Body, Mind & Spirit Articles and Latest News

Predictability modulates motor-auditory interactions in self-triggered audio-visual apparent motion.

Exp Brain Res. 2008 May 26;

Authors: Zvyagintsev M, Nikolaev AR, Mathiak KA, Menning H, Hertrich I, Mathiak K

We studied an effect of predictability in an audio-visual apparent motion task using magnetoencephalography. The synchronous sequences of audio-visual stimuli were self-triggered by subjects. The task was to detect the direction of the apparent motion in experimental blocks in which the motion either started from the side selected by subjects (predictable condition) or was random (unpredictable condition). Magnetic fields yielded three patterns of activity in the motor, auditory, and visual areas. Comparison of the dipole strength between predictable and unpredictable conditions revealed a significant difference of the preparatory motor activity in the time interval from -450 to -100 ms before self-triggering the stimulus. Perception of the audio-visual apparent motion was also modulated by predictability. However, the modulation was found only for the auditory activity but not for the visual one. The effect of predictability was selective and modulated only the auditory component N1 (100 ms after stimulus), which reflects initial evaluation of stimulus meaning. Importantly, the preparatory motor activity correlates with the following auditory activity mainly in the same hemisphere. Similar modulation by predictability of the motor and auditory activities suggests interactions between these two systems within an action-perception cycle. The mechanism of these interactions can be understood as an effect of anticipation of the own action outcomes on the preparatory motor and perceptual activity.

PMID: 18500638 [PubMed - as supplied by publisher]

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Irritable bowel syndrome: A single gastrointestinal disease or a general somatoform disorder?

J Psychosom Res. 2008 Jun;64(6):561-5

Authors: Enck P, Klosterhalfen S, Zipfel S, Martens U

PMID: 18501255 [PubMed - in process]

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Somatic comorbidities of irritable bowel syndrome: A systematic analysis.

J Psychosom Res. 2008 Jun;64(6):573-582

Authors: Riedl A, Schmidtmann M, Stengel A, Goebel M, Wisser AS, Klapp BF, Mönnikes H

OBJECTIVE: A large number of irritable bowel syndrome (IBS) patients are additionally afflicted with other somatic intestinal and/or extraintestinal comorbidities. The occurrence of one or more comorbidities is correlated with enhanced medical help seeking, worse prognosis, and higher rates of anxiety and depression-all resulting in a reduced quality of life. The aims of this study were, firstly, to review the literature on comorbidities of IBS and to assess gastrointestinal and extraintestinal comorbidities, and, secondly, to evaluate explanatory hypotheses and possible common pathophysiological mechanisms. METHODS: We systematically reviewed the scientific literature in the past 25 years, as cited in MEDLINE. RESULTS: IBS patients present with a twofold increase in somatic comorbidities compared to controls, possibly caused by common pathophysiological mechanisms. Nevertheless, to date, there has been no convincing evidence for a consolidated underlying pathophysiology or somatization. Gastrointestinal disorders, such as functional dyspepsia, gastroesophageal reflux disease, functional constipation, and anal incontinence, occur in almost half of the patients. In a broad variety of extraintestinal comorbidities, fibromyalgia, chronic fatigue syndrome, and chronic pelvic pain are best documented and appear in up to 65%. CONCLUSION: The knowledge and structured assessment of comorbid somatic symptoms might allow to identify subgroups of IBS patients with special characteristics and lead to adaptation of the therapeutic concept.

PMID: 18501257 [PubMed - as supplied by publisher]

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Brain imaging of visceral functions in healthy volunteers and IBS patients.

J Psychosom Res. 2008 Jun;64(6):599-604

Authors: Rapps N, van Oudenhove L, Enck P, Aziz Q

From experience, most people know about a link between psychological processes and gastrointestinal sensory and motor functions. Cognitive processes (e.g., attention) as well as affective processes (e.g., fear) play a role in gastrointestinal sensations in healthy controls and patients with irritable bowel syndrome (IBS) alike. However, the exact nature of this relationship has not been completely understood yet. Brain imaging techniques allow for the study of brain-gut interactions in vivo. Accordingly, positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) have been widely used to study neural mechanisms underlying visceral sensations. This article will summarize the results of functional brain imaging studies in healthy controls and selected studies assessing the influence of psychological processes on gastrointestinal functions. Subsequently, this article will deal with those brain areas activated by visceral stimulation in IBS patients. Special attention will be paid to recently published studies concerning psychological factors and novel research questions.

