health scores than an age-matched, normative population. Patients who underwent radical prostatectomy had the highest physical HRQL, followed by patients who received 'watchful waiting,' and patients who received radiotherapy. Patients who received hormone treatment, in general, had the lowest physical HRQL. CONCLUSIONS: The results of this study suggested that the long-term HRQL of prostate cancer survivors may vary significantly as a function of the type of primary treatment. Because baseline differences between treatment groups cannot be excluded as part of the explanation for these differences, the current findings need to be verified in longitudinal studies.

Increased health care utilisation among 10-year breast cancer survivors.

OBJECTIVE: We investigated self-reported health care utilisation of women who survived breast cancer for 10 years and identified predictors of health care utilisation. METHODS: The population-based Eindhoven Cancer Registry was used to select all women who were diagnosed with breast cancer in 1993, in six hospitals in the Netherlands, and were disease-free at the time of data collection. Health status, psychological well-being, satisfaction with life and health care use were compared with same age controls. Logistic regression was used to identify predictors of health care utilisation. RESULTS: Of the 254 women who were sent a questionnaire, 183 (72%) responded. Breast cancer survivors had a similar health status and psychological well-being and a better satisfaction with life compared to same age controls. The proportion of breast cancer survivors (79%) who visited a specialist in the past 12 months was significantly higher compared to controls (53%). Young breast cancer survivors (45-54 at time of completing questionnaire) more often visited a physical therapist (56%) or complementary caregiver (26%) than controls (29 and 13%, respectively). Spontaneously reported problems (fatigue, arm problems) as a consequence of cancer and co-morbidity showed the strongest associations with health care utilisation. CONCLUSIONS: Although self-reported health, satisfaction with life and psychological well-being were similar or even better in long-term breast cancer survivors compared to those in population controls, survivors more often attended a specialist, physical therapist and complementary caregiver in the past 12 months. Survivors of young age appear to have the highest use of health care services compared to age-matched controls, especially related to fatigue and arm problems.

Stress and outcome success in IVF: the role of self-reports and endocrine variables.

BACKGROUND: The aim of this study was to examine the associations between urinary levels of the stress hormones adrenaline, noradrenaline and cortisol during treatment with self reported stress, in order to investigate the mechanism for the previously observed negative association of anxiety and depression with the outcome of IVF/ICSI. METHODS: In a multicentre prospective cohort study, women entering their first cycle of IVF/ICSI treatment were asked to participate. From each participant nocturnal urine samples were collected; pre-treatment, before oocyte retrieval and before embryo-transfer (ET), to assess hormonal concentrations. Additionally, two questionnaires were administered before the start of the treatment to measure anxiety and depression. RESULTS: 168 women completed the questionnaires and collected at least two urine specimens. A significant positive correlation between urinary adrenaline concentrations at baseline and ET and the scores on depression at baseline were found. In women with successful treatment, lower concentrations of adrenaline at oocyte retrieval and lower concentrations of adrenaline and noradrenaline at ET, compared with unsuccessful women, were found. CONCLUSIONS: The significant positive association of adrenaline concentration with pregnancy and with depression suggested that this adrenal hormone could be one of the links in the complex relationship between psychosocial stress and outcome after IVF/ICSI.

The effect of episodic anxiety on an in vitro fertilization and intracytoplasmic sperm injection treatment outcome: a pilot study.

This study examines whether the inconsistent and contradictory findings from prospective studies on the effect of psychosocial factors on treatment outcome of in vitro fertilization (IVF) can be explained by the fact that no clear distinction has been made between acute and chronic emotional stress responses. Because chronicity is difficult to measure within the context of an IVF-procedure, the focus of the present study was on episodic anxiety. We compared its predictive value on treatment outcome after the second IVF and intracytoplasmic sperm injection (ICSI) with the predictive value of trait anxiety and acute anxiety. In a prospective study with 47 women who failed to conceive after the first IVF, state anxiety was measured both before and after the first IVF treatment. Episodic anxiety was operationalized as high state anxiety both before and after the first IVF treatment Student's t-test and logistic regression analysis were used to determine the predictive value of episodic anxiety compared with acute or trait anxiety. Women with episodic anxiety, but not those with high levels of trait or acute anxiety, were less likely to become pregnant after the second IVF/ICSI. The results suggest that future studies should differentiate between acute and chronic stress, when examining the effects of psychosocial factors on treatment outcome after a fertility treatment

Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy.