PMID: 18501260 [PubMed - in process]

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The relationship between somatisation and outcome in patients with severe irritable bowel syndrome.

J Psychosom Res. 2008 Jun;64(6):613-620

Authors: Creed F, Tomenson B, Guthrie E, Ratcliffe J, Fernandes L, Read N, Palmer S, Thompson DG,

OBJECTIVE: This study aimed to assess the relationship between somatisation and outcome in patients with severe irritable bowel syndrome (IBS). METHOD: Two hundred fifty-seven patients with severe IBS included in a randomised controlled trial were assessed at baseline and divided into four quartiles on the basis of their somatisation score. The patients were randomised to receive the following over 3 months: brief interpersonal psychotherapy, 20 mg daily of the SSRI antidepressant paroxetine, or treatment as usual. Outcome 1 year after treatment was assessed using the Short Form-36 physical component summary (PCS) score and total costs for posttreatment year. RESULTS: The patients in the quartile with the highest baseline somatisation score had the most severe IBS, the most concurrent psychiatric disorders, and the highest total costs for the year prior to baseline. At 1 year after the end of treatment, however, the patients with marked somatisation, who received psychotherapy or antidepressant, had improved health status compared to those who received usual care: mean (S.E.) PCS scores at 15 months were 36.6 (2.2), 35.5 (1.9), and 26.4 (2.7) for psychotherapy, antidepressant, and treatment-as-usual groups, respectively (adjusted P=.014). Corresponding data for total costs over the year following the trial, adjusted for baseline costs, were pound1092 (487), pound1394 (443), and pound2949 (593) (adjusted P=.050). CONCLUSIONS: Patients with severe IBS who have marked somatisation improve with treatment like other IBS patients and show a greater reduction of costs. Antidepressants and psychotherapy are cost-effective treatments in severe IBS accompanied by marked somatisation.

PMID: 18501262 [PubMed - as supplied by publisher]

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Irritable bowel syndrome and somatoform disorders.

J Psychosom Res. 2008 Jun;64(6):625-9

Authors: Henningsen P, Herzog W

OBJECTIVE: This article aims to review the conceptual and empirical relation of irritable bowel syndrome (IBS) and somatoform disorders (SFDs). METHOD: The method used is a narrative review that is partially based on discussions held at a symposium with the same topic in March 2007. RESULTS: The conceptual distance between IBS and SFDs has diminished due to developments of both concepts. There is widespread agreement about the existence of syndrome patterns restricted to core IBS and also characterized by multiple unexplained symptoms and additional psychobehavioral features. Current concepts for etiology, pathophysiology, and management reflect the usefulness, the common ground, and the need for differentiation between these two prototypes. An umbrella category such as “interface disorders” between general medicine and psychiatry and wider descriptive frameworks like somatization and medically unexplained symptoms might be useful. CONCLUSION: Further elaboration with an aim of abolishing counterproductive double perspectives on the same group of patients seems warranted.

PMID: 18501264 [PubMed - in process]

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Abnormalities in cognitive-emotional information processing in idiopathic environmental intolerance and somatoform disorders.

J Behav Ther Exp Psychiatry. 2008 May 21;

Authors: Witthöft M, Rist F, Bailer J

Idiopathic environmental intolerance (IEI) represents a functional somatic syndrome marked by diverse bodily complaints attributed to various substances in the environment. Evidence for abnormalities in affective information processing similar to somatoform disorders (SFD) has recently been found in people with IEI. In order to further investigate these cognitive-emotional abnormalities, we compared people with IEI (n=49), SFD only (n=43), and non-somatoform controls (n=54) with respect to their performance in the extrinsic affective Simon task (EAST). This task allowed us to dissociate indicators of automatic affective associations and emotional intrusion effects of both bodily complaints and IEI-trigger words. Negative association effects toward IEI-trigger words were strongest for IEI participants. Emotional intrusion effects of symptom words were larger both in IEI and SFD than in controls. The results of enhanced negative automatic evaluations of IEI-trigger words and greater attention allocation to symptom words support cognitive models of IEI.

PMID: 18501333 [PubMed - as supplied by publisher]

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Differences and similarities in the sensory and cognitive signatures of voice-hearing, intrusions and thoughts.