AIMS: The use of axillary lymph node dissection (ALND) in women with breast cancer is associated with considerable morbidity. Sentinel node biopsy (SNB) removes the lymph node in the axillary basin indicative for receiving first lymphatic drainage from the breast. This study compares the nature and severity of physical morbidity among breast cancer patients who underwent primary surgery for breast cancer combined with either ALND or SNB. Also, it assesses influence of subsequent radiotherapy on morbidity. METHOD: Two hundred and thirteen ALND patients were compared with 180 SNB patients retrospectively. Morbidity was measured using a disease-specific quality-of-life questionnaire. RESULTS: Patients' demographic characteristics were alike. The axillary procedure is the strongest and most consistent factor in explaining differences in a variety of self-reported complaints. Patients having had SNB have a 3.2-fold lower risk of experiencing pain, a 5-fold lower risk of lymph oedema, a 7.7-fold lower risk of numbness, a 3.7-fold lower risk of tingling sensations, a 7.1-fold lower risk of loss of strength in arm/hand, a 3.6-fold lower risk of loss of active motion range of the arm and a 2.9-fold lower risk of impaired use of the arm. Axillary radiation therapy adds to complaints next to the axillary surgical procedure by increasing the risk of lymph oedema 2.4-fold and enhancing the risk of impaired use of the arm by 2.6-fold. Axillary radiation therapy does not explain lymph oedema by itself. CONCLUSION: SNB is associated with less morbidity compared to ALND in patients with primary breast cancer.

Lymphoedema and reduced shoulder function as indicators of quality of life after axillary lymph node dissection for invasive breast cancer.

BACKGROUND: The aim was to explore measurements of arm circumference and shoulder abduction as indicators of quality of life after axillary lymph node dissection for invasive breast cancer. METHODS: Differences in arm circumference and shoulder abduction were measured in 465 consecutive women who underwent axillary lymph node dissection. These women received a treatment-specific questionnaire on the severity of physical disability and the effects on their daily life and well-being. RESULTS: The questionnaire was returned by 400 women (86 per cent). Of these 400, only the 332 women who did not receive axillary radiotherapy were included in the analysis. Their mean time since axillary lymph node dissection was 4.2 (range 0.3-28) years. For 86 patients (26 per cent) there was a difference in arm circumference of 2 cm or more, or a difference in abduction of 20 degrees or more. These patients found it more difficult to do household chores, were more likely to have given up hobbies, felt more disabled and were more likely to be treated by a physiotherapist. However, complaints also occurred among the women with smaller differences in arm circumference and shoulder abduction, although the frequency and severity of their complaints were similar to those in women without swelling of the arm or without restricted shoulder abduction. CONCLUSION: Measuring arm circumference and shoulder abduction during control visits identifies only some of the women whose daily life and well-being is affected by the side-effects of axillary lymph node dissection.

Daily hassles and stress vulnerability in patients with a whiplash-associated disorder.

The objectives of this study were to examine the self-reported, daily problems of patients with a whiplash-associated disorder (WAD) and a healthy control group, with the hypothesis that WAD patients would report more person-dependent hassles and perceive them as more serious than the healthy control group, due to the prior experience of a whiplash injury. In addition, it was expected that the person-independent seriousness rating would be elevated, reflecting the increased vulnerability of WAD patients to common stressors. Finally, a strong relationship was expected between frequency or seriousness of daily problems on the one hand and level of distress on the other. Forty-seven WAD patients seeking treatment and 47 matched healthy control participants completed the everyday problem checklist (EPCL). The level of distress was measured by the symptom checklist (SCL-90). As expected, most EPCL-scores in the WAD group were higher than the scores of the healthy participants. Regression analysis further revealed that 61% of the variance in general distress in the WAD group could be explained by EPCL scores and educational background. Chronic WAD patients report a high stress load, which is related specifically to personal functioning after the whiplash injury. In addition, WAD patients (especially those with a low educational level) appear to be more vulnerable and react with more distress than healthy people to all kinds of stressors. Stress responses probably play an important role in the maintenance or deterioration of whiplash-associated complaints.