Schizophr Res. 2008 May 23;

Authors: Moritz S, Larøi F

BACKGROUND: Auditory hallucinations are frequently conceptualized as a disorder of input, whereby random discharges in language-related cortical areas lead to sensory irritations that mimic real voices. Alternatively, auditory hallucinations may represent a disorder of interpretation, whereby none of its four prevalent characteristics (the “four A’s of hallucinations”: acoustic, alien (i.e., appears as non-self), autonomous (i.e., beyond subjective control), authentic (i.e., appears like a real voice)) can reliably discriminate real versus imagined voices. METHOD: The study explored the resemblance between imagined (i.e., auditory hallucinations) and real voices. Further, the cognitive and sensory profiles of thoughts, intrusions/obsessions and voice-hearing were examined. To circumvent conservative response biases, an Internet study was conducted. 160 subjects completed the survey. Of these, 45 were diagnosed with schizophrenia, 55 had obsessive-compulsive disorder (OCD) and 60 were non-clinical controls. RESULTS: In line with prior research, most schizophrenia patients and approximately every 7th non-clinical and every 7th OCD participant reported hearing voices. The results lend support to the claim that none of the four A’s of hallucinations is specific to voice-hearing and therefore challenges the assumption that this class of phenomena reflects a false but reasonable inference of anomalous input. Importantly, a large number of voice-hearers (37%) admitted that their voices did not appear very real, and that they were less loud than real voices (52%). Voice-hearers, irrespective of diagnostic status, reported greater vividness and loudness of mental events even for normal thoughts and obsessions suggesting that enhanced mental vividness, in addition to the presence of metacognitive biases, may represent vulnerability factors for the development of hallucinations. CONCLUSIONS: Differences between intrusions and voice-hearing are more quantitative than qualitative, supporting the view that voice-hearing is more than a disorder of input. The results do not completely refute a bottom-up account of voice-hearing but suggest the involvement of important top-down attributional processes.

PMID: 18502102 [PubMed - as supplied by publisher]

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Limitations of current therapies: Why do patients switch therapies?

Eur Neuropsychopharmacol. 2008 May 24;

Authors: Falkai P

The results of recent studies, including the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, the Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS), the European Schizophrenia Outpatient Health Outcome (SOHO), and the Spanish EFESO study have given some insight into why, in the course of real-world treatment, patients with schizophrenia discontinue or ask to be switched to other medications. Disappointingly, these studies consistently demonstrate that there is not one answer for these patients. The data from these studies indicate that an individual approach to treatment is required, and by doing this the need to adjust medications in advance of problems may be addressed. A combination of knowledge of the potential impact of each antipsychotic, typical or newer, alongside a more informed view of quality of life needs for these patients, might be useful to maximise treatment compliance of the currently available treatment options - with the potential for a not inconsiderable impact on efficacy in schizophrenia.

PMID: 18502616 [PubMed - as supplied by publisher]

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Related Articles

Brief relaxation versus music distraction in the treatment of dental anxiety: a randomized controlled clinical trial.

J Am Dent Assoc. 2008 Mar;139(3):317-24

Authors: Lahmann C, Schoen R, Henningsen P, Ronel J, Muehlbacher M, Loew T, Tritt K, Nickel M, Doering S

BACKGROUND: Dental anxiety is a significant cause of poor dental health. Because patients often prefer nonpharmacological interventions, the clinical effectiveness of clearly structured approaches is of particular interest. METHODS: This prospective randomized controlled study compares a brief relaxation method (BR) with music distraction (MD) and with a control group (C). The authors randomly assigned 90 patients with dental anxiety to BR, MD or C groups. They assessed the outcomes by means of the state anxiety subscale of the State-Trait Anxiety Inventory. RESULTS: Both BR and MD reduced dental anxiety significantly. In contrast, patients in the C group did not exhibit a significant change in their anxiety level. BR was significantly superior to MD. Stratification according to the patient’s general level of dental anxiety revealed that BR also was particularly effective in highly anxious subjects, whereas MD did not have a clinically relevant effect on these subjects. CONCLUSIONS: BR appears to be a safe, economically sound and effective nonpharmacological approach to the short-term reduction of dental anxiety. Additional investigations are needed to validate these findings in a larger clinical trial and to determine the long-term effects of this intervention. CLINICAL IMPLICATIONS: Relaxation techniques are a pragmatic, effective and cost-saving method of facilitating dental treatment in anxious patients.

PMID: 18310736 [PubMed - indexed for MEDLINE]

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